http://www.healthinformaticsforum.com/page/component-1-unit-1-lecture-b 1. Discussions for Lecture B 1. What is public health? 2.

Name some of the significant public health achie ements in the !" in the 2#th centur$. %ic& an e'ample of a public health achie ement that $ou consi(er to be impressi e) an( present $our fin(ings in the (iscussion threa(. *. What is epi(emiolog$? +ow (oes it help me(icine? ,. -here ha e been multiple confirme( cases of Disease . in $our communit$. /ou suspect that the (isease is cause( b$ long-term consumption of a particular foo( item. +ow woul( $ou begin to collect (ata that woul( help $ou pro e $our h$pothesis? +ow woul( $ou want to anal$0e this (ata? 1u(io -ranscript Welcome to 2ntro(uction to +ealthcare an( %ublic +ealth in the !": 2ntro(uction an( +istor$ of 3o(ern +ealthcare in the !". -his is Lecture b. -he component) 2ntro(uction to +ealthcare in the !") is a sur e$ of how healthcare an( public health are organi0e( an( ser ices are (eli ere( in the !". -he 4b5ecti es for 2ntro(uction an( +istor$ of 3o(ern +ealthcare in the !") are to: Delineate &e$ (efinitions in the healthcare (omain 6'plore components of healthcare (eli er$ an( healthcare s$stems Define public health an( re iew e'amples of impro ements in public health Discuss core alues an( para(igm shifts in !" healthcare Describe in o er iew terms) the technolog$ use( in the (eli er$ an( a(ministration of healthcare -his lecture will pro i(e a (efinition of public health an( (etail how public health has impro e( healthcare. 1ccor(ing to 7harles 6(war( Winslow) a famous 1merican bacteriologist an( public health e'pert in the first half of the 2#th centur$) public health is the science an( art of pre enting (isease) prolonging life) an( promoting health through the organi0e( efforts an( informe( choices of societ$) organi0ations both public an( pri ate) communities) an( in(i i(uals. "o what are the ten great public health achie ements in the !nite( "tates this centur$? -he 7enters for Disease 7ontrol an( %re ention lists them as: accination) motor ehicle safet$) safe wor& places) control of infectious (iseases) a (ecline in (eath from coronar$ heart (isease an( stro&e) safer an( healthier foo() healthier mothers an( babies) famil$ planning) the fluori(ation of (rin&ing water) an( the recognition of tobacco use as a health ha0ar(. 2t8s interesting that each of these achie ements re9uires large populations to acti el$ shift the wa$ the$ thin& about illnesses an( act in a large-scale fashion to ma&e changes in beha ior in or(er to successfull$ implement public health impro ement. 2t8s also interesting that though scientific a( ancements ha e spearhea(e( man$ of these achie ements) public e(ucation remains a primar$ moti ator of public health achie ements. Let8s focus our attention on the control of infectious (iseases. 1 classic e'ample of public health success in this arena is the successful control of t$phoi(. -$phoi( is cause( b$ bacteria an( is sprea( b$ ingesting contaminate( foo( or water. -he organism sprea(s ia the bloo(stream an( causes a fe er an( a s$stemic) sometimes potentiall$ fatal illness. 2n 1:;1 the t$phoi( (eath rate in 7hicago alone was 1<, per 1##)### people. Now) than&s to public health measures such as sanitation) the impro ement of h$giene) combine( with the (e elopment of a accine) onl$ about ,## cases are seen in the !nite( "tates each $ear an( most of these cases originate when patients tra el in (e eloping countries. 1nother e'ample of the role of public health in the successful control of infectious (isease is the e'ample of small po'. "mall po' is a (e astating (isease. 2t8s an epi(emic iral illness

an( was responsible for hun(re(s of millions of (eaths in the 2#th centur$ alone. No effecti e treatment was e er (e elope( for the (isease an( it &ille( about thirt$ percent of patients who were infecte(. Between si't$-fi e an( eight$ percent of those who sur i e( the (isease were mar&e( with (eep scars) most prominentl$ on the face. 1s late as the 1:th centur$) small po' was responsible for the (eath of e er$ tenth chil( born in =rance. 2n the earl$ 1;>#s) there were about fift$ million cases of small po' each $ear worl(wi(e. B$ 1;?<) this figure fell to ten-to-fifteen million because of mass accination (ri es. B$ 1;<<) small po' was era(icate(. -his was pre(ominantl$ (ue to an aggressi e public health program an( the use of an effecti e accine. 2nter entions (ictate( b$ public health ha e been responsible for the successful control of man$ nutritional (eficiencies. 1n e'ample is that of goiter. 1 goiter @A4/-(erB is an enlargement of the th$roi( glan( in the nec& (ue to impaire( th$roi( hormone s$nthesis (ue to the lac& of io(ine in (iet. -he solution to the problem of nutritional goiter in the !nite( "tates was to fortif$ salt with io(ine which irtuall$ era(icate( the problem. 1nother e'ample is the re(uction of tooth (eca$ in the population. =re(eric 3cCa$ in 1:;1 first (escribe( the association between a re(uction in the inci(ence of (ental caries @71D6ree0B) or tooth (eca$) in populations an( the a((ition of fluori(e to (rin&ing water. 2n 1;,>) Dr. +. -ren(le$ Dean an( associates at the National 2nstitute of +ealth) a((e( fluori(e to the water in Aran( Dapi(s) 3ichigan) an( showe( a subse9uent re(uction in caries. Now) more than 1#)### !" communities fluori(ate their water. "o how has public health impro e( healthcare? %ublic health is (irectl$ responsible for impro ement in un(erstan(ing (isease. 6pi(emiolog$ @ep-ih-(ee-mee-1LL-uh-5eeB is the basic science of public health. 2t is a 9uantitati e basic science built on a wor&ing &nowle(ge of probabilit$) statistics) an( soun( research metho(s. 2t is a metho( of causal reasoning base( on (e eloping an( testing h$potheses pertaining to currents an( pre ention of morbi(it$ an( mortalit$. 6pi(emiolog$ is also a tool for public health action to promote an( protect the public8s health base( on science) causal reasoning) an( a (ose of practical common sense. +ere is an e'ample of epi(emiolog$ at wor&: 2n 1:>,) an epi(emic of cholera ra age( Lon(on) 6nglan(. 7holera is a bacterial (isease sprea( b$ contamination of foo( or water. Lac& of sanitation an( o ercrow(ing were important factors that le( to the sprea( of (isease. Dr. Eohn "now) a ph$sician) lin&e( the sprea( of (isease to a contaminate( public water pump on Broa( "treet. "now h$pothesi0e( that the (isease was sprea( b$ contaminate( water) an( he use( statistics to connect the 9ualit$ of water to the number of cases of cholera. %ublic health successes ha e been assiste( b$ impro ements in the science an( processes associate( with (ata collection. 4riginal metho(s of (ata collection were somewhat cru(e. 1n e'ample of this woul( be fiel( sur e$s. %rogressi e impro ements in metho(olog$ ha e lea( to the use of sophisticate( scientific metho(s to collect (ata. 4ne e'ample is cohort stu(ies. -his is a form of a longitu(inal stu($ that follows two sets of patients. 4ne set has the factor that is being consi(ere() the other (oes not ha e the characteristic. 1nother use of sophisticate( scientific metho(olog$ is to con(uct public health trials as ran(omi0e( controlle( trials. Dan(omi0e( controlle( trials re(uce the element of bias in a scientific stu($. %atients are assigne( to one of two pools. 4ne pool recei es an inter ention an( the other (oes not. -his re(uces the influence of confoun(ing ariables in (ata anal$sis. 1n e'ample of impro ements in (ata collection lea(ing to better public health is the =ramingham heart stu($. 2n 1;,:) the National +eart 2nstitute) which is now the National +eart Lung an( Bloo( 2nstitute of the National 2nstitutes of +ealth) an( Boston !ni ersit$ began the =ramingham +eart "tu($. -he stu($ recruite( men an( women from the town of =ramingham) 3assachusetts) an( followe( them for a substantial number of $ears to attempt to i(entif$ factors that contribute to the (e elopment of car(io ascular (isease. 4 er the $ears) three generations of participants ha e helpe( to i(entif$ ma5or car(io ascular (isease ris& factors. With the assistance of these patients) researchers ha e also attempte( to un(erstan( the effects of car(io ascular (isease ris& factors on other (iseases such as h$pertension or high

bloo( pressure an( (ementia. 2n a((ition to impro ements in (ata collection) public health has also benefitte( from impro ements in (ata anal$sis. =or e'ample) use of tools such as multi- ariate an( metaanal$sis offer speciali0e( options to anal$0e collecti e (ata. -here has also been an impro ement in (isease sur eillance. 4ne e'ample is the Deal time 4utbrea& an( Disease "ur eillance) or D4D" @roa(sB Laborator$) which is a bio-sur eillance research laborator$ at the !ni ersit$ of %ittsburgh in %enns$l ania. -his laborator$ uses software an( algorithms to monitor emergenc$ rooms an( retail stores to (etect an( assess (isease outbrea&s. 1s $ou can imagine) this is of immense use in the public health arena. %ublic health has also benefitte( from impro ement in training. 2n the earl$ twentieth centur$) in part (ue to the Welch-Dose report of 1;1>) an( also partiall$ because of the support of the Doc&efeller =oun(ation) man$ schools of public health were establishe( an( awar(e( professional (egrees such as the 3aster of public health. 1n( finall$) public health has also benefitte( from impro ement in infrastructure at the fe(eral) state) an( local health (epartment le els. -his conclu(es Lecture FbG) of 2ntro(uction an( +istor$ of 3o(ern +ealthcare in the !". 2n summar$) %ublic +ealth is the science an( art of pre enting (isease) prolonging life) an( promoting health an( in ol es arious organi0ations within societ$. %ublic e(ucation remains a primar$ moti ator of public health achie ements. %ublic +ealth has significantl$ impacte( the control of infectious (iseases) such as t$phoi() small po' an( goiter) an( helpe( i(entif$ nutritional (eficiencies an( contribute( to a greater un(erstan(ing of (iseases. 2t has also supporte( impro ements in (ata collection) training an( infrastructure. 2. *. ,. >. ?. <. :. ;. 1#. 11. 12. 1*. 1,. 1>. 1?. 1<. http://'etnghiem(a&hoa.com/(ien(an/printthrea(.php?ti(H11,?