U.S. Public Health System

Mark Griswold

Maine CDC Office of Local Public Health

(Slides by Brenda M. Joly, PhD, MPH--USM faculty)

What is Public Health?

• Definitions vary

• Key terms– Population health– Prevention

Dictionary Definition

“the science and practice of protecting and improving the health of the community, as by preventive medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards.”

Source: The American Heritage Dictionary, Public Health Institute. PUBLIC HEALTH 101.

CEA Winslow’s Definition

“the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort.”

Source: CEA Winslow, 1920.

Federal Gov’t Definition

“Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy.”

Source: Institute of Medicine Report (IOM). THE FUTURE OF PUBLIC HEALTH. Washington DC: National Academy Press. 1988.

In general, Public Health . . .

• Prevents epidemics and the spread of disease• Protects against environmental hazards• Prevents injuries• Promotes and encourages healthy behaviors• Responds to disasters and assists communities in

recoveries• Assures the quality and accessibility of health

services

Public Health Approach

Public HealthModel

Medical Model

Versus

Public Health Approach

Public Health Model– Population– Disease Prevention– Health Promotion– Interventions

• Environment• Human behavior

– Government (Some private)

Medical Model– Individual– Diagnosis– Treatment– Intervention

• Medical care

– Private (Some public)

Public Health in the US

~Vision~Healthy People in Healthy Communities

~Mission~Promote physical and mental health

and Prevent disease, injury, disability

Healthy People 2010

• Goal 1: Increase Quality and Years of Healthy LifeThe first goal of Healthy People 2010 is to help individuals of all ages increase life expectancy and improve their quality of life.

• Goal 2: Eliminate Health DisparitiesThe second goal of Healthy People 2010 is to eliminate health disparities among segments of the population, including differences that occur by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation.

Public Health…

• Prevents epidemics and the spread of disease

• Protects against environmental hazards

• Responds to disasters and assists communities in recovery

Public Health cont’d…

• Prevents injuries

• Promotes healthy behaviors

• Assures the quality and accessibility of health services

Core Components

ASSESSMENTof the health of the community

ASSESSMENTof the health of the community

ASSURANCEof the public’s

health

ASSURANCEof the public’s

health

POLICY DEVELOPMENT

in the public’s interest

A Public Health System

• Who?– Public entities– Private entities– Voluntary entities

• What?– A network

The Public Health System

MCOs

Home Health

Parks

Economic Development

Mass Transit

Employers

Nursing Homes

Mental Health

Drug Treatment

Civic GroupsHMPs

Laboratory Facilities

Hospitals

EMS Community Centers

Doctors

Health Department

Churches

Philanthropist

Elected Officials

Tribal Health

Schools

Police

Fire

Corrections

Environmental Health

Determinants of Health

• Genetic• Behavioral• Social• Environment

al• Personal

health care

Domains & Early Deaths

Genetic30%

Social15%

Envir.5%

Medical Care10%

Behavioral40%

Genetic30%

Social15%

Envir.5%

Medical Care10%

Behavioral40%

Source: McGinnis et al., 2002

Determinants of Health

McGinnis et al, 2002.