Public Health part 2

Evolution of Public Health

Intends to provide some perspective on how protection of

citizens from health threats came to be a public responsibility and on how the public health system address

health threats.

↓ polluted water and lack of proper waste disposal

spread of vector-borne disease

↓ regulation of type of food eaten and certain behaviors

pork (Muslims), drinking alcohol, sexual relations

↓ government leaders to develop policies and programs

to understand the cause of disease, ensure stability, prosperity

Public Health

most ancient of human activities

public health measures

- strong rules/regulations/taboos/powers to protect the community's health

- imposed by the political system

belief system

- public health measures

- religion, superstitions, science

Air

poor quality can cause sickness/death, often in minutes

Water

poor quality/lack of water can cause sickness or death in days

Food

can sustain or injure; poor quality/lack

of food can cause sickness or death in

days or weeks

Shelter

must have, at least on a seasonal basis

Care and

mutual support

birthing and protecting the new generation

Tribal rules

related to protecting the mothers and children and fighting for survival

Bible (Leviticus)

driving away the leapers (leprosy)

health codes

based on the society's belief system and the society's understanding of health/disease

Ancient Greece (500 - 323 BC)

- personal hygiene,

- physical fitness,

- naturalistic concept

naturalistic concept

disease caused by imbalance between man and his environment

Hippocrates (460 BC)

-Father of western medicine

- Believed that illness had a physical and rational explanation.

-Looked for and described causal relationship between disease and factors such as climate, soil, water, lifestyle and nutrition.

**coined the term EPIDEMIC

Roman Empire (23 BC - 476 AD)

Public Diversion of Human Waste: Necessary Tenet of Public Health

Romans

- Adopted Greek health values

- Great engineers

= Sewage systems

= Aqueducts

- Administration*

= Public baths

= Water supply**

= Markets

Middle Ages / Dark Ages (476 - 1450 AD)

Chinese & Europe

Variolation (Smallpox Epidemic 1000BC)

the process by which material from smallpox sores (pustules) was given to people who has never has smallpox

Chinese

Variolation (Smallpox Epidemic 1000BC)

Europe

- physical body less important than spiritual self

- beginnings of Public Health Tools

- Quarantine in Medieval Period

The Plague / Black Death / Bubonic Plague

- 14th century EU epidemic

- A disease caused by the bacterium Yersinia pestis that circulates among wild rodents.

o Remove bodies of the dead

o Burning of cities

- death of 25 to 50% of population

Yersinia pestis

bacterium that caused the Black Death

Renaissance (1400 - 1600 AD)

Global Exploration

Global Exploration

- arts and literature and exploration flourished

- explorers and traders unknowingly spread disease

Smallpox

rash, large pustules in the skin, fever, restlessness, delirium, coma, death

Age of Reason and Enlightenment (1650 - 1800 AD)

Birth of Modern Medicine

- william harvey

- edward jenner

William Harvvey

- 1628 theories of circulation

- first to suggest that humans and other mammals reproduced via the fertilization of an egg by sperm

- used dissection (no microscope) to create theories

1628 theories of circulation

- Demonstrated function of the heart and circulatory

system

- Publication of Harvery's theories, "An Anatomical Study of the

Motion of the Heart and of the Blood in Animals"

Edward Jenner

- 1796 cowpox experiment

- coined the term "vaccine"

- laid the foundation of modern immunology as a science

Industrialization and Urbanization (1800s)

Produced a new set of public health problems: Slums, Poverty, Disease

"Great Sanitary Awakening" (1800s - 1900s)

Birth of Modern Public Health

Birth of Modern Public Health

- Great strides in scientific knowledge to help understand the

origin and treatment of disease.

- Interest in humanitarian ideals

- Acknowledge connection between poverty and disease

- new infrastructure for clean water and sewage removal

- system to monitor health status

Michael Foucault

- plaque model of governmentality

- treatment of cholera (Social medicine)

- Miasma theory of disease

Miasma theory of disease

disease from poor sanitation

Dr. John Snow (1813 - 1858)

- Father of Epidemiology

- First to identify a polluted public water as a source of 1854 cholera outbreak in London through Epidemiologic mapping.

Anton Von Leeuwenhoek

1680 microorganisms as cause of disease

Louis Pasteur

- Pasteurization

- 1862 germs caused many diseases

- 1888 first public health laboratory

Robert Koch

- 1883 identified the vibrio that causes cholera, 20

years after Snow's discovery; Vibrio cholerae (vibrio = water)

- Discovered the Mycobacterium tuberculosis bacterium

Modern Public Health

increase in life span through health efforts

500 BC

Greeks and Romans practice community sanitation measures

1840

The Public Health Act of 1848 was established in

the United Kingdom

1970

The Environmental Protection Agency was founded

Influenza

500 million infected worldwide in 1918

Polio

Vaccine introduced in 1955;

Eradication initiative launched in 1988

HIV

34 million living with HIV worldwide;

20% decline in new infections since 2001

Biologic Warfare

Plague used as a weapon of war during the Siege of Kaffa

September 2001

Public health surveillance conducted after the 9/11 attacks

Hurricane Katrina

Emergency services, public health surveillance, and disease treatment provided

Book of Leviticus

The world's first written health code (lepers)

Tobacco Laws

Laws banning smoking in public places

Obesity

Food labeling and promotion of physical

activity

prevention of disease

Public Health goal

community

public health patient

cure

goal of medicine

individual

medicine patient

Improved sanitation

major reason for increased longevity

Provision of clean water

major reason for increased longevity

Universal immunization programs

major reason for increased longevity

Health education and prevention practices

major reason for increased longevity

Improved treatment and prevention of chronic diseases

major reason for increased longevity

Science

how we understand threats to health, determine what interventions might work and evaluate whether the interventions worked

Politics

how we as society make decisions about what policies to implement

scope of public health

- infectious diseases

- chronic diseases

- nutrition disorders

- health of the vulnerable

- accidents, violence, injuries

- health equity

- occupational health

- environmental health

- access to health care

- quality of health care

- war

Pharmacists in public health

an accessible resource for health and medication information

Role Recognition of Pharmacists

- drug information

- health screening

- immunization

- pain control

- research

- counseling and health education

- self-management

- smoking cessation

- family planning

- medication indication and conditions

Public Health Education of Pharmacists

- Actively teaching allied-health professionals

- pharmacist involvement for quality care and advancing public health policy

- dual degree program

Levels of Pharmacist Public Health Activity

- patient centered; focus on prevention

- dispensing

- micro and macro

Public health and pharmacist's services

- monitor health status

- develop and mobilize community partners

- empower community members

Assessment

through research to assure that medications

are utilized

Policy Development

Public health legislation, regulation, and advocacy

Assurance

- Improved access to health care;

- Prevention of medication error;

- Access to health services and resources

Pharmacists and Prevention

- acts as first responders (OTC meds)

- education for prevention of chronic diseases

- provide rehabilitation support

- in rural settings

Desired Actions of Pharmacists

1. greater inclusion of public health concepts

2. awareness

3. trans disciplinary collaboration

4. pharmacists trained in public health for health worker shortages

5. legislation

6. participation

Pharmacoepidemiology

the study of the use and effects of drugs on large groups of people

Post-marketing surveillance

gathers data gathered after the drug is already open for public use, or marketed in areas where the drug is needed

Infectivity

- Refers to the proportion of exposed persons who become

infected.

- It is the ability of a pathogen to establish an infection.

Pathogenicity

- Refers to the proportion of infected individuals who develop

clinically apparent disease.

- the property of causing disease.

Virulence

- Refers to the proportion of clinically apparent cases that

are severe or fatal.

- It is the severity or harmfulness of as disease or poison.

Reservoir

the habitat in which

the agent normally lives, grows, and multiplies

Carriers

Are persons who are infectious but have subclinical disease

or these are persons with incubating disease or inapparent

infection.

Portal of Exit

Is the path by which an infectious agent leaves the reservoir.

Mode of Transmission

Is the movement of pathogens from the reservoir to the host.

Portal of Entry

Is the path by which an infectious agent enters the host.

Susceptible Host

Is a person lacking effective resistance to a particular pathogen.

Natural History of Disease

Refers to the progression of a disease process in an individual over time, in the absence of treatment.

incubation period

stage of subclinical disease, extending from the time of exposure to onset of disease symptoms for infectious diseases

- asymptomatic (no symptoms) or inapparent.

latency period

stage of subclinical disease, extending from the time of exposure to onset of disease symptoms for chronic diseases

- asymptomatic (no symptoms) or inapparent.

onset of symptoms

marks the transition from subclinical

to clinical disease.

stage of clinical disease

where most diagnoses are made

spectrum of disease

illness that ranges

from mild to severe or fatal

Epidemiologic Triad

host, agent, environment

Host

- refers to the human who can get the disease

- risk of exposure and resistance to infection

Agent

an infectious microorganism or

pathogen: bacterium, virus, fungus, or parasite

Environment

- refers to extrinsic factors that affect the agent and the opportunity for exposure

- sanitation and cleanliness of the unit,

temperature, and humidity, animate, inanimate objects

Opportunities for exposure

- sexual practices

- hygiene

- personal choices by age and sex

Susceptibility and response

- genetic composition

- nutritional and immunologic status

- anatomic structure

- presence of disease or medication

- psychological makeup