2003 What is Public Health? Presentation by: Dawn Gentsch, MPH, CHES Connecting Workshop 2003 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.) The word “health” does not appear in the U.S. Constitution, therefore health became a power to be executed by the states. 09/17/1787 Health is a primary public good because many aspects of human potential such as employment, social relationships, and political participation are contingent on it. In view of the value of health to employers, business, communities, and society in general, creating the conditions for people to be healthy should also be a shared social goal.

What does the term Public Health mean to you? Do a black board exercise Personal experiences? Larger view? How could the terms expressed be related?

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 How is this unique in the health arena? How does public health differ from Medicine?

The Paradigm of Public Health What we, as a society, do collectively to assure the conditions in which people can be healthy. IOM focused on ways to strengthen the public health infrastructure. IOM provided strong evidence to suggest that the public health system – the organizational mechanism for achieving the best population health – was in disarray. 1988 Institute of Medicine The Future of Public Health

Public health affects all of us, all of the time. The health of populations and individuals is shaped by a wide range of factors in the social, economic, natural, built and political environments.

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 Public health includes voluntary organizations, private organizations and individuals. 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 America Vision: Healthy People in Healthy Communities Mission: Promote Physical and Mental Health and Prevent Disease, Injury and Disability Public Health 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 Healthy People Vision: Healthy People in Healthy Communities. Healthy People is the health initiative for the nation.

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 People are healthier, live longer and enjoy lives that are less likely to be marked by injuries, ill health or premature death. Infant mortality and decreased and life expectancy had increased.

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

- How we do it - Public health practice is based on scientifically sound strategies for improving the quality of life and reducing morbidity and premature mortality.

Prevention is the primary obligation of public health. -- William Foege, MD, Bill and Melinda Gates Foundation Vaccines and antibiotics prevent life threatening ailments. Car seats and safety belts, among other safety items all work to increase safety of the public and decrease injury. Unparallel medical advances and a national investment in health care have resulted in improved health outcomes. Despite this success, U.S. lags behind. Health care spending: 95% of our spending is for medical care and biomedical research. Behavior and the environment are responsible for up to 70% of mortality. Health care is just one of the determinants of health.

Distinctions Between PH and Medicine PUBLIC 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 PUBLIC HEALTH 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

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 Many U.S. citizens lack health insurance or they are underinsured. The CHNA-HIP is an Iowa example on assessing the health of the population. 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 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 America Essential Public Health Services Vision: 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

Public Health System 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 We know the official public health agency has many partners that contribute to accomplishing public health improvements. We think of these partners as members of the public health system. So when we speak of the public health system we mean it is all the public private, and voluntary entities that contribute to the delivery of essential public health services within a jurisdiction. This description of the members of a public health system does not fully explain what it is. So what is a public health system? It is a network of entities with differing roles, relationships, and interactions. All of these entities contribute to the health and well-being of the community. This sphere encircled with this web is one way to think about the interconnections that exist between public health and its system partners. All of these partners are linked in different ways and play various roles in the health of the community. Okay who are these partners? Governmental public health is the backbone of the system. Public health must maintain partnerships with organizations and sectors of society, working closely with communities and community based organizations, the health care delivery system, academia, business and the media. 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

A Public Health System Is Complex Home Health Police Community Centers Churches EMS Jails MCOs Health Department Parks Schools Doctors Nursing Homes Elected Officials Philanthropist Hospitals Mass Transit A Public Health System is Complex Here is a cluttered depiction of the complexity of a public health system and examples of organizations and groups that it make-up the network. If you can read this slide, you will see many of the partner groups represented who contribute to health and delivery of the EPS, such as: Healthcare providers like hospitals, physicians, community health centers, mental health labs, nursing homes and others who provide preventive, curative, and rehabilitative care. Public safety such as police, fire and EMS. Their work is focused on preventing and coping with injury and other emergency health situations. Human Service and Charity Organizations such as food banks, public assistance agencies, transportation providers, and others that assist people to access healthcare and receive other health-enhancing services. Education and Youth Development Organizations like schools, faith institutions, youth centers, and others groups that assist with informing, educating, and preparing children to make informed decisions and act responsively regarding health and other life choices and to be productive contributors in the community. Recreation and Arts-related Organizations who contribute to the physical and mental well-being of the community and those that live, work and play in it. Economic and Philanthropic Organizations such as employers, community development and zoning boards, United Way, community and business foundations that provide resources necessary for individuals and organizations to survive and thrive in the community. Public health system partners studied by IOM and Committee working on the “Future of the Public’s Health” Community Health care delivery system Employers and business Media and Academia Environmental Health Civic Groups CHCs Fire Economic Development Tribal Health Employers Laboratory Facilities Drug Treatment Mental Health

Public health efforts have increased the average life span by nearly 30 years during the past century. Areas for action and change: adopting a focus on population health that includes multiple determinants of health Strengthening the public health infrastructure Building partnerships Developing systems of accountability Emphasizing evidence Improving communication

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.