Public Health and Prevention M6920 September 18, 2001

Public Health and Prevention

M6920September 18, 2001

Columbia University School of Nursing M6920, Fall, 2001

Goals

An overview of the public health perspective

An introduction to the relationship of public health to personal care

The contribution of Healthy People 2010


The IOM report on Public Health

1988 review of the system Significant statement of the role of

public health Governmental public health:

creating the conditions within which people can be healthy


IOM called for a PH system which performs

Assessment Policy Development Assurance


This system should include

Federal leadership State organizational focus Local presence


The scope includes

the maintenance of physical and emotional health

the reduction of threats to health the provision of care when illness

occurs the quality of all of the above


Currently

The focus on cost of illness care overshadows health

Most "Health Professionals" are in the sick care business

There is only a weakly unified voice in public health

The system is poorly documented


Public Health

is founded on the idea of shared futures

an understanding of community some degree of enlightened self-

interest acceptance of the role of

government to achieve goals


Prevention triangles

Population Oriented Prevention

Clinical Preventive Services

Primary Medical Care

Secondary Medical Care

Tertiary Medical Care RelativeInvestment

TertiaryPrevention

SecondaryPrevention

PrimaryPrevention 2% of $$


A familiar process

a continuous cycle of gathering information, deciding, acting, evaluating


Essential services of public health

surveillance investigation public information community

organization policy

development

regulation service access

and delivery workforce assurance of

quality/ effectiveness

research


Public health in disasters

Surveillance• identify a new risk• monitor ongoing exposure

Limit threats to health Communicate health information Use legal authority if needed Assure access to services


Role development in a changing world

convener quality assurer informer


A century of progress

Vaccination Motor-vehicle safety Safer workplaces Control of infectious

diseases Decline in deaths from

coronary heart disease and stroke

Safer and healthier foods

Healthier mothers and babies

Family planning Fluoridation of drinking

water Recognition of tobacco

use as a health hazard


Use of vaccines


Occupational Injury

occupational health.gif


Foodborne infections

foodborn illness.gif


Motor vehicle related deaths

traffic deaths.gif


Deaths from infectious diseases

infectious disease.gif


Death from cardiovascular disease

heart disease.gif


Fertility rates, 1917-1997

fertility.gif


Trends in tobacco use

tobacco.gif


State spending on tobacco prevention*

0

20

40

60

80

100

120

140

160

180

% of CDC per capita recommendation

Miss.Mass.Minn.Vt.ArizMd.HawaiiCalif.Wash.N.J.Ore.Va.NY.NH.Conn.R.I.Texas

*National Center for Tobacco-Free Kids, 1999 data

New York


Healthier moms

maternalmortality.gif

Maternal Mortality


and healthier babies

infant mortality.gif

Infant Mortality


Flouridated water

flouride.gif


Community Health Improvement Process

Select priorities Plan for each selected priority Involve community partners at

each step Identify preferred outcomes and

measures before you begin


Healthy People 2010

National decade-long process Began in late 1970’s First cycle almost entirely “federal” Second cycle (HP2000) involved

many more groups Third cycle just begun


Conceptual framework


Healthy People 2010

Increase Quality

and Yearsof Healthy Life

Healthy People in Healthy

Communities

EliminateHealth

Disparities


Health status meansimprovement in. . .

Life expectancy Burden of illness Quality of life


Possible interventions

Health promotion Health protection Disease prevention Care and treatment


Focus areas

Access to quality health services

Arthritis, osteoporosis/ chronic back condit’ns

Cancer Chronic kidney disease Diabetes Disability/secondary

conditions HIV

Educat’l and commun-ity-based programs Environmental health

Family planning and sexual health

Food safety Health communication Heart disease and stroke Immunizations and

infectious diseases


Focus, cont.

Injury and violence Prevention

Maternal, infant, and child health

Medical product safety

Mental health Nutrition Occupational safety

and health

Physical activity and fitness

Public health infrastructure

Respiratory diseases Sexually transmitted

diseases Substance abuse Tobacco Use Vision and hearing Oral health


1997 Baseline* 2010 Target % All ages 86 96

<17 years 93 96

Adults 84 96 .


Increase in specific source of ongoing care

1997 Baseline 2010 Target

All Ages 86 96

< 17 93 96

Adults 84 96

Target setting method: Better than the best


What would it take?

Genetics? Physical environment? Social environment? Behavior? Medical care? ???


Substance abuse

Reduce drug-related hospital emergency department visits.

Target: 350,000 visits per year.

Baseline: 542,544 drug-related hospital emergency department visits in 1998.

Target setting method: 35 percent improvement.


What would it take?



Reduce hospitalizations for asthma

Age Group 1997 Baseline 2010 Target Rate per 10,000 under age 5 60.9 25

5 to 64 years 13.8 8

65 years and older 19.3 10 Target setting method: Better than the best.


What would it take?


Documents

Public Health and Prevention M6920 September 18, 2001