Introduction to the Public Health Approach Glyn G

Introduction to the Public Health Approach Glyn G. Caldwell, MD December 13, 2006

What is Public health? • C. E. A. Winslow in 1923 defined Public Health as the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the

What is Public health? • environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment

What is Public health? • disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.

What is Public health? • John M. Last’s Dictionary of Public Health (2001) gives the following: • Public Health is one of the efforts organized by society to protect, promote, and restore the peoples’ health.

What is Public health? • Public health is the combination of sciences, skills, and beliefs that is directed to the maintenance and improvement of the health of all the people through collective or social actions.

What is Public health? • The programs, services, and institutions involved emphasize the prevention of disease and the health needs of the population as a whole.

What is Public health? • Public health activities change with changing technology and social values, but the goals remain the same: to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population.

What is Public health? • Public health is thus a social institution, a discipline, and a practice.

What is Public health? • The Acheson Report (1988) defines Public health more succinctly as: • The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society.

Essential Public Health Functions • 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.

Essential Public Health Functions • Mobilize community partnerships to identify and solve health problems. • Develop policies and plans that support individual and community health efforts.

Essential Public Health Functions • Enforce laws and regulations that protect health and ensure safety. • Link people to needed personal health services and assure the provision of health care when otherwise unavailable.

Essential Public Health Functions • Assure a competent public health care workforce. • Evaluate effectiveness, accessibility, and quality of personal and populationbased health services. • Research for new insights and innovative solutions to health problems.

Public Health Approach • Define the health problem. • Identify risk factors associated with the problem. • Develop and test community-level interventions to control or prevent the cause or the problem.

Public Health Approach • Implement interventions to improve the health of the population. • Monitor those interventions to assess their effectiveness.

Public Health Approach Surveillance: What is the problem? Problem Implementation: How do you do it? Intervention Evaluation: What works? Risk Factor Identification: What is the cause? Response

Public Health Approach • Requires the collection, analysis, and interpretation of data to define the problem and outline: – What – Where – When – Who – How

Public Health Approach • Requires a determination of: – Preventable or not preventable – Controllable or not controllable – Priority

Public Health Approach • The potential for prevention or control frequently requires: – A plan – A champion – A strategy/method – A method – The will – Funding

Public Health Approach Do it

Public Health Approach • After implementation the cycle begins again, but this time to evaluate the program results. – Did the strategy work as intended? – Were the results as expected? – If yes, can you expand or replicate the program? – If no, do you abandon or revise and try again?

Public Health Approach • Quiz: –What was the leading cause of death in Arizona children 04 years of age from 19861996?

Public Health Approach • Answer: Drowning

Drowning in Arizona • The Public Health Approach requires the collection, analysis, and interpretation of data to define the problem and outline: what, where, when, who, and how.

Drowning in Arizona

Drowning in Arizona •

Drowning in Arizona • The data outlines the problem to be: – A barrier problem (none, failed or inadequate) – Supervision failure

Drowning in Arizona • Is the problem preventable or not preventable? – The problem was considered preventable. • What was the priority? – High

Drowning in Arizona • The Goal! – One of the health objectives targeted in Arizona 2000 was to decrease the death rate for drowning to 1. 3/100, 000. The 1996 drowning rate for Arizona residents of all ages exceeded the target rate by 69 percent.

Drowning in Arizona • The response by the ADHS, DPCCA, CDC, ARC, and others was to: – Seek legislative action – Develop community educational program – Develop an individual pool safety program

Drowning in Arizona • Results: – The legislature passed a bill in 1991 requiring fencing and buyer notification (A. R. S. § 36 -1681) – The education programs were developed and implemented by realtors and volunteer groups

NO FENCE

FENCE

Alarm

FENCE

Drowning in Arizona

Drowning in Arizona • Arizona Republic Headlines: – Child Drownings Down 60% in Phoenix – Maricopa County Child-Drowning Rate Hits 20 -year Low

Drowning in Arizona • It worked! – Drowning mortality rates dropped • Year Rate/100. 000 • 1974 21. 3 • 1981 19. 5 • 1989 11. 9 • 1990 5. 8

Drowning in Arizona • Of 269 drownings from 1995 to 2001, only six occurred in pools that were fenced and had properly latching gates.

Drowning in Arizona • It was better, but it didn’t last – Drowning mortality rates began increasing • Year Rate/100. 000 • 1991 8. 5 • 1992 7. 1 • 1994 8. 0 • 1995 9. 9 • 1996 8. 5

Drowning in Arizona

Drowning in Arizona • What happened? • We have to return to data collection and analysis to seek the answers

Drowning in Arizona • The findings show: – Failure to use or maintain barriers – Failure to supervise – Parental inattention – No requirement for interior pools – Not all drowning occur in swimming pools

Drowning in Arizona • In addition: – The statute allowed cities and counties to pass their own ordinances provided they were equal to or more stringent that the statute, which lead to some confusion. – The need for a statewide standard.

Drowning in Arizona • And so, the cycle begins again until we accomplish our goal.