Introduction to Healthcare and

Public Health in the US

Introduction and History of
Modern Healthcare in the US
Lecture b
This material (Comp1_Unit1b) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Introduction and History of Modern
Healthcare in the US
Learning Objectives
2
Delineate key definitions in the healthcare domain
(Lectures a, b, c, d)
Explore components of healthcare delivery and
healthcare systems (Lecture a)
Define public health and review examples of
improvements in public health (Lecture b)
Discuss core values and paradigm shifts in US
healthcare (Lecture c)
Describe in overview terms, the technology used in the
delivery and administration of healthcare (Lecture d)
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
Public Health
3
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
is the science and art of preventing
disease, prolonging life and promoting
health through the organized efforts and
informed choices of society, organizations,
public and private, communities and
individuals.
(Winslow, C.E.A. 1920)
10 Great Public Health Achievements
US, 1900-1999
Vaccination
Motor-vehicle safety
Safe workplaces
Control of infectious diseases
Decline in deaths from coronary heart disease and
stroke
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of drinking water
Recognition of tobacco use as a health hazard

4
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
Public Health Successes (continued)
5
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
Control of infectious diseases
Example: Typhoid
spread by ingesting contaminated food or
water
In 1891 the typhoid death rate in Chicago
alone was 174 per 100,000 people
Now only about 400 cases are seen in the
US each year, most of whom originate
when patients travel in developing
countries

Public Health Successes (continued)
Control of infectious diseases
Example: Smallpox
Epidemic viral illness
In the early 1950s there were about 50
million cases of smallpox each year
worldwide
By 1977, smallpox was eradicated, thanks
to an aggressive public health program and
the use of an effective vaccine

6
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
Public Health Successes (continued)
Control of nutritional deficiencies
Example: Goiter
Lack of iodine in diet leads to impaired
thyroid hormone synthesis and an
enlargement of the thyroid gland in the
neck (a goiter)
Fortification of salt with iodine virtually
eradicated nutritional goiter in the US

7
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
Public Health Successes (continued)
Control of nutritional deficiencies
Example: Tooth Decay
Adding fluoride to drinking water
substantially reduces the incidence of
dental caries (tooth decay) in populations
In 1945 fluoride was added to water in
Grand Rapids, Michigan
Now over 10,000 US communities
fluoridate their water

8
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
How Has Public Health Improved
Healthcare?
Improvements in understanding disease
Epidemiology is considered the basic science
of public health and is
a quantitative basic science
a method of causal reasoning based on
developing and testing hypotheses pertaining to
occurrence and prevention of morbidity and
mortality
a tool for public health action to promote and
protect the publics health

9
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
How Has Public Health Improved
Healthcare? (continued)
An example of epidemiology at work:
In 1854: epidemic of cholera in London,
England
Cholera is a bacterial disease
Lack of sanitation and overcrowding led to
the spread of disease
Dr. John Snow linked the spread of disease
to a contaminated public water pump
Snows hypothesis: cholera was spread by
contaminated water

10
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
How Has Public Health Improved
Healthcare? (continued)
Improvements in data collection
Original methods of data collection were
crude
progressive improvement in methodology led
to the use of sophisticated scientific methods
to collect data
cohort studies
randomized controlled trials

11
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
How Has Public Health Improved
Healthcare? (continued)
Improvements in data collection
Example: the Framingham Heart Study
The study followed patients for a number of
years to identify factors that contribute to the
development of cardiovascular disease (CVD)
Over the years, multiple generations of
participants have helped identify major CVD
risk factors

12
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
How Has Public Health Improved
Healthcare? (continued)
Improvements in data analysis (use of
tools such as multivariate analysis and
meta-analysis)
Improvement in disease surveillance
Example: the Real-Time Outbreak and
Disease Surveillance (RODS) Laboratory at
the University of Pittsburgh, Department of
Biomedical Informatics

13
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
How has public health improved
healthcare? (continued)
Improvement in training
Establishment of many schools of public
health in the early 20
th
century
Professional degrees such as Master of
Public Health (M.P.H.)
Improvements in infrastructure
Federal
State
Local health departments

14
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
Introduction and History of Modern
Healthcare in the US
Summary Lecture b
15
Public Health Definition
Public Health Successes include the control of:
Infectious diseases
Nutritional deficiencies
Understanding disease
Public Health has improved:
Data collection, training and infrastructure
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b
Introduction and History of Modern
Healthcare in the US
References Lecture b
References
Centers for Disease Control and Prevention - Ten great public health achievementsUnited States, 19001999.
(1999, April 2). MMWR, 48(12), 241-243.
Definition of Epidemiology from Principles of Epidemiology, 2nd edition, CDC Self Study Course 3030-G. (2008).
Retrieved December 6, 2011, from Centers for Disease Control and Prevention website:
http://www2a.cdc.gov/phtn/catalog/pdf-file/Epi_course.pdf.
Ripa, L. W. (1993). A Half-century of Community Water Fluoridation in the United States: Review and
Commentary. Dept. of Childrens Dentistry; SUNY Stony Brook, 53(1), Retrieved from
http://aaphd.org/docs/position%20papers/A%20Half-Century%20of%20Community%20Water1993.pdf.
Smallpox. (2001). Retrieved December 6, 2011, from World Health Organization - Media Center website:
http://www.who.int/mediacentre/factsheets/smallpox/en/.
Typhoid Fever in the United States - NH Backgrounder. (2001, April 25). Retrieved December 6, 2011, from
National Institutes of Health, National Institute of Child Health and Human Development website:
http://www.nichd.nih.gov/news/releases/typhoid_background.cfm.
Typhoid Fever, Frequently Asked Questions. (2005, January 10). Retrieved December 6, 2011, from Centers for
Disease Control and Prevention - National Center for Emerging and Zoonotic Infectious Diseases website:
http://www.cdc.gov/nczved/divisions/dfbmd/diseases/typhoid_fever/.
Vandenbroucke, J. P. (1998). Clinical investigation in the 20th century: the ascendency of numerical reasoning.
Lancet, 352 (suppl 2)(12), 6. Retrieved from http://www.rods.pitt.edu/site.
William B. Kannel, MD - Pioneer in Cardiovascular Epidemiology, 19232011. (2011, January 10). Retrieved
December 6, 2011, from Framingham Heart Study website: http://www.framinghamheartstudy.org/index.html.
Winslow, C. E. (1920). The Untilled Fields of Public Health. Science, n.s. 51, 23.



16
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture b