Epidemiology: A Basic Public Health Science

Session 1, Part 1

E is for Epi Series Overview

• Designed for non-epidemiologists

• Provides introduction to:– History of epidemiology– Epidemiology specialties– Key terminology, measures, and resources

• Describes examples of epidemiology in public health practice

Learning ObjectivesSession 1, Part 1

• Define the 10 Essential Public Health Services

• Explain the science of epidemiology in the broader context of the ten Essential Public Health Services

OverviewSession 1, Part 1

• “Quiz”

• The 10 Public Health Essential Services

Quiz

Scenario

As you read the front page of the local paper, you notice an alarming article about an outbreak of “disease X” in your community. You read on to learn about the scientifically established cause of “disease X,” and precautionary measures for avoiding exposure.

 

Question 1

This valuable information was published as a front-page story because:

a. The local football team lost its game last nightb. The front-page columnist is on vacationc. State and local health officials and their staff

have worked for weeks to gather data, conduct laboratory and statistical tests, generate hypotheses, and collaborate with the media to alert and educate the public about “disease X” as effectively as possible

Question 1

This valuable information was published as a front-page story because:

a. The local football team lost its game last nightb. The front-page columnist is on vacationc. State and local health officials and their staff

have worked for weeks to gather data, conduct laboratory and statistical tests, generate hypotheses, and collaborate with the media to alert and educate the public about “disease X” as effectively as possible

Scenario 2

On your way into the local grocery store, you notice a flyer advertising a toll-free hotline number for enrolling uninsured children in a federally funded health insurance program.

 

Question 2This insurance program is being offered because:

a. The federal government has a budget surplus and is looking for a way to spend it

b. A telephone company offered the state health department a great deal on 1-800 numbers

c. Public health professionals have documented the numbers of uninsured children in their states, and worked with federal and state policy makers to institute outreach and “wrap around services” that assure the universal provision of health care

Question 2This insurance program is being offered because:

a. The federal government has a budget surplus and is looking for a way to spend it

b. A telephone company offered the state health department a great deal on 1-800 numbers

c. Public health professionals have documented the numbers of uninsured children in their states, and worked with federal and state policy makers to institute outreach and “wrap around services” that assure the universal provision of health care

Scenario 3

You and your sweetheart share a romantic dinner at your favorite restaurant. Not only is the meal delicious – you do not get food poisoning!

Question 3

This enjoyable experience has been brought to you by:

a. The restaurant management

b. Your local health department

c. A joint effort of the restaurant management and your local health department

Quiz #3: Question

This enjoyable experience has been brought to you by:

a. The restaurant management

b. Your local health department

c. A joint effort of the restaurant management and your local health department

10 Essential Public Health Services

Comparison of Services

Public Health Model Medical ModelPrimary focus on population Primary focus on the individual

Public service ethic, tempered by concerns for the individual

Personal service ethic, conditioned by awareness of social responsibilities

Emphasis on community prevention and health promotion

Emphasis on patient diagnosis, treatment, and care

Interventions for the environment, human behavior and lifestyles, and medical care

Interventions are medical care

Public Health Mission:

“To promote physical and mental health, and prevent disease,

injury, and disability”

1990 1991 1992 1993 19941988 1989

Consensus statement defines a detailed model of core public health functions

Federal health care system reform

“Core Functions” of Public Health• Assessment• Policy development• Assurance

Origin and Purpose

Core Public Health Functions and Essential Services

CDC, 2010

#1: Monitor health status to identify and solve community health problems

• Identification of health risks and determination of health service needs

• Utilization of technology to interpret and communicate health information to diverse audiences

• Attention to the vital statistics and health status of specific groups that are at higher risk

• Collaboration in integrating and managing public health information systems

#2: Diagnose and investigate health problems and health hazards in the community

• Epidemiological identification of outbreaks, patterns of infectious and chronic diseases and injuries

• Public health laboratory capability using modern technology to conduct rapid screening and high volume testing

• Infectious disease epidemiology programs

• Technical capacity for investigation of disease outbreaks and assessing patterns of chronic disease and injury

#3: Inform, educate, and empower people about health issues

• Health information, health education, and health promotion activities

• Health communication plans and activities such as media advocacy and social marketing

• Accessible health information and educational resources

• Health education and promotion program partnerships

#4: Mobilize community partnerships and action to identify and solve health problems

• Partnerships among community groups and associations to undertake preventive, screening, rehabilitation, and support programs

• Coalitions to draw upon the full range of potential human and material resources in the cause of community health

#5: Develop policies and plans that support individual and community health efforts

• Systematic community-level and state-level planning

• Development and tracking of measurable health objectives

• Establishing strategies and actions to guide community health improvement

• Development of legislation, codes, regulations, ordinances, and other policies to enable performance of the Essential Public Health Services

#6: Enforce laws and regulations that protect health and ensure safety

• Enforcement activities in areas of public health concern– Protection of drinking water and enforcement of clean air

standards

– Re-inspection of workplaces following safety violations

– Enforcement of laws governing the sale of alcohol and tobacco to minors

– Seat belt and child safety seat usage

– Childhood immunizations

#7: Link people to needed personal health services and assure the provision of health care when otherwise unavailable

• Identifying populations with barriers to personal health services

• Identifying personal health service needs of populations with limited access

• Assuring the linkage of people to appropriate personal health services through– Coordination of provider services– Development of interventions that address barriers to

care (e.g. language)

#8: Assure a competent public and personal health care workforce

• Education and training

• Credentialing technical and professional health personnel

• Adoption of continuous quality improvement and life-long learning programs

• Partnerships with professional workplace development programs

• Continuing education in management, cultural competence, and leadership development programs

#9: Evaluate effectiveness, accessibility, and quality of personal and population-based health services

• Evaluation and critical review of health programs – based on analyses of health status and

service utilization data– to determine program effectiveness– to provide information for allocating resources

and reshaping programs

#10: Research for new insights and innovative solutions to health problems

• Link with institutions of higher learning and research

• Mount timely epidemiological and economic analyses

• Conduct needed health services research – Survey design; conducting interviews and facilitating

focus groups– Conducting clinical trials– Accessing and using public records

Corresponding Services

Quiz Scenario Essential Service

Informing the public of an outbreak investigation in the community

#2: Diagnose and investigate health problems and hazards in the community

Promoting enrollment in a federally subsidized health insurance program

#7: Link people to needed personal health services and assure the provision of health care when otherwise unavailable

Maintenance of a sanitary restaurant environmental for public well-being

#6: Enforce laws and regulations that protect health and ensure safety

Summary

• Core Functions of public health are assessment, policy development, and assurance

• The 10 Essential Public Health Services create a “common ground” and a comprehensive infrastructure that provides a supportive context for any public health priority in a community

• Epidemiology is a quantitative tool that can be used to implement Essential Public Health services

References and Resources

• Gordis L. Epidemiology. 2nd ed. Philadelphia, Pa: WB Saunders Company; 2000.

• Hearne SA, Segal LM, Earls MJ, Unruh PJ. Ready or Not? Protecting the Public’s Health in the Age of Bioterrorism. Washington, DC: Trust for America’s Health; December 2004. Issue Report. Available at: http://healthyamericans.org/reports/bioterror04/BioTerror04Report.pdf. Accessed March 1, 2012.

• Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention 10 Essential Public Health Services [National Public Health Performance Standards Program Web site]. December 9, 2010. Available at: http://www.cdc.gov/nphpsp/essentialservices.html. Accessed March 1, 2012.

• Kipp A. Overview of Epidemiology in Public Health [online training]. North Carolina Center for Public Health Preparedness, University of North Carolina at Chapel Hill School of Public Health; 2004. NCCPHP Training Web Site.