What Exactly is Public Health? Some Multiple Perspectives

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What Exactly is Public Health? Some Multiple
Perspectives
Gary D. Gilmore, MPH, Ph.D., CHES Ayaz M.
Samadani, MD, DCH, DTMH Julie Willems Van Dijk,
RN, MSN, Ph.D. Bevan K. Baker, FACHE Thomas L.
Sieger August 8, 2008 Wisconsin Public Health
Council Wisconsin Medical Society Madison, WI
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Multiple Perspectives about Public Health
Challenges, Opportunities, Success Stories

• Overview Gary D. Gilmore, MPH, Ph.D., CHES
• Professor and Director, Graduate Community
  Health Programs
• University of Wisconsin at La Crosse
• Vice Chair, Wisconsin Public Health Council
• Physicians Perspective Ayaz Samadani, MD, DCH,
  DTMH
• Family Practice Physician
• Chair, Wisconsin Public Health Council
• Rural/Smaller Municipality Perspective Julie
  Willems Van Dijk, RN, MSN, Ph.D.
• Health Officer Marathon County
  Health Department
• Chair, Ad Hoc Finance Committee
• Urban Perspective Bevan Baker, FACHE
• Commissioner of Health, City of Milwaukee
• Chair, Emergency Preparedness Committee
• Statewide Perspective Thomas L. Sieger
• Deputy Administrator
• Wisconsin Division of Public Health

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Overview
Public Health

• A shared responsibility for community
  well-being through ongoing assessment,
• advocacy, and assurance.
• The combination of science, practical
• skills, and values (or beliefs) directed at
• the maintenance and improvement of the
• health of all people.
• Sources J. Last. Public Health and Human
  Ecology. 1998.
• C.G. Sheps. Higher
  Education for Public Health. 1976.

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Determinants of Population Health
SOURCE The Future of the Publics Health (IOM
2003).
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Vision Healthy People in Healthy
CommunitiesMission Promote Physical and Mental
Health Prevent Disease, Injury,
Disability

• Public Health
• 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 accessibility of health
  services

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• Essential Public Health Services
• Monitor health status to identify community
  health problems
• Diagnose and investigate health problems and
  health hazards in the community
• Inform, educate, and empower people about
  health issues
• Mobilize community partnerships to identify and
  solve health problems
• Develop policies and plans that support
  individual and community health efforts
• Enforce laws and regulations that protect health
  and ensure safety
• Link people to needed personal health services
  and assure the provision of health care when
  otherwise unavailable
• Assure a competent public health and personal
  health care workforce
• Evaluate effectiveness, accessibility, and
  quality of personal and population-

Source Public Health Functions Steering
Committee. July, 1995.
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Source Public Health Functions Steering
Committee. July, 1995.
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Ten Core Practices of Public Health
Assessment
1. Assess the health needs of the community
2. Investigate the occurrence of health effects
health hazards of the community 3. Analyze
the determinants of identified health needs
Policy Development
4. Advocate for public health, build
constituencies identify resources in the
community 5. Set priorities among health
needs 6. Develop plans policies to address
priority health needs
Assurance
7. Manage resources develop organizational
structure 8. Implement programs 9. Evaluate
programs provide quality assurance 10. Inform
educate the public
Source Dyal, WW. American Journal of
Preventive Medicine. 199511 (6 suppl)6-8.
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Public Healthin relation toHealth Services

• A Critical Balance
• What Exactly is Public Health?
• Physicians Perspective

Ayaz M.Samadani M.D., DCH., DTMH Family Practice
Physician Chair, Wisconsin Public Health Council
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Public Health Components

• Epidemiology
• Biostatistics
• Health Services
• Environmental
• Social
• Behavioral
• Occupational Health

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Relationship

• Inter-related
• Dependent on each other
• Medical Services
• Education
• Research

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Opportunities withinClinical Encounters

• Symptoms
• Examination
• Diagnosis
• Treatment

• Outcomes End Results
• Credible Information
• Data Management
• Stock for Policy Development
• Communication

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Opportunities

• Policy Development
• Protecting Health Safety of population
• Training of Providers
• Developing Network of partnerships

• Outcomes
• Maternal Care
• Successes
• Tobacco
• Immunization

Policy
Development Improved Care
Well trained work force
Improved Education Satisfied Population
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Partnership Collaboration

• Providers
• Doctors
• RNS
• NP
• PA
• MA
• Chiropractors
• Podiatrist
• Nutritionist
• Physiotherapist

• Work Force Issue
• Infectious Diseases
• Preventive Care
• Chronic Disease Management
• Patient Education
• Web services
• Volunteer Groups
• Obesity Pandemic

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Challenges

• Communication
• Funding
• Implementation
• Education of Partners
• Education of Providers
• HMO/PPO
• Education of Consumers
• Private pay/uninsured

• Society/Community responsibilities
• Governmental bodies
• Legislature
• Philanthropists

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Challenges

• Disasters
• Natural
• Man-made
• Outbreaks
• War
• Apathy

• Increased demands/Limited Resources
• Matching Funds for Federal Emergency Funding
• Special Population Preparedness
• Access to Mental Health

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Success Story

• Tobacco Control
• Vaccination of Target Population
• Voluntary National Accreditation Program

• Decreased demands
• Increased Cessation
• Decrease in Second Hand Smoke Exposure
• Advance Wisconsin as a Smoke Free State

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Rural/Smaller Municipality Perspective
Julie Willems Van Dijk, RN, MSN, Ph.D. Health
Officer, Marathon County Health Department Chair,
Ad Hoc Finance Committee
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Opportunity!!
To improve the health of Wisconsins people
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The Three Ps

• Prevention
• Population
• Partners

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Social Ecological Model

• Individual
• Family/
• Interpersonal
• Institutional
• Community
• Policy

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Challenges to Rural/Small City Public Health

• Root Causes (Its bigger than behavior.)
• Data (Small populations, Fewer Resources, Delayed
  Timing)
• Workforce (Fewer People, Smaller Pool of
  Professional Preparation, Wage Scales not
  Competitive)
• Financing (See Our Report 2 Tax Levy Caps
  Current Economy)

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Successes

• Community Health Improvement Processes (CHIP)
• Public Health Preparedness
• Immunization Rates (Marathon Co 63 to 90 in
  six years 1995-2001. Maintained at 90 for ten
  years)
• Adult Smoking Rates (Marathon Co 35 in early
  1990s 15 in 2006)

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Urban Public Health Perspective

• Bevan K. Baker, FACHE
• Commissioner of Health, City of Milwaukee
• Chair, Emergency Preparedness Committee

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Challenges
Budget -Decreasing tax levy -Increasing reliance
in categorical grants that dont support core
services
City of Milwaukee Health Department,2008 source
of revenue
Workforce -Need competencies that support
population health focus at the same time there is
an increasing need for more direct
service -Accreditation
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ChallengeMaking the Upstream Shift to Address
Disparities

• Income Social Status
• Social Support Networks
• Education and Literacy
• Employment and Working Conditions
• Physical Environments Social Environments

• Personal Health Practices and Coping Skills
• Health Child Development
• Biology and Genetics
• Health Services
• Gender
• Culture

Source Social Determinants of Health - Public
Health Agency of Canada http//www.phac-aspc.gc.c
a/ph-sp/determinants/index.htmldeterminants
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Opportunities

• Teen pregnancy epidemic hurts Milwaukee
  businesses
• The Business Journal of Milwaukee - A single
  teen pregnancy costs the Milwaukee community
  nearly 80,000 a year, and those mothers and
  their children are less likely to finish school,
  depleting the city's potential work force,
  according to a study released Thursday.

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SuccessMPS Immunization Rates
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Key Strategies

• Data reconciliation between WIR and MPS data
  system including working toward electronic data
  exchange
• Increasing parental awareness of immunization
  requirements and the immunization status of their
  children
• Increasing access to immunizations through school
  based immunization clinics
• Develop coordinated media and social marketing
  campaign to improve immunization rates
• Assuring compliance with state immunization
  statute

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Back to School Marketing

• Posters on new requirements
• Auto-dialer messaging to parents
• Back pack messaging to parents
• Distribution of educational materials at health
  fairs
• Radio commercials
• Bus tails
• MPS Open enrollment clinics
• McDonald tray liners

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Statewide Perspective
Thomas L. Sieger Deputy Administrator Wisconsin
Division of Public Health
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What is Public Health?

• A social enterprise that is focused on the
  population as a whole
• Organized efforts of society to protect, promote,
  and restore people's health, to reduce the amount
  of disease, premature death, and disease-produced
  discomfort and disability in the population.

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Public Health Successes

• Planning
• - HW 2010 (2020?)
• Disease Surveillance
• - WIR, WEDSS and PHIN
• Disease Prevention and Health Promotion
• - Tobacco use, Pb poisoning, Immunization
• Preparedness
• - Flooding, measles and E. coli in spinach
• Public Health Regulation
• - HFS 196, 172 and others

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Major Public Health Challenges

• Public Health Infrastructure
• Public Health Financing
• Workforce
• Health of the Population
• Burden of Chronic Disease
• Health Disparities
• Social and Economic Determinants of Health

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Crisis Danger/Opportunity
Source "Burdened by healthcare costs. US
Businesses seek a shift." The Christian Science
Monitor. February 13, 2007
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Opportunity Prevention

• An investment of 10/person/year in evidence
  based prevention programs could yield an ROI of
  6.15/1 over a 5 year period in healthcare
  savings,
• or in Wisconsin
• Total annual investment 54,990,000
• 5 Year Net Savings 337,900,000
• Source Trust for Americas health. 2008.
  Prevention for a Healthier America.

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We Can Do Better Improving the Health of the
American People

• The united states spends more on health care than
  any other nation in the world, yet it ranks
  poorly on nearly every measure of health status.
• How can this be? What explains this apparent
  paradox? The two-part answer is deceptively
  simple
• first, the pathways to better health do not
  generally depend on better health care, and
• second, even in those instances in which health
  care is important, too many Americans do not
  receive it, receive it too late, or receive
  poor-quality care.

Steven A. Schroeder, M.D. N Engl J Med
20073571221-8.
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Having a System that Lowers Costs by Helping
People be Healthy
Public Health

• PRICELESS

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Advocacy Organizations
Business Labor
Media
Community-Based Health Organizations
Faith Community
Health Care Providers
Civic Organizations
Community Health Centers
Educators
Healthcare Consumers
State and Local Public Health Departments
Foundations
Professional Organizations
Managed Care
Hospitals Clinics
Healthcare Purchasers
Community Residents
Colleges, Universities Technical Schools
Law Enforcement
DATCP, DNR, DPI and other governmental agencies
State Local Elected Officials
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• Summary
• Next Steps
• Questions