Connecting Workshop
2003
What is Public Health?
Presentation by:
Dawn Gentsch, MPH, CHES
What is Public Health? - Overview
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Public Health Definitions
What does Public Health Do?
History of Public Health
Core Functions and Essential Services
How does Public Health Work?
What is Health?
• The absence of Disease or Disability
• The “complete physical, mental and social
well being and not merely the absence of
disease or infirmity”. (W.H.O.)
What does the term
Public Health
mean to you?
Public Health
• Public Health encompasses a populationfocused, organized effort to assist individuals,
groups, and communities in the reduction of
health risks, and the maintenance or
improvement of health status.
– Healthy environment
– Obtain needed health care services
– Access to health promotion and disease prevention
services
WHO & IOM; ASPH June 2001
Selected Definitions of Public
Health
• “The science and art of preventing disease,
prolonging life and promoting health and efficiency
through organized community action.” Winslow
• “Successive re-definings of the unacceptable.”
Vickers
• “Fulfilling society’s interest in assuring conditions
in which people can be healthy” IOM
The Paradigm of Public Health
What we,
as a society, do collectively
to assure the conditions in which people can
be healthy.
Institute of Medicine
The Future of Public Health
Public health
affects all of us,
all of the time.
What is Public Health?
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Governmental Services (Especially Medical
Care for the Poor)
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The Methods (Knowledge and Techniques)
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The Profession
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The System and Social Enterprise
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The Health of the Public
Bernard J. Turnock
What does Public Health do?
• The public health system exists to address:
– the physical,
– mental,
– and environmental health concerns of
comminutes and populations at risk for disease
and injury
Public Health in America
Vision:
Healthy People in Healthy Communities
Mission:
Promote Physical and Mental Health and
Prevent Disease, Injury and Disability
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 recovery
 Assures the quality and accessibility of health services
The History of Public Health
• Prior to 1850 - Epidemics:
Avoidance and Acceptance
• 1850 - 1949 Sanitary
Reform through State and
Local Infrastructure
• 1950 - 1999 Gaps in
Medical Care and Expanding
Agenda
• After 1999 - Community PH
Practice and Bio-Terrorism
Ten Great Public Health
Achievements
• Vaccines
• Recognition of
Tobacco as a Hazard
• Motor Vehicle Safety
• Safer Workplaces
• Control of Infectious
Disease
• Fewer deaths from
heart disease and
stroke
• Safer and healthier
foods
• Healthy mothers and
babies
• Family planning
• Fluoridation
MMWR Vol 48, No 12
- How we do it Public health practice is based on
scientifically sound strategies
for improving the quality of life and reducing
morbidity and premature mortality.
Prevention is the primary
obligation of public health.
-- William Foege, MD,
Bill and Melinda Gates Foundation
Distinctions Between PH and Medicine
PUBLIC HEALTH
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Primary focus on population
Public service ethic, tempered by
concerns for the individual
Emphasis on prevention, health
promotion for the whole community
MEDICINE
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Public health paradigm employs a
spectrum of interventions aimed at
the environment, human behavior
and lifestyle, and medical care
Multiple professional identities with
diffuse public image
Variable certification of specialists
beyond professional public health
degree
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Primary focus on individual
Personal service ethic, conditioned by
awareness of social responsibilities
Emphasis on diagnosis and treatment, care
for the whole patient
Medical paradigm places predominant
emphasis on medical care
Well-established profession with sharp
public image
Uniform system for certifying specialists
beyond professional medical degree
Harvey Fineberg MD, PhD
Distinctions Between PH and Medicine
MEDICINE
PUBLIC HEALTH
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Lines of specialization organized, for
example, by: analytical method
(epidemiology)
setting and population (occupational
health)
substantive health problem (nutrition)
skills in assessment, policy
development, and assurance
Biologic sciences central, stimulated by
major threats to health of populations;
move between laboratory and field
Numeric sciences an essential feature of
analysis and training
Social sciences an integral part of public
health education
Clinical sciences peripheral to
professional training
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Lines of specialization organized, for
example, by:
organ system (cardiology)
patient group (pediatrics)
etiology, pathophysiology
(oncology, infectious disease)
technical skill (radiology)
Biologic sciences central, stimulated by
needs of patients; move between
laboratory and bedside
Numeric sciences increasing in
prominence, though still a relatively
minor part of training
Social sciences tend to be an elective
part of medical education
Clinical sciences an essential part of
professional training
The Evolving Agenda of Public
Health
Determinants of Health
Chronic Disease
Infections
Hygiene
Three Core Functions of Public
Health
• Assessment
• Policy Development
• Assurance
• This is the IOM Model as identified in 1988
that lead to the Essential Public Health
Services.
Assessment
The Process of Understanding
– Population Health Status
– Threats to Health
– Community Health Resources
Kristine Gebbe
Policy Development
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Reduce the threats to health
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Support positive resources
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Reduce disease
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Advance overall community health
Assurance
The process of assuring:
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Availability
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Accessibility
Quality
http://www.apha.org/ppp/science/10ES.htm
Public health agencies are a lot like fire
departments. They teach and practice
prevention at the same time they
maintain readiness to take on
emergencies. They are most
successful—and least noticed—when
their prevention measures work the
best.
-- 1998 Public Health Improvement Plan,
Washington State Department of Health
Public Health in America
Vision:
Healthy People in Healthy Communities
Essential Public Health Services
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Monitor health status
Diagnose and investigate health problems and health hazards
Inform, educate, and empower people about health issues
Mobilize community partnerships to identify and solve health problems
Develop policies and plans that support individual and community health
efforts
Enforce laws and regulations that protect health and ensure safety
Link people to needed personal health services
Assure a competent public health and personal health care workforce
Evaluate effectiveness, accessibility, and quality of personal and
population-based health services
Research for new insights and innovative solutions to health problems
Public Health System
A public health system includes: All public, private, and
voluntary entities that contribute to the delivery of
public health services within a jurisdiction.
A public health system is: A network of
entities with differing roles,
relationships, and interactions.
All entities contribute to the health and
well-being of the community.
CDC, 2001
Public Health Infrastructure
• “The backbone of the public health system”
• Resources and relationships necessary to carry out
the core functions and essential services of public
health
• Resources:
– Human: continuing education, leadership development,
certificate programs
– Informational: online data, integrate informational
systems, research
– Organizational: expanded partnerships, statutes, core
functions funding, statewide umbrella
– Financial: to finance all of the above
A Public Health System Is Complex
Police
Home Health
EMS
Community
Centers
MCOs
Health
Department
Churches Jails
Parks
Schools
Elected
Hospitals
Officials Nursing Mass Transit
Doctors
Philanthropist
Homes
Environmental
Civic Groups
Health
CHCs
Fire
Tribal Health
Economic
Laboratory
Employers
Drug
Mental
Development
Facilities
Treatment
Health
Public health efforts have
increased the average life
span by nearly 30 years
during the past century.
Behavioral and environmental
risk factors – smoking, poor diet,
lack of exercise, increased
pollution, stress and unsafe
sexual practices – have replaced
infectious disease as the leading
causes of premature death.
How Does Public Health Work?
• Public health address health concerns
through the application of:
– Health promotion and disease prevention
technologies and interventions designed to
improve and enhance quality of life
*These methods encompass a broad range of activities,
but are all grouped under 3 main core public health
functions.