MPH

• 1. Monitor health status.
• 2. Diagnose and Investigate health problems.
• 3. Inform, educate, and empower people about health issues
• 4. Mobilize community partnerships
• 5. Develop policies and plans that support individuals/communities
• 6. Enforce laws and regulations that protect health
• 7. Link people in need of services and assure the provision of care
• 8. Assure competent healthcare workforce
• 9. Evaluate effectiveness, accessibility, and quality
• 10. Research new insights into health problems.

• 1. Individual
• 2. Social Network (family, friends, etc.)
• 3. Institution (school, workplace)
• 4. Community (local government and agencies)
• 5. Society (policy, culture, environment, engineering and policy reform)

• Mission of public health: The fulfillment of society’s interest in assuring the conditions in
• which people can be healthy
• Substance of public health: Organized community efforts aimed at the Prevention of Disease and
• Promotion of Health. It links many disciplines and rests upon the science
• of epidemiology.
• Organizational Framework: Both activities undertaken within the
• formal structure of government and the associated efforts of private and
• voluntary organizations and individuals.

• mostly under the state or local control
• 10th amendment: the federal government has control over all powers not previously given to the federal government
• Commerce Clause: the federal government has the right to regulate commerce, and thus it can be involved in public health issues
• Power of the Purse: much of public health is funded by federal money so they have control over it

• Health and Human Services (HHS): includes CDC, FDA, Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMSHA)
• Research: NIH, Agency for Healthcare Research and Quality (AHRQ)
• Data Collection: National Healthcare Surveys (NHCS) and Behavioral Risk Factor Surveillance System (BRFSS)

assessment, policy development and assurance

• The age of Epidemics
• intervention: quarantine
• causes: industrialization and urbanization; over-crowding of living spaces; lack of sewer system
• endemic diseases: malaria, TB, MMR, pneumonia, flu,
• epidemic diseases: cholera, typhoid, salmonella
• NOTE: John Snow was the first epidemiologist in 1830 he determined that a cholera outbreak could be traced back to a specific water pump that was contaminated by a dirty diaper
• Late 19th century: Sanitation Movement (upper class and missionary led movement; disease control focused on "cleanliness and godliness"; London set up a board of health and a board of sanitation; focus on prevention)

• Luis Pasteur discovered bacteria
• increased diagnostic tests, identification of organisms, development of interventions (immunizations and water purification)
• led by scientists
• US Public Health Service established in 1912 and more power given to the surgeon general

• IOM definition: Extent to which health services
• increase the likelihood of desired health outcomes and are consistent with
• current professional knowledge (evidence based medicine)
• Rodman Definition: the right care to the right people at the right time and in the right setting

• get the data
• analyze the problem
• plan a solution
• do the solution
• check the progress and measure outcomes
• act acoordingly to modify the plan as needed

20% of the causes account for 80% of the problems

case that ruled that you cannot institutionalize a disabled person who is able to live in the community provided they have the proper support they need

• semi-private, mostly employer based insurance
• emplyees and their employers pay about half and half into non-profit "sickness funds"; the unemployed or disabled pay into the sickness funds via government subsidies
• 90% of people are covered by the sickness fund; wealthy and armed forces can opt out of it but cannot buy into it later
• after retirement, 60% of things are paid for by the sickness fund and the rest by the person's pension plan
• key points about service: GP's cannot work in hospital; hospital doctors are salaried; others paid eith global or FFS; PCPs are not gatekeepers

• single-payer, public, tax-financed system
• can purchade private insurance to cover the gaps in care but providers cannot bill private insurance companies for services covered by the public program
• GPs are gatekeepers
• most physicians get paid on a FFS basis while hospitals are paid global

• single-payer, public, tax-funded system
• ability to purchase private insurance that can be used for any services
• GPs are gatekeepers and paid for performance and via capacitance

• mostly employment-based social insurance
• there is a public option for those not offered insurance through their employers
• more decentralized and entrepenerial; many physicians run or own hospitals and clinics (usually small scale)
• government sets the pay scale and primary care is paid pretty high