English for special purpose in Public health

Introduction to public health and preventive medicine

Story of life expectancy Mortality Rate

CIA World Factbook 2007 Estimates for Life Expectancy at birth (years).

按联合国会员排名按国家或地区排 名 国家或地区总预期寿 命 男性预期寿 命 女性预期寿 命 1 澳門特別行政區 安道爾 日本 新加坡 聖馬利諾 香港 吉布拉塔 ( 英國 ) 英國 瑞典 澳洲 瑞士 法國 根西島 ( 英國 ) 根西島 英國 冰島 加拿大

76103 土耳其 中國 (mainland) 中國mainland 馬來西亞 巴西 聖克里斯多福及尼維斯 保加利亞 泰國 安地卡及巴布達 塞席爾 愛沙尼亞 哥倫比亞

索馬里 奈及利亞 查德 幾內亞比索 尼日 阿富汗 中非 吉布地 納米比亞 馬拉威 南非 莫三比克 獅子山 賴比瑞亞 賴索托 辛巴威 尚比亞 安哥拉 史瓦濟蘭

Major Reasons for Increased Longevity Improved sanitation Provision of clean water Universal immunization programs Health education and prevention practices Improved treatment of chronic diseases (for recent advances)

Healthy life expectancy Disability Adjusted Life Expectancy

How it is caculated? Morbidity and Mortality of commen diseases Living habits Social Violence Dietary pattern Substance abuse(drug,alcohol) Medical facilities Environment Climate And How many year been disability in average (subtract this number from life expectancy)

WHO 会员国主要国家健康预期寿命 ( 1999 年 )

排名 国 家 ( 歲 ) 健康预期寿命 ( 岁 ) 1 日本 澳洲 法国 瑞典 西班牙 意大利 希腊 瑞士 摩纳哥 安道尔侯国 圣玛利诺 加拿大 荷兰 英国 挪威 比利时 澳地利 71.6

18 卢森堡 冰岛 芬兰 马尔他 德国 以色列 美国 塞浦路斯 多明尼加 爱尔兰 丹麦 葡萄牙 新加坡 纽西兰 智利 古巴 斯洛法尼亚 捷克 牙买加 67.3

37 乌拉圭 克罗埃西亚 阿根廷 哥斯大黎加 中国大陆 乌干达 波札纳 尚比亚 马拉威 尼日 狮子山 25.9 Sources: UN Healthy Life Expectancy Ratings

J.P.Bunker’ s report (1994 published) Life expentancy from years Medical care contributes to only five years Improvement of public health contributes to the rest

Spending in 1992 Average medical care cost for each person: $3007 Public health spending for each person: $34 Distribution of national health dollars on public health: About 1%

Spending in 2001 Total national health expenditures: $1,424.5 billion Public health activities: $46.4 billion Distribution of national health dollars: 86.8% to personal health services/supplies 3.3% to government PH activities

Requirements for survival 1.air 2.water 3.food 4.shelter 5.care

Health The United Nations' World Health Organization defines health asWorld Health Organization "a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity."

What is Public health? In 1920, C.E.A. Winslow defined public health asC.E.A. Winslow "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."

The history of public health Public health is an old concept, dating back to when people first began living in communities. Through the ages, governments have shown varying degrees of concern for the public health.

The ancients Greeks, and the Romans after them, tried to ensure the health of their citizens by providing a supply of clean water (via aqueducts and pipelines), managing the disposal of waste working to control disease by hiring public physicians to treat the sick.

During the late 1800s European governments began turning their attention to matters of public health in an effort to control the spread of disease. (Because Epidemics of leprosy, the plague, cholera, and yellow fever).

In the United States, the public health became an official concern when in 1866 a cholera epidemic struck the nation-for the eighteenth consecutive year

What is 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."

The 'science' is concerned with making a diagnosis of a population's health problems, establishing their cause, and determining effective interventions. The 'art' is to address these problems creatively.

This definition underscores the broad scope of public health and the fact that public health is the result of society’s efforts as a whole, rather than that of single individuals.

In 2003, Detels defined the goal of public health as: The biologic, physical, and mental well-being of all members of society regardless of gender, wealth, ethnicity, sexual orientation, country, or political views. (This definition or goal emphasizes equity and the range of public health interests as encompassing not just the physical and biologic, but also the mental well-being of society.)

Both WHO and Detels’ goals depict public health as being concerned with more than merely the elimination of disease. To achieve the WHO goal of ‘health for all’, it is essential to bring many diverse disciplines to obtain the optimal health （ physical, biologic, and social sciences ）. The field of public health has adapted and applied these disciplines for the elimination and control of disease, and the promotion of health.

1988 Mission: Substance: Organizational framework: Core functions:

mission The fulfillment fo society’s interest in assuring the conditions in which people can be healthy

Substance Organized community efforts aimed at the prevention of disease and the promotion of health

Organizational framework Bothe activities undertaken within the formal structure of government and the associated efforts of private and voluntary organizations and individuals

Core functions Assessment Policy development Assurance

Monitor Health Status to Identify and Solve Community Health Problems Diagnose and Investigate Health Problems and Health Hazards in the Community  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 and Assure Health Care When Otherwise Unavailable 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

5 steps process 1. Define the health problem 2. Identify the risk factors associated with the problem 3. Develop and test community-level interventions to control or prevent the cause of the problem 4. Implement interventions to improve the health of the population 5. Monitor those interventions to assess their effectiveness

The science of Public health Epidemiology and statistics Biomedical sciences Social and behavior sciences Environmental sciences Health policy and management Health management

Ten Great Achievements in Public Health Vaccination. 2. Motor-vehicle safety. 3. Safer workplaces. 4. Control of infectious diseases. 5. Decline in deaths from coronary heart disease and stroke. 6. Safer and healthier foods. 7. Healthier mothers and babies. 8. Family planning. 9. Fluoridation of drinking water. 10. Recognition of tobacco use as a health hazard. CDC, Morbidity and Mortality Weekly Report, December 24, 1999 / 48(50); 1141.

Challenges Ahead New and Persistent Problems in Public Health

Leading causes of death,worldwide 2001 Source: WHO 2002

(suicide)

Leading infectious killers, worldwide 2001 Source: WHO 2002

Under-five mortality rate, Child deaths per 1,000 live births World 9580 Developed regions 117 Commonwealth of Independent States 46 Developing regions Northern Africa 8738 Sub-Saharan Africa Latin America and the Caribbean 5432 Eastern Asia 4837 Southern Asia South-Eastern Asia 7846 Western Asia 6860 Oceania 8677 Source: United Nations Statistics Division, “World and regional trends”, Millennium Indicators Database, available from (accessed June 2005); based on data provided by United Nations Children’s Fund and the World Health Organization. Statistics Division, Department of Economic and Social Affairs

Distribution of deaths by broad causes group and region 2001 Deaths (thousands) TotalGroup IGroup IIGroup IIIGroup II/Group I ratio World Developed Developing Group I: Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Group II: Noncommunicable conditions Group III: Injuries Source: WHO (2002)

Health Disparities Access and Outcomes Infant Mortality Cancer Screening and Management Cardiovascular Disease Diabetes HIV Infection/ AIDS Immunizations

Contemporary health issues The 20th century witnessed the transition of major disease burdens （ defined by death ） from infectious and/or communicable diseases to chronic diseases (Table 1.1.2). In 1900, the leading cause of death in the United States and other developed countries was reported to be pneumonia and influenza. By the end of the century, diseases of the heart were the leading cause of death, and pneumonia and influenza dropped to the seventh place, primarily affecting the elderly.

Communicable diseases Chronic diseases Mental illness Population changes: Ageing Pollution Disparity between the rich and the poor widen

Public health interventions One important task of public health professionals is to raise the level of anxiety of the public about public health problems to the level at which they will be willing to take an appropriate action.

Public health interventions can be divided into four categories:  biologic/environmental  social/behavioral  political  structural  The public health professional must use strategies in all categories to achieve the maximum health of the public.

biologic / environmental interventions The strategies:  improved standard of living, including provision of clean water and safe disposal of wastes.  The most cost-effective biologic intervention strategy is immunization  Eliminate of vectors of disease: DDT

Social/Behavior interventions Most public health interventions depend ultimately on behaviour ( personal or community behavior). At the personal or individual level, promotion of good health habits and avoidance of smoking, excess alcohol use, and other dependency disorders are important interventions that have a major impact on health.

Political interventions Public health is politics. Any process that involves obtaining the support of the public will involve politics and differing points of view. For example, the campaign to stop smoking

Structural interventions The end result of the political process is the passage of laws and regulations. This action, if implemented, can have a very significant impact on the improvement of the health of the public. For example, the law reducing the maximum speed in California from 65 to 55 miles per hour had a significant impact on lowering the automobile fatality rate

Impact of public health The dramatic achievements of public health in the 20 th century have improved our quality of life: an increase in life expectancy. world wide reduction in infant and child mortality elimination or reduction of many communicable disease.

As life expectancy increases in many developing countries, more people are developing those chronic diseases which have been a major burden in developed countries for many decades. Unlike developed countries, however, these countries still carry the burden of infectious diseases which have been greatly reduced in developed countries.

Because of the rapid advances in travel and communications, the developed world is threatened in new ways and thus cannot afford to ignore the problems of the developing world. Today, public health leaders must strengthen their roles as advocates for improved population-based health in an international, global community.

We have made tremendous strides to improve the health of the public, but the challenge to do better remains The future of public health

Leading cause of preventable death Leading causes of preventable deaths in the United States as of the year Cause Number of deaths resulting Smoking435,000 deaths or 18.1% of the total deaths OverweightOverweight and ObesityObesity365,000 deaths or 15.2% of the total deaths. Alcohol consumption85,000 deaths or 3.5% of the total deaths. Infections75,000 deaths or 3.1% of the total deaths. Toxic agents55,000 deaths or 2.3% of the total deaths. Motor vehicle collisions43,000 deaths or 1.8% of the total deaths. Incidents involving firearms29,000 deaths or 1.2% of the total. Sexually transmitted infections20,000 deaths or 0.8% of the total. Illicit use of drugs17,000 deaths or 0.7% of the total deaths.

Economic impact Individual liberty Moral and religious opposition Political interference with science Why is public health controversial?

Multiple Determinants of Health Individual Biology Behavior Physical Environment Social Environment Access to Quality Health Care Policies and Interventions Source: U.S. Department of Health and Human Services, Health People 2010

What is preventive medicine? The branch of medicine that is concerned with the prevention of disease and methods for increasing the power of the patient and community to resist disease and prolong life.

Preventive medicine is a medical discipline which focuses on preventing diseases and promoting a general state of health and well being. In both Europe and the United States, it is considered to be a board specialty, meaning that physicians can focus on preventive medicine while they get their medical degree, and use the skills they learn in school to reduce the outbreak of disease epidemics, improve public health, and increase the general quality of life for individuals all over the world.

Healthcare: health departments, academic institutions, state and national government, international or global institutions including the WHO, UN agencies or government agencies like the CDC or NASA, organized medical care programs in industry, voluntary health agencies, and the military. Preventive medicine

The history of preventive medicine Dating back for centuries to the time (Romes) when people first realized that unclean water made them sick, and that living conditions needed to be more hygienic to prevent illness.

Twentieth century, when numerous governments founded disease prevention centers such as the Centers for Disease Control and Prevention (CDC) in the United States. These scientific establishments began to set firm guidelines designed to minimize the transmission of disease, improve hygiene, and enable rapid responses to major outbreaks transmission

In addition to medicine and science, preventive medicine also looks at economic and social issues, as some populations are clearly more at risk of contracting dangerous diseases than others.

Many sociologists, psychologists, and economists work in the field of preventive medicine to assist people of low income, education, and social status all over the world. Organizations which promote preventive medicine work closely with these individuals in the hopes that all people on earth can enjoy healthy, disease free lives.

Training: Generally requires 2 years in residency after a clinical internship or transitional year. Training includes earning a Master of Public Health (MPH) degree which is usually done in one of the two years.

There are three specialty areas within preventive medicine:  General Preventive Medicine & Public Health  Occupational and Environmental Medicine  Aerospace Medicine

Core courses: biostatistics epidemiology management administration clinical preventive medicine occupational or environmental health.

Specific career paths: managed care public health practice occupational medicine environmental medicine aerospace medicine clinical medicine informatics policy development academic medicine consulting international medicine and research.

What differences between public health and medicine?

Medicine Individual Health Public Health Population Health Best outcome for individual Healthy community Balance of individual autonomy vs. limitations on individual Balance in allocation of resources Focus on prevention

Medicine Individual Health Public Health Population Health Thermometer Stethoscope Individual data, medical history Demographics Vital statistics Epidemiology