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Public Health
Biology 475
What is Public Health
Components of Public Health
The field of public health is highly varied and encompasses many
academic disciplines. However, public health is mainly composed of
the following core areas:
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Behavioral Science/Health Education
Biostatistics
Emergency Medical Services
Environmental Health
Epidemiology
Health Services Administration/Management
International/Global Health
Maternal and Child Health
Nutrition
Public Health Laboratory Practice
Public Health Policy
Public Health Practice
Impacts of Public Health
The dramatic achievements of Public Health in the 20th century have
improved our quality of life: an increase in life expectancy, world
wide reduction in infant and child mortality, and the elimination
or reduction of many communicable diseases.
In 1999, the Centers for Disease Control and Prevention named the ten
greatest public health achievements of the 20th century.
These advances have been largely responsible for increasing the
lifespan of populations; over twenty-five of the 30 years can be
accredited to public health initiatives, while medical advances
account for less than 4 years. Furthermore, since 1900, the average
life expectancy for Canadians and Americans has increased by
about 30 years.
Impacts of Public Health
The dramatic achievements of Public Health in the 20th century have
improved our quality of life: an increase in life expectancy, world
wide reduction in infant and child mortality, and the elimination
or reduction of many communicable diseases.
In 1999, the Centers for Disease Control and Prevention named the ten
greatest public health achievements of the 20th century.
These advances have been largely responsible for increasing the
lifespan of populations; over twenty-five of the 30 years can be
accredited to public health initiatives, while medical advances
account for less than 4 years. Furthermore, since 1900, the average
life expectancy for Canadians and Americans has increased by
about 30 years.
10 greatest achievements of public health (CDC – 1999)
1. Vaccination
Programs of population-wide vaccinations resulted in the eradication of
smallpox; elimination of polio in the Americas; and control of measles,
rubella, tetanus, diphtheria, Haemophilus influenzae type b, and other
infectious diseases in the United States and other parts of the world.
2. Motor-vehicle safety
Improvements in motor-vehicle safety have contributed to large reductions
in motor-vehicle-related deaths. These improvements include engineering
efforts to make both vehicles and highways safer and successful efforts to
change personal behavior (e.g., increased use of safety belts, child safety
seats, and motorcycle helmets and decreased drinking and driving).
3. Safer workplaces
Work-related health problems, such as coal workers' pneumoconiosis
(black lung), and silicosis -- common at the beginning of the century -have been significantly reduced. Severe injuries and deaths related to
mining, manufacturing, construction, and transportation also have
decreased; since 1980, safer workplaces have resulted in a reduction of
approximately 40% in the rate of fatal occupational injuries.
4. Control of infectious diseases
Control of infectious diseases has resulted from clean water
and better sanitation. Infections such as typhoid and cholera, major
causes of illness and death early in the 20th century, have been
reduced dramatically by improved sanitation. In addition, the
discovery of antimicrobial therapy has been critical to successful
public health efforts to control infections such as tuberculosis and
sexually transmitted diseases (STDs).
5. Decline in deaths from coronary heart disease and stroke
Decline in deaths from coronary heart disease and stroke have
resulted from risk-factor modification, such as smoking cessation
and blood pressure control coupled with improved access to early
detection and better treatment. Since 1972, death rates for
coronary heart disease has decreased 51%.
6. Safer and healthier foods
Since 1900, safer and healthier foods have resulted from decreases in
microbial contamination and increases in nutritional content. Identifying
essential micronutrients and establishing food-fortification programs have
almost eliminated major nutritional deficiency diseases such as rickets,
goiter, and pellagra in the United States.
7. Healthier mothers and babies
Healthier mothers and babies are a result of better hygiene and nutrition,
availability of antibiotics, greater access to health care, and technologic
advances in maternal and neonatal medicine. Since 1900, infant mortality
has decreased 90%, and maternal mortality has decreased 99%.
8. Family planning
Access to family planning and contraceptive services has altered social
and economic roles of women. Family planning has provided health
benefits such as smaller family size and longer interval between the birth
of children; increased opportunities for preconceptional counseling and
screening; fewer infant, child, and maternal deaths; and the use of barrier
contraceptives to prevent pregnancy and transmission of human
immunodeficiency virus and other STDs.
9. Fluoridation of drinking water
Fluoridation of drinking water began in 1945 and in 1999 reaches an
estimated 144 million persons in the United States. Fluoridation
safely and inexpensively benefits both children and adults by
effectively preventing tooth decay, regardless of socioeconomic
status or access to care. Fluoridation has played an important role in
the reductions in tooth decay (40%-70% in children) and of tooth
loss in adults (40%-60%).
10. Recognition of tobacco use as a health hazard
Recognition of tobacco use as a health hazard in 1964 has resulted
in changes in the promotion of cessation of use, and reduction
of exposure to environmental tobacco smoke. Since the initial
Surgeon General's report on the health risks of smoking, the
prevalence of smoking among adults has decreased, and millions of
smoking-related deaths have been prevented.
*Courtesy of CDC's MMWR Web Page
Guns, Germs and Steel
By: Jared Diamond
Jared Diamond is one of America's most celebrated scholars. A
professor of Geography and Physiology at the University of
California, he is equally renowned for his work in the fields of
ecology and evolutionary biology, and for his ground-breaking
studies of the birds of Papua New Guinea
Go to PBS Website for Guns Germs and Steel
Go to PBS Website for Guns Germs and Steel
Public Health 2
Definition of Public Health 1:
• The approach to medicine that is concerned with the health of the
community as a whole. Public health is community health. It has been
said that: "Health care is vital to all of us some of the time, but public
health is vital to all of us all of the time."
• The mission of public health is to "fulfill society's interest in assuring
conditions in which people can be healthy." The three core public health
functions are:
• The assessment and monitoring of the health of communities and
populations at risk to identify health problems and priorities;
• The formulation of public policies designed to solve identified local and
national health problems and priorities;
• To assure that all populations have access to appropriate and costeffective care, including health promotion and disease prevention
services, and evaluation of the effectiveness of that care
From: Medicine.net
Public Health 3
Definition of Public Health
1. Public Health is "the science and art of preventing disease,
prolonging life and promoting health through the organised
efforts and informed choices of society, organisations,
public and private, communities and individuals." It is
concerned with threats to the overall health of a community
based on population health analysis. The population in
question can be as small as a handful of people or as large
as all the inhabitants of several continents (for instance, in
the case of a pandemic).
– Public health is typically divided into epidemiology, biostatistics and
health services.
– Environmental, social, behavioral, and occupational health are also
important subfields.
2. The focus of public health intervention is to prevent
rather than treat a disease through surveillance of cases
and the promotion of healthy behaviors. In addition to
these activities, in many cases treating a disease may be
vital to preventing it in others, such as during an outbreak
of an infectious disease. Hand washing, vaccination
programs and distribution of condoms are examples of
public health measures.
3. The goal of public health is to improve lives through
the prevention and treatment of disease. The United
Nations' World Health Organization defines health as
"a state of complete physical, mental and social wellbeing and not merely the absence of disease or
infirmity."[1]
4. In 1920, C.E.A. Winslow defined public health as "the
science and art of preventing disease, prolonging life
and promoting health through the organized efforts and
informed choices of society, organizations, public and
private, communities and individuals.“
Public Health 4
In the United Kingdom, public health functions include:
1. Health surveillance, monitoring and analysis
2. Investigation of disease outbreaks, epidemics and risk to health
3. Establishing, designing and managing health promotion and disease
prevention programmes
4. Enabling and empowering communities to promote health and reduce
inequalities
5. Creating and sustaining cross-Government and intersectoral
partnerships to improve health and reduce inequalities
6. Ensuring compliance with regulations and laws to protect and promote
health
7. Developing and maintaining a well-educated and trained, multidisciplinary public health workforce
8. Ensuring the effective performance of NHS services to meet goals in
improving health, preventing disease and reducing inequalities
9. Research, development, evaluation and innovation
10. Quality assuring the public health function
From: Wikipedia December 28 2008
Public Health 6
Public Health and Environmental
Health
Public Health 7
Public Health
Example: Water and Sanitation
Water Sanitation and the Millennium Development Goals
• Better hygiene and access to drinking water and
sanitation will accelerate progress toward two MDGs:
“Reduce underfive child mortality rate by 2/3 between
1990 and 2015” and “By 2015 halve the proportion of
people without sustainable access to safe drinking water
and basic sanitation”.
• Meeting the latter goal will require infrastructure
investments of about US$23 billion per year, to improve
water services for 1.5 billion more people (292,000
people per day) and access to safe sanitation for 2.2
billion additional people (397,000 per day). Fewer than
one in five countries are on track for meeting this target.
How do water, sanitation and hygiene
affect health?
Water supply, sanitation and health are
closely related. Poor hygiene, inadequate
quantities and quality of drinking water,
and lack of sanitation facilities cause
millions of the world’s poorest people to
die from preventable diseases each year.
Women and children are the main victims
• Water, sanitation and health are linked in
many ways:
• contaminated water that is consumed may
result in water-borne diseases including
viral hepatitis, typhoid, cholera, dysentery
and other diseases that cause diarrhea
• without adequate quantities of water for
personal hygiene, skin and eye infections
(trachoma) spread easily
• water-based diseases and water-related
vector-borne diseases can result from
water supply projects (including dams and
irrigation structures) that inadvertently
provide habitats for mosquitoes and snails
that are intermediate hosts of parasites
that cause malaria, schistomsomisis,
lymphatic filariasis, onchocerciasis and
Japanese encephalitis
• drinking water supplies that contain high
amounts of certain chemicals (like arsenic
and nitrates) can cause serious disease
• Inadequate water, sanitation and hygiene
account for a large part of the burden of illness
and death in developing countries:
• Approximately 4 billion cases of diarrhea per
year cause 2.2 million deaths, most-1.7 millionchildren under the age of five, about 15% of all
under 5 deaths in developing countries.
• Diarrheal diseases account for 4.3% of the total
global disease burden (62.5 million DALYs). An
estimated 88% of this burden is attributable to
unsafe drinking water supply, inadequate
sanitation, and poor hygiene. These risk factors
are second, after malnutrition, in contributing to
the global burden of disease.
• intestinal worms infect about 10% of the
population of the developing world, and
can lead to malnutrition, anemia and
retarded growth.
• 6 million people are blind from trachoma
and the population at risk is about 500
million
• 300 million people suffer from malaria
• 200 million people are infected with
schistosomiasis, 20 million of whom suffer
severe consequences.
Other Aspects of Public Health
All Public Health at a Glance Factsheets
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Adolescent Health
Adolescent Nutrition
Alcohol
Anemia
Cardiovascular health
Child Health
Disability & HIV/AIDS
Environmental Health
Essential Newborn Care
HIV/AIDS
HIV/AIDS & Sexual and
Reproductive Health Linkages
HIV/AIDS & Youth
Immunization
Indoor Air Pollution
Injection Safety
Maternal Mortality
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Mental Health
Mother to Child Transmission
Nutrition
Reproductive health
Road Safety
School Deworming
School Health
Smoke-free Workplaces
Surveillance
Tobacco Control
Tobacco Pack Info.
Tobacco Quitlines
Trachoma
Tuberculosis
Vitamin A
Health Care Waste Management
Water, Sanitation & Hygiene
WHO
Sources
Leading Organizations in Public Health
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World Health Organization
Center for Disease Control, Atlanta
The World Bank
Health Canada
European Union Public Health Portal
Sources
• World Bank Organization Main Web site
– Public Health
– Public Health Functions
– Public Health Fact Sheets
– Water and Sanitation
http://web.worldbank.org/WBSITE/EXTERNAL/TOPI
CS/EXTHEALTHNUTRITIONANDPOPULATION/EXT
PHAAG/0,,enableDHL:TRUE~menuPK:64229809~p
agePK:64229836~piPK:64229814~theSitePK:67226
3,00.html
http://web.worldbank.org/WBSITE/EXTER
NAL/TOPICS/EXTHEALTHNUTRITIONAND
POPULATION/EXTPHAAG/0,,contentMDK:
20800297~menuPK:64229809~pagePK:642
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WHO
World malaria report 2010
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22 December 2010 -- This report
summarizes information received
from 106 malaria-endemic countries
and other sources and updates the
analyses presented in the 2009
Report. It highlights continued
progress made towards meeting the
World Health Assembly (WHA)
targets for malaria to be achieved
by the end of 2010 and by 2015.
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Download the publication
More publications about malaria
WHO
Global tuberculosis control 2010
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Download
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Full report [pdf 3.5Mb]
________________
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Main text
pdf, 724kb
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Annex 1 Methods
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pdf, 1.07Mb
Annex 2 Country data
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pdf, 2.35Mb
________________
Data and country profiles
Press release
2010 Global Report reveals the
latest snapshot on the AIDS
epidemic
The UNAIDS biennial report states that
the world has turned the corner - having
halted and beginning to reverse the
spread of HIV. Fewer people are being
infected with HIV and more people have
access to treatment.
•Download full report [pdf 3.9Mb]
•Download report in chapters
•Epidemiology slides
Featuring 2009 epidemiological data, the
core slides incorporate data and maps
globally and regionally. The slides include
estimates of the number of people living
with HIV, AIDS-related mortality, and new
infections for both adults and children
•Fact sheets
The global AIDS epidemic
Key WHO publications
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The World Health Report
Annual report with an expert assessment of global health including statistics. Focuses
on a particular theme every year.
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World Health Statistics
WHO's annual compilation of data from its 193 Member States.
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International Travel and Health
Publication on health risks for international travellers, vaccination requirements and
precautions to take.
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International Health Regulations
Latest edition of the public health regulations that are legally binding on WHO Member
States.
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The International Classification of Diseases
The international standard diagnostic classification for epidemiological and health
management purposes.
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International Pharmacopoeia
Collection of quality specifications for pharmaceutical substances and dosage forms,
for reference or adaptation by WHO Member States.
WHO Journals
• Bulletin of the World Health Organization
Monthly journal with peer-reviewed papers. Focus on developing
countries.
• Eastern Mediterranean Health Journal
Published by the WHO Regional Office for the Eastern
Mediterranean. Focus on policies and research in the region.
• Pan American Journal of Public Health
Published by the Pan American Health Organization (PAHO) in
English, Portuguese and Spanish. Contains technical and analytical
papers.
• Weekly Epidemiological Record
Epidemiological information on cases and outbreaks of
communicable diseases.
• WHO Drug Information
Quarterly journal on topics relating to medicines development and
regulation.
Public Health 5
See also:
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Wikipedia - Population Health
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Public Health Agency of Canada
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Canadian Journal of Public Health
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Google Books - The Future of Public Health
•
Google Scholar Search for "Public Health" in article titles (first 500
references of 232,000)
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Google Scholar search for Public Health with "microbiology", "bacteria" or
"microbial" in title (477 references)
Summary
• Public Health is concerned with the health
of the community as a whole.
• Public health is community health.
• It has been said that: "Health care is vital
to all of us some of the time, but public
health is vital to all of us all of the time."
• Public health is typically divided into
epidemiology, biostatistics and health
services.
• Environmental, social, behavioral, and
occupational health are also important
subfields
Figure illustrates the
individuals and groups
that may play a role in
the public health
assessment process.
Success Stories in Public Health
1. Eradicating smallpox. A massive global effort spearheaded by the
World Health Organization eradicated smallpox in 1977 and inspired
the creation of the Expanded Program on Immunization, which
continues today.
2. Controlling tuberculosis in China. To address the problem of early
dropout from treatment among tuberculosis patients, a national TB
program in China implemented a new approach called DOTS—
directly observed therapy, short course—in which patients with TB
are “watched” daily by a health worker for six months as they take
their antibiotics. The program helped reduce TB prevalence by 40%
between 1990 and 2000 and dramatically improved the cure rate in
half of China’s provinces.
3. Eliminating polio in the Americas. Beginning in 1985, in a regional
polio elimination effort led by the Pan American Health Organization,
almost every young child in the Americas was immunized, eliminating
polio as a threat to public health in the Western Hemisphere in 1991.
4. Reducing child mortality through vitamin A in Nepal. Capitalizing
on the discovery that vitamin A supplementation could save child
lives, the government of Nepal began the National Vitamin A
Program in 1995 that has since averted nearly 200,000 child deaths.
5. Saving mothers’ lives in Sri Lanka. Despite relatively low national
income and health spending, Sri Lanka’s commitment to providing a
range of “safe motherhood” services has led to a decline in maternal
mortality, from 486 to 24 deaths per 100,000 live births over four
decades.
6. Controlling onchocerciasis in sub-Saharan Africa. A multipartner
international effort begun in 1974 dramatically reduced the incidence
of river blindness and increased the potential for economic
development in large areas of rural west, central and southern
Africa. Transmission of the parasite has been virtually halted in West
Africa, and since the program’s inception in 1974, 22 million children
in the 11-country area have been free from the threat of contracting
river blindness.
7. Preventing infant deaths from diarrheal disease in Egypt. Using
modern communication methods, a national diarrhea control
program in Egypt increased the awareness and use of life-saving
oral rehydration therapy, helping reduce infant diarrheal deaths by
82% between 1982 and 1987.
8. Improving health in Mexico. Since 1997, Mexico’s PROGRESA
program now known as “Oportunidades“) has provided poor rural
households with conditional cash grants, resulting in lowered rates of
illness and malnutrition and increased school enrollment.
9. Controlling trachoma in Morocco. Since 1997, the incidence in
Morocco of trachoma, the leading preventable cause of blindness
worldwide, has been cut by more than 99% among children under
age 10 through a combined strategy of surgery, antibiotics, face
washing, and environmental controls.
10. Reducing guinea worm disease in Africa and Asia. A multipartner
eradication effort focusing on behavior change reduced the prevalence of
guinea worm disease by 99% in 20 endemic African and Asian countries.
Since the start of the campaign in 1986, the number of cases has fallen from
3.5 million to less than 11,000 in 2005.
11. Controlling Chagas disease in the southern cone of South America.
Through surveillance, environmental vector control, and house spraying, a
regional initiative launched in 1991 decreased the incidence of Chagas
disease by 94% in seven countries in the southern cone of Latin America.
Disease transmission has been halted in Uruguay, Chile, and large parts of
Brazil and Paraguay.
12. Eliminating measles in southern Africa. Measles vaccination campaigns
in seven African countries have nearly eliminated measles as a cause of
childhood death in southern Africa, reducing the number of measles cases
from 60,000 in 1996 to just 117 four years later. The number of reported
measles deaths fell from 166 to zero.
13. Preventing Hib disease in Chile and The Gambia. A national Hib
vaccination program in Chile reduced prevalence of Hib disease by 90% in
the early 1990s. In 1997, The Gambia introduced Hib vaccines into its
national immunization program and has virtually eliminated the disease from
the country.