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

2. Chapter 9 Future Challenges for Public Health in America

3. 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

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

5. Emerging Infectious Diseases

7. 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.

8. SARS: Global Outbreak…Local Impact Local Outbreak…Global Impact…

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

10. 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 †

11. 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

13. Obesity as an Emerging Public Health Issue

14. 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 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, JAMA. 2004;291 (10):

15. 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% %–14% 15%–19% %–24% ≥25%

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

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

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

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

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

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

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

25. 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?

26. 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?

27. 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?

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

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

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

31. 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):
The Unfulfilled Promise of Public Health: Deja Vu All Over Again. Fee E and Brown T. Health Affairs 2002;21(6):31-43