Component 1: Introduction to Health Care and Public Health in the U.S. 1.1: Unit 1: Introduction to modern healthcare in the US 1.1 b: Introduction to Public health Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Public Health "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals." C.E. A. Winslow, “The Untilled Fields of Public Health,” Science, n.s. 51 (1920), p. 23 Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

10 Great Public Health Achievements – US, 1900-1999 Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decline in deaths from coronary heart disease and stroke Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco use as a health hazard CDC. Ten great public health achievements—United States, 1900–1999. MMWR 1999;48:241–3. Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

Public Health Successes (continued) Control of infectious diseases Example: Typhoid spread by ingesting contaminated food or water In 1891 the typhoid death rate in Chicago alone was 174 per 100,000 people. Now, thanks to public health measures only about 400 cases are seen in the US each year, most of whom originate when patients travel in developing countries http://www.cdc.gov/ncidod/dbmd/diseaseinfo/TyphoidFever_g.htm Chicago typhoid rates at http://web.archive.org/web/20070409040022/www.chipublib.org/004chicago/disasters/19th20th_epidemics.html http://www.nichd.nih.gov/news/releases/typhoid_background.cfm Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

Public Health Successes (continued) Control of infectious diseases Example: Smallpox Epidemic viral illness, possibly responsible for hundreds of millions of deaths in the 20th century alone In the early 1950s there were about 50 million cases of smallpox each year worldwide By 1977, smallpox was eradicated, thanks to an aggressive public health program and the use of an effective vaccine From http://www.who.int/mediacentre/factsheets/smallpox/en/ Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

Public Health Successes (continued) Control of nutritional deficiencies Example: Goiter Lack of iodine in diet leads to impaired thyroid hormone synthesis and an enlargement of the thyroid gland in the neck (a goiter) Fortification of salt with iodine virtually eradicated nutritional goiter in the US Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

Public Health Successes (continued) Control of nutritional deficiencies Example: Tooth Decay Adding fluoride to drinking water substantially reduces the incidence of dental caries (tooth decay) in populations In 1945 fluoride was added to water in Grand Rapids, Michigan, which resulted in a reduction in cavities. Now over 10,000 US communities fluoridate their water http://aaphd.org/docs/position%20papers/A%20Half-Century%20of%20Community%20Water1993.pdf Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

How has public health improved healthcare? Improvements in understanding disease Epidemiology is considered the basic science of public health and is a quantitative basic science a method of causal reasoning based on developing and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality a tool for public health action to promote and protect the public’s health Definition of epidemiology from Principles of Epidemiology, 2nd edition, CDC Self Study Course 3030-G at http://www2a.cdc.gov/phtn/catalog/pdf-file/Epi_course.pdf Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

How has public health improved healthcare? Improvements in understanding disease An example of epidemiology at work: In 1854 -- epidemic of cholera in London, England. Cholera is a bacterial disease spread by contamination of food or water Lack of sanitation and overcrowding -- important factors that led to the spread of disease Spread of disease linked to a contaminated public water pump by Dr John Snow Snow’s hypothesis: cholera was spread by contaminated water Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

How has public health improved healthcare? (continued) Improvements in data collection Original methods of data collection were crude progressive improvement in methodology led to the use of sophisticated scientific methods to collect data cohort studies randomized control trials Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

How has public health improved healthcare? (continued) Improvements in data collection Example: the Framingham Heart Study The study followed patients for a number of years to identify factors that contribute to the development of cardiovascular disease (CVD) Over the years, three generations of participants have helped identify major CVD risk factors http://www.framinghamheartstudy.org/index.html Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

How has public health improved healthcare? (continued) Improvements in data analysis (use of tools such as multivariate analysis and metaanalysis) Improvement in disease surveillance Example: the Real-Time Outbreak and Disease Surveillance (RODS) Laboratory at the University of Pittsburgh, Department of Biomedical Informatics Vandenbroucke JP. Clinical investigation in the 20th century: the ascendency of numerical reasoning. Lancet 1998;352(suppl 2):12–6. http://www.rods.pitt.edu/site/ Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010

How has public health improved healthcare? (continued) Improvement in training Establishment of many schools of public health in the early 20th century Professional degrees such as Master of Public Health (M.P.H.) Improvements in infrastructure Federal State Local health departments Turnock BJ. The organization of public health in the United States. In: Turnock BJ, ed. Public health: What it is and how it works. Gaithersburg, Maryland: Aspen Publication, 1997:1121–68. http://www.deltaomega.org/WelchRose.pdf Component 1 / Unit 1 Health IT Workforce Curriculum Version 1.0/Fall 2010