CLASS WEBSITE

Not on CCLI:

http://www.ph.ucla.edu/epi/faculty/

detels/PH150/schedule_2013.htm

The fundamental maxim of

public health is that the health of the individual is best

ensured by maintaining and improving the health of the

community.

David Satcher, 1995

PUBLIC HEALTHPUBLIC HEALTH

The science and art of preventing disease, prolonging life and promoting health through the organized efforts of society.

Acheson Report, London 1988

PUBLIC HEALTH IS:PUBLIC HEALTH IS:

The process of mobilizing local, state/provincial, national and international resources to assure the conditions in which all people can be healthy.

Breslow/Detels, 1997

Public health does not guarantee optimal health, but creates the conditions

under which it can be achieved by society

THE GOAL OF PUBLIC HEALTHTHE GOAL OF PUBLIC HEALTH

The biologic, physical and mental well-being of all members of the global society, regardless of ethnicity, religion, gender, sexual orientation, country or political views.

Detels, 2003

Public health is an exciting field that Public health is an exciting field that can improve the health and quality can improve the health and quality

of life for all.of life for all.

OBJECTIVES OF COURSE (1)An understanding of:

The concept and importance of public health, not only for preventing disease, but also for assuring access and the tools to achieve a healthy community and healthy personal lifestyles

The population approach to health, which is the basis of public health

The scope of public health

OBJECTIVES OF COURSE (2)The major disciplines of public health, their strategies, and how they contribute to assuring the health of the public

The major intervention strategies used by public health to promote the health of the community

The major health problems currently faced by public health in the United States and globally

Barriers to promoting public health and strategies to overcome these barriers

GLOBAL HEALTH GLOBAL HEALTH PROBLEMS PROBLEMS (EXAMPLES)(EXAMPLES)

Drugs Now Deadlier than Autos Drugs Now Deadlier than Autos and Guns and Guns

LA Times Sept 18, 2011LA Times Sept 18, 2011

EPIDEMIC OF FORMULA-ASSOCIATED INFANT DEATH –

China 2008• Melamine in infant formula causes four

deaths

• 40,000 children flood health care facilities

• 12,900 hospitalized with severe kidney damage

• Chinese milk products recalled in Japan, Hong Kong, Singapore and Southeast Asia

European E. coli Outbreak Traced Back To Lot of Fenugreek Seeds Imported From Egypt

The outbreak of shiga-toxin producing E. coli (STEC) in May and June 2011 in Europe has now totaled 265 cases with Hemolytic Uremic Syndrome (HUS) and 3151 non-HUS cases and there have been 42 deaths, all but one in Germany. A report from the European Food Safety Authority in early July implicated a particular lot of fenugreek seeds imported from Egypt in December 2009 [http://www.efsa.europa.eu/en/supporting/doc/176e.pdf]. Several seed types (alfalfa, fenugreek, lentils, adzuki beans, and radish) were suspected in Germany, however, a separate cluster of cases occurring in France in June 2011 gave investigators an important clue. While three types of sprouting seeds were implicated in France (fenugreek, mustard, and rocket), only fenugreek seeds were common to both outbreaks. They became the focus of the investigation and were traced back to Egypt. Results from the microbiological tests carried out on seeds have been negative, possibly due to the limitations of the tests used or the sampling plan used to select the seeds for testing. The hypothesis is that the fenugreek seeds became contaminated with STEC 0104:H4, the implicated agent, at some point prior to leaving the Egyptian importer. According to the report, this reflects a production or distribution process which allowed contamination of fecal material of human or animal origin, possibly at the farm level but still not established.

LA Times,

Sept 2012

LA Times, Sept 2012

This year's outbreak of West Nile virus is the worst since the illness was first observed in the United States in 1999, officials from the U.S. Centers for Disease Control and Prevention said Wednesday. The number of confirmed cases rose by 25% last week to 1,993 -- although

only an estimated 2% to 3% of cases are reported

to the government. Those are generally the most serious infections: Most people who contract the virus do not develop severe symptoms, and many never even know they were infected. The most common symptoms are a fever and neck stiffness. Severe cases can lead to encephalitis or

meningitis.

LA Times, Sept 2012

Lindsey NP, et al. West Nile Virus and Other Arboviral Diseases — United States, 2012. MMWR 62(25):515, June 29, 2013

Selkoe DJ. Preventing Alzheimer's disease. Science 337:1488-1492, 2012

EPIDEMIC OF OBESITY/DIABETES

http://www.dailymail.co.uk/news/article-499925/Obese-8-months-baby-tips-scales-3-stone.html

National Center for Health Statistics. MMWR 61(7):130, 2012.

LA Times, August 16 2013

LA Times, 21 Sept, 2012

LA Times, 1 Sept 2010

Valderrama AL, et al. Vital signs: awareness and treatment of uncontrolled hypertension among adults – United States, 2003-2010. MMWR 61(35):705, 2012.

LA Times, 24 September 2009

San Pedro port pollution

Historic Life ExpectancyHistoric Life Expectancy

Source: U.S. DHHS, 2006

World Health Organization, 2010

WHO: The World Health Report 2008 http://www.who.int/whr/2008/whr08_en.pdf

Major Reasons for Increased Major Reasons for Increased LongevityLongevity

• Improved sanitation

• Provision of clean water

• Universal immunization programs

• Health education and prevention practices

• Improved treatment and prevention of chronic diseases (for recent advances)

Stone R. Asia’s looming social challenge: coping with the elder boom. Science 330:1599, 2010

LA Times, Sept 2012

Top Ten Causes of Deaths World-Wide

http://www.who.int/mediacentre/factsheets/fs310/en/index.html

Top Ten Causes of Deaths in Low-Income Countries

http://www.who.int/mediacentre/factsheets/fs310/en/index.html

Top Ten Causes of Deaths in High-Income Countries

http://www.who.int/mediacentre/factsheets/fs310/en/index.html

World Health Organization, 2010

http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf

http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf

http://ucatlas.ucsc.edu/cause.php

Non-communicable disease deaths; http://www.who.int/nmh/publications/ncd_report_full_en.pdf

http://www.who.int/nmh/publications/ncd_report_full_en.pdf

http://www.globalhealth.org/infectious_diseases/global_view/

http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf

http://www.globalhealthfacts.org/data/topic/map.aspx?ind=91&gclid=CLCeqKC72aoCFVAaQgodIwM58g

Disability-Adjusted Life Years (DALYS)

One DALY can be thought of as one lost year of "healthy" life. The sum of these DALYs across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation where the entire population lives to an advanced age, free of disease and disability.DALYs for a disease or health condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality in the population and the Years Lost due to Disability (YLD) for incident cases of the health condition.Calculation: The YLL basically correspond to the number of deaths multiplied by the standard life expectancy at the age at which death occurs. The basic formula for YLL (without yet including other social preferences discussed below), is the following for a given cause, age and sex:where:N = number of deathsL = standard life expectancy at age of death in years

Panel A shows the percentage of total DALYs due to noncommunicable diseases in each country. Noncommunicable diseases are defined in the hierarchical list of causes11 in the Global Burden of Disease 2010 study and include the following major cause groups: cancers; cardiovascular and circulatory diseases; chronic res piratory diseases; cirrhosis; digestive diseases; neurologic conditions; mental and behavioral disorders; diabetes; urogenital, blood, and endocrine diseases; musculoskeletal diseases; and other noncommunicable diseases such as congenital anomalies and skin diseases

Figure 1. Percentage of Total Disability-Adjusted Life-Years (DALYs) in 2010 According to Country (pt 1)

Panel B shows the percentage of total DALYs due to years lived with disability per country

Murray CLJ et al. Measuring the Global Burden of Disease. N Engl J Med 2013;369:448-57

Figure 1. Percentage of Total Disability-Adjusted Life-Years (DALYs) in 2010 According to Country (pt 2)

World Health Organization 2010

Years of Potential Life Lost from Unintentional Injuries Among Persons Aged 0-19 Years—United States, 2000-2009. MMWR 61(41):833, 2012.

World Health Organization 2010

Shuman EK. Global climate change and infectious diseases. NEJM 362:1062, 2010

http://www.globalhealth.org/infectious_diseases/global_view/

Health in the U.S.

Welcome to Downey*Welcome to Downey*

**but don’t drink the waterbut don’t drink the water

Health Care Crisis in the U.S.

30 Million Americans Without Health Insurance

LA Times: Bridging a gap in care. Free dental services at LA Sports Arena, 28 April 2010.

Anderson GF, et al. Reevaluating “Made in America”— Two Cost-Containment Ideas from Abroad. NEJM 368;24 ne.

Leading causes of death in the United States Leading causes of death in the United States (1900, 1950, 1990, 1997, 2001)(1900, 1950, 1990, 1997, 2001)

Rates

1900 1950 1990 1997 2001

Disease of Heart 167 307 152 131 248

Malignant neoplasms 81 125 135 126 196

Cerebrovascular disease 134 89 28 26 58

Chronic obstructive lung disease ─ 4 20 13 44

Motor vehicle injuries ─ 23 19 16 15

Diabetes mellitus 13 14 12 13 25

Pneumonia and influenza 210 26 14 13 22

HIV Infection ─ ─ 10 6 5

Suicide 11 11 12 11 10

Homicide and legal intervention 1 5 10 8 7

*Age-adjusted per 100,000

Source: McGinnis and Foege (1993); US DHHS (2003)

Schroeder, NEJM 357(12):1222, 2007

Schroeder, NEJM 357(12):1223, 2007

Numbers of U.S. Deaths from Behavior Causes, 2002

In Essential Concepts of Healthy Living, 5th ed, Jones & Bartlett, 2009, p. 5.

Paul Conrad. LA Times, 4 Sept 2010.

Life expectancy at birth and at 65 years of Life expectancy at birth and at 65 years of age in the United States age in the United States

(1900, 1950, 1997, 2001, 2004)(1900, 1950, 1997, 2001, 2004)

At birth Gain At 65 years Gain

1900 47.3 ─ 11.9 ─

1950 68.2 20.9 13.9 2.0

1997 76.5 8.3 17.7 3.8

2001

2004

77.2

77.8

0.7

0.6

18.1

18.7

0.4

0.4

Source: US DHHS

U.S. life expectancy 2004 – African-U.S. life expectancy 2004 – African-American vs. CaucasianAmerican vs. Caucasian

Male At Birth At 65 YearsCaucasian 75.7 years 17.2 yearsAfrican-American 69.5 years 15.2 yearsDifference 6.2 years 2.0 years

Female At Birth At 65 YearsCaucasian 80.8 years 20.0 yearsAfrican-American 76.3 years 18.6 yearsDifference 4.5 years 1.4 years

Source: U.S. DHHS, 2006

LA Times, September 8 2013

MAJOR PREVENTABLE RISK MAJOR PREVENTABLE RISK FACTORSFACTORS

• Substance abuse– Tobacco– Alcohol– Drugs

• Unhealthy diet

• Physical inactivity

• Environmental/occupational hazards

SMOKING FACTS - 2010SMOKING FACTS - 2010

• #1 cause of preventable deaths (446,000/yr)

• >50% of children exposed to second-hand smoke

• 24% of men and 18% of women smoke

• 31% of smokers earn wages below poverty line

THE SCOPE OF PUBLIC HEALTH (1)THE SCOPE OF PUBLIC HEALTH (1)

• Infectious diseases• Chronic diseases

– Heart disease, metabolic disorders, cancer, etc.

– Mental health

• Nutrition disorders• Health of the vulnerable

– e.g. poor, children, women, elderly, etc.– Substance abusers: drugs, alcohol,

tobacco

THE SCOPE OF PUBLICTHE SCOPE OF PUBLICHEALTH (2)HEALTH (2)

• Accidents/violence/injuries

• Health equity

• Occupational health

• Environmental health

• Access to health care

• Quality of health care

• War

STRATEGIES OF PUBLIC STRATEGIES OF PUBLIC HEALTH (1)HEALTH (1)

• Assess the current health situation

– Surveys

– Surveillance

– Morbidity and mortality reporting

• Identify the problem

STRATEGIES OF PUBLIC STRATEGIES OF PUBLIC HEALTH (2)HEALTH (2)

• Research correlates of occurrence• Develop and evaluate interventions• Disseminate results• Influence policy to incorporate results

(science-based policy)

INTERVENTION STRATEGIESINTERVENTION STRATEGIES

• Immunization programs

• Health education

• Behavioral modification strategies

• Community intervention/mobilization

• Structural interventions (laws, regulations)