Foundations of Public HealthPH-200 Fall 2009

Week 10

Integrating Diverse Foundations of Public Health Into Solutions and Sustainable Infrastructures

Outline• 9:30 AM – 9:45 AM : Questions and Review

• 9:45 AM – 11:00 AM : Integrating and Translating Theoretical Foundations of Public Health

• 11:00 AM – 11:15 AM : Recess

• 11:15 AM – 12:15 PM : Proposal Summaries– The Unfulfilled Promise of Public Health

• 12:15 PM – 12:30 PM : Summary

Pop-quiz• What is the relationship between “demographic

transition” and “epidemiologic transition?”

• Discuss notable exceptions to the traditional epidemiological transition model.

• Research challenges in public health are embedded in the gap between “what is” and “what ought to be.” But what “ought to be” is subject to a variety of ethical considerations. Discuss your understanding of public health ethics.

Integrative Models in Public Health

• Ecological Model: The health of populations and individuals is influenced by the interaction of biological, environmental, and behavioral factors. The Institute of Medicine recommends the use of the ecological model as the basis for public health education and interventions (IoM, 2003).

• Some Schools of Public Health, such as the University of California at Berkeley (UC Berkeley), are using this model as the basis for teaching, research, and community interventions to improve health. The model is the cornerstone of Berkeley’s recently developed strategic plan, along with a commitment to associated interdisciplinary action and social justice to improve public health.

Ecological Model (UC Berkeley)

BiologyBiology

EnvironmentBehaviorBehavior

Goal: Improve Human Health

Ecological Perspective

Movement from Publication to Public Action

Diversity,Human Rights,Social Justice

Interdisciplinary Approach

Interdisciplinary Approach

Healthy People 2010

• Healthy People 2010: Established a national goal of eliminating health disparities by 2010. It recommends that organizations and communities design, implement, and evaluate interventions using a framework that incorporates elements of the ecological model and also includes policy and health care factors.

Healthy People 2010 Model

Policies and InterventionsPolicies and

Interventions

Determinants of Health

Behavior

Individual

Biology

Physical Environment

Social Environment

Access to Quality Health Care

Access to Quality Health Care

Hierarchical Models: How useful are they?

For research? For practice? For education?

Life course

Health and DevelopmentHealth and

Development

Pathological Biomarkers

GeneticsHuman Biology

SocioeconomicPsychosocial -

Behavioral

Organizational Connections

(Communities)

Social and Economic PoliciesCulture

Promote children’s optimal development and readiness to learn, so that they may reach their fullest

potential

Improved child health & physical well-being

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Sample Program Logic Model

Program and System Supports

Developing & implementin

g service coordination

policies, protocols

For all children to be healthy, safe, and secure within strong families

and communities

Pregnancy, Birth, and Infancy --- Parenting & Family Support

Increased accessibility of pregnancy &

child development intervention

programming

Improved school

readiness

Increased child

prosocial behaviour

s

Increased coordination & integration of

services in community

Increased entry into

appropriate supports & services

Creating, disseminatin

g child development

resource materials

Developing networks of

service providers

Training of, consulting

with, service

providers

Increased service provider

knowledge of pregnancy &

child development supports &

services/gaps

Increased service

provider, parent, &

community awareness of

the importance of the early

years

Increased parent &

community awareness of pregnancy &

child development

services

Promotional advocacy

campaigns

Ongoing parental

awareness media

campaigns

Organizing community

events

Improved knowledge of

supports & services for

healthy pregnancy & infant/child

development

Providing

referral info & hotline

Increased use of other supports &

services

Improved parenting

knowledge and practices (pre-

& postnatal care, nutrition,

child development,

parenting skills, health/safety)

Increased service provider

collaboration

Increased general

awareness of the

importance of parenting

Increased commitment,

support, programming

for EY services

Increased community

participation in EY &

prevention activities

Improved identification

of at-risk parents,

infants and children (PPD,

P4, developmental delay, etc).

Improved maternal

health

Improved infant

health & well-being

Promote Healthy Pregnancy & the Birth of Healthy Babies

Provide small

learning groups for children

Providing parent

education & training

Providing professionally led support

groups for parents

Providing child

screening &

assessment

Providing counselin

g to parents

Providing

personal, practical support

to parents

Evaluating provincial

NP services &

community impact

Increased capacity to

assess program

planning & effectivenes

s

Enhancing & expanding

core programmin

g

Increased SP knowledge &

skills of pregnancy &

child development

best practices & interventions

Increased child

stimulation &

interaction

Early Childhood Development,

Learning & Care

Providing parent

screening &

assessment

Link to Map

Increased feelings of family &

social support

Increased parenting capacity

Improved emotional

functioning & well being of

children

• “Ecological” Model : Patz et al. Environmental Health Perspectives Volume 112, Number 10, July 2004

Course Summary– OBJECTIVES:

– The graduate “foundations” course is designed for incoming graduate students in professional public health degrees, taking into consideration diverse academic backgrounds and skills.

– The course provides an opportunity for students to investigate the fundamental determinants and the complex set of intermediate factors that underpin health and disease status in different populations at various scales of analysis.

– After completing the course, students should be knowledgeable about the diversity of conceptual and methodological approaches and academic disciplines which inform public health research and practice.

– The course content highlights core competencies and cross cutting themes ‐essential for successful public health intervention programs

Course Organization– During the first segment, students are introduced to how public

health is practiced at the international, nation, regional, and local levels, with presentations drawing from “Milestones in Public Health” a project that highlights historical developments on 10 major causes of morbidity and mortality in human populations (http://www.pfizerpublichealth.com/podcasts.aspx) .

– Each student is expected to build on these presentations to develop a scholarly review of current burden of disease at the regional or global level, using concrete examples of how public health core disciplines and cross cutting themes are made to work for identifying and solving ‐problems at those scales of analyses.

– For this review, students are expected to consult, for example, the World Health Organization’s project on the Global Burden of Disease (http://www.who.int/topics/global_burden_of_disease/en/).

Organization..continued• The second requirement is for each student to develop a public health

problem solving proposal that builds upon our exploration of the ‐theoretical foundations necessitating transdisciplinary approaches in the natural and social sciences and administrative functions in public health.

• These theoretical linkages, following exposure to how public health practice is organized in the world, will hopefully prepare students to explore more deeply within the curriculum organized around the core disciplines of biostatistics, epidemiology, environmental health sciences, social and behavioral sciences, and health policy and management.

• The final examination will be based on lecture materials.

Schedule of Topics• Week 1 – Introduction and orientation to the core and cross-cutting,

interdisciplinary approaches in public health.

• Milestone: Eradication of Smallpox

Week 2• The real causes of death and disability: The “Global Burden of Disease”

project.• Essential Resource: World Health Organization’s (

http://www.who.int/topics/global_burden_of_disease/en/)

• Milestone: Automotive Safety

Week 3 (Public Health and Law Symposium)

• Integrative public health research and practice at the national level– Centers for Disease Control and Prevention– Essential Resource: (http://www.cdc.gov/)

• Milestone: Environmental Health

Week 4• Integrative public health research and practice at the regional level

– California Department of Health Services – Essential Resource:(http://www.dhs.ca.gov/)

• Milestone: Infectious Disease Control

Week 5• Integrative public health research and practice at the local level.

– Essential Resource; Orange County Health Care Agency (http://www.ochealthinfo.com/)

• Milestone: Cancer

Week 6

• Week 6 – Scholarly Review– Student Presentations

• Milestone: Cardiovascular Disease

Week 7• Theoretical foundations of the transdisciplinary approaches in public

health research and practice – The natural sciences.

• Milestone: Safer and Healthier Foods

Week 8• Theoretical foundations of the transdisciplinary approach in public

health research and practice – The social and behavioral sciences

• Milestone: Maternal and Child Health

Maternal Mortality

Old and New Challenges to M&C H• Since ~ 1982, U.S. Maternal Mortality has reached a

plateau at 7 – 8 maternal deaths per 100,000 live births.

• Twenty countries have reduced their maternal mortality rates below U.S. levels.

• Legalization of induced abortions led to 89% reduction in deaths from septic processes between 1950 and 1973.

• Insurance coverage of pre-natal care

Infant mortality

Per 1,000 live births

Infant Mortality Challenges• 100 years ago, 1/6 live births• Today, < 1/100 live births in the U.S.• Low birth-weight • Vaccination / Autism• Sudden Infant Death Syndrome (Ethnic disparities)• Chinese experience with one-child per family, and

gender selection.• Genetic Counseling• “Family Planning” and government support at the

global level.

Population-Level Intervention

• Multivitamins and birth defects • (Folic acid/Spinal bifida)

Recommended Daily Intake (Folic Acid)

Men Women

(19+) (19+) Pregnancy Breast feeding

400 µg 400 µg 600 µg 500 µg

1 µg of food folate = 0.6 µg folic acid from supplements and fortified foods

Week 10• Theoretical foundations of the transdisciplinary approach in public

health research and practice – Public health administration and intervention program implementation.

• Milestone: Oral Health

Cancrum oris (Noma)

Week 10• Discussion of Proposals. • Milestone: Addiction • Milestone: Public Health Infrastructure

Pop Quiz• What, in your opinion, are the grand challenges for

maternal and child health in the world today?

• Why is Dentistry a separate profession from Medicine? Is this a “good” or “bad” arrangement for public health?– Where do you stand on the issue of “mandatory” public water

fluoridation? Compare California and Michigan.– Where do you stand on the issue of dental mercury amalgams?

• Vancouver City established supervised injection sites (Insites) for drug addicts. Where do you stand on this policy?

Week 11

• Final Examination – Lecture contents– This room at 10:00 AM on December 11th.

Proposal Writing• Scholars Grants in Public Health

http://www.promisingminds.com/AwardDetails.aspx?ProgramID=204&PrevGrant=1

• Program Description – These awards are meant to support the career development of junior faculty in

public health. This educational grants is nationally competitive, and chosen by an independent Academic Advisory Board of recognized leaders in public health.

– Up to $130,000, paid over two years, will be awarded to individuals who are pursuing community-based, public health practice research intended to foster academic science and knowledge of public health, and collaborative partnerships between accredited schools or programs of public health and state and local departments of public health. The proposed research should support the needs of a state or local public health organization. The research should focus on public health practice issues likely to have a demonstrable impact on community health and/or the public health system.

– Award funding is primarily intended for salary support. The applicant must demonstrate that at least 75% of his or her professional time will be devoted to research. Proposals involving head-to-head clinical trials or veterinary health will not be considered. Interdisciplinary and translational research proposals are encouraged.

Research Proposals

• Due in the DropBox, Friday 11th December 2009

Grading Criteria

– Topical Review Article (4000 words) = 40% • (and exercises)

– Proposal Development = 40% • (and exercises)

– Final Examination = 20%

Proposal Idea PresentationsStudent# Name Email Major35927958 ARJIAN, ARDA M. AARJIAN@UCI.EDU PUBHLTH40528603 BAILEY, MORGAN MICHAEL MBAILEY@UCI.EDU ENGRENV67003581 CARREON, DAISY CALPO CARREOND@UCI.EDU SOCIOL43842064 DIXIT, AMRUTA AMRUTAD@UCI.EDU PUBHLTH43848856 HAI, XIANGSHU XHAI@UCI.EDU PUBHLTH91176816 HAYASHI, HITOMI DOLLY HAYASHIH@UCI.EDU PUBHLTH

23492990 HAYASHI, TOMOMI SAMANTHA THAYASHI@UCI.EDU PUBHLTH

79844927 HEINZ, THOMAS RANDAL THEINZ@UCI.EDU PUBHLTH94921771 HINGA, BRIANA MARIE BHINGA@UCI.EDU EDMAPHD94128406 HOANG, ERIC EHOANG1@UCI.EDU PUBHLTH78008353 JAAFARI, TAHEREH TJAAFARI@UCI.EDU P H POL75967473 JOO, HEE JIN HJJOO@UCI.EDU PUBHLTH54128979 NGUYEN, ANN M. ANNN@UCI.EDU PUBHLTH57081413 RAMDEO, RAJIV RRAMDEO@UCI.EDU PUBHLTH57289688 SHIAH, STEVEN SHIAHS@UCI.EDU PUBHLTH

49247240 SIMBULAN, MARIA STEPHANIE PONCE MSIMBULA@UCI.EDU PUBHLTH

63885204 TRUONG, KIMBERLY KAY KIMBERKT@UCI.EDU PUBHLTH70084376 VAISENBERG, LIAT LVAISENB@UCI.EDU PUBHLTH60329476 VU, JOHN THUAN DUY VUJ1@UCI.EDU PUBHLTH79223884 WANG, LAWRENCE CHRISTIE LAWRENCW@UCI.EDU PUBHLTH