Public Health In America:Public Health In America:A State/Local Perspective A State/Local Perspective

Georges C. Benjamin, M.D., FACPGeorges C. Benjamin, M.D., FACPExecutive DirectorExecutive DirectorAmerican Public Health AssociationAmerican Public Health Association

“Public Health: Prevent, Promote, Protect”

“Working for a Healthier World”

1854 Cholera Epidemic1854 Cholera EpidemicLondon, EnglandLondon, England

Severe and widespread cholera in LondonSevere and widespread cholera in London Dr. John Snow’s hypothesis: People were Dr. John Snow’s hypothesis: People were

getting cholera through contaminated getting cholera through contaminated drinking water; an infectious agentdrinking water; an infectious agent

Common view was it was from miasma or Common view was it was from miasma or bad airbad air

London obstetrician-mid-1800sLondon obstetrician-mid-1800s

1854 London Cholera Epidemic1854 London Cholera Epidemic

Documented cholera cases Documented cholera cases throughout the city throughout the city according to their according to their proximity to two different proximity to two different water companieswater companies

Demonstrated that cholera Demonstrated that cholera was occurring more often was occurring more often in people consuming in people consuming water from the Southwark water from the Southwark and Vauxhill company’s and Vauxhill company’s pumppump

Removed the Broad St. Removed the Broad St. water pump handlewater pump handle

Stopped the epidemicStopped the epidemic

Institute of MedicineInstitute of Medicine

“…“…[A] public health professional is [A] public health professional is a person educated in public health a person educated in public health or a related discipline who is or a related discipline who is employed to improve health employed to improve health through a population focus.”through a population focus.”

IOM 2002

The Public Health SystemThe Public Health System

CommunityCommunityHealth CareHealth Care

Delivery SystemDelivery System

Employers & Employers & BusinessBusiness

Governmental Public Governmental Public Health InfrastructureHealth Infrastructure

AcademicsAcademics The MediaThe Media

Assuring Conditions Assuring Conditions for Population Healthfor Population Health

IOM 2002IOM 2002

LegislatorsLegislators “Working for a Healthier World”

*Unpublished Survey Hill & Knowlton 2000

Public Health’s Contribution Public Health’s Contribution To HealthTo Health

Public health is responsible for Public health is responsible for the greatest increases in human the greatest increases in human life spanlife span

Yet it has been “invisible” to Yet it has been “invisible” to the publicthe public

Tragically in CY 2000, 78% of Tragically in CY 2000, 78% of Americans believe they had not Americans believe they had not ever used a public health ever used a public health service*service*

Its best work is done when Its best work is done when nothing happensnothing happens

Basic Framework For Public HealthBasic Framework For Public Health10 Essential Services10 Essential Services

A Day in the Life of a A Day in the Life of a Public Health OfficerPublic Health Officer

Your Community USA Your Community USA

Today Today

SymptomsSymptoms

FeverFeverMuscle achesMuscle achesAbdominal painAbdominal painDiarrheaDiarrhea

8:30 A.M.8:30 A.M.

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

8:45 A.M.8:45 A.M.

Local health officerLocal health officerchecks healthchecks healthdepartment’s onlinedepartment’s onlinedisease surveillance systemdisease surveillance systemfor latest information for latest information

8:50 A.M.8:50 A.M.

0

500

1000

1500

2000

Monday Wednesday Friday Sunday

High number of reported High number of reported ambulance runs noted ambulance runs noted over last 24 hours over last 24 hours

Larger statewide outbreak Larger statewide outbreak suspectedsuspected

State-integrated electronic State-integrated electronic surveillance system details surveillance system details mapping of cases by mapping of cases by county and zip codecounty and zip code

No. Cases Reported

Physician Report

Database GEPI 96

GIS SoftwareHealth

Department

9:00 A.M.9:00 A.M.

Local health officer alerts Local health officer alerts state health officials of a state health officials of a possible statewide possible statewide outbreak by e-mailoutbreak by e-mail

State health officer alerts State health officer alerts heads of medical, heads of medical, education, epidemiology, education, epidemiology, and public relations teams and public relations teams and schedules a 9:45 and schedules a 9:45 meeting using PDAsmeeting using PDAs

9:10 A.M.9:10 A.M.

Public relations & Public relations & education staff are in the education staff are in the building building

Epidemiologist and Epidemiologist and medical chief are at medical chief are at satellite office 60 miles satellite office 60 miles awayaway

They message back they They message back they can meet via the state’s can meet via the state’s interactive video systeminteractive video system

9:20 A.M.9:20 A.M.

State health official State health official views health views health department Web site department Web site

Reviews information Reviews information on infectious agentson infectious agents

Suspects food-borne Suspects food-borne cause!cause!

9:45 A.M.9:45 A.M.

Health official meets with Health official meets with staff to review new data: staff to review new data: notices outbreak crosses notices outbreak crosses State linesState lines

Case finding and disease Case finding and disease surveillance identifying surveillance identifying new casesnew cases

GIS mapping indicates GIS mapping indicates new cases in three States new cases in three States

Reports through wireless Reports through wireless communication systemcommunication system

10:30 A.M.10:30 A.M.

State health official State health official continues to watch data on continues to watch data on wireless computerwireless computer

Neighboring health Neighboring health agencies contacted in agencies contacted in three Statesthree States

Health agencies agree on Health agencies agree on regional strategy using regional strategy using interactive video interactive video conferencingconferencing

12:05 P.M.12:05 P.M.

Epidemiologist has audio Epidemiologist has audio conference with their conference with their counterparts in three counterparts in three jurisdictions jurisdictions

12:30 P.M.12:30 P.M.

Three State health Three State health officials have conference officials have conference callcall

Lab Results: Stool Positive for Lab Results: Stool Positive for Pathogenic E.ColiPathogenic E.Coli

Paper reportsPaper reports Some can view actual results Some can view actual results

through telemedicine linkage through telemedicine linkage with medical center or with medical center or public health lab public health lab

Suspect it’s the beef that was Suspect it’s the beef that was served through several served through several distributorsdistributors

1:10 P.M.1:10 P.M.

Health official alerts CDC, Health official alerts CDC, medical community, and medical community, and law enforcement through law enforcement through health alert networkhealth alert network

Regional screening and Regional screening and treatment protocols sent treatment protocols sent outout

Updates the 1-800 Updates the 1-800 “hotline” that informs “hotline” that informs community about public community about public health emergencieshealth emergencies

1:25 P.M.1:25 P.M.

Public Information staff Public Information staff issue press release to issue press release to alert media and educate alert media and educate publicpublic

Blast faxBlast fax E - mail E - mail

2:20 P.M.2:20 P.M.

Health educator Health educator teleconferences with teleconferences with community physicians via community physicians via interactive high speed interactive high speed fiber optic video networkfiber optic video network

Gives new information on Gives new information on diagnosis and therapydiagnosis and therapy

Start antibiotic treatment Start antibiotic treatment

Public Health Professionals Use Secure Public Health Professionals Use Secure Video Conferencing System to Coordinate Video Conferencing System to Coordinate

Regional Outbreak Response Regional Outbreak Response

4:00 P.M.4:00 P.M.

Regional response Regional response coordinatedcoordinated

Outbreak identified Outbreak identified Treatment givenTreatment given Disease containment Disease containment

begunbegun Lives saved! Lives saved!

Public Health Has A Broad MissionPublic Health Has A Broad Mission

Chronic Diseases

Bioterrorism

Safe Water

Safe Food

Clean Environment

Operating Environment Has Operating Environment Has Changed Changed

Invisible Invisible Visible Visible 9-5 Mon - Fri 9-5 Mon - Fri 24/7 24/7 Results tomorrow Results tomorrow Results now! Results now! Science & politics Science & politics Science and politics Science and politics Evolving science Evolving science Fast science Fast science Controlled communication Controlled communication Information Information

overloadoverload National scope National scope Global involvement Global involvement

Change Driven by Change Driven by Highly Visible Public Health EventsHighly Visible Public Health Events

Security dominates Security dominates national agendanational agenda

Public health part of Public health part of national security agendanational security agenda

Growing public interest in Growing public interest in healthhealth

Protection & preventionProtection & prevention Building infrastructure Building infrastructure

now a prioritynow a priority

Reducing Disease Burden:Reducing Disease Burden:Addressing Root Causes Addressing Root Causes

1.1. Heart diseaseHeart disease

2.2. CancerCancer

3.3. StrokeStroke

4.4. Unintentional InjuryUnintentional Injury

5.5. COPDCOPD

6.6. DiabetesDiabetes

7.7. Influenza & pneumoniaInfluenza & pneumonia

8.8. Alzheimer diseaseAlzheimer disease

9.9. Renal diseaseRenal disease

10.10. SepsisSepsis

National vital statistics reports, 2002

TobaccoTobacco Diet/activity patterns Diet/activity patterns AlcoholAlcohol Microbial agentsMicrobial agents Toxic agentsToxic agents FirearmsFirearms Sexual behaviorSexual behavior Motor vehiclesMotor vehicles Illicit use of drugsIllicit use of drugs

Ensuring A 21Ensuring A 21stst-Century -Century Public Health SystemPublic Health System

Building infrastructureBuilding infrastructure PeoplePeople TrainingTraining ToolsTools Resources (money, linkages, facilities)Resources (money, linkages, facilities)

Structural reform at local levelStructural reform at local level Insufficient investment in public health research Insufficient investment in public health research Strengthening nongovernmental public healthStrengthening nongovernmental public health Sustaining & reforming resource investmentsSustaining & reforming resource investments

Georges C. Benjamin, MD, FACPGeorges C. Benjamin, MD, FACP

Executive DirectorExecutive Director

American Public Health AssociationAmerican Public Health Association

www.apha.orgwww.apha.org

“ Public Health: Prevent, Promote, Protect”