Why Public Health?

This Interactive Guide Was Developed for Healthy Communities,

Portland, Oregon.

Made possible by funding from the turning point grant provided by

W.K. Kellogg foundation.

Getting To Know Public Health Many people have heard of public health yet

we all define it differently. With valuable community input this

presentation was developed to increase the communities’ understanding of public health.

After viewing this presentation it is our hope that you will leave with a better understanding of the role public health plays in your life.

Two Broad Turning Point Goals

To educate the public so they can ask questions and speak out about health concerns.

To work together as a community. Public health agencies can’t address your needs until they are made aware.

Results=improved community health.

Public Health is Unique

It has basis in Social Justice philosophy It is inherently political in nature It involves dynamic disciplines including:

biology, medicine, environment, health services, epidemiology, environmental science, behavioral science, and statistics

It is linked to government by both policies and programs

History of Public Health: The 10 Greatest Achievements in U.S. Public Health from 1900-1999 Vaccinations- resulting in eradication of

small pox, elimination of polio, and control of infectious disease

Motor-vehicle Safety Safer Workplaces Control of Infectious diseases- clean

water and improved sanitation have reduced transmission of disease

Achievements continued Decline in deaths from Coronary heart

disease and stroke Safe and Healthy Foods Maternal and Infant Care - better hygiene

and nutrition, improved availability of antibiotics, greater access to care

Family Planning- Access to planning and contraceptive services

Achievements continued

Fluoridation of Drinking Water -began in 1945 and played a significant role in reducing tooth decay

Recognition of Tobacco Use as a Health Hazard- resulting in changing social norms, promotion of smoking cessation, and reduced exposure to environmental tobacco smoke

What do you think?

Are these all great achievements?

Has anything been left out?

What are some of your concerns or fears?

Goals of Healthy People 2010 Shaping the agenda for tax supported programs.

1. Increase quality and years of healthy life

2. Eliminate health disparities

You may ask what is Healthy People 2010?

It is a set of health objectives for the Nation to achieve over the first decade of the new century.

Healthy People 2010 Leading Health Indicators

1. Physical Activity

2. Overweight and Obesity

3. Tobacco Use

4. Substance Abuse

5. Responsible Sexual Behavior

6. Mental Health

7. Injury and Violence

8. Environmental Quality

9. Immunization

10. Access to Health Care

Healthy People 2010 Focus Areas

Access to Quality Health Services Arthritis, Osteoporosis, and Chronic Back

conditions Cancer Chronic Kidney Disease Disability and Secondary conditions Diabetes Educational and Community-Based Programs

Focus Areas continued Tobacco Use Environmental Health Family Planning Food Safety Health Communication Heart Disease and Stroke HIV/ STDs (Sexually Transmitted Diseases) Immunization and Infectious Diseases Injury and Violence Prevention Vision and Hearing

Focus Areas continued Maternal, Infant, and Child Health Medical Product Safety Mental Health Nutrition and Overweight Occupational Safety and Health Oral Health Physical Fitness Public Health Infrastructure Respiratory Diseases Substance Abuse

What do you think?

Do you agree with these focus areas? Are your priorities on the list? What would you take off? What would you add to the list?

Oregon Contacts:Multnomah County

Lillian Shirley: 1-503-988-3674

Washington County

Susan Irwin: 1-503-846-4402

Clackamas County

Marina Stansell: 1-503-655-8478

Future Projections of Health in the U.S.

Projections for 2020 from the

“Global Burden of Disease: Changing

Risk Profile for the Future”

1. Heart disease

2. Major depression

3. Road traffic accidents

4. Stroke

5. Chronic obstruction in the lungs

Lifestyle Choices Many of the items we discussed are a

result of lifestyle choices. It is very difficult to change our habits but

often times a healthy balanced diet, exercise, proper sleep, and lots of water can make a person feel great.

We must consider our choices when it comes to feeling healthy.

This includes things like recycling, buying responsibly, driving less.

The Portland Area: Multnomah, Washington, and Clackamas Counties

We conducted focus groups in each county to hear from citizens.

Census Data was used to determine population make-up of each county.

Local Data was used to determine the services being offered in each county.

Federal Community Health Status Reports gave a picture of where we are at currently regarding community health.

Who lives in Multnomah County?

660,486 people (census 2000) White: 79% Black or African American: 6% American Indian & Alaska Native:1% Asian: 6% Native Hawaiian & Other Pacific Islander: .003% Some other race: 4% Two or more races: 4% Hispanic or Latino(of any race): 8%

Who lives in Washington County?

445,342 people (Census 2000) White:82% Black or African American:1% American Indian & Alaska Native:1% Asian: 7% Native Hawaiian & Other Pacific Islander: 0.003% Some other race: 6% Two or more races: 3% Hispanic or Latino(of any race):11%

Who lives in Clackamas County?

338,391 People (Census 2000) White: 91% Black or African American: 1% American Indian & Alaska Native:1% Asian: 2.5% Native Hawaiian & Other Pacific Islander: 0.001% Some other race:2% Two or more races: 2.5% Hispanic or Latino(of any race): 5%

A Look at the Health of Multnomah County

Average live expectancy is 74.7 years, slightly less than U.S. average (75.4)

Average number of unhealthy days was 5.8 compared to 5.1 nationally

When combining all causes for death the death toll in Multnomah was lower than the national average

11.8% percent of adults reported poor health, national average being 14.7%

What people in Multnomah County had to say

They feel public health services should be free and available to all people

They feel public health services are important, especially for moms, the elderly, and kids

Because kids begin a new cycle of life their health needs are very important

When we asked members of Multnomah County what they avoid for their health Common things mentioned included

alcohol, tobacco, & sweets

Health care was mentioned as an item people avoid: an alarming statement We asked why and were told, “The health care system is a mess”

What people of Multnomah County do for their health Eat low on the food chain Exercise daily Eat and buy organics Breast cancer screenings Fund raising events Take vitamins Reduce stress

Where do residents get Health Services in Multnomah County

Overwhelmingly people went to the ER-this is not timely or cost effective

Some had a trusted family doctor or nurse practitioner

Many mentioned paying for alternative care out of pocket (Naturopath, Massage, Acupuncture, Chiropractor)

Barriers faced in Multnomah?

No insurance No choice because of insurance plan Reluctance on part of physician to refer

to a specialist Short visit with doctor after long wait Lacked prenatal care (no insurance) No one to trust for immigrants

When asked what local and state health departments do responses included: Research Sanitation STD clinic Contraception AIDS test Kitchen checks Provide clinics for uninsured

When we expand our definition to include more than just physical health in Multnomah county Balance is needed for mental health Spiritual community that cares for you Access to space to relax, “stare off” Environment with clean air and water NE Portland Brownfields and asthma “I

know it is not scientific but greater than average number of people have asthma”

Expanding on Health continued

There is neighborhood violence Tension Poverty Households with kids in despair. “I work

with children and we built birdhouses one day. One child said she did not want to take home her birdhouse because she did not have birds in her backyard”

Expanding on health continued

Oral Health is an issue Not enough dentists Clinics have long waits No insurance for dental “I have almost given up on dental” “I grew up going to the dentist twice a year.

I see no time in the foreseeable future when I would be able to go”

A look at Washington County

Average live expectancy is 78.2 years, more than U.S. average (75.4)

Average number of unhealthy days was 4.7, low compared to 5.1 nationally

When combining all causes for death the death toll in Washington County was well below the national average

9.2% percent of adults reported poor health, well below the national (14.7%)

What people in Washington County had to say

Public health means the prevention of disease, education, and health care availability

Need education materials for people who don’t speak English

Health care should not be only for those who can afford it

Health care should include alternatives, not just Medical Doctors

What people in Washington County do for their health Pay for Blue Cross Exercise Eat properly Limit sugar Eat a diet high in fruit and vegetables Take Vitamins and supplements

Barriers faced in Washington County

Wait a long time to see a doctor Managed care Big bills are a shock Doctors no longer accepting new

patients “I don’t have barriers, but I know of

others who have struggled”

When asked what public health does:

Women’s health issues Helps those with no regular doctor Helps kids Disseminates information Oregon Health Plan Educates about illness WIC

Washington County Continued

“Public Health should do more to let people know what is available”

“I do not feel aware of how and where to access care”

“Clinics turn people away for not being sick enough. You have to become more ill to receive care”

Washington County Continued Need more counselors (kids/adults) Mental health services are badly needed “Depression, anger, and violence go

untreated when help is not available” One parent expressed “My daughter had

emotional problems and did not know who she could talk with, school counselors are necessary for our kids”

When asked what local and state health departments do responses included I don’t know because I don’t need them Head Start workers Oregon Health Plan Welfare Kitchen and restaurant sanitation

inspection Outreach to schools

When we expand our definition to include more than just physical health in Washington County

Mental health Environmental health Quality of the air Asbestos removal Safe levels of Lead Safety belts in cars Car seats for children

Expanding on health continued

Spiritual health Abuse of spouse and children Alcoholism Family dynamics Emotional health Stress Asthma from pollution

A look at Clackamas County

Average live expectancy is 77.3 years, more than U.S. average (75.4)

Average number of unhealthy days was 5.7, higher than the national (5.1)

When combining all causes for death, the death toll in Clackamas County was well below the national average.

10.5% percent of adults reported poor health, below national average (14.7%)

What people in Clackamas had to say about public health

Public health provides a sense of security Public health services are free of charge

for all citizens Public health means prevention and

education It is the obligation of government to

maintain a healthy environment

Clackamas County continued

Very important to have public health Focused on the need for a more holistic

approach to health care Valued more than just western doctor Talked about vitamins, alternative choices,

Tai Chi, exercise, proper diet “I go to Fred Meyer Nutrition Center for

health advice”

What people in Clackamas County do for their own health

Use the YMCA Practice preventative care Balance work with leisure Sleep enough Drink lots of water Obtain knowledge from books and the

internet

What do you avoid for your health

Over eating Limit sugar Limit alcohol Avoid smoking

Barriers to care in Clackamas County

No choice in alternative care Insurance plan limits physician selection Medications too expensive Throw out people who need mental health

services No nutritionists Wait too long to see a doctor Language barriers

Barriers continued

Not always comfortable with the doctor If can’t receive needed care then urgent

care is used or Emergency care “Try home remedies because we can’t

see the doctor in a timely manner” this includes over the counter drugs and herbs

When asked what local and state health departments do

responses included:

Maintain sanitary conditions Chicano and migrant workers are able

to receive care OSHA sets standards for workers safety Health Clinics Oregon Health Division

When we expand our definition to include more than just physical

health in Clackamas County Oral health services Eye care Mental health care Depression Compliance with medicine is a problem.

Often side effects are present and a person just stops taking medication.

Expanding on Health continued

Not all Americans view health the same way

Some Americans view illness as a system in which all aspects of life must be well and balanced in order to feel healthy

Being well includes our social health, mental health, spiritual health, and emotional health

Public Health Messages that catch the eye include:

Funny ads Ads with cute babies Unique or unexpected (Adults getting shots) Outbreaks or scares Anything that personally speaks to their needs

(for example Diabetes) AIDS Campaigns because it is a huge health

threat

Where should ads in the Portland Metro area be placed?

At community colleges Bus stops MAX Magazines Nutrition centers Billboards TV and radio

Who is the Surgeon General? Out of curiosity we asked this question in

focus groups Nobody knew who!! Most remembered Koop, a few

remember Jocelyn Elders Why? “Because he is not in our

living room” He is not on television or in the paper

The Surgeon General is: Dr. David Satcher Since 1871, the Surgeon General of the

United States has been the nation’s leading spokesman on matters of public health

David Satcher is the 16th person to occupy the post, and the 1st African American

He would like to be remembered as the Surgeon General who listened to the American people

Focus groups in the Metro Area yielded common themes

People want care to be available for all People want alternative care to be offered

at an affordable price, or as part of insurance plans

People want affordable dental care People want affordable eye care National health care is important to

citizens, but especially for young people

Common Themes continued

Mental health needs are not being met for some citizens in the Portland Metro area

One person stated “Money runs out but people don’t” in regards to mental health

People feel that technology created some big messes

Medical technology and industrial technology can be helpful but it can also harm people and the environment

Common Themes continued People want the health care system

that we have to work better People wait so long for appointments,

while getting sicker in the mean time “We are in a state of confusion in our

health care system” Many people are not aware of health

services that are offered Some are aware of services but have

had bad experiences in receiving care

More Common Themes

“It is arbitrary what the government chooses to regulate. We know smoking is prevalent and deadly, yet it is legal. I feel we must have less concern for $$’s and more concern for Health”

Oregon Health Plan is not working for folks. It is hard to get coverage. “I owed $18.00 and was turned away”

Conclusion Portland area citizens want everyone to

receive socialized care. The role public health plays needs to be

more visible to citizens. Mental health services need to be visible, it

is of much concern. The stigma placed on mental/emotional health must be eliminated.

Children's health needs are of highest importance.

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