PUBLIC HEALTH

MEDICINE ON A
GRAND SCALE
SARAH SIMMONS MD
N E W C A S T L E U N I V E R S I T Y M A L AY S I A
LEARNING OUTCOMES

• Demonstrate the application of key principles of population health and prevention in managing
clinical conditions and reducing health inequalities.
• Describe and recognize the role of the doctor and relevant organizations in public health at
the national and local level.
• Demonstrate the ability to provide evidence to guide public health policy and clinical practice
to protect, restore, and promote the health of a population.
PUBLIC HEALTH IS…

• The science and art of promoting and protecting health and well-being, preventing ill-
health and prolonging life through the organised efforts of society.
• The major functions include:
– The assessment and monitoring of the health of communities and populations at risk to identify
health problems and priorities Define the problem
– The formulation of public policies designed to solve identified local and national health problems and
priorities Try to fix the problem
– Assuring that all populations have access to appropriate and cost-effective care, including health
promotion and disease prevention services Make sure it’s fair
DID I LOSE YOU ALREADY?
What do you think of when you
think about public health?
A DIFFERENT WAY TO LOOK AT THE
SAME THING
MEDICINE PUBLIC HEALTH

• Treating a gunshot wound • Identify the causes of gun violence and develop
interventions

• Treating premature or low birth-weight babies • Investigate the factors that cause premature labor
and develop programs to keep babies healthy

• Prescribing medication for high blood pressure.

• Examine the links among obesity, diabetes and
heart disease and use the data to influence policy
aimed at reducing the conditions.
A QUICK HISTORY LESSON
• Pandora’s box
– The Greeks believed that the gods were angry about man accepting the gift of fire
– Zeus crammed all the diseases, sorrows, vices, and crimes that afflict humanity into a box and gave it to Epimetheus, the husband of Pandora
– Pandora wanted desperately to know what was in the box, so she opened it, letting out all of the ills to spread throughout the human world
• Hippocratic Corpus
– Attempt to think about diseases, not as punishment from the gods, but as an imbalance of man with the environment
– Opened up the possibility of intervening to prevent or treat disease
• The Bubonic plague (14th century)
– Quarantine was created- travelers that had potentially been exposed to disease were isolated for a period to ensure that they weren't infected
• Louis Pasteur (late 1800s)
– a French biologist and chemist who made contributions to germ theory and to the control of disease
-Developed vaccines against anthrax and rabies
AND THEN THERE WAS JOHN SNOW
JOHN SNOW,
FATHER OF EPIDEMIOLOGY
• A physician in London in the 1800s during a huge epidemic of cholera
• The prevailing opinion was that cholera was spread either by “bad airs”
• Snow began found that victims initial symptoms were always related to the gastrointestinal
tract. He reasoned that if cholera was spread by bad air it should cause pulmonary symptoms,
but since the symptoms were gastrointestinal perhaps it was transmitted by water or food
• When cholera broke out in the Broad Street area, Snow investigated where victims received
their water and traced it to a hand water pump.
• He argued to have the pump removed
• The epidemic quickly subsided
MODERN PUBLIC HEALTH
ACHIEVEMENTS
• Vaccination to reduce epidemic diseases
– dramatic declines in morbidity and mortality against preventable diseases
– eradication of smallpox
• Improved motor vehicle safety
– Since 1925, there has been a 90% decrease in the annual death rate due to motor vehicle travel
– regulations developed and enforced regarding safety belts, alcohol-impaired drivers, and child safety seats
• Control of infectious diseases
– Sanitation and hygiene, vaccination, and antibiotics
• Food Safety
– refrigeration, pasteurization, pest control, animal control, and food safety regulations promote better hygiene and
sanitation
• Improvements in maternal and child health
– Global infant mortality rate and maternal mortality rate have improved due to nutrition, standards of living,
access to health care, and monitoring of disease
PUBLIC HEALTH PROBLEMS RARELY HAVE ONE
CAUSE OR RESPOND TO ONE TARGETED
INTERVENTION.
Whoever wishes to investigate medicine properly should ... consider ... the mode in which
inhabitants live, and what are their pursuits, whether they are fond of drinking and eating to
excess, and given to indolence, or are fond of exercise and labour.
-HIPPOCRATES (5TH CENTURY BC)
PUBLIC HEALTH EFFECTS THE
PRACTICE OF MEDICINE
• Epidemiological
– e.g. changing patterns of disease, the ageing population
• Organizational
– National Health Service and social care reforms
• Political
– changes to the welfare state, changes in government
• Professional
– changes in concepts of ‘professionalism’
• Social
– the persistent gap between rich and poor, changing public expectations
• Technological
– advances in genetics, advances in treatment options.
 FACTORS THAT AFFECT HEALTH
Examples
Smallest
Impact Condoms, eat healthy,
Counseling be physically active
& Education

Rx for high blood

Clinical pressure, high
Interventions cholesterol

Immunizations, brief
intervention, cessation
Long-lasting treatment, colonoscopy
Protective Interventions

Fluoridation, 0g trans
Changing the Context fat, iodization, smoke-
to Make Individuals’ Default free laws, tobacco tax
Decisions Healthy
Largest
Impact Poverty, education,
housing, inequality
Socioeconomic Factors

Frieden TR. A framework for public health action. Am J Public Health. 2010;100(4):590–595.
• Public health is built on expertise and skills from many areas, including biology, environmental
science, sociology, psychology, government, medicine, statistics & communication
• Public health is about interventions that prevent disease from occurring
• The benefits tend to be less obvious when compared to life-saving medical procedures
designed to treat the problem
• Prevention of disease both prolongs life and improves the quality of life
 SCIENCE MEETS ART
SCIENCE A RT
• making a diagnosis of a population’s health • create, advocate for, and use opportunities
problems to implement effective solutions to
• establishing the causes and effects of those population health and health care
problems problems.

• determining effective interventions.

In a sense, public health is the heart disease that never
developed, the epidemic that didn't happen, the outbreak of
foodborne illness that never occurred, the child that would
have developed asthma, but didn't. Public health is the
disaster that didn't happen.
LOOK AT THAT DEFINITION AGAIN

• Public health goals

– The assessment and monitoring of the health of communities and populations at risk to identify
health problems and priorities
– The formulation of public policies designed to solve identified local and national health problems and
priorities
– Assuring that all populations have access to appropriate and cost-effective care, including health
promotion and disease prevention services
Effective medical practitioners must be concerned with contributing to each goal
 Health prevention
-use public health education, social campaigns,
laws, regulations, surveillance and
preparedness to benefit individual patients

Epidemiology Influences on health

-understand the cause & distribution
-understand environmental, nutritional,
of disease
social, and behavioral factors on health,
-interpret the medical literature &
illness, recovery & wellness
apply findings to individual patients
-understand the risk & best
management of disease

Improves shared decision

New opportunities making
-community engagement, -emphasizes cultural sensitivity,
global health, disaster community engagement, & health
response, health policy, & literacy
environmental health
Systems thinking
-supports the ability of patients to
-explains observed performance in terms of
participate in their own health care
connected parts that interact in a variety of
and to protect their family’s health
interdependent ways (just like physiology!)
-directly supports patient safety & the quality
of medical care
PUBLIC HEALTH IN THE UK

• Administered by the Department of Health

• Responsible for
health protection programmes (e.g. immunization, infectious disease surveillance)
health improvement programmes (e.g. smoking reduction)
reducing health inequalities
• The Department of Health works through the NHS, local authorities and other government
departments and the private and voluntary sectors
– recognize that education, employment, economic status, transport, environment and housing all have
an impact on public health
 Police
Home Health
EMS Community Churches Corrections
Centers MCOs
Health
Department
Parks

Schools
Elected
Doctors Hospitals Officials Nursing Mass Transit
Philanthropist Homes
Environmental
Civic Groups Health
CHCs Fire
Tribal Health
Economic
Laboratory Drug Mental Employers
Development
Facilities Treatment Health
PUBLIC HEALTH IN MALAYSIA
PUBLIC HEALTH IN THE WORLD
WATCH THIS!

• Hans Rosling's 200 Countries, 200 Years, 4 Minutes - The Joy of Stats
– https://www.youtube.com/watch?v=jbkSRLYSojo
THE FUTURE OF PUBLIC HEALTH

• The world’s population is growing

• http://www.worldometers.info/world-population/
THE FUTURE OF PUBLIC HEALTH

• Double Burden of disease

• communicable diseases and non communicable diseases
• Globalization
– ease of communication & travel
– spread of mass media

• Changing role in health governance

– local, national, international
– Socio-economic and political changes
NEW PUBLIC HEALTH WORRIES
• HIV
– Age extremes
– “If the world does not rapidly scale up in the next five years,
the epidemic is likely to spring back” –UNAIDS
• Terrorism
– Emergency medical care, mental health, bioterrorism threats
• Childhood obesity
– Globally, 43 million children under age 5 are overweight/obese today, a 60% increase since 1990.
– Places the greatest burden on the poorest.
• Pandemic concerns
– Measles! 450 deaths
– Ebola! 4,500 deaths
– Zika! 11 countries, 242 cases in Singapore
– What’s next?
The aim of medicine is to prevent disease and
prolong life, the ideal of medicine is to eliminate the
need of a physician
-WILLIAM J MAYO (1861-1939)
WHAT DID YOU LEARN?
PUBLIC HEALTH IS…