LECTURE 1

• Public Health


  • General state of people's health
  • Measures we take as a society to bring about and maintain health improvements
• Tuberculosis was a leading cause of death in the 19th century
• Public health improvements since the 19th century


  • Cleaner water, air, and food
  • Safe disposal of sewage
  • Knowledge of healthy/unhealthy behaviors
• Government's role in public health


  • Take primary responsibility for promoting health
  • At local (LGU's: county government), state, and national level
  • Through regulations, laws, research, and education
• Charles-Edward A. Winslow's definition of public health (1920)


  "the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts"
• Public health redefined in 1980s


  Due to AIDS epidemic, environmental pollution, healthcare spending, rise in violence/substance use in communities
• Four-part definition of public health


  • Mission: "the fulfillment of society's interest in assuring the conditions in which people can be healthy"
  • Substance: "Organized community efforts aimed at the prevention of disease and the promotion of health"
  • Organizational framework: "both activities undertaken within the formal structure of government and the associate efforts of private and voluntary organizations and individuals"
  • Core functions: Assessment, Policy development, Assurance
• Core functions of public health

  1. Assessment: Monitoring, diagnosing, and investigating health problems in the community

  2. Policy development: Educating/empowering individuals; mobilizing community resources/partnerships; developing policies/plans to support community health

  3. Assurance: Enforcing laws/regulations to protect health/safety; linkages/access for individuals to healthcare; ensure a competent public health/healthcare workforce; evaluate effectiveness/accessibility/quality of healthcare services
• The Ten Essential Public Health Services (EPHS)


  • Original framework developed in 1994, translated the 3 Core functions into concrete set of activities
  • The Futures Initiative (2020) brought the EPHS in line with current and emerging public health practice needs, emphasizing the importance of health equity and its effects on health outcomes
• Public Health vs Medical Care


  • Public Health: Preventing illness in the community
  • Medical Care: Healing individual patients
• Public Health: Science


  • Science is how we understand threats to health and determine interventions and evaluate if they worked
  • Life expectancy has increased by 30 years over the 20th century, only 5 of the 30 years are attributed to modern medicine
  • PH improvements in sanitation, nutrition, and housing
• Public Health: Politics


  • Politics is how we make decisions about what politics to implement, balancing benefits vs individual freedom
  • Nation spends less than 3% of total health spending on public health
  • Politics is part of policy development and assurance functions
• Public Health Disciplines


  • Epidemiology
  • Statistics
  • Biomedical Sciences
  • Environmental Health Science
  • Social and Behavioral Sciences
  • Healthy Policy and Management
• Public Health Disciplines and Core Functions


  • Assessment: Epidemiology, Statistics
  • Policy Development: Biomedical Sciences, Environmental Health Sciences, Social and Behavioral Sciences
  • Assurance: Health Policy and Management
• Public Health Approach


  1. Define the health problem

  2. Identify risk factors associated with the problem

  3. Develop and test community-level interventions to control or prevent the cause of the problem

  4. Implement interventions to improve the health of the population

  5. Monitor interventions to assess their effectiveness
• Public Health Prevention


  • Primary prevention: Prevents an illness or injury from occurring at all
  • Secondary prevention: Minimizes the severity of the disease or injury once it has occurred
  • Tertiary prevention: Minimizes disability by providing medical care and rehabilitation services
• Chain of Causation


  • Illness as a result of: Agent (disease causing bacteria/virus), Host (susceptible human being), Environment (means of transmission to host: contaminated air, water, food)
  • Interventions can focus on interrupting any of these targets
• Public Health: Bioterrorism


  • PH has important role in controlling damage//minimizing injury (secondary and tertiary interventions)
  • Public health response to disasters (natural/man-made): control the damage & prevent further harm to survivors/rescuers
  • Activities include: coordinating emergency medical care, ensuring safety of first responders/residents, minimizing environmental contamination, sanitation efforts
  • Classic PH measures applied to bioterrorism: Epidemiologic investigations to minimize damage/spread of biological agents