Introduction to the Public Health Approach

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Introduction to the Public Health Approach

• Glyn G. Caldwell, MD
• December 13, 2006

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What is Public health?

• C.E.A. Winslow in 1923 defined Public Health as
  the science and art of preventing disease,
  prolonging life, and promoting physical health
  and efficiency through organized community
  efforts for the sanitation of the

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What is Public health?

• environment, the control of community infections,
  the education of the individual in principles of
  personal hygiene, the organization of medical and
  nursing services for the early diagnosis and
  preventive treatment

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What is Public health?

• disease, and the development of the social
  machinery which will ensure to every individual
  in the community a standard of living adequate
  for the maintenance of health.

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What is Public health?

• John M. Lasts Dictionary of Public Health (2001)
  gives the following
• Public Health is one of the efforts organized by
  society to protect, promote, and restore the
  peoples health.

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What is Public health?

• Public health is the combination of sciences,
  skills, and beliefs that is directed to the
  maintenance and improvement of the health of all
  the people through collective or social actions.

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What is Public health?

• The programs, services, and institutions involved
  emphasize the prevention of disease and the
  health needs of the population as a whole.

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What is Public health?

• Public health activities change with changing
  technology and social values, but the goals
  remain the same to reduce the amount of disease,
  premature death, and disease-produced discomfort
  and disability in the population.

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What is Public health?

• Public health is thus a social institution, a
  discipline, and a practice.

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What is Public health?

• The Acheson Report (1988) defines Public health
  more succinctly as
• The science and art of preventing disease,
  prolonging life, and promoting health through
  organized efforts of society.

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Essential Public Health Functions

• Monitor health status to identify community
  health problems.
• Diagnose and investigate health problems and
  health hazards in the community.
• Inform, educate, and empower people about health
  issues.

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Essential Public Health Functions

• Mobilize community partnerships to identify and
  solve health problems.
• Develop policies and plans that support
  individual and community health efforts.

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Essential Public Health Functions

• Enforce laws and regulations that protect health
  and ensure safety.
• Link people to needed personal health services
  and assure the provision of health care when
  otherwise unavailable.

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Essential Public Health Functions

• Assure a competent public health care workforce.
• Evaluate effectiveness, accessibility, and
  quality of personal and population-based health
  services.
• Research for new insights and innovative
  solutions to health problems.

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Public Health Approach

• Define the health problem.
• Identify risk factors associated with the
  problem.
• Develop and test community-level interventions to
  control or prevent the cause or the problem.

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Public Health Approach

• Implement interventions to improve the health of
  the population.
• Monitor those interventions to assess their
  effectiveness.

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Public Health Approach
Implementation How do you do it?
Intervention Evaluation What works?
Problem
Response
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Public Health Approach

• Requires the collection, analysis, and
  interpretation of data to define the problem and
  outline
• What
• Where
• When
• Who
• How

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Public Health Approach

• Requires a determination of
• Preventable or not preventable
• Controllable or not controllable
• Priority

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Public Health Approach

• The potential for prevention or control
  frequently requires
• A plan
• A champion
• A strategy/method
• A method
• The will
• Funding

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Public Health Approach

• Do it

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Public Health Approach

• After implementation the cycle begins again, but
  this time to evaluate the program results.
• Did the strategy work as intended?
• Were the results as expected?
• If yes, can you expand or replicate the program?
• If no, do you abandon or revise and try again?

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Public Health Approach

• Quiz
• What was the leading cause of death in Arizona
  children 0-4 years of age from 1986-1996?

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Public Health Approach

• Answer
• Drowning

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Drowning in Arizona

• The Public Health Approach requires the
  collection, analysis, and interpretation of data
  to define the problem and outline what, where,
  when, who, and how.

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(No Transcript)
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Drowning in Arizona
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Drowning in Arizona

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Drowning in Arizona

• The data outlines the problem to be
• A barrier problem (none, failed or inadequate)
• Supervision failure

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Drowning in Arizona

• Is the problem preventable or not preventable?
• The problem was considered preventable.
• What was the priority?
• High

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Drowning in Arizona

• The Goal!
• One of the health objectives targeted in Arizona
  2000 was to decrease the death rate for drowning
  to 1.3/100,000. The 1996 drowning rate for
  Arizona residents of all ages exceeded the target
  rate by 69 percent.

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Drowning in Arizona

• The response by the ADHS, DPCCA, CDC, ARC, and
  others was to
• Seek legislative action
• Develop community educational program
• Develop an individual pool safety program

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Drowning in Arizona

• Results
• The legislature passed a bill in 1991 requiring
  fencing and buyer notification (A.R.S. 36-1681)
• The education programs were developed and
  implemented by realtors and volunteer groups

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NO FENCE
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FENCE
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FENCE
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FENCE
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FENCE
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Alarm
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FENCE
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Drowning in Arizona
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Drowning in Arizona
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Drowning in Arizona

• Arizona Republic Headlines
• Child Drownings Down 60 in Phoenix
• Maricopa County Child-Drowning Rate Hits 20-year
  Low

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Drowning in Arizona

• It worked!
• Drowning mortality rates dropped
• Year Rate/100.000
• 1974 21.3
• 1981 19.5
• 1989 11.9
• 1990 5.8

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Drowning in Arizona

• Of 269 drownings from 1995 to 2001, only six
  occurred in pools that were fenced and had
  properly latching gates.

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Drowning in Arizona

• It was better, but it didnt last
• Drowning mortality rates began increasing
• Year Rate/100.000
• 1991 8.5
• 1992 7.1
• 1994 8.0
• 1995 9.9
• 1996 8.5

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Drowning in Arizona
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Drowning in Arizona

• What happened?
• We have to return to data collection and analysis
  to seek the answers

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Drowning in Arizona

• The findings show
• Failure to use or maintain barriers
• Failure to supervise
• Parental inattention
• No requirement for interior pools
• Not all drowning occur in swimming pools

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Drowning in Arizona

• In addition
• The statute allowed cities and counties to pass
  their own ordinances provided they were equal to
  or more stringent that the state statute, which
  lead to some confusion.
• The need for a statewide standard.

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Drowning in Arizona

• And so, the cycle begins again until we
  accomplish our goal.