University of Massachusetts Amherst ScholarWorks@UMass Amherst UMass Institute for Global Health Community Education and Outreach UMass Institute for Global Health 2010 The Complementary Roles of Public Health & Medicine in the US Health Care System David Buchanan University of Massachusetts - Amherst, buchanan@schoolph.umass.edu Follow this and additional works at: https://scholarworks.umass.edu/umigh_outreach Part of the Public Health Commons Buchanan, David, "The Complementary Roles of Public Health & Medicine in the US Health Care System" (2010). UMass Institute for Global Health Community Education and Outreach. 2. Retrieved from https://scholarworks.umass.edu/umigh_outreach/2 This Article is brought to you for free and open access by the UMass Institute for Global Health at ScholarWorks@UMass Amherst. It has been accepted for inclusion in UMass Institute for Global Health Community Education and Outreach by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact scholarworks@library.umass.edu.
THE COMPLEMENTARY ROLES OF PUBLIC HEALTH & MEDICINE IN THE US HEALTH CARE SYSTEM NOVGOROD STATE UNIVERSITY INTERNATIONAL PROGRAMS WEEK MAY 17-21, 2010 David Buchanan, DrPH Director, Institute for Global Health
Overview I. Comparative Health Statistics II. Public Health vs. Medicine III. Public Health Model IV. US Public Health Care System
I. Comparative health statistics Life expectancy Healthy life expectancy Heart disease Stroke Diabetes Drunk driving deaths Maternal mortality Infant mortality
Life expectancy, 2008 90 80 70 75.7 74.2 80.7 60 61.8 50 40 Male Russia Female United States
Healthy Life Expectancy 80 70 60 67 64 71 50 53 40 Male Female Russia United States
Heart disease rates 800 751 600 400 453 200 279 177 0 Male Russia Female United States
Heart disease rates, US, 1950 vs. 2005 600 500 593 400 300 200 100 279 205 177 0 Male 1950 2005 Female
Stroke death rates 300 250 251 200 150 100 32 50 0 Russia United States
Diabetes rates, per 100,000 14.0% 14% 12.0% 10.0% 8.0% 6.0% 4.0% 4.2% 2.0% 0.0% Russia United States
Drunk driving death, total number 15000 12500 15000 13470 10000 7500 5000 Russia United States
Drunk driving deaths rates, per 100,000 12 10 10.7 8 6 4 3.8 2 0 Russia United States
Maternal mortality rates, 2008 35 30 34 25 20 15 17 10 5 0 Russia United States
Infant Mortality Rates, 2009 12 10 11.5 8 6 6.22 4 2 0 Russia United States
Smoking rates 60.0 50.0 58.1 40.0 30.0 20.0 10.0 23.9 15.8 18 0.0 Male Female Russia United States
Obesity rates 40 35 30 25 20 15 10 5 0 9.7 Male 33.3 35.3 23.6 Female Russia United States
II. Pubic Health vs. Medicine Medicine is the art and science of healing. It encompasses a range of care practices designed to restore health by treating illness. The goal of medicine is to heal sick persons in the encounter, here and now, between the physician and individual patient.
II. Pubic Health vs. Medicine The goal of public health is to protect and promote the health of the population as a whole. Public health is the science and politics of prevention.
Six major differences between Medicine and Public Health Characteristic Medicine Public Health Primary moral obligation Best interests of individual patient; moral obligation to provide the best treatment possible Goal Treatment Prevention Best interests of society; scarce/limited resources necessitates priority setting; moral obligation to provide the most costeffective interventions possible
Six major differences between Medicine and Public Health Characteristic Medicine Public health Recipient of services Aim Individual Focus on controlling the agent (after invading the host) Population Focus on changing the environment
Six major differences between Medicine and Public Health Characteristic Medicine Public Health Scientific foundation Based in biological & physiological sciences Multi-disciplinary; multi-sectoral Authority Voluntary compliance Police powers of state
Definition of Public Health Public health is the sum of all those activities that fulfill a society s collective responsibility for assuring the conditions for people to be healthy. Adapted from Institute of Medicine, The Future of Public Health, 1988
Mission of Public Health Prevent epidemics & the spread of disease Protect against environmental hazards Prevent injuries Promote & encourage healthy behaviors Respond to disasters & assist communities in recovery Assure quality & accessibility of health services
Essential Public Health Services Monitor health status to identify community health problems. Diagnose and investigate health problems and health hazards in the community Inform, educate, and empower people about health issues. Mobilize community partnerships to identify and solve health problems. Develop policies and plans that support individual and community health efforts.
Essential Public Health Services Enforce laws and regulations that protect health and ensure safety. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. Assure a competent public health and personal healthcare workforce. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. Research for new insights and innovative solutions to health problems.
Looking upstream My friend, Irving Zola, relates the story of a physician trying to explain the dilemmas of the modern practice of medicine: "You know, sometimes it feels like this. There I am standing by the shore of a swiftly flowing river and I hear the cry of a drowning man. So I jump into the river, put my arms around him, pull him to shore and apply artificial respiration. Just when he begins to breathe, there is another cry for help. So I jump into the river, reach him, pull him to shore, apply artificial respiration, and then just as he begins to breathe, another cry for help. So back in the river again, reaching, pulling, applying, breathing and then another yell. Again and again, without end, goes the sequence. You know, I am so busy jumping in, pulling them to shore, applying artificial respiration, that I have no time to see who the hell is upstream pushing them all in." - John McKinlay
Definition of risk factor A health risk factor is anything that increases one s chances of getting a disease. Common categories of risk factors include: Biological or physiological factors Behavioral factors Psychosocial factors Physical Environment Social determinants of health
Risk Factor Analysis Direct contributing factor Indirect contributing factor Indirect contributing factor Health problem Determinant Direct contributing factor Indirect contributing factor Indirect contributing factor Determinant Direct contributing factor Indirect contributing factor Indirect contributing factor Indirect contributing factor
Risk factor analysis
Typical Public Health Services Family Health & Nutrition Community Health Promotion Environmental Health Health Statistics Substance Abuse Services Infectious Disease control Emergency Preparedness Health Care Safety & Quality
National spending on public health services Total amount, all public health services, $46.4 billion 3.3% of all health care spending
Massachusetts Department of Public Health $800 million 60% from state; 40% from federal government (CDC & HRSA) ~$109 per person MA ranks 11 th in nation; highest spends $220 per person