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SCN195 Community Health vs. Public Health 2

Community § Community Health: a field of public health focused on the health of a

defined group of people, or community, and factors that protect and
Health improve the health of that community
§ Communities are:
Class #1 • Geographic areas such as
u Cities or Towns

u Districts, Neighborhoods

þ Video: What is Public Health(3m) • Groups of people with shared

characteristics such as
þ Public Health àCommunity Health
u Gender and Sexual Orientation

þ Chapter 1 - Public Health: The Population Health Approach u Race and Ethnicity

u Age and National Origin

Announcements: • Groups of people affiliated by a

common bond such as
Ø Read the article posted on blackboard for next class u Professional Interests NYC has 42 geographically
Ø Bring Research Activity Worksheet to class u Social Interests defined neighborhoods

Community Health Concerns 3

Three Tools of Community Health Practice 4

§ Those individuals who make up a community live in a somewhat
localized area under the same general regulations, norms, values, and
organizations
§ Community Health concentrates on three areas
• Health Promotion: Educational and social efforts designed to help
people take greater control of and improve their health
u Such as hand-washing, immunization, circumcision, condom use
• Health Protection: Laws, rules, or policies approved in a
community as a result of health promotion or legislation
u Such as minimum age to drive, buy tobacco or alcohol
u Safe Water, Sanitation, Speed Limits
• Health Services: Governmental (DOH), quasi-governmental (Red
Cross), & non-governmental organizations (March of Dimes) that
provide services to the community
u Vaccination programs, blood drives, food banks
§ Epidemiology: the study of the distribution and determinants of
diseases and injuries in human populations
• Data are recorded as number of cases or as rates (number per 1000 or
percentage)
• Sometimes been referred to as population medicine
§ Community Organizing: bringing people together to combat shared
problems and increase their say about decisions that affect their lives
• Communities may organize around a common concern such as
violence in a neighborhood
§ Health Education: Involves health promotion and disease prevention
(HP/DP) programming for the purpose of improving or maintaining the
health of a community or population
• A smoking cessation program for a company's employees
• A stress management class for church members
• A community-wide safety belt campaign

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Public Health Defined
§ What do we mean by Public Health?
• Groups who are vulnerable to poor health are typical focus
• The concerns for the society as a whole
§ Early Definition: Public Health is the science and art of preventing
disease, prolonging life and promoting health through organized
community effort
§ Later Definition: Public Health is the organized community effort
aimed at the prevention of disease and the promotion of health
§ The 21 st Century definition: The totality of all
evidence based public and private efforts that
preserve and promote health and prevent
disease, disability and death
• This “big picture” thinking in the 21 st
century is sometimes called the Population
Health Approach
Eras of Public Health:
Health Protection (Antiquity - 1830s)
§ Throughout human history there have been evolving and expanding
approaches to public health
§ Organized community efforts to promote health and prevent disease
have existed since ancient times
§ In ancient times, individual and community health behaviors were
controlled by authorities, political (e.g., tribal leaders, chieftains) and
religious rulers
§ Cultural practices and religious doctrine prohibited some behaviors and
promoted others
• Quarantine for epidemics: isolate the sick from the healthy or the
healthy from the sick
• Sexual prohibitions to reduce disease transmission such as abstinence
before marriage, monogamy, circumcision
• Dietary restrictions to reduce food-borne disease based on past
illnesses from eating foods such as pork, beef or shellfish
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21st Century Public Health Concepts 6
§ Prolonging life and improving quality of life
§ Protection of health and promotion of health
§ New technologies: New ways to communicate create new communities
§ Evidence-based Practice: options for intervention as well as increasing
awareness of potential harms and costs
§ Public-Private Partnerships: collaborations between government
agencies and private groups are increasingly more common
§ Multiple problems require multiple solutions: complex health problems
are part of larger health and social systems
§ Social Determinants: environmental, social & economic factors that
impact health
§ The Structure and Function of the Healthcare Delivery System
§ Public Policies: Can effect health even when health is not the focus of
the policies
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Health Protection (Antiquity - 1830s) 8
§ With advances in human knowledge, science began to play a role in the
protection of human health
§ During the 18 th and 19 th centuries, some individuals did discover
important findings in disease prevention
• 1740s: James Lind discovers eating citrus
fruits prevent and treats scurvy (Vitamin C
deficiency)
• 1796: Edward Jenner created first “vaccine”
u He noticed that milkmaids did not get
smallpox he got the idea that regular
exposure to cowpox must provide immunity
u He exposed his son others to cowpox fluids
u Vaccine come from the Latin work for cows,
vacs!
u Science would not be able to explain how vaccines work for
another 40 years!
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Hygiene movement (1840 - 1870s) 9 Hygiene movement (1840 - 1870s) 10

§ Started in Europe where it was noticed that social conditions of § 1854: John Snow, the “father of epidemiology” used statistics to show
inequality create health disparities, e.g., the poor are less healthy that water from the Broad St. Pump was the source of the Cholera
• Led to the social justice movement which continues to this day epidemic…he removed handle, epidemic ended
§ Environmental action on a community-wide basis separate from
personal healthcare
§ Sanitary conditions become the basis for improving health
§ 1847: Ignaz Semmelweis the founder of infection control
• Called the “savior of mothers” for promoting
hand washing before delivering a baby
u Prevented infection as many women died
form puerperal (childbirth) fever
• He was ridiculed, went insane and died from an
infection in an asylum in 1865
§ Collection of vital statistics became the empirical
• It was 40 years later that germs were proven to foundation for Public Health and Epidemiology
exist by the work of Louis Pasteur and Robert
Koch § 1872: American Public Health Association founded

Contagion control (1880 - 1940s) 11

Contagion control (1880 - 1940s) 12

§ During this time American doctors and public health leaders often went § Linkage of epidemiology, bacteriology, and immunology to form TB
to Europe to for training and to learn new medical techniques Sanatoriums
§ 1860: Louis Pasteur promotes germ theory of disease § Communicable disease control practices at this time:
• Pasteurization: Heating milk & wine prevents illness • Investigating outbreaks in the general population
• Opens the Pasteur Institute in 1888. • Vaccination (smallpox, tetanus, and diphtheria)
§ Before germ theory… • Environmental control
• Miasma theory: “bad air,” associated with foul smells • Sanatoriums
u Miasma was considered to be a poisonous vapor or mist filled with The Riverside Hospital
particles from decomposed matter (miasmata) that caused illnesses. was opened as a
u People wore bird-like masks that was filled with flowers and other quarantine facility in
good smelling things and carried pocket’s full of posies 1885 on North Brother
• Spontaneous generation: “things just happen” emerged in ancient Island, located between
Greece Riker’s Island and the
u later adopted by Christians because it explained the creation of the Bronx on the East River
world and life (“an act of God”)

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Medical Care System (1950s - mid-1980s) 13

Medical Care system (1950s - mid-1980s) 14

§ The Centers for Disease Control became firmly establish in the 1950s § Modification of risk factors becomes a
to coordinate national efforts to combat communicable diseases new method to improve health
• Public system for care of and control of specific infectious • Surgeon General reports on the
§ Diseases and vulnerable populations distinct from general health care dangers cigarette smoking (1964)
system; care of high-risk populations as part of medical care
• Framingham Heart Study begins
§ 1965: Medicaid (low following people throughout their
income) & Medicare lives to identify risks for
(for the elderly) cardiovascular disease
§ Community Health u Study is still ongoing!
Centers established as
an outgrowth of the
§ Integrated health maintenance
organizations with integration of
social justice
preventive services into general health
movement
care system
§ Development of
Evidence Based Public § Antibiotics become regularly used
Health and Evidence § Scientists use randomized clinical trials
Based Medicine to study health and disease

Health Promotion Disease Prevention (Mid- 15

Population Health (21st century) 16

1980s - 2000) § Global and Science based perspectives

§ Environmental Health: reduce pollution to impact rates of lung disease § Evidence Based Medicine and Public Health
and asthma • focus on harms and costs as well as benefits of interventions
§ Focus on individual behavior and disease detection in vulnerable and
the general populations § Coordination of Public Health and Health Care Delivery
• Pap Smears • Based upon shared evidence-based systems thinking
• Mammography • Evidence-based recommendations & information management
• Coronary Artery Disease • Information technology & reducing medical errors
• Blood Pressure & Cholesterol screening § Globalization
• Newborns screened for disease & genetic abnormalities • The role of trade, e.g., importing contaminated toys and foods
§ Clinical and population oriented prevention with focus on individual § Global Collaboration, e.g., SARS, HIV/AIDS
control of decision making and multiple interventions
• Smoking § Antibiotic resistance
• Obesity § Bioterrorism
• Coronary Heart Disease § Tobacco control
• AIDS epidemic and need for multiple interventions to reduce risk § Climate change

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Population Health 17
Population Health 18

§ Public Health addresses society wide concerns focused on everyone

and while also focusing on the needs of vulnerable populations
§ Population Health: differs from community health only in the scope of
people it might address
• People who are not organized or have no identity as a group or
locality may constitute a population, but not necessarily a community
§ Defined as all the ways that society as a whole or communities within § Improving the Average approach
society are affected by health issues & their response to these issues • Reducing the risk for everyone
• Population health is about healthy people and healthy populations u Speed limits
§ Full range of strategies designed to protect health, and prevent disease, u Trans fat ban in NYC
disability, and death, such as:
u Smoking restrictions
• Preventive efforts, e.g., nutrition and vaccination
• Curative Efforts, e.g., antibiotics and tumor removal surgery
• Preventing Complications & Restoring function, e.g., follow up care,
physical therapy

Vulnerable Groups 19
Population Health Approaches 20

§ Vulnerable Groups: High Risk approach § Health Care: Systems for delivering one-on-one individual health
services including those aimed at prevention, cure, palliation, and
• Focus on the those who are most likely to develop a disease rehabilitation
• Concentrate on those with § Traditional Public Health: Group and community based interventions
known risk factors for directed at health promotion and disease prevention
prevention, screening and
treatment § Social Policy: Interventions with another non-health related purpose,
which have secondary impacts on health
u Exposure to pollutants
(The Bronx) § Contributory Causes: Things that may cause disease
u High rates of STD/HIV • Smoking à Cancer
within pool of potential • HIV à AIDS
partners, e.g., gay men, • Asbestos à Mesothelioma
people of color
§ Determinants: underlying factors that ultimately bring about disease
u Poor food choice options
that lead to obesity (Upper • These factors may exist years before a disease develops
Manhattan, the Bronx, • There is no official or agreed upon list of determinants of disease,
central and far Brooklyn) however there is wide agreement about some of the factors

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Determinants of Disease: BIG GEMS 21

Population Changes & Health 22

§ BEHAVIOR: Actions related to health

• Smoking, diet, exercise, drug & alcohol use, unprotected sex § Three major past trends of the 20 th century
have implications for the 21 st century
§ I NFECTIONS: Exposure to pathogens
• Some cancers are now known to be caused by infection (HPV) § Demographic Transition (population
expansion)
• Ulcers caused by infection with Helicobacter pylori
§ GENETICS: Inheritable conditions • Falling childhood death rates à a larger
population
• Rarely the sole cause of disease
§ GEOGRAPHY: Location • Longer life spans; people are living longer
• Some diseases spread within specific locations (e.g., Malaria) • Plus rising birth rates can cause
§ ENVIRONMENT: The physical surroundings populations to expand over time
• Air quality, mold, roach infestation can increase risk of asthma
§ MEDICAL CARE: Access and quality of care
• Vaccinations, insurance, availability of well trained professionals
§ SOCIAL-ECONOMIC- CULTU RAL: The social environment
• Income and Education impact health
• Religion and culture influence decisions about health

Population Changes & Health 23

Next Class 24

§ Epidemiologic Transition § Read Chapter 2

(or Public Health Transition)
• As social and economic § Read article on Blackboard
developments occur, different
types of diseases become
• Schlecht, N., et al. (2013). Burden of cervical, anal, and
predominant oral HPV in an inner-city pre-vaccine adolescent
population. Journal of Urban Health: Bulletin of the New
u In less developed countries: York Academy of Medicine, 90, 141-146.
communicable disease
u In developed countries: § Bring “Report Activity – Stage I” worksheet to class
non communicable diseases • Completing worksheet during class is worth 5 points of
§ Nutritional Transition (food availability) final report grade
• Consequences of under and over nutrition
u Poorly balanced diets in poor countries
u Diets high in fat, sugar and salt in developed countries