Growing and Strengthening Preventive Medicine

Transcription

1 Growing and Strengthening g Preventive Medicine Miriam Alexander, MD, MPH, FACPM President ACPM and Director of the General Preventive Medicine Residency Program Johns Hopkins Bloomberg School of Public Health September 27, 2012

2 Our Goal Today Do you want to treat the patient or do you want to improve health?? What the history of public health can teach us What prevention really is L l d f I d t i l H i d Lesson learned from Industrial Hygiene and Safety

3 The History of Public Health (in one slide!) Quarantine Sanitary Idea World of Work Education and mothering Body spaces: from inoculation to immunization Professionalization Courtesy of Graham Mooney, PhD

4 What can we learn from Public Health??

5 Twentieth th Century U.S. Mortality Rate: Source: Deaths p er 1, Year

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7 Cause of Death (U.S. 1990) Tobacco 19% Diet/Activity 14% Alcohol 5% Microbial agents 4% Toxic Agents 3% Firearms 2% Sexual Behavior 1% Motor Vehicles 1% Illicit Drug Use <1% Diet/Activity ti it Tobacco McGinnis & Foege, JAMA, 1993

8 Health System Funding Safer Healthier People Vulnerable People Affected People without complications (undiagnosed asymptomatic) Affected People with complications Traditional Healthcare Dennis Lenaway, CDC (Source: Senate Finance Cmte.) >95% of Health Expenditures

9 Prevention Funding Safer Healthier People Vulnerable People Affected People without complications (undiagnosed asymptomatic) Affected People with complications Public Health System <5% of Health Expenditures Dennis Lenaway, CDC (Source: Senate Finance Cmte.)

10 Rebalancing Health Priorities Safer Healthier People Vulnerable People Affected People without complications Affected People with complications Public Health System Healthcare Delivery System Dennis Lenaway, CDC (Source: Senate Finance Cmte.)

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12 Prevention Prevention is done by many, it is not a clinical construct What prevention really is Primary addresses ALL people Secondary addresses those with risk factors Tertiary prevents those with disease from getting worse! Clinicians DON T do Primary Prevention

13 3 Levels of Prevention Commission on Chronic Illness, 1957 Primary prevent injury or disease from occurring (decrease number of new cases) Secondary early y detection and swift treatment (reduce prevalence of established cases) Tertiary therapy, management, rehab y py, g, (decrease disability, prevent mortality from existing disorder)

14 3L Levels of fpreventive Interventions ti Institute of Medicine, 1994 Universal target entire population (desirable for general public, risk not identified for particular individuals) Selective target individuals or sub-groups (with identified elevated risk) Indicated targeted to high risk individuals (identified with minimal, detectable signs/symptoms)

15 CDC Health Impact Pyramid Factors that Affect Health Smallest Impact Examples p Eat healthy, be physically active Counseling & Education Largest Impact Clinicali l Interventions Long-lasting Protective Interventions Changing the Context to make individuals default decisions healthy Socioeconomic Factors Rx for high blood pressure, high cholesterol, diabetes Immunizations, brief intervention, cessation treatment, colonoscopy Fluoridation, trans fat, smoke-free laws, tobacco tax Poverty, education, housing, inequality

16 Who is our patient? Individual Patient Medical Office Health Care System Public/Population

17 How Can We Make Prevention A Continum A Win for One and A Win for All

18 How do we Make Decisions? Evidence/Science Social Will Political Will

19 WHAT CAN WE POSSIBLY LEARN FROM THE INDUSTRIAL HYGIENE/SAFETY WORLD??

20 Hierarchy of Controls Engineering Controls (ie. substitution, elimination, etc) Administrative i ti Controls (ie. Scheduling, policies and procedures, work practices, etc) Education (ie. Training, i certifying, i etc) Personal Protective Equipment (protect the person) Hope the person does their best!

21 How should we choose the right control?? Best: At the source Second Best: Along the Path Least Desirable: At the worker UIC.edu/sph/glakes/hierarchyofcontrolfactsheet.doc

22 How Can You Get Involved???

23 Preventive Medicine (PM) The medical specialty dedicated to health promotion and disease prevention ACPM 1954 One of the 24 specialties recognized by American Board of Medical Specialties ABPM 1947 Only board-certified specialty that combines clinical and population-based health practice

24 Training Programs in Preventive Medicine 3 years and 3 components Clinical Didactic Practicum

25 What do you think???