Introduction to Public Health January, 2015 Course Coordinators: Professor Waleed Milaat Professor Sherine Shawky What is Public Health? What we as a society do collectively to assure the conditions in which people can be healthy* *The Future of Public Health. Institute of Medicine Washington, D.C.: National Academy Press, What is Public Health The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts Including support of measures to ensure that every individual in the community has a standard of living adequate for the maintenance of health C.-E. A. Winslow, The Evolution and Significance of the Public Health Campaign. Yale University Press, Reprinted in the Journal of Public Health Policy (1), WHO Constitution The enjoyment of the highest attainable standard of health is a fundamental right of every human being. 4 Attributes of Medicine/Dentistry/Nursing Primary focus on the individual Personal service ethic, in the context of social responsibilities Emphasis on disease diagnosis, treatment, and care for the individual patient Biological sciences are central, stimulated by needs of patients; research moves between laboratory and bedside Numerical sciences have a minor role in training Social sciences are elective 5 Attributes of Public Health - Primary focus on populations - Public service ethic, as an extension of concerns for the individual - Emphasis on disease prevention and health promotion for the whole community - Public health paradigm employs a spectrum of interventions aimed at the environment, human behavior and lifestyle, and medical care - Life sciences central, with a prime focus on major threats to the health of populations; research moves between laboratory and field - Population sciences and quantitative disciplines are essential features of analysis and training - Social and public policy disciplines an integral part of education 6 Goals of Public Health To prevent disease To prolong life To promote physical and mental health 7 Methods of Public Health Surveillance Protecting the physical environment Controlling community infections Educating individuals Organizing medical services for early diagnosis and prevention of disease 8 Health Achievements in the Past Century Enormous progress Reduced infant mortality Increased life expectancy Progress against infectious diseases Safer homes, workplaces, and transportation What are the Major Causes of This Progress? Yet challenges remain and new challenges are emerging 9 Challenges Enormous disparities in health and access to health care Reemergence of infectious diseases New chronic disease threats, often driven by changes in diet and lifestyle 10 Resource Allocation In the US, about 95 percent of healthcare expenditures are directed toward medical care and biomedical research. Yet there is strong evidence that behavior and environment are responsible for more than 70 percent of avoidable mortality The current pattern of spending gives insufficient attention to behavioral, social, and environmental factors that contribute to ill health. Moreover, many Americans receive inadequate health care. 11 Improving Population Health Traditional approaches to disease prevention focus on high-risk individuals 12 Improving Population Health But disease risk is a continuum, not a dichotomy. The majority of cases of diseases caused by obesity occur in individuals who are not in the high risk group. Thus, we need to shift the distribution of the risk factor 13 Improving Population Health The medical care system can not achieve this goal by acting alone. Effective strategies for addressing threats to population health require a multidisciplinary approach. One mission of the public health system is to formulate and lead the implementation of these strategies 14 The AIDS Epidemic 1981: First observations of Kaposis sarcoma and pneumocystis pneumonia 1982: Recognition that the illness is a disorder of the immune system 1984: Discovery of the AIDS virus 15 16 17 Challenges of AIDS The most effective strategy is prevention Common link to illegal or controversial behaviors IV drug use, sexual acts Tension between the right to privacy and the obligation to protect innocent individuals The only way to prevent AIDS is to change behavior. This raises difficult issues about the role of government 18 Public Health in Post-Soviet Russia Public health was neglected in the Soviet era But things became much worse after By the mid- 1990s, deaths were twice as common as births. Male life-expectancy fell from 65.4 years to 57.3 in Underlying causes appeared to be economic stress and social breakdown. The effects of alcohol exceeded all other health risks. 19 20 21 Changing Life Expectancy in Russia22 Original Article Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus Abdullah Assiri, M.D., Allison McGeer, M.D., Trish M. Perl, M.D., Connie S. Price, M.D., Abdullah A. Al Rabeeah, M.D., Derek A.T. Cummings, Ph.D., Zaki N. Alabdullatif, M.D., Maher Assad, M.D., Abdulmohsen Almulhim, M.D., Hatem Makhdoom, Ph.D., Hossam Madani, Ph.D., Rafat Alhakeem, M.D., Jaffar A. Al-Tawfiq, M.D., Matthew Cotten, Ph.D., Simon J. Watson, Ph.D., Paul Kellam, Ph.D., Alimuddin I. Zumla, M.D., Ziad A. Memish, M.D., for the KSA MERS-CoV Investigation Team N Engl J Med Volume 369(5): August 1, Study Overview Between April 1 and May 23, 2013, 23 cases of MERS-CoV infection were reported in the eastern province of Saudi Arabia. Symptoms included fever, cough, shortness of breath, and gastrointestinal symptoms As of June 12, 2013, 15 patients (65%) had died, 6 (26%) had recovered, and 2 (9%) remained hospitalized 24 Epidemiologic Plot of Confirmed and Probable Cases of MERS-CoV Infection in Saudi Arabia, April 1May 23, Assiri A et al. N Engl J Med 2013;369: Transmission Map of Outbreak of MERS-CoV Infection. Assiri A et al. N Engl J Med 2013;369: Estimates of the Incubation Period and Serial Interval of MERS-CoV Infection. Assiri A et al. N Engl J Med 2013;369: Conclusions Person-to-person transmission of MERS-CoV can occur in health care settings and may be associated with considerable morbidity. Surveillance and infection-control measures are critical to a global public health response. 28 29 30 31 Largest Connected Subcomponent of the Social Network in the Framingham Heart Study in the Year Christakis NA, Fowler JH. N Engl J Med 2007;357: Changing Patterns of Obesity Over Time Framingham Heart Study 33 Ebola Virus in West Africa On March 23, 2014, the World Health Organization (WHO) was notified of an outbreak of Ebola virus disease (EVD) in Guinea. On August 8, the WHO declared the epidemic to be a public health emergency of international concern. By September 14, 2014, a total of 4,507 probable and confirmed cases, including 2,296 deaths from EVD (Zaire species) had been reported from five countries in West Africa Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. Ebola Virus in West Africa 34 Recent Developments NY Times, January 23, 2015 The World Bank announced that the number of new Ebola cases has fallen to the lowest level in months Liberia, which reported more than 300 new cases a week in August and September, recorded only eight new cases in the week to Jan. 18. In Sierra Leone, where the infection rate is now highest, there were 118 new cases, compared with 184 in the previous week and 248 in the week before that. 35 Multidimensional Determinants of Health 36 Implications Multifaceted strategies, involving many partners, are required to address threats to population health The mission of the public health system is to develop and lead the implementation of those strategies 37 The Essential Functions of PH I.Assessment 1. Monitor the health status of the population to identify and solve health problems 2. Diagnose and investigate health problems and hazards in the community 38 The Essential Functions of PH II. Policy Development: 3. Inform, educate, and empower people about health issues 4. Mobilize community partnerships and action to identify and solve health problems 5. Develop policies and plans that support individual and community health efforts 39 The Essential Functions of PH III. Assurance: 6. Enforce laws and regulations that protect health and ensure safety 7. Increase access to health care 8. Assure competent public and personal health care workforce 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services 10. Research for innovative solutions to health problems 40 Five Core Disciplines of Public Health Epidemiology Biostatistics Environmental Health Science Health Policy and Management Social and Behavioral Health 41