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Overview of Public Health
(Part 2)
Richard Taylor, PhD, MPH
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Learning Objectives
Define eras of public health
Illustrate the uses of health care, traditionalpublic health, and social interventions inpopulation health
Identify a range of determinants of disease Describe major public health achievements in
20thCentury
Discuss modern public health challenges
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History of Public Health
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Mohenjo-Daro and Harappa
Civilizations
http://en.wikipedia.org/wiki/File:Civilt%C3%A0ValleIndoMappa.png8/13/2019 Overview of Public HealthPart 2 (1)
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Well and bathing platforms
Harappa
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Palace of Knossos on Crete
~2,000 B.C.
Magnificent bathing
facilities
Flushingarrangements for
toilets
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Era of Health Protection
Antiquity1830s
Focus; Authority-based control of
individual and community behaviors
Framework: Religious and cultural
practices and prohibited behaviors
Examples: Isolation and quarantine
Sexual prohibitions
Dietary restrictions
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James Lind
1740s British Naval
commander
Demonstrated lemons and
other citrus fruitcould prevent and
treat scurvy
One of the first clinical
experiments recorded
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Edward Jenner (17491823)
Last years of 18thcentury
English physician
Father of immunology Cowpox protected
those who developed itagainst smallpox
Innoculated JamesPhipps in 1796
1979 Smallpoxeradicated
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Hygiene movement
18401870s
Focus: improve health through improved
sanitary conditions
Framework: Community-based
environmental improvements
Examples: John Snow on Cholera
Semmelweiss and puerperal fever
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Ignaz Semmelweis (18181865)
1847 incidence ofpuerperal fever(childbed fever) couldbe controlled by handwashing.
Could reducematernal mortalityfrom 10%35% toless than 1%.
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Vital Statistics
Mid-19thcentury in
England
Development of birth
and death records Allowed for
population-wide
assessment of health
status
Edwin Chadwick
William Farr
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Contagion Control
18801940s
Focus: Germ theory,
infectious origins of
disease Framework: Control of
communicable disease,
vaccination, sanatoriums,
Examples:
Tb Sanatoriums,
Outbreak investigations
Louis Pasteur
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Sanitation and Hygiene
Population shift led to repeated disease
outbreaks
1900,
40 of 45 states had established health departments
Collective public health action
19301950
Improvements in sewage disposal
Water treatment
Food safety
Organized solid waste removal
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Sir Alexander Fleming (18811955)
Scientist who
discovered penicillin
First used in March
1942 to treatstreptococcal
infection
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Post WWII: Advancing the
Medical Care System 1950smid 1980s
Focus: Control of communicable disease
Risk factor modification
Target of high-risk populations
Framework: public system for care of and specific control of diseases and
vulnerable populations
Integration of preventive services
Examples: Antibiotics
1965 establishment of Medicare and Medicaid
Clinical trials; community trials
Health maintenance organizations
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Health Promotion and Disease
Prevention Mid-1980s2000
Focus:
Individual behavior
Disease detection
Framework
Population prevention
Clinical prevention
Multiple interventions
Examples
Early Screening for
cancer
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Population Health
21stCentury Approach
Focus:
Coordinated public health and health
care delivery based on shared
evidence-based systems thinking
Frameworks
Globalization
Cost vs. benefit analysis
Community and population level
interventions thinking
Examples
Health informatics
Antibiotic resistance
Global collaboration
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Risk: Everyone vs.
Vulnerable Groups High-risk approach
Focus on only those
with highest risk to
bring them toward the
average
Smokers
Occupational groups
High-risk sexual
behaviors
Improving the
average approach
Everyone has some
degree of risk. Reduced cholesterol
levels through diet
Presidential Challenge
Weight loss programs
to reduce risk ofdiabetes.
Age Adj sted Death Rates* for the 10 Leading
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Age-Adjusted Death Rates* for the 10 Leading
Causes of DeathNational Vital Statistics System,
United States, 2006 and 2007
*Rate per 100,000 U.S. standard population.Data for 2006 are final. Data for 2007 are preliminary.
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Deaths and Death RatesTexas 19432007
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On an Average Day In Texas
2007 The Population Increased by
678 Persons. [The rate ofnatural increase (Births -Deaths)]
There were 1,116 ResidentBirths
53 babies had no prenatalcare
94 low birth weight babieswere born (less than 2,500grams or less than 5 lbs. 9oz.)
54 babies were born toteenage mothers (less than 18years of age)
376 babies were delivered byC-section
There were 439 ResidentDeaths 108 of these deaths were due
to heart disease
96 of these deaths were dueto cancer
26 of these deaths were dueto accidents
7 of these were infant deaths
There were 483 Marriages
There were213 Divorces
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Ten Great Public Health Achievements
United States, 19001999
Vaccination
Motor-vehicle safety
Safer workplaces
Control of infectious diseases
Decline in deaths fromcoronary heart disease andstroke
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of drinking water
Recognition of tobacco use asa health hazard
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Infant mortality rate,* by year
United States, 19151997
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Maternal mortality rate, by year
United States, 19001997
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Motor Vehicle Safety
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Motor Vehicle Safety
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Recognition of tobacco use as a
health hazard
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Control of infectious diseases
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Age-adjusted death rates for total cardiovascular
disease, diseases of the heart, coronary heart disease,
and stroke, by yearUnited States, 19001996
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Public Health Challenges
Travel to tropical rain forestsand wilderness habitatsincrease encounters withreservoirs for unknowninfectious diseases
Development of antimicrobialagents has hastened thedevelopment of drugresistance.
Modern medical treatmentsmay lead to increased
acquisition of opportunisticinfections
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Public Health Challenges
Spread of disease through modern
ventilation systems
Spread of disease through blood
transfusions
Food-borne diseases are spread oncentrally processed foods
Airplanes have replaced ships as major
vehicles of international disease spread
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Questions and Discussion
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Recognition of tobacco use as a
health hazard
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Fluoridation of drinking water
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Fluoridation of drinking water
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Other Public Health Victories
Cumulative gains in public healthat the turn of this century
900,000 fewer reported cases
of measles than 1941
200,000 fewer cases of
diphtheria than 1921
250,000 fewer cases of
whooping cough than 1934
21,000 fewer cases of polio
than in 1951
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Other Public Health Victories
45 Million fewer smokers than expected trends in tobacco use
through 1965
2 Million Americans were alive that would have otherwise have
died from heart disease
Protection of the US Blood supply prevented:
>50,000 HIV infections
1.5 Million Hepatitis B and C infections
Saved more than 3.5 billion in medical costs associated with those
three diseases.
Blood Lead Levels dropped by 1/3 since 1976
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Age-Adjusted Rates* of Death from Heart Disease,
by Race and Sex United States, 19792006
* Per 100,000 standard population. Data for 2006 are preliminary.
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Access to Family Planning
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FIVE LEADING CAUSES OF
DEATH, USA, AGES 1524, 1998
CAUSE PERCENTNUMBER
S
(1) Accidents 51.8% 12,752
(2) Homicide 21.3% 5,233
(3) Suicide 16.3% 4,003
(4) Cancer 6.8% 1,670
(5) Heart Disease 3.9% 961
Five-year averages of annual number of deaths
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Five year averages of annual number of deaths
related to coal mine explosionsUnited states,
19011995