Transcript Public Health Definition, Philosophy and Purpose

Public Health
Definitions, Philosophy and Purpose
Dr. Anjum Odhwani MD, MPH
Definition of Public Health
• The word “Public” means a defined
group of people
• Health is derived from the word hal
which means “hale, sound or whole”
• WHO (1947) Definition of Health
– a state of complete physical, mental, and
social well-being and not merely the
absence of disease or infirmity
Definitions of Health
• Hahn and Payne (2001)
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Physical
Emotional
Mental/Intellectual
Social
Spiritual
Environmental/Occupational
Definitions of Health
• Health may be defined as a
dynamic state or condition that is
multidimensional in nature and
results from an individuals
adaptations to his or her
environment. It is a resource for
living and exists in varying
degrees.
Source: McKenzie, Pinger, Kotecki. An introduction to
community health 4th ed
Definition of Public Health
• Winslow’s definition of 1920
– public health is the science and art of
• preventing disease
• prolonging life
• promoting physical health
• efficiency through organized community
effort
• for:
Public Health continued
• The following
– the sanitation of the environment
– the control of communicable infections
– the education of the individual in personal
hygiene
– the development of the social machinery to
insure everyone in the community a standard
of living adequate for the maintenance of
health
– the organization of health care services for
early diagnosis and preventive treatment
Definition of Public Health
• Public Health refers to the health
status of a defined group of people
and the governmental actions and
conditions to promote, protect and
preserve their health
Group of people and governmental actions
Source: McKenzie, Pinger, Kotecki.
An introduction to community health 4th ed
The continuum of health
Treatment
Health
&
Primary
Promotion
Prevention
Susceptibility
• risk factors
• no signs/
symptoms
Secondary
Prevention
Tertiary
Prevention
Presympt.
disease
• signs
Clinical
manifestation
• signs
• no symptoms
• symptoms
Disability
Examples of phases of prevention
Community
Provider
Self-care
Primary
Secondary Tertiary
Water purification
Seat belt law
Needle
exchange
program
Immunization (MD)
Subluxation correction*
(DC)
Dental prophylaxis (DDS)
Lifestyle advice (all)
Exercise
Healthy diet
Screening
exams
Rehab
Self exams
Rehab
exercises
* Based on chiropractic principles
Relationship between Individual,
Community and Nation
Individual
Community
Nation
Community and community health
• Community
– is a group of people who have common
characteristics; communities can be defined by
location, race, ethnicity, age, occupation, interest in
particular problem or outcomes or common bonds
• Community health
– Refers to the health status of a defined group of
people and the actions and conditions both private
and governmental to promote, protect and preserve
health
Group of people and the actions and conditions
by private and government
Healthy people 2010
Factors that Affect the Health of a
Community
• Biology
• Physical factors
• Social and/or cultural
factors
• Community
organization
• Individual behaviors
• Policies and
interventions
• Access to health care
Factors that Affect the Health of a
Community
• Biology
– Individual’s genetic make up
– Factors with which he or she is born with
– Family history which may suggest risk for
disease (e.g. sickle cell anemia)
– Acquired physical and mental health problems
during life (e.g. Diabetes)
Factors that Affect the Health of a
Community
• Physical factors
– Geography (tropical countries-parasitic
and infectious diseases, Temperateobesity and heart diseases)
– Environment (Take the charge of soil,
water and air)
– Community size (positive and negative
impact)
– Industrial development (positive and
negative impact)
Factors that Affect the Health of a
Community
• Social and cultural factors
– Social factors are those that arise from the
interaction of individuals or groups within the
community (e.g. urban communities, fast-paced
life, higher rates of stress-related illnesses)
– Cultural factors arise from guidelines (both
explicit and implicit) that individuals inherit from
being part of a particular society
Factors that Affect the Health of a
Community
• Social and cultural factors (continued)
– Beliefs, traditions and prejudices
– Economy
Factors that Affect the Health of a
Community
• Social and cultural factors (continued)
– Religion (permit medical treatment, blood
transfusion, abortion, premarital sex)
– Social norms (smoking, alcohol)
– Socioeconomic status
Relationship Between Household Income
and Fair or Poor Health Status
Factors that Affect the Health of a
Community
• Community organizing
– Definition
• a process through which communities are helped
to identify common problems or goals, mobilize
resources and in other ways develop and
implement strategies for reaching the goals they
have collectively set.
• Communities organize their resources effectively
they will be better equipped to address and resolve
their community health problems
Factors that Affect the Health of a
Community
• Individual behavior
– Behavior of individual community
members contributes to the health of
the entire community
– Concentrated effort (recycling, seat
belts)
– Herd immunity
Factors that Affect the Health of a
Community
• Policies and interventions
– Powerful positive and negative effect on
the health of individual and communities
– E.g. health promotion campaign to prevent
smoking
– School health education programs
– Healthy lunches in schools
Leading Health Indicator of
Healthy people 2010
• Access to Health Care
• Strong predictors of access to quality health care
are
– Health insurance
– Regular primary care provider or other source
of ongoing health care.
– Use of clinical preventive services, such as
early prenatal care, serves as an indicator of
access to quality health care services.
Objectives of Healthy people 2010
for access
• Increase the proportion of persons with
health insurance.
• Increase the proportion of persons who have
a specific source of ongoing care.
• Increase the proportion of pregnant women
who begin prenatal care in the first trimester
of pregnancy
Increase the proportion of persons with
health insurance
• Health insurance provides access to health care.
• Persons with health insurance are more likely to
have a primary care provider and to receive
appropriate preventive care such as Pap test,
immunization, or early prenatal care.
• Adults with health insurance are twice as likely
to receive a routine checkup as are adults
without health insurance
Source: healthy people 2010
Increase the proportion of persons with
health insurance
• More than 44 million people in the United
States do not have health insurance
• Including 11 million uninsured children
• About one-third of adults under age 65
years below the poverty level are
uninsured
• Mexican Americans has one of the highest
uninsured rates at 40 percent
Source: healthy people 2010
Ongoing Sources of Primary Care
• More than 40 million Americans do not have a
particular doctor’s office, clinic, health center, or
other place where they usually go to seek health
care or health-related advice..
• People aged 18 to 24 years are the most likely
to lack a usual source of ongoing primary care
• Only 80 percent of individuals below the poverty
level and 79 percent of Hispanics had a usual
source of ongoing primary care
Source: healthy people 2010
Barriers to Access
• Financial: not having financial capacity
• Structural: lack of primary care providers,
medical specialists, or other health care
professionals or lack of health care facilities
• Personal barriers: cultural or spiritual
differences, language barriers, not knowing what
to do or when to seek care, or concerns about
confidentiality or discrimination
Source: healthy people 2010
Essential Public Health Services
Marine Hospital Service 1798
Essential Public Health Services
• 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
Essential Public Health Services
• Enforce laws and regulations that protect
health and ensure safety
• Link people with needed personal health
services and assure the provision of health
• Care when otherwise unavailable
• Assure a competent public health and
personal health care work force
Essential Public Health Services
• Evaluate effectiveness, accessibility, and
quality of personal and population-based
health services
• Research for new insights and innovative
solutions to health problems
Source: Reprinted from Essential Public Health Services Working Group
of the Core Public Health. Functions Steering Committee, 1994, U.S.
Public Health Service.
Results of Public Health Services
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Improved health status
Diseases prevented
Scarce resources saved
Improved quality of life
CAUSES OF DEATH, USA, 2002
FORMAL NAME
(1) Diseases of the
heart
INFORMAL
NAME
% ALL
DEATHS
heart attack
(mainly)
28.5%
cancer
22.8%
stroke
6.7%
(4) Chronic lower
respiratory disease
emphysema,
chronic
bronchitis
5.1%
(5) Unintentional
injuries
accidents
4.4%
(2) Malignant
neoplasms
(3) Cerebrovascular
disease
Top 5 Chronic Diseases in the US
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Heart disease
Cancers
Stroke
Chronic obstructive pulmonary disease
Diabetes
Account for over 2/3 of all deaths in the
United States
• 70% of total health care budget spent on
these
Important aspect
• Where should health care dollars and
public health spending be focused?
– Should it be on spending for management of
these chronic diseases, or should it be put
more into prevention and “wellness care”?
– What should the role of chiropractic be in
this?
Governmental Presence in
Health
• Is this good or bad?
• Rome was concerned with the well-being
of its citizens
– they enhanced the public health of the people
• Many object to the government being
involved
– public health threatens a person’s right to be
dirty
Governmental Presence in
Health
• How far should the government be
involved in public health?
– Should the government be able to
mandate that all children should be
immunized before they can attend a
public school?
– Quarantining of people with an
infectious disease (SARS)
One Idea to consider about Public
Health Services
• What is the economic value of a life?
• Many have tried to answer this question
– since the 1600’s
• Comes down to factors
– capital cost
– installation value
– period of productivity
– period of retirement
Capital Cost
• Investment society has in each infant by
the time he/she is born
– economic incapacitation of mother
– risk of death or injury of mother
– cost of childbearing
– risk of death or injury of infant
Installation Cost
• Investment from birth until child reaches 18
– physical needs
– value of parenting
– education
– health care
– recreation and transportation
– insurance and interest
– risk of death or disability
Period of productivity
• return society can expect on investment
– credit
• earning potential and interest
• non-economic potential
– debit
• risk of disability, death, reduced potential interest
• medical costs
Period of retirement
• People are living longer
– a greater percentage of the population has
reached retirement age
– they are surviving longer
– while the birth rate has gone down
– Overall the percentage of the population
working is decreasing
• As the individual ages their health
condition gradually worsens, how should
they be cared for?
Geriatric population
• In last 100 years
– Total population increased by 5x
– Geriatric population increased by 15x
• Fastest growing subset: 85+
• 100,000 over age 100 now in US
Life expectancy 1900-2050 (est.)
2004
How can the Economic value of
Health Programs be assessed?
• Compare spending on the program to the
overall savings at a result
– about 50 years ago in NY
• spent $500,000 on an early case-finding program
for pneumonia
• saved $5,000,000 a year in health care costs
– Detroit
• spent $1,000,000 on a program against TB
• saved $5,000,000 a year
Public health in America
• Vision:
– Healthy people in healthy communities
• Mission
– Promote physical, mental health and
prevent disease, injury and disability