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Public Health (Part 1) Lecture A
- 1. Introduction to Health Care and Public Health in the U.S. Public Health, Part 1 Lecture a This material (Comp 1 Unit 7) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.
- 2. Public Health, Part 1 Learning Objectives - 1 • Discern the main differences and similarities between public and private health (Lecture a) • Delineate the historic timeline and achievements of public health in the U.S. (Lecture a) 2
- 3. Public Health, Part 1 Learning Objectives - 2 • Define and discuss key terminology of public health (Lecture b) • Illustrate the general organization of public health agencies and public health data flow (Lecture b) • Evaluate and explain the impact and value of public health (Lecture c) 3
- 4. What is Public Health? • Private Health – Clinicians, health practitioners – Treat individual health problems – Action usually taken after illness/injury occurs • Public Health – Agencies – Treat/maintain health of populations – Actions include education, policy, research, monitoring 4
- 5. Determination of Public Health Interest • To be of interest to public health, a condition usually needs: 5
- 6. History of Public Health in the U.S. • 1798: An act establishing a federal network of hospitals for ill/disabled merchant seamen. – Marine Hospital Fund was created: The federal government deducted monthly sums from seamen’s wages. – Marine Hospital Fund later became the Marine Hospital Service, the predecessor of the Public Health Service 6
- 7. History of Public Health in the U.S. The 1800s • 1800: Smallpox vaccination introduced in the U.S. • 1878: National Quarantine Act transferred quarantine functions from state to federal level • 1891: Immigration legislation passed, assigning medical examination of immigrants to the Marine Hospital Service 7
- 8. History of Public Health in the U.S. The 1900s • 1900: Pneumonia and influenza are leading causes of death in the U.S. (“Leading causes,” n.d.) • 1902: The Marine Hospital Service changed to the Public Health and Marine Hospital Service. In 1912, renamed the Public Health Service. • 1906: The Pure Food and Drugs Act was passed. 8
- 9. History of Public Health in the U.S. The 1910s • 1910: Garment industry’s high rate of tuberculosis triggered the Public Health Service to enter the arena of workplace health and safety. • 1916: First non-military school of public health in the U.S. established at Johns Hopkins University. (Sommer, 2016) 9
- 10. History of Public Health in the U.S. The 1920s - 1944 • 1921: Bureau of Indian Affairs Health Division created. • 1935-38: Passage of the Social Security Act and the Federal Food, Drug, and Cosmetic Act. • 1944: Massive use of penicillin drastically changes treatment of infections and sexually transmitted diseases. (Parascandola, 1997) 10
- 11. History of Public Health in the U.S. 1946: The CDC • Establishment of the Communicable Disease Center (CDC) – Focus: mosquito control to fight malaria, primarily through application of the pesticide DDT – Outgrowth of the wartime agency MCWA - Malaria Control in War Areas 11
- 12. History of Public Health in the U.S. The CDC • The CDC has grown into its current emphases: – Working with states and other partners to monitor and prevent outbreaks – Maintain national health statistics – Prevent and control infectious and chronic diseases, injuries, and environmental health hazards 12
- 13. History of Public Health in the U.S. The 1950s • 1953: Department of Health, Education, and Welfare Created – In 1979, the Department of Education was split off, leaving the separate Department of Health and Human Services (HHS). • 1955: Salk polio vaccine licensed. Indian Health Service moved to HHS. 13
- 14. History of Public Health in the U.S. The 1960s - 1 • 1961-69: – International smallpox eradication program established – The first Surgeon General’s Report on Smoking released 14
- 15. History of Public Health in the U.S. The 1960s - 2 • 1961-69: – Migrant Health Act providing clinics for agricultural workers. – Older Americans Act created social and nutritional programs. – Head Start program was created. – Medicare and Medicaid programs were created. 15
- 16. History of Public Health in the U.S. The 1970s • 1970-1979: National Health Service Corps created. National Cancer Act passed. – Health Care Financing Administration created to manage Medicare and Medicaid. – Worldwide eradication of smallpox in 1977. 16
- 17. History of Public Health in the U.S. The 1980s • National Organ Transplantation Act. • McKinney Act (health care for homeless). • Agency for Health Care Policy and Research created. 17
- 18. History of Public Health in the U.S. The 1980s: AIDS/HIV • 1981: AIDS identified • 1984: HIV virus identified by the Public Health Service and French scientists • 1985: HIV detection blood test licensed 18
- 19. History of Public Health in the U.S. The 1990s - 1 • Human Genome Project established • Nutrition Labeling and Education Act passed • Ryan White Comprehensive AIDS Resource Emergency (CARE) Act 19
- 20. History of Public Health in the U.S. The 1990s - 2 • Establishment of Vaccines for Children Program – Free immunizations to children in low-income families) • Enactment of the Health Insurance Portability and Accountability Act (HIPAA) • State Children's Health Insurance Program (SCHIP) created; enabled states to extend health coverage to more uninsured children. 20
- 21. History of Public Health in the U.S. The 2000s • Human genome sequencing published • HHS responds to anthrax bioterrorism attack • Creation of Office of Public Health Emergency Preparedness • CDC responds to H1N1 flu pandemic (CDC, 2009) • WHO declares a public health emergency for Zika virus; CDC activates Emergency Operations Center (CDC, n.d.-a) 21
- 22. History of Public Health in the U.S. Significant Legislation • Medicare Prescription Drug Improvement and Modernization Act of 2003 expands Medicare to include a prescription drug benefit. • American Recovery and Reinvestment Act (ARRA) of 2009 includes the Health Information Technology for Economic and Clinical Health Act, HITECH, stimulus opportunity. 22
- 23. Public Health, Part 1 Summary – Lecture a • Similarities and differences between public and private health • Importance of criteria for assigning public health • Review of history of public health in the U.S. 23
- 24. Public Health, Part 1 References – 1 – Lecture a References Centers for Disease Control and Prevention. (n.d.-a). About Zika Virus Disease. Retrieved January 30, 2017 from http://www.cdc.gov/zika/about/index.html Centers for Disease Control and Prevention. Leading Causes of Death, 1099-1998. (n.d.- b). Retrieved January 30, 2017, from http://www.cdc.gov/nchs/fastats/leading-causes- of-death.htm Centers for Disease Control and Prevention. Our History - Our Story. (n.d.-c). Retrieved January 30, 2017, from http://www.cdc.gov/about/history/ourstory.htm Centers for Disease Control and Prevention. (2009). 2009 H1N1 Flu. Retrieved January 30, 2017 from http://www.cdc.gov/h1n1flu/ . Fraenkel, G.J. (1998). Penicillin at the beginning. Annals of Diagnostic Pathology, 2, 422- 424. doi: http://dx.doi.org/10.1016/S1092-9134(98)80043-9 Historical Highlights. (2010, last reviewed, August 2014). Retrieved January 30, 2017, from U.S. Department of Health & Human Services website: http://www.hhs.gov/about/hhshist.html Parascandola, J. The Introduction of Antibiotics in Therapeutics. (1997). In J.W. Leavitt and R.L. Numbers (Eds), Sickness and health in America: Readings in the history of medicine and public health. Madison, WI: Univ of Wisconsin Press. 24
- 25. Public Health, Part 1 References – 2 – Lecture a References Sommer, A. (2016). The Johns Hopkins Bloomberg School of Public Health: a brief history of a century of epidemiologic discovery. American journal of epidemiology, 183(5), 340-344. doi: 10.1093/aje/kwv157 Charts, Tables, Figures 7.1 Figure: Severity, Preventability, Prevalence – Created by Magnuson, JA (2010). 25
- 26. Introduction to Health Care and Public Health in the U.S. Public Health, Part 1 Lecture a This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. 26
Editor's Notes
- Welcome to Introduction to Health Care and Public Health in the U.S.: Public Health, Part 1. This is lecture a. This component, Introduction to Health Care and Public Health in the U.S., is a survey of how healthcare and public health are organized and how services are delivered in the US.
- The learning objectives for Public Health, Part 1, are to: Discern the main differences and similarities between public and private health Delineate the historic timeline and achievements of public health in the U.S.
- Define and discuss key terminology of public health Illustrate the general organization of public health agencies and public health data flow Evaluate and explain the impact and value of public health
- This lecture will discuss the history of Public Health. It is important to remember the differences between private and public health. Some of the most important differences are these: Private health generally consists of clinicians and other health care providers. While many health care providers work in public health, the distinction is that public health is an agency-based field rather than a clinic-based field. Private health focuses on the health of the individual, whereas public health focuses on the health of the population. The population in question may be defined variously, such as a county, a state, or even the world. Private health generally takes action after an illness or injury has occurred. Public health is perhaps more focused upon prevention, education, and monitoring.
- Public health resources are limited, and not every condition can receive public health attention. In order for a condition to realistically be of interest to public health, it will usually have to fit the following criteria: The condition must be severe enough in its effects to warrant the investment to mount some kind of intervention. The condition must be preventable by means of a health intervention, or at least able to be mitigated in a meaningful way. And finally, the condition must affect enough of the population, which is called prevalence, to make it worthwhile for public health to intervene.
- The United States was not the first country to work with public health. However, public health in the U.S. is the focus of our review. The start of public health in the U.S. is usually credited to 1798, when legislation was passed to establish a federal network of hospitals for ill or disabled merchant sailors, known as the Marine Hospital Fund, which later became the Marine Hospital Service. The federal government deducted a portion of the sailor’s wages to help underwrite this effort. Please note that public health had earlier beginnings in other parts of the world which are not addressed here.
- The 19th century saw some landmark developments in U.S. public health. In 1800, the smallpox vaccination was introduced into the country. In the late 1800’s, two acts were passed that brought an increasing level of federal activity into the arena of public health: The National Quarantine Act of 1878 started the transfer of quarantine functions from state to federal level, to the Marine Hospital Service. In 1891, immigration legislation was passed that assigned the medical examination of immigrants to the Marine Hospital Service.
- The first half of the 20th century saw considerable change and progress taking place in public health. Pneumonia and influenza were leading causes of mortality at the turn of the century. In 1906, the Pure Food and Drugs Act passed, which authorized the federal government to monitor food and drug safety. This is now the responsibility of the FDA. Also, the name of the Marine Hospital Service was changed to the Public Health Service.
- The Public Health Service entered the arena of workplace health and safety in 1910, triggered by the high rate of tuberculosis in the garment industry. In 1916, the first non-military school of public health came into being at Johns Hopkins University, enabled by a Rockefeller Foundation grant.
- In 1921, the Bureau of Indian Affairs was created. It was the predecessor of the Indian Health Service. In the 1930’s, the Social Security Act and the Federal Food, Drug, and Cosmetic Act both improved population health. And, enthusiastic use of penicillin remarkably improved treatment of infections and sexually transmitted diseases.
- In 1946, a major event in U.S. public health occurred with the creation of the Communicable Diseases Center, predecessor of the Centers for Disease Control and Prevention, or CDC. The CDC was initially focused primarily on mosquito control. Fighting malaria largely through the use of the pesticide DDT, the center was an outgrowth of the wartime Malaria Control in War Areas, or MCWA.
- From that relatively humble beginning, the CDC has grown into one of the preeminent public health organizations in the world, with a current focus on working with states to monitor and prevent outbreaks, maintain national health statistics, and prevent and control infectious and chronic diseases, injuries, and environmental health hazards.
- In 1953, the Department of Health, Education, and Welfare was created. A quarter century later, the Department of Education split off, leaving the separate Department of Health and Human Services. In 1955, the Salk polio vaccine was licensed, paving the way to control of that fearsome disease. Also, the Indian Health Service was moved to the Department of Health and Human Services.
- In the 1960s, a number of notable public health events occurred: The International Smallpox Eradication program was established The first Surgeon General’s Report on Smoking was released, a milestone of epidemiology
- Acts were passed to improve health for underserved groups. The migrant health act provided clinics for migrant workers. The Older Americans Act created programs to help older adults meet nutritional and social needs. The Head Start program was created to prepare economically disadvantaged preschool-aged youths to enter public schooling. In 1965, the Medicare and Medicaid programs were established. This provided health care to millions of Americans.
- While the 1970s saw several important public health accomplishments, such as the creation of the National Health Service Corps to help provide primary care in underserved areas, passage of the National Cancer Act to strengthen national efforts against cancer, and increased management of Medicare and Medicaid, there was one outstanding accomplishment: In 1977, smallpox was eradicated from the globe – an amazing triumph of public health.
- There were many public health milestones in the 1980s, such as the National Organ Transplantation Act, which established a national registry for organ matching; the McKinney Act, which provided health care for the homeless; and the creation of the Agency for Health Care Policy and Research.
- However, the spotlight for public health in the 1980s focused on detection of Acquired Immune Deficiency Syndrome, or AIDS. AIDS is a chronic condition, caused by the human immunodeficiency virus. In 1981, AIDS was identified as a condition; in 1984, the virus was identified; and in 1985, a detection blood test was licensed.
- The 1990s was typified by numerous public health events. The Human Genome Project was established to study human DNA. Support for AIDS patients came from the Ryan White Comprehensive AIDS Resource Emergency, or CARE, Act.
- Free immunizations to low-income children came via the Vaccines for Children Program. Insurance was affected by the Health Insurance Portability and Accountability Act, or HIPAA, which established far-reaching privacy controls. And, states were able to extend health insurance to many uninsured children by the creation of the State Children’s Health Insurance Program, or SCHIP.
- The first decade of the 21st century was marked by publication of human genome sequencing, by the public health response to the anthrax bioterrorism attack, and creation of the Office of Public Health Emergency Preparedness. More recently the CDC has responded to an H1N1 flu pandemic in 2009. In 2016, the World Health Organization, or WHO declared the Zika virus a public health emergency and the CDC activated its Emergency Operations Center to address Zika, a disease spread by mosquitos that can cause serious birth defects if pregnant women are infected.
- In 2003, Medicare expanded coverage to include a prescription drug benefit. In 2009, the American Recovery and Reinvestment Act, or ARRA was enacted, and included the Health Information Technology for Economic and Clinical Health Act, or HITECH, stimulus opportunity. HITECH included some public health-related Meaningful Use objective menu options, involving electronic laboratory reporting, immunizations reporting, and syndromic surveillance.
- This concludes lecture a of Public Health, Part 1. In summary, the similarities and differences between public and private health were discussed. Criteria for assigning public health importance were explained. The history of public health in the U.S. was reviewed with the help of some important historical highlights, including the creation of the Centers for Disease Control and Prevention, or CDC.
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