Introduction to Public

Health
& Epidemiology
FRANCES AVILÉS
BSc. MD. MPH.

What is Public Health?

 Prevent disease, promote health, prolong life
for a community as a whole

 Prime focus on major threats to the Health of
Populations

 Social Determinants of Health, Health Equity &
Justice

 Aim: Environment, Human Behavior,
Social Interaction, and Health Factors

2 Harvard School of Public Health

What is Public Health?

 The dimensions of health can encompass "a state of complete
physical, mental and social well-being and
not merely the absence of disease or infirmity”
- United Nations' World Health Organization

 Public health incorporates the interdisciplinary approaches of
 Epidemiology, Biostatistics, Health services,
 Environmental health,
 Community health, Behavioral health,
 Health economics, Public policy, Insurance medicine,
 Occupational Safety and Health

3,4 WHO, Wikipedia

treatment. in the context of social responsibilities  Emphasis on disease diagnosis. MEDICINE  Primary Focus on the INDIVIDUAL  Personal service ethic. and care for the individual patient 2 Harvard School of Public Health .

including public health emergencies. and reducing inequalities. and radiation). treatment.Effective Medical Practitioners must be concerned with contributing to each of the following Public Health Goals  Improving services: organization and delivery of safe. high quality services for prevention. aimed at preventing disease. in housing. employment.g. family/community life. education.  Health protection: measures to control infectious disease risks and environmental hazards (such as chemicals. poisons. 5 University of Cambridge . and care.  Health improvement: societal interventions (e. promoting health. and lifestyle) that are not primarily delivered through health services.

Public Health Functions  3 Core functions  ASSESSMENT: assessing and monitoring the health of a population at risk to identify health priorities and problems  POLICY DEVELOPMENT: create public policy/laws to target health priorities. problems and risks at global. prevention and promotion 8 WHO . national or local level  ASSURANCE: guarantee the population’s access to effective and accessible health care.

Prevention and Intervention Approach  Define the Health Problem  Identify the RISK FACTORS associated with the Problem  Develop and Test Community Level Interventions to CONTROL or PREVENT the cause of the Problem  Implement Interventions to improve the health of the population  Monitor those Interventions to assess their effectiveness 10 US Public Health Service .

Essential Public Health Services  Assessment: Monitor Health Status. Ensure Safety. Evaluate  RESEARCH: New Problems need New Solutions 9 Schneider . Assure a competent workforce. Plans and Policy Development  Assurance: Law Enforcement. Educate. Community Partnerships. Regulation. Diagnose & Investigate  Policy Development: Inform. Link people to health services.

NIH. Highway Traffic Safety Adm (Dpt of Transportation). etc. FDA. CMS. Dpt of Education. Homeland Security .  Each State has the responsibility to collect population data and of regulation enforcement  Other important Federal Agencies with PH Responsibilities  Dpt of Agriculture. EPA.PH Authority in the United States  FEDERAL > STATE Health Dpt > LOCAL Health  Federal: Department of Health and Human Services  CDC. OSHA (Dpt of Labor).

 One of the most important biomedical research centers in the world. medical devices. food additives. evaluates all new drugs.  Ensures that food supply is safe and nutritious. . The main assessment and epidemiologic agency for the US.

“Health is a state of complete physical. mental and social well-being and not merely the absence of disease or infirmity” .Global Context: .

EPIDEMIOLOGY .

people.on/upon. logos- study of "Study of what happens to a people/population.frequency and patterns of health events in human 11 populations CDC . and the application of this study to the control of health problems” ." • ∴Epidemiology is the: “the study of the distribution and determinants of health-related states or events in specified populations. demos . What Is Epidemiology? • Greek: epi .

Epidemiology: Assessment  Investigate: Cause of Disease  Study: Patterns in Disease Occurrence and influencing factors  Evaluate: Effectiveness of Medical and Public Health Interventions .

 In sampling. healthcare facility  The global community 11 CDC . state. county. the Population may refer to the units from which the sample is drawn  ∴ Examples of populations include:  A neighborhood. territory. or country  A school.“of a population”  Population: The total number of inhabitants of a given area or country. city.

Haiti earthquake (2010)  Terrorism World Trade Center (2001). Air pollutants and other asthma triggers  Infectious diseases Foodborne illness.PROBLEMS & SOCIAL EVENTS  Environmental exposures Lead and heavy metals. Influenza and pneumonia  Injuries Increased homicides in a community. Anthrax release (2001) 11 CDC . National surge in domestic violence  Non-infectious diseases Localized/widespread increase in any type of cancer or a major birth defect  Natural disasters Hurricanes Katrina and Rita (2005).

Etiology & Natural History of Disease  Etiology: The CAUSE or ORIGIN of a condition  Natural history: The way a disease progresses in the absence of medical or public health intervention • Prevent disease from occurring • Slow the progression of disease 12 Katz .

Arrest. PRIMARY PREVENTION EARLY Intervention/Prevention Pre-Disease Examples… Disease has begun but asymptomatic. Examples… Evidently symptomatic pt. Stages of Disease and Prevention PREVENT disease from starting. Intervention may: TERTIARY PREVENTION Slow. SECONDARY PREVENTION Screen for disease and provide treatment to Latent Disease PREVENT Progression. Reverse Progression Symptomatic Examples… 12 Katz .

EXAMPLE  Let’s say you are the mayor of a town near a swimming hole used by kids and adults alike. You decide to take action. 13 At Work . you learn that citizens are developing serious and persistent rashes after swimming as a result of a chemical irritant in the river. One summer.

secondary and tertiary interventions are needed to achieve a meaningful degree of prevention and protection. prevention experts say that the further “upstream” one is from a negative health outcome.For many health problems. However. . the likelier it is that any intervention will be effective. a combination of primary. as this example shows.

exercising regularly. use of seatbelts and bike helmets)  Education about healthy and safe habits (e.g. Primary Prevention  AIM: prevent disease or injury before it ever occurs. asbestos) or to mandate safe and healthy practices (e. not smoking)  Immunization against infectious diseases. eliminate the cause  Legislation and enforcement to ban or control the use of hazardous products (e.g.  Prevent exposures to hazards.g. eating well. 13 At Work .

you are engaging in primary prevention.Primary Prevention Example  1. You are removing the hazardous exposure and preventing rashes in the first place. 13 At Work .You approach the company upstream that is discharging the chemical into the river and make it stop.

g.  Detect and treat to slow/stop a progress. mammograms to detect breast cancer) 13 At Work . to better existing health conditions  Regular exams and screening tests to detect disease in its earliest stages (e. to promote preventive care and individual routines. Secondary Prevention  AIM: Reduce the impact of a disease or injury that has already occurred.

you are engaging in secondary prevention. Secondary Prevention Example  You ask lifeguards to check swimmers as they get out of the river to look for signs of a rash that can then be treated right away. 13 At Work . You are not preventing rashes. but you are reducing their impact by treating them early on so swimmers can regain their health and go about their everyday lives as soon as possible.

13 At Work . often-complex health problems and injuries (e.g.)  Support groups that allow members to share strategies for living well  Vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible. etc.g. depression. their quality of life and their life expectancy. permanent impairments) in order to improve as much as possible their ability to function. chronic disease management programs (e. chronic diseases. Tertiary Prevention  AIM: Decrease the impact of an ongoing illness or injury that has lasting effects  Help people manage long-term. arthritis. for diabetes.  Cardiac or stroke rehabilitation programs.

but you are softening their impact by helping people live with their rashes as best as possible. you are engaging in tertiary prevention. You are not preventing rashes or dealing with them right away.Tertiary Prevention  You set up programs and support groups that teach people how to live with their persistent rashes. 13 At Work .

” Sir William Osler . so do it first.“The most important thing is caring. for the caring Physician best inspires hope and trust.

You will transcribe by your own hand and in handwriting the Hippocratic Oath and scan the document to PDF File to upload to Moodle Platform (if available). 1.Why was it an important Public Health measure then and still relevant now? 4-Discussion will be begun in class March 2nd . Assignment 1 Your first assigned task for this Public Health course is a reflection of your Medical Profession utilizing the Hippocratic Oath you swore to at the beginning of your Career. 2.Reflect on this document’s meaning for your career 3.

Chappel D. http://www.who. February 2016. For a Healthy Nation: Returns On Investment in Public Health.healthypeople.gov/2020/topics- objectives/topic/social-determinants-of-health 8. 2016.int/trade/glossary/story076/en/ 9. http://www. Public Health.uk/files/2014/03/PublicHealthEducation.who. Constitution of the World Health Organization. Harvard TH Chan School of Public Health. University of Cambridge. 10. Social Determinants of Health. 3rd Ed.cdc. Wikipedia. Jones and Bartlett: Ma.harvard. New Zealand College of Public Health.wikipedia. What is Epidemiology? Centers for Disease Control and Prevention.who. 2016.html . Public Health and Medicine. Public Health Education for Medical Students: A guide for medical schools. Healthy People 2020. Social Determinants of Health. http://www.txt 11.hsph.org/wiki/Public_health 5. http://www. http://www. Pp 1-18.nzcphm. Archive: https://archive.pdf 6.pdf 4. Ch 1-2. World Health Organization.org/stream/forhealthynation00unse/forhealthynation00unse_djvu.phpc.ac. Schneider MJ. http://www. http://www. https://en. Introduction to Public Health. World Health Organization. Public Health. http://www. References 1.edu/about/public-health-medicine/ 3.css/layouts/home/slide1.org.nz/design.int/social_determinants/sdh_definition/en/ 7. Department of Public Health and Primary Care. et al.int/governance/eb/who_constitution_en. 2011.gov/EXCITE/epidemiology.jpg 2. Oct 2006. Feb 2008.cam. World Health Organization. US Public Health Service.

2015. Jekel’s Epidemiology. 13.iwh. http://apps.gov/ophss/csels/dsepd/ss1978/lesson1/section1. Institute for Work and Health.cdc. Katz D.on.cdc.html 17. Saunders: Philadelphia. 4th Ed. secondary and tertiary prevention. http://www.who. Biostatistics. and Public Health.ca/wrmb/primary- secondary-and-tertiary-prevention 14.html 15. http://www. PA.int/iris/bitstream/10665/43541/1/9241547073_eng.int/mediacentre/factsheets/fs310/en/ . 2014.gov/about/facts/cdcfastfacts/epidemiology. Preventive Medicine. What researchers mean by primary. http://www.cdc. http://www. http://www.gov/ophss/csels/dsepd/SS1978/SS1978. http://www.pdf 19. At Work. et al.html 16.who.gov/excite/epidemiology. References 12.cdc. Issue 80.pdf 18.