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Introduction to State Health Policy: A Seminar for New State Legislators

Slide Presentation by Georges C. Benjamin, M.D., F.A.C.P.

On April 1, 2005, Georges C. Benjamin made a presentation in a seminar entitled Introduction to State Health Policy.

This is the text version of Dr. Benjamin's slide presentation. Select to access the PowerPoint® Slides (4.8 MB).

Public Health in America: A State and Local Perspective

Georges C. Benjamin
Executive Director
American Public Health Association
APHA: "Working for a Healthier World"
"Public Health: Prevent, Promote, Protect"

A glass half filled with water is shown. The title slide has a picture of the speaker and the APHA logo.

Slide 1

1854 Cholera Epidemic, London, England

  • Severe and widespread cholera in London
  • Doctor John Snow's hypothesis: People were getting cholera through contaminated drinking water; an infectious agent
  • Common view was it was from miasma or bad air
  • London obstetrician, mid 1800s

A photo of John Snow's face is shown.

Slide 2

1854 London Cholera Epidemic

  • Documented cholera cases throughout the city according to their proximity to two different water companies
  • Demonstrated that cholera was occurring more often in people consuming water from the Southwark and Vauxhill company's pump
  • Removed the Broad Street water pump handle
  • Stopped the epidemic

A water pump is shown on an old-fashioned city street.

Slide 3

Institute of Medicine

"A public health professional is a person educated in public health or a related discipline who is employed to improve health through a population focus."

Source: IOM 2002.

Slide 4

The Public Health System

A set of overlapping ovals is shown. The center oval is marked Working for a Healthier World: Assuring Conditions for Population Health. The six ovals it overlaps are marked Community, Health Care Delivery System, Employers and Business, The Media, Academics, and Government Public Health Infrastructure. The last oval is also overlapped by an oval marked Legislators.

Source: IOM 2002.

Slide 5

Public Health's Contribution to Health

  • Public health is responsible for the greatest increases in human life span.
  • Yet it has been "invisible"to the public.
  • Tragically in CY 2000, 78 percent of Americans believed they had not ever used a public health service; this information is from an unpublished survey by Hill and Knowlton, 2000.
  • Its best work is done when nothing happens.

A faucet is shown suspended in the sky, pouring water onto a human's cupped hands.

Slide 6

Basic Framework for Public Health: 10 Essential Services

The slide shows a wheel. Around the outside of a wheel, arrows point from the word Assessment to the words Policy Development to the word Assurance and back to Assessment.

The center of the wheel is divided into wedges. Beneath Assessment are a wedge marked Monitor Health and another marked Diagnose and Investigate. Beneath Policy Development are a wedge marked Inform, Educate, Empower; another marked Mobilize Community Partnerships; and another marked Develop Policies. Beneath Assurance are Enforce Laws, Link to or Provide Care, Assure Competent Workforce, and Evaluate.

At the center of the wheel is a smaller wheel, divided into seemingly random wedges collectively marked Research, with the words System Management around the outside of the smaller wheel.

Slide 7

A Day in the Life of a Public Health Officer

Your Community U.S.A. Today

A cityscape is shown in broad daylight.

Slide 8


  • Fever.
  • Muscle aches.
  • Abdominal pain.
  • Diarrhea.

Illustrations include a sick-looking man with a tissue, a doctor giving a girl a tongue depressor, a woman in bed with a hot water bottle, and a man wrapped in a blanket with a thermometer in his mouth. Many slides from this point on have a clock icon in the corner.

Slide 9

8:30 A.M.

"Hello. This is Dr. Phillips from Metro Hospital. I think you better sit down. Last night we admitted three unrelated patients ages 23, 44, and 79 from the emergency room with fever, muscle aches, and diarrhea. Preliminary lab tests show an infectious diarrhea. What's most interesting is that all three patients attended the same conference over the weekend with 300 other people. Not sure what's going on, but I knew you needed to know!"

Slide 10

8:45 A.M.

Local health officer checks health department's online disease surveillance system for latest information.

A screen shot of is shown.

Slide 11

8:50 A.M.

  • High number of reported ambulance runs noted over last 24 hours.
  • Larger statewide outbreak suspected.
  • State-integrated electronic surveillance system details mapping of cases by county and zip code.

A bar graph is titled Number of Cases Reported. The x-axis represents days of the week, and the y-axis represents numbers of cases. The number of cases reported continues to increase, from about 1,000 on Monday to about 2,000 on Sunday. Also shown is an ambulance.

Slide 12


Arrows point from a box marked Physician Report to a picture of skyscrapers marked Health Department to a computer marked Database GEPI 96 to a box marked GIS Software to a map of Maryland's counties, color coded for Baltimore City, the Northwest Area, the Baltimore Metro Area, the National Capital Area, the Southern Area, and the Eastern Shore Area.

Slide 13

9:00 A.M.

  • Local health officer alerts State health officials of a possible statewide outbreak by E-mail.
  • State health officer alerts heads of medical, education, epidemiology, and public relations teams and schedules a 9:45 meeting using PDAs.

A screen shot of a GroupWise Web Access window is shown.

Slide 14

9:10 A.M.

  • Public relations and education staff are in the building.
  • Epidemiologist and medical chief are at satellite office 60 miles away.
  • They message back they can meet via the State's interactive video system.

Photos show two people at Web cams and one on a phone in an office.

Slide 15

9:20 A.M.

  • State health official views health department Web site.
  • Reviews information on infectious agents.
  • Suspects food-borne cause!

A screen shot of is shown.

Slide 16

9:45 A.M.

  • Health official meets with staff to review new data: notices outbreak crosses State lines.
  • Case finding and disease surveillance identifying new cases.
  • GIS mapping indicates new cases in three States.
  • Reports through wireless communication system.

A map is shown. A composite of photos shows the work of doctors.

Slide 17

10:30 A.M.

  • State health official continues to watch data on wireless computer.
  • Neighboring health agencies contacted in three States.
  • Health agencies agree on regional strategy using interactive video conferencing.

A screen shot of is shown.

Slide 18

12:05 P.M.

Epidemiologist has audio conference with counterparts in three jurisdictions.

12:30 P.M.

Three State health officials have conference call.

A conference is shown with a speaker at a podium.

Slide 19

Lab Results: Stool Positive for Pathogenic E. Coli

  • Paper reports.
  • Some can view actual results through telemedicine linkage with medical center or public health lab.
  • Suspect it's the beef that was supplied through several distributors.

A health insurance claim and a lab test sample are shown.

Slide 20

1:10 P.M.

  • Health official alerts CDC, medical community, and law enforcement through health alert network.
  • Regional screening and treatment protocols sent out.
  • Updates the 1-800 hotline that informs community about public health emergencies.

A screen shot of is shown.

Slide 21

1:25 P.M.

Public Information staff issue press release to alert media and educate public.

  • Blast fax.
  • E-mail.

A screen shot of is shown.

Slide 22

2:20 P.M.

  • Health educator teleconferences with community physicians via interactive high-speed fiber optic video network.
  • Gives new information on diagnosis and therapy.
  • Start antibiotic treatment.

A person is shown watching a conference on TV.

Slide 23

Public Health Professionals Use Secure Video Conferencing System to Coordinate Regional Outbreak Response

Two photos show people at a conference looking at a speaker's face on TV. Another photo shows two men adjusting a set of TV monitors.

Slide 24

4:00 P.M.

  • Regional response coordinated.
  • Outbreak identified.
  • Treatment given.
  • Disease containment begun.
  • Lives saved!

A cartoon shows a U.S. Military Cantonment in which a man labeled Health Officer threatens penned dogs labeled Typhoid, Venereal Disease, Tuberculosis, and Contagious Diseases with a club labeled Sanitation.

Slide 25

Public Health Has a Broad Mission

A rectangle is divided into jigsaw puzzle-style pieces. The centerpiece is labeled Clean Environment and shows purple liquid spilling from a city street gutter. The other pieces are Safe Water, showing a running faucet; Chronic Disease, showing an American Journal of Public Health cover that asks what if cigarette ads told the truth; Bioterrorism, showing a suspicious envelope addressed to Senator Daschle from a fourth grade class; and Safe Food, showing ground beef packages with the words Crisis Management?

Slide 26

Operating Environment Has Changed

  • Invisible becomes Visible.
  • 9 to 5 Monday to Friday becomes 24 slash 7.
  • Results tomorrow becomes Results now!
  • Science and politics becomes Science and politics.
  • Evolving science becomes Fast science.
  • Controlled communication becomes Information overload.
  • National scope becomes Global involvement.

Slide 27

Change Driven by Highly Visible Public Health Events

  • Security dominates national agenda.
  • Public health part of national security agenda.
  • Growing public interest in health.
  • Protection and prevention.
  • Building infrastructure now a priority.

A composite of photos shows smog behind a U.S. flag, people wearing masks to breathe, a mosquito, and a Commissioner of Health poster warning about influenza.

Slide 28

Examples of Emerging and Re-emerging Diseases

On a world map, red dots point to areas of outbreak for:

  • Vancomycin-resistant Staphylococcus aureus-North America, Asia.
  • Cryptosporidiosis-North America, Europe.
  • Cyclosporiasis-North America.
  • E. coli O157:H7-North America, Japan.
  • Hepatitis C-North America, Africa.
  • Lyme disease-North America.
  • West Nile virus-North America.
  • Whitewater Arroyo virus-North America.
  • Hantavirus pulmonary syndrome-North America, South America.
  • Dengue-North America, South America.
  • Yellow fever-South America, Africa.
  • Cholera-South America, Africa, Asia.
  • Lassa fever-Africa.
  • Marburg virus-Africa.
  • Multidrug-resistant tuberculosis-North America, Africa, Europe, Asia.
  • Typhoid fever-Asia.
  • Diphtheria-Eastern Europe.
  • Drug-resistant malaria-South America, Africa. Asia.
  • Ebola hemorrhagic fever-Africa.
  • Rift Valley fever-Africa.
  • HIV-Africa.
  • Plague-Africa.
  • Human monkeypox-Africa .
  • Enterovirus 71-Asia.
  • V-CJD-Europe.
  • Hendra virus-Australia.
  • Nipah virus-Asia.
  • H5N1 avian influenza-Asia.

Slide 29

Reducing Disease Burden: Addressing Root Causes

  1. Heart disease.
  2. Cancer.
  3. Stroke.
  4. Unintentional Injury.
  5. COPD.
  6. Diabetes.
  7. Influenza and pneumonia.
  8. Alzheimer disease.
  9. Renal disease.
  10. Sepsis.

The following topics are in a box. An arrow points from the box to the list of diseases above.

  • Tobacco.
  • Diet and activity patterns.
  • Alcohol.
  • Microbial agents.
  • Toxic agents.
  • Firearms.
  • Sexual behavior.
  • Motor vehicles.
  • Illicit use of drugs.

Source: National vital statistics reports, 2002.

Slide 30

Ensuring a 21st Century Public Health System

  • Building infrastructure.
    • People.
    • Training.
    • Tools.
    • Resources; money, linkages, facilities.
  • Structural reform at local level.
  • Insufficient investment in public health research.
  • Strengthening nongovernmental public health.
  • Sustaining and reforming resource investments.

Slide 31

APHA: Working for a Healthier World
Practice public health? So do we. Join us.

Georges C Benjamin, M.D., F.A.C.P.
Executive Director
American Public Health Association

"Public Health: Prevent, Promote, Protect"

Current as of October 2005

Internet Citation:

Public Health in America: A State and Local Perspective. Text version of a slide presentation at Introduction to State Health Policy: A Seminar for New State Legislators. Agency for Healthcare Research and Quality, Rockville, MD.

Return to Seminar

The information on this page is archived and provided for reference purposes only.

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