Public Health
An Introduction
Public Health in the U.S.
• This introduction provides a broad
overview of public health – what it is, its
origins and evolution and how it is
structured and administered at the federal,
state and local levels in the United States.
What Is Public Health?
• It is often easier to talk about examples of
public health initiatives, such as
vaccination programs and milk
pasteurization, than to describe exactly
what public health is.
• http://www.youtube.com/watch?v=R1aloiS
Y3dI
What Are You Studying?
• Suppose your Uncle Joe stops you and
asks you what is Public Health?
• What would you tell him?
Uncle Joe
Public Health Accomplishments: A
Field That Makes A Difference
• Technology, science, the arts: Lots of
disciplines improve and enrich our lives.
• But none can match public health in
extending the length – and improving the
quality – of life in the United States over
the past century.
Increased Years of Life
80
75
70
65
60
55
50
45
40
.
*
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
How did we add 30 years in one
century?
• Mostly through the accomplishments of
public health.
• Five of the 30 years can be attributed to
improvements in medicine and drugs.
• The other years are due to various public
health initiatives.
Contributions to Increase Life
Expectancy
Public Health Accomplishments
1. 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
The Evolving Need for Public
Health 1700s-1800s
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The Age of Industrialization
People moved from the farms to the cities
Small pox inoculations - Lady Mary Wortley Montagu
Development of the smallpox vaccine - Edward Jenner
Introduction of epidemiology – John Snow
The Germ Theory of Disease - Louis Pasteur
The four postulates of infectious disease – Robert Koch
The unhealthy conditions of New York City tenements – Lillian Wald
Lady Mary Wortley Montagu
Lillian Wald
Snow: The Initial Investigations
• Snow on Cholera
http://www.ph.ucla.edu/epi/snow/Snowpart1_files/frame.
htm
• The Initial Investigations
http://breeze.unc.edu/p60491740/
• Next Steps http://breeze.unc.edu/p15812471/
• Snow Takes Action http://breeze.unc.edu/p24403330/
• Further Investigation http://breeze.unc.edu/p17552645/
• The Case of the Hampstead Widow
http://breeze.unc.edu/p35464436/
The Evolving Need for Public
Health 1900s to the Present
• 1918 Influenza Pandemic
• In 1964, the U.S. Surgeon General report
on cigarette smoking and its connection
with cancer
• In 1981, the HIV-AIDS virus was first
recognized
• In 1990, as awareness of the relationship
between diet and disease increased
• In 2001, the threat of bioterrorism
Development of the U.S. Public
Health Infrastructure
1798. The U.S. Public Health Service
The first marine hospital owned
by the Federal Government was
purchased from the State of
Virginia in 1801 and was located
at Washington Point in Norfolk
County.
Other Public Health Infrastructure
Developments
• 1798: First local public health board
• 1870s: State boards of health created
• Late-1800s: Shift to social reform as
strategy for public health
• 1970s – 1990s: Public health’s
responsibilities broaden to include chronic
diseases
Lemuel Shattuck
New York, New York. Bread line beside
the Brooklyn Bridge approach, 1930s.
Public Health Today
• “Old” infectious diseases, such as tuberculosis,
rear their ugly heads with new, more virulent
strains,
• “Newer” diseases, such as West Nile virus and
Severe Acute Respiratory Syndrome (SARS),
have emerged.
• Infectious agents can travel faster – and farther
– than ever before
• “Chronic” conditions, such as diabetes, heart
disease, cancer and obesity, have become the
leading causes of death and disability.
Public Health Today (Continued)
• The anthrax crisis of 2001
• Sudden Acute Respiratory Syndrome
(SARS)
• Monkey virus
Public Health in the Future
• Public health issues are difficult to predict
and are episodic (such as the spread of a
new infectious disease).
• Other challenges are very predictable
such as the impact of smoking and chronic
diseases
• To be prepared the U.S. government has
established national health objectives
called “Healthy People 2010”
Goals of Healthy People 2010
• Goal 1: Increase quality and years of
healthy life
Help individuals of all ages to increase life
expectancy and improve their quality of
life.
• Goal 2: Eliminate health disparities
Help our nation eliminate health disparities
among different segments of our
population.
What Are the Leading Health
Indicators?
• Will be used to measure the health of the
Nation over the next 10 years.
• Each of the 10 Leading Health Indicators
has one or more objectives from Healthy
People 2010 associated with it.
• Each were selected on the basis of their
ability to motivate action, the availability of
data to measure progress, and their
importance as public health issues.
What Are the Leading Health
Indicators? (continued)
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Physical Activity
Overweight and Obesity
Tobacco Use
Substance Abuse
Responsible Sexual Behavior
Mental Health
Injury and Violence
Environmental Quality
Immunization
Access to Health Care
Who is Responsible for the
Public’s Health?
• Government agencies
– federal,
– state and
– local
• Non-governmental agencies, such as nonprofit organizations.
Federal Authority and
Responsibility
• The colonies’
Suspicion of a strong
central government
has led to dominance
of the states and local
governments
• Health as a federal
responsibility is not
specifically mentioned
in the Constitution.
Interpretation of the Constitution
• The Preamble to the Constitution
• Section 8 of Article I
Overview of Health and Human
Services
• Responsible for protecting the health of
Americans and providing essential human
services, especially for citizens least able to help
themselves
• it is charged with most (but not all) public health
activities.
• The Secretary of Health and Human Services
serves as a member of the President's Cabinet.
is appointed by the President and must be
approved by the U.S. Senate.
National Organizations For Public
Health Professionals
• American Public Health Association
• Association of State and Territorial Health
Officials
• National Association of City and County
Health Officers
• HRSA Public Health Training Centers
Network
State Authority and Responsibilities
• The more complete and coordinated
structure for public health activities is at
the state and local levels.
• Various states have taken different
approaches to organizing and
administering public health.
• Centralized vs. decentralized
Local Health Departments and
Boards of Health
• Each community has its own unique local public
health system
• Generally, public health decisions at the local
level are made by professionals at regional or
county health departments and by their boards
of health.
• Public health practitioners at these departments
are responsible for ensuring that all members of
the community are served. Generally, a local
board of health has primary responsibility and
legal authority for public health decisions.
Role of Non-Governmental Entities
• Organizations that are not part of the
government also play a vital role in the U.S.
public health infrastructure.
• These organizations include hospitals, health
care providers in private practice, and health
plans.
• Private, non-profit organizations, too, contribute
to public health’s mission. Among them are the
United Way, American Red Cross and American
Cancer Association.
Summary of Public Health
Organizational Structure
• Primary responsibility and authority for public
health in the U.S. is assigned to federal, state
and local public health agencies
• Federal agencies set policy and standards and
provide guidance and funding;
• State agencies define policies and establish and
help fund local or regional public health
initiatives; and
• Local/regional health departments implement
public health programs.