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  1. Division of Distance and Distributed Learning

  2. RURAL PUBLIC HEALTH SYSTEMSPHPM 601 INTRODUCTION AND THE HISTORY OF PUBLIC HEALTH MODULE 1

  3. Introduction and History of Public HealthOBJECTIVES • Slides provide a brief exposure to the U.S. health system with a more detailed discussion/definition of public health. • Students gain first introduction to the population health perspective. • History of public health is described from its early roots in 19th century London.

  4. Rural Public Health Systems • Individual introductions • Course introduction • Group Assignments • General discussion of the history of public health • Video: James Burke — The Day the Universe Changed: Social Impacts of new Medical Knowledge • Brief intro to next session

  5. Brief Introductions • Name • History • Job history or academic background • Experiences related to public health • Future • Why interested in PH, where going • Department affiliation • What you want to do when you grow up!

  6. COURSE INFORMATION • Description • Objectives • Requirements • Exams, Presentations, Thought Papers, Rural Health Policy Analysis • Readings • Miscellaneous • Course Outline

  7. Public Health • What is public health? • Where did it come from? • What are some good examples of public health practices? • Who does these things? • Why is it important to us today?

  8. WHAT IS PUBLIC HEALTH?

  9. DEFINITIONS OF HEALTH/PUBLIC HEALTH • “the science and art of preventing disease, prolonging life and promoting health and efficiency thru organized community effort” (Winslow, 1920) • “successive re-definings of the unacceptable” (Vickers, 1958) • “fulfilling society’s interest in assuring conditions in which people can be healthy” (IOM, 1988)

  10. DISEASE PREVENTION(S&K, Ch. 1) • Primary prevention -- prevent the onset of disease • Secondary prevention – identify disease processes are early as possible and intervene to prevent progression beyond early stage • Tertiary prevention – rehabilitation or minimizing effect of disease

  11. WHERE DID PUBLIC HEALTH COME FROM?

  12. EARLY MODELS OF DISEASE • Disease as “magic” • Disease as “divine punishment” • Disease (individual and epidemic) as a function of environmental factors

  13. History of Public Health • Consider children’s health • Could trace to Middle Ages • children essentially enslaved • Early Colonial Life (1600’s) • kidnapped native children • imported Black slaves • “apprenticed” poor English white children

  14. Plight of Infants • 1665-1714 Queen Anne (England) 18 births • 5 live born, 1 survived infancy • 1700s Infant Mortality Rates 400-600/1000 • 1800s IMRs 200-600/1000 • first studies of sanitary conditions • first evidence of schools and hospitals and workplace as sources of ill health

  15. True Rise of Public Health • Early view--plague phenomena that simply had to be accepted • Impact of industrialization • crowded conditions • poor working conditions • poverty • giant germ culture

  16. 1700’s • Waves of epidemics hit the urban areas • Particularly near ports • Disease isolation • fear, tradition, scientific speculation

  17. 1800’s • Battles over isolation vs environmental clean-up • Introduction of early registries and public health datasets • Impact of French & US civil wars on heath and medicine

  18. 1800’s epidemiology • 1837 Chadwick’s report on sanitary cond’s • 1848 & Snow’s Broad Street pump • 1855 Lambert Water Company • 1858 Thames river flowing lavatory • 1864 Lister’s antiseptic • Koch’s introduction of bacteriology • Far argued in favor of proximal variables

  19. Revisit: What is Public Health • The System & Social Enterprise • The Profession • The Methods (knowledge and techniques) • Governmental Services • The Health of the Public

  20. IOM public health mission • Fulfilling society’s interest in assuring conditions in which people can be healthy.” • Core values: • improving health status of others provides benefits to all • assuring means vigilantly promoting and protecting everyone’s interests

  21. Three core functions orWhat Public Health Does • Assessment • Policy development • Assurance

  22. Winslow’s definition of Public Health • Science and art • organized community effort • birthright of health and longevity

  23. As A System • Broad social enterprise • interdisciplinary approach • emphasis on prevention • linkage to government • components include: • inputs, processes, outputs and outcomes

  24. Unique Features • Basis in social justice • Inherently political nature • Dynamic, ever-expanding agenda • Link with government • Grounding in science • Preventive focus • Uncommon culture and bond

  25. Vickers Definition of Public Health • “The landmarks of political, economic and social history are the moments when some condition passed from the category of the given into the category of the intolerable. I believe that the history of public health might well be written as a record of successive re-definings of the unacceptable.”

  26. DO WE NEED PUBLIC HEALTH TODAY?

  27. LIFE EXPECTANCY AT BIRTH AND INFANT MORTALITY RATES

  28. Rose’s Paradox • What do we know about Down’s Syndrome? • What strategies would you use to impact the problem? • What subset of the population would you target?

  29. Rose’s Paradox

  30. What is Public Health ? • Tragedy of the Commons • Clean Water • 25% kids uninsured • Vast majority on death row African American males • Social Causation

  31. Module 2 • Determinants of Health and the Population Health Perspective • Readings: • IOM Ch. 2 • Glass & McAtee • Optional Readings: • S&K Ch. 3 • Lee & Estes Ch. 2

  32. Division of Distance and Distributed Learning