Public Health and the PA

Public health

the practice of protecting and improving the health of people in a community; population is primary focus; prevention/public health emphasis; public sector; clinical sciences are peripheral to professional training

Medicine

primary focus is on the individual; diagnosis and treatment emphasis; private sector; clinical sciences major component of training

Primary prevention

intervening before health effects occur

banning substances known to cause health effects; dietary modification, smoking cessation, vaccinations

what are some examples of primary prevention

secondary prevention

identifying diseases in early stages -- screening

mammography, blood pressure checks

examples of secondary prevention

tertiary prevention

slowing down or stopping disease progression; preventing complications

Chemotherapy, rehabilitation, preventing and screening for complications.

examples of tertiary prevention

assessment, policy development, assurance

public health core functions

Assessment

Collect, analyze, make available information on healthy communities.

Policy development

Promote use of scientific knowledge base in policy and decision making.

Assurance

Ensure provision of services

John Snow

father of epidemiology; mapped out cholera cases in London and discovered cholera was water borne from contaminated sewage and not airborne, as previously thought.

Epidemiology

the study of the distribution and determinants of health-related states/events in specific populations, and the application of this study to the control of health problems; application of study to control health problems

Descriptive epidemiology

Study of distribution of diseases or determinants/patterns in cases and populations

Inherent characteristics

individual attributes such as race, national origin, religion, and gender

Acquired characteristics

traits altered by an individual organism during its life; marital status, vaccination status

Behaviors and activities

occupation, leisure activities, seatbelt use, tobacco use

Incidence

rate with which new events occur during a specified period; NEW cases only

Prevalence

proportion of people in a population which have a disease at a specific point in time or during a specified period; OLD AND NEW CASES

Point prevalence

The number of cases of a specific condition or disorder that can be found in a population at one given point in time.

Period prevalence

all cases of a disease within a period of time

Morbidity

state of being symptomatic or unhealthy for a disease and condition; described as disease incidence/prevalence; population's likelihood of developing an illness, injury, or disability or adverse health condition

Mortality

number of deaths caused by a health event under investigation; frequency of occurrence of death among a defined population during a specified time period

Analytic epidemiology

a form of epidemiology that investigates causes and associations between factors or events and health

Observational studies

case control or cohort studies

Experimental studies

randomized controlled trials

Vital records (births and deaths)

Birth certificates

Death certificates

Morbidity and laboratory reporting systems

Epidemic investigations

Health care data systems - ICD (International Classification of Diseases)

Health and non health related surveys

examples of data sources used in analytic epidemiology

Surveillance

Collecting, analyzing, interpreting data and disseminating that data to those who need to know; used to monitor, control, and prevent the occurrence and spread of disease

CDC Division of Health Informatics and Surveillance

Helps health departments collect and manage information

National Notifiable Disease Surveillance System

Rely on data from local, tribal, or state health authorities

Healthy People 2030

Science based 10-yr national health objectives aimed at improving the health of individuals

Core Objectives Healthy People 2030

Measurable high priority public health issues; evidence based data/interventions (2015 or later)

Developmental Objectives Healthy People 2030

High priority public health issues evidence-based interventions, without reliable baseline data

Research Objectives Healthy People 2030

Issues with high economic burden/disparities; missing baseline data and evidence-based interventions

ECBP-16

Increase the inclusion of core clinical prevention and population health content in physician assistant training

ECBP-D11 (2030)

Increase core clinical prevention and population health education in physician assistant training programs.

United States Preventive Services Task Force

Volunteer panel of experts in prevention and evidence-based medicine (in multiple specialties); makes recommendations on preventative services

AHRQ (Agency for Healthcare Research and Quality)

Supports research that improves the quality of health care and helps people make informed health care decisions, develops partnerships that create long term improvement in America health care, research goals measure improvements in terms of client outcome, decreased mortality, improved quality of life and cost effective quality care, and focus on safety and quality, effectiveness, and efficiency

Indian Health Service (IHS)

The federal agency within HHS that is responsible for providing federal healthcare services to American Indians and Alaskan natives

Health Resources and Services Administration

the primary federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable

State and Local Health Departments

Function in Surveillance (Assessment); Collecting population health data and analyzing information on health status; Policy development to maintain and promote health; assurance that population has access to public health services

State Health Agencies

Agency within the state that has primary responsibility for public health in the state

quarantine and isolation, vaccination, licensing of healthcare providers, water fluoridation, standards for food and drinking water (not consistent among the 50 states)

state health agency powers

EMS regulation/licensing

Lab inspection

Vital records - birth and death certificates

Licensing medical providers

PDMP (Prescription Drug Monitoring Program)

Shares with 21 states, military health systems

SHA responsibilities

Communicable Disease Control

Prevention, detection, and control of communicable diseases

Health Promotion and Risk Reduction

Chronic disease, injury prevention, violence prevention; Evidence based prevention strategies

Immunization programs

Sexually transmitted infection counseling and partner notification

Tb control

HIV/AIDS screening

how does Communicable Disease Control function?

Increased focus on culture and policy change

Bike lanes on roads

Fresh produce in low-income neighborhoods

Data collection on behavioral risk factors

what does Health Promotion and Risk Reduction do in society?

Maternal, Child, and Family Health

Nutrition support for pregnant women, infants, and children (WIC); services for children with special health care needs

Access to Clinical Care

Address health disparities and minority health initiatives; rural health services; identify health professional shortage areas