Public Health:
What It Is and How It Works,
Fourth Edition
• Chapter-by-Chapter Power Point Slides
• Links to Internet-based resources
Chapter 1
What Is Public Health?
Chapter 1 Will Help You To:
• articulate several different definitions of public health
• describe the origins and content of public heath
responses over history
• trace the development of the public health system in the
U.S.
• broadly characterize the contributions and value of public
health
• Identify 3 or more distinguishing features of public health
• describe public health as a system with inputs,
processes, outputs, and results, including the role of
core functions and essential public health services in the
public health system
• identify 5 or more Internet web sites that provide useful
information on the U.S. public health system
Brief History of Public Health
•
•
•
•
•
•
Plagues throughout history
Imperialism
New worlds and new markets
Industrial Revolution
Chadwick and Snow
Themes throughout history: science and
social values
SNOW AND CHOLERA
• "I had an interview with the
Board of Guardians of St.
James's parish, on the
evening of Thursday, 7th
September, and represented
the above circumstances to
them. In consequence of what
I said, the handle of the pump
was removed on the following
day."
- John Snow in his 1855 book
Discussion
Based on Snow on Cholera: Part 1:
• What aspects of Snow’s journal reflect
modern thinking about the communicability
of diseases?
• What aspects reflect thinking prior to the
germ theory?
• Which factors described in Snow’s journal
contributed most to the control of the
cholera outbreak near Golden Square?
Discussion
• Consider the European colonization of the
Americas beginning in the 16th century.
How was it possible for Hernan Cortes and
other European explorers to overcome
well-established Native American cultures
with of millions of people? What role, if
any, did public health themes and issues
play?
Public Health in Early America
•
•
•
•
•
•
Plagues and epidemics
Shattuck’s Report
Port city boards of health
U.S. Constitution and Federalism
Police powers and general welfare
Local and state health departments
Public Health Eras in America
Prior to 1850
Battling Epidemics
1850-1949
Building State and Local Public
Health Infrastructure
1950-1999
Filling Gaps in Medical Care
Delivery
After 1999
Preparing for and Responding to
Community Health Threats
Images of Public Health
•
•
•
•
•
System and Social Enterprise
Profession
Methods (Knowledge and Techniques)
Governmental Services
Health of the Public
When you hear the term “public health,”
which of the following do you think of?
Not sure
10%
Policies and
programs that
maintain healthy
living conditions
27%
Protecting the
public from disease
16%
A government
provided healthcare
system for all and
health care for the
poor
47%
Definitions of Public Health
• Science and art of preventing disease,
prolonging life and promoting health and
efficiency through organized community
effort (Winslow, 1920)
• Successive re-definings of the
unacceptable (Vickers, 1958)
• Fulfilling society’s interest in assuring
conditions in which people can be healthy
(Institute of Medicine, 1988)
Public Health as a System
Source: Handler A, Issel M and Turnock BJ. A conceptual framework to measure performance of the public health
system. Amer J Pub Health 2001;91(8):1235-1239
Unique Features of Public Health
“Science and Social Values”
• Social Justice Perspective
• Inherently Political
• Evolving Expectations = Expanding
Agenda
• Link with Government
• Grounding in Science
• Focus on Prevention
• Uncommon Culture
Discussion
• Review the Public Health Code of Ethics.
• Then identify a public health figure, past or
present, whose career you believe
embodies these principles.
• Describe the rationale for your choice.
Value of Public Health
•
•
•
•
Mortality and morbidity prevented
Economic benefits
Quality of life
20th Century Achievements
Ten Great Public Health
Achievements of the 20th Century
•
•
•
•
Immunizations
Motor Vehicle Safety
Workplace Safety
Control of Infectious
Diseases
• Declines in Heart
Disease and Stroke
• Safer and Healthier
Foods
• Healthier Mothers and
Babies
• Family Planning
• Fluoridation of
Drinking Water
• Tobacco as a Health
Hazard
Life Expectancy at Birth and Infant
Mortality Rates, Selected Years, U.S.
120
110
Life Expectancy at Birth (in years)
Infant Mortality Rate (per 1000 live births)
100
80
76.9
68.2
60
40
47.3
29.2
20
6.9
0
1900
1950
2000
The 10 leading causes of death as a percentage of all deaths,
United States, 1900 and 1997
Baseline 20th Century Annual Morbidity and 1998 Provisional Morbidity
from 9 Diseases with Vaccines Recommended before 1990 for
Universal Use for Children, United States.
Disease
Baseline 20th century
annual morbidity
1998 Morbidity
Percent
Decrease
48,164
0
100%
Diphtheria
175,885
1
100%
Pertussis
147,271
6,279
95.7%
Tetanus
1,314
34
97.4%
16,316
0
100%
Measles
503,282
89
100%
Mumps
152,209
606
99.6%
Rubella
47,745
345
99.3%
Congenital rubella syndrome
823
5
99.4%
Hemophilus influenza type b
20,000
54
99.7%
Smallpox
Poliomyelitis (paralytic)
Number of Reported Mumps Cases by Year,
United States, 1980-2006.
Discussion
• Review the History of Selected Public Health
Events in Chicago from 1834-1999 and Public
Health in Illinois: A Timeline. (or similar
information from another state)
• Consider how public health strategies and
interventions have changed over time in the U.S.
• What influences were most responsible for these
changes?
• Does this suggest that public health functions
have changed over time as well?
Discussion
• Your boss will be speaking for approximately 30
minutes at two different meetings: (1) a meeting
of the local Chamber of Commerce at their
monthly luncheon meeting; and (2) a meeting of
the medical staff at the local hospital.
• She directs you to develop a slide presentation
for these meetings.
• Based on the content from this chapter, how
would you approach this task? What messages
and content would be most appropriate?
Internet Resources
Examine each of the following public health web sites. Which ones did you find to be
the most useful for providing information and insights related to the central topic of
Chapter 1 (What Is Public Health?) Why?
•
•
•
•
•
•
•
•
•
•
American Public Health Association
Association of State and Territorial Health Officials
National Association of County and City Health Officials
Public Health Foundation
US Department of Health and Human Services and its various Public Health Service
Agencies (Centers for Disease Control and Prevention, Food and Drug
Administration, Health Resources and Services Administration, National Institutes of
Health, Agency for Health Care Policy and Research, etc.)
US Environmental Protection Agency
State Health Departments (such as the Illinois Department of Public Health or others
that you may find at the ASTHO web site)
Local Health Departments (such as the Chicago Department of Public Health or
others you may find through some of the various national web sites or those of state
health departments)
Association of Schools of Public Health and individual schools (such as the University
of Illinois at Chicago School of Public Health and others accessible through the ASPH
web site)
What Is Public Health? Developed by the Association of Schools of Public Health
through funding from Pfizer Pharmaceutical Corporation
Additional Resources
• Delta Omega Classics (classic public health manuscripts and
reports, many from the 19th century)
• Invisible Safety Net Video: Part 1--What is Public Health? University
of Washington School of Public Health and Community Medicine,
Northwest Center for Public Health Practice; 1994
• John Snow Web Site. UCLA Department of Epidemiology
• Orientation to Public Health. Online introductory course developed
by the New York-New Jersey Public Health Training Center; 2002.
• Outbreak at Watersedge: A Public Health Discovery Game.
University of Minnesota School of Public Health
• Public Health Code of Ethics. American Public Health Association
• Snow and Cholera. Slide and audio presentation developed by the
University of North Carolina School of Public Health
• What Is Public Health? Association of Schools of Public Health and
Pfizer Pharmaceutical Corporation
• What Is Public Health? Public Health Data Standards Consortium