01-07a - introduction to healthcare and public health in the us - unit 07 - public health part 1 -...

Introduction to Health Care and Public Health in the US

Public Health (Part 1)

Lecture aThis material (Comp1_Unit7a) was developed by Oregon Health and Science University funded by the Department of Health

and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

Public Health (Part 1)Learning Objectives

2

Discern the main differences and similarities between public and private health (Lecture a)

Delineate the historic timeline and achievements of public health in the US (Lecture a)

Define and discuss key terminology of public health (Lecture b)

Illustrate the general organization of public health agencies and public health data flow (Lecture b)

Evaluate and explain the impact and value of public health (Lecture c)

Health IT Workforce Curriculum Version 3.0/Spring 2012

Introduction to Health Care and Public Health in the US Public Health, Part 1

Lecture a

What is Public Health?• Private Health

– Clinicians, Health Practitioners

– Treat Individual Health Problems

– Action usually taken after illness/injury occurs

• Public Health– Agencies– Treat/Maintain

Health of Populations

– Actions include Education, Policy, Research, Monitoring

3Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture a

Determination of Public Health Interest



Lecture a

In order for a condition to realistically be of interest to public health, it usually needs to match some degree of each of the following criteria: The condition/disease must be a) severe enough in its effects to warrant some type of intervention/monitoring, b) preventable or at least able to be mitigated by health interventions, behavioral modifications, etc., and c) prevalent enough in the population to warrant some type of intervention/monitoring.

7.1 Figure: Severity, Preventability, Prevalence

History of Public Health in the US



Lecture a

The Official Beginning

1798: An act passed that established a federal network of hospitals for ill/disabled merchant seamen. The Federal government deducted monthly sums from seamen’s wages. This act was widely considered to have laid the foundation for the national public health service.

(Note: Public Health had earlier beginnings in other parts of the world, which are not addressed here).

History of Public Health in the US1800s• 1800: Technique of smallpox vaccination introduced into the US

• 1878: National Quarantine Act passed, starting transfer of quarantine functions from state to federal level (at that time, the Marine Hospital Service).

• 1891: Immigration legislation passed, assigning medical examination of immigrants to the Marine Hospital Service. Wording of the law directed the exclusion of “all idiots, insane persons, paupers or persons likely to become public charges, persons suffering from a loathsome or dangerous contagious disease“ (and also criminals).

• 1893: First US school of public health and preventive medicine established, the Army Medical School (renamed Walter Reed Army Institute of Research in 1953).



Lecture a

History of Public Health in the US1900 – 1944• 1900: Pneumonia and influenza are leading causes of death in the

US.• 1902: The Marine Hospital Service changed to the Public Health and

Marine Hospital Service. In 1912, renamed the Public Health Service.

• 1910: The high rate of tuberculosis in the garment industry was one of the triggers leading to the entry of the Public Health Service into the arena of workplace health and safety.

• 1916: First non-military school of public health in the US established at Johns Hopkins University (enabled by Rockefeller Foundation grant).

• 1921: Bureau of Indian Affairs Health Division created (Predecessor of the Indian Health Service).

• 1935-40: Passage of the Social Security Act and the Federal Food, Drug and Cosmetic Act.

• 1944: Massive use of penicillin drastically changes treatment of infections and Sexually Transmitted Diseases.



Lecture a

History of Public Health in the US1946: • Establishment of the Communicable Disease Center,

predecessor of the Centers for Disease Control and Prevention (CDC)– The CDC’s overwhelming first focus was mosquito control to

fight malaria, primarily through application of the pesticide DDT– The new center was actually an outgrowth of the wartime

agency MCWA - Malaria Control in War Areas

• From that beginning, CDC grew into its current emphases of working with states and other partners to monitor and prevent outbreaks, maintain national health statistics, and to prevent and control infectious and chronic diseases, injuries, and environmental health hazards.



Lecture a


1950s• 1953: Creation of the Department of

Health, Education and Welfare. In 1979, the Department of Education was split off, leaving the separate Department of Health and Human Services (HHS).

• 1955: Salk polio vaccine licensed. Indian Health Service moved to HHS.



Lecture a


1960s• 1961-69: Migrant Health Act passed, providing clinics for

agricultural workers. The first Surgeon General’s Report on Smoking released. Medicare and Medicaid programs were created. Older Americans Act created social and nutritional programs. Head Start program created. International Smallpox Eradication program established.

• 1967: CDC assumes foreign quarantine functions.• 1969: CDC provided quarantine procedures, equipment,

for the Apollo moon landings and other US space travels.



Lecture a


1970s• 1970-1979: National Health Service Corps

created. National Cancer Act passed.• Worldwide eradication of smallpox in

1977.• Health Care Financing Administration

created to manage Medicare and Medicaid.



Lecture a


1980s • AIDS-HIV

– 1981 – AIDS identified– 1984 – HIV virus identified by PHS and French scientists– 1985 – HIV detection blood test licensed

• Also, passage of National Organ Transplantation Act and McKinney Act (health care for homeless). Agency for Health Care Policy and Research created.



Lecture a

History of Public Health in the US1990s• Human Genome Project established; Nutrition

Labeling and Education Act passed; Ryan White Comprehensive AIDS Resource Emergency (CARE) Act began providing support for people with AIDS; establishment of Vaccines for Children Program (free immunizations to children in low-income families); Enactment of the Health Insurance Portability and Accountability Act (HIPAA); State Children's Health Insurance Program (SCHIP) created (enabling states to extend health coverage to more uninsured children).



Lecture a


2000-2009• Human genome sequencing published; HHS

responds to anthrax bioterrorism attack; creation of Office of Public Health Emergency Preparedness; Medicare Prescription Drug Improvement and Modernization Act of 2003 expands Medicare

• American Recovery and Reinvestment Act (ARRA) of 2009 includes the HITECH stimulus opportunity.



Lecture a

Public Health (Part 1)Summary – Lecture a

15

• Similarities and differences between public and private health

• Importance of criteria for assigning public health

• Review of history of public health in the US

Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture a

Public Health (Part 1)References – Lecture a

References• Historical Highlights. (2010). Retrieved December 6, 2011, from US Department of Health &

Human Services website: http://www.hhs.gov/about/hhshist.html.• Our History - Our Story. (2011). Retrieved December 6, 2011, from Centers for Disease Control

and Prevention website: http://www.cdc.gov/about/history/ourstory.htm.

Charts, Tables, Figures• 7.1 Figure: Severity, Preventability, Prevalence – Created by Magnuson, JA (2010).



Lecture a

http://www.hhs.gov/about/hhshist.html

http://www.cdc.gov/about/history/ourstory.htm

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