Public Health Overview

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Public Health Overview

• Sam Stebbins, MD, MPH
• San Mateo County Public Health
• sstebbins_at_co.sanmateo.ca.us

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What is Public Health?

• The science and art of preventing disease,
  prolonging life, and promoting health through
  organized efforts of society.
• Public health is the organised response by
  society to protect and promote health and to
  prevent illness, injury and disability
• Public health is community health. It has been
  said that "Health care is vital to all of us
  some of the time, but public health is vital to
  all of us all of the time.

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What is Public Health?

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

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Local Public Health System
Group Practices
Hospitals
Health Department
MCOs
Nursing Facilities
MCO Hospitals
Schools
Drug Treatment
Mental Health
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Public Health is the ultimate systems challenge
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The Web of Causality

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

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10 greatest public health achievements of the
20th century

• Safer Foods
• Healthier Mothers and Babies
• Family Planning
• Fluoridation of Drinking Water
• Tobacco Reduction

• Vaccination
• Motor Vehicle Safety
• Safer Workplaces
• Control of Infectious Diseases
• Decreased deaths from heart disease and stroke

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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
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The 3 Kinds of Prevention

• Primary Prevention
• Secondary Prevention
• Tertiary Prevention

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What is pre-diabetes?

• Impaired Glucose Tolerance
• Impaired fasting glucose
• 110-125 mg/dL
• Greater than normal but less than gt 126 which
  is diagnostic of diabetes

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I. Role of the Public Health Laboratory

• 1. To provide laboratory tests for the various
  program units of the health department
• 2. To assist in the diagnosis, control, and
  prevention of communicable diseases and other
  illnesses of public health concern
• 3. To provide specialized knowledge in public
  health microbiology for the purpose of
  consultation with other specialists in the county

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II. Practices of P.H. Laboratory

• A. To provide laboratory services
• 1. STD control
• 2. TB control
• 3. CD control
• 4. Environmental Health
• 5. Zoonotic disease control
• 6. Epidemiological investigations
• 7. Educational activities

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Nuestro Canto de Salud-Our Song of Health

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

• Partners
• Goals Objectives
• Strategies
• Community Focused

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Chronic Disease Management Team

• Health Promoters (Promotores de Salud)
• Community Street Outreach
• Community Presentations/Events
• Resource referrals
• Community screenings
• Community Health Workers
• Clinical Team (RN/RD/CDE)

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Strategies

• Demystify health through training field
  experience
• Utilize natural support networks environments
• Community access to prevention intervention
• Link to needed medical care

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Definition

• Epidemiology is
• The study of the distribution and determinants of
  health related states or events in specified
  populations, and
• The application of this study to the control of
  health problems

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Objectives of Epidemiology

• Identify cause of a disease and risk factors
• Determine extent of disease found in a community
• Study the natural history and prognosis of
  disease
• Evaluate existing and new preventive and
  therapeutic measures
• Provide foundation for developing public policy
  and regulatory decisions

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Distribution Descriptive Epidemiology

• The frequency and pattern of health events in a
  population
• The who, what, where, when,
• and how many

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Determinants Analytic Epidemiology

• The how and why
• Do schools with snack and soda machines have
  higher rates of obesity than schools without?
• Do smokers have higher rates of lung cancer than
  nonsmokers?

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Prevalence

• Proportion of persons in a population that has
  disease
• Number of persons with condition at a given time
  
• Number of persons in the population at that
  time

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Prevalence of Obesity among U.S. Adults, BRFSS,
1993
Source Mokdad A H, et al. J Am Med Assoc
199928216.
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Prevalence of Obesity among U.S. Adults, BRFSS,
1996
Source Mokdad A H, et al. J Am Med Assoc
199928216.
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Source Mokdad A H, et al. Am Med Assoc
200028413
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Incidence

• Proportion of a population at risk that becomes
  diseased over a specified period of time
• Number of new events during a given time
• ______________
• Number of people at risk during a given time

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Test Characteristics

• Is the test useful?
• Will it accurately identify who really does and
  does not have the condition?

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Testing Sensitivity

• The proportion of people with disease who are
  correctly identified as such by the test
• The probability of a positive test if disease is
  present
• Is the test sensitive enough to find everyone
  with the condition?

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Testing Specificity

• The proportion of people without disease who are
  correctly identified as such
• The probability of a negative test if disease is
  absent
• Is a positive test result specific to this
  disease, identifying only people who truly have
  it?

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Modes of transmission

• Direct
• Direct contact (kissing, skin-to-skin, sexual
  intercourse)
• Droplet spread
• Vertical transmission

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Modes of transmission

• Indirect
• Airborne (dust, droplet nuclei)
• Vehicle-borne (food, water, soil, bio product,
  fomites)
• Vector-borne (mechanical, biological)

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What is an outbreak?

• Outbreak (AKA epidemic) the occurrence of cases
  of an illness clearly in excess of expectancy for
  a given time period
• Endemic persistent or baseline level of
  disease the level of disease usually present in
  a community (not necessarily the preferred level)
• Pandemic when an epidemic spreads over several
  countries or continent (the Spanish flu pandemic
  of 1918)

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Why Investigate an Outbreak?

• To identify additional unreported or unrecognized
  cases
• To control the spread of disease
• To identify the source or vehicle of infection
  (to control or eliminate it)
• To learn more about the disease itself (natural
  history of disease, clinical spectrum,
  descriptive epidemiology, and risk factors)

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Really Useful Information

• Disease Reporting in San Mateo County
• Call [phone] (regular hours)
• Call (650) 363- 4981 (after hours urgent needs)
• Fax (650) 573 - 2919
• San Mateo County www.smhealth.org
• What diseases to report and how to report them
• Restaurant inspection results
• Beach and stream water quality testing
• How to dispose of household hazardous wastes
• Local/State bioterrorism and disaster resources
• Local Data www.plsinfo.org/healthysmc/
• Immunizations http//www.immunize.org/
• American Public Health Assoc www.apha.org