# Presentation: 159123

## Public Health In America:A State/Local Perspective 

**Georges C. Benjamin, M.D., FACP**
- Executive Director
- American Public Health Association

- “Public Health: Prevent, Promote, Protect”

*“**Working for a Healthier World”*

## 1854 Cholera EpidemicLondon, England

- Severe and widespread cholera in London
- Dr. John Snow’s hypothesis: People were getting cholera through contaminated drinking water; an infectious agent
- Common view was it was from miasma or bad air
- London obstetrician-mid-1800s

**Notes:**
-For all you ladies who are big fans of the epidural, we have Dr. Snow to thank for that one! 
-Dr. Snow became interested in the cause and transmission of cholera, and hypothesized that the infectious pathogen responsible for causing the disease was present in human vomitus and excrement, and that sewage contaminated water served as a means of transmission-This different greatly from the supported theory of the time-miasma, or bad air

## 1854 London Cholera Epidemic

- Documented cholera cases throughout the city according to their proximity to two different water companies
- Demonstrated that cholera was occurring more often in people consuming water from the Southwark and Vauxhill company’s pump
- Removed the Broad St. water pump handle
- Stopped the epidemic

**Notes:**
-Southwark and Vauxhill company drew its water from the lower Thames, where it was becoming contaminated with London sewage, whereas the other company obtained its water from the upper Thames, upstream from the pollution
-At the intersection of Cambridge St and Broad St, the epidemic had escalated to over 500 deaths occurring in 10 days; Snow concluded that the cause was centered around the Broad St pump, and advised city officials to remove the pump handle
-Sure enough, the cholera epidemic was contained! This infamous “birth of epidemiology” story is one of great importance in that it demonstrates the very strong linkage between the environment, in this case, water, and public health

## Institute of Medicine

- “...[A] public health professional is a person educated in public health or a related discipline who is employed to improve health through a population focus.”

- IOM 2002

## The Public Health System

**Community**

**Health Care**
**Delivery System**

**Employers & **
**Business**

**Governmental Public **
**Health Infrastructure**

**Academics**

**The Media**

**Assuring Conditions **
**for Population Health**

**IOM 2002**

**Legislators**

*“****Working for a Healthier World”***

## Public Health’s Contribution To Health

**Public Health’s Contribution ****To Health**

- Public health is responsible for the greatest increases in human life span
- Yet it has been “invisible” to the public
- Tragically in CY 2000, 78% of Americans believe they had not ever used a public health service*
- Its best work is done when nothing happens

## Basic Framework For Public Health10 Essential Services

## A Day in the Life of a Public Health Officer

**Your Community USA  **
**Today **

## Symptoms

- Fever
- Muscle aches
- Abdominal pain
- Diarrhea

## 8:30 A.M.

**“****Hello. This is Dr. Phillips from Metro Hospital. I think you better sit down. Last night we admitted three unrelated patients ages 23, 44, and 79 from the emergency room with fever, muscle aches, and diarrhea. Preliminary lab tests show an infectious diarrhea. What’s most interesting is that all three patients attended the same conference over the weekend with 300 other people. Not sure what’s going on. but I knew you needed to know!”**

## 8:45 A.M.

**Local health officer**
**checks health**
**department’s online**
**disease surveillance system**
**for latest information **
** **

## 8:50 A.M.

- High number of reported ambulance runs noted over last 24 hours
- Larger statewide outbreak suspected
- State-integrated electronic surveillance system details mapping of cases by county and zip code

**No. Cases Reported**

## Physician Report

**Physician ****Report**

**Database ****GEPI 96**

**GIS Software**

**Health Department**

## 9:00 A.M.

- Local health officer alerts state health officials of a possible statewide outbreak by e-mail
- State health officer alerts  heads of medical, education, epidemiology, and public relations teams and schedules a 9:45 meeting using PDAs

## 9:10 A.M.

- Public relations & education staff are in the building
- Epidemiologist and medical chief are at   satellite office 60 miles away
- They message back they can meet via the state’s  interactive video system

## 9:20 A.M.

- State health official views health department Web site
- Reviews information on infectious agents
- Suspects food-borne cause!

## 9:45 A.M.

- Health official meets with staff to review new data: notices outbreak crosses State lines
- Case finding and disease surveillance identifying new cases
- GIS mapping indicates new cases in three States
- Reports through wireless communication system

## 10:30 A.M.

- State health official continues to watch data on wireless computer
- Neighboring health agencies  contacted in three States
- Health agencies agree on  regional strategy using interactive video conferencing

## 12:05 P.M.

- Epidemiologist has audio     conference with their counterparts in three jurisdictions
**12:30 P.M.**
- Three State health officials have conference call

## Lab Results: Stool Positive for Pathogenic E.Coli

- Paper reports
- Some can view actual results through telemedicine linkage with medical center or public health lab
- Suspect it’s the beef that was served through several distributors

## 1:10 P.M.

- Health official alerts CDC,      medical community, and law enforcement through health alert network
- Regional screening and treatment protocols sent out
- Updates the 1-800 “hotline” that informs community about  public health emergencies

## 1:25 P.M.

- Public Information staff issue press release to alert media and educate public
- Blast fax
- E - mail

## 2:20 P.M.

- Health educator teleconferences with community physicians via interactive high speed fiber optic video network
- Gives new information on  diagnosis and therapy
- Start antibiotic treatment

## Public Health Professionals Use Secure Video Conferencing System to Coordinate Regional Outbreak Response  

## 4:00 P.M.

- Regional response coordinated
- Outbreak identified
- Treatment given
- Disease containment begun
- Lives saved!

## Public Health Has A Broad Mission

- Chronic Diseases

- Bioterrorism

- Safe Water

- Safe Food

- Clean

- Environment

## Operating Environment Has Changed 

- Invisible   Visible
- 9-5 Mon - Fri   24/7
- Results tomorrow  Results now!
- Science & politics  Science and politics
- Evolving science  Fast science
- Controlled communication  Information overload
- National scope  Global involvement

## Change Driven by Highly Visible Public Health Events

- Security dominates national agenda
- Public health part of national security agenda
- Growing public interest in health
- Protection & prevention
- Building infrastructure now a priority

## Slide 29

## Reducing Disease Burden:Addressing Root Causes 

- Heart disease
- Cancer
- Stroke
- Unintentional Injury
- COPD
- Diabetes
- Influenza & pneumonia
- Alzheimer disease
- Renal disease
- Sepsis

- National vital statistics reports, 2002

- Tobacco
- Diet/activity patterns
- Alcohol
- Microbial agents
- Toxic agents
- Firearms
- Sexual behavior
- Motor vehicles
- Illicit use of drugs

## Ensuring A 21st-Century Public Health System

- Building infrastructure
- People
- Training
- Tools
- Resources (money, linkages, facilities)
- Structural reform at local level
- Insufficient investment in public health research
- Strengthening nongovernmental public health
- Sustaining & reforming resource investments

## “ Public Health: Prevent, Promote, Protect”

**Georges C. Benjamin, MD, FACP**
** ****Executive Director**
** ****American Public Health Association**
**www.apha.org**

***“ ******Public Health: Prevent, Promote, Protect”***