Transcript Preventive Medicine: State of the Specialty

Growing and Strengthening
Preventive Medicine
Miriam Alexander, MD, MPH, FACPM
President-elect of ACPM
and
Director of the General Preventive Medicine Residency
Program
Johns Hopkins Bloomberg School of Public Health
February 19, 2011
Our Goal Today
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Do you want to treat the patient or do you want
to improve health??
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What the history of public health can teach us
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What prevention really is…
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Lesson learned from Industrial Hygiene and
Safety
The History of Public
Health (in one slide!)
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Quarantine
Sanitary Idea
World of Work
Education and mothering
Body spaces: from inoculation to immunization
Professionalization
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Courtesy of Graham Mooney, PhD
Preventive Medicine
(PM)
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The medical specialty dedicated to health
promotion and disease prevention—ACPM
1954
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One of the 24 specialties recognized by
American Board of Medical Specialties ABPM
1947
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Only board-certified specialty that combines
clinical and population-based health practice
Training Programs in
Preventive Medicine
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Fellowships—unstructured
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Fellowships—structured
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Residencies—generally defined
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Residencies—increasing structure
Residency Training
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Yesterday
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Today
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Fights,
Battles and Wars
Tomorrow
What can we learn from
Public Health??
Twentieth Century
U.S. Mortality Rate: 1900-2001
Deaths per 1,000
Source: www.infoplease.com
18
17
16
15
14
13
12
11
10
9
8
0 25 34 39 44 49 54 59 65 70 75 80 85 90 95 00
0
19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20
Year
Cause of Death (U.S. 1990)
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Tobacco
Diet/Activity
Alcohol
Microbial agents
Toxic Agents
Firearms
Sexual Behavior
Motor Vehicles
Illicit Drug Use
19%
14%
5%
4%
3%
2%
1%
1%
<1%
Tobacco
Diet/Activity
McGinnis & Foege, JAMA, 1993
Who is our patient?
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Individual
Patient
Medical Office
Health Care System
Public/Population
How Can We Make
Prevention A
Continum
A Win for One and A Win for All
How do we Make
Decisions?
Evidence/Science
Social Will
Political Will
WHAT CAN WE POSSIBLY
LEARN FROM THE
INDUSTRIAL
HYGIENE/SAFETY
WORLD??
Hierarchy of Controls
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Engineering Controls (ie. substitution,
elimination, etc)
Administrative Controls (ie. Scheduling,
policies and procedures, work practices, etc)
Education (ie. Training, certifying, etc)
Personal Protective Equipment (protect the
person)
Hope the person does their best!
How should we choose
the right control??
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Best: At the source
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Second Best: Along the Path
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Least Desirable: At the worker
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UIC.edu/sph/glakes/hierarchyofcontrolfactsheet.doc
What do you think???