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Vol. LXII, No. 12
 
Wednesday, March 19, 2008
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Population-Based Healthcare Focus of Saturday Science Talk

Ellen Gilbert

People in the 1700s believed in “vapors”; in the 1800s poor hygiene was recognized as a source of disease. The late 1800s saw the germ theory take hold, and mass immunizations followed the Federal government interventions that characterized public health in the mid-1900s. What now? According to Dr. Joan Beckwith in a recent “Science on Saturday” talk at the Princeton Plasma Physics Laboratory, the face of public health in the 21st century is population-based healthcare, a system that focuses on promoting health and preventing disease before it happens.

Casting the wide net required by this effort, she said, requires the collaboration of many individuals and agencies, such as the Center for Disease Control and the National Institutes of Health. She cited the successful interaction of three “core functions: assessment, policy development, and assurance” as essential to promoting population-based healthcare.

Dr. Beckwith, who is a Clinical Instructor in the Department of Medicine at Temple University, and a Clinical Director in the Philadelphia Department of Public Health, described the first core function, “assessment,” as “syndromic surveillance,” or data-collecting by epidemiologists who observe factors affecting the health and illness of populations.

When particular trends are identified, scientists, community leaders, social workers, and physicians develop policy, the second step, by prioritizing data and suggesting an “action plan” that might include issuing public alerts and warnings, and sponsoring laws that will help preclude epidemics or even pandemics .

The third piece of population-based healthcare, “assurance,” consists of the implementation of policies, using outreach programs, immunizations, staff education, and “guarantees of service.” Assurance, Dr. Beckwith said, “is not based on one-on-one encounters,” but usually involves multi-media use to “spread the word” on radio, television, mailings, using celebrity endorsements, and the like.

Looking Ahead

A real-life example of population-based healthcare at work is the “Healthy People 2010” initiative adopted by the U.S. Department of Health and Human Services in 2000. Pointing to a screen listing the 28 “focus areas” of this program, Dr. Beckwith emphasized just “how expansive” the range of public health concerns is, including arthritis, cancer, HIV/AIDS, medical product safety, nutrition and weight, oral health, vision and hearing. She noted, perhaps for the benefit of the many young people in the audience, the “inherent multi-disciplinarity” of the field, saying that “no matter what your major, it can have a public health component.”

Efforts at “primary prevention,” or intervening before there’s a health problem (e.g., encouraging people to exercise and eat right before diabetes and other obesity-related diseases set in) may be stymied in the future, Dr. Beckwith said, by the overuse or incorrect use of antibiotics, the resurgence of pathogens, possibly due to laxity in implementation practices, and the rise of new pathogens, possibly as a result of changes in the environment. She cited biologist E.O. Wilson, author of The Diversity of Life, as a champion of concern for global welfare.

National Public Health Week

The focus of this year’s National Public Health Week, from April 7 13, is “Climate Change: Our Health in the Balance.” The American Public Health Association notes that “there is a direct connection between climate change and the health of our nation today.” For more on National Public Health Week go to www.nphw.org.

To learn more about “Health People 2010” go to www.healthypeople.gov/.

Dr. Beckwith’s talk was the last in a series of nine presented by the Princeton Plasma Physics Laboratory. Other presentations this spring include Professor Janna Levin of Barnard College asking “Is the Universe Infinite”; Professor Jim Stone’s talk, “From Accreting Black Holes to Merging Galaxies,” and Professor Bernard Brooks of Rochester Institute of Technology speaking about “Spreading Rumors on Facebook.” Earlier talks are being made available online and can be viewed using “Real Player” (download from www.real.com).

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