Judul : Core Functions Of Public Health
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Core Functions Of Public Health
[music playing] welcome to the introductionto public health laboratories course. i work at the centers fordisease control and prevention in the office of the associatedirector for science.
Core Functions Of Public Health, this course covers thefollowing six topics that will help youunderstand some basic aspects of public health laboratories. number one, a publichealth approach.
two, what are publichealth laboratories? three, core functions of statepublic health laboratories. four, public healthlaboratory infrastructure. five, laboratory safety. and the sixth topicis using the results to affect public health. after today'ssession, you will be able to describe the role ofpublic health laboratories, summarize the core functionsof state public health
laboratories, describethe parts that are common to allpublic health laboratory system infrastructures,recognize the need for differentlaboratory levels and safety practices, explain thenecessity for communicating with a laboratory whencollecting and submitting samples for testing, describehow laboratory results are used to affect public health. first we will learn aboutthe public health approach
and how it relates topublic health core science. let's talk about publichealth in a broader context. public healthproblems are diverse and can include infectiousdiseases, chronic diseases, emergencies, injuries,environmental health problems, and other health threats. regardless of the topic, thefollowing four general steps are taken in approachingany public health problem. first, we ask, whatis the problem?
in public health, weidentify the problem by using surveillance systemsto monitor health events and behaviors occurringamong a population. after we haveidentified the problem, the next question is, whatis the cause of the problem? for example, arethere factors that might make certain populationsmore susceptible to disease, such as somethingin the environment or certain behaviors thatpeople are practicing?
after we have identifiedthe risk factors related to the problem, weask, what intervention works to address the problem? we look at what hasworked in the past in addressing the same problem,and if a proposed intervention makes sense with ouraffected population. in the last step,we ask, how can we implement the intervention? given the resourceswe have and what
we know about the affectedpopulation, will this work? as we go throughthis course, you will see different examplesof this public health approach at work. to implement thepublic health approach, practitioners use andapply scientific methods. these methods come froma series of core sciences that provide the foundation. these sciences includepublic health surveillance,
which we use to monitor apublic health situation. epidemiology enablesus to determine where diseases originate,how or why they move through populations,and how we can prevent them. public health laboratoriessupport public health by performing tests toconfirm disease diagnoses. laboratories alsosupport public health by conductingresearch and training. as we continue to move fromthe use of paper documents
to electronic health records,public health informatics continues to increasein importance. informatics dealswith the methods for collecting, compiling, andpresenting health information. it enables us to useelectronic data effectively when addressing apublic health situation. prevention effectivenessis closely linked to public health policy. prevention effectivenessstudies provide
important economic informationfor decision makers to help them choose thebest option available. together, thesefive core sciences can help us protect andpromote the public's health by giving public healthpractitioners the answers they need. public health is better ableto respond to the situation by using contributions fromeach of these sciences. one science alone cannot answerthe questions and provide
a solution. it is the application of thesecore sciences taken together. in the secondtopic, we are going to find out what publichealth laboratories are and what type ofservices they provide. this slide has abrief video that provides an overall descriptionof what a public health laboratory, or a phl, is. [video playback]
-ever wonder who identifieshealth threats to keep your world safe and healthy? it's the laboratorians atpublic health laboratories across the country. as part of thepublic health system, these governmental labs work tokeep your communities healthy. and they play a biggerrole in your life than you may haveguessed, starting with newborn screeningsthat identify dangerous
genetic and metabolic disordersthat can cause disabilities or even death earlyenough to treat them. laboratorians aredisease detectives, working tirelesslyto prevent outbreaks by monitoring communitiesfor pathogens that spread through contact withpeople or your environment, and testing to protect youfrom foodborne illnesses. public health labs test drinkingand some recreational water for bacteria,parasites, pesticides,
and other harmfulsubstances, all as a part of a coordinatedhealth system effort to have fewer sickpeople, and ultimately a more comfortableenvironment to live in. you may not haveheard about them, but in one way oranother, their work has affected your life andthat of every american. learn more about how publichealth laboratories protect your health at aphl.org.
[end playback] after watching this video,how would you now describe public health laboratories? public healthlaboratories, or phls, serve as the firstline of defense to protect the public againstdiseases and other health hazards. working in collaboration withother arms of the nation's public healthsystem, phls provide
clinical diagnostic testing,disease surveillance, advanced skills inlaboratory practice. the goal of publichealth laboratories is to protect andimprove public health by testing samples, providingexpertise, and communicating scientific information. public health labs support theidentification and confirmation of illness during outbreaks. they conduct researchfor future responses
to public health situations. and they provideinformation that can be used to generatepolicies and procedures that are related to public health. you probably understand theconcept of a laboratory, but you might be thinkingmore about the role that laboratories play inclinical laboratory testing. for example, when you goto your doctor's office for an examination, youmight need some routine tests
performed, such as cholesterolscreening or routine blood work. these types of testsare usually performed in clinical laboratories,where the focus is on the individual patient. clinical laboratories are oftenprivately owned and operated. by comparison, phls,or public health labs, focus on diseases and healthstatus of the population groups by performing limited diagnostictesting, reference testing,
disease surveillance, andemergency response support. they also performapplied research by using the practicalapplication of science. and they provide trainingfor laboratory personnel. public health labs providemany public health functions, such as screening of allnewborn babies for diseases and conditions. in august of 2013, the nationcelebrated the 50th anniversary of the first newbornscreening tests.
these tests were developed todetect conditions among infants immediately after birth,because certain conditions, such as metabolicdisorders, can result in serious illnessand even death. the testing panel hasexpanded over the years substantially since the firsttests were administered. although newborn screenings varyamongst the different public health laboratories, a commontest is for hypothyroidism. this condition occurs whenthe thyroid gland does not
produce adequate amountsof thyroid hormone to meet the body's needs. hypothyroidism canaffect an infant's growth and cause brain damage. however, if thiscondition is identified through a newbornscreening test, the infant can betreated with medication. let's do a quickknowledge check based on what you've learned so far.
which of the following areactivities and services performed by publichealth laboratories? select all that apply. a, conducting blood tests aspart of the ongoing management of a patient's disease. b, testing samples collectedduring a disease outbreak. c, providing screeningfor all newborns. and d, training publichealth laboratory personnel. b, c, and d are all examplesof activities and services
that public health labs provide. answer a relates toa clinical laboratory that likely performstests that are part of the medical managementof an individual patient with a chronic oran ongoing disease. which of the followingis the best example of what public healthlaboratories do as opposed to clinical laboratories? a, cholesterol testing.
b, diagnostic testing. c, routine blood testing. and d, disease surveillance. the correct answer isd, disease surveillance. now that we have coveredwhat public health labs are, let's learn about thecore functions of state public healthlaboratories, which is the third topic in this course. the association of publichealth laboratories, or aphl,
has established11 core functions that provide a basis forassessing and improving the quality of laboratoryactivities being conducted by public health labs. the list demonstratesthe variety of functions that are performedby state public health labs or laboratories atthe local, regional, and at the national level withina broader public health lab system.
let's take a closer lookat these core functions. this slide covers corefunctions 1, 2, and 3. the first function isdisease prevention, control, and surveillance. it includes the ability toprovide accurate and precise results in a timelymanner and serves as the center of expertise. it also provides specializedtesting and population surveillance.
reflecting back on thenewborn screening example, this function is usedfor early detection of congenital disordersamong newborns. integrated data managementincludes the gathering and sharing ofscientific information that supports publichealth programs serving the needs of state. an example wouldinclude the ability to capture data to detecttrends and analyze outbreaks
by reviewing the datato detect increases in a specific strainof flu, for example. state public healthlaboratories serve as the primaryreference laboratory for specialized testing. for example, thismight include testing for rare but extremelyserious diseases, such as those causedby anthrax, plague, or other agents of bioterrorism.
certain kinds of testscan be highly complex. they might requirespecial equipment, personnel withspecialized training, or exceptional safety practices. not every clinicallaboratory can or should have the ability to runthese kinds of tests. this slide outlines thecore functions 4, 5, and 6. environmental healthand protection refers to the ability to conductanalysis and provide services
related toenvironmental samples, such as testing performedafter the 2011 oil spill in the gulf of mexico thatresulted from an oil rig explosion. laboratories might also testfor toxic chemical, radiologic, or microbiologic contaminantsin air, water, and soil, or for contaminants resultingfrom hazardous waste. state public healthlaboratories are also expected to test andanalyze specimens
related to food safety. this includes samplesfrom persons, food, or beverages duringfoodborne illness outbreaks to detect theresponsible pathogen. items such as beef,milk, and ice cream are routinely tested for safety. the state publichealth laboratory takes a leadership rolein laboratory regulations by coordinating and promotingquality assurance programs.
they also overseelicensure, accreditation, and laboratory certification. state public healthlabs inspect many of the clinical andprivate laboratories to ensure that theyare in compliance with federal andstate regulations regarding the testingof clinical samples. this is crucial for ensuringthat test results are accurate. we will learn aboutcore functions
7, 8, and 9 in this slide. state public healthlabs are charged with providing both scientificand managerial leadership in the development of state andfederal public health policies and standards of practice. this generatesscientific evidence on which to base public healthpractice, standards, and laws. public health labsalso play a key role in emergencypreparedness and response
by responding to requests forrapid, timely notification and secure messagingof results that are associated with actsof biologic or chemical terrorism or other high-prioritypublic health emergencies. an example of thisis the response to the anthrax-taintedletters that were sent through theunited states postal mail in october of 2001. the clinical laboratorysent the suspicious isolate
to florida state public healthlab, where the identification was quickly confirmed,resulting in an immediate national response. next is public-health-relatedresearch. this function can be performedby all public health labs. public health labs arean essential collaborator for research into newways to identify diseases, new drugs to fightdiseases, and new vaccine to prevent diseases.
many public healthlabs work with partners to validate new methodsbefore they're implemented in other public health labs. finally, in this slide, wewill learn about core functions 10 and 11. state public healthlabs serve as resources for training andeducation and are expected to be skilled inthe latest procedures and use of equipment.
for example, a statepublic health lab might be the first to receivea newly developed piece and they mightbring in technicians from other laboratories to teachthem how to use the equipment. developing andstrengthening partnerships between state, county, city,organization, academia, and private industries isalso a core public health lab function. here, public health labsparticipate in strategic policy
planning and work on maintainingstrong communication channels among different types ofpublic health personnel. these laboratories linkto national networks and help support thecoordination of public health activities. thinking back to newbornscreening program we discussed earlier,what public health lab core functions do you thinkapply to newborn screening tests?
let's do anotherquick knowledge check. newborn screenings vary amongpublic health laboratories. however, they all testfor which condition? a, diabetes. b, leukemia. c, jaundice. and d, hypothyroidism. the correct answeris d, hypothyroidism. 11 core functionshave been established
by the association of publichealth laboratories, or aphl, to provide a basis for blank andblank the quality of laboratory activities being conducted. a, assessing and maintaining. b, assessing, improving. c, maintaining, standardizing. and d, improving, standardizing. the correct answer is b,assessing and improving. now that we know more aboutthe core functions of state
public health labs, let'sdiscuss topic number 4, which is the public healthlaboratory infrastructure. public health lab systems area network of federal, state, and local laboratoriesthat work in collaboration with private laboratories,such as clinical and physician laboratories. in addition, state and citypublic health departments were at the forefrontof establishing the first public health labs,whereas federal laboratories
were not established until 1946. because the basis ofpublic health authority rests with the states, thestate public health lab is considered the central focusof the public health system. each state or territory'slaboratory infrastructure varies on the basis ofavailable resources, the needs within eachstate, and governance in that jurisdiction. public health labsserve many agencies
and perform diverse functions. therefore, theirstructure is often based on theavailability of resources and the laboratory's functionsin the case of an incident or situation. although this graphicthat we're looking at depicts some ofthe key functions of the infrastructure,each public health system varies and might includeadditional components
or stakeholders, such as firstresponders and epidemiologists. in certain situations,environmental health laboratories operate underthe federal government, but the state publichealth laboratory is part of the state'shealth department. some of the key componentsof state public health labs include environmentallaboratories, physician laboratories,clinical laboratories, local public healthdepartments and laboratories,
and federal publichealth laboratories. the public healthlaboratory infrastructure varies across jurisdictionsbecause of differences in funding, grants,associations with universities, and state governmentaffiliations. communication andinteractivity is vital within theinfrastructure, because it can affect how quickly andaccurately public health lab situations are addressed.
for example, aphysician laboratory might refer aparticular specimen to a clinicalreference laboratory. and that laboratory mightrefer it to a state laboratory. public health surveillancesystems and public health labs depend on thereferral and reporting by physicians andclinical laboratories. in certain situations,laboratories share their resourcesacross jurisdictions
to better fulfill theessential functions. alternatively, apublic health lab might need to work withmultiple laboratories to diagnose and implementnew diagnostic practices. now let's take a closer lookat the public health system infrastructure and itsvarious components. state and territorial labscomprise the first component. every state and territoryhas a public health lab. these centralized publichealth laboratories
perform tests on behalfof their jurisdiction and are often part of thestate health department or another departmentwithin the state. they assist in regulatinglaboratories within the state by developing new policiesand methods for detecting and combating disease. many states also have localor regional laboratories that support publichealth activities. state public health labsand some local or regional
laboratories mighthave the ability to conduct testingunavailable elsewhere. the second component iscomprised of federal labs. federal publichealth labs become involved when additionalassistance is needed or a widespread publichealth threat occurs. cdc, the united statesarmy medical research institute ofinfectious diseases, and the food anddrug administration
are examples offederal agencies that operate public health labs. federal public health labsperform specialized testing that state andlocal public health labs are unable to perform,such as identifying certain chemical,toxin, radiologic, and biological substances. they also haveresponsibility for follow-up on a larger scale.
for example, in the case ofwidespread chemical spill, not only would the localand state public health labs and the environmentalprotection personnel respond, but the united statesenvironmental protection agency might be called in to assistwith the cleanup and testing. cdc might becomeinvolved by assisting with the epidemiologicinvestigation, and with testing specimens fromthose persons who were exposed to a particular chemical.
federal public healthlabs might also help develop newmethodologies that can be passed down tostate public health labs for further testing,research, and implementation. the third component includesenvironmental laboratories that focus on testing samplesfor air, food, soil, water, and zoonotic illnesses,zoonotic meaning a disease that normallyexists in animals but that can infect humans.
as mentionedpreviously, they might operate within or undera different organization than the state or localhealth department. private laboratoriescomprise the final component. although privately operated,clinical or physician office laboratories areoften used to identify the initial cases associatedwith a given outbreak. in reporting systemsand networks, these laboratories refer resultsand information up the chain
to state laboratories. here's a quick check basedon what you've just learned. which laboratory serves as thecenter of the public health laboratory systeminfrastructure? the correct answer is b,state public health labs. here's another knowledgecheck question. in the event of asalmonellosis outbreak, what role might a federallaboratory perform? a, collect specimensrequired for testing.
b, send specimens to clinicallaboratories for confirmation of initial findings. c, confirm casesthrough testing. and d, provide guidelines andrecommendations for testing salmonella bacteria. the correct answer is d, provideguidelines and recommendations for testing salmonella bacteria. now that you have beenintroduced to the public health lab infrastructure,let's take a look
at another important aspect,which is laboratory safety. each laboratory must havekey safety principles and procedures in place tominimize the risk to laboratory personnel and others forcontamination and exposure to the pathogens thatare being tested. specimen submittalprotocols are crucial, because each laboratory has itsown safety procedures in place for collecting, shipping,labeling, and performing tests. as the risk associated witha sample increases, the level
equipment and personnelprotective equipment needed also increases. in biologic laboratories,one of four biosafety levels is assigned, with level 1being the lowest and level 4 the highest. level selection depends ondifferent factors, including how the organisms spread amongpersons, for example, by air, water, orperson-to-person contact. as the risks associatedwith the microbe increases,
the assigned level increases. for example, a virusthat spreads by air can spread very quickly andeasily from person to person, and requires complicatedhandling in the laboratory. if a vaccine or effectivetreatment does not exist, a high biosafetylevel is required. however, an organism that doesnot cause severe disease only requires a low biosafety level. each laboratory must displaysigns notifying personnel
of the applicable biosafetylevel that represents how the agent should be handled. each biosafety level has its ownspecific containment controls, safety equipment, and requiredfacility construction. different types of specializedcontrols and equipment are used to provide barriersbetween the microbes and the laboratory practitioner,ranging from disposable gloves and face shields tocomplex biosafety cabinets. overall, laboratorysafety is governed
by local, state, federalregulations administered by different agencies. the occupational safety andhealth administration, or osha, has published extensive guidancefor minimizing the risks and making laboratories safer. osha standards providerules that protect workers from chemical hazards aswell as biological, physical, and safety hazards. other federal entities issueguidelines and regulations
for programmatic testing, suchas the clinical laboratory improvement amendments,or clia, which are federal regulatorystandards that apply to all clinicallaboratory safety practices. the usda, doj, epa, fda,the cdc, and nih all have additional guidelinesand regulations in place regarding how testingand laboratory practice must be conducted. safe specimenhandling and shipment
is a crucial part oflaboratory practice. all public health labs havespecific specimen collection manuals that must beprovided to users. quality standardsgovern laboratories in terms of specimencollection and shipping. incorrect collectionand shipping can result in thelaboratory being unable to performthe requested test, or can cause it toprovide invalid results.
because specifications,collection methods, and shippingprocedures are based on the qualifications ofthe receiving laboratory and the type of specimensbeing collected, entities submittingsamples for testing need to know the correctprotocols to follow. before sample collection,those entities should know what typeof samples to collect, what methods to use forcollection of samples,
how to store the samples, whichlaboratory can receive and test the samples, how to pack,label, and ship the samples. packing and shipping techniquesmight include refrigeration or the use of dry ice whereultra-low temperatures are needed. the importance of correctpackaging and shipping cannot be overstated. for example, anthraxsamples that are incorrectly packaged and shippedwill be rejected,
because that places thelaboratory personnel at a very high risk for infection. this will delaypublic health response and impede crucial publichealth interventions. before shippingsamples, staff should determine if the specimen isappropriate for the designated public health lab, identify thecorrect packing and shipping techniques that needto be used, and ensure that the specimens have correctdocumentation and labels.
after the laboratorycompletes the testing, the test results are deliveredby telephone, us postal mail, express mail delivery,or email, depending on the laboratory and theurgency of the needed test results. here's another knowledgecheck question based on what you've just learned. true or false, safetyprinciples and practices are the same forall laboratories.
a, true. and b, false. the correct answer is b, false. now that you know moreabout laboratory safety, we will take a closerlook at the last topic, which relates to how laboratorydata are used in public health. as noted earlier in the course,communication and collaboration within the public healthinfrastructure is critical. electronic labreporting, or elr,
uses automated systemsfor the rapid reporting to health authorities, whichcan help them quickly identify trends and alert otherpublic health professionals. these reports are used forsurveillance and disease intervention, andhave many benefits, including improved timeliness,reduction of manual data entry errors, and reportsthat are more complete. examples of elrs include thefollowing, the laboratory response network,or lrn, that focuses
on bioterrorism andchemical terrorism response. the food emergencyresponse network, or fern, integrates the nation'sfood testing laboratories at the local, state,and federal levels into a network that is ableto respond to emergencies involving biologic, chemical,or radiologic contamination of food. pulsenet is a national networkof public health and food regulatory agency laboratoriesmaintained by the cdc.
pulsenet facilitates earlyidentification of common source outbreaks by comparing theindividual dna fingerprints from certain bacteriaidentified by public health labs and determining if bacteriawith matching fingerprints might be associated with agiven foodborne outbreak. communicationwithin this network can help foodregulatory agencies. after the public healthdata from the elr are collected anddisseminated, they
can be used to monitortrends and detect changes. for example, increasedresistance to antibiotics can be identified, orsyndromic surveillance can be used to enhancelaboratory and informatics data analysis. data can be used to identifyor confirm an outbreak. for example, laboratoriesperform seasonal testing for the west nile virus, avirus caused by mosquitoes. testing is conducted on humanspecimens and mosquito pools
to confirm that anoutbreak is occurring or is likely to occur. after a laboratory confirmationthat a disease is occurring in a community, thepublic health authorities can take immediate action byissuing guidance and control measures. in the west nile virusexample, authorities might conductprevention activities, such as communitywideinsecticide spraying
to eliminate mosquitoes,or broadcasting prevention messages to the public. laboratory data are also helpfulin evaluating and creating public health policy. again in the case ofthe west nile virus, one potentialpolicy change might be to require seasonalcommunity mosquito control programs as a matterof course, instead of waiting for the illnessto occur each and every year.
public health labs are also usedin determining disease history. for example, westnile virus was first found in the west niledistrict of uganda in 1937. but it did not appearin north america until 1999, when itwas first identified in laboratory specimensfrom both humans and horses. laboratory data can be used toprioritize resource allocation, including funding or personnel. laboratory results formosquitoes infected
with west nile virus allows thefocusing of mosquito control efforts to specificgeographic areas, rather than throughout anentity, city, state, or region. laboratory datacan provide a base for epidemiologic research. this can help guidelong-term resource allocation to prevent futurewest nile virus outbreaks in a specificregion, for example. the data can also helpidentify environmental hazards
and exposures. an example wouldbe lab data that indicates if environmentalhazards were created as a result of the communitywideinsecticide spraying to prevent the spread of west nile virus. which of the following describehow public health laboratory data are used toaffect public health? a, guide public policy. b, determine disease history.
c, detect changes. and d, all of the above. the correct answer isd, all of the above. now that you havecompleted this course, you should be able to describethe role of public health laboratories, summarizethe core functions of state public health laboratories,describe the parts that with the laboratory whencollecting and submitting this slide provides youwith additional resources
and reading material.
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