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EPID 600 - Introduction to Public Health Practice - Fall 2014

Introductory session

History, goals and organization of public health.

Students should be able to describe:

The scope & expertise necessary to practice public health requires a study of the fundamentals of biostatistics, epidemiology,  environmental science, toxicology, ethology, physiology and behavioral science will permeate each sessions of this course.

Federal and State organizations and their responsibilities for Public Health Services. The major players in the game. An overview of traditional public health programs, the disciplines needed to carry them out are a focus of this course.

References

A History of Public Health. George Rosen and 'Future of Public Health'. IOM. 

Reading

Introduction to Public health :Schneider 4th edition.. Chapters 1 through 3, Also Chapters 5 & 7 for basic epidemiologic terms used in course..


Essentials of Public Health. Turnock (1st or 2nd edn). Chapter 1
Review difference between medical care and public health practice. Keep these differences in mind when you answer assignments and use discussion board.
Review the USPHS & Virginia Department of Health [VDH] Web pages
To read journals on-line use this library access web page


Special Reference. For students who have no experience with the US Health Care System a primer is provided here. Take your time over this. It can be completed over the course of the semester and will prepare you for classes on U.S. Health Policy.


The continuing theme of this course is that epidemiologic and biostatistical expertise are the underlying skills needed for all activities, whatever the field, in public health.  Visit Healthy People 2010 and HP 2020 before each week's session and review that part of the Healthy People Process which relates to the week's discussion, to prepare your thoughts for the discussion boards. Also review this recent analysis of progrtesds toward HP2020 goals

The first, and probably the only material you need to memorize from the entire course is:

these functions are the basis of public health as it enters the second millennium. They are the most recent consensus among the major national public health groups, following the 1998 "Future of Public Health" book (see link to the on-line text below), produced by the Institute of Medicine of the National Academy of Sciences.   This book should be part of your own permanent library. You can also view the CDC PPT Slide Show of the 10 Essentials. This Ppt is worth downloading and keeping in your files to refer to throughout this course.

The triumph of public health.

Until recently, the concept of prevention was most often tied to public health efforts, in particular to the prevention of infectious diseases. These preventive interventions had their roots in the 1800s.

In 1846, Ignaz Semmelweis instituted hand washing on his obstetrical ward in Vienna’s teaching hospital, cutting the death rate among delivering mothers more than fivefold. Joseph Lister later credited his developments in antiseptic surgery to Semmelweis, “Without Semmelweis, my achievements would be nothing.”

In 1854, John Snow, Queen Victoria’s anesthesiologist, removed the handle from the Broad Street public water pump in London’s Soho district, ending a cholera epidemic that had killed more than 70 people over two days.

As a further example of progress in PH look at this recent article from the NEJM.

Most of the improvement in health in the USA over the last 200 years has been from environmental reduction of exposure to untreated sewage and untreated drinking water as well as population health programs directed at pregnant women and children and use of vaccines.

Also scan at this issue of the Lancet: Volume 384, Issue 9937, 5–11 July 2014

The ten essentials are the culmination of over 2000 years of development of 'Hygiene" practice as identified in the web page on the history of public health.  Dr. Ted Tweel, past health director of Hanover County Health Department, has provided a short history of major events in Virginia's public health. Also review the History of Public Health in Virginia, a Power Point presentation prepared by Jeff Lake, recently retired Deputy Commissioner of Health, VDH. (.pdf version), Review the Consensus Statement on Quality in the Public Health System
Take a look at death rates for the five leading cause of death in 1900 and see how they have changed, See the two graphics immediately below.. Also, look at the changes in life expectancy in the U.S. over the last 150 years

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10 leading causes of death

Look at the WHO Global Challenges for Public Health -2002. How good is health care in the US, compared to other countries? Can you find the answer on the web and put your conclusion in the first section of the discussion board? Take a look at this introductory Chapter into the recent IOM study on international health disparities! particularly the first three pages, Also this month's article from JAMA on the US Burden of Disease.
Then look at the Public Health Network Home Page

An essential and REQUIRED reading about past history: Elizabeth Fee's Unfulfilled Promise (only 13 pages)

Also, review summaries of three projects from the Robert Wood Johnson Fund (RWJF) identifying weaknesses in the Public Health System.

For every lecture/discussion of the MPH program you should consider how the specific session incorporates the five basic skills of public health which are:

Having already viewed the Principles of Public Health Ethics (See above) consider whether they are also incorporated into the following extended skill set which the IOM 2003 study (scan chapter 4 on-line) recommended as being incorporated into all public health education:

Also look at the Core Competencies Project of the Council of Linkages.  These core competencies are the application of the ten essentials (above.)  While you are visiting this site look at the CCP home page to learn about the Council on Linkages.  Each session will include a continuing focus on public health policy in practice.  Policy development will be discussed in the Spring Health Policy course.  The outline of Dr. Nelson's discussion of goals and policies in the public health arena are found in the Goals PPT show.

Also, in preparation for the remainder of the course review the content for training in public health AGAIN, recommended by the Teachers of Preventive Medicine.   This outline was prepared as a supplement to the Ten Essential Functions, referred to above. This outline is pertinent to anyone planning to practice public health and should be used as a learning tool in every course you take. This will allow you to see how the various elements of each course fit into, and complement, the other courses to ensure that you will be have acquired the skills necessary to carry out the Ten Essentials. when you are awarded your MPH. Read The Recent National Prevention Council's "National Prevention Strategy" and compare this with the Healthy People 2020 (New) topics.

There is a belief by many people that in United States that we actually have a health care system.In fact we have set of different activities each of which is a system of its own that makes up the delivery of public health and health care in the United States, see the graphic in the paragraph below.After reviewing this slide you should understand that the Health Programs in the USA are not a "system": but a set of minisyetms spread among mnay organisations with minmal coordination.
To help you understand this is basic to the changes in public health and personal health care that is occurring at present, by looking at this set of articles from JAMA. The first looks at health outcomes in the United States compared with other countries. Then the article from JAMA on the so-called health system in the United States, followed by discussion of critical issues and values and then the article on linking individual health care and health of populations and the role of population health which is what this introductory courses about. Then look at this progress on seven current objectives from the CDC which focus on population health.

As one way of displaying the major elements of health care provided in the U.S. look at this graphic. If you want to print out this graphic use landscape mode. [When you mouse-over this image the pointer will change to a hand indicating a linked popup box. Click on the area and read the text. Be sure to close the popup before trying to access the next one.] If you have any problem with the text boxes you can see the information in the US Health System pdf. Also review this viewpoint of the US health Care system from a recent article in JAMA., Also scan at this article by Dr. Friedman, director of the CDC, in The New England Journal,

The WHO Statistical Report of HEALTH SYSTEMS Performance for 2003 (see page 13) indicated that the US was 37th when measured by health outcomes such as death rates, disability rates, and survival rates. Also review the report, issued in August 2006, from the Commonwealth Fund about development of a "High Performance Health System" in the US. If you want to follow this up I will be happy to forward the complete report (some 18 pages) by e-mail upon request, and the update in August 2010 2010Update

Finally see the report of the last decade of worldwide achievements of Public Health, and the new Challenges of Prevention.

A topic I introduced last year is that of longevity and definitions of health as these need changing. Take a look at the following two articles as I'll be coming back to them in nearly every session in one form or another: First on Longevity. Second on definition of Health. Also this recent "think piece' from JAMA. I have introduced a new module on Chronic Diseases which has become a leading issue for pubic health in the last 5-10 years.

Valuable URLS:
WHO A guide to statistical information at WHO
WHO Statistics 2007 Ten Highlights (.pdf)
The next two documents should be scanned for this session but read through during the rest of the course as the contents will place many of the other issues into perspective in the rapidly changing field of pubic health policy, particularly the segments on primary care access and caring for he uninsured
Obstacles to changing the system. Scan Only
Bookmarks To start building your own reference files

Also, You may want to place the following in your Links for public health on your web browser as you start to develop a pubic health library.
National Academies Webcasts
Is American health care the best? (The website registration should be free)
Bioinformatics Standards
Prevention Database Look at the 2010 data sets.
Key Resources on Health Coverage and the Uninsured
JHU Pod Med weekly broadcasts.

Additional Useful Readings to add to your public health library:

Does the US have the best HC System in the world? (Short Video) While you watch Dr. Lundberg's short talk ask yourself how many of the criteria for care that he recommends, do you and your classmates meet? Take a poll!
Closing the Digital Divide
How to read an article
WHO & US Health Care
State H. D. Organization Charts
National Academy Press
Investing in a Healthier Future, from the IOM.
The Public's opinion about Public Health
The Future of Public Health