Introduction to Health Care and Public Health in the U.S.

1. Introduction to Health Care and Public Health in the U.S. Introduction to and History of Modern Health Care in the U.S. Lecture b This material (Comp 1 Unit 1) 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. Introduction to and History of Modern Health Care in the U.S.Learning Objectives – 1 • Define key terms in health care and public health (Lectures a, b, c, d) • Describe components of health care delivery and health care systems (Lecture a) • Discuss examples of improvements in public health (Lecture b)

3. Introduction to and History of Modern Health Care in the U.S.Learning Objectives – 2 • Define core values and paradigm shifts in U.S. health care (Lecture c) • Describe the technology used in the delivery and administration of health care (Lecture d)

4. Public Health • Charles Edward Winslow • “Public health is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.” • Thomas Frieden • “Public health focuses on denominators — what proportion of all people who can benefit from an intervention actually benefit”

5. 10 Great Public Health Achievements – U.S., 1900-1999 • Vaccination • Motor-vehicle safety • Safe workplaces • Control of infectious diseases • Decline in deaths from coronary heart disease and stroke • Safer and healthier foods • Healthier mothers and babies • Family planning • Fluoridation of drinking water • Recognition of tobacco use as a health hazard

6. Control of Infectious Diseases • Typhoid • Spread by ingesting contaminated food or water • 1891 Death rate in Chicago was 174 per 100,000 people • Now only about 400 cases are seen in the U.S. each year • Smallpox • Epidemic viral illness • Early 1950s About 50 million cases of smallpox each year worldwide • 1977 Smallpox eradicated

7. Control of Nutritional Deficiencies • Goiter • Enlargement of the thyroid gland in the neck • Fortification of salt with iodine virtually eradicated nutritional goiter in the U.S. • Tooth Decay • Adding fluoride to drinking water substantially reduces the incidence of dental caries • 1945 Fluoride added to drinking water in Grand Rapids, Michigan • Over 10,000 U.S. communities fluoridate their water

8. How Has Public Health Improved Health Care? - 1 • Improvements in understanding disease • Epidemiology: The basic science of public health • Quantitative basic science • Method of causal reasoning based on developing and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality • Tool for public health action to promote and protect the public’s health

9. How Has Public Health Improved Health Care? - 2 • Example of epidemiology at work: • 1854 Cholera epidemic in London, England • Cholera is a bacterial disease • Lack of sanitation and overcrowding led to the spread of disease • Dr. John Snow linked the spread of disease to contaminated Broad Street public water pump • Snow’s hypothesis: Cholera was spread by contaminated water

10. How Has Public Health Improved Health Care? - 3 • Improvements in data collection have led to the use of better scientific methods to collect data and carry out experiments • Field surveys • Cohort studies • Randomized controlled trials

11. How Has Public Health Improved Health Care? - 4 • Improvements in data collection • Framingham Heart Study • Followed patients for a number of years to identify factors that contribute to the development of cardiovascular disease (CVD) • Over the years, multiple generations of participants have helped identify major CVD risk factors • Helped to understand the effects of CVD on other diseases

12. How Has Public Health Improved Health Care? - 5 • Improvements in data analysis • Use of tools such as multivariate analysis and meta-analysis • Improvement in disease surveillance • The Real-Time Outbreak and Disease Surveillance (RODS) Laboratory at the University of Pittsburgh, Department of Biomedical Informatics

13. How Has Public Health Improved Health Care? - 6 • Improvement in training • Establishment of many schools of public health in the early 20th century • Professional degrees such as Master of Public Health (M.P.H.) • Improvements in infrastructure • Federal • State • Local health departments

14. Introduction to and History of Modern Health Care in the U.S.Summary – Lecture b • Public Health Definition • Public Health Successes include the control of: • Infectious diseases • Nutritional deficiencies • Understanding disease • Public Health has improved • Data collection • Training and infrastructure

15. Introduction to and History of Modern Health Care in the U.S.References – 1 – Lecture b References Centers for Disease Control and Prevention - Ten great public health achievements—United States, 1900–1999. (1999, April 2). MMWR, 48(12), 241-243. Definition of Epidemiology from Principles of Epidemiology in Public Health Practice, 3rd edition, CDC Self Study Course SS1978. Retrieved January 19, 2017, from Centers for Disease Control and Prevention: https://www.cdc.gov/ophss/csels/dsepd/ss1978/ss1978.pdf. Frieden, TR (2015). Shattuck Lecture: The Future of Public Health. New England Journal of Medicine. 373: 1748-1754. Ripa, L. W. (1993). A Half-century of Community Water Fluoridation in the United States: Review and Commentary. Dept. of Children’s Dentistry; SUNY Stony Brook, 53(1), Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8474047. Smallpox. (n.d.). Retrieved January 19, 2017, from http://www.who.int/csr/disease/smallpox/en/

16. Introduction to and History of Modern Health Care in the U.S.References – 2 – Lecture b References Typhoid Fever in the United States. (2001, April 25). Retrieved January 19, 2017, from https://www.nichd.nih.gov/news/releases/pages/typhoid_background.aspx Typhoid Fever. (2013, May 14). Retrieved January 19, 2017, from https://www.cdc.gov/typhoid-fever/index.html Vandenbroucke, J. P. (1998). Clinical investigation in the 20th century: the ascendency of numerical reasoning. Lancet, 352 (suppl 2)(12), 6. https://www.ncbi.nlm.nih.gov/labs/articles/9798639/ Framingham Heart Study. (n.d.). Retrieved January 19, 2017, from http://www.framinghamheartstudy.org/ Winslow, C. E. (1920). The Untilled Fields of Public Health. Science, n.s. 51, 23.

17. Introduction to Health Care and Public Health in the U.S. Introduction to and History of Modern Health Care in the U.S.Lecture b 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.