Public Health in Public Health in Jefferson CountyJefferson County

September 8, 2010September 8, 2010Dr. Mark B. Johnson, MD, MPHDr. Mark B. Johnson, MD, MPH

Executive DirectorExecutive DirectorJefferson County Public HealthJefferson County Public Health

What if...What if...

...there was no health care ...there was no health care system ?system ?

Would it make any Would it make any difference where you difference where you

lived?lived?

It’s public health that makes the It’s public health that makes the difference!difference!

So... what is public So... what is public health, and how does health, and how does it differ from medical it differ from medical

care?care?

Most health care workers Most health care workers focus on an individual patient focus on an individual patient

and are concerned with and are concerned with treatment.treatment.

Public Health focuses on a Public Health focuses on a community and is concerned community and is concerned

with prevention.with prevention.

Public Health

Preventive Care

Primary Care

Specialty Care

Hospital Care

Public Health

Preventive Care

Primary Care

Specialty Care

Hospital Care

Public Health

Preventive Care

Primary Care

Specialty Care

Hospital Care

Historically, public health has Historically, public health has included at least six services:included at least six services:

►Vital recordsVital records►Communicable disease controlCommunicable disease control►Environmental safetyEnvironmental safety►Public health laboratory servicesPublic health laboratory services►Reproductive health and Reproductive health and

maternal/child health servicesmaternal/child health services►Health education for the communityHealth education for the community

Corresponding Divisions Corresponding Divisions at JCPHat JCPH

► Administration - Vital records, emergency Administration - Vital records, emergency preparedness and epidemiologypreparedness and epidemiology

► Community Health Services – Infectious Community Health Services – Infectious and chronic diseases; reproductive and chronic diseases; reproductive health/MCH; access to health carehealth/MCH; access to health care

► Health Promotion – Disease prevention Health Promotion – Disease prevention and health education; promoting health and health education; promoting health behaviorsbehaviors

► Environmental Health Services – Disease Environmental Health Services – Disease prevention and health regulation; prevention and health regulation; providing a safe and healthy environmentproviding a safe and healthy environment

The primary rule of The primary rule of public health:public health:

Never put a barrier Never put a barrier between an individual and between an individual and

the public’s good.the public’s good.

Public Health and Infectious Public Health and Infectious DiseasesDiseases

► Modern public health Modern public health began in Europe in began in Europe in the Middle Ages the Middle Ages because of infectious because of infectious disease epidemics disease epidemics that were of such that were of such magnitude that no magnitude that no individual or single individual or single city could deal with city could deal with them alone.them alone.

The “Black Death” The “Black Death” in Europe from the in Europe from the

1414thth to the 18 to the 18thth Centuries killed Centuries killed almost a third of almost a third of the population.the population.

Public Health measures, such as quarantining, have Public Health measures, such as quarantining, have often been controversial and confrontational.often been controversial and confrontational.

A visiting public health nurse shows a A visiting public health nurse shows a mother how to sanitize baby bottles.mother how to sanitize baby bottles.

A public health nurse checks for lice.A public health nurse checks for lice.

Major public health issues in Major public health issues in infectious diseases.infectious diseases.

►Antibiotic resistanceAntibiotic resistance►Emerging infectionsEmerging infections►Bioterrorism and altered agentsBioterrorism and altered agents►Re-emerging diseasesRe-emerging diseases► Influenza pandemicsInfluenza pandemics

Medical breakthroughs in medicine have contributed to longer lives…

50

55

60

65

70

75

80

Source: Centers for Disease Control and Prevention, National Vital Statistics Reports, vol. 53, no. 6, November 10, 2004

Average Life Expectancy in the United StatesAverage Life Expectancy in the United States1940 – 20021940 – 2002

Avera

ge L

ife E

xpect

ancy

in

Years

20001940 1945 1950 1955 1960 1965 1970 1975 1980 1985

1990 1995

Major Accomplishment: Life Expectancy

►In the 20th Century life expectancy increased by 0.3 years each year = 3 years per decade.

►Two-thirds of the increase in life expectancy at birth occurred before 1950.

►Two-thirds of the increase in life expectancy at age 65 occurred after 1950.

Chronic Disease Chronic Disease Control Control

The epidemics of lifestyle.The epidemics of lifestyle.

First…we needed First…we needed some education for some education for

our health our health professionals!professionals!

Next…we needed some public Next…we needed some public education!education!

In many In many immigrant immigrant

families, parents families, parents were concerned were concerned if their kids were if their kids were

thin, because thin, because being skinny was being skinny was a sign of poverty.a sign of poverty.

Obesity Trends* Among U.S. AdultsBRFSS, 1985

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1986

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1987

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1988

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1989

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1991

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1992

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1993

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1994

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1995

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 2001

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsBRFSS, 2003

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsBRFSS, 2004

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. AdultsBRFSS, 2005

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2006

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2007

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends* Among U.S. AdultsBRFSS, 2008

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

County-level Estimates of Diagnosed Diabetes for Adults County-level Estimates of Diagnosed Diabetes for Adults aged ≥ 20 years: United States 2005aged ≥ 20 years: United States 2005

Environmental Health Environmental Health IssuesIssues

Our impact on the Our impact on the environment, and the environment, and the

environment’s impact on us.environment’s impact on us.

A major improvement in health came from A major improvement in health came from separating us from our waste and our animals.separating us from our waste and our animals.

Early Early precautions precautions

about indoor air about indoor air quality.quality.

Early Americans ignoring the Early Americans ignoring the precautions.precautions.

Consumer Consumer protection protection

continues to be continues to be one of the top one of the top

priorities in priorities in Environmental Environmental

Health.Health.

Environmental Environmental health programs health programs

focusing on focusing on zoonotic diseases.zoonotic diseases.

Hazardous materials and their impact on Hazardous materials and their impact on the environment.the environment.

The Medically The Medically Uninsured and Uninsured and UnderinsuredUnderinsured

Have we made progress in Have we made progress in providing care to the “poor?”providing care to the “poor?”

Equality in health care accessEquality in health care accessOver 47 million Americans, including 16% of Over 47 million Americans, including 16% of

Coloradoans (700,000), are uninsured or underinsured Coloradoans (700,000), are uninsured or underinsured today and the number is rising.today and the number is rising.

Welcome to JCPH!Welcome to JCPH!