Public Health-The Past, Present & Future


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A short view of the past 50 years of Public Health, how it has changed, how it will change in the future.

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  • Thank you for letting me talk with you today. In preparing this presentation I have reviewed over 50 years of scrapbooks of my career since starting private practice in 1956.
  • Public Health-The Past, Present & Future

    1. 1. Public Health Practice: How it Was, Is and Could Be. CMG Buttery, MBBS, MPH, FACPM Adjunct Professor of Public Health Dept. Epidemiology & Community Health Virginia Commonwealth University
    2. 2. How I started. 1946 Completed High School Military Service-RAMC-Lab.Tech. 1948 Completed Military Service entered Med School 1954 graduated Besides skills in trauma medicine, 20-30 major diseases for which we had reasonable intervention. Hospitals filled with children with communicable disease
    3. 3. Public Health in the 1950s <ul><li>MCH </li></ul><ul><li>DPT </li></ul><ul><li>Waste disposal, potable water, food service </li></ul><ul><li>Primary care access assured for all in UK </li></ul><ul><li>Physicians trained to deliver primary care </li></ul><ul><li>Hospitals full of children with infectious diseases </li></ul><ul><li>Average life span just over 60 years </li></ul><ul><li>Many PHNs worked out of primary care practices </li></ul>
    4. 4. Private Practice 1957-1966 <ul><li>I started practice with a set of punch cards to </li></ul><ul><ul><li>Track my patients </li></ul></ul><ul><ul><li>Ensure quality control. &quot;Clinical investigation in general practice: the use of a simplified data-recording system.” Southern Medical Journal , 1963 </li></ul></ul><ul><li>I found: </li></ul><ul><ul><li>Most of my practice related to a few conditions </li></ul></ul><ul><ul><li>Much of the care I gave revolved around chronic diseases. </li></ul></ul><ul><ul><li>There were few useful interventions </li></ul></ul><ul><ul><li>The outcome of these interventions was mostly poor. </li></ul></ul>
    5. 5. Public Health 1966-1995 <ul><li>Strategic Interventions: </li></ul><ul><li>Portsmouth: Rental Housing Reform </li></ul><ul><li>Norfolk (EVMS): Primary care. Prevention clerkship </li></ul><ul><li>Corpus Christi: Restaurant Code enforced jointly by Restaurant Association and PHD </li></ul><ul><li>State of Virginia: Study on Primary Care Access </li></ul>
    6. 6. Where we Are Today-I <ul><li>100’s of disease for which we intervene, some more successfully than others. </li></ul><ul><li>Relatively few communicable diseases due to a multitude of vaccines and improved sanitation </li></ul><ul><li>Large numbers of people living past 80 years of age </li></ul><ul><li>Many dying after paying for extensive medical intervention with minimal success in last 6-12 months of life. </li></ul><ul><li>Limited access to Primary Care for 15% of population </li></ul>
    7. 7. Today -II <ul><li>Physicians in the US trained as Specialists. </li></ul><ul><li>Many Primary Care MDs imported. </li></ul><ul><li>Focus of medical care on ‘premies’ and Elderly </li></ul><ul><li>Doctors reimbursed for procedures not prevention. </li></ul><ul><li>NO universal point of access for care other than ERs. </li></ul>
    8. 8. Today -III <ul><li>MCH still dominant, but interventions only mildly successful in reducing premature deliveries </li></ul><ul><li>Multiple Vaccinations with schedules that change several times a year ( see comments in March 15 ‘08 issue of the Lancet. Prioritization of routine vaccines: a mistake for the USA ) </li></ul><ul><li>Immunization rates improved but not good enough </li></ul><ul><li>Focus on sewage and water, food service </li></ul>
    9. 9. Current Philosophical Concerns <ul><li>Concern about no-one being exposed to any hazard however remote </li></ul><ul><li>Dominated by activist politics rather than disease epidemiology </li></ul><ul><ul><li>Hurricane Preparedness </li></ul></ul><ul><ul><li>Pandemic Preparedness </li></ul></ul><ul><ul><li>Food borne outbreaks </li></ul></ul><ul><ul><li>Vaccines linked to autism </li></ul></ul><ul><li>Domination by the ‘WE’ generation. </li></ul>
    10. 10. Where should we be Going? <ul><li>Public Health equivalence of clinical excellence, E.G. epidemiology based (AHRQ) </li></ul><ul><ul><li>US Preventive Services Task Force </li></ul></ul><ul><ul><li>Outcomes and Effectiveness practices. </li></ul></ul><ul><ul><li>Local Health Department Accreditation. </li></ul></ul><ul><li>IOM study: Who Will Keep the Public Healthy? </li></ul><ul><li>IOM study: Future of PH in the 21 st Century </li></ul><ul><ul><li>Translation research to be improved </li></ul></ul>
    11. 11. Future PH training - 2010 + <ul><li>Ecological Analysis </li></ul><ul><ul><li>Concern for culture & differences </li></ul></ul><ul><li>Linkages between PH and Primary Care </li></ul><ul><ul><li>to ensure access and prevention priorities </li></ul></ul><ul><li>Non-Traditional Research </li></ul><ul><ul><li>Community Based </li></ul></ul><ul><li>Team Practice </li></ul><ul><ul><li>Nurse, social workers, mental health workers, aging workers: Removing the Silos </li></ul></ul>
    12. 12. Important new skills needed <ul><li>Data-based decision-making </li></ul><ul><li>Focus on Genomics </li></ul><ul><li>Focus on chronic disease </li></ul><ul><li>Use of the WWW 1 & 2 </li></ul><ul><li>Distance Training (live classroom. Camtasia, internet) </li></ul><ul><li>Effects of Globalization (travel/climate effects, Chikungunya) </li></ul><ul><li>Use of GIS e.g. Global Cancer Atlas </li></ul>
    13. 13. My Concerns for the Future <ul><li>Is Public Health changing from an educational enterprise into a policing enterprise? We have always used laws to support Public Health </li></ul><ul><ul><li>Quarantine, people and animals </li></ul></ul><ul><ul><li>Condemnation, food, water sources, lead paint </li></ul></ul><ul><li>But – Do we use police powers to decide who can eat what? </li></ul><ul><li>Do we continue to let the population expand exponentially? What does Genetic life extension and massive infectious disease prevention do to population (see Science, March 14 –Dueling Visions of a hungry World)? </li></ul><ul><li>Do we start to require genetic counseling prior to procreation? </li></ul><ul><li>Where does all this fit into Chronic disease prevention. </li></ul><ul><li>Role in Community Planning </li></ul>
    14. 14. <ul><li>This presentation can be found at </li></ul><ul><ul><ul><li> </li></ul></ul></ul>