Public Health In America: A State/Local Perspective

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Public Health In AmericaA State/Local
Perspective
Working for a Healthier World

• Georges C. Benjamin, M.D., FACP
• Executive Director
• American Public Health Association

Public Health Prevent, Promote, Protect
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1854 Cholera EpidemicLondon, England

• Severe and widespread cholera in London
• Dr. John Snows hypothesis People were getting
  cholera through contaminated drinking water an
  infectious agent
• Common view was it was from miasma or bad air
• London obstetrician-mid-1800s

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1854 London Cholera Epidemic

• Documented cholera cases throughout the city
  according to their proximity to two different
  water companies
• Demonstrated that cholera was occurring more
  often in people consuming water from the
  Southwark and Vauxhill companys pump
• Removed the Broad St. water pump handle
• Stopped the epidemic

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Institute of Medicine

• A public health professional is a person
  educated in public health or a related discipline
  who is employed to improve health through a
  population focus.

IOM 2002
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The Public Health System
Health Care Delivery System
Community
Assuring Conditions for Population Health
Employers Business
Governmental Public Health Infrastructure
Legislators
Working for a Healthier World
Academics
The Media
IOM 2002
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Public Healths Contribution To Health

• Public health is responsible for the greatest
  increases in human life span
• Yet it has been invisible to the public
• Tragically in CY 2000, 78 of Americans believe
  they had not ever used a public health service
• Its best work is done when nothing happens

Unpublished Survey Hill Knowlton 2000
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Basic Framework For Public Health10 Essential
Services
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A Day in the Life of a Public Health Officer

• Your Community USA
• Today

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Symptoms

• Fever
• Muscle aches
• Abdominal pain
• Diarrhea

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830 A.M.

• Hello. This is Dr. Phillips from Metro Hospital.
  I think you better sit down. Last night we
  admitted three unrelated patients ages 23, 44,
  and 79 from the emergency room with fever, muscle
  aches, and diarrhea. Preliminary lab tests show
  an infectious diarrhea. Whats most interesting
  is that all three patients attended the same
  conference over the weekend with 300 other
  people. Not sure whats going on. but I knew you
  needed to know!

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845 A.M.

• Local health officer
• checks health
• departments online
• disease surveillance system
• for latest information

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850 A.M.

• High number of reported ambulance runs noted over
  last 24 hours
• Larger statewide outbreak suspected
• State-integrated electronic surveillance system
  details mapping of cases by county and zip code

No. Cases Reported
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Physician Report
GIS Software
Health Department
Database GEPI 96
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900 A.M.

• Local health officer alerts state health
  officials of a possible statewide outbreak by
  e-mail
• State health officer alerts heads of medical,
  education, epidemiology, and public relations
  teams and schedules a 945 meeting using PDAs

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910 A.M.

• Public relations education staff are in the
  building
• Epidemiologist and medical chief are at
  satellite office 60 miles away
• They message back they can meet via the states
  interactive video system

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920 A.M.

• State health official views health department Web
  site
• Reviews information on infectious agents
• Suspects food-borne cause!

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945 A.M.

• Health official meets with staff to review new
  data notices outbreak crosses State lines
• Case finding and disease surveillance identifying
  new cases
• GIS mapping indicates new cases in three States
• Reports through wireless communication system

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1030 A.M.

• State health official continues to watch data on
  wireless computer
• Neighboring health agencies contacted in three
  States
• Health agencies agree on regional strategy using
  interactive video conferencing

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1205 P.M.

• Epidemiologist has audio conference with
  their counterparts in three jurisdictions
• 1230 P.M.
• Three State health officials have conference call

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Lab Results Stool Positive for Pathogenic E.Coli

• Paper reports
• Some can view actual results through telemedicine
  linkage with medical center or public health lab
• Suspect its the beef that was served through
  several distributors

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110 P.M.

• Health official alerts CDC, medical
  community, and law enforcement through health
  alert network
• Regional screening and treatment protocols sent
  out
• Updates the 1-800 hotline that informs
  community about public health emergencies

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125 P.M.

• Public Information staff issue press release to
  alert media and educate public
• Blast fax
• E - mail

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220 P.M.

• Health educator teleconferences with community
  physicians via interactive high speed fiber optic
  video network
• Gives new information on diagnosis and therapy
• Start antibiotic treatment

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Public Health Professionals Use Secure Video
Conferencing System to Coordinate Regional
Outbreak Response
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400 P.M.

• Regional response coordinated
• Outbreak identified
• Treatment given
• Disease containment begun
• Lives saved!

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Public Health Has A Broad Mission

Safe Water
Chronic Diseases
Clean
Environment
Safe Food
Bioterrorism
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Operating Environment Has Changed

• Invisible ? Visible
• 9-5 Mon - Fri ? 24/7
• Results tomorrow ? Results now!
• Science politics ? Science and politics
• Evolving science ? Fast science
• Controlled communication ? Information overload
• National scope ? Global involvement

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Change Driven by Highly Visible Public Health
Events

• Security dominates national agenda
• Public health part of national security agenda
• Growing public interest in health
• Protection prevention
• Building infrastructure now a priority

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Reducing Disease BurdenAddressing Root Causes

• Tobacco
• Diet/activity patterns
• Alcohol
• Microbial agents
• Toxic agents
• Firearms
• Sexual behavior
• Motor vehicles
• Illicit use of drugs

1. Heart disease
2. Cancer
3. Stroke
4. Unintentional Injury
5. COPD
6. Diabetes
7. Influenza pneumonia
8. Alzheimer disease
9. Renal disease
10. Sepsis

National vital statistics reports, 2002
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Ensuring A 21st-Century Public Health System

• Building infrastructure
• People
• Training
• Tools
• Resources (money, linkages, facilities)
• Structural reform at local level
• Insufficient investment in public health research
  
• Strengthening nongovernmental public health
• Sustaining reforming resource investments

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Georges C. Benjamin, MD, FACP Executive
Director American Public Health
Association www.apha.org
Public Health Prevent, Promote, Protect