Public Health Definitions, Philosophy and Purpose Dr. Anjum Odhwani MD, MPH

Public Health

Definitions, Philosophy and Purpose

Dr. Anjum Odhwani MD, MPH

Definition of Public Health

• The word “Public” means a defined group of people

• Health is derived from the word hal which means “hale, sound or whole”

• WHO (1947) Definition of Health– a state of complete physical, mental, and

social well-being and not merely the absence of disease or infirmity

Definitions of Health

• Hahn and Payne (2001)• Physical • Emotional • Mental/Intellectual • Social • Spiritual• Environmental/Occupational

Definitions of Health

• Health may be defined as a dynamic state or condition that is multidimensional in nature and results from an individuals adaptations to his or her environment. It is a resource for living and exists in varying degrees.

Source: McKenzie, Pinger, Kotecki. An introduction to

community health 4th ed


• Winslow’s definition of 1920– public health is the science and art of

• preventing disease• prolonging life• promoting physical health• efficiency through organized community

effort

• for:

Public Health continued• The following

– the sanitation of the environment– the control of communicable infections– the education of the individual in personal

hygiene– the development of the social machinery to

insure everyone in the community a standard of living adequate for the maintenance of health

– the organization of health care services for early diagnosis and preventive treatment


• Public Health refers to the health status of a defined group of people and the governmental actions and conditions to promote, protect and preserve their health

Source: McKenzie, Pinger, Kotecki.

An introduction to community health 4th ed

Group of people and governmental actions

The continuum of health

Tertiary Prevention

Secondary Prevention

Treatment

Clinical manifestation• signs• symptoms

Presympt. disease• signs• no symptoms

Susceptibility• risk factors • no signs/ symptoms

Disability

Health & PrimaryPromotion Prevention

Examples of phases of prevention

Self-care

Provider

Community

ExerciseHealthy diet

Immunization (MD)Subluxation correction* (DC)Dental prophylaxis (DDS)Lifestyle advice (all)

Water purification

Primary

Self exams

Screening exams

Seat belt law

Secondary

Rehab exercises

Rehab

Needle exchange program

Tertiary

* Based on chiropractic principles

Relationship between Individual, Community and Nation

Individual

Community

Nation

Community and community health

• Community– is a group of people who have common

characteristics; communities can be defined by location, race, ethnicity, age, occupation, interest in particular problem or outcomes or common bonds

• Community health– Refers to the health status of a defined group of

people and the actions and conditions both private and governmental to promote, protect and preserve health

Group of people and the actions and conditions by private and government

Healthy people 2010

Factors that Affect the Health of a Community

• Biology• Physical factors• Social and/or cultural

factors• Community

organization• Individual behaviors• Policies and

interventions• Access to health care


• Biology– Individual’s genetic make up– Factors with which he or she is born with– Family history which may suggest risk for

disease (e.g. sickle cell anemia)– Acquired physical and mental health problems

during life (e.g. Diabetes)


• Physical factors– Geography (tropical countries-parasitic

and infectious diseases, Temperate-obesity and heart diseases)

– Environment (Take the charge of soil, water and air)

– Community size (positive and negative impact)

– Industrial development (positive and negative impact)


• Social and cultural factors– Social factors are those that arise from the

interaction of individuals or groups within the community (e.g. urban communities, fast-paced life, higher rates of stress-related illnesses)

– Cultural factors arise from guidelines (both explicit and implicit) that individuals inherit from being part of a particular society


• Social and cultural factors (continued)– Beliefs, traditions and prejudices

– Economy


• Social and cultural factors (continued)– Religion (permit medical treatment, blood

transfusion, abortion, premarital sex)

– Social norms (smoking, alcohol)– Socioeconomic status

Relationship Between Household Income

and Fair or Poor Health Status


• Community organizing– Definition

• a process through which communities are helped to identify common problems or goals, mobilize resources and in other ways develop and implement strategies for reaching the goals they have collectively set.

• Communities organize their resources effectively they will be better equipped to address and resolve their community health problems


• Individual behavior– Behavior of individual community

members contributes to the health of the entire community

– Concentrated effort (recycling, seat belts)

– Herd immunity


• Policies and interventions– Powerful positive and negative effect on

the health of individual and communities– E.g. health promotion campaign to prevent

smoking– School health education programs– Healthy lunches in schools

Leading Health Indicator of Healthy people 2010

• Access to Health Care

• Strong predictors of access to quality health care are – Health insurance– Regular primary care provider or other source

of ongoing health care. – Use of clinical preventive services, such as

early prenatal care, serves as an indicator of access to quality health care services.

Objectives of Healthy people 2010 for access

• Increase the proportion of persons with health insurance.

• Increase the proportion of persons who have

a specific source of ongoing care.

• Increase the proportion of pregnant women who begin prenatal care in the first trimester of pregnancy

Increase the proportion of persons with health insurance

• Health insurance provides access to health care.• Persons with health insurance are more likely to

have a primary care provider and to receive appropriate preventive care such as Pap test, immunization, or early prenatal care.

• Adults with health insurance are twice as likely to receive a routine checkup as are adults without health insurance

Source: healthy people 2010

Increase the proportion of persons with health insurance

• More than 44 million people in the United States do not have health insurance

• Including 11 million uninsured children

• About one-third of adults under age 65 years below the poverty level are uninsured

• Mexican Americans has one of the highest uninsured rates at 40 percent


Ongoing Sources of Primary Care

• More than 40 million Americans do not have a particular doctor’s office, clinic, health center, or other place where they usually go to seek health care or health-related advice..

• People aged 18 to 24 years are the most likely to lack a usual source of ongoing primary care

• Only 80 percent of individuals below the poverty level and 79 percent of Hispanics had a usual source of ongoing primary care


Barriers to Access• Financial: not having financial capacity• Structural: lack of primary care providers,

medical specialists, or other health care professionals or lack of health care facilities

• Personal barriers: cultural or spiritual differences, language barriers, not knowing what to do or when to seek care, or concerns about confidentiality or discrimination


Essential Public Health Services

Marine Hospital Service 1798


• Monitor health status to identify community health problems

• Diagnose and investigate health problems and health hazards in the community

• Inform, educate, and empower people about health issues

• Mobilize community partnerships to identify and solve health problems

• Develop policies and plans that support individual and community health efforts


• Enforce laws and regulations that protect health and ensure safety

• Link people with needed personal health services and assure the provision of health

• Care when otherwise unavailable

• Assure a competent public health and personal health care work force


• Evaluate effectiveness, accessibility, and quality of personal and population-based health services

• Research for new insights and innovative solutions to health problems

Source: Reprinted from Essential Public Health Services Working Group of the Core Public Health. Functions Steering Committee, 1994, U.S. Public Health Service.

Results of Public Health Services

• Improved health status

• Diseases prevented

• Scarce resources saved

• Improved quality of life

FORMAL NAMEINFORMAL NAME

% ALL DEATHS

(1) Diseases of the heart

heart attack (mainly)

28.5%

(2) Malignant neoplasms

cancer 22.8%

(3) Cerebrovascular disease

stroke 6.7%

(4) Chronic lower respiratory disease

emphysema, chronic

bronchitis 5.1%

(5) Unintentional injuries

accidents 4.4%

CAUSES OF DEATH, USA, 2002

Top 5 Chronic Diseases in the US

• Heart disease

• Cancers

• Stroke

• Chronic obstructive pulmonary disease

• Diabetes

• Account for over 2/3 of all deaths in the United States

• 70% of total health care budget spent on these

Important aspect

• Where should health care dollars and public health spending be focused?– Should it be on spending for management of

these chronic diseases, or should it be put more into prevention and “wellness care”?

– What should the role of chiropractic be in this?

Governmental Presence in Health

• Is this good or bad?

• Rome was concerned with the well-being of its citizens– they enhanced the public health of the people

• Many object to the government being involved– public health threatens a person’s right to be

dirty

Governmental Presence in Health

• How far should the government be involved in public health?

– Should the government be able to mandate that all children should be immunized before they can attend a public school?

– Quarantining of people with an infectious disease (SARS)

One Idea to consider about Public Health Services

• What is the economic value of a life?

• Many have tried to answer this question – since the 1600’s

• Comes down to factors– capital cost– installation value– period of productivity– period of retirement

Capital Cost

• Investment society has in each infant by the time he/she is born– economic incapacitation of mother– risk of death or injury of mother– cost of childbearing– risk of death or injury of infant

Installation Cost

• Investment from birth until child reaches 18– physical needs– value of parenting– education– health care– recreation and transportation– insurance and interest– risk of death or disability

Period of productivity

• return society can expect on investment– credit

• earning potential and interest• non-economic potential

– debit• risk of disability, death, reduced potential interest• medical costs

Period of retirement• People are living longer

– a greater percentage of the population has reached retirement age

– they are surviving longer– while the birth rate has gone down – Overall the percentage of the population

working is decreasing

• As the individual ages their health condition gradually worsens, how should they be cared for?

Geriatric population

• In last 100 years

– Total population increased by 5x

– Geriatric population increased by 15x

• Fastest growing subset: 85+

• 100,000 over age 100 now in US

Life expectancy 1900-2050 (est.)

2004

How can the Economic value of Health Programs be assessed?

• Compare spending on the program to the overall savings at a result– about 50 years ago in NY

• spent $500,000 on an early case-finding program for pneumonia

• saved $5,000,000 a year in health care costs

– Detroit• spent $1,000,000 on a program against TB• saved $5,000,000 a year

Public health in America

• Vision:– Healthy people in healthy communities

• Mission– Promote physical, mental health and

prevent disease, injury and disability

Documents

Public Health Definitions, Philosophy and Purpose Dr. Anjum Odhwani MD, MPH