Introduction To Public Health

Lecture 11

Magda Khutsishvili, Pharm B, MPH

Lecturer in the University of Georgia
School of Health Sciences
magda.khutsishvili@ug.edu.ge
• Theme: Public Health in the Twenty-First Century: Achievements and
Challenges
• Reading Materials: Introduction to Public Health 5th Edition by Mary-
Jane Schneider (Author) chapter: 31, pages: 513-525.
 Public Health progress in 20 century in US th
The United States in the 20th century saw great progress in
public health in different directions:
• Biomedical achievements: Identification of the organisms
that cause infectious diseases and development the
methods to control them.
• Epidemiological achievements: Recognition of risk factors
for chronic illnesses and using this information to reduce
them
• Environmental Clean-up caused: Improvements in water and
air safety
• Health education campaigns led to: improved health
behaviors and reductions in tobacco use and drunk driving.
• Technological achievements: availability of health-related
data and computer software capable of analyzing them
• Health outcomes: The average lifespan has increased by 30
years since 1900
“Top ten” list of great public health achievements of
the 20th century by CDC
 Public Health Challenges for the 21 st century
In the early 21st century, public health faces many challenges, both old and new.
1. Renewed threats from infectious diseases, such as AIDS, antibiotic resistance, and
foodborne pathogens.
2. Climate change, caused by overpopulation and economic development
3. Rising costs of medical care for the aging population
4. The challenge of understanding human behaviors, which contribute to premature
mortality
5. The decline in cigarette smoking has slowed
6. Rates of alcohol and illicit drug use among adolescents are unchanged over the past
decades
7. Physical inactivity and unhealthy diet contribute to the increasing prevalence of
obesity
8. Injury is still a major cause of death nowadays
 Institute of Medicine’s (IOM) 1988 report:
‘The Future of Public Health’

• The problem, recognized in this report was that:

during the second half of the 20th century, the
medical approach—curing health problems
rather than preventing them—gained
acceptance.

• This report prompted public health agencies,

policy makers, and academic institutions to
initiate a national discussion on the role of public
health and the steps necessary to strengthen its
capacity to fulfill its role.
 Institute of Medicine’s (IOM) 2003 report:
‘The Future of Public Health in the 21 st century’
This report stated that:
• “the public health system that was in disarray in 1988 remains
in disarray today.”

• Nation’s emphasis on
1. Medical care rather than preventive services
2. Biomedical research rather than prevention research.

• There are serious and persistent disparities in health status

among various population groups, according to race and
ethnicity, gender, and socioeconomic status.
This report recommended that Public health
workforce needs:
1. Better education and training
2. Better coordination among states and territories
3. Advances in information technology should be
used more effectively to provide adequate
surveillance
 Institute of Medicine’s (IOM) 2009 report:
‘For the Public’s Health: Investing in a Healthier Future’
This report stated that:
• The health system’s failure to develop and deliver effective
prevention strategies continues to take a toll on the
economy and society.

This report recommended that:

• Public health departments need adequate funding
• All public health agencies should develop a minimum
package of public health services that all health
departments should deliver
• This report suggested a tax on all healthcare transactions,
as a source of a revenue
 Strategic Planning for Public Health [1].
• In the beginning of 1979, the U.S. Public
Health Service adopted planning process
called: “management by objectives”,
toward decentralizing governmental
responsibilities, which involved: setting
measurable goals and objectives and
periodically assessing progress.
• The federal government has led this
planning process over the past several
decades, and involvement has expanded
to include state, county, and local
communities.
• The result has been substantial progress
toward achieving public health goals, but
the goals must be constantly reset.
Strategic Planning for Public
Health [2].

• The Public Health Service set the national goals

in 1990, published as:
‘ Healthy People: The Surgeon General’s Report
on Health Promotion and Disease Prevention’

• Targets were to reduce mortality rates in

different age groups, with specific objectives
designed to meet each target.
 Strategic Planning for Public Health [2].

The results of the first planning cycle:

• The numerical mortality goals were met for three of the four age groups: infants,
children, and adults aged 25 through 64.

• Only targets for adolescents and young adults were not met, because of continued
high rates of fatal motor vehicle injuries, homicides, and suicides.

• One problem that became obvious during the first decade of the program was a lack
of data systems that could track progress, especially at the local level.
 Strategic Planning for Public Health [3].
• “Healthy People 2000” sets three overall goals,
with over 300 measurable objectives divided
into 22 priority areas.

• These objectives set targets for:

1. Individual behavioral change
2. Environmental and regulatory protections
3. Access to preventive health services.

• “Healthy People 2000” also addressed the

problem of inadequate data, which had
hindered evaluation of progress toward the
1990 objectives.
 Strategic Planning for Public Health [4].
• “Healthy People 2000-final review” was published in 2001 that evaluated the nation’s
progress in meeting the Healthy People 2000 objectives.
 Strategic Planning for Public Health [4].
• Progress was achieved on over 60 percent of the
objectives.
1. Targets were met in:
• Reducing deaths from coronary heart disease and cancer
• Reducing AIDS incidence, homicide, suicide, and firearm-
related deaths.
• Reducing tobacco-related mortality rates.
• Reducing health disparities
2. Targets were nearly met in goals for:
• Infant mortality rates
• The number of children with elevated blood lead levels
3. Targets were not met for: reducing the prevalence of
overweight and obesity, especially among adolescents
 Strategic Planning for Public Health [5].
• “Healthy People 2010”, launched in January 2000 and had two overall goals:
1. Increase quality and years of healthy life.
2. Eliminate health disparities.
• Healthy People 2010 was organized into 28 focus areas, many of which were the same as the
priority areas in Healthy People 2000.
 Strategic Planning for Public Health [5].
A final review of Healthy People 2010 was published in
2011, assessing progress in achieving the objectives in
each of the 28 focus areas.

The results have shown that:

1. There were slight improvements in “years in good or
better health” and “expected years free of activity
limitations.” However, “expected years free of
selected chronic conditions” declined.
2. Eliminating health disparities, did not show evidence
of systematic improvement:
Status on the objectives was improving for most
populations, but the differences among the groups were
generally not declining.
 Strategic Planning for Public Health [6].
• “Healthy People 2020” set four overarching goals:
1. Attain high-quality, longer lives free of preventable
disease, disability, injury, and premature death.
2. Achieve health equity, eliminate disparities, and
improve the health of all groups.
3. Create social and physical environments that promote
good health for all.
4. Promote quality of life, health development, and health
behaviors across all life stages.

• “Healthy People 2020” has replaced the traditional print

publication with an interactive website: http://
wwwhealthypeople.gov
• There are 42 topic areas, with more than 1200
objectives.
Strategic Planning for Public Health [6].
 Integration of Public Health and Medical Practice [1]
• Managed care plans: are a type of health insurance. They have contracts with health care
providers and medical facilities to provide care for members at reduced costs.
• Managed care moved the incentives of medical practice closer to the mission of public health:
keeping people healthy, by promoting healthy behaviors and preventing diseases.
• With managed care, medicine is driven by the same kind of measurable goals and objectives
that public health has been developing and provide medicine and public health with strong
incentives to work together.
Integration of Public Health and Medical Practice
[2]
• Managed care organizations (MCOs) are responsible for all their members, yielding
financial rewards when the need for expensive medical services is averted.
• Managed care has lost its popularity since the late 1990s, because the benefits that
come from incentives to keep MCO members healthy were not obvious to the public.
 The Affordable Care Act (ACA)
• The Affordable Care Act (ACA) is President Obama’s reform of the healthcare system,
compensates somewhat for the failures of the managed care movement by including a
number of prevention and wellness measures.
• The ACA provides for a Prevention and Public Health Fund, which sets aside a specific amount
every year “to improve health and help restrain the rate of growth in private and public health
care costs.”
 The Ultimate Challenge to Public Health in the 21 st
Century
• The challenge for public health continues to be: educating the public and policymakers about
the role of these nonmedical factors in determining people’s health and convincing people of
the importance of the core public health functions in protecting and promoting the health of
the entire population.
• It is probable that, the most important challenge faced by public health in the 21st century
will be to encourage a society-wide debate on how public resources should be allocated to
most effectively improve the health of the population as a whole.
Thank You For Your Attention!