Why Public Health?

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Why Public Health?
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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.

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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.

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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 cant address your needs until they are
  made aware.
• Resultsimproved community health.

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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

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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

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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

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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

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What do you think?

• Are these all great achievements?
• Has anything been left out?
• What are some of your concerns or fears?

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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.

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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

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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

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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

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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

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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?

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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
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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

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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.

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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.

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Who lives in Multnomah County?

• 660,486 people (census 2000)
• White 79
• Black or African American 6
• American Indian Alaska Native1
• Asian 6
• Native Hawaiian Other Pacific Islander .003
• Some other race 4
• Two or more races 4
• Hispanic or Latino(of any race) 8

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Who lives in Washington County?

• 445,342 people (Census 2000)
• White82
• Black or African American1
• American Indian Alaska Native1
• 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

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Who lives in Clackamas County?

• 338,391 People (Census 2000)
• White 91
• Black or African American 1
• American Indian Alaska Native1
• Asian 2.5
• Native Hawaiian Other Pacific Islander 0.001
• Some other race2
• Two or more races 2.5
• Hispanic or Latino(of any race) 5

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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

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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

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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

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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

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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)

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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

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When asked what local and state health
departments do responses included

• Research
• Sanitation
• STD clinic
• Contraception
• AIDS test
• Kitchen checks
• Provide clinics for uninsured

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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

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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

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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

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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)

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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 dont
  speak English
• Health care should not be only for those who can
  afford it
• Health care should include alternatives, not just
  Medical Doctors

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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

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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 dont have barriers, but I know of others who
  have struggled

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When asked what public health does

• Womens health issues
• Helps those with no regular doctor
• Helps kids
• Disseminates information
• Oregon Health Plan
• Educates about illness
• WIC

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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

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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

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When asked what local and state health
departments do responses included

• I dont know because I dont need them
• Head Start workers
• Oregon Health Plan
• Welfare
• Kitchen and restaurant sanitation inspection
• Outreach to schools

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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

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Expanding on health continued

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

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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)

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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

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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

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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

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What do you avoid for your health

• Over eating
• Limit sugar
• Limit alcohol
• Avoid smoking

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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

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Barriers continued

• Not always comfortable with the doctor
• If cant receive needed care then urgent care is
  used or Emergency care
• Try home remedies because we cant see the
  doctor in a timely manner this includes over the
  counter drugs and herbs

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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

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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.

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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

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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
  

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Where should ads in the Portland Metro area be
placed?

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

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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

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The Surgeon General is

• Dr. David Satcher
• Since 1871, the Surgeon General of the United
  States has been the nations 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

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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

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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
  dont 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

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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

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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

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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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Feedback

• We have learned from you. We hope you have
  learned from us.
• Please give us your thoughts at this time.

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