What Exactly is Public Health? Some Multiple Perspectives

Gary D. Gilmore, MPH, Ph.D., CHESAyaz M. Samadani, MD, DCH, DTM&HJulie Willems Van Dijk, RN, MSN, Ph.D.

Bevan K. Baker, FACHEThomas L. Sieger

August 8, 2008August 8, 2008

Wisconsin Public Health CouncilWisconsin Public Health Council

Wisconsin Medical Society Wisconsin Medical Society Madison, WIMadison, WI

Multiple Perspectives about Public Health: Challenges, Opportunities, Success Stories

• Overview: Gary D. Gilmore, MPH, Ph.D., CHESProfessor and Director, Graduate Community Health ProgramsUniversity of Wisconsin at La CrosseVice Chair, Wisconsin Public Health Council

• Physician’s Perspective: Ayaz Samadani, MD, DCH, DTM&HFamily Practice PhysicianChair, Wisconsin Public Health Council

• Rural/Smaller Municipality Perspective: Julie Willems Van Dijk, RN, MSN, Ph.D.Health Officer Marathon County Health DepartmentChair, Ad Hoc Finance Committee

• Urban Perspective: Bevan Baker, FACHECommissioner of Health, City of MilwaukeeChair, Emergency Preparedness Committee

• Statewide Perspective: Thomas L. SiegerDeputy AdministratorWisconsin Division of Public Health

Overview• A shared responsibility for community

well-being through ongoing assessment,

advocacy, and assurance.

• The combination of science, practical

skills, and values (or beliefs) directed at

the maintenance and improvement of the

health of all people. Sources: J. Last. Public Health and Human Ecology. 1998.

C.G. Sheps. Higher Education for Public Health. 1976.

Public Health:

Determinants of Population Health

SOURCE: The Future of the Public’s Health (IOM 2003).

Vision: Healthy People in Healthy CommunitiesMission: Promote Physical and Mental Health & Prevent Disease, Injury, & Disability

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 recovery

• Assures the quality and accessibility of health services

Essential Public Health Services

• Monitor health status to identify community health problems

• Diagnose and investigate health problems and health hazards in the community

• Inform, educate, and empower people about health issues

• Mobilize community partnerships to identify and solve health problems

• Develop policies and plans that support individual and community health efforts

• Enforce laws and regulations that protect health and ensure safety

• Link people to needed personal health services and assure the provision of health care when otherwise unavailable

• Assure a competent public health and personal health care workforce

• Evaluate effectiveness, accessibility, and quality of personal and population-based health services

• Research for new insights and innovative solutions to health problemsSource: Public Health Functions Steering Committee. July, 1995.

Source: Public Health Functions Steering Committee. July, 1995.

Ten Core Practices of Public HealthAssessment

Policy Development

1. Assess the health needs of the community 2. Investigate the occurrence of health effects & health hazards of the community 3. Analyze the determinants of identified health needs

4. Advocate for public health, build constituencies & identify resources in the community 5. Set priorities among health needs 6. Develop plans & policies to address priority health needs

Assurance

7. Manage resources & develop organizational structure 8. Implement programs 9. Evaluate programs & provide quality assurance10. Inform & educate the public

Source: Dyal, WW. American Journal of Preventive Medicine. 1995;11 (6 suppl):6-8.

Public HealthPublic Healthin relation toin relation to

Health ServicesHealth ServicesA Critical Balance

What Exactly is Public Health?

Physician’s PerspectiveAyaz M.Samadani M.D., DCH., DTM&HAyaz M.Samadani M.D., DCH., DTM&HFamily Practice PhysicianChair, Wisconsin Public Health Council

Ayaz M.Samadani M.D., DCH., DTM&HAyaz M.Samadani M.D., DCH., DTM&HFamily Practice PhysicianChair, Wisconsin Public Health Council

Public Health ComponentsPublic Health Components

EpidemiologyEpidemiology BiostatisticsBiostatistics Health ServicesHealth Services EnvironmentalEnvironmental SocialSocial BehavioralBehavioral Occupational HealthOccupational Health

RelationshipRelationship

Inter-relatedInter-related Dependent on each Dependent on each

otherother Medical ServicesMedical Services EducationEducation ResearchResearch

Opportunities Opportunities withinwithin

Clinical EncountersClinical Encounters SymptomsSymptoms ExaminationExamination DiagnosisDiagnosis TreatmentTreatment

Outcomes & End Outcomes & End ResultsResults

Credible InformationCredible Information Data ManagementData Management Stock for Policy Stock for Policy

DevelopmentDevelopment CommunicationCommunication

OpportunitiesOpportunities Policy Development Protecting Health &

Safety of population Training of Providers Developing Network of

partnerships

Outcomes Maternal Care

Successes Tobacco Immunization

Policy DevelopmentPolicy Development

Improved CareImproved Care Well trained work force Well trained work force

Improved Education Satisfied PopulationImproved Education Satisfied Population

Partnership & CollaborationPartnership & Collaboration

ProvidersProviders DoctorsDoctors RNSRNS NPNP PAPA MAMA ChiropractorsChiropractors PodiatristPodiatrist NutritionistNutritionist PhysiotherapistPhysiotherapist

Work Force IssueWork Force Issue Infectious DiseasesInfectious Diseases Preventive CarePreventive Care Chronic Disease Chronic Disease

ManagementManagement Patient EducationPatient Education Web servicesWeb services Volunteer GroupsVolunteer Groups Obesity PandemicObesity Pandemic

ChallengesChallenges

CommunicationCommunication FundingFunding ImplementationImplementation Education of PartnersEducation of Partners Education of ProvidersEducation of Providers

HMO/PPO HMO/PPO

Education of ConsumersEducation of Consumers Private pay/uninsuredPrivate pay/uninsured

Society/Community Society/Community responsibilitiesresponsibilities

Governmental bodiesGovernmental bodies LegislatureLegislature PhilanthropistsPhilanthropists

ChallengesChallenges

DisastersDisasters NaturalNatural Man-madeMan-made OutbreaksOutbreaks WarWar ApathyApathy

Increased Increased demands/Limited demands/Limited ResourcesResources

Matching Funds for Matching Funds for Federal Emergency Federal Emergency FundingFunding

Special Population Special Population PreparednessPreparedness

Access to Mental Access to Mental HealthHealth

Success StorySuccess Story

Tobacco ControlTobacco Control Vaccination of Target Vaccination of Target

PopulationPopulation Voluntary National Voluntary National

Accreditation Accreditation ProgramProgram

Decreased demandsDecreased demands Increased CessationIncreased Cessation Decrease in Second Decrease in Second

Hand Smoke Hand Smoke ExposureExposure

Advance Wisconsin Advance Wisconsin as a Smoke Free as a Smoke Free StateState

Rural/Smaller Rural/Smaller Municipality Municipality PerspectivePerspective

Julie Willems Van Dijk, RN, MSN, Ph.D.

Health Officer, Marathon County Health Department

Chair, Ad Hoc Finance Committee

Opportunity!!Opportunity!!

To improve the health of To improve the health of Wisconsin’s peopleWisconsin’s people

The Three P’sThe Three P’s

PreventionPrevention PopulationPopulation PartnersPartners

Social Ecological ModelSocial Ecological Model

IndividualIndividual Family/Family/

InterpersonalInterpersonal InstitutionalInstitutional CommunityCommunity PolicyPolicy

Challenges to Rural/Small City Challenges to Rural/Small City Public HealthPublic Health Root Causes (It’s bigger than behavior.)Root Causes (It’s bigger than behavior.) Data (Small populations, Fewer Data (Small populations, Fewer

Resources, Delayed Timing)Resources, Delayed Timing) Workforce (Fewer People, Smaller Pool of Workforce (Fewer People, Smaller Pool of

Professional Preparation, Wage Scales Professional Preparation, Wage Scales not Competitive)not Competitive)

Financing (See Our Report + 2% Tax Levy Financing (See Our Report + 2% Tax Levy Caps + Current Economy) Caps + Current Economy)

SuccessesSuccesses

Community Health Improvement Community Health Improvement Processes (CHIP)Processes (CHIP)

Public Health PreparednessPublic Health Preparedness Immunization Rates (Marathon Co: 63% Immunization Rates (Marathon Co: 63%

to 90% in six years [1995-2001]. to 90% in six years [1995-2001]. Maintained at 90% for ten years)Maintained at 90% for ten years)

Adult Smoking Rates (Marathon Co: 35% Adult Smoking Rates (Marathon Co: 35% in early 1990’s; 15% in 2006)in early 1990’s; 15% in 2006)

Think Health. Act Now! . CITY OF MILWAUKEE HEALTH DEPARTMENT . www.milwaukee.gov/Health© Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission.

Urban Public Health Perspective

Bevan K. Baker, FACHE

Commissioner of Health, City of Milwaukee

Chair, Emergency Preparedness Committee

ChallengesBudget:

-Decreasing tax levy

-Increasing reliance in categorical grant’s that don’t support core services Workforce

-Need competencies that support population health focus at the same time there is an increasing need for more direct service

-Accreditation

City of Milwaukee Health Department,2008 source of revenue

ChallengeMaking the Upstream Shift to Address Disparities

• Income & Social Status

• Social Support Networks

• Education and Literacy

• Employment and Working Conditions

• Physical Environments Social Environments

• Personal Health Practices and Coping Skills

• Health Child Development

• Biology and Genetics

• Health Services

• Gender

• Culture

Source: Social Determinants of Health - Public Health Agency of Canada; http://www.phac-aspc.gc.ca/ph-sp/determinants/index.html#determinants

Opportunities

Teen pregnancy epidemic hurts Milwaukee businesses

• The Business Journal of Milwaukee - A single teen pregnancy costs the Milwaukee community nearly $80,000 a year, and those mothers and their children are less likely to finish school, depleting the city's potential work force, according to a study released Thursday.

Think Health. Act Now! . CITY OF MILWAUKEE HEALTH DEPARTMENT . www.milwaukee.gov/Health© Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission.

Success:MPS Immunization Rates

64%

71%

83%

45%

61%

69%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2005-2006 2006-2007 2007-2008School Year

Per

cen

tag

e

In Compliance

Meet Minimum

Think Health. Act Now! . CITY OF MILWAUKEE HEALTH DEPARTMENT . www.milwaukee.gov/Health© Content in this presentation may not be duplicated, copied, or reproduced outside the purview of MHD without permission.

Key Strategies

• Data reconciliation between WIR and MPS data system – including working toward electronic data exchange

• Increasing parental awareness of immunization requirements and the immunization status of their children

• Increasing access to immunizations through school based immunization clinics

• Develop coordinated media and social marketing campaign to improve immunization rates

• Assuring compliance with state immunization statute

Back to School Marketing

• Posters on new requirements

• Auto-dialer messaging to parents

• Back pack messaging to parents

• Distribution of educational materials at health fairs

• Radio commercials

• Bus tails

• MPS Open enrollment clinics

• McDonald tray liners

Statewide PerspectiveStatewide Perspective

Thomas L. SiegerDeputy Administrator

Wisconsin Division of Public Health

Thomas L. SiegerDeputy Administrator

Wisconsin Division of Public Health

What is Public Health?

• A social enterprise that is focused on the population as a whole

• Organized efforts of society to protect, promote, and restore people's health, to reduce the amount of disease, premature death, and disease-produced discomfort and disability in the population.

Public Health Successes• Planning

- HW 2010 (2020?)

• Disease Surveillance - WIR, WEDSS and PHIN

• Disease Prevention and Health Promotion - Tobacco use, Pb poisoning, Immunization

• Preparedness - Flooding, measles and E. coli in spinach

• Public Health Regulation - HFS 196, 172 and others

Major Public Health Challenges

• Public Health Infrastructure– Public Health Financing– Workforce

• Health of the Population– Burden of Chronic Disease– Health Disparities

• Social and Economic Determinants of Health

*Source: "Burdened by healthcare costs. US Businesses seek a shift." The Christian Science Monitor. February 13, 2007

Crisis = Danger/Opportunity

Opportunity = Prevention

An investment of $10/person/year in evidence based prevention programs could yield an ROI of 6.15/1 over a 5 year period in healthcare savings,

or in WisconsinTotal annual investment = $54,990,000

5 Year Net Savings = $337,900,000

Source: Trust for Americas health. 2008. “Prevention for a Healthier America.”

We Can Do Better — Improving the Health of the American People

The united states spends more on health care than any other nation in the world, yet it ranks poorly on nearly every measure of health status.

How can this be? What explains this apparent paradox? The two-part answer is deceptively simple

first, the pathways to better health do not generally depend on better health care, and

second, even in those instances in which health care is important, too many Americans do not receive it, receive it too late, or receive poor-quality care.

Steven A. Schroeder, M.D. N Engl J Med 2007;357:1221-8.

Having a System that Lowers Costs by Helping People be Healthy:

PRICELESS

Public Health

State and Local Public Health Departments

Healthcare Purchasers

Managed Care

Community Health Centers

Health Care Providers

Healthcare Consumers

Hospitals & Clinics

Business & Labor

Advocacy Organizations

Media

Educators

Colleges, Universities & Technical Schools

DATCP, DNR, DPI

and other governmental agencies

State & Local Elected Officials

Law Enforcement

Community Residents

Foundations

Civic Organizations

Professional Organizations

Faith Community

Community-Based Health Organizations

• Summary• Next Steps• Questions