Introduction to Health Care and
Public Health in the US
Public Health (Part 2)
Lecture b
This material (Comp1_Unit8b) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Introduction to Healthcare in the US
Learning Objectives
• Give examples of and explain the general program
categories of public health, including communicable
disease, chronic disease, terrorism response, and
environmental public health (Lecture a)
• Discuss the activities and achievements of public health
in the realm of communicable disease (Lecture a )
• Compare and contrast the different types of terrorism
and the different public health responses (Lecture b )
• Describe chronic disease activities and achievements of
public health, and the work of public health in the realm
of environmental health hazards (Lecture c )
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
2
Terrorism and Public Health
• The specter of terrorism continues to concern US
government and public
• Emergency Preparedness and Response – public health
programs
• Categories of Terrorism
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Bioterrorism
Agricultural terrorism
Chemical terrorism
Nuclear/radiation terrorism
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
3
Bioterrorism
• Definition: intentional use of microorganisms or
their derived products, to produce death or
disease in humans, animals, or plants
• Classified as Overt (announced) or Covert
(unannounced)
– Overt attacks - intended to create psychological
(panic) damage along with physical damage, as well
as to encourage spread of an agent (exposed people
fleeing an area take the agent with them)
– Covert attacks - intended to cause maximum damage
before a response can be mounted. Methods debated
for detection for covert attacks include laboratory
results and syndromic surveillance.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
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Bioterrorism (continued)
• In the United States, the history of bioterrorism is
relatively short. Some of the most notable events
were:
– 1984 Oregon. Considered by some to be the first incident of BT
on US soil (others disagree, citing examples such as the
military’s apparently deliberate distribution of smallpoxcontaminated blankets to Native Americans in the 1700s). The
1984 incident was discovered by a small clinical laboratory,
which noticed high numbers of Salmonella typhimurium results
and alerted public health officials. It was eventually determined
that the central Oregon cult of the Rajneeshees intentionally
contaminated salad bars in The Dalles, resulting in 751 cases of
infection.
– 2001. Letters containing anthrax were mailed to various targets.
Five people were killed.
– 2003 Greenville, SC, and 2004 Washington DC. Ricin letter
incidents.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
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Bioterrorism (continued)
• Bioterrorism agents are separated into three categories by CDC,
depending on their ease of transmission and severity of effect
• Category A: Highest risk
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Easily transmitted from person to person
High death rates (mortality)
Could cause public panic
Require special public health preparedness response
Examples: Anthrax, Botulism, Pneumonic Plague, Smallpox, Tularemia, Ebola
• Category B: Next highest risk
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Moderately easy to spread
Moderate illness rates, low death rates
Response would require specific enhancements of existing laboratory capacity and enhanced disease
monitoring systems
Examples: Ricin Toxin, Brucellosis, Q Fever, Typhus, food and waterborne pathogens
• Category C: Third highest risk – emerging pathogens
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Easily available and spread
Potential for high illness (morbidity) and death (mortality) rates and major health impact
Examples: Nipah Virus, Hantaviruses, Yellow Fever, Multidrug-resistant Tuberculosis
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
6
Terrorism Public Health Preparedness
and Response
• Planning, monitoring, and education are
three of the main activities
• The Lab Response Network is an
important part of public health activities
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
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Lab Response Network – LRN
• LRN - national network of local, state and
federal public health, food testing,
veterinary diagnostic, and environmental
testing laboratories
• Provide response capacity for biological
and chemical terrorism, as well as other
public health emergencies
• More than 150 biological and 62 chemical
LRN labs
• Most are state public health labs, but
veterinary, military, and international labs
are also important participants
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
8
Agricultural Terrorism
• Chemical and biological (unlike nuclear) weapons are
often manufactured from readily available raw materials,
raw materials that are usually in common use or found in
nature.
• Agriculture, a building block of all civilizations, is an
attractive target.
• Although there have been an unfortunately large number
of introductions of agricultural pests and pathogens
(example, chestnut blight, which effectively exterminated
the American chestnut tree), they have been caused by
accident, neglect, or ignorance - not terrorism.
• The USDA Animal and Plant Inspection Service (APHIS)
attempts to prevent importation of agricultural hazards.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
9
Chemical Terrorism
• As with other categories of terrorism, chemical terrorism
could result from covert or overt exposure of chemical
hazards to the population
• One system dealing with chemical hazards is the
Hazardous Substances Emergency Events Surveillance
(HSEES)
• Hazardous substance release information is gathered
from various sources including emergency response
systems, state fire marshals, and the National Response
Center
• 31 states as well as several territories and other
jurisdictions provide info for the Agency for Toxic
Substances and Disease Registry (ATSDR) national
database
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
10
Chemical Emergencies
CDC categorizes hazardous chemicals by type of chemical
and effects of exposure:
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Bio-toxins —poisons from plants or animals
Blister agents —chemicals that severely blister the eyes, respiratory tract, and skin
Blood agents —poisons that affect the body by being absorbed into the blood
Caustics (acids) —chemicals that burn or corrode people's skin, eyes, and mucus membranes
Choking/lung/pulmonary agents —chemicals that cause severe irritation or swelling of the
respiratory tract
Incapacitating agents —drugs that cause mental confusion or altered state of consciousness
Long-acting anticoagulants —poisons that prevent blood from clotting, which can lead to
uncontrolled bleeding
Metals —agents that consist of metallic poisons
Nerve agents —highly poisonous chemicals that prevent the nervous system from working
properly
Organic solvents —agents that damage the tissues of living things by dissolving fats and oils
Riot control agents/tear gas —highly irritating agents often by individuals for protection (for
example, mace)
Toxic alcohols —poisonous alcohols that can damage the heart, kidneys and nervous system
Vomiting agents —chemicals that cause nausea and vomiting
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
11
Nuclear or Radiation Terrorism
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Both the sun and the earth are sources of natural, background radiation
Man-made radiation occurs from sources such as TV sets, microwave
ovens, and X-rays
Nuclear terrorism threats are generally divided into
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Radiological Dispersion Devices (RDDs), also known as "dirty bombs“. A means
of dispersing radioactive materials
Radioactive contamination of drinking water or food supplies
Direct attacks on nuclear power plants or nuclear fuel reprocessing facilities
Use of nuclear weapons by countries
Locating radioactive sources in heavily populated areas
Public Health Preparedness and Response
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Education and information for the public
Education and information for health care providers
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
12
Public Health (Part 2)
Summary – Lecture b
• Four main categories of terrorism:
– Bioterrorism
– agricultural terrorism
– chemical terrorism
– nuclear/radiation terrorism
• Categorization of bioterrorism agents
• Laboratory Response Network
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
13
Public Health (Part 2)
References – Lecture b
References
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Emergency Preparedness and Response - Bioterrorism Agents/Diseases. (n.d.). Retrieved
December 6, 2011, from Centers for Disease Control and Prevention website:
http://www.bt.cdc.gov/agent/agentlist-category.asp
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Emergency Preparedness and Response - Chemical Emergencies. (n.d.). Retrieved December 6,
2011, from Centers for Disease Control and Prevention website: http://www.bt.cdc.gov/chemical
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Emergency Preparedness and Response - Radiation Emergencies. (n.d.). Retrieved December 6,
2011, from Centers for Disease Control and Prevention website: http://www.bt.cdc.gov/radiation
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Public Health, Part 2
Lecture b
14