introduction to the public health approach glyn g. caldwell, md december 13, 2006

Introduction to the Introduction to the Public Health ApproachPublic Health Approach

Glyn G. Caldwell, MDGlyn G. Caldwell, MD

December 13, 2006December 13, 2006

What is Public health?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


• disease, 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.


• John M. Last’s Dictionary of Public Health (2001) gives the following:

• Public Health is one of the efforts organized by society to protect, promote, and restore the peoples’ health.


• Public health is the combination of sciences, skills, and beliefs that is directed to the maintenance and improvement of the health of all the people through collective or social actions.


• The programs, services, and institutions involved emphasize the prevention of disease and the health needs of the population as a whole.


• 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 is thus a social institution, a discipline, and a practice.


• 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.

Essential Public Health Essential Public Health FunctionsFunctions

• Monitor health status to identify community health problems.

• Diagnose and investigate health problems and health hazards in the community.

• 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 and assure the provision of health care when otherwise unavailable.


• Assure a competent public 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 ApproachPublic 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.


• Implement interventions to improve the health of the population.

• Monitor those interventions to assess their effectiveness.

Public Public Health Health

ApproachApproach

Problem Response

Surveillance:What is the

problem?

Risk FactorIdentification:What is the

cause?

InterventionEvaluation:

Whatworks?

Implementation:How do you

do it?


• Requires the collection, analysis, and interpretation of data to define the problem and outline:

– What

– Where

– When

– Who

– How


• Requires a determination of:

–Preventable or not preventable

–Controllable or not controllable

–Priority


• The potential for prevention or control frequently requires:– A plan – A champion– A strategy/method– A method– The will– Funding


Do it


• 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?


• Quiz:

–What was the leading cause of death in Arizona children 0-4 years of age from 1986-1996?


• Answer:

Drowning

Drowning in ArizonaDrowning 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.


•


• The data outlines the problem to be:

–A barrier problem (none, failed or inadequate)

–Supervision failure


• Is the problem preventable or not preventable?

–The problem was considered preventable.

• What was the priority?– High


• 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.


• The response by the ADHS, DPCCA, CDC, ARC, and others was to:– Seek legislative action

– Develop community educational program

– Develop an individual pool safety program


• 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 FENCENO FENCE

FENCEFENCE

AlarmAlarm

FENCEFENCE


• Arizona Republic Headlines:

–Child Drownings Down 60% in Phoenix

–Maricopa County Child-Drowning Rate Hits 20-year Low


• It worked!

–Drowning mortality rates dropped

• Year Rate/100.000

• 1974 21.3

• 1981 19.5

• 1989 11.9

• 1990 5.8


• Of 269 drownings from 1995 to 2001, only six occurred in pools that were fenced and had properly latching gates.


• It was better, but it didn’t 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


• What happened?

• We have to return to data collection and analysis to seek the answers


• 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


• 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.


• And so, the cycle begins again until we accomplish our goal.

introduction to the public health approach glyn g. caldwell, md december 13, 2006

Documents

maintenance of health

public health activities

defined public health

physical health

health needs

health hazards

health issues

peoples health