Public Health: What It Is and How It Works, Fourth Edition Chapter-by-Chapter Power Point Slides Links to Internet-based resources

Chapter 9 Future Challenges for Public Health in America

Chapter 9 Will Help You To: describe lessons learned from the threats and challenges faced by public health in the 21st century characterize the limitations and challenges facing public health in the new century determine how these limitations and challenges can be overcome

Lessons from a Century of Progress in Public Health Remarkable achievements Unfinished agenda Science and social values Public health system: a work in progress

Emerging Infectious Diseases

Origin of Emerging Infectious Diseases Changes in environment (technology and industry) Economic development Population growth or migration Human behavior International travel and commerce Microbial adaptation Breakdown in public health measures The cause of almost all emerging infectious diseases can be traced to changes in environment (technology and industry), economic development and land use, human population growth or migration, human behavior, international travel and commerce, microbial adaptation, or a breakdown in public health measures. Under suitable circumstances, a new infection anywhere in the world could traverse entire continents within days or weeks. USDHHS (1998). Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention.

SARS: Global Outbreak…Local Impact Local Outbreak…Global Impact…

SARS Transmission in Singapore February 25 – April 30, 2003 Bogatti SP. Reprinted in MMWR 5-9-03

SARS Transmission Spring 2003 Hospital 2 Hong Kong A H J B 4 other Hong Kong Hospitals Hospital 3 Hong Kong Hospital 1 HK Hospital 4 Hong Kong 2 family members C D E 34 HCWs HCW Germany Bangkok Singapore United States I L§ M§ Vietnam Ireland K † 37 HCWs 0 HCWs 28 HCWs 156 close contacts of HCWs and patients Canada G † F 4 family members 10 HCWs 37 close contacts 99 HCWs (includes 17 medical students) 4 HCWs* 3 HCWs Unknown number close contacts 2 close contacts SARS Transmission Spring 2003 Hotel M Hong Kong Guangdong Province, China A B J H C D E I K † F G †

Monkeypox Outbreak 2003 Rodent Shipment Ghana NJ RS, BP TS, SM TX-2 GR TEXAS 50 Gambian giant rats (GR) 53 rope squirrels (RS) 2 brushtail porcupines (BP) 47 tree squirrels (TS) 100 striped mice (SM) ~510 dormice (DM) WI Human cases: 17 confirmed 22 probable/ suspect IL‡ Human cases: 8 confirmed 4 probable/ suspect TX-3 RS, SM DM 1 PD traced 200 prairie dogs (PDs) at facility 11 PDs traced 24 PDs traced 14 PDs traced 42 PDs traced IL-1§ GR, DM IN Human cases: 7 confirmed 9 probable/ suspect IA† GR, DM TX-4 DM TX-5 DM MO Human cases: 2 confirmed KS Human cases: 1 confirmed TX-9 DM TX-6 TS, SM DM SC No human cases TX-7 DM TX-8 DM MI No human cases TX-10 DM IL-2 DM Japan DM MN DM WI DM

Obesity as an Emerging Public Health Issue

Health Problems: Two Different Views Leading Causes of Death* United States, 2000 Actual Causes of Death† United States, 2000 5 10 15 20 25 30 35 Percentage (of all deaths) Heart Disease Cancer Stroke Chronic lower respiratory disease Unintentional injuries Diabetes Pneumonia/influenza Alzheimer’s disease Kidney disease Tobacco Poor diet/physical inactivity Alcohol consumption Microbial agents (e.g., influenza, pneumonia) Toxic agents (e.g., pollutants, asbestos) Motor vehicles Firearms Sexual behavior Illicit drug use 5 10 15 20 Percentage (of all deaths) *Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: final data for 2000. National Vital Statistics Reports 2002; 50(15):1-20. †Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291 (10): 1238-1246.

Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003 (*BMI 30, or about 30 lbs overweight for 5’4” person) 1996 1991 2003 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14%

Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20

Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Factors Contributing to Obesity Biological Genetic Metabolism Medications Behavioral Diet Physical Activity Environmental Culture Socioeconomic Status Home Schools Work

Discussion What was the most important achievement of public health in the twentieth century? Why?

Discussion What will be the most important achievement of public health in the twenty-first century? Why?

Discussion Using a scale from 1 to 10, how effective is the public health system in the United States? How did you arrive at this rating?

Discussion Do you agree with the IOM assertion that public health is in disarray or with the counter-assertion that it is government, not public health, that is in disarray?

Discussion What impact did The Future of Public Health have on the public health community during the 1990s? What impact has The Future of the Public’s Health in the 21st Century had on the public health community since 2003?

Discussion What do you think are the most important new or expanded roles for public health in the twenty-first century?

Discussion Your state has $100 million from tobacco settlement funds. What strategies and programs should receive funding? Why?

Discussion How has your understanding of what public health is and how it works changed after examining the topics in this book?

Additional Resources Public Health: Costs of Complacency. Government Performance Project Governing Feb 2004. The Personal Predicament of Public Health. Smith JS. Chronicle of Higher Education; June 27, 2003. The Pitfalls of Bioterrorism Preparedness: The Anthrax and Smallpox Experiences. Cohen HW, Gould RM, and Sidel VW. AJPH 2004;94(10):1667-1671 The Unfulfilled Promise of Public Health: Deja Vu All Over Again. Fee E and Brown T. Health Affairs 2002;21(6):31-43