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

2. 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)

3. 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)

4. 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)

5. 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
“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)

6. 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)

7. Public Health Approach
Model
Medical
Model
Versus

8. 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)

9. 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

10. 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

11. 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

12. 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

13. 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.

14. 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

15. 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

16. Determinants of Health
Genetic
Behavioral
Social
Environmental
Personal health care

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