PC & Public Health
3/29/11
1
PC & Public Health
3/29/11
2
PC & Public Health
3/29/11
3
PC & Public Health
3/29/11
Source: Holland WW, Detels R, Knox G. Oxford Textbook of Public
Health, 2nd edition. Volume 1: Influences of Public Health. Oxford, UK,
and New York, NY: Oxford University Press, 1991.
4
PC & Public Health
3/29/11
5
PC & Public Health
3/29/11
In this study of self-perceptions of public health personnel, evaluation and
promotion of coverage and access to health services ranked lowest among
public health functions: less than half (45%) of public health institutions viewed
these among their functions. In view of the importance of societal commitment
to organizing health services to provide universal financial coverage, equitable
distribution of resources, low or no copayments, and comprehensiveness of
services, the low extent of commitment to appropriate health services in the
world is a concern. Increasing commitment and the increasing populationorientation of health services may facilitate an improvement in public health
commitment to heath services.
Source: Binder S, Adigun L, Dusenbury C, Greenspan A, Tanhuanpää P.
National Public Health Institutes: contributing to the public good. J Public
Health Policy 2008;29:3-21.
6
PC & Public Health
3/29/11
7
PC & Public Health
3/29/11
Source: Statement, Public Health Functions Steering Committee (US),
1994.
Bettcher DW, Sapirie S, Goon EH. Essential public health functions:
results of the international Delphi study. World Health Stat Q 1998; 51
(1):44-54.
8
PC & Public Health
3/29/11
9
PC & Public Health
3/29/11
In many places, clinical care still is organized to respond only to the
needs of individuals without recognizing that these needs may be part
of a pattern of influences on health in communities and populations.
This is especially the case in health systems where individuals or
groups of practitioners restrict their practices (either by financial or
geographical means) to certain population groups only. This is
particularly characteristic of developing countries, although it also
occurs in some highly industrialized countries (such as the United
States), where separate, uncoordinated delivery systems make it
impossible to discern population health needs. As standardized
information systems are developed and employed to document health
needs, natural histories of the development of ill health, and impact of
interventions, even better ascertainment of population health and
different health needs may be possible.
10
PC & Public Health
3/29/11
Source: Lasker R, Committee on Medicine and Public Health. Medicine
and Public Health: The Power of Collaboration. New York, NY: New
York Academy of Medicine, 1997.
11
PC & Public Health
3/29/11
This table divides interventions according to whether they are directed
at societal change or at changes in individuals, and according to
whether they are environmental (physical and/or social), health
services, or individuals. It might be expected that areas would vary in
the balance of approaches they adopt. A major challenge to the field of
public health is to determine which approaches are most cost-effective
and lead to greater equity in health, and under what conditions.
12
PC & Public Health
3/29/11
This matrix indicates the possible locus of responsibility for each of the
types and according to whom the intervention is generally directed.
13
PC & Public Health
3/29/11
This matrix provides examples of types of interventions that may be
provided within each cell of the matrix.
14
PC & Public Health
3/29/11
Preventive services are generally divided into 4 types, depending on
how far back the intervention is in the “chain” (or, more appropriately,
“web”) of influences. Interventions may be directed at populations as a
whole, individuals in whole populations, selected subpopulations, or
individuals taken one by one, as in conventional clinical care.
15
PC & Public Health
3/29/11
This matrix indicates the possible locus of responsibility for each of the
types and according to whom the intervention is generally directed.
16
PC & Public Health
3/29/11
This matrix provides examples of types of interventions that may be
provided within each cell of the matrix.
17
PC & Public Health
3/29/11
Source: Sheridan SL, Harris RP, Woolf SH, Shared Decision-Making Group of
the U.S. Preventive Services Task Force. Shared decision making about
screening and chemoprevention: a suggested approach from the U.S.
Preventive Services Task Force. Am J Prev Med 2004;26:56-66.
This chart provides an alternative way of viewing the different types of
intervention to improve health. It is similar to the previous charts, but does not
separate out those interventions that need to be targeted at special
subpopulations.
18
PC & Public Health
3/29/11
19
PC & Public Health
3/29/11
20
PC & Public Health
3/29/11
21
PC & Public Health
3/29/11
The areas for study of the locus of selected preventive services were
chosen because of the availability of knowledgeable experts in the
areas. There were five European areas (two countries of between 4 and
5 million population each, and one country of about 60 million people),
three provinces of one large country (Spain) with populations between 1
and 7 million each, one Canadian province of about 7.5 million people,
and one US state with about 12 million people.
22
PC & Public Health
3/29/11
23
PC & Public Health
3/29/11
24
PC & Public Health
3/29/11
25
PC & Public Health
3/29/11
26
PC & Public Health
3/29/11
27
PC & Public Health
3/29/11
28
PC & Public Health
3/29/11
29
PC & Public Health
3/29/11
30
PC & Public Health
3/29/11
31
PC & Public Health
3/29/11
32
PC & Public Health
3/29/11
33
PC & Public Health
3/29/11
34
PC & Public Health
3/29/11
This, and the ensuing several charts, characterize preventive procedures
according to the nature of the influences on the condition and the population
group targeted for the preventive activity. In no case is there uniformity of
procedures across all of the areas included in the study.
35
PC & Public Health
3/29/11
36
PC & Public Health
3/29/11
37
PC & Public Health
3/29/11
38
PC & Public Health
3/29/11
39
PC & Public Health
3/29/11
40
PC & Public Health
3/29/11
41
PC & Public Health
3/29/11
42
PC & Public Health
3/29/11
43
PC & Public Health
3/29/11
Source: Fitzpatrick M. Swine flu: public health has become a public nuisance.
Br J Gen Pract 2009;59:615.
44
PC & Public Health
3/29/11
45