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Public Health:
•  Deals with the health of populations in terms of disease causation, disease investigation and surveillance.
•  Focuses on the prevention and control of disease and disability, health promotion, health protection, and health maintenance in populations.
•  Addresses community health/social problems.
•  Is based on a broad range of many professional disciplines including:

  1. Basic Sciences-- Deal with experimental medicine. Deals with animal research on disease models either observed or experimentally produced in lab. e.g. Chemistry, Physics, Biology (Molecular Biology), Anatomy, Physiology, Biochemistry, Genetics, Ecology, Bacteriology, Genetics, Microbiology, Statistics, Embryology, Entomology, etc.
  2. Clinical Sciences/Medicine-- The focus is on sick individuals. Deals with clinical studies on disease process at the bedside or pathological samples. This can occur in hospitals, emergency rooms, ambulatory care, doctors' offices, etc.
    e.g. Radiology, Virology, Immunology, Pathology, Obstetrics, and Gynecology, Urology, Neonatology, etc.
    Patient- Nurse- Doctor relationships
  3. Population/Community Medicine-- Focus on People (human population)
    Epidemiology is the Tool. This is the study of health and disease in human population. Focus is on populations/Community not individual patients. It deals with Health Maintenance through disease prevention, health promotion and protection.
    e. g. Demography, Ecology, Sociology, and other Social/Behavioral Sciences.

Public Health assists in:
•  Defining the health/social problems of a community.
•  Identifying risk factors associated with problems.
•  Developing and testing community-level interventions to control or prevent the cause of the problems.
•  Implementing interventions to improve the health of the population.
•  Monitoring the interventions to assess their effectiveness.

The core missions of Public Health:
•  Monitoring the occurrence and spread of disease/injury in populations
•  Immunization
•  Infant health
•  Infectious disease control
•  Health Education and Promotion
•  Health Protection—Sanitation of the environment

The core functions of Public Health involve:
Assessment- This is a diagnostic function in which a public health agency collects, assembles, analyzes, and makes available information on the health of the population e.g. a bioterrorist attack/threat, an outbreak of an emerging disease, factors that influence health status, etc.(Allied Health Professionals are involved in the assessment)
Policy development- Is the use of scientific knowledge to devise a strategic approach to improving the public's health (Allied Health involvement)
Assurance- It deals with the provision and accessibility of educational, environmental, basic medical and essential services needed to protect the public's health. (Allied Health Professionals are involved in this process)

Public health Professionals:
•  Protect the health of the community.
•  Investigate health/health-related problems (e.g. bioterrorism) and provide guidance to individual doctors and other health care providers in their community.
•  Work with schools, industry, and the general public to protect the community.
•  Assure that families are safe from epidemics and other threats to their health.
•  Assure that vaccines and antibiotics are available to the whole community and can be administered and/or distributed as necessary to protect the public's health.

Communicable/Infectious Disease Causation:
The chain of infection in communicable/infectious disease causation involves six intertwined factors- Pathogen (germ/agent), reservoir, portal of exit, mode of transmission, portal of entry, and a new host.

A causative agent (pathogen) : A living organism (biological agent) must exist (pathogen) that is capable of invading the body and causing disease/injury. Allied Health Professionals are involved in the identification of the agent.

A reservoir (habitat) : The pathogen must have a place to live and multiply until it is passed on to a host, such as a human being.

A means of escape: The pathogen must have a means of escape from the reservoir (Portal of exit).

A means of transmission: The pathogen must have a means of contacting a host (Direct contact, Indirect contact).

A means of entry: The pathogen must have a way to enter the host (Portal of entry).

A new host that is susceptible to the pathogen: The host must receive the pathogen. Disease established in a new host. Strong body defenses or Immunity can fight off the pathogen before the disease occurs. Immunity can be natural, acquired, passive or active.

Chain of Infection (Communicable/Infectious Disease Cycle)



NOTE: Breaking the chain at any point leads to control of the disease/injury. Speculate what roles Allied Health Professionals could play in the control/preventive measures of breaking the chain.

Public health prevention programs function through interventions designed to interrupt the chain of infection that leads to an illness or injury.

Preventive measures can be applied at three levels:
Primary Prevention- Is the inhibition of the development of a disease/injury before it occurs. It is the reduction of incidence by lowering the number of new cases of disease/injury occurrence.
Secondary Prevention- Aims at early detection, early diagnosis, screening and treatment. Such preventive measure minimizes the damage caused by the illness or injury-causing event.
Tertiary Prevention- Involves the minimization of any ensuing disability by providing medical care, rehabilitation and adequate training. Physical therapists, psychologists, communication disorder specialists, etc will be involved.

Note: Allied Health professionals play key roles in the 3 levels of prevention

Surveillance:
Public health deals with disease detection, prevention and surveillance
Surveillance is the constant tracking/monitoring of health and health-related conditions that affect human populations
Surveillance involves:

• What to monitor/track? E.g. bioterrorism threats
• What to be alert to? E.g. bioterrorism threats
• Who to call when the community is concerned about a threat/outbreak? —Needs teamwork for coordination.
• Data collection and record-keeping process to track the emergence and spread of disease-causing organisms such as the agents involve in bioterrorism and also antibiotic-resistant bacteria.

In disease detection and surveillance, there is need to:
•  Rapidly detect disease outbreak, biological attack etc in case of person-to-person transmission (direct contact). (Allied Health involvement).
•  Set up high-speed surveillance system that connects hospitals, emergency rooms, laboratories, and public health departments (Allied Health involvement).
•  Establish a standard protocol for specimen collection- (Allied Health function).
•  Educate front-line health care providers so that whoever sees the first patient or wave of patients can reorganize an attack early and sound the alarm.
•  Develop a sustainable, standardized information-gathering database, which is shared among laboratories- (Allied Health involvement) and CDC.
•  Develop consistency among different agencies with regards to environmental sampling, develop standardized sampling protocols- (Allied Health involvement).
•  Develop a protocol for processing and transporting clinical aerosol samples to laboratories where they can be examined- (Allied Health involvement).

Public Health, Bioterriorism, & Roles of Allied Health Professionals

•  Identification of bioterrorism agents (BNICE).
•  Disease surveillance.
•  Response to threats/attacks-Planning and management of intervention.
•  The 3 E's of Safety: Education, Enforcement of Public Health Laws, and Engineering- (design of new equipment, protocol) etc.
•  Education of the public: How to use protective equipments etc?
•  Risk assessment of bioterrorism threats/attack.
•  Capacity building in preventing and responding to bioterrorism.
•  Communicating effective response.
•  Collaborating/cooperating with the public health infrastructure, law enforcement and safety agencies, and medical facilities- (Team work).
•  Recognizing the basic signs and symptoms of the outbreak/disease state.

References:
The Future of the Public's Health in the 21 st Century. Institute of Medicine Report, National Academy Press. Washington , D.C. 2003

Schneider Mary-Jane. (2000) Introduction to Public Health. Aspen Publication, Gaithersburg , MD

Institute of Medicine , Committee for the Study of the Future of Public Health, The Future of Public Health. Washington, D.C. National Academy Press, 1988

U.S. Public Health Service, For a Healthy Nation: Returns on Investment in Public Health. Washington , D.C. U.S. Govt. Printing Office, 1994