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Public Health Practice: How it Was, Is and Could Be.

Public Health Practice: How it Was, Is and Could Be. CMG Buttery, MBBS, MPH, FACPM Adjunct Professor of Public Health Dept. Epidemiology & Community Health Virginia Commonwealth University. How I started. 1946 Completed High School Military Service-RAMC- Lab.Tech .

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Public Health Practice: How it Was, Is and Could Be.

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  1. Public Health Practice: How it Was, Is and Could Be. CMG Buttery, MBBS, MPH, FACPM Adjunct Professor of Public Health Dept. Epidemiology & Community Health Virginia Commonwealth University

  2. How I started. 1946 Completed High School Military Service-RAMC-Lab.Tech. 1948 Completed Military Service entered Med School 1954 graduated Besides skills in trauma medicine, 20-30 major diseases for which we had reasonable intervention. Hospitals filled with children with communicable disease

  3. Public Health in the 1950s • MCH • DPT • Waste disposal, potable water, food service • Primary care access assured for all in UK • Physicians trained to deliver primary care • Hospitals full of children with infectious diseases • Average life span just over 60 years • Many PHNs worked out of primary care practices

  4. Private Practice1957-1966 • I started practice with a set of punch cards to • Track my patients • Ensure quality control."Clinical investigation in general practice: the use of a simplified data-recording system.” Southern Medical Journal, 1963 • I found: • Most of my practice related to a few conditions • Much of the care I gave revolved around chronic diseases. • There were few useful interventions • The outcome of these interventions was mostly poor.

  5. Public Health 1966-1995 Strategic Interventions: Portsmouth: Rental Housing Reform Norfolk (EVMS): Primary care. Prevention clerkship Corpus Christi: Restaurant Code enforced jointly by Restaurant Association and PHD State of Virginia: Study on Primary Care Access

  6. Where we Are Today-I • 100’s of disease for which we intervene, some more successfully than others. • Relatively few communicable diseases due to a multitude of vaccines and improved sanitation • Large numbers of people living past 80 years of age • Many dying after paying for extensive medical intervention with minimal success in last 6-12 months of life. • Limited access to Primary Care for 15% of population

  7. Today -II • Physicians in the US trained as Specialists. • Many Primary Care MDs imported. • Focus of medical care on ‘premies’ and Elderly • Doctors reimbursed for procedures not prevention. • NO universal point of access for care other than ERs.

  8. Today -III • MCH still dominant, but interventions only mildly successful in reducing premature deliveries • Multiple Vaccinations with schedules that change several times a year (see comments in March 15 ‘08 issue of the Lancet. Prioritization of routine vaccines: a mistake for the USA) • Immunization rates improved but not good enough • Focus on sewage and water, food service

  9. Current Philosophical Concerns • Concern about no-one being exposed to any hazard however remote • Dominated by activist politics rather than disease epidemiology • Hurricane Preparedness • Pandemic Preparedness • Food borne outbreaks • Vaccines linked to autism • Domination by the ‘WE’ generation.

  10. Where should we be Going? • Public Health equivalence of clinical excellence, E.G. epidemiology based (AHRQ) • US Preventive Services Task Force • Outcomes and Effectiveness practices. • Local Health Department Accreditation. • IOM study: Who Will Keep the Public Healthy? • IOM study: Future of PH in the 21st Century • Translation research to be improved

  11. Future PH training - 2010+ • Ecological Analysis • Concern for culture & differences • Linkages between PH and Primary Care • to ensure access and prevention priorities • Non-Traditional Research • Community Based • Team Practice • Nurse, social workers, mental health workers, aging workers: Removing the Silos

  12. Important new skills needed • Data-based decision-making • Focus on Genomics • Focus on chronic disease • Use of the WWW 1 & 2 • Distance Training (live classroom. Camtasia, internet) • Effects of Globalization (travel/climate effects, Chikungunya) • Use of GIS e.g. Global Cancer Atlas

  13. My Concerns for the Future • Is Public Health changing from an educational enterprise into a policing enterprise?We have always used laws to support Public Health • Quarantine, people and animals • Condemnation, food, water sources, lead paint • But – Do we use police powers to decide who can eat what? • Do we continue to let the population expand exponentially? What does Genetic life extension and massive infectious disease prevention do to population (see Science, March 14 –Dueling Visions of a hungry World)? • Do we start to require genetic counseling prior to procreation? • Where does all this fit into Chronic disease prevention. • Role in Community Planning

  14. This presentation can be found at http://www.commed.vcu.edu

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