Public health professionals identify issues as public health problems based on key criteria like the size and severity of the problem's impact, availability of interventions, and economic and social effects. They examine leading causes of death and illness across populations to determine which medical issues warrant public health concern and action. Public health threats can include infectious diseases and other issues that negatively impact large groups, like addiction or natural disasters. Experts consider the criteria to prioritize problems and develop evidence-based solutions to address current and emerging threats to community well-being.

1. When do we consider a Health Issue
as a Public Health Problem?
Seminar no: 8

2. Introduction
• Public health is the science of improving the well-being of communities through
research, health programs, policies, and education. Unlike the health care field, public
health is more about protecting entire populations (CDC Foundation, 2018).
• A public health problem, therefore, is a medical issue that affects a significant portion
of a specific population. Some examples include chronic illnesses like Type 2 diabetes,
infectious diseases such as HIV and tuberculosis, mental health challenges, and even
motor vehicle accidents.

3. • The Centers for Disease Control and Prevention (CDC), along with other government
agencies, collect detailed information on the leading causes of death, injuries,
illnesses, and risk factors for medical conditions to help keep track of these and
other public health issues.
• Using this information, data analysts and statisticians can create raw statistics about
diseases and mortality. Once a public health problem has been identified, medical
experts and public health professionals' band together to develop prevention
techniques and educational materials that can be disseminated to the target
population.

4. • According to a 2018 report from the CDC, the life expectancy for the U.S. population
declined to 78.6 years in 2017 (Centers for Disease Control and Prevention, 2018).
• The leading causes of death, which accounted for 74% of all mortalities, included heart
disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke,
alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease
Top Public Health Problems For The Modern Age
• While these specific causes represent key public health concerns, there are a variety of
medical issues and behaviors that contribute to their growing mortality rates.
• For example, individuals who are not physically active are often at higher risk of heart
disease, stroke, and diabetes (American Heart Association, 2016).

5. 1. Antibiotic-resistant microbes
2. Air pollution
3. Opioid epidemic
4. Obesity
5. Influenza epidemic
6. Alcohol and tobacco use
7. Motor vehicle accidents
7 Public health issues causing concern in 2019 (US)

6. 1. Communicable disease problem
2. Nutritional problem
3. Environmental sanitation problem
4. Medical care problem
5. Population problem
7 Public health issues causing concern in 2019 (US)

7. • One of the many concerns of the AHA, WHO, and HHS is tackling the growing issue of
obesity in developed countries.
• Obesity rates have risen significantly among U.S. adults over the past decade, from
33.7% between 2007 and 2008 to 39.6% in 2016 (American Cancer Society, 2018).
• Being severely overweight is more than a cosmetic concern, as it can increase a
person’s risk of diabetes, cardiovascular disease, and certain cancers.
• While public health professionals are continuously developing new programs to help
reduce obesity rates, the decision to consistently practice healthy behaviors ultimately
rests with the individual.
Other Key Public Health Problems

8. • Foodborne illness is another top concern for health organizations and government
agencies, as 1 in 6 Americans suffer from food-related complications each year (Centers
for Disease Control and Prevention, 2018).
• Although the mortality rates aren’t as high as those associated with infectious diseases
or vehicle accidents, the cost of treating foodborne illnesses is immense – around $15.6
billion is spent annually.
• These conditions are entirely preventable, which is why the CDC and USDA have taken
a leading role in promoting food safety at the local, state and federal levels.

9. • Size of the problem
• Seriousness of the problem
• Availability of current interventions
• Economic or social impact
• Public health concern
• Political will to address issue
• Availability of resources
• Disease of international interest
• Equity
Criteria For Prioritizing Public Health Problems (CDC)

10. 1. Size of a problem
• Definition: Number of percentage of people effected by a health condition in a
particular area
• Source to learn number affected: prevalence data
Rating for size of problem
1= relatively few people affected
2= moderate number affected in particular subgroups
3=moderate number affected across the entire population
4=large number affected in particular subgroups
5= large number affected across entire population.

11. 2. Seriousness of problem
• Definition: potential of a health problem to result in severe disability or death
• Source of information on seriousness:
• Cause specific mortality tables
• DALY’s (Disability Adjusted Life Years)
Rating for seriousness of problem
1=not life threatening or disabling
2=not life threating but sometime disabling
3=moderately life threatening or disabling
4=moderately life threatening, with a strong likelihood of disability
5=high likelihood of death or disability

12. 3. Availability of current interventions
• Are there evidence-based interventions or promising practices to prevent or control
this health problem?
• Can these interventions or practices be implemented easily
Rating for availability of current interventions
1= no evidence- based interventions or promising practice available
2=no evidence-based interventions available but promising practices are available
3=evidence-based interventions available and can be implemented with moderate effort
4=evidence-based interventions available and can be implemented easily.

13. 4. Economic and social impact
• Monitory cost
• Societal costs
Rating for economic and social impact
1= economic or societal costs are minimal
2= there is some potential increase costs
3=there is likely to be moderate costs
4=there is likely to be substantial costs

14. Health
Problem
Size Seriousness Interventions Impact
Resulting
rating
Diabetes 5 4 4 4 320
Hypertension 4 4 3 4 240
Breast Cancer 4 5 4 5 400
Obesity 4 3 5 3 180
Alcohol use 5 2 3 4 120
Prioritizing problems:
Example

15. PUBLIC HEALTH PROBLEM IN INDIA
Criteria 1:Size of problem
Incidence- 98.7 per 100,000 population
Females- 712,758
Males- 679,421
Criteria 2: Seriousness of problem
Mortality rate (CMR/105
)
Male: 51.8
Female: 46.4
Both: 49.1
DALYs - 5%
Criteria 3: Availability of current interventions
Subcentre:
• Health education
• Motivation for cancer screening
• Collection of pap smear
• Inspection of the cervix
• Teaching self-inspection of the oral cavity and breast
PHC:
• Biopsy
• Cancer-related physical examination
• Management of pre-cancers
District level:
• Management of early cancers
• Colposcopy
• FNAC and Pap smear
• Cerviscopy
• Staining of cytology smears
Criteria 4:Economic and Social Impact
• US$21,096 costs per death
• 0.36% of GDP
• Total productivity loss-US$7.2 Billion

16. PUBLIC HEALTH PROBLEM IN INDIA
Criteria 1:Size of problem
Incidence- 274 per 100,000 population
Females- 34% of 2,404,815
Males- 59% of 2,404,815
Criteria 2: Seriousness of problem
Mortality rate (CMR/105
)= 125 thousand
DALYs – 1100 per 100,000 population
Criteria 3: Availability of current interventions
At national level: (14 committees)
• National Laboratory Coordination Committee
• National TB-Comorbidity Coordination Committee
• National Task Force for Medical Colleges
• National TB Forum
At state level:
State Health Secretary and MD-NHM
State Tuberculosis Officer (STO)
State TB Training and Demonstration Centre (STDC)
At district level:
Chief District Health Officer (CDHO) / Chief District
Medical Officer (CDMO)
At sub- district level:
Tuberculosis Unit
Criteria 4:Economic and Social Impact
• TB deaths- 35% reduction by 2020
• 1 % of GDP
• Total productivity loss-US$7.2 Billion
Reasons:
• poor knowledge of TB;
• poor knowledge of services
available through the national
public program;
• the convenience of services in the
private sector;
• a desire for confidentiality;
• a desire for personalized care.

17. PUBLIC HEALTH PROBLEM IN INDIA
Criteria 1:Size of problem
Prevalence- 31.5% – 89%
Criteria 2: Seriousness of problem
DALYs – 24 per 100,000 person years for
total tooth loss
Criteria 3: Availability of current interventions
• Health education and health promotion
• Use of fluoride in toothpastes and mouth rinses
• Effective and efficient plaque control
• Tobacco cessation and freedom from the habit of
tobacco consumption
• Treatment care remains a high priority service
Criteria 4:Economic and Social Impact
The expenses due to dental disease per
capita increased to US $0.52 (Rs. 33.8)
and the productivity loss was 6.69 (Rs.
434.85) per capita.
Reasons:
• Treatment costs
• Functional limitations
• Impaired growth in children and
general health
• Impact on esthetics and educational
attainments
• Reduced productivity of the
workforce
• Fear/Anxiety

18. PUBLIC HEALTH PROBLEM IN US
Criteria 1:Size of problem
Prevalence- 7.4% and around 538 million people
Criteria 2: Seriousness of problem
DALYs – 49 per 100,000 person years for
total tooth loss
Criteria 3: Availability of current interventions
Patient-performed control of the dental biofilm,
professional interventions, and control of risk factors.
Preventing periodontal disease typically uses an
individual approach and focuses on two general areas:
(a) promoting oral hygiene activities such as
tooth brushing, flossing, and using mouth
rinse; and
(b) recognizing an individual's risk factor(s) and
recommending intervention
for modifiable risks such as smoking.
Criteria 4:Economic and Social Impact
• Lost productivity-USD 54 billion per
year
• GBP - 2.8 billion
• Economic impact -USD 440 billion

19. PUBLIC HEALTH PROBLEM IN US
Criteria 1:Size of problem
Incidence- 8.6 to 12.9 per 100,000 inhabitants
Criteria 2: Seriousness of problem
Mortality rate (CMR/105
)
21.6 per 100,000
DALYs – 281.2 rate per 100,000
Criteria 3: Availability of current interventions
Maximizing PDMPs
• Making it easier to use and access
• Making PDMP data more timely
• Expanding and improving proactive PDMP reporting to
identify and address inappropriate prescribing patterns
• Using PDMP data to better understand the nature of the
prescription drug overdose epidemic
Community or Insurer/Health Systems Interventions
• Providing technical assistance to high-burden communities
Improving opioid prescribing interventions for insurers and
health systems
• Enhancing use of evidence-based opioid prescribing
guidelines
Policy Evaluations
• Evaluating interventions to better understand what works to
prevent prescription drug overdoses
Rapid Response Project
• Implementing a project to advance an innovative prevention
approach and respond to new and emerging crises and
opportunities
Criteria 4:Economic and Social Impact
value of life lost due to overdose deaths was
$480.7 billion
Reasons:
• Stigma towards people who use drugs
• Legislation that supports syringe service
programs, MAT, and expansion of
behavioral health services
• Polices that promote racial and health
equity
• Economic wellbeing and housing stability
• Health insurance coverage for mental
health and substance use treatment
• Naloxone protocol for pharmacies
• Impacts of justice involvement on
economic and social advancement

20. Identify criteria for prioritization
1. Magnitude of the problem
2. Severity of the problem
3. Need among vulnerable populations
4. Community’s capacity and willingness to act on the issue
5. Ability to have a measurable impact on the issue
Based on the community health assessment toolkit by ACHI
Step- 5 : Prioritize community health issues
6. Availability of hospital and community resources
7. Existing interventions focused on the issue
8. Whether the issue is a root cause of other problems
9. Trending health concerns in the community

21. • Public health professionals identify and prevent health problems that impact entire
communities, regions or populations (such as children or those living in poverty).
• These experts look for key criteria when determining which issues qualify as public
health concerns.
• “A public health threat is an illness with public health significance”—that is, a
pathogen that can be transmitted between people and that raises the risk of death
or serious injury to a certain group of people
• If a disease becomes more aggressive, it’s going to catch the attention of public
health professionals.
How do experts determine public health threats?

22. • However, not all public health issues are infectious diseases. Concerns like natural
disasters and addiction can also have a negative effect on large groups of people.
• The Centers for Disease Control and Prevention (CDC) consider these types of
issues to be public health threats when they become “leading causes of death and
disability.”

23. Examining the state of public health:
These public health issues affect people around the nation and the world.
Thanks to the public health professionals who work to solve these problems, we
can all look forward to healthier communities in the future.

24. Public health professionals address current public health issues across health care, government,
nonprofit, private and educational settings. They must stay aware of the latest developments in
research and evidence-based solutions and spread awareness among communities
Conclusions

25. References
• https://onlinedegrees.unr.edu/blog/top-public-health-problems-concerns-unr-online-degree/
• https://www.cdc.gov/csels/dsepd/ss1978/lesson5/section3.html
• https://www.cdc.gov/globalhealth/healthprotection/fetp/training_modules/4/Prioritize-
Problems_FG_Final_09262013.pdf
• Janakiram C, Dye BA. A public health approach for prevention of periodontal disease. Periodontol
2000. 2020;84:202–214. https://doi.org/10.1111/prd.12337
• Balaji SM. Economic impact of dental caries in India. Indian J Dent Res 2018;29:132
• Kassebaum NJ, Smith AGC, Bernabé E, et al. Global, Regional, and National Prevalence, Incidence, and
Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990-2015: A Systematic Analysis
for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res. 2017;96(4):380-387.
doi:10.1177/0022034517693566