1. Introduction to the Public Health Approach Glyn G. Caldwell, MD December 13, 2006

2. What is Public health? C.E.A. Winslow in 1923 defined Public Health as the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the

3. What is Public health? environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment

4. What is Public health? disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.

5. What is Public health? John M. Last’s Dictionary of Public Health (2001) gives the following: Public Health is one of the efforts organized by society to protect, promote, and restore the peoples’ health.

6. What is Public health? Public health is the combination of sciences, skills, and beliefs that is directed to the maintenance and improvement of the health of all the people through collective or social actions.

7. What is Public health? The programs, services, and institutions involved emphasize the prevention of disease and the health needs of the population as a whole.

8. What is Public health? Public health activities change with changing technology and social values, but the goals remain the same: to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population.

9. What is Public health? Public health is thus a social institution, a discipline, and a practice.

10. What is Public health? The Acheson Report (1988) defines Public health more succinctly as: The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society.

11. Essential Public Health Functions Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community. Inform, educate, and empower people about health issues.

12. Essential Public Health Functions Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts.

13. Essential Public Health Functions Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

14. Essential Public Health Functions Assure a competent public 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.

15. Public Health Approach Define the health problem. Identify risk factors associated with the problem. Develop and test community-level interventions to control or prevent the cause or the problem.

16. Public Health Approach Implement interventions to improve the health of the population. Monitor those interventions to assess their effectiveness.

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

18. Public Health Approach Requires the collection, analysis, and interpretation of data to define the problem and outline: –What –Where –When –Who –How

19. Public Health Approach Requires a determination of: –Preventable or not preventable –Controllable or not controllable –Priority

20. Public Health Approach The potential for prevention or control frequently requires: –A plan –A champion –A strategy/method –A method –The will –Funding

21. Public Health Approach Do it

22. Public Health Approach After implementation the cycle begins again, but this time to evaluate the program results. –Did the strategy work as intended? –Were the results as expected? –If yes, can you expand or replicate the program? –If no, do you abandon or revise and try again?

23. Public Health Approach Quiz: –What was the leading cause of death in Arizona children 0- 4 years of age from 1986- 1996?

24. Public Health Approach Answer: Drowning

25. Drowning in Arizona The Public Health Approach requires the collection, analysis, and interpretation of data to define the problem and outline: w hat, where, when, who, and how.

27. Drowning in Arizona

29. Drowning in Arizona The data outlines the problem to be: –A barrier problem (none, failed or inadequate) –Supervision failure

30. Drowning in Arizona Is the problem preventable or not preventable? –The problem was considered preventable. What was the priority? –High

31. Drowning in Arizona The Goal! –One of the health objectives targeted in Arizona 2000 was to decrease the death rate for drowning to 1.3/100,000. The 1996 drowning rate for Arizona residents of all ages exceeded the target rate by 69 percent.

32. Drowning in Arizona The response by the ADHS, DPCCA, CDC, ARC, and others was to: –Seek legislative action –Develop community educational program –Develop an individual pool safety program

33. Drowning in Arizona Results: –The legislature passed a bill in 1991 requiring fencing and buyer notification (A.R.S. §36-1681) –The education programs were developed and implemented by realtors and volunteer groups

34. NO FENCE

35. FENCE

36. FENCE

37. FENCE

38. FENCE

39. Alarm

40. FENCE

41. Drowning in Arizona

43. Arizona Republic Headlines: –Child Drownings Down 60% in Phoenix –Maricopa County Child-Drowning Rate Hits 20-year Low

44. Drowning in Arizona It worked! –Drowning mortality rates dropped YearRate/100.000 197421.3 198119.5 198911.9 1990 5.8

45. Drowning in Arizona Of 269 drownings from 1995 to 2001, only six occurred in pools that were fenced and had properly latching gates.

46. Drowning in Arizona It was better, but it didn’t last –Drowning mortality rates began increasing YearRate/100.000 19918.5 19927.1 19948.0 19959.9 19968.5

47. Drowning in Arizona

48. What happened? We have to return to data collection and analysis to seek the answers

49. Drowning in Arizona The findings show: –Failure to use or maintain barriers –Failure to supervise –Parental inattention –No requirement for interior pools –Not all drowning occur in swimming pools

50. Drowning in Arizona In addition: –The statute allowed cities and counties to pass their own ordinances provided they were equal to or more stringent that the state statute, which lead to some confusion. –The need for a statewide standard.

51. Drowning in Arizona And so, the cycle begins again until we accomplish our goal.