CLASS WEBSITE
Not on CCLI:
http://www.ph.ucla.edu/epi/faculty/
detels/PH150/schedule_2013.htm
The fundamental maxim of
public health is that the health
of the individual is best
ensured by maintaining and
improving the health of the
community.
David Satcher, 1995
PUBLIC HEALTH
The science and art of preventing
disease, prolonging life and
promoting health through the
organized efforts of society.
Acheson Report, London 1988
PUBLIC HEALTH IS:
The process of mobilizing local,
state/provincial, national and
international resources to assure the
conditions in which all people can be
healthy.
Breslow/Detels, 1997
Public health does not
guarantee optimal health,
but creates the conditions
under which it can be
achieved by society
THE GOAL OF PUBLIC HEALTH
The biologic, physical and mental wellbeing of all members of the global
society, regardless of ethnicity,
religion, gender, sexual orientation,
country or political views.
Detels, 2003
Public health is an exciting field
that can improve the health and
quality of life for all.
OBJECTIVES OF COURSE (1)
An understanding of:
The concept and importance of public health, not
only for preventing disease, but also for assuring
access and the tools to achieve a healthy
community and healthy personal lifestyles
The population approach to health, which is the
basis of public health
The scope of public health
OBJECTIVES OF COURSE (2)
The major disciplines of public health, their
strategies, and how they contribute to assuring the
health of the public
The major intervention strategies used by public
health to promote the health of the community
The major health problems currently faced by
public health in the United States and globally
Barriers to promoting public health and strategies
to overcome these barriers
GLOBAL HEALTH
PROBLEMS
(EXAMPLES)
Drugs Now Deadlier than Autos
and Guns
LA Times Sept 18, 2011
EPIDEMIC OF FORMULAASSOCIATED INFANT DEATH –
China 2008
• Melamine in infant formula causes four
deaths
• 40,000 children flood health care facilities
• 12,900 hospitalized with severe kidney
damage
• Chinese milk products recalled in Japan,
Hong Kong, Singapore and Southeast
Asia
European E. coli Outbreak Traced Back To Lot of
Fenugreek Seeds Imported From Egypt
The outbreak of shiga-toxin producing E. coli (STEC) in May and June 2011
in Europe has now totaled 265 cases with Hemolytic Uremic Syndrome
(HUS) and 3151 non-HUS cases and there have been 42 deaths, all but one
in Germany. A report from the European Food Safety Authority in early July
implicated a particular lot of fenugreek seeds imported from Egypt in
December 2009 [http://www.efsa.europa.eu/en/supporting/doc/176e.pdf].
Several seed types (alfalfa, fenugreek, lentils, adzuki beans, and radish)
were suspected in Germany, however, a separate cluster of cases occurring
in France in June 2011 gave investigators an important clue. While three
types of sprouting seeds were implicated in France (fenugreek, mustard,
and rocket), only fenugreek seeds were common to both outbreaks. They
became the focus of the investigation and were traced back to Egypt.
Results from the microbiological tests carried out on seeds have been
negative, possibly due to the limitations of the tests used or the sampling
plan used to select the seeds for testing. The hypothesis is that the
fenugreek seeds became contaminated with STEC 0104:H4, the implicated
agent, at some point prior to leaving the Egyptian importer. According to the
report, this reflects a production or distribution process which allowed
contamination of fecal material of human or animal origin, possibly at
the farm level but still not established.
LA Times,
Sept 2012
LA Times, Sept 2012
LA Times, Sept 2012
This year's outbreak
of West Nile virus is the
worst since the illness was
first observed in the
United States in 1999,
officials from the U.S.
Centers for Disease
Control and Prevention
said Wednesday. The
number of confirmed
cases rose by 25% last
week to 1,993 -- although
only an estimated 2% to
3% of cases are reported
to the government. Those
are generally the most
serious infections: Most
people who contract the
virus do not develop
severe symptoms, and
many never even know
they were infected. The
most common symptoms
are a fever and neck
stiffness. Severe cases
can lead to encephalitis or
meningitis.
Lindsey NP, et al. West Nile Virus and Other Arboviral Diseases — United States,
2012. MMWR 62(25):515, June 29, 2013
Selkoe DJ.
Preventing
Alzheimer's
disease.
Science
337:14881492, 2012
EPIDEMIC OF OBESITY/DIABETES
http://www.dailymail.co.uk/news/a
rticle-499925/Obese-8-monthsbaby-tips-scales-3-stone.html
National Center for Health Statistics. MMWR 61(7):130, 2012.
LA Times, August 16 2013
LA Times, 21 Sept, 2012
LA Times, 1 Sept 2010
Valderrama AL, et al. Vital signs: awareness and treatment of uncontrolled
hypertension among adults – United States, 2003-2010. MMWR 61(35):705, 2012.
San Pedro
port
pollution
LA Times, 24
September
2009
Historic Life Expectancy
Source: U.S. DHHS, 2006
World Health Organization, 2010
WHO: The World Health Report 2008 http://www.who.int/whr/2008/whr08_en.pdf
Major Reasons for Increased
Longevity
•
•
•
•
•
Improved sanitation
Provision of clean water
Universal immunization programs
Health education and prevention practices
Improved treatment and prevention of
chronic diseases (for recent advances)
Stone R. Asia’s
looming social
challenge: coping
with the elder
boom. Science
330:1599, 2010
LA Times, Sept 2012
Top Ten Causes of Deaths World-Wide
http://www.who.int/mediacentre/factsheets/fs310/en/index.html
Top Ten Causes of Deaths in Low-Income Countries
http://www.who.int/mediacentre/factsheets/fs310/en/index.html
Top Ten Causes of Deaths in High-Income Countries
http://www.who.int/mediacentre/factsheets/fs310/en/index.html
World Health Organization, 2010
http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf
http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf
http://ucatlas.ucsc.edu/cause.php
Non-communicable disease deaths; http://www.who.int/nmh/publications/ncd_report_full_en.pdf
http://www.who.int/nmh/publications/ncd_report_full_en.pdf
http://www.globalhealth.org/infectious_diseases/global_view/
http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf
http://www.globalhealthfacts.org/data/topic/map.aspx?ind=91&gclid=CLCeqKC72aoCFVAaQgodIwM58g
Disability-Adjusted Life Years
(DALYS)
One DALY can be thought of as one lost year of "healthy" life. The sum of these
DALYs across the population, or the burden of disease, can be thought of as a
measurement of the gap between current health status and an ideal health situation
where the entire population lives to an advanced age, free of disease and disability.
DALYs for a disease or health condition are calculated as the sum of the Years of
Life Lost (YLL) due to premature mortality in the population and the Years Lost due
to Disability (YLD) for incident cases of the health condition.
Calculation: The YLL basically correspond to the number of deaths multiplied by
the standard life expectancy at the age at which death occurs. The basic formula for
YLL (without yet including other social preferences discussed below), is the
following for a given cause, age and sex:
where:
N = number of deaths
L = standard life expectancy at age of death in years
Figure 1. Percentage of Total Disability-Adjusted Life-Years (DALYs) in 2010 According to Country (pt 1)
Panel A shows the percentage of total DALYs due to noncommunicable diseases in each country. Noncommunicable
diseases are defined in the hierarchical list of causes11 in the Global Burden of Disease 2010 study and include the
following major cause groups: cancers; cardiovascular and circulatory diseases; chronic res piratory diseases; cirrhosis;
digestive diseases; neurologic conditions; mental and behavioral disorders; diabetes; urogenital, blood, and endocrine
diseases; musculoskeletal diseases; and other noncommunicable diseases such as congenital anomalies
and skin diseases
Figure 1. Percentage of Total Disability-Adjusted Life-Years (DALYs) in 2010 According to Country (pt 2)
Panel B shows the percentage of total DALYs due to years lived with disability per country
Murray CLJ et al. Measuring the Global Burden of Disease. N Engl J Med 2013;369:448-57
World Health Organization 2010
Years of Potential Life Lost from Unintentional Injuries Among Persons Aged 0-19
Years—United States, 2000-2009. MMWR 61(41):833, 2012.
World Health Organization 2010
Shuman EK. Global climate change and infectious diseases. NEJM 362:1062, 2010
http://www.globalhealth.org/infectious_diseases/global_view/
Health in the U.S.
Welcome to Downey*
*
but don’t drink the water
Health Care Crisis in the U.S.
30 Million Americans Without Health
Insurance
LA Times: Bridging a gap in care. Free dental services at LA Sports Arena, 28 April 2010.
Anderson GF, et al. Reevaluating “Made in America”— Two Cost-Containment
Ideas from Abroad. NEJM 368;24 ne.
Leading causes of death in the United States
(1900, 1950, 1990, 1997, 2001)
Rates
1900
1950
1990
1997
2001
Disease of Heart
167
307
152
131
248
Malignant neoplasms
81
125
135
126
196
Cerebrovascular disease
134
89
28
26
58
Chronic obstructive lung disease
─
4
20
13
44
Motor vehicle injuries
─
23
19
16
15
Diabetes mellitus
13
14
12
13
25
Pneumonia and influenza
210
26
14
13
22
HIV Infection
─
─
10
6
5
Suicide
11
11
12
11
10
Homicide and legal intervention
1
5
10
8
7
*Age-adjusted per 100,000
Source: McGinnis and Foege (1993); US DHHS (2003)
Schroeder, NEJM 357(12):1222, 2007
Numbers of U.S. Deaths from Behavior Causes, 2002
Schroeder, NEJM 357(12):1223, 2007
In Essential Concepts of
Healthy Living, 5th ed, Jones
& Bartlett, 2009, p. 5.
Paul Conrad. LA
Times, 4 Sept 2010.
Life expectancy at birth and at 65 years of
age in the United States
(1900, 1950, 1997, 2001, 2004)
At birth
Gain
At 65 years
Gain
1900
47.3
─
11.9
─
1950
68.2
20.9
13.9
2.0
1997
76.5
8.3
17.7
3.8
2001
77.2
0.7
18.1
0.4
2004
77.8
0.6
18.7
0.4
Source: US DHHS
U.S. life expectancy 2004 – AfricanAmerican vs. Caucasian
Male
At Birth
Caucasian
75.7 years
African-American 69.5 years
Difference
6.2 years
At 65 Years
17.2 years
15.2 years
2.0 years
At Birth
Female
Caucasian
80.8 years
African-American 76.3 years
Difference
4.5 years
At 65 Years
20.0 years
18.6 years
1.4 years
Source: U.S. DHHS, 2006
LA Times, September 8 2013
MAJOR PREVENTABLE RISK
FACTORS
• Substance abuse
– Tobacco
– Alcohol
– Drugs
• Unhealthy diet
• Physical inactivity
• Environmental/occupational hazards
SMOKING FACTS - 2010
• #1 cause of preventable deaths
(446,000/yr)
• >50% of children exposed to secondhand smoke
• 24% of men and 18% of women smoke
• 31% of smokers earn wages below
poverty line
THE SCOPE OF PUBLIC HEALTH (1)
• Infectious diseases
• Chronic diseases
– Heart disease, metabolic disorders,
cancer, etc.
– Mental health
• Nutrition disorders
• Health of the vulnerable
– e.g. poor, children, women, elderly, etc.
– Substance abusers: drugs, alcohol,
tobacco
THE SCOPE OF PUBLIC
HEALTH (2)
•
•
•
•
•
•
•
Accidents/violence/injuries
Health equity
Occupational health
Environmental health
Access to health care
Quality of health care
War
STRATEGIES OF PUBLIC
HEALTH (1)
• Assess the current health situation
– Surveys
– Surveillance
– Morbidity and mortality reporting
• Identify the problem
STRATEGIES OF PUBLIC
HEALTH (2)
•
•
•
•
Research correlates of occurrence
Develop and evaluate interventions
Disseminate results
Influence policy to incorporate results
(science-based policy)
INTERVENTION STRATEGIES
• Immunization programs
• Health education
• Behavioral modification strategies
• Community intervention/mobilization
• Structural interventions (laws,
regulations)