History of Public Health

• Common public health images include hand washing, smoking bans, and sex education.

8 P's of Public Health

• Prevention
• Protection
• Promotion
• Prolonging
• Product safety
• Physical, social and economic environments
• Picture (Big)
• Populations
• Public health is the practice of protecting and improving community health.
• Health is a state of complete physical, mental, and social well-being, not merely the absence of disease, and includes quality of life.

Dimensions of Health

• Physical
• Social
• Emotional
• Intellectual
• Spiritual
• Environmental
• Financial
• Occupational
• Physical health is the absence of disease and disability, adequate functioning, and the physical condition of the body.
• Emotional health is the ability to feel and express a full range of human emotions and to express/control them appropriately.
• Social health is the ability to interact and communicate effectively, connect with others, demonstrate respect, and have a sense of belonging.
• Intellectual health is the ability to make sound decisions, think critically, and strive for continued personal growth.
• Spiritual health involves unifying forces within individuals and seeking meaning and purpose.
• Environmental health is awareness of the environment's importance to health, as well as human influence on the environment.
• Financial health refers to how financial resources affect physical, mental, and social health.
• Occupational health is gaining satisfaction and meaning through work.
• Contributory causes are often considered the immediate causes of disease, disability, and death.
• Determinants of health are underlying factors that ultimately bring about disease, disability, and death and are sometimes called the causes of causes.
• Determinant of health examples include behavior, infection, genetics, geography, environment, medical care, socioeconomic status, and culture.
• The most significant factor in determining the health of a community is economic status.
• The three controversial issues in "Why is PH controversial" are economic impact, individual liberties, and moral and religious opposition.

Leading causes of death

• In 1900: tuberculosis (TB), gastroenteritis, diphtheria, polio, and influenza/pneumonia
• In 2016: heart disease, cancer, COVID-19, stroke, chronic lower respiratory disease, Alzheimer's, diabetes, influenza/pneumonia, kidney disease, and suicide
• Acute conditions have signs and symptoms of short duration, usually severe, and impair normal functioning.
• Chronic conditions persist over time.
• Most chronic health problems and conditions are preventable.

Levels of Prevention

• Primary: obstructs the onset of illness or injury before evidence of signs or symptoms
• Secondary: leads to early diagnosis and prompt treatment to limit disability, impairment, dependency, or severity
• Tertiary: aimed at rehabilitation
• Ecological Perspective involves multiple factors and pathways.
• Risk factors increase the likelihood of a condition or disease.
• Social and cultural determinants include social status and standing.
• Global health influences include population, pollution, and poverty.
• Behaviors and behavior changes are most complex at the population level.
• Behaviors are modifiable, teachable, and learnable.
• Behaviors exist with multiple influences.

Examples of multiple influences of behaviors include

• Environmental factors
• Social factors
• Organizational factors
• Economic factors
• Requirements for survival from bottom to top of the pyramid of needs are air, water, food, shelter, and care/mutual support.
• Health codes are based on society's belief system and understanding of health and disease.

Public health codes include

• Tribal Rules
• Hieroglyphs
• Chinese Empire
• Bible (Leviticus)
• Koran
• Roman Senate
• Ancient Greeks understood the importance of washing hands, bathing, exercising, and eating well.
• The Ancient Greeks believed that disease was caused by an imbalance between man and his environment.
• Hippocrates believed that illness had a physical and rational explanation and looked for causal relationships between disease and factors such as climate, water, lifestyle, and nutrition.
• Hippocrates is known as the father of Western medicine and coined the term "epidemic."
• The Roman Empire adopted Greek health values, were great engineers (sewage and aqueducts), and collected taxes to support public services, including public baths, water supply, and markets.
• During the Middle Ages, there was a decline in hygiene and sanitation, and faith and prayer were accepted as treatment, but this period marked the beginnings of public health tools.
• Public health tools from the Middle Ages include quarantine of ships and isolation of individuals with disease.
• The Plague/Black Death killed 25-50% of the population in Western Europe.
• The plague was an epidemic disease with two types: bubonic and pneumonic.
• Pneumonic plague spread by sneezing, and bubonic plague spread by flea bites.

Renaissance era

• Disease spread by traders and explorers.
• 90% of indigenous people in the new world were killed from disease spread.
• The age of reason and enlightenment marked the birth of modern medicine with William Harvey and Edward Jenner.
• William Harvey recognized the full circulation of human blood in 1628 (theories of circulation), reproduced via fertilization of an egg by sperm, and used dissection to create theories.
• Edward Jenner performed the 1796 cowpox experiment and coined the term vaccine.
• Health is not mentioned in the US Constitution.

Industrialization/urbanization brought

• New and worse public health problems.
• Poverty
• Slums.
• Disease
• English working class life expectancy of 7 years
• John Snow was a "GW" of public health educated despite his working-class family who made observations during a cholera outbreak and took the handle off the Broad Street pump, which subsided the outbreak.

The Great Sanitary Awakening brought

• Growth in scientific knowledge.
• Humanitarian ideals.
• Connection between poverty and disease.
• Water supply and sewage removal.
• Monitoring community health status.
• The Sanitary Reform in England around 1842 was Edwin Chadwick's "Survey into the Sanitary Condition of the Labouring Classes in Great Britain" provided landmark research, graphic descriptions of filth and disease spread in urban areas where the 1848 General Board of Health was and novels brought public attention.

The Sanitary Reform in the United States during the 1850s

• 1850 "Report of the Sanitary Commission of Massachusetts" occurred.
• 1869 MA State Board of Health occurred.
• Health records and vital public health statistics were used as tools to fight disease.
• A system of sanitary inspection, vaccination programs, and public health information for citizens were established.
• Louis Pasteur discovered germs caused many diseases in 1862 and opened the first public health lab in 1888.
• Robert Koch identified the vibrio that causes cholera, 20 years after Snow's discovery, and discovered the TB bacterium.

Sanitation revolution consisted of

• Clean water; water treatment
• Food inspection
• Soaps, disinfectants, and pharmaceuticals
• Personal hygiene (bathing)
• Public works departments; garbage collection, landfills, and street cleaning
• Public health departments and regulation

Public Health Eras in America

• Prior to 1850: battling epidemics/infectious disease
• 1850-1949: building state and local public health infrastructure
• 1950-1985: filling gaps in medical care delivery, controlling infectious diseases, report on smoking
• 1985-2000 health promotion, disease prevention, multiple risk factor interventions, HIV/AIDS
• 2000-present preparing for and responding to community health threats, population health, global collaboration, health care access/insurance
• Social determinants of health affect access to money, power, and resources and are the circumstances in which people are born, grow up, live, work, and age.

Social Determinants of Health DHHS components consist of

• Economic stability.
• Education access and quality.
• Health care access and quality.
• Neighborhood and environment.
• Social and community context.

Social Determinant of Health KFF components consist of

• Economic stability.
• Neighborhood and environment.
• Education access and quality.
• Food.
• Social and community context.
• Health care access and quality.
• The difference between DHHS and KFF is food.
• DDHS stands for the Department of Health and Human Services.
• Population health interplay between health care systems, traditional public health, and social policy.
• Population health is addressed through evidence-based strategies to prevent disease, disability, and death and to protect health.

Population health is important because

• Mortality and morbidity are preventable
• Life expectancy is longer
• Quality of life
• There are 20th-century achievements
• Life expectancy has decreased in the US overall, but it has impacted people of color the most.
• Hispanic immigrants in the US have a longer life expectancy because they unite and use each other as a protective factor.
• There was an early death crisis before COVID-19 due to drugs/heart disease/accidents.
• Females have a longer life expectancy than males.

Men have a lower life expectancy due to

• Risky behaviors
• Genetic factors
• Work environment
• Inability to release emotion
• Accidents

5 races/ethnicities identified in the life expectancy cause of death PDF consist of

• AIAN (American Indian Alaskan Native)
• Asian
• Hispanic
• Black
• White
• The races most prevalent in COVID from the "Out of the 5 Races" study were Black, Hispanic, and AIAN (all people of color).
• Accidents are the most prevalent COD (cause of death) trait across the board.
• Homicide is one of the top ten COD for only black people.
• Gun violence is not getting better in the US.
• US causes of death shifted from infectious to chronic and acute .

Ten Great Public Health Achievements 1900-1999

• Vaccination
• Motor-vehicle safety
• Safer workplaces
• Control of infectious diseases
• Decline in deaths from coronary heart disease and stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco use as a health hazard

Unique features of public health science and social values

• A social justice perspective
• Inherently political
• Evolving expectations leading to an expanding agenda
• Linked with government
• Grounded in science
• Focused on prevention
• Uncommon culture

Components of health law policy and ethics in health care: SCOPE

• Access, quality, and cost of healthcare
• Organizational and professional structures for the delivery of care
• Public health federalism concerns that "Health" is hard to find in the US Constitution, the relative roles of national, state, and local governments in health matters shift over time, and social values shift over time.

Different sources of law

• Constitutionally based law
• Legislatively based law
• Administrative law
• Judicially based law

Purposes of public health laws

• Protect and promote health (police and general welfare powers)
• Assure rights of individuals
• Major levels of governmental public health: national, tribal, state, and local
• The National Level of Governmental Public Health includes federal health agencies such as DHHS and its components.
• The Tribal Level of Governmental Public Health includes the Indian Health Service and others.
• State health agencies include state health departments and human service agencies.
• Local public health agencies are often called local health departments.
• Leaders of federal health agencies include Xavier Becerra, Mandy K. Cohen, and Vice Admiral Vivek H. Murth
• Xavier Becerra is the secretary of DHHS, the first Latino to hold this office, the first in his family to earn a 4-year degree, and has a JD from Stanford.
• Mandy K. Cohen is the Director of the CDC.
• Vice Admiral Vivek H. Murthy previously served as US Surgeon General under Obama.
• Ensure all levels of government have the capabilities to provide essential public health services is the Federal Public Health Responsibilities.

The Federal Public Health Responsibilities also

• Act when health threats may span more than one state, a region, or the entire nation.
• Act where the solutions may be beyond the jurisdiction of individual states.
• Act to assist the states when they lack the expertise or resources to effectively respond in a public health emergency.
• Facilitate the formulation of public health goals.

Other roles of federal public health

• Leadership.
• Operational and financial resources.
• Research and education.
• Intergovernmental relations before 1915 included having the federal government having minimal health role and little financial power; states had authority, but local governments were where the action was.
• Intergovernmental relations after 1915 involved federal tax resources and social shifts pushing the federal government to become more active, states retaining primary authority and local governments unable to keep up with local needs and expectations.

Legal relation

• Federal government can preempt state and local government
• State can use state constitution and laws to preempt local government in nearly all areas (Masks)
• Arrangements within a state can either be decentralized or centralized.
• Decentralized arrangements within a state relate primarily to local government, although they may also report to a state health agency.
• Centralized arrangements within a state means a unit of the state health agency.
• Local decentralized health departments are units led by local governments, which make most the decisions in fiscal.
• Mixed local health departments are when some local health departments are led by state government, and some are led by local government where no one arrangement predominates in the state.
• All local health departments being units of state government, which makes the most decisions in fiscal represents state/centralized arrangements.
• SC is state/centralized.
• Shared Local Health Departments are governed by both state and local authorities.

State Health Agencies

• Health roles and duties often scattered among dozens of agencies
• Many different configurations for state health agency
• The SC DHEC vision is healthy people living in a health community.
• The SC DHEC mission is to improve the quality of life for all South Carolinians by protecting and promoting the health of the public and the environment.
• Changes are coming to DHEC and will split DHEC into two agencies:
  • Department of Public Health with a director appointed by the Governor, and.
  • Department of Environmental Services with a director appointed by the Governor.
• A public health problem/issue is considered to be the cause of death, disease, or disability (e.g., diabetes).
• A risk factor includes attributes, characteristics, or exposures that increase the likelihood of a person from developing a disease or health disorder (e.g., access to insulin).
• The expansive view asks people to give up a degree of personal liberty for the common good.
• The idealistic view states that public health is a broad social movement, a campaign to maximize health for everyone in the population through distributing benefits and responsibilities in an equitable way.
• Legislatively based laws are when the Congress senate and house pass laws
• Administrative Law is when the governor passes law.
• Judicial-based law is the Supreme and federal courts
• Xavier Becerra is the cabinet member appointed by the president, secretary of DHHS.

The 3 core functions of public health include

• Assessment (evaluation)
• Policy development (in education and law)
• Assurance (quality and diverse access to workforce)
• All the 3 core functions of public health impact mean the equity and health of everyone.
• Infant mortality rate: death of an infant from the time of live birth to one year. It does not include stillbirths
• Relevance of infant mortality rate is to compare populations health
• Indicates current health status of the population and predicts health of the next generation

There is an Increased risk of Infant Mortality if

• Low birth weight (less than 5lbs 6oz)
• Very low birth weight (less than 3lbs 4oz)
• Premature birth
• Male infant
• Maternal age ( y/o or 60 y/o)
• Birth order (1st born and those @th)
• U.S born mother
• Maternal smoking, substance abuse, nutritional status, prenatal care
• Poverty

Problems contributing to the "cradle of shame" (babies in rural South Carolina have a lower chance of survival than a child born in Syria )

• Doctors don't want to live in these rural areas, often no OBGYNs close to rural towns
• Must travel far to get to big-city hospitals, and many people in these communities don't have the means to travel
• May not be able to afford the cost of prenatal care, and are not educated on the importance of the diet
• Obesity is a problem in SC and has a large impact on infant health
• 8 of 46 counties do not have OBGYN
• 25% of mothers received little/no prenatal care

To combat infant mortality, there was a program created

• Have nurses travel from MUSC to rural towns, expensive, with a goal to combat infant mortality
• With the program, there was found significant reduction in infant mortality

Explore the history of public health, from the origins of the term 'epidemic' to modern prevention strategies. Learn about key events like the Black Death, the impact of industrialization, and the contributions of figures like William Harvey. Understand risk factors and social determinants of health.