Connecting Workshop2003

What is Public Health?

Presentation by:

Dawn Gentsch, MPH, CHES

What is Public Health? - Overview

• Public Health Definitions

• What does Public Health Do?

• History of Public Health

• Core Functions and Essential Services

• How does Public Health Work?

What is Health?

• The absence of Disease or Disability

• The “complete physical, mental and social well being and not merely the absence of disease or infirmity”. (W.H.O.)

What does the termPublic Healthmean to you?

Public Health

• Public Health encompasses a population-focused, organized effort to assist individuals, groups, and communities in the reduction of health risks, and the maintenance or improvement of health status.– Healthy environment– Obtain needed health care services– Access to health promotion and disease prevention

services

WHO & IOM; ASPH June 2001

Selected Definitions of Public Health

• “The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community action.” Winslow

• “Successive re-definings of the unacceptable.” Vickers

• “Fulfilling society’s interest in assuring conditions in which people can be healthy” IOM

The Paradigm of Public Health

What we,

as a society, do collectively

to assure the conditions in which people can

be healthy.

Institute of MedicineThe Future of Public Health

Public health

affects all of us,

all of the time.

What is Public Health?

• Governmental Services (Especially Medical

Care for the Poor)

• The Methods (Knowledge and Techniques)

• The Profession

• The System and Social Enterprise

• The Health of the Public

Bernard J. Turnock

What does Public Health do?

• The public health system exists to address:– the physical, – mental, – and environmental health concerns of

comminutes and populations at risk for disease and injury

Public Health in AmericaVision:

Healthy People in Healthy Communities

Mission:Promote Physical and Mental Health and

Prevent Disease, Injury and Disability

Prevents epidemics and the spread of disease

Protects against environmental hazards

Prevents injuries

Promotes and encourages healthy behaviors

Responds to disasters and assists communities in recovery

Assures the quality and accessibility of health services

Public Health

The History of Public Health

• Prior to 1850 - Epidemics: Avoidance and Acceptance

• 1850 - 1949 Sanitary Reform through State and Local Infrastructure

• 1950 - 1999 Gaps in Medical Care and Expanding Agenda

• After 1999 - Community PH Practice and Bio-Terrorism

Ten Great Public Health Achievements

• Vaccines• Recognition of

Tobacco as a Hazard• Motor Vehicle Safety• Safer Workplaces• Control of Infectious

Disease

• Fewer deaths from heart disease and stroke

• Safer and healthier foods

• Healthy mothers and babies

• Family planning• Fluoridation

MMWR Vol 48, No 12

Public health practice is based on

scientifically sound strategies

for improving the quality of life and reducing

morbidity and premature mortality.

- How we do it -

Prevention is the primary obligation of public health.

-- William Foege, MD,

Bill and Melinda Gates Foundation

Distinctions Between PH and MedicinePUBLIC HEALTH

• Primary focus on population • Public service ethic, tempered by

concerns for the individual • Emphasis on prevention, health

promotion for the whole community

• Public health paradigm employs a spectrum of interventions aimed at the environment, human behavior and lifestyle, and medical care

• Multiple professional identities with diffuse public image

• Variable certification of specialists beyond professional public health degree

MEDICINE

• Primary focus on individual

• Personal service ethic, conditioned by awareness of social responsibilities

• Emphasis on diagnosis and treatment, care for the whole patient

• Medical paradigm places predominant emphasis on medical care

• Well-established profession with sharp public image

• Uniform system for certifying specialists

beyond professional medical degree

Harvey Fineberg MD, PhD

Distinctions Between PH and Medicine

• Lines of specialization organized, for example, by: analytical method (epidemiology)setting and population (occupational health)substantive health problem (nutrition)skills in assessment, policy development, and assurance

• Biologic sciences central, stimulated by major threats to health of populations; move between laboratory and field

• Numeric sciences an essential feature of analysis and training

• Social sciences an integral part of public health education

• Clinical sciences peripheral to professional training

• Lines of specialization organized, for example, by:organ system (cardiology)patient group (pediatrics)etiology, pathophysiology(oncology, infectious disease)technical skill (radiology)

• Biologic sciences central, stimulated by needs of patients; move between laboratory and bedside

• Numeric sciences increasing in prominence, though still a relatively minor part of training

• Social sciences tend to be an elective part of medical education

• Clinical sciences an essential part of professional training

PUBLIC HEALTH MEDICINE

The Evolving Agenda of Public Health

Hygiene

Infections

Chronic Disease

Determinants of Health

Three Core Functions of Public Health

• Assessment

• Policy Development

• Assurance

• This is the IOM Model as identified in 1988 that lead to the Essential Public Health Services.

Assessment

The Process of Understanding

– Population Health Status

– Threats to Health

– Community Health Resources

Kristine Gebbe

Policy Development

• Reduce the threats to health

• Support positive resources

• Reduce disease

• Advance overall community health

Assurance

The process of assuring:

• Availability

• Accessibility

• Quality

http://www.apha.org/ppp/science/10ES.htm

Public health agencies are a lot like fire departments. They teach and practice prevention at the same time they maintain readiness to take on emergencies. They are most successful—and least noticed—when their prevention measures work the best.

-- 1998 Public Health Improvement Plan,Washington State Department of Health

Public Health in AmericaVision:

Healthy People in Healthy Communities

Essential Public Health Services

Monitor health status Diagnose and investigate health problems and health hazards Inform, educate, and empower people about health issues Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health

efforts Enforce laws and regulations that protect health and ensure safety Link people to needed personal health services Assure a competent public health and personal health care workforce Evaluate effectiveness, accessibility, and quality of personal and

population-based health services Research for new insights and innovative solutions to health problems

A public health system includes: All public, private, and voluntary entities that contribute to the delivery of public health services within a jurisdiction.

A public health system is: A network of entities with differing roles, relationships, and interactions.

All entities contribute to the health and well-being of the community.

Public Health System

CDC, 2001

Public Health Infrastructure

• “The backbone of the public health system”• Resources and relationships necessary to carry out

the core functions and essential services of public health

• Resources: – Human: continuing education, leadership development,

certificate programs– Informational: online data, integrate informational

systems, research– Organizational: expanded partnerships, statutes, core

functions funding, statewide umbrella– Financial: to finance all of the above

MCOs

Home Health

Parks

Economic Development

Mass Transit

Employers

Nursing Homes

Mental Health

Drug Treatment

Civic GroupsCHCs

Laboratory Facilities

Hospitals

EMS Community Centers

Doctors

Health Department

A Public Health System Is Complex

Churches

Philanthropist

Elected Officials

Tribal Health

Schools

Police

Fire

Jails

Environmental Health

Public health efforts have increased the average life span by nearly 30 years during the past century.

Behavioral and environmental risk factors – smoking, poor diet,

lack of exercise, increased pollution, stress and unsafe

sexual practices – have replaced infectious disease as the leading

causes of premature death.

How Does Public Health Work?

• Public health address health concerns through the application of:– Health promotion and disease prevention

technologies and interventions designed to improve and enhance quality of life

*These methods encompass a broad range of activities, but are all grouped under 3 main core public health functions.