Introduction to Healthcare and Public Health in the US

1
Introduction to Healthcare and Public Health in
the US

• Introduction and History of Modern Healthcare in
  the US

• Lecture b

• This material (Comp1_Unit1b) was developed by
  Oregon Health and Science University, funded by
  the Department of Health and Human Services,
  Office of the National Coordinator for Health
  Information Technology under Award Number
  IU24OC000015.

2
Introduction and History of Modern Healthcare in
the USLearning Objectives

• Delineate key definitions in the healthcare
  domain (Lectures a, b, c, d)
• Explore components of healthcare delivery and
  healthcare systems (Lecture a)
• Define public health and review examples of
  improvements in public health (Lecture b)
• Discuss core values and paradigm shifts in US
  healthcare (Lecture c)
• Describe in overview terms, the technology used
  in the delivery and administration of healthcare
  (Lecture d)

3
Public Health

• is the science and art of preventing disease,
  prolonging life and promoting health through the
  organized efforts and informed choices of
  society, organizations, public and private,
  communities and individuals.
• (Winslow, C.E.A. 1920)

4
10 Great Public Health Achievements US,
1900-1999

• Vaccination
• Motor-vehicle safety
• Safe workplaces
• Control of infectious diseases
• Decline in deaths from coronary heart disease and
  stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco use as a health hazard

5
Public Health Successes (continued)

• Control of infectious diseases
• Example Typhoid
• spread by ingesting contaminated food or water
• In 1891 the typhoid death rate in Chicago alone
  was 174 per 100,000 people
• Now only about 400 cases are seen in the US each
  year, most of whom originate when patients travel
  in developing countries

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Public Health Successes (continued)

• Control of infectious diseases
• Example Smallpox
• Epidemic viral illness
• In the early 1950s there were about 50 million
  cases of smallpox each year worldwide
• By 1977, smallpox was eradicated, thanks to an
  aggressive public health program and the use of
  an effective vaccine

7
Public Health Successes (continued)

• Control of nutritional deficiencies
• Example Goiter
• Lack of iodine in diet leads to impaired thyroid
  hormone synthesis and an enlargement of the
  thyroid gland in the neck (a goiter)
• Fortification of salt with iodine virtually
  eradicated nutritional goiter in the US

8
Public Health Successes (continued)

• Control of nutritional deficiencies
• Example Tooth Decay
• Adding fluoride to drinking water substantially
  reduces the incidence of dental caries (tooth
  decay) in populations
• In 1945 fluoride was added to water in Grand
  Rapids, Michigan
• Now over 10,000 US communities fluoridate their
  water

9
How Has Public Health Improved Healthcare?

• Improvements in understanding disease
• Epidemiology is considered the basic science of
  public health and is
• a quantitative basic science
• a method of causal reasoning based on developing
  and testing hypotheses pertaining to occurrence
  and prevention of morbidity and mortality
• a tool for public health action to promote and
  protect the publics health

10
How Has Public Health Improved Healthcare?
(continued)

• An example of epidemiology at work
• In 1854 epidemic of cholera in London, England
• Cholera is a bacterial disease
• Lack of sanitation and overcrowding led to the
  spread of disease
• Dr. John Snow linked the spread of disease to a
  contaminated public water pump
• Snows hypothesis cholera was spread by
  contaminated water

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How Has Public Health Improved Healthcare?
(continued)

• Improvements in data collection
• Original methods of data collection were crude
• progressive improvement in methodology led to the
  use of sophisticated scientific methods to
  collect data
• cohort studies
• randomized controlled trials

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How Has Public Health Improved Healthcare?
(continued)

• Improvements in data collection
• Example the Framingham Heart Study
• The study followed patients for a number of years
  to identify factors that contribute to the
  development of cardiovascular disease (CVD)
• Over the years, multiple generations of
  participants have helped identify major CVD risk
  factors

13
How Has Public Health Improved Healthcare?
(continued)

• Improvements in data analysis (use of tools such
  as multivariate analysis and meta-analysis)
• Improvement in disease surveillance
• Example the Real-Time Outbreak and Disease
  Surveillance (RODS) Laboratory at the University
  of Pittsburgh, Department of Biomedical
  Informatics

14
How has public health improved healthcare?
(continued)

• Improvement in training
• Establishment of many schools of public health in
  the early 20th century
• Professional degrees such as Master of Public
  Health (M.P.H.)
• Improvements in infrastructure
• Federal
• State
• Local health departments

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Introduction and History of Modern Healthcare in
the USSummary Lecture b

• Public Health Definition
• Public Health Successes include the control of
• Infectious diseases
• Nutritional deficiencies
• Understanding disease
• Public Health has improved
• Data collection, training and infrastructure

16
Introduction and History of Modern Healthcare in
the USReferences Lecture b

• References
• Centers for Disease Control and Prevention - Ten
  great public health achievementsUnited States,
  19001999. (1999, April 2). MMWR, 48(12),
  241-243.
• Definition of Epidemiology from Principles of
  Epidemiology, 2nd edition, CDC Self Study Course
  3030-G. (2008). Retrieved December 6, 2011, from
  Centers for Disease Control and Prevention
  website http//www2a.cdc.gov/phtn/catalog/pdf-fil
  e/Epi_course.pdf.
• Ripa, L. W. (1993). A Half-century of Community
  Water Fluoridation in the United States Review
  and Commentary. Dept. of Childrens Dentistry
  SUNY Stony Brook, 53(1), Retrieved from
  http//aaphd.org/docs/position20papers/A20Half-C
  entury20of20Community20Water1993.pdf.
• Smallpox. (2001). Retrieved December 6, 2011,
  from World Health Organization - Media Center
  website http//www.who.int/mediacentre/factsheets
  /smallpox/en/.
• Typhoid Fever in the United States - NH
  Backgrounder. (2001, April 25). Retrieved
  December 6, 2011, from National Institutes of
  Health, National Institute of Child Health and
  Human Development website http//www.nichd.nih.go
  v/news/releases/typhoid_background.cfm.
• Typhoid Fever, Frequently Asked Questions. (2005,
  January 10). Retrieved December 6, 2011, from
  Centers for Disease Control and Prevention -
  National Center for Emerging and Zoonotic
  Infectious Diseases website http//www.cdc.gov/nc
  zved/divisions/dfbmd/diseases/typhoid_fever/.
• Vandenbroucke, J. P. (1998). Clinical
  investigation in the 20th century the ascendency
  of numerical reasoning. Lancet, 352 (suppl
  2)(12), 6. Retrieved from http//www.rods.pitt.edu
  /site.
• William B. Kannel, MD - Pioneer in Cardiovascular
  Epidemiology, 19232011. (2011, January 10).
  Retrieved December 6, 2011, from Framingham Heart
  Study website http//www.framinghamheartstudy.org
  /index.html.
• Winslow, C. E. (1920). The Untilled Fields of
  Public Health. Science, n.s. 51, 23.