6 - Public Health in the US

What are the major activities of public health?

• preventing disease & prolonging life

• promoting health through environmental efforts

• controlling communicable diseases

• advocating health education through personal hygiene

• organizing medical services for early diagnosis and preventative treatment of disease

• ensure health as a right of every citizen

What were the early public health initiatives?

• local health boards responding to epidemics - 1700s

• discovery of vaccines - 1796

• started linking sanitation to health - 1847

• linked sanitation to cholera - 1854

What is public health today?

• assessment

• policy development

• assurance

How is public health assessed?

investigate and address health hazards

How is public health policy developed?

• communication & education

• support & mobilize communities

• create & implement policies

• utilize legal & regulatory action

How is public health assured?

• build & maintain strong organizational infrastructure

• build skilled, diverse workforce

• enable equitable access

• innovate with evaluation, research, and quality improvement

Define individual health medicine

focuses on health of the individual, one patient at a time

• i.e. provision of appropriate medications, reduces pain and suffering for the individual

can often judge success precisely and quickly

Define public health

focuses on improving the health of the public as a whole, specifically on prevention of morbidity and mortality

• i.e. improve Arkansas’ health with nutrition, diet, and exercise programs

more difficult to judge the success of public health interventions

Define population health

improves the well-being of a specific group of people within the public at large

• populations sharing factors (location, ethnicity, age, disease)

Define epidemiology

the study of the factors that determine the frequency and distribution of disease in human populations

How is epidemiology data used?

to generate hypotheses regarding cause/effect of disease considering:

• host

• environment

• agent (exposures)

can be used to report health statistics

Identify government organizations that are important in the provision of public health services

US Department of Health & Human Services:

• FDA

• CDC

• agency for healthcare research & quality

• admin on aging

• indian health service

• CMS

• health resources & services admin

• NIH

• surgeon general

What is the function of the food & drug administration (FDA)?

responsible for protecting public health by assuring safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, and food supply

What is the function of the centers for medicare and medicaid services (CMS)?

provides health coverage through medicare, medicaid, the children’s health insurance program, and the health insurance marketplace

What is the function for centers for disease control and prevention (CDC)?

• protect public health from foreign and domestic health hazards

• fight disease - illness, chronic conditions, injuries, disabilities

• promotes safety

What is the function of the national institutes of health (NIH)?

steward of medical and behavioral research, seeks to apply knowledge to enhance health, lengthen life, and reduce illness & disability

What is the function of the office of the surgeon general (OSG)?

oversees the US public health services commissioned corps

What are the relationships between global, national, state, and local public health entities?

global entities (i.e. World Health Organization - WHO) divides into regional entities, which divide into national agencies

Define primary disease prevention

prevent disease or injury before it ever occurs, usually in a healthy population

• do this by preventing exposures to hazards that cause disease or injury or altering unhealthy/unsafe behaviors

Define secondary disease prevention

reduces impact of a disease or injury that has already occurred

• detecting and treating disease/injury as soon as possible to halt or slow its progress

Define tertiary disease prevention

limiting disability or the impact of disease when disease has already occurred

What are the levels of health promotion interventions?

• community level

• state/national level

• individual level

What is the role of community level health promotion interventions?

create a healthy environment

• i.e. sanitation, smoking regulation, bike lanes

What is the role of state/national level health promotion interventions?

pass laws and provide appropriate resource allocation to enable health-promoting services

• i.e. healthcare laws, federal motor vehicle safety standards

What is the role of individual level health promotion interventions?

persuade individuals to take actions known to affect health positively

• i.e. health education, calorie information at restaurants

What is the role of the state department of health?

state agencies devoted to public health

• emergency/disaster preparedness, certificates & registries, licensing, diseases & conditions, prevention, public health safety

• conduit between federal & county health offices

What is the role of local health departments?

• derives power from local government

• one-on-one interactions occur as well as community intervention

• many cities and counties form combined departments

What is the role of local health boards?

• hires and advises director of local health department

• appointed by mayor or local government

What is the US public health workforce?

• people employed at local, state, and federal government health agencies

• public health research academia

• private sector healthcare delivery organizations

What are common powers of the local health department?

fines, closure, ability to condemn, revocation of permits

What are opportunities for pharmacists to make a significant public health impact?

• pharmacists are often hired by the US public health service to review and monitor drugs, conduct research, and assist in public health emergencies

• MedWatch - pharmacist can complete the voluntary reporting form which monitors the incoming ADE

What is the influence of public health activities on health?

gain of 25 years of life expectancy largely due to public health in the previous century

List health promotion activities that can be performed by pharmacists

• pharmacovigilance - the detection, assessment, and prevention of ADE

• drug take backs - can reduce drug diversion

What resources can identify public health priorities and public health interventions in the US?

healthy people 2030 objectives & measures:

• data-driven goals to improve health over the next decade

• guides national health promotions and disease prevention efforts

clinical preventive services:

• evaluate benefits of primary and secondary prevention, assists clinicians in screening

• offer evidence based recommendations