Adjunct Associate Professor of Epidemiology
College of Policy & Health
Delaware State University
To the memories of my grandmother (Nkoyo Attah), grandfather (Duke Holmes), father (Morrison Holmes), and Laura Krueger, & Elton Krueger, Willie Kolwes of Brenham, Texas, whose lives and dedication to family values reflect a true leadership in public health, thanks to their perpetual application of the fundamental principles of family/socioeconomic support system in enabling healthful lifestyles and outcomes.
About the Author
Introduction: Principles and Practice of Public Health
Notion of Public Health
Public Health versus Medicine
Public Health Approach to Disease and Disability and Injury Prevention
Core Functions of Public Health and Essential Public Health Services
Origin of Public Health .
Modern Functions and Accomplishments of Public Health.
Core Areas and Disciplines of Public Health.
Challenges of Public Health
Chapter 1: Principles and Methods of Biostatistics in Public Health
Core Competencies Learning objectives
Basic Notions of Statistics and Biostatistics
Types of Distribution
Performance and Screening Test
Types of Variables, Random Variables, and Probability Distributions
Sampling, Sample Size, and Power
Research Questions, Hypothesis Testing, and Statistical Inference (Testing)
Analysis Techniques for Epidemiologic Data
Critique of Scientific Literature—Interpreting Statistics in Public Health Research.
Chapter 2: Environmental Sciences in Public Health
Core Competencies Learning objectives
Environmental Sciences and Public Health
Health Hazards and Risk Assessment.
Major Sources of Environmental Hazards and Their Health Impacts.
Genetic, physiologic and psychological factors to environmental hazards susceptibility
Mechanism of Disease Causation with Environmental Pollutants and Toxins
Environmental Protection Agency and Regulatory Entities
EPA, Environmental Justice and Public Health
Chapter 3: Principles and Methods of Epidemiology
Core Competencies Learning objectives
Definition of Epidemiology
Role of Epidemiology in Public Health
History and Modern Concept of Epidemiology
Models of Disease Causation.
Measures of Disease Frequency
Measures of Disease Occurrence
Uses of Incidence and Prevalence Data
Limitations of Prevalence Data in Public Health
Types of Rates (Crude, Specific, Adjusted)
Measures of Disease Comparison.
Sources of Epidemiologic Data
Epidemiologic Study Designs (Experimental and Observational)
Study Validity (Bias, Confounding, Random Error)
Epidemiologic Causal Inference
Disease Screening: Principles, advantages and limitations
Bias in disease screening and detection
Ethical and legal duties of epidemiology in study design, data collection, analysis and dissemination of study findings
Chapter 4: Health Policy and Management Sciences in Public Health
Core Competencies Learning objectives
Management and Policy Sciences and Public Health
General Notion of Policy Formulation and Implementation.
Health Policies and Governmental Role in Development and Implementation.
Public Health Laws and Application to Health Promotion and Disease Prevention
Public Health Ethics
Health Disparities: Insurance and Race/Ethnicity
Community Health safety and preparedness
Organizational Problem Resolution: Organization and management theories
Strategic Planning and Marketing in Public Health [PHCC.4.9]
Quality and performance improvement
Program planning, development, conduct and evaluation
Chapter 5: Social and Behavioral Sciences in Public Health
Core Competencies Learning objectives
Notion of Behavioral Sciences and Its Role in Health Promotions and the Prevention of Health-Related Events
Health Demographics and Health Disparities (Inequity)
Health Surveys and Behavior Interventions to Promote Health and Prevent Diseases
Health Theories and Health Beliefs
Behavioral Risk Factors in Major Diseases
Health Promotion Components and Levels of Disease Prevention
Role of social and community factors in both the onset and solution of public health problems
Social and behavioral factors that affect health of individuals and populations
Ethical principles to public health program planning, implementation and evaluation
Principles of evidence-based public health and public health resources
Public health, the science and art of disease prevention and health promotion, remains significant in the advances of medical and health sciences in ameliorating the health of the population. The contributions of public health to the health of the U.S. population has been remarkable in the 21st century, and it continues to be so as public health confronts emerging challenges due to the aging U.S. population, climate changes, global warming, bioterrorism, and emerging pathogenic microbes. Remarkably, the epidemiologic transition from infectious diseases as the leading cause of mortality in 1900s to chronic diseases today came as a result of persistent immunization and the reduction in vaccine-preventable diseases, and improvement in sanitation and nutrition, even before the streptomycin trials in mycobacterium tuberculae in 1947, thanks to public health contributions. Illustratively, public health achievements in the 21st century are viewed in light of their contributions to motor vehicle safety, safer workplaces, infectious disease control, decline in coronary artery disease and stroke mortality, safer and healthier food, healthier mothers and babies, family planning, fluorination of drinking water, vaccination, and recognition of tobacco as a health hazard.
The scope of public health is broad and reflects what we, as a society, do collectively to ensure the conditions necessary for people to remain healthy. Within this scope, the framework for public health performance recommends the collaboration between governmental agencies (federal, state, and local), public and private sectors, and the communities. The Institute of Medicine, in its 1988 response to “public health in disarray,” clearly described the core functions of public health as: (1) assessment, (2) policy development, and (3) assurance. The process upon which public health carries these out requires the integration of its core functions into the essential public health services, namely, (1) health services monitoring and identification of community health needs; (2) diagnoses and investigation of health problems and health hazards in the community; (3) informing, educating, and empowering people about health issues; (4) mobilizing community partnerships to identify and solve health problems; (5) enforcing laws and regulations that protect and ensure safety; (6) linking people with needed personal health services and ensuring the provision of health care when otherwise unavailable; (7) ensuring a competent public health and personal healthcare workforce; (8) evaluating effectiveness, accessibility, and quality of personal and population-based health services; and (9) researching new insights and innovative solutions to health problems.
The training of public health professionals to address the essential public health services requires a curriculum that integrates the core functions of public health into the core disciplines of public health, mainly (1) epidemiology, (2) biostatistics, (3) behavioral and social sciences, (4) environmental sciences, and (5) management and policy sciences. The knowledge of these areas and the application of cross-cutting core competencies (such as communication and informatics, diversity and culture, animal control, public health biology and pathology, professionalism, programs planning, and systems thinking) serve to provide the graduates of public health programs with the preparation (knowledge and skills) needed to succeed in this field today.
The author and the contributors of this text, the Fundamentals of Public Health Core Competencies, have presented—in a simplified and concise manner—the introduction to public health as public health principles and practice, which is rarely presented in graduate programs, and have discussed the mission, goal, core functions, history, and challenges of public health. Whereas graduates of public health tend to focus on a set module or discipline, in spite of our recommendation of the broad knowledge of the public health core disciplines, this fundamental has made it possible for graduates and potential graduates of public health to acquire competency in these core areas. This book is intended to prepare graduates of public health for an important examination that will bring collegiality and credibility to this profession. I hope that this work will point readers in a direction that will stimulate their appetite to learn more about the assessment of health issues in the population, about making sense of data, about the role of behavior in health, about the impact of environment on health as well as environmental justice, and about policy development in the management of public health services. If you believe that all books are perspectives, then no book, no matter the volume, will be able to present all the subject matter of any given field.
This book which has presented the core competencies as learning objectives should serve to remind the faculty at the various schools of public health in the nation of what the students are expected to acquire in terms of knowledge, attitude and skills prior to joining the public health workforce. To the graduate students of public health, this book should serve as a companion to the CPH Review by the same author and publisher. Therefore it is with great optimism that I recommend this book, with the hope that knowledge gained from a simplified text of this nature will inform quality performance and evidence-based public health as well as systems thinking in public health program development, conduct and evaluation.
James Harlan Steele, DVM, MPH
Retired U.S. Assistant Surgeon General
Professor Emeritus, University of Texas
Health Sciences Center at Houston
School of Public Health, Houston, Texas
Public health is an interdisciplinary science, requiring many subspecialties in its approach to disease prevention and health promotion. This book, Fundamentals of Public Health Core Competencies, would never have been prepared without contributions from my colleagues from the various disciplines that sustain essential public health functions and research infrastructures. Whereas I do assume partial credit for preparing this book to assist candidates preparing for the National Public Health Certification Examination, any errors originating from the use of this material are absolutely mine.
This book has been written to aid in the understanding of the core competencies in public health, and for the public health certification examination, CPH. A certification examination in this perspective is challenging—and will remain so, pending transition in the presentation of public health core areas and their core competencies at the graduate level. Schools of public health had traditionally prepared students to focus on their module or discipline with very little exposure to mastery in the five core disciplines: epidemiology, biostatistics, social and behavioral sciences, environmental sciences, and health policy and management sciences. Realistically, graduate programs are designed to create a focus, thus gearing toward specialized knowledge. However, a broad knowledge of these core disciplines requires not only introductory courses in these core areas but some level of formation and application of these concepts in the real world. With this gap in mind, this book has made it possible for graduates of public health programs to acquire some mastery in these core areas and the cross-cutting areas (communications and informatics, diversity and culture, leadership, public health biology, professionalism, programs planning, and systems thinking).
Many sources of information were consulted during the gestational period of this review. I am very grateful to all authors whose works we have consulted prior to the preparation of this book. I sincerely appreciate the knowledge and information gained from your intense and meaningful contributions to the field of public health. However, if you feel you have not been adequately acknowledged, I am willing to do so at the first opportunity.
I am indebted to my colleagues at the Texas Medical Center, who provided instant assistance when required to assemble research materials for the many sections in this book that required extra-intense review. It will be impossible to list names. I acknowledge, with thanks, your contributions.
I owe the basic sciences of public health chapters to the experience gained from teaching graduate students in Texas, medical students in the Caribbean over the many years of my teaching career, and recently surgical residents and postdoctoral research fellows in Wilmington, Delaware . Because teaching is a learning experience, I have learned by teaching epidemiology and biostatistics in these settings. I hope this experience reflects the information provided in these two chapters.
I am indebted to my parents, uncles and aunts for never asking me not to ask them “Why?” I am grateful to Jenni, my spouse and gatekeeper for our kids Maddy, MacKenzie, and Landon, and their grandparents, Dalton and Sue, for their patience and unconditional acceptance even when I avoided contact with them and turned to the computer in order to complete a sentence or section of this review.
Public health is not an exact science. We have consulted with sources of information judged to be valid during the period of the preparation of this text. However, information presented today is subject to change as new information becomes available tomorrow. Therefore, readers are required to consult with similar sources for the confirmation of information provided here.
Finally, we are grateful to Michael Brown, Katey Birtcher, Tracey Chapman, and the staff at Jones and Bartlett for their enthusiasm and constant editorial support.
James H. Steele, DVM, MPH
Retired U.S. Assistant Surgeon General
University of Texas, School of Public Health
Larry Holmes, Jr., PhD, DrPH
Alfred I. duPont Hospital for Children
Adjunct Associate Professor of Epidemiology,
College of Policy & Health
Delaware State University, Dover, DE
Doriel D. Ward, PhD, MPH
Health Policy and Management Sciences and Behavioral Sciences
University of Texas, MD Anderson Cancer Center
Jennifer Thompson, MS, MA, MPH
Harris County, Texas
Gbade Ogungbade, DVM, PhD
Health Services and Health Policy and Management Sciences
Population Health Research Institute
John Balogun, MD, MPH
Disease Control and Preventive Health Services
University of Texas, School of Public Health
Joan Nwuli, JD
Health Policy and Management Sciences
Nwuli & Associates Law Firm
ABOUT THE AUTHOR
Larry Holmes, Jr., PhD, DrPH has over nine years of experience as a reviewer of the United Sates Medical Licensing Examination (USMLE) questions (1994–2003). During this period, he taught the quantitative medicine (epidemiology, biostatistics) among other courses, and was responsible for both the summative and formative examination preparation materials for the medical schools in the Caribbean.
At the International University of the Health Sciences (IUHS) in St. Kitts, Holmes directed the assessment for the basic medical sciences and clinical correlates and managed over 18 thousand questions in the examination bank. He was responsible for preparing the summative examination of 350 questions for every organ-system in the USMLE learning objectives, and these examinations were offered every three months at IUHS. Holmes also wrote review questions for immunology and infectious diseases, quantitative medicine (epidemiology and biostatistics), preventive medicine, behavioral sciences, geriatrics, and pharmacology.
Dr. Holmes is currently a Clinical Epidemiologist at the Alfred I. duPont Hospital for Children in Wilmington, Delaware where he oversees the clinical research methodology (modern epidemiology and biostatistics) research and education program for postdoctoral research fellows and surgical residents. He is a published primary or senior author in many peer reviewed scientific journals, a reviewer for scientific journals including Military Medicine and AIDS Care and a member of the American College of Epidemiology.
Public health can be defined as what we as a society can do to remain healthy. This broad notion of public health is indicative of the shared responsibility of the governmental agencies, public and private sectors, and the community in meeting the demands of the core functions of public health, namely assessment, policy, and assurance. These core functions are fused into the essential public health services: (1) health services monitoring and identification of community health needs; (2) diagnoses and investigation of health problems and health hazards in the community; (3) informing, educating, and empowering people about health issues; (4) mobilizing community partnerships to identify and solve health problems; (5) enforcing laws and regulations that protect and ensure safety; (6) linking people with needed personal health services and ensuring the provision of health care when otherwise unavailable; (7) ensuring a competent public health and personal healthcare workforce; (8) evaluating effectiveness, accessibility, and quality of personal and population-based health services; and (9) researching new insights and innovative solutions to health problems.
The core functions of public health and the essential public health services serve as the reference point for the core competencies and cross-cutting areas in public health. The competencies in these core areas are indicative of the broad knowledge of public health in fulfilling its substance as declared by the Institute of Medicine in The Future of Public Health: disease control prevention and health promotion. The core competencies simply set the path regarding the volume of knowledge, attitude, and skills required of graduates of public health in delivering public health direct services, research, and teaching.
There is a need to standardize these core disciplines in terms of the core competencies in order to administer an examination that will fairly test knowledge and performance in these core competencies and their cross-cutting areas. Using the core disciplines in public health and the cross-cutting areas (professionalism, leadership, systems thinking, program planning, diversity and culture, and public health biology), we reviewed public health knowledge and practice with the intent to provide candidates with the information needed to acquire public health competencies and obtain a high yield in the National Public Health Certification Examination.
This book is not a substitute for the recommended textbooks used in these various public health disciplines. To benefit from this book, graduates of public health are expected to have had a good exposure to these core disciplines prior to graduation. However, if less time was dedicated to these areas, readers or candidates for the certification examination will find this book useful as well, but it may initially appear to be challenging. Therefore, for optimal success in using this text, we recommend that candidates read these materials in conjunction with the CPH Review. In this book we have tried to present the core competencies as the learning objects for each of the chapters. To some these learning objectives may appear novel, but this should not be the case since we utilized the ASPH guidelines available to Schools of Public Health in coding these learning objectives. For example, PHCC.1.3 refers to Public Health Core Competencies, Biostatistics, Descriptive techniques in summarizing public health data. Materials are presented throughout the chapter to reflect the depth of knowledge required to meet the objectives, as well as vignettes to illustrate the application of concept to the “real world” situation.
The first chapter, the introduction addresses the notion of public health, mission, substance and goal of public health. A brief history is offered to illustrate the role of public health in the epidemiologic transition from infectious diseases to chronic diseases. The achievements of public health during the 21st century are presented as well as the current challenges of public health. Chapter 1 presents biostatistics as the tool utilized by public health in the assessment of health issues in specific populations. Chapter 2 delves into the effect of the environment on human health as well as the emerging concerns for environmental justice in protecting the health insult from government and industries on the poor, economically marginalized segments of the US population. Chapter 3 addresses the use of epidemiology as a tool in public health and its primary role in assessment as well as its application in intervention designs and health policy development and health legislation. Chapter 4 presents the role of health policy and management in public health program development, implementation and evaluation. The last chapter, 5 addresses the behavioral and social determinants of health, health theories, and the application of social and behavioral data in public health interventions, as well as the factors influencing health disparities.
Finally, because public health is an ever-changing science, we have consulted with information judged to be reliable at the time of the presentation of these materials. In spite of this, and because of the possibility of human error, the author, contributors, and publisher cannot be held responsible for any errors resulting from the use of this information. Therefore, readers are advised to consult other texts for the confirmation of the data presented herein.
We sincerely welcome suggestions, criticisms, and remarks for the improvement of this text as examination recall materials become available.
Public Health Science: Principles and Practice
Larry Holmes, Jr., Doriel Ward, Jennifer Thompson, and John Balogun
Public health emerged from the need to provide clean and safe water and protect the population from contaminated food in an attempt to reduce morbidity and mortality from infectious diseases; it remains a collective attempt by the government, public and private sectors, and individual communities to ensure that we as a society or people stay healthy. Whereas there are many definitions of public health, simply, public health is the science and art of disease, disability and injury prevention, and health promotion at a population level.
These introductory materials address the mission, goal, substance, and core functions of public health. To achieve these core functions, the framework of public health integrates both the substance of public health, which are disease prevention and health promotions, and the essential public health services, namely, (a) health services monitoring and identification of community health needs; (b) diagnoses and investigation of health problems and health hazards in the community; (c) informing, educating, and empowering people about health issues; (d) mobilizing community partnerships to identify and solve health problems; (e) enforcing laws and regulations that protect and ensure safety; (f) linking people with needed personal health services and ensuring the provision of health care when otherwise unavailable; (g) ensuring a competent public health and personal health care workforce; (h) evaluating effectiveness, accessibility, and quality of personal and population-based health services; and (i) researching new insights and innovative solutions to health problems.
The history of public health is reviewed, with the main focus on the achievement of public health during the 21st century, namely, (a) motor vehicle safety, (b) safer workplaces, (c) infectious disease control, (d) decline in coronary artery disease and stroke mortality, (e) safer and healthier food, (f) healthier mothers and babies, (g) family planning, (h) fluorination of drinking water, (i) vaccination, and (j) recognition of tobacco as a health hazard. The challenges of public health today are also briefly mentioned: (a) aging U.S. population with the associated chronic diseases and disabilities, (b) climate changes and global warming, (c) bioterrorism and disaster preparedness, and (d) increasing health disparities.
I. Notion of Public Health
A. Public health is the interdisciplinary science and art of disease, disability, injury prevention, and control in the human population.
1. Public health focuses on preventing diseases, prolonging life, and promoting physical and mental health, sanitation, personal hygiene, infection control, and organization of health services.
2. Public health also focuses on enhancing health in human populations through organized community efforts.
3. Public health is what we, as a society, do collectively to ensure that people can be healthy.
B. The mission of public health is to fulfill society’s interest in ensuring conditions in which the people (community) can be healthy.
C. The goal of public health is to promote population health through shared responsibility, organized efforts, and managed care.
D. The core functions of public health agencies at all levels of government, are assessment of needs and health status, policy development, and assurance of public health services.
E. Public health substance is disease, injury, and disability control and prevention, and health promotion, achieved through organized community effort.
F. Health is defined by the World Health Organization (WHO) as the state of physical, mental, and social well-being, not the mere absence of a disease.
G. Health care is the prevention, treatment, and management of illness and the preservation of mental and physical well-being through the services offered by the medical, nursing, and allied health professions.
1. According to the WHO, health care embraces all the goods and services designed to promote health, including “preventive, curative and palliative interventions, whether directed to individuals or to populations.”
II. Public Health versus Medicine
A. Public health is concerned with the community or population, including animal populations (veterinary public health).
B. Medicine is concerned with individual patients.
C. Public health focuses on preventing illness, disabilities, and injuries.
D. Medicine focuses on the treatment of individual patients.
III. Public Health Approach to Disease and Disability and Injury Prevention
Table 1 The Stages in Public Health Initiative in Disease, Disabilities, and Injuries Prevention at the Population Level
Health problem ascertainment
Clear and unambiguous definition of the health problem
Risk/protective factors identification
Postulated and researched risk factors
Intervention design and pilot
Program monitoring and evaluation
Data collection, analysis, and interpretation and results dissemination
IV. Core Functions of Public Health and Essential Public Health Services
A. Core Functions of Public Health
Table 2 The Core Functions of Public Health
Assembling data (processing)
Dissemination of information on the health of the community, including health status statistics, community health needs, and epidemiologic and other studies of health problems
The process by which society makes:
Decisions about problems
Chooses goals and the proper means to reach them
Handles conflicting views about what should be done
Provision of high-quality services, including personal health services, needed for the protection of public health are available and assessable to all persons
Proper allocation of state, federal, and local resources for public health
Availability of information on how to obtain and comply with health services requirements
B. Essential Public Health Services
1. Monitoring and identifying of community health needs.
2. Diagnosing and investigating of health problems and health hazards in the community.
3. Informing, educating, and empowering people about health issues.
4. Mobilizing community partnerships to identify and solve health problems.
5. Enforcing laws and regulations that protect and ensure safety.
6. Linking people with needed personal health services and ensuring the provision of health care when otherwise unavailable.
7. Ensuring a competent public health and personal health care workforce.
8. Evaluating effectiveness, accessibility, and quality of personal and population-based health services.
9. Researching new insights and innovative solutions to health problems.
V. Origin of Public Health
A. Early History
1. Diversion of human waste to protect public health (Roman times).
2. Variolation (subcutaneous inoculation of attenuated pustule material in patients) following smallpox epidemic around 1000 B.C. (Chinese).
3. Vaccination to treat smallpox by Edward Jenner (1820s).
4. Removing dead bodies to prevent bacterial infection during the Black Death in Europe (14th century).
5. Quarantine to mitigate infectious diseases (Medieval Europe).
6. Development of the miasma theory of disease after cholera pandemic in Europe (1829–1851).
B. Modern History
1. Identification of polluted water well as the source of cholera epidemic in London in 1854 (John Snow). This indicated a transition from miasma theory of disease to the germ theory and was the foundation of the science of epidemiology.
2. Observation of microorganisms as the cause of most infectious diseases (Anton van Leeuwenhoek, 1680).
3. Germ theory—disease, single pathogen—defines a one-to-one relationship between a microorganism and the occurrence of disease (Robert Koch, mid- to late-1880s).
4. Artificial vaccine production and the theory that specific transmissible pathogens are responsible for disease (Louis Pasteur, mid-1800s).
5. Infant mortality lowering in the United States using preventive methods (feed, bathe, and dress babies)—Sara Josephine Baker, 21st century.
6. Increase in average life span in 21st-century United States due to public health achievements in vaccination programs and control of infectious diseases, motor vehicle and occupational safety, improved family planning, drinking water fluorination, and smoking cessation programs.
7. HIV/AIDS epidemic (1980s) and global response to HIV/AIDS epidemic.
8. Emerging infectious diseases such as sudden acute respiratory syndrome (SARS) in 2002.
9. Increase in obesity and type II diabetes (USA, 1990–2000s).
10. Population-level risk factors—health disparities, inequality, poverty, and education (1980s).
11. New public health challenge to address health inequalities by addressing social determinants of health, thus narrowing and eliminating health disparities in gender, education, race, and age.
12. Advocate policies that promote the health of the whole population in an equitable pattern (USA, 2000s).
13. Socioeconomic and social determinants of health being highly recognized (WHO, 2003).
14. Terrorism and bioterrorism preparedness (2000s).
15. Natural disaster preparedness (Katrina in United States and Tsunami in Asia, 2000s).
Identification of polluted water source in cholera epidemic in London
Jakob Henle, Robert Koch
Disease causation based on germ theory
First water protection regulation
First Health Officer
Identification of swamp drainage as essential in stopping malaria
Review of sanitation practices, enforcement of sanitation code, and the establishment of the Massachusetts local Board of Health
Establishment of the State Board of Health
Polio vaccine development reducing the number of U.S. cases from 58,000 in 1952 to 5,000 in 1957
VI. Modern Functions and Accomplishments of Public Health
A. Health surveillance, monitoring, and analysis (epidemiology and biostatistics—assessment core function).
B. Disease outbreak investigation, epidemic and disease risk factors (epidemiology and biostatistics—assessment core function).
C. Establishing, designing, and managing health promotion and disease prevention programs (policy science, epidemiology, biostatistics, behavioral sciences—policy development and assessment core functions).
D. Enabling and empowering communities to promote health and reduce inequalities (policy and management science, health promotion and health promotion practices—policy and assurance core functions).
E. Ensuring compliance with regulations and laws to protect and promote health (management and policy science—assurance core function).
F. Creating and sustaining federal, state, local, and private sector partnership to improve health and reduce health disparities (policy and management science—policy and assurance core functions).
G. Developing and maintaining a well-educated and well-trained, multidisciplinary public health task force.
H. Providing comprehensive and current information in the training of able future leaders into the field of public health.
I. Ensuring the effective performance of Healthy People 2010 objectives in improving health, preventing diseases, and eliminating health disparities.
J. Encouraging research, development, evaluation, and innovation.
K. Increasing quality assurance in public health functions.
Table 4 21st-Century Public Health Achievement in the United State
Motor vehicle safety
Control of infectious diseases––infant mortality reduction
Decline in coronary health disease and stroke deaths––reduction in cigarette smoking
Safer and healthier food––FDA enforcement of related federal public health laws
Healthier mothers and babies––improvement in maternal and child health services
Fluorination of drinking water
Recognition of tobacco as a hazard
Source: Centers for Disease Control and Prevention, http://www.cdc.gov/tobacco/ mm4812.pdf
VII. Core Areas and Disciplines of Public Health
A. Basic Sciences of Public Health
Table 5 Basic Sciences of Public Health: Discipline and Basic Components/Features, Basic Sciences
Epidemiology: Science of disease, injuries and disabilities distribution, determinants and prevention in the human and related animal populations
Assessment of disease, disabilities, and injuries
Disease distribution in human and related animal populations
Measures of disease frequency
Appropriate study designs to answer the research question(s)
Determines study validity through critique and other measures
Evidence-based risk and protective factors identification
Biostatistics: Science of inferences on random sample
Quantification of disease, disabilities and injuries
Sampling techniques and appropriate sample (decision on how many will be in the study)
Response rate and attrition
Probability of performance/diagnostic test
Sensitivity, specificity, predictive value
Design and analysis techniques for observational and clinical trial studies
Hypotheses testing (parametric and nonparametric)
Role of statistics in epidemiologic/public health research
Inferential statistics and studies recommendation
B. Applied Sciences of Public Health
Table 6 Basic Sciences of Public Health: Discipline and Basic Components/Features, Applied Sciences
Behavioral and social sciences: Multidisciplinary science of human actions and reactions
Health theories, models, and beliefs
Behavioral risk and protective factors in disease
Social determinants of diseases and racial disparities in screening, diagnosis, treatment, and prognosis
Behavioral interventions (community-based intervention trials, education intervention, behavior modeling, and motivation to change behavior)
Health promotions and risk avoidance (HIV/AIDS, chronic diseases, obesity, cancer, infant mortality, prenatal care, etc.)
Environmental and occupational health: Science of environmental influence on health and effect of working environment on disease, disabilities, and injuries
Impact of environment on human health, occupational injury, diseases, and mortality
Environmental factors in health promotion
Routes and effects of exposure to environmental hazards
Assessment of environmental risk
Methods of environmental modification
Major sources of environmental hazards
Effect of under-nutrition and over-nutrition
Effect of excessive caloric intake and inadequate physical activities on health and disease outcomes
Management and policy science: Decision making on intervention goal and resources allocation
Policy development and public health
Factors affecting public health
Administration of public health
Goals of public health
VIII. Challenges of Public Health
A. Global Warming
1. Climate warming and human health with the consequences being:
a. Emerging hyperthermia.
b. Emerging infections.
c. Heat stroke, especially in individuals with cardiovascular system compromization or diseases and the elderly.
d. Cutaneous malignancy.
e. Increase in air and water pollution, resulting in infectious diseases.
f. Asthma and pulmonary congestion.
g. These conditions are likely to involve the socioeconomically marginalized segments of the U.S. population, mainly ethnic/racial minorities.
B. Aging America
1. Aging population predisposes to chronic disabilities and chronic disease and malignancies.
2. Public health is charged with implementing programs to address lifestyle variables and decrease chronic disabilities and illnesses and promote successful aging and disease-free longevity.
C. Obesity and Overweight
1. More than 66% of the U.S. population is overweight and obese; the consequences of obesity and overweight are:
a. Type II diabetes.
b. Cardiovascular diseases.
c. Some cancers.
d. Preterm and low birth weights, congenital anomalies, and infant mortality.
e. Maternal morbidity (gestational diabetes, pre-eclampsia).
2. Public health is charged with preventing obesity by behavioral intervention to address excessive caloric intake and enhance regular and moderate exercise.
1. Whereas public health is not designed to control or prevent terrorism, public health is charged with the responsibility of responding to such attacks by coordinating services needed to reduce causalities and respond to the attack, thus preventing further damages to human health and loss of human lives.
E. Disaster Preparedness
1. Disasters, which public health cannot control, and the response to the aftermath of such disasters remain the responsibilities of public health.
2. A prompt response to disasters such as Katrina in New Orleans and tsunami in Asia requires a well-coordinated disaster preparedness effort from the public health services.
F. Health Disparities Elimination
1. Healthy People 2010 focuses on health disparities elimination.
2. Public health is charged with the responsibility of providing equitable preventive services to all sectors of the population, especially the socioeconomically marginalized, children, women, elderly, and racial and ethnic minorities.
3. Realistically, the future of the U.S. population’s health depends on the collective and shared effort of public health agencies to develop and enforce policies that will ensure the provision of health services to all at a population level, regardless of the ability to afford such services (e.g., immunization as primary prevention of vaccine-preventable diseases).
G. Community Participatory Research, Translational Research and Environmental Justice
1. Community Participatory Research advocates the involvement of the community in research planning, conduct and evaluation. The community provides data for public health assessment of needs, risks, benefits and resources. Public health programs development, implementation and evaluation must involve the community. Community must provide informed consent for research to be conducted. This is in part the notion behind community participatory research.
a. Further, public health research findings must be shared with the community. Public health is faced with applying community participatory research in addressing interventions designed to benefit the community.
2. Translational research is at the center of the benefits of research at the community level. The ultimate purpose of research is to improve the health status of the community by applying what is known at the intervention trial to the routine practice at the community level. The barriers to this translation had been recently the focus of the National Institute of Health.
a. Public health is challenged with designing measures that will facilitate the application of research findings in public health to the community on routine use, away from the trial or controlled environment that does not represent the “real world” situation.
3. Environmental justice advocates the role of the popular movement, the poor in the improvement of public health and the recognition of the contribution of this movement to the achievement of public health in his nation. Economically marginalized segments of our population are disproportionately burdened by the adverse effect of toxic environment on health. The poor physical environment tends to be identified with toxic waste deposition by the government and the industry.
a. Environment justice represents the movement to reduce the burden of environmental health on the vulnerable and poor segment of our population.
4. Public health is challenged with including those who live in these environmentally “unsafe” ambience in the decision to improve their health, since the will or desire (motivation) to remain healthy is essential in any effort to control disease and improve health.
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