Introduction
Good morning, ladies and gentlemen. As members of the New York State Board of Health, it is highly essential that you be adequately knowledgeable about public health and its policies. The purpose of this presentation is to provide board members with basic information regarding public health and its policies, New York State Department of Health (NYS DOH), as well as some insight on genetics, epidemiology, and some diseases as it relates to New York State (NYS) public health. Firstly, I will broadly discuss public health, including important historical figures and achievements, public health organizations and workforce, and public health laws of NYS. Furthermore, I will give a brief overview on the integration of genetic information with public health and its importance, epidemiology, infectious disease, chronic disease, and public health challenges faced by NYS. Finally, I will summarize the content of this presentation. I as well, intend to reserve some time to entertain questions from board members.
Public Health
Public health can be described as the science and art of promoting healthy living, sustaining life, and preventing disease via coordinated attempts and informed selections of institutions, societies, individuals, public and private sectors (Amory, 2001). It deals with health menaces based on the analysis of communal health. Public health comprises of interdisciplinary concepts of health services, epidemiology and biostatistics services; also, occupational health, environmental health, behavioral health and public policy, as well as other relevant fields (Amory, 2001). Public health aims at preventing and managing disease and other health challenges by encouraging healthy behaviors and case surveillance. It also performs key roles in the control of diseases through non-governmental organizations and local health agencies.
Public health focuses on improving life quality and health, by treating and preventing disease and addressing other health challenges which maybe physical or mental, encouraging healthy behaviors and case surveillance. Examples of major public health measures include encouraging breastfeeding, clean environment and hand washing, provision of condoms to check the spread of STDs, and availability of vaccines (Amory, 2001).
In the 20th century, public health began to pay greater attention to chronic diseases, as a dramatic drop was experienced in the spread of infectious diseases. Earlier attempts in numerous developed countries resulted in a striking decrease in infant mortality rate when preventive measures were used. In the United States, for instance, a public health official initiated several programs to assist poor citizens in NYS, maintaining the health of their infant, enlightening women on basic healthy behaviors, and reaching crowded localities in Hell’s Kitchen through teams of nurses (New York State Public Health Council [NYSPHC], 2003).
In the 20th and early 21st century, the rise in average life span is an achievement of public health. In achieving this, public health established vaccination programs to control infectious diseases such as smallpox, polio and yellow fever; put up effective health; as well as safety policies such as occupational safety, enhance family planning, initiate measures to control tobacco consumption; and programs to reduce non-communicable diseases by addressing known risk factors (NYSPHC, 2003).
These achievements of public health in the 20th and early 21st century have impacted NYS greatly, as the state has experienced a dramatic reduction in infant mortality and an increase in average life span. Also, programs to benefit NYS citizens of low income, improve vaccination, control the spread of infectious diseases, encourage healthy behaviors, and maintain healthy living, were established.
Public Health Organization
The United States constitution defines a federalism system that puts into the states, the power to dictate what duties they hold and what duties are assigned to the local government level within the public health (Department of Health [DOH], 2004). The Institute of Medicine (2002) has pointed out that there is no consistent organizational authorization or plan regarding the way public health services are rendered by NYS. NYS public health system encompasses state and local government agencies, public and private agencies, as well as health care providers and insurers.
The local government obtains their authority, as well as resources from the state government. NYS DOH, 77 district health departments and Mental Health are basically responsible for the provision of services of public health at local levels. Among the twenty-six states in the U.S. characterized by the decentralized provision of public health service, NYS is one (DOH, 2004). Also, public health departments function under Local Government administrative authority. NYS public health ordinances require that a Commissioner of Health head counties with a population of over 250,000 people (DOH, 2004).
Health departments at state and local levels organize programs and services to promote health in their respective localities. Each and every local health department provide key public health services that perform certain functions such as evaluating community health, providing family health services and health education, control and preventing diseases. In addition to the aforementioned services provided by states and local health departments, several other services are rendered. For example, forty-seven local health departments in NYS run health agencies that are certified, fifty-three direct Early Intervention Program, thirty-two run well infant clinics, thirty run inclusive treatment and diagnostic clinics, and 10 supervise public health laboratories (DOH, 2004).
NYS Public Health Workforce
The public health workforce can be described as those people who are responsible for rendering basic public health services, irrespective of the body they function under, and are competent to carry out functions of public health, as well as ensure the delivery of these basic services (NYSPHC, 2003). The public health workforce in NYS and states throughout the country is an issue of contemporary discourse at the national level.
Research conducted by NYSPHC (2003) has revealed that, in 1997, 45% of public health staff nationwide had formal training in public health, and 77% of local health department principals nationwide had not obtained graduate degrees in public health. Several researches carried out in 1998 and 1999 showed that NYS public health workforce requires additional training to improve health assessment conduction. In this light, the NYS Department of health with the State University of NY put together the Memorandum of Understanding (MOU) to create opportunities for workers to continue their education in public health (NYSPHC, 2003).
NYS Public Health Laws
Public Health Law (PHL) in NYS deals with legal matters relating to public health practice, public health consequences of legal practice, and describes the overall duties of NYS DOH (Helfand, Lazarus & Theerman, 2001).
PHL in NYS may be found at NYS DOH or its website. NYS DOH website provides general information on public health issues in NYS, such as public health law, records of birth, death, divorce and marriage, health insurance programs, data and statistics, among other valuable information regarding public health in NYS (DOH, 2004).
Genetic Information and Public Health
Several researches have stressed the importance of genetic information and public health integration. Genetic information provides proper comprehension of disease etiology, preventive measures to avoid the outbreak of disease, and allow timely, as well as pre-symptomatic diagnosis (Mount, 2004). Aswini & Varun (2010) asserted that genetic information and public health integration has provided understanding on how genetics affects other factors, supports public health programs and policies that provide people with information to hone their decisions relating to genetic technology utilization, and permits the enlightenment of public health workers about the utilization of genetic information to promote health.
A number of genetic programs have been carried out by public health; examples of such programs include newborn screening, carrier-screening programs, folic acid and neural tube defects, and many others. Newborn screening system encompasses a collection of samples and dispatch of screening equipment, screening test performance, dissemination of test results to referring health practitioners and parents, and swift access to specialized care and evaluation for newborns having abnormal results (Laberge, 2004).
Epidemiology: Basic Science of Public Health
Many scholars have identified and described epidemiology as the basic science of public health. Olsen et al. (2000) defined epidemiology as “the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems” (p. 11). Epidemiology is a branch of science that is based on scientific inquiry methodology.
Overview of Epidemiologic Study Design
Epidemiologic research employs various kinds of study designs. Major epidemiological study designs include experimental, cohort, ecological, observational, case-control and case-sectional studies (MacMahon & Trichopoulos, 1996). Experimental study design usually studies disease treatment and prevention, while observational study design usually studies disease treatment, causes, and prevention. Cohort study design usually investigates numerous health results of exposure. Case-control usually investigates various disease-related exposures; here, histories of exposures are compared, cases and controls of subjects are considered. Cross-section study design investigates disease prevalence and exposure relationship within a defined population at a given time. Ecological study design investigates exposure and diseases relationship with population-level data.
Epidemiology-applied achievements
Epidemiology and other basic scientific information have been practiced in NYS DOH. NYS DOH has employed epidemiological studies in public health surveillance, program planning; investigation and evaluation of the spread of diseases and other health-related studies (Thacker & Buffington, 2001). For example, Policy on Breastfeeding and HIV, and multi-site analytic follow-up studies conducted by the NYS DOH utilized epidemiological and other basic scientific information.
The NYS DOH has directly collected several data relating to the health of the public. Examples of data collected by NYS DOH include cancer registry in NYS, statistics on drowning incidents at NYS public bathing facilities, statistics on hospital maternity-related practices and processes, County Health Indicator Profiles (CHIP), and many others (DOH, 2004). he NYS DOH also uses data from other researchers, agencies and organizations such as the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC).
Infectious Disease
Infectious disease, otherwise known as communicable disease includes clinically proven illness caused by infection, development and presence of infectious agents in a host organism. Infectious agents that because illness includes some protozoa, prions (deviant proteins), viruses, multi-cellular parasites and fungi (Schlipköter & Flahault, 2010).
Infectious diseases are transmitted from other infected organisms, through various modes and mechanisms. Ingestion of contaminated food and water is the common cause of gastrointestinal diseases. Contact with aerosolized droplets from infected persons is the common cause of meningitis and respiratory diseases. Sexually Transmitted Diseases (STDs) are contracted during contact with infected body fluids during sexual activities. Other diseases may be acquired via direct skin penetration and contact with contaminated objects.
Several infectious diseases such as Tuberculosis and HIV have posed a great threat to public health. However, the NYS health department has made efforts in preventing and controlling these diseases through the implementation of certain programs (Schlipköter & Flahault, 2010). Examples of such programs are the NYS Emerging Infections Program (EIP) and the tuberculosis Directly Observed Therapy (DOT) Program. These programs are put in place to evaluate the public health effect of developing infections and assess ways of preventing and controlling infectious diseases (Schlipköter & Flahault, 2010).
Chronic Diseases
Chronic diseases are diseases that are persistent in their effects. In the United States, virtually 50% of the entire population are affected by at least one chronic medical condition, and the number is predicted to rise above 1% annually, by 2030 (Danaei et al., 2009). Some common chronic diseases include Alzheimer’s disease, emphysema, cancer, hypertension, arthritis, respiratory diseases, sickle cell anemia, and many others.
NYS DOH has established a number of programs to address chronic diseases; an example is the NYS Arthritis Program. Since the initiation of the NYS Arthritis Program in 2001, it has maintained collaborations with public and private health organizations to address arthritis and arthritis-related diseases in New Work (Schlipköter & Flahault, 2010).
Public health challenges faced by NYS
NYS has faced some public health challenges over the years. Newly infectious diseases such as tuberculosis and HIV, and the outbreak of new kinds of influenza have posed a major challenge to public health in NYS today. Since the 1980s, NYS has experienced the emergence of new infectious diseases, as well as the resurgence of already known diseases and the occurrence of unknown or resistant versions of already known infectious agents (Schlipköter & Flahault, 2011). In the last few decades, more than 15 new pathogens have been identified, presenting public health with great challenges. Some examples include Severe Acute Respiratory Syndrome (SARS), methicillin-resistant staphylococcus aureus, Creutzfeld-Jakod disease, drug-resistant tuberculosis and several others (Schlipköter & Flahault, 2011). Other challenges include overweight and obesity, and tobacco use.
Conclusion
In conclusion, public health focuses on improving life quality and health, by treating and preventing disease, and plays vital roles in disease control and prevention. Public health has made several achievements in the last century that has impacted NYS. NYS public health system encompasses state and local government agencies, public and private agencies, as well as health care providers and insurers. Public health laws describe the overall duties of NYS DOH and can be obtained from NYS DOH and its website. Incorporation of genetic information with public health is important as it has aided public health in achieving its objectives. Epidemiology has been identified as the science of public health and employs various study designs such as experimental, cohort, ecological, observational, case-control and case-sectional studies (MacMahon & Trichopoulos, 1996). Several epidemiology-applied policies and programs have been put in places such as the Policy on Breastfeeding and HIV. NYS DOH has put in place several policies and programs to address infectious and chronic diseases in NYS, such as NYS Emerging Infections Program (EIP), tuberculosis Directly Observed Therapy (DOT) Program, and NYS Arthritis Program. Various new and re-emerging diseases, such as HIV, tuberculosis and SARS, have posed great public health challenges to NYS.
Many thanks for your time and keen interest. You may kindly ask your questions, if any.
References
Amory, W. C. (2001). The Untilled Fields of Public Health. Science, 51 (1306), 23–33.
Aswini, Y. B. & Varun, S. (2010). Genetics in public health: Rarely explored. India J Hum Genet, 16(2), 47-54.
Danaei G. et al. (2009). The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLoS Medicine, 6 (4).
Department of Health. (2004). Strengthening New York’s Public Health System for the 21st Century: Report of the Public Health Infrastructure Work Group to the Public Health Council. Web.
Institute of Medicine. (2002).The Future of the Public’s Health in the 21st Century. New York, NY: National Academy Press.
Laberge, A. M. (2004). Genetics and Public Health: Atlas Genet Cytogenet Oncol Haematol. Web.
MacMahon, B. & Trichopoulos, D. (1996). Epidemiology Principles and Methods. Boston, MA: Little, Brown and Company.
Mount, D. M. (2004). Bioinformatics: Sequence and Genome Analysis. New York, NY: Cold Spring Harbor Press.
New York State Public Health Council. (2003). Strengthening New York’s public health system for the 21st century. Web.
Olsen, S.J., MacKinon, L.C., Goulding, J.S., Bean, N.H. & Slutsker, L. (2000). Surveillance for foodborne disease outbreaks–United States. MMWR, 49(1), 1–59.
Schlipköter, U. & Flahault, A. (2010).Communicable diseases: achievements and challenges for public health. Public Health Reviews, 32, 90-119.
Thacker, S. B. & Buffington, J. (2001). Applied epidemiology for the 21st Century. Int J Epidemiol, 30(2), 320-5.
World Health Organization. (2011). Diabetes Fact Sheet N°312.