Public Health Concepts

Public Health Prof. Emily Díaz Acevedo, MSN, APRN, FNP-C What is Public Health? • Public Health is the discipline that addresses health at a population level. • The health of the population as a whole, monitored, regulated, and promoted by the state. • What is Public Health? • https://www.youtube.com/watch?v=jA8uYvJ_i8Y What is Public Health? • Public health promotes and protects the health of people and the communities where they live, learn, work and play. • While a doctor treats people who are sick, those of us working in public health try to prevent people from getting sick or injured in the first place. • We also promote wellness by encouraging healthy behaviors. What is Public Health? • From conducting scientific research to educating about health, people in the field of public health work to assure the conditions in which people can be healthy. That can mean vaccinating children and adults to prevent the spread of disease. Or educating people about the risks of alcohol and tobacco.

• Public health sets safety standards to protect workers and develops school nutrition programs to ensure kids have access to healthy food. What is Public Health? • Public health works to track disease outbreaks, prevent injuries and shed light on why some of us are more likely to suffer from poor health than others. • The many facets of public health include speaking out for laws that promote smoke-free indoor air and seatbelts, spreading the word about ways to stay healthy and giving science-based solutions to problems. What is Public Health? • Public health saves money, improves our quality of life, helps children thrive and reduces human suffering. • https://www.apha.org/what-is-public-health Public Health Background • Two factors have shaped the modern public health system: – The growth of scientific knowledge about sources and means of controlling disease – The growth of public acceptance of disease control as both a possibility and a public responsibility. Public Health Background • In earlier centuries society tended to regard illness with a degree of resignation. • As understanding of sources of contagion and means of controlling disease became more refined, more effective interventions against health threats were developed. • Public organizations and agencies were formed to employ newly discovered interventions against health threats. Public Health Background • Before 18th Century – Plague, Cholera and Smallpox emerge. – Epidemic disease was considered a sign of poor moral and spiritual condition, to be mediated through prayer – Isolation and quarantine, examples of public efforts. • 18th Century – Isolation and quarantine common measures for containing contagious diseases (some laws were passed for regulation) – New ideas about cause and meaning of disease. Public Health Background • 19th Century – “The Great Sanitary Awakening” – Identification of cause of disease and vehicle of transmission, resulted in social reforms. – Sanitation – Illness was an indicator of poor social and environmental conditions – Measures of Isolation and quarantine were inadequate; because of industrialization and the citizens could not afford to stop working. – Local sanitary surveys were conducted. – Shattuck Report of Massachusetts Sanitary Commission (1850). – Morbidity and Mortality statistics. Differences due to urbanization and areas of dense population and immoral life-style. ©AbeBooks.com ©concordlibrary.org Public Health Background • 19th Century – Advances in scientific knowledge. Louis Pasteur proved that anthrax is cause by bacteria. – Identification of bacteria and the development of interventions such as immunization and water purification techniques provided a means of controlling the spread of disease and even of preventing disease. Public Health Background • 20th Century – The Move Toward Personal Care – Disease control was based on bacteriology – In the early twentieth century, the New York and Baltimore health departments began offering home visits by public health nurses. – New York established a campaign for education on tuberculosis. – As public agencies moved into clinical care and education, the orientation of public health shifted from disease prevention to promotion of overall health. Public Health Background • 20th Century – 1906–Congress passed the Food and Drug Act, which initiated controls on the manufacture, labeling, and sale of food. – Sheppard-Towner Act (1922) established the Federal Board of Maternity and Infant Hygiene, provided administrative funds to the Children’s Bureau, and provided funds to states to establish programs in maternal and child health. In order to receive federal funds, states were required to develop a plan for providing nursing, home care, health education, and obstetric care to mothers in the state. Public Health Background • 20th Century – 1938, Second venereal disease control act, which provided federal funds to states for investigation and control of venereal diseases. – 1939, the Federal Security Agency, housing the Public Health Service and national programs in education and welfare, was established. – The Social Security Act was passed in 1935. – “Tuskegee Study of Untreated Syphilis in the Negro Male” (1932-1972) Source: thoughtgallery.org Public Health Background • 20th Century – By the 1970s, the financial impact of the expansion in public health activities of the 1930s through the 1960s, including new public roles in the financing of medical care, began to be apparent. – New health problems have continued to surface. AIDS, a previously unknown contagious disease, is reaching epidemic proportions. Public Health Background • 21st Century – Many other issues are of growing concern— Alzheimer’s disease, alcoholism and drug abuse, and homelessness are just a few. – New health problems continue to be identified, conflicting with concerns about the growth of government and government spending in health. Goals, Agencies and Services Introduction • What are the goals and roles of governmental public health agencies? Public Health Concepts

• What are the 10 essential public health services? • What are the roles of local and state and federal public health agencies? • What are the roles of global public health organizations and agencies? • How can public health agencies work together? Public Health Core Functions • The three (3) core functions of public health: – Assessment, – Policy development, and – Assurance • These functions have been developed by the Institute of Medicine’s report • The Future of Public Health (1988) are widely accepted among public health’s policy and academic community. Essential Public Health Services and IOM Core Functions Core Functions of Public Health and How They Relate to the 10 Essential Services • Assessment 1. Monitor environmental and health status to identify and solve community environmental health problems 2. Diagnose and investigate environmental health problems and health hazards in the community Core Functions of Public Health and How They Relate to the 10 Essential Services • Policy Development Inform, educate, and empower people about environmental health issues 2. Mobilize community partnerships and actions to identify and solve environmental health problems 3. Develop policies and plans that support individual and community environmental health efforts 1. Core Functions of Public Health and How They Relate to the 10 Essential Services • Assurance Enforce laws and regulations that protect environmental health and ensure safety 2. Link people to needed environmental health services and assure the provision of environmental health services when otherwise unavailable 3. Assure a competent environmental health workforce 4. Evaluate effectiveness, accessibility, and quality of personal and population-based environmental health services 5. Research for new insights and innovative solutions to environmental health problems 1. Ten Essential Public Health Services Core Function: Assessment Essential Service Meaning of Essential Service 1. Monitor health status to identify and solve community health problems. This service includes accurate diagnosis of the community’s health status; identification of threats to health and assessment of health service needs; timely collection, analysis, and publication of information on access, utilization, costs, and outcomes of personal health services; attention to the vital statistics and health status of specific groups that are at a higher risk than the total population; and collaboration to manage integrated information systems with private providers and health benefit plans. Example Vital Statistics Health Surveys Surveillance, Including Reportable Diseases Ten Essential Public Health Services Core Function: Assessment Essential Service Meaning of Essential Service 2. Diagnose and investigate health problems and health hazards in the community. This service includes epidemiologic identification of emerging health threats; public health laboratory capability using modern technology to conduct rapid screening and high-volume testing; active infectious disease epidemiology programs; and technical capacity for epidemiologic investigation of disease outbreaks and patterns of chronic disease and injury. Example Epidemic Investigations CDC–Epidemiology Intelligence Service State Public Health Laboratories Ten Essential Public Health Services Core Function: Policy Development Essential Service Meaning of Essential Service 3. Inform, educate, This service includes social and empower people marketing and media about health issues. communications; providing accessible health information resources at community levels; active collaboration with personal health care providers to reinforce health promotion messages and programs; and joint health education programs with schools, churches, and worksites. Example Health education campaigns, such as comprehensive state tobacco programs Ten Essential Public Health Services Core Function: Policy Development Essential Service Meaning of Essential Service 4. Mobilize community partnerships and action to identify and solve health problems. This service includes convening and facilitating community groups and associations, including those not typically considered to be health-related, in undertaking defined preventive, screening, rehabilitation, and support programs; and skilled coalition building to draw upon the full range of potential human and material resources in the case of community health. Example Lead control programs: testing and follow-up of children, reduction of lead exposure, educational followup, and addressing underlying causes Ten Essential Public Health Services Core Function: Policy Development Essential Service Meaning of Essential Service 5. Public Health Concepts

Develop policies and plans that support individual and community health efforts. This service requires leadership development at all levels of public health; systematic communityand state-level planning for health improvement in all jurisdictions; tracking of measurable health objectives as a part of continuous quality improvement strategies; joint evaluation with the medical health care system to define consistent policy regarding prevention and treatment services; and development of codes, regulations, and legislation to guide public health practice. Example Newborn screening program for PKU and other genetic and congenital diseases Ten Essential Public Health Services Core Function: Assurance Essential Service Meaning of Essential Service This service involves full 6. Enforce laws and enforcement of sanitary codes, regulations that especially in the food industry; full protect health and protection of drinking water ensure safety supplies; enforcement of clean air standards; timely follow-up of hazards, preventable injuries, and exposure-related diseases identified in occupational and community settings; monitoring quality of medical services (e.g., laboratory, nursing home, and home health care); and timely review of new drug, biological, and medical device applications. Example Local: Fluoridation and chlorination of water State: Regulation of nursing homes Federal: FDA drug approval and food safety Ten Essential Public Health Services Core Function: Assurance Essential Service Meaning of Essential Service 7. Link people to needed personal health services and ensure the provision of health care when otherwise unavailable. Public Health Concepts

Example This service (often referred to Community Health as “outreach” or “enabling” Centers service) includes ensuring effective entry for socially disadvantaged people into a coordinated system of clinical care; culturally and linguistically appropriate materials and staff to ensure linkage to services for special population groups; ongoing “care management”; and transportation. Ten Essential Public Health Services Core Function: Assurance Essential Service Meaning of Essential Service 8. Ensure the provision of a competent public and personal health care workforce. This service includes education and training for personnel to meet the needs for public and personal health services; efficient processes for licensure of professionals and certification of facilities with regular verification and inspection followup; certification programs; active partnerships with professional training programs to ensure community-relevant learning experiences for all students; and continuing education in management and leadership development programs for those charged with administrative roles. Example Licensure of physicians, nurses, and other health professionals Ten Essential Public Health Services Core Function: Assurance Essential Service Meaning of Essential Service 9. Evaluate effectiveness, accessibility, and quality of personal and populationbased health services. This service calls for ongoing evaluation of health programs, based on analysis of health status and service utilization data, to assess program effectiveness and to provide information necessary for allocating resources and reshaping programs. Example Development of evidence-based recommendations Ten Essential Public Health Services Core Function: ALL THREE IOM Essential Service Meaning of Essential Service 10. Research for new This service includes insights and innovative solutions continuous linkage with to health problems appropriate institutions of higher learning and research and an internal capacity to mount timely epidemiologic and economic analyses and conduct needed health services research. Example NIH, CDC, AHRQ other federal agencies Federal Health Agencies of the Department of Health and Human Services • Centers for Disease Control and Prevention (CDC) – The lead agency for prevention, health data, epidemic investigation, and public health measures aimed at disease control and prevention • Agency for Toxic Substances and Disease Registry (ATSDR) – The CDC administers ATSDR, which works with the Environmental Protection Agency to provide guidance on health hazards of toxic exposures. Federal Health Agencies of the Department of Health and Human Services • National Institutes of Health (NIH) – Lead research agency; also funds training programs and communication of health information to professional community and the public. • Food and Drug Administration (FDA) Public Health Concepts

– Consumer protection agency with authority for safety of foods and safety and efficacy of drugs, vaccines, and other medical and public health interventions Federal Health Agencies of the Department of Health and Human Services • Health Resources and Services Administration (HRSA) – Seeks to ensure equitable access to comprehensive quality health care • Agency for Healthcare Research and Quality (AHRQ) – Research agenda to improve the outcomes and quality of health care, including patient safety and access to services Federal Health Agencies of the Department of Health and Human Services • Substance Abuse and Mental Health Services Administration (SAMHSA) • Works to improve quality and availability of prevention, treatment, and rehabilitation for substance abuse and mental illness • Indian Health Services (IHS) • Provides direct health care and public health services to federally recognized tribes Global Public Health Organizations • World Health Organization (WHO) Public Health Concepts

• United Nations Organization • UNICEF; UNAIDS • Focus on childhood Vaccinations Focus on AIDS • UN Organizations UN: “The Millennium Report” – Millennium development goals (MDGs) • The MDGs were developed to relieve poor health conditions around the world and to establish positive steps to improve living conditions (UN, 2013). By the year 2005, all member nations pledged to meet Millennium goals. – – – – – – – – Copyright © 2016 by Elsevier Inc. MDG 1: MDG 2: MDG 3: MDG 4: MDG 5: MDG 6: MDG 7: MDG 8: Eradicate extreme poverty and hunger. Achieve universal primary education Promote gender equality and empower women. Reduce child mortality Improve maternal health. Combat HIV/AIDS, malaria, and other diseases. Ensure environmental sustainability Develop a global partnership for development 42 American Public Health Association (APHA) • APHA support the health of all people and all communities. Empower the public health profession and speak out for public health issues and policies backed by science. • Mission: Improve the health of the public and achieve equity in health status • Vision: Create the healthiest nation in one generation • APHA publishes the American Journal of Public Health and The Nation’s Health newspaper American Public Health Association (APHA) “We all deserve access to a culture of health – living as long as you can, as well as you can and having a short but glorious ending. It also means having a system in place that ensures we can all achieve it.” – APHA Executive Director Georges Benjamin, MD Affordable Care Act • Need for insurance – Though the ACA has helped about 20 million get health insurance. • Emphasis on prevention – Seven in 10 deaths in the U.S. are related to chronic diseases such as obesity, diabetes, high blood pressure, heart disease, and cancer, which are largely preventable. – 86 percent of our health care dollars are spent treating such diseases. Public Health Concepts

– Only three cents of each health care dollar spent in the U.S. go toward prevention. References American Public Health Association. www.apha.org Center for Disease Control and Prevention. www.cdc.gov Center for Disease Control. (2013). United States Public Health 101. Retrieved from https://www.cdc.gov/publichealthgateway/docs/usph101.pdf Goudreau, K.A. & Smolenski, M.C. (2014). Health policy and advanced practice nursing: Impact and implications. ISBN: 9780826169426 References Healthy People 2020. www.healthypeople.gov National Institute of Health. www.nih.gov U.S. Department of Health and Human Services. www.hhs.gov U.S. Public Health Services. www.usphs.gov Public Health Prof. Emily Díaz Acevedo, MSN, APRN, FNP-C What is Public Health? • Public Health is the discipline that addresses health at a population level. • The health of the population as a whole, monitored, regulated, and promoted by the state. • What is Public Health? • https://www.youtube.com/watch?v=jA8uYvJ_i8Y What is Public Health? • Public health promotes and protects the health of people and the communities where they live, learn, work and play. • While a doctor treats people who are sick, those of us working in public health try to prevent people from getting sick or injured in the first place. • We also promote wellness by encouraging healthy behaviors. What is Public Health? • Fro … Public Health Concepts