URBS 350 Why do we care about public healthUrban Planning and Public HealthUrban Planning and Public HealthFunctions of Public HealthPublic Health OrganizationsCDC, MMWRPublic HealthGlobal Disease BurdenCauses of Death, WHO (2008)Causes of Death, WHO (2008)Slide Number 12Slide Number 13Slide Number 14Differences between the Rich and Poor (WHO, 2004)ChildrenSlide Number 17Slide Number 18Slide Number 19Slide Number 20Health conditionsMeasuresMorbidity / Mortality RatesPrevalenceIncidenceTypes of deficienciesMicronutrient MarasmusKwashiorkorSlide Number 31Low birth weightAnthropometryAddressing Health ProblemsImmunizationsImmunizationVaccine preventable diseasesSlide Number 38Health Care SystemsHealth Care System - IndiaOther Sources of MedicineCities – Health Advantage?Developing Healthcare systems in the 3rd worldOne approach..to health systemsURBS 350Abhishek TiwariPublic HealthWhy do we care about public health• Public health and economic development are intimately related• The residents of poor countries are not only more likely to get sick, but they are likely to contract illnesses that have been eradicated (or almost eradicated) from developed countries• Some types of sickness disproportionately impact the working age population (e.g. HIV). • A sick population is less productiveUrban Planning and Public Health• Share common mission (emphasize needs assessment and service delivery, manage complex social systems, population level focus, community based, etc.)• Both ultimately seek to improve human well being• John Snow – Early GIS and Cholera Outbreak• Fredrick Law Olmsted (Lincoln’s Sanitary Commission Secretary)– Community design and physical/mental healthUrban Planning and Public Health• Creation of green and open spaces to promote physical activity• Social integration and improvements in mental health• Prevention of infectious diseases through development and management of infrastructure (e.g. drinking water, sewage, industrial and environmental exposure through zoning)• Air quality management• Injury prevention• Transportation planning to reduce accidents, deaths , reduce greenhouse gas production• Increasing neighborhood walkability• Emergency preparednessFunctions of Public Health• Surveillance -- keeping track of disease specific prevalence, incidence, morbidity and mortality• Epidemiology – origin of a disease, its spread, its impact• Health education -- e.g. anti-smoking campaigns• Emergency Preparedness• Program planning, implementation and evaluation • Health services, including immunizations•Data collection, analysis and disseminationPublic Health Organizations• http://www.who.int/about/en/• http://www.cdc.gov/• http://www.ladhs.org/wps/portal/• http://www.hhs.gov/CDC, MMWR• http://www.cdc.gov/mmwr/pdf/wk/mm6015.pdf• Mortality and Morbidity Weekly Report• “Agency’s primary vehicle for scientific publication of timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations”•“The data in the weekly MMWR are provisional, based on weekly reports to CDC by state health departments.”Public HealthSurveillance and Epidemiology, CDC•http://www.cdc.gov/CDCTV/DiseaseDetectives/index.htmlHealth Services, Immunization, WHO•http://www.youtube.com/watch?v=wFDX2WfzpegGlobal Disease Burden• Almost 10% of the global disease burden could be prevented by improving water supply, sanitation, hygiene and management of water resources. Estimated number of deaths that could be prevented: • - 1.4 million child deaths from diarrhea • - 500 000 deaths from malaria • - 860 000 child deaths from malnutrition • - 280 000 deaths from drowningCauses of Death, WHO (2008)Lower Income Millions% Middle Income Millions%Lower Respiratory Infections 2.94 11.2 Stroke 3.47 14.2Coronary Heart Disease 2.47 9.4 Coronary Heart Disease 3.40 13.9Diarrheal Disease 1.81 6.9 COPD 1.80 7.8HIV/AIDS 1.51 5.7 Lower Respiratory Infections 0.92 3.8Stroke and other Cerebrovascular1.48 5.6 Trachea, Lung Cancers 0.69 2.9COPD 0.94 3.6 Road Accidents 0.67 2.8TB 0.91 3.5 Hypertensive Heart Disease 0.62 2.5Neonatal Infections 0.90 3.4 Stomach Cancer 0.55 2.2Malaria 0.86 3.3 TB 0.54 2.2Prematurity / LBW 0.84 3.2 Diabetes 0.52 2.1Causes of Death, WHO (2008)Causes of Death, Upper Income Millions %Coronary heart disease 1.33 16.3Stroke and other cerebrovascular diseases 0.76 9.3Trachea, bronchus, lung cancers 0.48 5.9Lower respiratory infections 0.31 3.8Chronic obstructive pulmonary disease 0.29 3.5Alzheimer and other dementias 0.28 3.4Colon and rectum cancers 0.27 3.3Diabetes mellitus 0.22 2.8Breast cancer 0.16 2.0Stomach cancer 0.14 1.8Coronary heart disease 1.33 16.3Stroke and other cerebrovascular diseases 0.76 9.3Differences between the Rich and Poor (WHO, 2004)• In high-income countries more than two-thirds of all people live beyond the age of 70 and predominantly die of chronic diseases: cardiovascular disease, chronic obstructive lung disease, cancers, diabetes or dementia. Lung infection remains the only leading infectious cause of death.• In middle-income countries, nearly half of all people live to the age of 70 and chronic diseases are the major killers, just as they are in high-income countries. Unlike in high-income countries, however, tuberculosis and road traffic accidents also are leading causes of death.• In low-income countries less than a quarter of all people reach the age of 70, and over a third of all deaths are among children under 14. People predominantly die of infectious diseases: lung infections, diarrheal diseases, HIV/AIDS, tuberculosis, and malaria. Complications of pregnancy and childbirth together continue to be leading causes of death, claiming the lives of both infants and mothers.Children• Over 10 million deaths in 2004 were among children under five years of age, and 99% of them were in low- and middle-income countries.Health conditions• Infectious/ Communicable diseases – HIV, TB, Flu, Malaria (more common in 3rdworld)• Chronic diseases - Heart Disease, Hypertension, Cancer (More common in developed regions)• Injuries / Trauma – common in both 3rdworld and developed, however, the causes vary• Malnutrition – Micro/Macro nutrient deficiencies (significant proximal cause of 3rdworld morbidity/mortality)• Disability• Mental health – Schizophrenia, depression, bipolar disorder, underdiagnosed in 3rdworldMeasures• Rates