Foreword

xvii

Preface to the Second Edition

xix

Acknowledgments

xxi

Introduction to the First Edition

xxiii

1

A History of Public Health

1

Introduction

1

Prehistoric Societies

1

The Ancient World

2

The Early Medieval Period (Fifth to Tenth Centuries CE)

4

The Late Medieval Period (Eleventh to Fifteenth Centuries)

4

The Renaissance (1500-1750)

6

Enlightenment, Science, and Revolution (1750-1830)

7

Eighteenth-Century Reforms

8

Applied Epidemiology

8

Jenner and Vaccination

9

Foundations of Health Statistics and Epidemiology

9

Social Reform and the Sanitary Movement (1830-1875)

11

Snow on Cholera

13

Germ Versus Miasma Theories

14

Hospital Reform

15

The Bacteriologic Revolution

16

Pasteur, Cohn, Koch, and Lister

16

Vector-Borne Disease

17

Microbiology and Immunology

18

Poliomyelitis

18

Advances in Treatment of Infectious Diseases

19

Maternal and Child Health

19

Nutrition in Public Health

20

Military Medicine

21

Internationalization of Health

23

The Epidemiologic Transition

23

Achievements of Public Health in the Twentieth Century

25

Creating and Managing Health Systems

26

Summary

26

Historical Markers

28

Electronic Resources

31

Recommended Readings

31

Bibliography

32

2

Expanding the Concept of Public Health

33

Introduction

33

Concepts of Public Health

33

Evolution of Public Health

35

Health and Disease

36

Host-Agent-Environment Paradigm

37

The Natural History of Disease

38

Society and Health

39

Modes of Prevention

41

Health Promotion

41

Primary Prevention

42

Secondary Prevention

43

Tertiary Prevention

43

Demographic and Epidemiologic Transition

43

Interdependence of Health Services

44

Defining Public Health

44

Social Medicine and Community Health

45

Social Hygiene Eugenics, and Corruption of Public Health Concepts

46

Medical Ecology

46

Community-Oriented Primary Care

46

World Health Organization’s Definition of Health

47

Alma-Ata: Health for All

47

Selective Primary Care

49

The Risk Approach

50

The Case for Action

50

Political Economy and Health

52

Health and Development

53

Health Systems: The Case for Reform

54

Advocacy and Consumerism

55

Professional Advocacy and Resistance

55

Consumerism

57

The Health Field Concept

58

The Value of Medical Care in Public Health

58

Health Targets

59

United States Health Targets

59

International Health Targets

61

European Health Targets

61

United Kingdom Health Targets

61

Individual and Community Participation in Health

62

Ottawa Charter for Health Promotion

62

State and Community Models of Health Promotion

63

Healthy Cities/Towns/Municipalities

63

Human Ecology and Health Promotion

65

Defining Public Health Standards

65

Integrative Approaches to Public Health

66

The Future of Public Health

67

The New Public Health

68

Summary

68

Electronic Resources

70

Recommended Readings

71

Bibliography

71

3

Measuring and Evaluating the Health of a Population

73

Introduction

73

Demography

74

Fertility

75

Population Pyramid

76

Life Expectancy

76

Epidemiology

77

Social Epidemiology

SO

Epidemiology in Building Health Policy

82

Definitions and Methods of Epidemiology

82

Rates and Ratios

82

Measures of Morbidity

84

Prevalence Rates

85

Measures of Mortality

85

Social Classification

87

Sentinel Events

87

The Burden of Disease

88

Years of Potential Life Lost

88

Qualitative Measures of Morbidity and Mortality

88

Measurement

89

Research and Survey Methods

89

Variables

90

The Null Hypothesis

90

Confounders

91

Sampling

91

Randomization

91

Normal Distribution

92

Standardization of Rates

92

Direct Method of Standardization

93

Indirect Method of Standardization

93

Potential Errors in Measurement

94

Reliability

94

Validity

95

Screening for Disease

95

Epidemiologic Studies

96

Observational Studies

96

Experimental Epidemiology

99

Establishing Causal Relationships

100

Notification of Diseases

100

Special Registries and Reporting Systems

101

Disease Classification

103

Hospital Discharge Information

103

Health Information Systems (Informatics)

105

Who European Region Health for All Database

106

Surveillance, Reporting, and Publication

107

Assessing the Health of the individual

107

Assessment of Population Health

108

Defining the Population

109

Socioeconomic Status

109

Nutrition

111

Environment and Occupation

111

Health Care Financing and Organization

111

Health Care Resources

111

Utilization of Services

112

Health Care Outcomes

112

Quality of Care

113

Self-Assessment of Health

114

Costs and Benefits

114

Effects of Intervention

114

Qualitative Methods

114

Summary — From Information to Knowledge to Policy

116

Electronic Resources

117

Recommended Readings

117

Bibliography

118

4

Communicable Diseases

121

Introduction

121

Public Health and the Control of Communicable Disease

122

The Nature of Communicable Disease

122

Host-Agent-Environment Triad

123

Classifications of Communicable Diseases

124

Modes of Transmission of Disease

125

Immunity

125

Surveillance

126

Health Care-Associated Infections

128

Endemic and Epidemic Disease

128

Epidemic Investigation

129

Control of Communicable Diseases

130

Treatment

130

Methods of Prevention

130

Vaccine-Preventable Diseases

131

Immunization Coverage

133

Vaccine-Preventable Diseases

144

Essentials of an Immunization Program

144

Regulation of Vaccines

146

Vaccine Development

146

Control/Eradication of Infectious Diseases

147

Smallpox

147

Eradication of Poliomyelitis

148

Other Candidates for Eradication

149

Future Candidates for Eradication

149

Vector-Borne Diseases

156

Malaria

156

Rickettsial Infections

157

Arboviruses (Arthropod-Borne Viral Diseases)

157

Lyme Disease

160

Parasitic Diseases

161

Echinococcosis

161

Tapeworm

162

Onchocerciasis

162

Dracunculiasis

162

Schistosomiasis

163

Leishmaniasis

163

Trypanosomiasis

164

Other Parasitic Diseases

164

Legionnaire’s Disease

165

Leprosy

165

Trachoma

165

Sexually Transmitted Infections

166

Syphilis

166

Gonorrhea

166

Other Sexually Transmitted Infections

166

Control of Sexually Transmitted Infections

167

HIV/AIDS

168

Diarrheal Diseases

170

Salmonella

170

Shigella

170

Escherichia colt

171

Cholera

171

Viral Gastroenteritis

171

Parasitic Gastroenteritis

172

A Program Approach to Diarrheal Disease Control

172

Acute Respiratory Infections

173

Inequalities in Control of Communicable Diseases

174

Communicable Disease Control in the New Public Health

175

Summary

176

Electronic Resources

176

Recommended Readings

177

Bibliography

177

5

Noncommunicable Conditions

181

Introduction

181

The Rise of Chronic Disease

182

The Burden of Chronic Conditions

183

Risk Factors and Causation of Chronic Conditions

184

Chronic Manifestations of Infectious Diseases

187

Cardiovascular Diseases

188

Chronic Lung Disease

195

Asthma

195

Chronic Obstructive Pulmonary Disease

196

Restrictive Lung Diseases

196

Occupational Lung Diseases

196

Diabetes Mellitus

197

Prevention of Diabetes and Its Complications

199

End-Stage Renal Disease

200

Cancer

200

Prevention of Cancer

203

Chronic Liver Disease

204

Disabling Conditions

205

Arthritis and Musculoskeletal Disorders

205

Osteoporosis

205

Degenerative Osteoarthritis

206

Rheumatoid Arthritis and Gout

206

Low Back Syndromes

206

Neurologic Disorders

206

Alzheimer’s Disease

206

Parkinson’s Disease

206

Multiple Sclerosis

206

Epilepsy or Seizures

207

Brain and Spinal Cord Injury

207

Visual Disorders

207

Hearing Disorders

208

Trauma, Violence, and Injury

208

Motor Vehicle Accidents

210

Domestic Violence

211

Suicide and Suicide Attempts

212

Homicide

212

Prevention of Violence

212

Chronic Conditions and the New Public Health

213

Summary

213

Electronic Resources

213

Recommended Readings

214

Bibliography

215

6

Family Health

217

Introduction

217

The Family Unit

218

Maternal Health

219

Fertility

219

Public Health Concerns of Fertility

220

Family Planning

220

Maternal Mortality and Morbidity

221

Pregnancy Care

223

High-Risk Pregnancy

224

Labor and Delivery

226

Safe Motherhood Initiatives

227

Care of the Newborn

227

Care in the Puerperium

229

Genetic and Birth Disorders

230

Rhesus Hemolytic Disease of the Newborn

231

Neural Tube Defects

231

Cerebral Palsy

232

Intellectual Disability

232

Down Syndrome

233

Cystic Fibrosis

233

Sickle-Cell Disease

233

Thalassemia

233

Phenylketonuria

234

Congenital Hypothyroidism

235

Fetal Alcohol Syndrome

235

Tay-Sachs Disease

235

G6PD

235

Familial Mediterranean Fever

235

Infant and Child Health

235

Fetal and Infant Mortality

236

Infancy Care and Feeding

237

Anticipatory Counseling

238

Documentation, Records, and Monitoring

238

The Preschooler (Ages 1-5 Years)

240

School and Adolescent Health

241

Smoking

242

Alcohol Abuse

243

Drug Abuse

243

Sexual Risk Behavior

244

Dietary Risk Behavior

244

Physical Activity

245

Violence and Gang Behavior

245

Adult Health

245

Women’s Health

246

Men’s Health

24«

Health of Older Adults

249

Health Maintenance for Older Adults

250

Summary

254

Electronic Resources

255

Recommended Readings

256

Bibliography

256

7

Special Community Health Needs

259

Introduction

259

Mental Health

260

Historical Changes in Methods of Treatment

262

Mental Health Epidemiology

263

Mental Disorder Syndromes

265

Controversies in Mental Health Policies

269

Community-Oriented Mental Health

270

Prevention and Health Promotion

271

Mental Disability

271

Oral Health

272

Fluoridation

273

Periodontal Disease

273

Dental Care

274

Oral Cancer

274

Physical Disability and Rehabilitation

274

Special Group Health Needs

276

Gay and Lesbian Health

276

Native Peoples’ Health

277

Prisoners’ Health

278

Migrant Population Health

280

Homeless Population Health

280

Refugee Health

281

Military Medicine

282

Health in Disasters

283

Summary

286

Electronic Resources

287

Recommended Readings

287

Bibliography

288

8

Nutrition and Food Safety

291

Introduction

291

Development of Nutrition in Public Health

292

Nutrition in a Global Context

292

Nutrition and Infection

293

Functions of Food

294

Composition of the Human Body

294

Human Nutritional Requirements

294

Carbohydrates

295

Proteins

295

Fats and Oils

295

Vitamins

296

Minerals and Trace Elements

296

Growth

296

Measuring Body Mass

298

Recommended Dietary Intakes

299

Disorders of Undernutrition

300

Underweight: Protein-Energy Malnutrition (PEM)

303

Failure to Thrive

304

Marasmus

304

Kwashiorkor

304

Vitamin A Deficiency

304

Vitamin D Deficiency (Rickets and Osteomalacia)

306

Vitamin C Deficiency

308

Vitamin K Deficiency (Hemorrhagic Disease of the Newborn)

308

Vitamin B Deficiencies

308

Iron-Deficiency Anemia

310

Iodine-Deficiency Diseases

310

Osteoporosis

311

Eating Disorders

311

Diseases of Overnutrition

312

Overweight/Obesity

312

Cardiovascular Diseases

313

Cancer

313

Nutrition in Pregnancy and Lactation

314

Promoting Healthy Diets and Lifestyles

315

Dietary Guidelines

315

Vitamin and Mineral Enrichment of Basic Foods

315

Controversy in Food Enrichment

316

Food and Nutrition Policy

317

The Evolution of a Federal Role

317

Nutrition Issues in Development Policies

318

The Role of the Private Sector and NGOs

319

The Role of Health Providers

319

Nutrition Monitoring and Evaluation

320

Standard Reference Populations

320

Measuring Deviation from the Reference Population

322

Food Quality and Safety

322

Nutrition and the New Public Health

326

Summary

327

Electronic Resources

328

Recommended Readings

328

Bibliography

329

9

Environmental and Occupational Health

333

Environmental Health

333

Introduction

333

Environmental Issues

334

Geographic and Environmental Epidemiology

335

Environmental Targets

335

Global Environmental Change

335

Climate Change

337

Environmental Impact on Health Burden of Disease

337

Community Water Supplies

338

Waterborne Diseases

339

Sewage Collection and Treatment

340

Toxins

343

Toxic Effects on Fertility

343

Toxic Effects of Lead in the Environment

344

Agricultural and Environmental Hazards

346

Air Pollution

346

The External Environment

346

Methyl Tertiary Butyl Ether

348

Indoor Pollution

349

Radon Gas

349

Outdoor-Indoor Pollutants

349

Biological Pollutants

350

Sick Building Syndrome

350

Hazardous or Toxic Wastes

350

Minimata Disease

351

Toxic Waste Management

351

Radiation

351

Ionizing Radiation

351

Non-Ionizing Radiation

352

Environmental Impact

352

Emergency Events Involving Hazardous Substances

352

Man-Made Disasters, War, Terrorism

354

Preventing and Managing Environmental Emergencies

354

Environmental Health Organization

355

Occupational Health

356

Introduction

356

Development of Occupational Health

358

The Health of Workers

359

The Burden of Occupational Morbidity and Mortality

359

Occupational Health Priorities in the United States

360

International Issues in Occupational Health

360

National and Management Responsibilities

361

Standards and Monitoring

362

Occupational Health Targets

363

Toxicity at the Workplace and in the Environment

363

Lead

364

Asbestos

364

Silica

365

Cotton Dust (Byssinosis)

366

Vinyl Chloride

366

Agent Orange

366

Workplace Violence

366

Occupational Health in Clinical Practice

367

Inspecting the Place of Work

368

Risk Assessment

368

Preventing Disasters in the Workplace

368

Occupation and the New Public Health

369

Summary

369

Electronic Resources

370

Recommended Readings

371

Bibliography — Water Quality and Waterborne Disease

372

Bibliography — Occupational and Environmental Health

373

10

Organization of Public Health Systems

375

Introduction

375

Government and Health of the Nation

376

Federal and Unitary States

377

Checks and Balances in Health Authority

377

Government and the Individual

378

Functions of Public Health

378

Regulatory Functions of Public Health Agencies

379

Methods of Providing or Assuring Services — Direct or Indirect?

379

Nongovernmental Roles in Health

380

Disasters and Public Health Preparedness

381

Medical Practice and Public Health

382

Incentives and Regulation

383

Promotion of Research and Teaching

385

Accreditation and Quality Regulation

386

National Government Public Health Services

386

State Government Public Health Services

388

Local Health Authorities

389

Monitoring Health Status

392

National Health Targets

393

Universal Health Coverage and the New Public Health

393

Hospitals in the New Public Health

395

Hospital Classification

396

Supply of Hospital Beds

396

The Changing Role of the Hospital

398

Regulation of Hospitals

399

The Uninsured as a Public Health Challenge

399

Summary

400

Electronic Resources

401

Recommended Readings

401

Bibliography

402

11

Measuring Costs: The Economics of Health

405

Introduction

405

Economic Issues of Health Systems

406

Investing in Health

407

National Health Care Spending

408

Basic Concepts in Health Economics

408

Supply, Need, Demand, and Utilization of Health Services

408

Normative Needs

409

Felt Need

409

Expressed Need

410

Comparative Need

410

Demand

410

Supply

411

Grossman’s Demand Model

411

Competition in Health Care

412

Elasticities of Demand

413

Measuring Costs

415

Economic Measures of Health Status

415

Cost-Effectiveness Analysis

416

Cost-Benefit Analysis

417

Basic Assessment Scheme for Intervention Costs and Consequences

419

The Value of Human Life

419

Health Financing — The Macroeconomic Level

421

Costs of Illness

424

Costs and Variations in Medical Practice

424

Cost Containment

425

Medical and Hospital Care — Microeconomics

426

Payment for Doctor’s Services

426

Payment for Comprehensive Care

426

Health Maintenance and Managed Care Organizations

427

District Health Systems

428

Paying for Hospital Care

429

Capital Costs

430

Hospital Supply, Utilization, and Costs

430

Modified Market Forces

432

Economics and the New Public Health

432

Summary

434

Electronic Resources

434

Recommended Readings

435

Bibliography

435

12

Planning and Managing Health Systems

439

Introduction

439

Health Policy and Planning as Context

440

The Elements of Organizations

442

Scientific Management

442

Bureaucratic Pyramidal Organizations

442

Organizations as Energy Systems

443

Cybernetics and Management

444

Target-Oriented Management

445

Operations Research

445

Management by Objectives

445

Human Relations Management

445

The Hawthorne Effect

446

Maslow’s Hierarchy of Needs

446

Theory X-Theory Y

447

Network Organization

448

Total Quality Management

449

Changing Human Behavior

450

Empowerment

451

Strategic Management of Health Systems

451

Health System Organization Models

452

Functional Model

453

Corporate Model

453

Matrix Model

454

Skills for Management

454

The Chief Executive Officer of Health Organizations

455

Community Participation

456

Integration — Lateral and Vertical

456

Norms and Performance Indicators

457

Health Promotion and Advocacy

457

Philanthropy and Volunteerism

457

New Organizational Models

458

New Projects and Their Evaluation

458

Systems Approach and the New Public Health

460

Summary

461

Electronic Resources

461

Recommended Readings

461

Bibliography

462

13

National Health Systems

465

Introduction

466

Health Systems in Developed Countries

467

Evolution of Health Systems

467

The United States

469

Federal Health initiatives

469

Medicare and Medicaid

471

The Changing Health Care Environment

472

Health Information

474

Health Targets

475

Social Inequities

476

The Dilemma of the Uninsured

477

Summary

478

Canada

478

Reform Pressures and Initiatives

479

Provincial Health Reforms

480

Health Status

480

Summary

481

The United Kingdom

482

The National Health Service

482

Structural Reforms of the National Health Service

482

Reforms Since 1990

482

Social Inequities

484

Health Promotion

484

Health Reforms

484

Primary Care Trusts

485

Summary

486

The Nordic Countries

486

Sweden

487

Denmark

489

Norway

489

Finland

489

Western Europe

491

Germany

491

The Netherlands

494

Russia

495

The Soviet Model

496

Epidemiologic Transition

497

Post-Soviet Reform

499

Future Prospects

501

Summary

501

Israel

502

Origins of the Israeli Health System

502

Health Resources and Expenditures

503