The Basics of Public Health

Overview

Questions to be addressed:
What is public health?
What is a public health system?
Why take a public health approach?
Can public health make a difference?
What is Public Health?
Definitions vary

Key terms
Population health
Prevention
 What is Public Health?
C.E.A. Winslow in 1923 defined Public Health as the science
and art of preventing disease, prolonging life, and promoting
physical health and efficiency through organized community
efforts for the sanitation of the environment, the control of
community infections, the education of the individual in
principles of personal hygiene, the organization of medical and
nursing services for the early diagnosis and preventive
treatment and the development of the social machinery which
will ensure to every individual in the community a standard of
living adequate for the maintenance of health.
What is Public Health?
The Acheson Report (1988) defines
Public health more succinctly as:

The science and art of preventing

disease, prolonging life, and
promoting health through organized
efforts of society.
What is Public Health?
Public health activities change with
changing technology and social
values, but the goals remain the
same:
to reduce the amount of disease, premature
death, and disease-produced discomfort and
disability in the population.
Public Health in the US
~Vision~
Healthy People in Healthy Communities

~Mission~
Promote physical and mental health
and
Prevent disease, injury, disability
 Public Health
Prevents epidemics and the spread
of disease

Protects against environmental

hazards

Responds to disasters and assists

communities in recovery
 Public Health

Prevents injuries

Promotes healthy behaviors

Assures the quality and

accessibility of health services
A Public Health System
Who?
Public entities
Private entities
Voluntary entities

What?
A network
The Public Health System
Police
Home Health
EMS Community Churches Corrections
Centers MCOs
Health
Department
Parks

Schools
Elected
Doctors Hospitals Officials Nursing Mass Transit
Philanthropist Homes
Environmental
Civic Groups Health
CHCs Fire
Tribal Health
Economic
Laboratory Drug Mental Employers
Development
Facilities Treatment Health
 Workforce
Diverse and Multidisciplinary
Examples
Biostatisticians

Dieticians

Environmental Health Specialists

Behavioral Health Specialists

Core Components
POLICY
ASSESSMENT
DEVELOPMENT
of the health of
in the publics
the community
interest

ASSURANCE
of the publics
health
10 Essential Services
1. Monitor health status
to identify community
health problems

2. Diagnose and investigate

health problems and health
hazards in the community
10 Essential Services
3. Inform, educate, and
empower people about
health issues

4. Mobilize community partnerships

to identify and solve
health problems
10 Essential Services
5. Develop policies and
plans that support
health efforts

6. Enforce laws and regulations that

protect health and
ensure safety
10 Essential Services
7. Link people to personnel
health services and
assure the provision of
health care

8. Assure a competent public health

and health care
workforce
10 Essential Services
9. Evaluate the effectiveness,
accessibility, and quality
of services

10. Research for new insights and

innovative solutions to
health problems
Public Health Approach
Public Health Medical
Model Versus Model
Determinants of Health
Determinants of Health
Genetic
Behavioral
Social
Environmental
Personal
health care
 Public Health Approach
Define the health problem.
Identify risk factors associated with
the problem.
Develop and test community-level
interventions to control or prevent
the cause or the problem.
 Public Health Approach
Implement interventions to improve
the health of the population.

Monitor those interventions to assess

their effectiveness.
 Public Implementation:
How do you
Health do it?

Approach Intervention
Evaluation:
What
works?
Risk Factor
Identification:
What is the
cause?
Surveillance:
What
is the
problem?
Problem Response
 Public Health Approach
Requires the collection, analysis, and
interpretation of data to define the
problem and outline:
What
Where
When
Who
How
 Public Health Approach

Requires a determination of:

Preventable or not preventable
Controllable or not controllable
Priority
 Public Health Approach
The potential for prevention or control
frequently requires:
A plan
A champion
A strategy/method
The will
Funding
Public Health Approach

Do it
 Public Health Approach
After implementation the cycle begins
again, but this time to evaluate the
program results.
Did the strategy work as intended?
Were the results as expected?
If yes, can you expand or replicate the
program?
If no, do you abandon or revise and try
again?
 Public Health Approach

Quiz:
What was the leading cause of
death in Arizona children 0-4
years of age from 1986-1996?
 Public Health Approach

Answer:

Drowning
 Drowning in Arizona

The Public Health Approach requires the

collection, analysis, and interpretation of
data to define the problem and outline:
what, where, when, who, and how.
Drowning in Arizona
 Drowning in Arizona

 Drowning in Arizona

The data outlines the problem to be:

A barrier problem (none, failed or
inadequate)
Supervision failure
 Drowning in Arizona
Is the problem preventable or not
preventable?
The problem was considered
preventable.
What was the priority?
High
 Drowning in Arizona
The Goal!
One of the health objectives targeted
in Arizona 2000 was to decrease the
death rate for drowning to
1.3/100,000. The 1996 drowning rate
for Arizona residents of all ages
exceeded the target rate by 69
percent.
 Drowning in Arizona
The response by the different
departments was to:
Seek legislative action
Develop community educational
program
Develop an individual pool safety
program
 Drowning in Arizona
Results:
The legislature passed a bill in 1991
requiring fencing and buyer
notification (A.R.S. 36-1681)
The education programs were
developed and implemented by
realtors and volunteer groups
NO FENCE
FENCE
FENCE
FENCE
FENCE
Alarm
FENCE
Drowning in Arizona
Drowning in Arizona
 Drowning in Arizona
Arizona Republic Headlines:

Child Drownings Down 60% in

Phoenix

Maricopa County Child-Drowning

Rate Hits 20-year Low
 Drowning in Arizona
It worked!
Drowning mortality rates dropped
Year Rate/100.000
1974 21.3
1981 19.5
1989 11.9
1990 5.8
 Drowning in Arizona

Of 269 drownings from 1995 to 2001,

only six occurred in pools that were
fenced and had properly latching
gates.
 Drowning in Arizona
It was better, but it didnt last
Drowning mortality rates began
increasing
Year Rate/100.000
1991 8.5
1992 7.1
1994 8.0
1995 9.9
1996 8.5
Drowning in Arizona
 Drowning in Arizona
What happened?

We have to return to data collection

and analysis to seek the answers
 Drowning in Arizona
The findings show:
Failure to use or maintain barriers
Failure to supervise
Parental inattention
No requirement for interior pools
Not all drowning occur in swimming
pools
 Drowning in Arizona
In addition:
The statute allowed cities and counties
to pass their own ordinances provided
they were equal to or more stringent
that the state statute, which lead to
some confusion.
The need for a statewide standard.
 Drowning in Arizona

And so, the cycle begins again

until we accomplish our goal.