Public Health in the United States:Public Health in the United States:

BACK TO THE FUTUREBACK TO THE FUTURE

Jay H. Glasser, Ph.D., president-electJay H. Glasser, Ph.D., president-elect

American Public Health AssociationAmerican Public Health Association

The Seaman’s Retreat Hospital being now entirely free from debt, the trustees are enabled to offer the merchant marine the following schedule of reduced fees, viz.:

At the Gates - OurSafety Depends onEternal Vigilance

The Nation's Health Dollar: 2000

Where It Came From

Where It Went

Probability of Being Uninsured for Population Under Age 65, By State, 1977-1999

Levels of Analysis for Examining the Effects of Uninsurance

HEALTH and DEVELOPMENT inHEALTH and DEVELOPMENT inthe 20th CENTURYthe 20th CENTURY

from The World Health Report 1999, Making a Difference (WHO, Geneva)

““The 20th century has seen a global transformation in The 20th century has seen a global transformation in human heath unmatched in history”human heath unmatched in history”

““Economic historians and demographers debate the Economic historians and demographers debate the genesis of increases in life expectancy...at least partially genesis of increases in life expectancy...at least partially linked to the economic changes resulting from the linked to the economic changes resulting from the agricultural and industrial revolutions. One aspect the agricultural and industrial revolutions. One aspect the economic change-urbanization-actually affected health economic change-urbanization-actually affected health adversely by exposing an increasing proportion to crowded adversely by exposing an increasing proportion to crowded conditions, thereby facilitating the spread of infection. conditions, thereby facilitating the spread of infection. Somewhat more counterbalancing this effect though were Somewhat more counterbalancing this effect though were increases in nutrient intake and improvements in sanitation increases in nutrient intake and improvements in sanitation and water supply resulting from higher income levels”and water supply resulting from higher income levels”

FOUR AIMS of STEPHEN SMITH and THE 7 FOUNDERS FOUR AIMS of STEPHEN SMITH and THE 7 FOUNDERS OF THE AMERICAN PUBLIC HEALTH OF THE AMERICAN PUBLIC HEALTH ASSOCIATIONASSOCIATION (April 18,1872)(April 18,1872)

Through the medium of a national organization:Through the medium of a national organization:

1.1. awaken and maintain the active and permanent interest awaken and maintain the active and permanent interest of people in sanitary administrationof people in sanitary administration

2.2. greatly facilitate the enlightenment of the the public greatly facilitate the enlightenment of the the public

3.3. promote the appointment of more competent health promote the appointment of more competent health authoritiesauthorities

4.4. the advancement of sanitary science and promotion of the advancement of sanitary science and promotion of organizations and measures for practical application to organizations and measures for practical application to public hygiene.” public hygiene.”

The founders included physicians, a superintendent of health, The founders included physicians, a superintendent of health, a military and legal medical specialist, an architect, health a military and legal medical specialist, an architect, health statistician, an urban housing specialiststatistician, an urban housing specialist

CDC’s role as a sentinel for the health of people in the United States and CDC’s role as a sentinel for the health of people in the United States and throughout the world. CDC strives to promote disease prevention and health throughout the world. CDC strives to promote disease prevention and health promotion goals that will foster a safe and healthful environment where promotion goals that will foster a safe and healthful environment where health is protected, nurtured, and promoted.health is protected, nurtured, and promoted.

GOALSGOALSSCIENCESCIENCE Assure a strong science base for public health actionAssure a strong science base for public health action

ASSESSMENTASSESSMENT Detect and assess threats to public healthDetect and assess threats to public health

POLICYPOLICY Provide leadership for the Nation in prevention policy and Provide leadership for the Nation in prevention policy and practicepractice

ASSURANCEASSURANCE Assure the public's health through the translation of Assure the public's health through the translation of research into effective community-based actionresearch into effective community-based action

CDC VISION FOR THE 21 ST CENTURYHEALTHY PEOPLE IN A HEALTHY WORLD—THROUGH PREVENTION

Tools of PreventionTools of Prevention• • SurveillanceSurveillance

• • Health StatisticsHealth Statistics

• • EpidemiologyEpidemiology

• • LaboratoryLaboratory

• • Behavioral Risk ReductionBehavioral Risk Reduction

• • Technology TransferTechnology Transfer

• • Prevention Research, Strategies, and ProgramsPrevention Research, Strategies, and Programs

• • Health Communication and Social MarketingHealth Communication and Social Marketing

CDC VISION FOR THE 21 ST CENTURYHEALTHY PEOPLE IN A HEALTHY WORLD—THROUGH PREVENTION

AND THEN9/11

BIOTERRORISM : Anything is Possible?

The Two Book Ends of TerrorismThe Two Book Ends of Terrorism

    Traditional Terrorism Post ModernTraditional Terrorism Post Modern

  

BIG BIG SMALLSMALL

  

BOOM BOOM SILENTSILENT

  

BANDBAND SINGLESINGLE

  

BRIEFBRIEF SUSTAINEDSUSTAINED

Old Scourges Return in Weaponized Versions?

ARE

WE

UPTO

DATE?

Or do it the old way? Patron Saint of Palermo, Italy Delivered a Miracle: Saved the City from Plague in 1634

Conference Report on Public Health Conference Report on Public Health Security and Bioterrorism Security and Bioterrorism Preparedness and Response Act- HR Preparedness and Response Act- HR 34483448

  RequiresRequires

   Preparedness Plans:Preparedness Plans: respond to bioterrorism respond to bioterrorism and other public health emergenciesand other public health emergencies

   Other Preparedness:Other Preparedness: children and terrorism, children and terrorism, emergency public information and communication, emergency public information and communication, education programs for children and vulnerable education programs for children and vulnerable people, availability of Potassium Iodide within to people, availability of Potassium Iodide within to populations within 20 miles of a nuclear power plantpopulations within 20 miles of a nuclear power plant

Control on Biological Agents and Control on Biological Agents and ToxinsToxins

• Registration RequirementRegistration Requirement

• Protection of Animals and PlantsProtection of Animals and Plants

• Security and Personnel ScreeningSecurity and Personnel Screening

•   Food Supply Protection: Food Supply Protection: detaining food, bar detaining food, bar certain food importers, increase inspectionscertain food importers, increase inspections

• Drug Supply Protection: Drug Supply Protection: registration of foreign registration of foreign manufacturers of import drugs and devicesmanufacturers of import drugs and devices

• Water Supply Protection, vulnerability Water Supply Protection, vulnerability Assessment, emergency response plans, Assessment, emergency response plans, prevent prevent intentional contaminationintentional contamination

Conference Report on Public Health Conference Report on Public Health Security and Bioterrorism Preparedness Security and Bioterrorism Preparedness and Response Act- HR 3448and Response Act- HR 3448

BIOTERRORISM PREPAREDNESSBIOTERRORISM PREPAREDNESS

• Emergency Medical StockpilesEmergency Medical Stockpiles $1.15 Billion$1.15 Billion

• Center for Disease ControlCenter for Disease Control $300 Million$300 Million

• State and Local PreparednessState and Local Preparedness $1.6 Billion$1.6 Billion

• Hospital and Clinic PreparednessHospital and Clinic Preparedness $520 Million$520 Million

• Antimicrobial ResistanceAntimicrobial Resistance $25 Million$25 Million

• Food Supply ProtectionFood Supply Protection $100 Million$100 Million

•  Water Supply ProtectionWater Supply Protection $160 Million$160 Million

AND BREAKING NEWS from The President

Proposed Cabinet-Level Homeland Security Proposed Cabinet-Level Homeland Security Department Would Be Responsible for Department Would Be Responsible for Dealing with Biological/Chemical AttacksDealing with Biological/Chemical Attacks

The department would have four main divisions:The department would have four main divisions:   • Chemical, Biological, Radiological and Nuclear Chemical, Biological, Radiological and Nuclear

Countermeasures Countermeasures   • Emergency Preparedness and ResponseEmergency Preparedness and Response  • Information Analysis and Infrastructure ProtectionInformation Analysis and Infrastructure Protection  • Border and Transportation SecurityBorder and Transportation Security  Source: Ricks, Washington Post, June 7, 2002

Public Health ResponsibilitiesPublic Health ResponsibilitiesSource: various newspapers June 7, 2002Source: various newspapers June 7, 2002

In the new department, a division would be tasked with protecting against In the new department, a division would be tasked with protecting against chemical, biological and nuclear threats, assuming control of public health, chemical, biological and nuclear threats, assuming control of public health, defense and research operations currently handled by the Departments of defense and research operations currently handled by the Departments of Health and Human Services, Energy and Agriculture Health and Human Services, Energy and Agriculture   The CDC's Bioterrorism Preparedness and Response Program, which The CDC's Bioterrorism Preparedness and Response Program, which distributes funds to the states, and National Pharmaceutical Stockpile distributes funds to the states, and National Pharmaceutical Stockpile Program likely would be shifted to the new department, Program likely would be shifted to the new department,   Those two programs means that the CDC would lose about 300 employees Those two programs means that the CDC would lose about 300 employees and $4 billion from its budget and $4 billion from its budget   The emergency response division would be responsible for responding to an The emergency response division would be responsible for responding to an attack involving weapons of mass destruction, absorbing responsibilities attack involving weapons of mass destruction, absorbing responsibilities held by HHS' Chemical, Biological, Radiological and Nuclear Response held by HHS' Chemical, Biological, Radiological and Nuclear Response Assets operation.Assets operation.

Public Health ResponsibilitiesPublic Health ResponsibilitiesSource: various newspapers June 7, 2002Source: various newspapers June 7, 2002

•The new department's border and transportation division would absorb The new department's border and transportation division would absorb the Agriculture Department's Animal and Plant Health Inspection Service the Agriculture Department's Animal and Plant Health Inspection Service

  •In a televised speech to outline his plan, Bush said the new department In a televised speech to outline his plan, Bush said the new department would "bring together our best scientists to develop technologies that would "bring together our best scientists to develop technologies that detect biological, chemical and nuclear weapons." He added that it would detect biological, chemical and nuclear weapons." He added that it would "discover the drugs and treatments to best protect our citizens" "discover the drugs and treatments to best protect our citizens"

  •Bush hopes to have the new department running by Jan. 1, 2003. It Bush hopes to have the new department running by Jan. 1, 2003. It remains uncertain if Bush will nominate Ridge to head the new department remains uncertain if Bush will nominate Ridge to head the new department ((Wall Street JournalWall Street Journal, 6/7)., 6/7).

And from Congress: First Amendment to HR 4775

Sen Dirksen, “Well you know what they say about the Sen Dirksen, “Well you know what they say about the Federal Budget, a billion here and a billion there and Federal Budget, a billion here and a billion there and before long it starts to add up to real money.”before long it starts to add up to real money.”

31 bil. total31 bil. total

14 bil military operations14 bil military operations

8.3 bil homeland security8.3 bil homeland security

5.5 N bil NYC Sept 11th recovery includes mass transit5.5 N bil NYC Sept 11th recovery includes mass transit

1.35 bil foreign aid Afghanistan, Pakistan, Russia,1.35 bil foreign aid Afghanistan, Pakistan, Russia,

200 mil AIDS program to focus on mother to child transmission200 mil AIDS program to focus on mother to child transmission

100 mil for AIDS Global Fund 100 mil for AIDS Global Fund

4.4 bil Transportation Security Administration (includes airport security)4.4 bil Transportation Security Administration (includes airport security)

and 417 mil Veterans Adm Medical careand 417 mil Veterans Adm Medical care

First Responders 1 bilFirst Responders 1 bil

Port Security 970 milPort Security 970 mil

Nuclear Laboratory 200 milNuclear Laboratory 200 mil

Cyber security 115 milCyber security 115 mil

Agroterrorism 200 milAgroterrorism 200 mil

Water systems reviewsWater systems reviews

Secret Service and FBI, national monument 340 milSecret Service and FBI, national monument 340 mil

US Postal Service effort 87 milUS Postal Service effort 87 mil

Nuclear non proliferation 100 milNuclear non proliferation 100 mil

And from Congress: First Amendment to HR 4775 (continued)

Is there a newSpirit ofPatriotism andService?Where will it Lead?

BACK TO THE FUTURE?

THE PUBLIC HEALTH MISSION of HEALTHY PEOPLE in HEALTHY COMMUNITIES (July 1995 consensus statement of Public Health Steering Committee )

• PREVENTS EPIDEMICS and the spread of diseasePREVENTS EPIDEMICS and the spread of disease

• PROTECTS against ENVIRONMENTAL HAZARDSPROTECTS against ENVIRONMENTAL HAZARDS

• PREVENTS INJURIESPREVENTS INJURIES

• PROMOTES and encourages HEALTHY BEHAVIORSPROMOTES and encourages HEALTHY BEHAVIORS

• RESPONDS to DISASTERS and assists communities RESPONDS to DISASTERS and assists communities in recoveryin recovery

• ASSURES the QUALITY and ACCESSABILITY of ASSURES the QUALITY and ACCESSABILITY of HEALTH SERVICESHEALTH SERVICES

CONTEMPORARY PROBLEMS

In 1964, Smoking

And Health

Captured the

Permanent

Attention of

Physicians and

The Nation

Obesity* Trends Among U.S. Adults BRFSS, 1991, 1995 and 2000

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)1991 1995

2000

Source: Mokdad A H, et al. JAMA 1999;282:16, 2001;286:10.

No Data <10% 10%-14% 15-19% 20%

As We Face the Known and Unknown

LEADERSHIP

APHA INITIATIVES and ALLIANCESAPHA INITIATIVES and ALLIANCES

•ELIMINATING ETHNIC and RACIAL HEALTH ELIMINATING ETHNIC and RACIAL HEALTH DISPARITIESDISPARITIES

•EMS and PUBLIC HEALTH COALITION FOR EMS and PUBLIC HEALTH COALITION FOR HOMELAND SECURITYHOMELAND SECURITY

•MEDICINE and PUBLIC HEALTH INITITATIVEMEDICINE and PUBLIC HEALTH INITITATIVE (AMA, (AMA, APHA and partners)APHA and partners)

•THE PUBLIC HEALTH WORKFORCE & STANDARDSTHE PUBLIC HEALTH WORKFORCE & STANDARDS

Continuing Education and CredentialingContinuing Education and CredentialingStandards for Public Health EntitiesStandards for Public Health Entities

•HUMAN RIGHTS and HEALTH CURRICULUMHUMAN RIGHTS and HEALTH CURRICULUM

•GLOBAL HEALTH:GLOBAL HEALTH: The World Federation of Public The World Federation of Public Health AssociationsHealth Associations

Estimated 42.1 Million Uninsured People

TEN ESSENTIAL PUBLIC HEALTH SERVICESTEN ESSENTIAL PUBLIC HEALTH SERVICES

•   MONITOR HEALTH STATUSMONITOR HEALTH STATUS and identify community and identify community problemsproblems

• DIAGNOSE and INVESTIGATE HEALTH DIAGNOSE and INVESTIGATE HEALTH PROBLEMSPROBLEMS and health hazards in the communityand health hazards in the community

• INFORM, EDUCATE and EMPOWER PEOPLEINFORM, EDUCATE and EMPOWER PEOPLE about Health Issuesabout Health Issues

• MOBILIZE COMMUNITY PARTNERSHIPSMOBILIZE COMMUNITY PARTNERSHIPS to identify to identify and solve community health effortsand solve community health efforts

• ENFORCE LAWSENFORCE LAWS and Regulates that PROTECT and Regulates that PROTECT HEALTH and Ensure SafetyHEALTH and Ensure Safety

• LINK PEOPLE to NEEDED PERSONAL HEALTH LINK PEOPLE to NEEDED PERSONAL HEALTH SERVICESSERVICES and Assure the Provision of Health and Assure the Provision of Health

Care When Otherwise AvailableCare When Otherwise Available

• ASSURE a COMPETENT PUBLIC HEALTHASSURE a COMPETENT PUBLIC HEALTH and and Personal Health CarePersonal Health Care WORKFORCEWORKFORCE

• EVALUATE EFFECTIVENESS, ACCESSIBILITY EVALUATE EFFECTIVENESS, ACCESSIBILITY and QUALITYand QUALITY of personal and population -based of personal and population -based

HEALTH SERVICESHEALTH SERVICES

• RESEARCH for NEW INSIGHTS and RESEARCH for NEW INSIGHTS and INNOVATIVE SOLUTIONSINNOVATIVE SOLUTIONS to Health Problemsto Health Problems

THE APHA and AMA Medicine and Public Health Initiative

Federal-Aid Highway Act of 1956:CREATING THE INTERSTATE SYSTEM

Eisenhower planned to address a conference of state governors in Lake George, N.Y., July 12, 1954. The president was unable to attend, and Vice President Richard M. Nixon delivered the message. Nixon told the governors that the increased funding authorized earlier that year was "a good start" but "a $50 billion highway program in 10 years is a goal toward which we can - and we should - look." Such a program, over and above the regular federal-aid program, was needed because "... our highway network is inadequate locally, and obsolete as a national system

Federal-Aid Highway Act of 1956:CREATING THE INTERSTATE SYSTEM

Eisenhower’s first realization of the value of good highways occurred in 1919, when he participated in the U.S. Army's first transcontinental motor convoy from Washington, D.C., to San Francisco. The convoy experienced all the woes known to motorists - an endless series of mechanical difficulties; vehicles stuck in mud or sand; trucks and other equipment crashing through wooden bridges; and, for the soldiers, worst of all, speeches in every town along the way. After 63 days on the road, the convoy reached San Francisco, where it was greeted with medals, a parade, and more speeches

Together, the united forces of our communication and transportation systems are dynamic elements in the very name we bear - United States. Without them, we would be a

mere alliance of many separate parts." - President Dwight D. Eisenhower, Feb. 22, 1955

WHAT KIND OF TENT? INTENT of Public Health and WHAT KIND OF TENT? INTENT of Public Health and CONTENT of Public HealthCONTENT of Public Health

Public Health is an admixture, a complex evolution that parallels society in all Public Health is an admixture, a complex evolution that parallels society in all respects, advancement and enduring problems, and not without criticsrespects, advancement and enduring problems, and not without critics

Looking Back, The Three Eras of Public HealthLooking Back, The Three Eras of Public Health

Sanitation Biological Behavioral Sanitation Biological Behavioral 

Looking Forward,Looking Forward, Genetics, nanobiology, informatics, health care/self care Genetics, nanobiology, informatics, health care/self care advancement and complexity, implosion......? advancement and complexity, implosion......?

Critics such as Dr. Sally Satel now say there is fourth revolution: Critics such as Dr. Sally Satel now say there is fourth revolution: politically correct medicinepolitically correct medicine “powered by the idea that injustice produces “powered by the idea that injustice produces disease and political empowerment is the cure” disease and political empowerment is the cure” 

source: PC MD: How Political Correctness is Corrupting Medicine, Basic source: PC MD: How Political Correctness is Corrupting Medicine, Basic Books, 2000Books, 2000

  ““If you reach a fork in the road...take it” Yogi BerraIf you reach a fork in the road...take it” Yogi Berra

Stephen Smith, 1921, at age Stephen Smith, 1921, at age 98, addressing APHA members 98, addressing APHA members on the 50th Anniversary of on the 50th Anniversary of APHA APHA

  

  

““So let us on this most So let us on this most auspicious anniversary look auspicious anniversary look backward and learn the lessons backward and learn the lessons of experience which it teaches of experience which it teaches before we take a step into the before we take a step into the uncharted future.”uncharted future.”