Public HealthPublic HealthWhat it is and Why you What it is and Why you

should care.should care.Virginia M. Dato MD MPH FACPM FAAPVirginia M. Dato MD MPH FACPM FAAP

President President

American Association ofAmerican Association of

Public Health PhysiciansPublic Health Physicians

vmdato@aaphp.orgvmdato@aaphp.org

Clinical MedicineClinical Medicine

Diagnosing symptomsDiagnosing symptoms

Treating and preventing diseasesTreating and preventing diseases

Providing ComfortProviding ComfortRelieving PainRelieving Pain

Enhancing the Capacity Enhancing the Capacity to Functionto Function

medicine & public health the power of collaborationmedicine & public health the power of collaboration

The Public Health PerspectiveThe Public Health PerspectiveImplementing and evaluating population Implementing and evaluating population based strategies to promote health and based strategies to promote health and prevent diseaseprevent disease

Assuring the provision of essential health Assuring the provision of essential health servicesservices

Developing and Enforcing Public Health LawsDeveloping and Enforcing Public Health Laws

Assessing and monitoring health problemsAssessing and monitoring health problems

medicine & public health the power of collaborationmedicine & public health the power of collaboration

Public Health is the science and art of (1) preventing Public Health is the science and art of (1) preventing disease, (2) prolonging life, and (3) promoting health disease, (2) prolonging life, and (3) promoting health and efficiency through organized community efforts for and efficiency through organized community efforts for

the sanitation of the environment, the sanitation of the environment, the control of community infections, the control of community infections, the education of the individual, the education of the individual, the organization of medical and nursing service for the early diagnosis the organization of medical and nursing service for the early diagnosis

and preventive treatment of disease, and and preventive treatment of disease, and the development of the social machinery which will ensure to the development of the social machinery which will ensure to

everyone a standard of living adequate for the maintenance of health.everyone a standard of living adequate for the maintenance of health. So organizing these benefits as to enable every citizen to So organizing these benefits as to enable every citizen to

realize his birthright of health and longevity.realize his birthright of health and longevity. C.E.A. Winslow, 1920C.E.A. Winslow, 1920

Public HealthPublic Health

Organized community efforts Organized community efforts aimed at the prevention of aimed at the prevention of disease and promotion of disease and promotion of health. It links many health. It links many disciplines and rests upon the disciplines and rests upon the scientific core of Epidemiology scientific core of Epidemiology (The Future of Public Health)(The Future of Public Health)

Encompasses both activities Encompasses both activities undertaken within the formal undertaken within the formal structure of government and structure of government and the associated efforts of the associated efforts of private and voluntary private and voluntary organizations and individuals” organizations and individuals” (The Future of Public Health)(The Future of Public Health)“

The Organizational The Organizational Framework of Public HealthFramework of Public Health

Mission of Public HealthMission of Public Health

The fulfillment of society’s The fulfillment of society’s interest in assuring the interest in assuring the conditions in which people conditions in which people can be healthy -can be healthy - (The Future (The Future of Public Health) of Public Health)

The fundamental obligation The fundamental obligation of agencies responsible for of agencies responsible for population-based health is population-based health is

to:to: Prevent epidemics and the spread Prevent epidemics and the spread

of disease of disease Protect against environmental Protect against environmental

hazards hazards Prevent injuries Prevent injuries

Promote and encourage healthy Promote and encourage healthy behaviors and mental health behaviors and mental health

Respond to disasters and assist Respond to disasters and assist communities in recovery communities in recovery

Assure the quality and Assure the quality and accessibility of health servicesaccessibility of health services

VisionVision

Healthy People in Healthy People in Healthy CommunitiesHealthy Communities

Mission Mission

Promote physical and Promote physical and mental health and mental health and prevent disease, injury, prevent disease, injury, and disability.and disability.

Old Wine In New BottlesOld Wine In New BottlesF. Douglas ScutchfieldF. Douglas Scutchfield

Panacea and Hygeia - the Greek Panacea and Hygeia - the Greek Gods of Healing and HealthGods of Healing and Health

Hippocrates “urged physicians to Hippocrates “urged physicians to pay attention to the environment, pay attention to the environment, social, and behavioral context in social, and behavioral context in which illness occurs”which illness occurs”– medicine & public healthmedicine & public health

““When a committee of the When a committee of the Massachusetts legislature Massachusetts legislature

confidently asserted, on May 22, confidently asserted, on May 22, 1869 that all governments since 1869 that all governments since

the time of Moses had made the time of Moses had made provision to protect the life and provision to protect the life and

health of their people, the health of their people, the legislators affirmed a tradition of legislators affirmed a tradition of corporate responsibility for the corporate responsibility for the

welfare of their people.”welfare of their people.”From Public Health and the State - Changing Views in Massachusetts, 1842-1936 - Barbara Gutman Rosenkrantz Harvard University Press - 1972

Historical RelationshipHistorical Relationship an early supportive relationship prior to the early an early supportive relationship prior to the early

20th century20th century a period of professionalization and practice a period of professionalization and practice

transformation spurred by the emergence of transformation spurred by the emergence of bacteriologybacteriology

an acceleration of functional separation in the an acceleration of functional separation in the post-World War II erapost-World War II era

the brave new world of managed care and cost the brave new world of managed care and cost emphasisemphasis

New understanding of public health in the post New understanding of public health in the post 9/11/01 world9/11/01 world

Why should you care Why should you care about Public Health?about Public Health?

Duty and obligation (codified in Duty and obligation (codified in law) to report certain conditions law) to report certain conditions and cooperate with authorities.and cooperate with authorities.

Help get individual patients Help get individual patients services they need services they need

Help improve the legal, financial Help improve the legal, financial and social environment that you and social environment that you work in.work in.

Medicine and Public Health Medicine and Public Health Synergies -Synergies - Models of Models of

CollaborationCollaboration Medicine & Public Health, The Power of Collaboration Medicine & Public Health, The Power of Collaboration

I. Improving health care by coordinating I. Improving health care by coordinating services for individualsservices for individuals

II. Improving access to care by II. Improving access to care by establishing frameworks to provide care establishing frameworks to provide care for the uninsuredfor the uninsured

III. Improving the quality and cost-III. Improving the quality and cost-effectiveness of care by applying a effectiveness of care by applying a population perspectivepopulation perspective

IV Using clinical practice to identify and IV Using clinical practice to identify and address community health problemsaddress community health problems

V Strengthening health promotion and V Strengthening health promotion and health protection by mobilizing health protection by mobilizing community campaignscommunity campaigns

VI Shaping the future direction of the VI Shaping the future direction of the health system by collaborating around health system by collaborating around policy, training and research. policy, training and research.

Amendment 10Amendment 10The powers not delgated to The powers not delgated to

the United States by the the United States by the Consitution, nor prohibited Consitution, nor prohibited

by it to the States, are by it to the States, are reserved to the States reserved to the States respectively, or to the respectively, or to the

peoplepeople..

The “police power”The “police power” Sovereign power of Sovereign power of statesstates

To provide for health, safety, & To provide for health, safety, & welfarewelfare

DelegatedDelegated to local governments to local governments

DelegatedDelegated to the federal to the federal governmentgovernment

Formal Structure of Formal Structure of Government in the USGovernment in the US

Federal GovernmentFederal Government– commercecommerce– fundingfunding– national securitynational security

State GovernmentState Government– primary responsibilityprimary responsibility

Local GovernmentLocal Government– as delegated by the stateas delegated by the state

PennsylvaniaPennsylvania

"communicable disease declared "communicable disease declared reportable by regulation" or " any unusual reportable by regulation" or " any unusual or group expression of illness which in or group expression of illness which in the opinion of the Secretary, may be a the opinion of the Secretary, may be a public health emergency" is covered public health emergency" is covered under Chapter 3 of the Consolidated under Chapter 3 of the Consolidated Statues - Prevention of Spread of Statues - Prevention of Spread of Diseases - Communicable Diseases. Diseases - Communicable Diseases. Reports are covered under 521.4 of the Reports are covered under 521.4 of the Diseases Prevention and Control Law of Diseases Prevention and Control Law of 1955. 1955.

How Does Public Health How Does Public Health Work?Work?

Core FunctionsCore Functions

AssessmentAssessment Policy DevelopmentPolicy Development AssuranceAssurance

The Ten Essential The Ten Essential Services of Public Health Services of Public Health

AssessmentAssessment

The assessment function is The assessment function is the collection, assemble, the collection, assemble, analysis and distribution of analysis and distribution of information on the information on the community's healthcommunity's health

The Ten Essential The Ten Essential Services - AssessmentServices - Assessment

Monitor health status to Monitor health status to identifyidentify community health problemscommunity health problems

Diagnose and investigate health Diagnose and investigate health problems and health hazards in the problems and health hazards in the communitycommunity

Evaluate effectiveness, accessibility, Evaluate effectiveness, accessibility, and quality of personal and and quality of personal and population-based health servicespopulation-based health services

Policy DevelopmentPolicy Development This core function involves This core function involves

the development of the development of comprehensive policies comprehensive policies based upon scientific based upon scientific knowledge and decision knowledge and decision making. making.

The Ten Essential The Ten Essential Services - PolicyServices - Policy

Inform, educate, and empower Inform, educate, and empower people about health issuespeople about health issues

Mobilize community partnerships to Mobilize community partnerships to identify and solve health problemsidentify and solve health problems

Develop policies and plans that Develop policies and plans that support individual and community support individual and community health effortshealth efforts

AssuranceAssurance The committee recommended that a The committee recommended that a

set of personal and community-wide set of personal and community-wide services be determined by involving key services be determined by involving key policy makers and the general public. policy makers and the general public.

Once identified, the committee Once identified, the committee recommended that these services be recommended that these services be

provided to all members of the provided to all members of the community either though encouraging community either though encouraging

actions by others, by requiring action by actions by others, by requiring action by others or by direct provision. others or by direct provision.

The Ten Essential The Ten Essential Services - AssuranceServices - Assurance

Assure a competent public health Assure a competent public health and personal health care workforceand personal health care workforce

Enforce laws and regulations that Enforce laws and regulations that protect health and ensure safetyprotect health and ensure safety

Link people to needed personal Link people to needed personal health services and assure the health services and assure the provision of health care when provision of health care when otherwise unavailableotherwise unavailable

The Tenth Essential The Tenth Essential ServiceService

Impacts Assessment, Policy and Impacts Assessment, Policy and AssuranceAssurance

Research for new insights and Research for new insights and innovative solutions to health innovative solutions to health problemsproblems

Examples of the 10 Examples of the 10 Essential Services in ActionEssential Services in Action

Monitor health status to Monitor health status to identifyidentify community community

health problemshealth problems Examples: Death Certificates, Examples: Death Certificates,

Birth Certificates, Birth Certificates, Immunizations Registries, Immunizations Registries, Surveillance Surveillance

Diagnose and investigate Diagnose and investigate health problems and health problems and health hazards in the health hazards in the

communitycommunity

Examples: Outbreak Examples: Outbreak Investigations, Child Death Investigations, Child Death Review BoardsReview Boards

Inform, educate, and Inform, educate, and empower people about empower people about

health issueshealth issues Example:Lead Paint displays in Example:Lead Paint displays in

hardware stores, New Releases hardware stores, New Releases on Rabies and West Nile Viruson Rabies and West Nile Virus

Mobilize community Mobilize community partnerships to identify partnerships to identify

and solve health and solve health problemsproblems

Example: ACHD Tobacco Example: ACHD Tobacco Stakeholders Group, Advisory Stakeholders Group, Advisory Boards, Collaborative ActivitiesBoards, Collaborative Activities

Develop policies and Develop policies and plans that support plans that support

individual and community individual and community health effortshealth efforts

Example: Smoking Bans, Example: Smoking Bans, Helmet Laws, Restaurant Helmet Laws, Restaurant Inspection LawsInspection Laws

Enforce laws and Enforce laws and regulations that protect regulations that protect

health and ensure safetyhealth and ensure safety

Example: Food Inspection Example: Food Inspection Certificates, Enforcement of Certificates, Enforcement of Smoking RegulationsSmoking Regulations

Link people to needed Link people to needed personal health services personal health services and assure the provision and assure the provision

of health care when of health care when otherwise unavailableotherwise unavailable

Example: Children’s Health Example: Children’s Health Insurance Programs, Federally Insurance Programs, Federally Qualified Centers. Qualified Centers.

Assure a competent Assure a competent public health and public health and

personal health care personal health care workforce.workforce.

Example:Conferences, Training Example:Conferences, Training programs, journals, School of programs, journals, School of Public Health, Satellite Public Health, Satellite Programs, CertificationsPrograms, Certifications

Evaluate effectiveness, Evaluate effectiveness, accessibility, and quality accessibility, and quality

of personal and of personal and population-based health population-based health

servicesservices Example: Outcome evaluation Example: Outcome evaluation

and Economic Analysesand Economic Analyses

Research for new insights Research for new insights and innovative solutions and innovative solutions

to health problemsto health problems

Example: Needle Exchange Example: Needle Exchange ProgramsPrograms

Example: Heart DiseaseExample: Heart Disease

Monitor health status to Monitor health status to identifyidentify community health problemscommunity health problems

Diagnose and investigate health Diagnose and investigate health problems and health hazards in the problems and health hazards in the communitycommunity

Inform, educate, and empower Inform, educate, and empower people about health issuespeople about health issues

Mobilize community partnerships to Mobilize community partnerships to identify and solve health problemsidentify and solve health problems

Develop policies and plans that Develop policies and plans that support individual and community support individual and community health effortshealth efforts

Assure a competent public health Assure a competent public health and personal health care workforceand personal health care workforce

Enforce laws and regulations that Enforce laws and regulations that protect health and ensure safetyprotect health and ensure safety

Link people to needed personal Link people to needed personal health services and assure the health services and assure the provision of health care when provision of health care when otherwise unavailableotherwise unavailable

Evaluate effectiveness, Evaluate effectiveness, accessibility, and quality of personal accessibility, and quality of personal and population-based health and population-based health servicesservices

Research for new insights and Research for new insights and innovative solutions to health innovative solutions to health problemsproblems

Exercise: Think about a current public health problem faced by you or your institution. Take that public health problem or issue and think about how the 10 essential services of public health can solve that problem.

““Never doubt that a small Never doubt that a small group of throughtful, group of throughtful,

committed citizens can committed citizens can change the world; indeed, it change the world; indeed, it

is the only think that ever is the only think that ever has”has”

Margaret MeadMargaret Mead