1. Transitions in Public Health
Boris D. Lushniak, MD, MPH
Rear Admiral, USPHS (Ret)
Dean and Professor, School of Public Health,
University of Maryland
31OCT2017
The events of late 2001 have made bioterrorism a reality on the soil of our nation. As experts in diseases of the skin, dermatologists can better diagnose skin disease, including those caused by biological weapons, than any other physician. Another of our goals is to educate non-dermatologists regarding the skin signs of biological agents used by terrorists. After a short background about biological warfare in general, this talk will focus on anthrax and smallpox with less attention paid to plague, tularemia, and viral hemorrhagic fevers.

2. Disclaimer
The views expressed in this presentation are those of the author and do not reflect the official policy or position of the University of Maryland

3. Defining Health
Health: “A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO Constitution)

4. 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.
CEA Winslow, 1920

5. Core Public Health Functions
Assessment and monitoring of the health of communities and populations at risk
identify health problems and priorities - surveillance
The formulation of public policies
designed to solve identified local and national health problems and priorities
Assure that all populations have access to appropriate and cost-effective care
including health promotion and disease prevention services
evaluation of the effectiveness of that care

6. Public Health Core Functions and 10 Essential Services

7. Public Health Model Implementation: How do you do it? Intervention
Evaluation:
What
works?
Risk Factor
Identification:
What is the
cause?
Surveillance:
What
is the
problem?
Problem
Response

8. Public health agenda The nature of the hazards to health
Our ability to counteract those hazards
Prior to WW I
Poverty
Infectious disease
Inadequate delivery of medical care
Today, chronic and sociological conditions have been added to infectious diseases

9. 10 Great Public Health Achievements-US 1900-1999
Vaccination
Motor-vehicle safety
Safer workplaces
Control of infectious diseases
Decline in deaths from heart disease and stroke
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of water
Recognition of tobacco as a health hazard
MMWR 1999 Apr 2;48(12):241-3.

10. Epidemiologic transitions
The Age of Pestilence and Famine: Where mortality is high and fluctuating, precluding sustained population growth, with low and variable life expectancy, vacillating between 20 and 40 years.
The Age of Receding Pandemics: Where mortality progressively declines, with the rate of decline accelerating as epidemic peaks decrease in frequency. Average life expectancy increases steadily from about 30 to 50 years. Population growth is sustained and begins to be exponential.
The Age of Degenerative and Man-Made Diseases: Mortality continues to decline and eventually approaches stability at a relatively low level.

11. Health transitions in 20th century
Source:

12. Adapted from Morens DM et al 2004, Nature 430:242-49

13. University of Maryland School of Public Health