Public Health OverviewPublic Health Overview

Sam Stebbins, MD, MPHSam Stebbins, MD, MPH

San Mateo County Public HealthSan Mateo County Public Health

sstebbins@co.sanmateo.ca.ussstebbins@co.sanmateo.ca.us

What is Public Health?What is Public Health?The science and art of preventing disease, The science and art of preventing disease, prolonging life, and promoting health through prolonging life, and promoting health through organized efforts of society. organized efforts of society.

Public health is the organised response by Public health is the organised response by society to protect and promote health and to society to protect and promote health and to prevent illness, injury and disabilityprevent illness, injury and disability

Public health is community health. It has Public health is community health. It has been said that: "Health care is vital to all of us been said that: "Health care is vital to all of us some of the time, but public health is vital to some of the time, but public health is vital to all of us all of the time.”all of us all of the time.”

What is Public Health?What is Public Health?

……what society does collectively to what society does collectively to assure the conditions for people to be assure the conditions for people to be healthy.healthy.

Health Department

Hospitals MCO Group

Practices

MCO MDs

Nursing FacilitiesMDs

Mental Health

Voluntary Agencies

Social Services

Churches

Group Practices

Nursing Facilities

MCOs

Home Health

Employers

Drug Treatment

Schools

Local Public Health System

MCO Hospitals

Public Health is the ultimate Public Health is the ultimate systems challengesystems challenge

The “Web” of CausalityThe “Web” of Causality

What is the cause?What is the cause? Necessary factorsNecessary factors Augmenting Augmenting

factorsfactors

10 greatest public health 10 greatest public health achievements of the 20achievements of the 20thth century century

VaccinationVaccination Motor Vehicle Motor Vehicle

SafetySafety Safer WorkplacesSafer Workplaces Control of Control of

Infectious DiseasesInfectious Diseases Decreased deaths Decreased deaths

from heart disease from heart disease and strokeand stroke

Safer FoodsSafer Foods Healthier Mothers Healthier Mothers

and Babiesand Babies Family PlanningFamily Planning Fluoridation of Fluoridation of

Drinking WaterDrinking Water Tobacco ReductionTobacco Reduction

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

The 3 Kinds of PreventionThe 3 Kinds of Prevention

Primary PreventionPrimary Prevention

Secondary PreventionSecondary Prevention

Tertiary PreventionTertiary Prevention

What is “pre-diabetes”?What is “pre-diabetes”?

Impaired Glucose Impaired Glucose ToleranceTolerance Impaired fasting Impaired fasting

glucoseglucose 110-125 mg/dL110-125 mg/dL Greater than “normal” Greater than “normal”

but less than but less than >> 126 126 which is diagnostic of which is diagnostic of diabetesdiabetes

I. Role of the Public Health I. Role of the Public Health LaboratoryLaboratory

1. To provide laboratory tests for the 1. To provide laboratory tests for the various program units of the health various program units of the health departmentdepartment

2. To assist in the diagnosis, control, and 2. To assist in the diagnosis, control, and prevention of communicable diseases and prevention of communicable diseases and other illnesses of public health concernother illnesses of public health concern

3. To provide specialized knowledge in 3. To provide specialized knowledge in public health microbiology for the purpose public health microbiology for the purpose of consultation with other specialists in the of consultation with other specialists in the countycounty

II. Practices of P.H. LaboratoryII. Practices of P.H. Laboratory

A. To provide laboratory services A. To provide laboratory services 1. STD control1. STD control 2. TB control2. TB control 3. CD control3. CD control 4. Environmental Health4. Environmental Health 5. Zoonotic disease control5. Zoonotic disease control 6. Epidemiological investigations6. Epidemiological investigations 7. Educational activities7. Educational activities

Nuestro Canto de SaludNuestro Canto de Salud-Our Song of Health-Our Song of Health – –

PartnersPartners

Goals & ObjectivesGoals & Objectives

StrategiesStrategies

Community FocusedCommunity Focused

Bridging medical expertise and community outreach to Bridging medical expertise and community outreach to implement culturally/linguistically appropriate health care implement culturally/linguistically appropriate health care

services.services.

Chronic Disease Management Chronic Disease Management TeamTeam

Health Promoters (Promotores de Salud)Health Promoters (Promotores de Salud)

Community & Street OutreachCommunity & Street Outreach

Community Presentations/EventsCommunity Presentations/Events

Resource referralsResource referrals

Community screeningsCommunity screenings

Community Health WorkersCommunity Health Workers

Clinical Team (RN/RD/CDE)Clinical Team (RN/RD/CDE)

StrategiesStrategies

Demystify health through training & field Demystify health through training & field experienceexperience

Utilize natural support networks & Utilize natural support networks & environmentsenvironments

Community access to prevention & Community access to prevention & interventionintervention

Link to needed medical careLink to needed medical care

DefinitionDefinition

Epidemiology is Epidemiology is TheThe study study of the of the distributiondistribution and and

determinants determinants of health related states or of health related states or events in specified populations, and events in specified populations, and

TheThe application application of this study to the of this study to the control of health problemscontrol of health problems

Objectives of EpidemiologyObjectives of Epidemiology Identify cause of a disease and risk factorsIdentify cause of a disease and risk factors Determine extent of disease found in a Determine extent of disease found in a

communitycommunity Study the natural history and prognosis of Study the natural history and prognosis of

diseasedisease Evaluate existing and new preventive and Evaluate existing and new preventive and

therapeutic measurestherapeutic measures Provide foundation for developing public Provide foundation for developing public

policy and regulatory decisionspolicy and regulatory decisions

Distribution: Distribution: Descriptive Epidemiology Descriptive Epidemiology

The frequency and pattern of health The frequency and pattern of health events in a populationevents in a population

The The who, what, where, whenwho, what, where, when, ,

and and how manyhow many

Determinants:Determinants: Analytic Epidemiology Analytic Epidemiology

The The how how and and whywhy Do schools with snack and soda machines Do schools with snack and soda machines

have higher rates of obesity than schools have higher rates of obesity than schools without?without?

Do smokers have higher rates of lung Do smokers have higher rates of lung cancer than nonsmokers?cancer than nonsmokers?

PrevalencePrevalence

Proportion of persons in a population Proportion of persons in a population that has diseasethat has disease

Number of persons with condition at a given timeNumber of persons with condition at a given time

Number of persons in the population at that timeNumber of persons in the population at that time

Prevalence of Obesity Prevalence of Obesity among among

U.S. Adults, BRFSS, 1993U.S. Adults, BRFSS, 1993

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16.

<10%<10% 10-15% 10-15% >15%>15% N/A N/A

Prevalence of Obesity Prevalence of Obesity among among

U.S. Adults, BRFSS, 1996U.S. Adults, BRFSS, 1996

Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16.

<10%<10% 10-15% 10-15% >15%>15% N/A N/A

Prevalence of Obesity Prevalence of Obesity among among

U.S. Adults, BRFSS, 1999U.S. Adults, BRFSS, 1999

Source: Mokdad A H, et al. Am Med Assoc 2000;284:13

<10%<10% 10-15% 10-15% >15%>15% N/A N/A

IncidenceIncidence

Proportion of a population at risk that Proportion of a population at risk that becomes diseased over a specified becomes diseased over a specified period of timeperiod of time

Number of new events during a given timeNumber of new events during a given time____________________________

Number of people at risk during a given timeNumber of people at risk during a given time

Test CharacteristicsTest Characteristics

Is the test useful? Is the test useful? Will it accurately identify who really does Will it accurately identify who really does

and does not have the condition?and does not have the condition?

Testing: SensitivityTesting: Sensitivity

The proportion of people with disease The proportion of people with disease who are correctly identified as such by who are correctly identified as such by the testthe test

The probability of a positive test if The probability of a positive test if disease is presentdisease is present Is the test sensitive enough to find Is the test sensitive enough to find

everyone with the condition?everyone with the condition?

Testing: SpecificityTesting: Specificity

The proportion of people without The proportion of people without disease who are correctly identified as disease who are correctly identified as such such

The probability of a negative test if The probability of a negative test if disease is absentdisease is absent Is a positive test result specific to this Is a positive test result specific to this

disease, identifying only people who truly disease, identifying only people who truly have it?have it?

Modes of transmissionModes of transmission

DirectDirect Direct contact (kissing, skin-to-skin, Direct contact (kissing, skin-to-skin,

sexual intercourse)sexual intercourse) Droplet spread Droplet spread Vertical transmissionVertical transmission

Modes of transmissionModes of transmission

IndirectIndirect Airborne (dust, droplet nuclei)Airborne (dust, droplet nuclei) Vehicle-borne (food, water, soil, bio Vehicle-borne (food, water, soil, bio

product, fomites)product, fomites) Vector-borne (mechanical, biological)Vector-borne (mechanical, biological)

What is an outbreak?What is an outbreak?

Outbreak (AKA epidemic) – the occurrence Outbreak (AKA epidemic) – the occurrence of cases of an illness clearly in excess of of cases of an illness clearly in excess of expectancy for a given time periodexpectancy for a given time period

Endemic – persistent or baseline level of Endemic – persistent or baseline level of disease; the level of disease usually present disease; the level of disease usually present in a community (not necessarily the in a community (not necessarily the preferred level)preferred level)

Pandemic – when an epidemic spreads over Pandemic – when an epidemic spreads over several countries or continent (the Spanish several countries or continent (the Spanish flu pandemic of 1918)flu pandemic of 1918)

Why Investigate an Outbreak?Why Investigate an Outbreak?

To identify additional unreported or To identify additional unreported or unrecognized casesunrecognized cases

To control the spread of diseaseTo control the spread of disease To identify the source or vehicle of infection To identify the source or vehicle of infection

(to control or eliminate it)(to control or eliminate it) To learn more about the disease itself To learn more about the disease itself

(natural history of disease, clinical (natural history of disease, clinical spectrum, descriptive epidemiology, and spectrum, descriptive epidemiology, and risk factors)risk factors)

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 - 2919Fax (650) 573 - 2919

San Mateo County: www.smhealth.orgSan Mateo County: www.smhealth.org What diseases to report and how to report themWhat diseases to report and how to report them Restaurant inspection resultsRestaurant inspection results Beach and stream water quality testingBeach and stream water quality testing How to dispose of household hazardous wastesHow to dispose of household hazardous wastes Local/State bioterrorism and disaster resourcesLocal/State bioterrorism and disaster resources

Local Data: www.plsinfo.org/healthysmc/Local Data: www.plsinfo.org/healthysmc/ Immunizations: http://www.immunize.org/Immunizations: http://www.immunize.org/ American Public Health Assoc: www.apha.orgAmerican Public Health Assoc: www.apha.org

Really Useful Information