Public health 101 for informaticians

Abstract

Abstract Public health is a complex discipline that has contributed substantially to improving the health of the population. Public health action involves a variety of interventions and methods, many of which are now taken for granted by the general public. The specific focus and nature of public health interventions continue to evolve, but the fundamental principles of public health remain stable. These principles include a focus on the health of the population rather than of individuals; an emphasis on disease prevention rather than treatment; a goal of intervention at all vulnerable points in the causal pathway of disease, injury, or disability; and operation in a governmental rather than a private context. Public health practice occurs at local, state, and federal levels and involves various professional disciplines. Public health principles and practice are illustrated by a case study example of neural tube defects and folic acid. The application of information science and technology in public health practice provides previously unfathomed opportunities to improve the health of the population. Clinical informaticians and others in the health care system are crucial partners in addressing the challenges and opportunities offered by public health informatics.

Figure 1

Public health approach. Reproduced from materials used by the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.

Figure 2

U.S. Standard Certificate of Birth.

Figure 3

Causal pathway of disease.

Figure 4

Median serum folate concentrations among non-pregnant women between 15 and 44 years of age, from the National Health and Nutrition Examination Survey (NHANES) III, conducted 1988 to 1994.

Figure 5

Trends in total neural tube defects (anencephaly and spina bifida) among all births, 1990–1999, for 45 U.S. states and Washington, DC. source: National Center for Health Statistics Vital Statistics Data. Adapted from Honein et al.²⁶

Figure 6

Trends in total neural tube defects (anencephaly and spina bifida) among births to women who received no prenatal care or prenatal care in the third trimester only, 1990–1999, for 45 U.S. states and Washington, DC. source: National Center for Health Statistics, Vital Statistics Data. Adapted from Honein et al.²⁶

Figure 7

Prevalence of anencephaly and spina bifida, Metropolitan Atlanta Congenital Defects Program, 1968– 2000. Dark bars indicate prenatally diagnosed cases; light bars, hospital-based cases, which include both liveborn and stillborn infants.