U.S. Public Health System Mark Griswold Maine CDC Office of Local Public Health (Slides by Brenda M. Joly, PhD, MPH--USM faculty)

What is Public Health? Definitions vary Key terms Population health Prevention “The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community efforts” (Winslow, 1920) “Fulfilling society’s interest in assuring conditions in which people can be healthy” (IOM report, 1988)

Dictionary Definition “the science and practice of protecting and improving the health of the community, as by preventive medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards.” Source: The American Heritage Dictionary, Public Health Institute. PUBLIC HEALTH 101. “The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community efforts” (Winslow, 1920) “Fulfilling society’s interest in assuring conditions in which people can be healthy” (IOM report, 1988)

CEA Winslow’s Definition “the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort.” Source: CEA Winslow, 1920. “The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community efforts” (Winslow, 1920) “Fulfilling society’s interest in assuring conditions in which people can be healthy” (IOM report, 1988)

Federal Gov’t Definition “Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy.” Source: Institute of Medicine Report (IOM). THE FUTURE OF PUBLIC HEALTH. Washington DC: National Academy Press. 1988. “The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community efforts” (Winslow, 1920) “Fulfilling society’s interest in assuring conditions in which people can be healthy” (IOM report, 1988)

In general, 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 recoveries Assures the quality and accessibility of health services “The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community efforts” (Winslow, 1920) “Fulfilling society’s interest in assuring conditions in which people can be healthy” (IOM report, 1988)

Public Health Approach Model Medical Model Versus

Public Health Approach Public Health Model Population Disease Prevention Health Promotion Interventions Environment Human behavior Government (Some private) Medical Model Individual Diagnosis Treatment Intervention Medical care Private (Some public)

Public Health in the US ~Vision~ ~Mission~ Healthy People in Healthy Communities ~Mission~ Promote physical and mental health and Prevent disease, injury, disability Fulfilling society’s interest in assuring conditions in which people can be healthy. Institute of Medicine, 1988

Healthy People 2010 Goal 1: Increase Quality and Years of Healthy Life The first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life. Goal 2: Eliminate Health Disparities The second goal of Healthy People 2010 is to eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation. Prevents injuries: Example – head trauma due to bicycle crash Promote healthy behavior: Example – smoking cessation, good nutrition, etc. Assure health services: Example – access to prenatal care

Public Health… Prevents epidemics and the spread of disease Protects against environmental hazards Responds to disasters and assists communities in recovery Spread of Disease: Example – West Nile Virus Environmental Hazards: Example – Lead Poisoning Responds to Disasters: Example - Bioterrorism

Public Health cont’d… Prevents injuries Promotes healthy behaviors Assures the quality and accessibility of health services Prevents injuries: Example – head trauma due to bicycle crash Promote healthy behavior: Example – smoking cessation, good nutrition, etc. Assure health services: Example – access to prenatal care

in the public’s interest Core Components ASSESSMENT of the health of the community POLICY DEVELOPMENT in the public’s interest ASSURANCE of the public’s health Assessment This function includes the regular collection, analysis, and sharing of health data and information about risks and resources in a community. The purpose of this function is to identify trends in illness, injury, and death including the factors that may cause these conditions. Policy Development Information collected during the assessment phase is often used to develop local and state health policies. Good public policy development involves the consideration of political, organizational, and community values. Assurance This function includes the assurance of the availability of quality and effective programs and services necessary to achieve the agreed-upon goals.

A Public Health System Who? What? Public entities Private entities Voluntary entities What? A network WHO: All public, private, and voluntary entities that contribute to public health in a given area WHAT: A network of entities with differing roles, relationships, and interactions. All entities contribute to the health and well-being of the community. NOTE: A public health system is more than the public health agency

The Public Health System MCOs Home Health Parks Economic Development Mass Transit Employers Nursing Homes Mental Health Drug Treatment Civic Groups HMPs Laboratory Facilities Hospitals EMS Community Centers Doctors Health Department Churches Philanthropist Elected Officials Tribal Health Schools Police Fire Corrections Environmental Health

Determinants of Health Genetic Behavioral Social Environmental Personal health care

Determinants of Health Domains & Early Deaths Determinants of Health Source: McGinnis et al., 2002 McGinnis et al, 2002.