Public Health:What It Is and How It Works,

Fourth Edition

• Chapter-by-Chapter Power Point Slides• Links to Internet-based resources

Chapter 1What Is Public Health?

Chapter 1 Will Help You To:

• articulate several different definitions of public health • describe the origins and content of public heath

responses over history • trace the development of the public health system in the

U.S. • broadly characterize the contributions and value of public

health • Identify 3 or more distinguishing features of public health • describe public health as a system with inputs,

processes, outputs, and results, including the role of core functions and essential public health services in the public health system

• identify 5 or more Internet web sites that provide useful information on the U.S. public health system

Brief History of Public Health

• Plagues throughout history• Imperialism• New worlds and new markets• Industrial Revolution• Chadwick and Snow• Themes throughout history: science and

social values

SNOW AND CHOLERA

• "I had an interview with the Board of Guardians of St. James's parish, on the evening of Thursday, 7th September, and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day." 

      - John Snow in his 1855 book

Discussion

Based on Snow on Cholera: Part 1:

• What aspects of Snow’s journal reflect modern thinking about the communicability of diseases?

• What aspects reflect thinking prior to the germ theory?

• Which factors described in Snow’s journal contributed most to the control of the cholera outbreak near Golden Square?

Discussion

• Consider the European colonization of the Americas beginning in the 16th century. How was it possible for Hernan Cortes and other European explorers to overcome well-established Native American cultures with of millions of people? What role, if any, did public health themes and issues play?

Public Health in Early America

• Plagues and epidemics

• Shattuck’s Report

• Port city boards of health

• U.S. Constitution and Federalism

• Police powers and general welfare

• Local and state health departments

Public Health Eras in America

Prior to 1850 Battling Epidemics

1850-1949 Building State and Local Public Health Infrastructure

1950-1999 Filling Gaps in Medical Care Delivery

After 1999 Preparing for and Responding to Community Health Threats

Images of Public Health

• System and Social Enterprise

• Profession

• Methods (Knowledge and Techniques)

• Governmental Services

• Health of the Public

When you hear the term “public health,” which of the following do you think of?

Protecting the

public from disease

16%

A government

provided healthcare

system for all and

health care for the

poor

47%

Not sure

10%

Policies and

programs that

maintain healthy

living conditions

27%

Definitions of Public Health

• Science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort (Winslow, 1920)

• Successive re-definings of the unacceptable (Vickers, 1958)

• Fulfilling society’s interest in assuring conditions in which people can be healthy (Institute of Medicine, 1988)

Public Health as a System

Source: Handler A, Issel M and Turnock BJ. A conceptual framework to measure performance of the public health system. Amer J Pub Health 2001;91(8):1235-1239

Unique Features of Public Health

“Science and Social Values”

• Social Justice Perspective• Inherently Political• Evolving Expectations = Expanding Agenda• Link with Government• Grounding in Science• Focus on Prevention• Uncommon Culture

Discussion

• Review the Public Health Code of Ethics.

• Then identify a public health figure, past or present, whose career you believe embodies these principles.

• Describe the rationale for your choice.

Value of Public Health

• Mortality and morbidity prevented

• Economic benefits

• Quality of life

• 20th Century Achievements

Ten Great Public HealthAchievements of the 20th Century

• Immunizations• Motor Vehicle Safety• Workplace Safety• Control of Infectious

Diseases• Declines in Heart

Disease and Stroke

• Safer and Healthier Foods

• Healthier Mothers and Babies

• Family Planning• Fluoridation of

Drinking Water• Tobacco as a Health

Hazard

Life Expectancy at Birth and Infant Mortality Rates, Selected Years, U.S.

47.3

68.276.9

110

29.2

6.90

20

40

60

80

100

120

1900 1950 2000

Life Expectancy at Birth (in years)

Infant Mortality Rate (per 1000 live births)

The 10 leading causes of death as a percentage of all deaths,

United States, 1900 and 1997

Baseline 20th Century Annual Morbidity and 1998 Provisional Morbidity from 9 Diseases with Vaccines Recommended before 1990 for

Universal Use for Children, United States.

Disease Baseline 20th century

annual morbidity

1998 Morbidity Percent Decrease

Smallpox 48,164 0 100%

Diphtheria 175,885 1 100%

Pertussis 147,271 6,279 95.7%

Tetanus 1,314 34 97.4%

Poliomyelitis (paralytic) 16,316 0 100%

Measles 503,282 89 100%

Mumps 152,209 606 99.6%

Rubella 47,745 345 99.3%

Congenital rubella syndrome 823 5 99.4%

Hemophilus influenza type b 20,000 54 99.7%

Number of Reported Mumps Cases by Year,United States, 1980-2006.

Discussion

• Review the History of Selected Public Health Events in Chicago from 1834-1999 and Public Health in Illinois: A Timeline. (or similar information from another state)

• Consider how public health strategies and interventions have changed over time in the U.S.

• What influences were most responsible for these changes?

• Does this suggest that public health functions have changed over time as well?

Discussion

• Your boss will be speaking for approximately 30 minutes at two different meetings: (1) a meeting of the local Chamber of Commerce at their monthly luncheon meeting; and (2) a meeting of the medical staff at the local hospital.

• She directs you to develop a slide presentation for these meetings.

• Based on the content from this chapter, how would you approach this task? What messages and content would be most appropriate?

Internet ResourcesExamine each of the following public health web sites. Which ones did you find to be the most useful for providing information and insights related to the central topic of Chapter 1 (What Is Public Health?) Why?

• American Public Health Association • Association of State and Territorial Health Officials • National Association of County and City Health Officials • Public Health Foundation • US Department of Health and Human Services and its various Public Health Service

Agencies (Centers for Disease Control and Prevention, Food and Drug Administration, Health Resources and Services Administration, National Institutes of Health, Agency for Health Care Policy and Research, etc.)

• US Environmental Protection Agency • State Health Departments (such as the Illinois Department of Public Health or others

that you may find at the ASTHO web site) • Local Health Departments (such as the Chicago Department of Public Health or

others you may find through some of the various national web sites or those of state health departments)

• Association of Schools of Public Health and individual schools (such as the University of Illinois at Chicago School of Public Health and others accessible through the ASPH web site)

• What Is Public Health? Developed by the Association of Schools of Public Health through funding from Pfizer Pharmaceutical Corporation

Additional Resources• Delta Omega Classics (classic public health manuscripts and

reports, many from the 19th century) • Invisible Safety Net Video: Part 1--What is Public Health? University

of Washington School of Public Health and Community Medicine, Northwest Center for Public Health Practice; 1994

• John Snow Web Site. UCLA Department of Epidemiology • Orientation to Public Health. Online introductory course developed

by the New York-New Jersey Public Health Training Center; 2002. • Outbreak at Watersedge: A Public Health Discovery Game.

University of Minnesota School of Public Health • Public Health Code of Ethics. American Public Health Association • Snow and Cholera. Slide and audio presentation developed by the

University of North Carolina School of Public Health • What Is Public Health? Association of Schools of Public Health and

Pfizer Pharmaceutical Corporation • What Is Public Health? Public Health Data Standards Consortium