Public Health Biology 475 What is Public Health

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: – – – 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 20 th 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 20 th 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 has resulted from clean water and better sanitation. Infections such as typhoid and cholera, major causes of illness and death early in the 20 th 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 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 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 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 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 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

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). 1. Public health is typically divided into epidemiology, biostatistics and health services. 2. 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 • • • • Adolescent Health Adolescent Nutrition Alcohol Anemia Cardiovascular health Child Health Disability & HIV/AIDS Environmental Health Essential Newborn Care HIV/AIDS & Sexual and Reproductive Health Linkages HIV/AIDS & Youth Immunization Indoor Air Pollution Injection Safety Maternal Mortality • • • • • 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 • • • 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 Functions – Public Health Fact Sheets – Water and Sanitation

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WHO World malaria report 2010 1. 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. 2. 3. Download the publication More publications about malaria

WHO Global tuberculosis control 2010 • Download • Full report [pdf 3. 5 Mb] ________ • Main text pdf, 724 kb • Annex 1 Methods • pdf, 1. 07 Mb Annex 2 Country data • • pdf, 2. 35 Mb ________ 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. 9 Mb] • 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 • • • The World Health Report Annual report with an expert assessment of global health including statistics. Focuses on a particular theme every year. World Health Statistics WHO's annual compilation of data from its 193 Member States. International Travel and Health Publication on health risks for international travellers, vaccination requirements and precautions to take. International Health Regulations Latest edition of the public health regulations that are legally binding on WHO Member States. The International Classification of Diseases The international standard diagnostic classification for epidemiological and health management purposes. 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: • Wikipedia - Population Health • Public Health Agency of Canada • Canadian Journal of Public Health • Google Books - The Future of Public Health • Google Scholar Search for "Public Health" in article titles (first 500 references of 232, 000) • 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 1990 s. In 1997, The Gambia introduced Hib vaccines into its national immunization program and has virtually eliminated the disease from the country.