Public Health Overview Sam Stebbins, MD, MPH San Mateo County Public Health...

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Transcript of Public Health Overview Sam Stebbins, MD, MPH San Mateo County Public Health...

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  • Public Health Overview Sam Stebbins, MD, MPH San Mateo County Public Health [email protected]
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  • What is Public Health? The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society. Public health is the organised response by society to protect and promote health and to prevent illness, injury and disability Public health is community health. It has been said that: "Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.
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  • What is Public Health? what society does collectively to assure the conditions for people to be healthy.
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  • Health Department Hospitals MCO Group Practices MCO MDs Nursing Facilities MDs Mental Health Voluntary Agencies Social Services Churches Group Practices Nursing Facilities MCOs Home Health Employers Drug Treatment Schools Local Public Health System MCO Hospitals
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  • Public Health is the ultimate systems challenge
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  • The Web of Causality What is the cause? What is the cause? Necessary factors Necessary factors Augmenting factors Augmenting factors
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  • 10 greatest public health achievements of the 20 th century Vaccination Vaccination Motor Vehicle Safety Motor Vehicle Safety Safer Workplaces Safer Workplaces Control of Infectious Diseases Control of Infectious Diseases Decreased deaths from heart disease and stroke Decreased deaths from heart disease and stroke Safer Foods Safer Foods Healthier Mothers and Babies Healthier Mothers and Babies Family Planning Family Planning Fluoridation of Drinking Water Fluoridation of Drinking Water Tobacco Reduction Tobacco Reduction
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  • MASS PROPHYLAXIS The ability to provide antibiotics, vaccination and/or medical triage to all residents of San Mateo County in an emergency as quickly and effectively as possible
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  • The 3 Kinds of Prevention Primary Prevention Primary Prevention Secondary Prevention Secondary Prevention Tertiary Prevention Tertiary Prevention
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  • What is pre-diabetes? Impaired Glucose Tolerance Impaired Glucose Tolerance Impaired fasting glucose Impaired fasting glucose 110-125 mg/dL 110-125 mg/dL Greater than normal but less than > 126 which is diagnostic of diabetes Greater than normal but less than > 126 which is diagnostic of diabetes
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  • I. Role of the Public Health Laboratory 1. To provide laboratory tests for the various program units of the health department 1. To provide laboratory tests for the various program units of the health department 2. To assist in the diagnosis, control, and prevention of communicable diseases and other illnesses of public health concern 2. To assist in the diagnosis, control, and prevention of communicable diseases and other illnesses of public health concern 3. To provide specialized knowledge in public health microbiology for the purpose of consultation with other specialists in the county 3. To provide specialized knowledge in public health microbiology for the purpose of consultation with other specialists in the county
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  • II. Practices of P.H. Laboratory A. To provide laboratory services A. To provide laboratory services 1. STD control 1. STD control 2. TB control 2. TB control 3. CD control 3. CD control 4. Environmental Health 4. Environmental Health 5. Zoonotic disease control 5. Zoonotic disease control 6. Epidemiological investigations 6. Epidemiological investigations 7. Educational activities 7. Educational activities
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  • Nuestro Canto de Salud -Our Song of Health Partners Goals & Objectives Strategies Community Focused Bridging medical expertise and community outreach to implement culturally/linguistically appropriate health care services.
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  • Chronic Disease Management Team Health Promoters (Promotores de Salud) Community & Street Outreach Community Presentations/Events Resource referrals Community screenings Community Health Workers Clinical Team (RN/RD/CDE)
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  • Strategies l Demystify health through training & field experience l Utilize natural support networks & environments l Community access to prevention & intervention l Link to needed medical care
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  • Definition Epidemiology is Epidemiology is The study of the distribution and determinants of health related states or events in specified populations, and The study of the distribution and determinants of health related states or events in specified populations, and The application of this study to the control of health problems The application of this study to the control of health problems
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  • Objectives of Epidemiology Identify cause of a disease and risk factors Identify cause of a disease and risk factors Determine extent of disease found in a community Determine extent of disease found in a community Study the natural history and prognosis of disease Study the natural history and prognosis of disease Evaluate existing and new preventive and therapeutic measures Evaluate existing and new preventive and therapeutic measures Provide foundation for developing public policy and regulatory decisions Provide foundation for developing public policy and regulatory decisions
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  • Distribution: Descriptive Epidemiology The frequency and pattern of health events in a population The frequency and pattern of health events in a population The who, what, where, when, The who, what, where, when, and how many and how many
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  • Determinants: Analytic Epidemiology The how and why The how and why Do schools with snack and soda machines have higher rates of obesity than schools without? Do schools with snack and soda machines have higher rates of obesity than schools without? Do smokers have higher rates of lung cancer than nonsmokers? Do smokers have higher rates of lung cancer than nonsmokers?
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  • Prevalence Proportion of persons in a population that has disease Proportion of persons in a population that has disease Number of persons with condition at a given time Number of persons in the population at that time Number of persons in the population at that time
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  • Prevalence of Obesity among U.S. Adults, BRFSS, 1993 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16. 15% N/A 15% N/A
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  • Prevalence of Obesity among U.S. Adults, BRFSS, 1996 Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16. 15% N/A 15% N/A
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  • Prevalence of Obesity among U.S. Adults, BRFSS, 1999 Source: Mokdad A H, et al. Am Med Assoc 2000;284:13 15% N/A 15% N/A
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  • Incidence Proportion of a population at risk that becomes diseased over a specified period of time Proportion of a population at risk that becomes diseased over a specified period of time Number of new events during a given time ______________ Number of people at risk during a given time
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  • Test Characteristics Is the test useful? Is the test useful? Will it accurately identify who really does and does not have the condition? Will it accurately identify who really does and does not have the condition?
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  • Testing: Sensitivity The proportion of people with disease who are correctly identified as such by the test The proportion of people with disease who are correctly identified as such by the test The probability of a positive test if disease is present The probability of a positive test if disease is present Is the test sensitive enough to find everyone with the condition? Is the test sensitive enough to find everyone with the condition?
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  • Testing: Specificity The proportion of people without disease who are correctly identified as such The proportion of people without disease who are correctly identified as such The probability of a negative test if disease is absent The probability of a negative test if disease is absent Is a positive test result specific to this disease, identifying only people who truly have it? Is a positive test result specific to this disease, identifying only people who truly have it?
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  • Modes of transmission Direct Direct Direct contact (kissing, skin-to-skin, sexual intercourse) Direct contact (kissing, skin-to-skin, sexual intercourse) Droplet spread Droplet spread Vertical transmission Vertical transmission
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  • Modes of transmission Indirect Indirect Airborne (dust, droplet nuclei) Airborne (dust, droplet nuclei) Vehicle-borne (food, water, soil, bio product, fomites) Vehicle-borne (food, water, soil, bio product, fomites) Vector-borne (mechanical, biological) Vector-borne (mechanical, biological)
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  • What is an outbreak? Outbreak (AKA epidemic) the occurrence of cases of an illness clearly in excess of expectancy for a given time period Outbreak (AKA epidemic) the occurrence of cases of an illness clearly in excess of expectancy for a given time period Endemic persistent or baseline level of disease; the level of disease usually present in a community (not necessarily the preferred level) Endemic persistent or baseline level of disease; the level of disease usually present in a community (not necessarily the preferred level) Pandemic when an epidemic spreads over several countries or continent (the Spanish flu pandemic of 1918) Pandemic when an epidemic spreads over several countries or continent (the Spanish flu pandemic of 1918)
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  • Why Investigate an Outbreak? To identify additional unreported or unrecognized cases To identify additional unreported or unrecognized cases To control the spread of disease To control the spread of disease To identify the source or vehicle of infection (to control or eliminate it) To identify the source or vehicle of infection (to control or eliminate it) To learn more about the disease itself (natural history of disease, clinical spectrum, descriptive epidemiology, and risk factors) To learn more about the disease itself (natural history of disease, clinical spectrum, descriptive epidemiology, and risk factors)
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  • Disease Reporting in San Mateo County: Disease Reporting in San Mateo County: Call (650) 573-2346 (regular hours) Call (650) 573-2346 (regular hours) Call (650) 363- 4981 (after hours urgent needs) Call (650) 363- 4981 (after hours urgent needs) Fax (650) 573 - 2919 Fax (650) 573 - 2919 San Mateo County: www.smhealth.org San Mateo County: www.smhealth.orgwww.smhealth.org What diseases to report and how to report them What diseases to report and how to report them Restaurant inspection results Restaurant inspection results Beach and stream water quality testing Beach and stream water quality testing How to dispose of household hazardous wastes How to dispose of household hazardous wastes Local/State bioterrorism and disaster resources Local/State bioterrorism and disaster resources Local Data: www.plsinfo.org/healthysmc/ Local Data: www.plsinfo.org/healthysmc/www.plsinfo.org/healthysmc/ Immunizations: http://www.immunize.org/ Immunizations: http://www.immunize.org/http://www.immunize.org/ American Public Health Assoc: www.apha.org American Public Health Assoc: www.apha.orgwww.apha.org Really Useful Information