Public Health in the United States: BACK TO THE FUTURE Jay H. Glasser, Ph.D., president-elect

1. Public Health in the United States: BACK TO THE FUTURE Jay H. Glasser, Ph.D., president-elect American Public Health Association

2. The Seaman’s Retreat Hospital being now entirely free from debt, the trustees are enabled to offer the merchant marine the following schedule of reduced fees, viz.:

3. At the Gates - Our Safety Depends on Eternal Vigilance

5. The Nation's Health Dollar: 2000 Where It Came From

6. Where It Went

7. Probability of Being Uninsured for Population Under Age 65, By State, 1977-1999

8. Levels of Analysis for Examining the Effects of Uninsurance

9. HEALTH and DEVELOPMENT in the 20th CENTURY from The World Health Report 1999, Making a Difference (WHO, Geneva) “The 20th century has seen a global transformation in human heath unmatched in history” “Economic historians and demographers debate the genesis of increases in life expectancy...at least partially linked to the economic changes resulting from the agricultural and industrial revolutions. One aspect the economic change-urbanization-actually affected health adversely by exposing an increasing proportion to crowded conditions, thereby facilitating the spread of infection. Somewhat more counterbalancing this effect though were increases in nutrient intake and improvements in sanitation and water supply resulting from higher income levels”

10. FOUR AIMS of STEPHEN SMITH and THE 7 FOUNDERS OF THE AMERICAN PUBLIC HEALTH ASSOCIATION(April 18,1872) • Through the medium of a national organization: • awaken and maintain the active and permanent interest of people in sanitary administration • greatly facilitate the enlightenment of the the public • promote the appointment of more competent health authorities • the advancement of sanitary science and promotion of organizations and measures for practical application to public hygiene.” • The founders included physicians, a superintendent of health, a military and legal medical specialist, an architect, health statistician, an urban housing specialist

11. CDC VISION FOR THE 21 ST CENTURY HEALTHY PEOPLE IN A HEALTHY WORLD— THROUGH PREVENTION CDC’s role as a sentinel for the health of people in the United States and throughout the world. CDC strives to promote disease prevention and health promotion goals that will foster a safe and healthful environment where health is protected, nurtured, and promoted. GOALS SCIENCEAssure a strong science base for public health action ASSESSMENTDetect and assess threats to public health POLICYProvide leadership for the Nation in prevention policy and practice ASSURANCEAssure the public's health through the translation of research into effective community-based action

12. CDC VISION FOR THE 21 ST CENTURY HEALTHY PEOPLE IN A HEALTHY WORLD— THROUGH PREVENTION Tools of Prevention • Surveillance • Health Statistics • Epidemiology • Laboratory • Behavioral Risk Reduction • Technology Transfer • Prevention Research, Strategies, and Programs • Health Communication and Social Marketing

13. AND THEN 9/11

14. BIOTERRORISM : Anything is Possible?

15. The Two Book Ends of Terrorism Traditional Terrorism Post Modern BIG SMALL BOOM SILENT BAND SINGLE BRIEFSUSTAINED

17. Old Scourges Return in Weaponized Versions?

18. A R E W E UP TO D A T E ?

19. Or do it the old way? Patron Saint of Palermo, Italy Delivered a Miracle: Saved the City from Plague in 1634

20. Conference Report on Public Health Security and Bioterrorism Preparedness and Response Act- HR 3448  Requires Preparedness Plans:respond to bioterrorism and other public health emergencies Other Preparedness:children and terrorism, emergency public information and communication, education programs for children and vulnerable people, availability of Potassium Iodide within to populations within 20 miles of a nuclear power plant

21. Control on Biological Agents and Toxins • Registration Requirement • Protection of Animals and Plants • Security and Personnel Screening •   Food Supply Protection: detaining food, bar certain food importers, increase inspections • Drug Supply Protection: registration of foreign manufacturers of import drugs and devices • Water Supply Protection, vulnerability Assessment, emergency response plans, prevent intentional contamination

22. Conference Report on Public Health Security and Bioterrorism Preparedness and Response Act- HR 3448 • BIOTERRORISM PREPAREDNESS • Emergency Medical Stockpiles $1.15 Billion • Center for Disease Control $300 Million • State and Local Preparedness $1.6 Billion • Hospital and Clinic Preparedness $520 Million • Antimicrobial Resistance $25 Million • Food Supply Protection $100 Million •  Water Supply Protection $160 Million

23. AND BREAKING NEWS from The President

24. Proposed Cabinet-Level Homeland Security Department Would Be Responsible for Dealing with Biological/Chemical Attacks • The department would have four main divisions: • Chemical, Biological, Radiological and Nuclear Countermeasures • Emergency Preparedness and Response • Information Analysis and Infrastructure Protection • Border and Transportation Security • Source: Ricks, Washington Post, June 7, 2002

25. Public Health ResponsibilitiesSource: various newspapers June 7, 2002 In the new department, a division would be tasked with protecting against chemical, biological and nuclear threats, assuming control of public health, defense and research operations currently handled by the Departments of Health and Human Services, Energy and Agriculture The CDC's Bioterrorism Preparedness and Response Program, which distributes funds to the states, and National Pharmaceutical Stockpile Program likely would be shifted to the new department, Those two programs means that the CDC would lose about 300 employees and $4 billion from its budget The emergency response division would be responsible for responding to an attack involving weapons of mass destruction, absorbing responsibilities held by HHS' Chemical, Biological, Radiological and Nuclear Response Assets operation.

26. Public Health ResponsibilitiesSource: various newspapers June 7, 2002 • The new department's border and transportation division would absorb the Agriculture Department's Animal and Plant Health Inspection Service • In a televised speech to outline his plan, Bush said the new department would "bring together our best scientists to develop technologies that detect biological, chemical and nuclear weapons." He added that it would "discover the drugs and treatments to best protect our citizens" • Bush hopes to have the new department running by Jan. 1, 2003. It remains uncertain if Bush will nominate Ridge to head the new department (Wall Street Journal, 6/7).

27. And from Congress: First Amendment to HR 4775 Sen Dirksen, “Well you know what they say about the Federal Budget, a billion here and a billion there and before long it starts to add up to real money.” 31 bil. total 14 bil military operations 8.3 bil homeland security 5.5 N bil NYC Sept 11th recovery includes mass transit 1.35 bil foreign aid Afghanistan, Pakistan, Russia, 200 mil AIDS program to focus on mother to child transmission 100 mil for AIDS Global Fund 4.4 bil Transportation Security Administration (includes airport security)

28. And from Congress: First Amendment to HR 4775 (continued) and 417 mil Veterans Adm Medical care First Responders 1 bil Port Security 970 mil Nuclear Laboratory 200 mil Cyber security 115 mil Agroterrorism 200 mil Water systems reviews Secret Service and FBI, national monument 340 mil US Postal Service effort 87 mil Nuclear non proliferation 100 mil

29. Is there a new Spirit of Patriotism and Service? Where will it Lead?

30. BACK TO THE FUTURE?

31. THE PUBLIC HEALTH MISSION of HEALTHY PEOPLE in HEALTHY COMMUNITIES(July 1995 consensus statement of Public Health Steering Committee ) • 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 ACCESSABILITY of HEALTH SERVICES

32. CONTEMPORARY PROBLEMS

33. In 1964, Smoking And Health Captured the Permanent Attention of Physicians and The Nation

36. As We Face the Known and Unknown

38. L E A D E R S H I P

42. APHA INITIATIVES and ALLIANCES • ELIMINATING ETHNIC and RACIAL HEALTH DISPARITIES • EMS and PUBLIC HEALTH COALITION FOR HOMELAND SECURITY • MEDICINE and PUBLIC HEALTH INITITATIVE(AMA, APHA and partners) • THE PUBLIC HEALTH WORKFORCE & STANDARDS • Continuing Education and Credentialing Standards for Public Health Entities • HUMAN RIGHTS and HEALTH CURRICULUM • GLOBAL HEALTH:The World Federation of Public Health Associations

45. Estimated 42.1 Million Uninsured People

49. TEN ESSENTIAL PUBLIC HEALTH SERVICES • MONITOR HEALTH STATUSand identify community problems • DIAGNOSE and INVESTIGATE HEALTH PROBLEMSand health hazards in the community • INFORM, EDUCATE and EMPOWER PEOPLEabout Health Issues • MOBILIZE COMMUNITY PARTNERSHIPSto identify and solve community health efforts

50. ENFORCE LAWSand Regulates that PROTECT HEALTH and Ensure Safety • LINK PEOPLE to NEEDED PERSONAL HEALTH SERVICESand Assure the Provision of Health Care When Otherwise Available • ASSURE a COMPETENT PUBLIC HEALTH and Personal Health CareWORKFORCE • EVALUATE EFFECTIVENESS, ACCESSIBILITY and QUALITYof personal and population -based HEALTH SERVICES • RESEARCH for NEW INSIGHTS and INNOVATIVE SOLUTIONSto Health Problems