PUBLIC

HEALTH
MEDICINE ON A
G RA N D S C A L E
SARAH SIMMONS MD
N E W C A S T L E U N I V E R S I T Y M A L AY S I A
LEARNING OUTCOMES

• Demonstrate the application of key principles of population health and

prevention in managing clinical conditions and reducing health inequalities.
• Describe and recognize the role of the doctor and relevant organizations in
public health at the national and local level.
• Demonstrate the ability to provide evidence to guide public health policy
and clinical practice to protect, restore, and promote the health of a
population.
PUBLIC HEALTH IS…

• The science and art of promoting and protecting health and well-being,
preventing ill-health and prolonging life through the organised efforts
of society.
• The major functions include:
– The assessment and monitoring of the health of communities and populations at risk
to identify health problems and priorities Define the problem
– The formulation of public policies designed to solve identified local and national health
problems and priorities Try to fix the problem
– Assuring that all populations have access to appropriate and cost-effective care,
including health promotion and disease prevention services Make sure it’s
fair
DID I LOSE YOU ALREADY?
What do you think of
when you think about
public health?
A DIFFERENT WAY TO
LOOK AT THE SAME THING
MEDICINE PUBLIC HEALTH

• Identify the causes of gun violence and

• Treating a gunshot wound develop interventions
• Investigate the factors that cause
premature labor and develop programs to
• Treating premature or low birth- keep babies healthy
weight babies
• Examine the links among obesity,
diabetes and heart disease and use the
• Prescribing medication for high
data to influence policy aimed at reducing
blood pressure. the conditions.
A QUICK HISTORY LESSON
• Pandora’s box
– The Greeks believed that the gods were angry about man accepting the gift of fire
– Zeus crammed all the diseases, sorrows, vices, and crimes that afflict humanity into a box and gave it to Epimetheus,
the husband of Pandora
– Pandora wanted desperately to know what was in the box, so she opened it, letting out all of the ills to spread
throughout the human world
• Hippocratic Corpus
– Attempt to think about diseases, not as punishment from the gods, but as an imbalance of man with the environment
– Opened up the possibility of intervening to prevent or treat disease
• The Bubonic plague (14th century)
– Quarantine was created- travelers that had potentially been exposed to disease were isolated for a period to ensure that
they weren't infected
• Louis Pasteur (late 1800s)
– a French biologist and chemist who made contributions to germ theory and to the control of disease
-Developed vaccines against anthrax and rabies
AND THEN THERE WAS JOHN
SNOW
JOHN SNOW,
FATHER OF EPIDEMIOLOGY
• A physician in London in the 1800s during a huge epidemic of cholera
• The prevailing opinion was that cholera was spread either by “bad airs”
• Snow began found that victims initial symptoms were always related to the
gastrointestinal tract. He reasoned that if cholera was spread by bad air it should
cause pulmonary symptoms, but since the symptoms were gastrointestinal
perhaps it was transmitted by water or food
• When cholera broke out in the Broad Street area, Snow investigated where
victims received their water and traced it to a hand water pump.
• He argued to have the pump removed
• The epidemic quickly subsided
MODERN PUBLIC HEALTH
ACHIEVEMENTS
• Vaccination to reduce epidemic diseases
– dramatic declines in morbidity and mortality against preventable diseases
– eradication of smallpox
• Improved motor vehicle safety
– Since 1925, there has been a 90% decrease in the annual death rate due to motor vehicle
travel
– regulations developed and enforced regarding safety belts, alcohol-impaired drivers, and
child safety seats
• Control of infectious diseases
– Sanitation and hygiene, vaccination, and antibiotics
• Food Safety
– refrigeration, pasteurization, pest control, animal control, and food safety regulations
promote better hygiene and sanitation
• Improvements in maternal and child health
– Global infant mortality rate and maternal mortality rate have improved due to nutrition,
standards of living, access to health care, and monitoring of disease
PUBLIC HEALTH PROBLEMS RARELY
HAVE ONE CAUSE OR RESPOND TO ONE
TARGETED INTERVENTION.
Whoever wishes to investigate medicine properly should ... consider ... the
mode in which inhabitants live, and what are their pursuits, whether they are
fond of drinking and eating to excess, and given to indolence, or are fond of
exercise and labour.
-HIPPOCRATES (5TH CENTURY BC)
PUBLIC HEALTH EFFECTS
THE PRACTICE OF MEDICINE
• Epidemiological
– e.g. changing patterns of disease, the ageing population
• Organizational
– National Health Service and social care reforms
• Political
– changes to the welfare state, changes in government
• Professional
– changes in concepts of ‘professionalism’
• Social
– the persistent gap between rich and poor, changing public expectations
• Technological
– advances in genetics, advances in treatment options.
 FACTORS THAT AFFECT HEALTH
Examples
Smallest
Impact Condoms, eat healthy,
Counseling be physically active
& Education

Rx for high blood

Clinical pressure, high
Interventions cholesterol

Immunizations, brief
intervention, cessation
Long-lasting treatment, colonoscopy
Protective Interventions

Fluoridation, 0g trans
Changing the Context fat, iodization, smoke-
to Make Individuals’ Default free laws, tobacco tax
Decisions Healthy
Largest
Impact Poverty, education,
housing, inequality
Socioeconomic Factors

Frieden TR. A framework for public health action. Am J Public Health. 2010;100(4):590–595.
• Public health is built on expertise and skills from many areas, including
biology, environmental science, sociology, psychology, government,
medicine, statistics & communication
• Public health is about interventions that prevent disease from occurring
• The benefits tend to be less obvious when compared to life-saving medical
procedures designed to treat the problem
• Prevention of disease both prolongs life and improves the quality of life
 SCIENCE MEETS ART
SCIENCE A RT
• making a diagnosis of a • create, advocate for, and use
population’s health problems opportunities to implement
• establishing the causes and effective solutions to population
effects of those problems health and health care problems.

• determining effective
interventions.
In a sense, public health is the heart disease
that never developed, the epidemic that didn't
happen, the outbreak of foodborne illness that
never occurred, the child that would have
developed asthma, but didn't. Public health is
the disaster that didn't happen.
LOOK AT THAT DEFINITION
AGAIN
• Public health goals
– The assessment and monitoring of the health of communities and populations at
risk to identify health problems and priorities
– The formulation of public policies designed to solve identified local and national
health problems and priorities
– Assuring that all populations have access to appropriate and cost-effective care,
including health promotion and disease prevention services
Effective medical practitioners must be concerned with contributing to
each goal
 Health prevention
-use public health education, social
campaigns, laws, regulations,
surveillance and preparedness to
benefit individual patients

Epidemiology Influences on health

-understand the cause &
-understand environmental,
distribution of disease
nutritional, social, and
-interpret the medical
behavioral factors on health,
literature & apply findings to
illness, recovery & wellness
individual patients
-understand the risk & best
management of disease

Improves shared
New decision making
opportunities -emphasizes cultural
-community sensitivity, community
engagement, global engagement, & health
Systems thinking literacy
health, disaster -explains observed performance in
response, health -supports the ability of
terms of connected parts that
policy, & patients to participate in
interact in a variety of
environmental health their own health care and to
interdependent ways (just like
protect their family’s health
physiology!)
-directly supports patient safety &
the quality of medical care
PUBLIC HEALTH IN THE UK

• Administered by the Department of Health

• Responsible for
health protection programmes (e.g. immunization, infectious disease
surveillance)
health improvement programmes (e.g. smoking reduction)
reducing health inequalities
• The Department of Health works through the NHS, local authorities and other
government departments and the private and voluntary sectors
– recognize that education, employment, economic status, transport, environment and
housing all have an impact on public health
 Police
Home Health
EMS Community Churches Corrections
Centers MCOs
Health
Department
Parks

Schools
Elected
Doctors Hospitals Officials Nursing Mass Transit
Philanthropist Homes
Environmental
Civic Groups Health
CHCs Fire
Tribal Health
Economic
Laboratory Drug Mental Employers
Development
Facilities Treatment Health
PUBLIC HEALTH IN MALAYSIA
PUBLIC HEALTH IN THE
WORLD
WATCH THIS!

• Hans Rosling's 200 Countries, 200 Years, 4 Minutes - The Joy of Stats
– [Link]
THE FUTURE OF PUBLIC
HEALTH
• The world’s population is growing

• [Link]
THE FUTURE OF PUBLIC
HEALTH
• Double Burden of disease

• communicable diseases and non communicable diseases

• Globalization

– ease of communication & travel

– spread of mass media

• Changing role in health governance

– local, national, international

– Socio-economic and political changes

NEW PUBLIC HEALTH
WORRIES
• HIV
– Age extremes
– “If the world does not rapidly scale up in the next five years,
the epidemic is likely to spring back” –UNAIDS
• Terrorism
– Emergency medical care, mental health, bioterrorism threats
• Childhood obesity
– Globally, 43 million children under age 5 are overweight/obese today, a 60%
increase since 1990.
– Places the greatest burden on the poorest.
• Pandemic concerns
– Measles! 450 deaths
– Ebola! 4,500 deaths
– Zika! 11 countries, 242 cases in Singapore
The aim of medicine is to prevent disease
and prolong life, the ideal of medicine is to
eliminate the need of a physician
-WILLIAM J MAYO (1861-1939)
WHAT DID YOU LEARN?
• Almodiente
• Ga
• Sorreno
• Costoy
• Albino- C
• Vingno
• Embang
• Montepolca- C
• Rodriguez
PUBLIC HEALTH IS…