1. 3 rd Year Public Health Session Current high profile: SARS; West Nile; Walkerton; smoking bans; needle exchange & harm reduction... What’s next?? Current high profile: SARS; West Nile; Walkerton; smoking bans; needle exchange & harm reduction... What’s next?? New emerging infections New emerging infections New emerging infections New emerging infections MCC exam objectives; recently revised MCC exam objectives; recently revisedexam objectives;exam objectives; SIM web site resources SIM web site resourcesweb site web site FRCP(C) residency training programs in Community Medicine in Toronto, McMaster, Kingston & (soon) Ottawa FRCP(C) residency training programs in Community Medicine in Toronto, McMaster, Kingston & (soon) Ottawa

2. Structure and Brief History Boards of Health established in 1833 in Upper Canada “to guard against the introduction of malignant, contagious and infectious disease. Boards of Health established in 1833 in Upper Canada “to guard against the introduction of malignant, contagious and infectious disease.” Public Health Act passed in Ontario in 1873Public Health Act passed in Ontario in 1873 First Medical Officer of Health (MOH) in Toronto in 1883First Medical Officer of Health (MOH) in Toronto in 1883 Health units established in 1945Health units established in 1945 In 1989, Mandatory Health Programs revised to take a population approach to prevent disease and promote health.In 1989, Mandatory Health Programs revised to take a population approach to prevent disease and promote health. 37 health units in Ontario, of which 27 are rural area units. Grouped under 9 regions; Toronto has its own health department 37 health units in Ontario, of which 27 are rural area units. Grouped under 9 regions; Toronto has its own health department Coordinated at the municipal level Coordinated at the municipal level 50:50 shared funding between province and municipalities (to go to 75:25) 50:50 shared funding between province and municipalities (to go to 75:25) Medical Officers of Health in teaching health units hold an FRCP(C) in Community Medicine Medical Officers of Health in teaching health units hold an FRCP(C) in Community Medicine

3. City of Ottawa Public Health City of Ottawa Public Health Covering legislation contained in the 2008 Ontario Public Health Standards under the Ontario Health Protection and Promotion Act). These establish requirements for basic public health services in the province. Covering legislation contained in the 2008 Ontario Public Health Standards under the Ontario Health Protection and Promotion Act). These establish requirements for basic public health services in the province. Ontario Public Health Standards Ontario Public Health Standards Standards cover: Standards cover: Chronic diseases & injury programsChronic diseases & injury programs Family health programsFamily health programs Infectious disease controlInfectious disease control Environmental health, andEnvironmental health, and Emergency preparedness.Emergency preparedness.

4. Essential Functions of Public Health 1: Health Protection  Food safety—inspections; helping with recalls  Safe water—follow-up on reports of problems  Infection control in institutions, child care facilities and personal service settings  Vaccine preventable diseases — supply vaccine & advice to physicians, school immunization program, flu shot clinics Vaccine preventable diseases Vaccine preventable diseases  Sexually transmitted infections — partner notification

5. Essential Functions of Public Health 1. Health Protection (con’t)  Tuberculosis—directly observed treatment for all cases; contact testing Tuberculosis—directly observed treatment Tuberculosis—directly observed treatment  Rabies—supply vaccine and immune globulin; work with Animal Control for pets and Min. of Nat. Resources for raccoon rabies control  Health hazard investigation  Public swimming pool inspection  Inspections of residential care facilities and rooming houses for health hazards  Emergency preparedness—e.g., bioterrorism

6. Essential Functions of Public Health 2: Health Surveillance Reporting of notifiable diseases in order to recognize outbreaks and assess effectiveness of control programs Reporting of notifiable diseases in order to recognize outbreaks and assess effectiveness of control programsnotifiable diseases notifiable diseases Behavioural risk factor surveys Behavioural risk factor surveys Local data available from public health department Local data available from public health department Local data Local data

7. Essential Functions of Public Health 3: Population Health Assessment CDC in Atlanta estimates that 2/3 of premature mortality is preventable by applying available knowledge So, Health Dep’t seeks to develop better services and policies, by asking: What is the health of the population?What is the health of the population?health of the populationhealth of the population What factors underlie good health?What factors underlie good health? What factors create health risks?What factors create health risks?

8. “Population Perspective” Tries to address needs rather than demands Tries to address needs rather than demands Focus on Determinants of Health Focus on Determinants of HealthDeterminants of HealthDeterminants of Health Ottawa health department’s perspective: “ Public health means more to our city than the prevention of infectious disease, illness and injury - it is about creating healthier environments at home, at work and in the community, promoting healthier lifestyles and choices, adopting programs and initiatives that lead to healthier children and families, and offering protection to the health of all citizens.” Ottawa health department’s perspective: “ Public health means more to our city than the prevention of infectious disease, illness and injury - it is about creating healthier environments at home, at work and in the community, promoting healthier lifestyles and choices, adopting programs and initiatives that lead to healthier children and families, and offering protection to the health of all citizens.” Cf. CANMEDS 2005 & Royal College’s “Physician skills for the new millennium” Cf. CANMEDS 2005 & Royal College’s “Physician skills for the new millennium”CANMEDS 2005 CANMEDS 2005 PHAC web site on Population Health PHAC web site on Population HealthPopulation HealthPopulation Health

9. Essential Functions of Public Health 4. Disease and Injury Prevention Alcohol Alcohol Bicycle safety Bicycle safety Bullying prevention Bullying prevention Car seats Car seats Cold alert Cold alert Dog bite prevention Dog bite prevention Driving safely Driving safely Drowning prevention Drowning prevention Heat alert Heat alert Needle exchange program (SITE) Needle exchange program (SITE) Smog alerts Smog alerts Snowmobiling Snowmobiling Sun safety Sun safety Tattooing and body piercing Tattooing and body piercing Water safety— backyard pools; public pools Water safety— backyard pools; public pools West Nile mosquito monitoring West Nile mosquito monitoring

10. Essential Functions of Public Health 5. Health Promotion City of Ottawa Healthy Living City of Ottawa Healthy Living programs City of Ottawa Healthy Living Alcohol, drugs and tobacco Alcohol, drugs and tobacco Dental Health Dental Health Nutrition & body weight Nutrition & body weight Physical activity Physical activity Safety & injury prevention Safety & injury prevention Sexual health Sexual health These mainly offer informational material & links to other programs Professionals (includes Physician’s Update) Professionals (includes Physician’s Update)Physician’s Update)Physician’s Update)

11. Essential Functions of Public Health 5. Health Promotion (cont’d) Most activities now occurring as result of community partnerships: Partners in Healthy Living Most activities now occurring as result of community partnerships: Partners in Healthy Living Partners in Healthy Living Partners in Healthy Living They emphasize education & skill building; advocacy; partnerships. They emphasize education & skill building; advocacy; partnerships. Numerous examples of programs Numerous examples of programsexamples of programsexamples of programs