PUBLIC HEALTH PRINCIPLES AND PERSPECTIVES

John Q. Wong, MD, MSc22 Jun 2010

SCHEDULE

22 Jun, Tue PH perspective RCT Cohort

23 Jun, Thu Evidence-based

public health (EBPH) How to read an article

about Prognosis Harm

FOUR REASONS NOT TO SPECIALIZE IN PUBLIC HEALTH (PH)

John Q. Wong, MD, MSc22 June 2010

BENEFITS OF PUBLIC HEALTH PROGRAMS LIE IN THE FUTURE

Medical care provides quick relief for immediate concerns

Natural response Great effort into

putting out today’s fires

Little into preventing tomorrow’s conflagrations

PH programs You bear the costs

now but the benefits will be reaped on someone else’s watch

Examples Improving road safety Preventing measles Limiting climate

change

BENEFICIARIES OF PH MEASURES ARE GENERALLY UNKNOWN

Medicine deals with identifiable people – patients

Directed at helping you

PH deals with statistical ‘lives’

Directed at improving the health of a group of people Although it’s unclear

whose lives were saved

TYPHOON ONDOY

ONDOY: RESCUE VS. PREVENTION

ABS-CBN P95M cash donations P109M in-kind donations

European Commission P700M in tents,

construction materials, water and sanitation facilties improvements, food, cash-for-work programs, basic agricultural inputs

Individual European countries P600M

Why couldn’t the money have been spent on prevention? Wider and more

extensive sewer systems

De-clogging of sewer systems

Desiltation of rivers Reforestation

PRIVATE MEDICAL CARE VS. PUBLIC HEALTH

St. Luke’s Global City Cost P9.5B 620 patient rooms 500 doctors 1.2:1 patient to

doctor ratio

DOH budget in 2007 P13B 90M Filipinos 63,000 government

doctors 1,428 Filipinos to 1

government doctor

BENEFACTORS, TOO, ARE OFTEN UNKNOWN

Who’s Christiaan Barnard? Heart transplant

surgery 5,000 per year

Who’s Denton Cooley? Coronary artery

bypass graft 800,000 per year

Who’s Maurice Hilleman? Developed more than

40 vaccines Including vaccines for

measles, mumps, hepatitis A and B, meningitis, pneumonia, H. influenza, and rubella

Saves 8,000,000 lives per year

BENEFACTORS, TOO, ARE OFTEN UNKNOWN

Physician providing curative care is more easily identified

People often don’t recognize that they have benefited from a PH measure

People take for granted when They don’t get sick at

work Aren’t poisoned Don’t get run over

SOME PH EFFORTS ENCOUNTER NOT JUST DISINTEREST BUT OUT- AND –OUT OPPOSITION

Medical care is promoted by large special interests Pharmaceutical

companies Private hospitals Insurance companies Medical societies

Some PH measures require societal change Anti-Tobacco Law Alcohol restrictions Gun control Seatbelts Pollution control

Goes against powerful special interests

SUMMARY

Medical practitioners Can see their

patients recover Know their patients

personally Are recipients of the

gratitude and respect of their patients

Are supported by powerful interest groups

Public health practitioners Will not see the fruits

of their labor Don’t know who will

benefit from their work

Receive no credit for their work

Need to go up against special interest groups

WHY SOME OF US ARE IN PUBLIC HEALTH

Public health Produces benefits for many years even

generations Saves lives…millions at at time Not everyone needs recognition Produces fundamental societal change