Focus 580; The Role of Public Health

In this part of focus 580 will be talking about the role and the challenge of Public Health. I think it's fair to say that if you go back to the era before modern medical technology before we had MRI eyes and before we had antibiotics the kinds of tools that physicians use today if there was an improvement in the health of people it was in large part due to developments in public health. More reason in recent years particularly now that we have gotten into the into the time of high tech in medicine we seem to have not paid quite so much attention to public health anymore. And some people would suggest that that was a mistake particularly now that in the last couple of months we've been starting to think about serious threats to public health in this country. Some of them perhaps introduced intentionally or some accidentally certainly within the last few years one of the things that we've seen around the world is a resurgence in infectious disease. And then recently we've been worried about bioterrorism and so now we find ourselves turning

to the public health infrastructure and realizing that we have really allowed it to to decline to erode in recent years. This morning in this our focus we will talk a little bit about public health with two guests here in the studio with me Jack McIntyre. He's director of community health nursing and clinical services at the champagne Urbana public health district. And also joining us by telephone is Dr. Quentin Young. He is a physician. He is past president of the American Public Health Association. He was for a number of years between 72 and 81 chairman of medicine at Cook County Hospital in Chicago and has been now for some time a very vocal proponent of national health. He's joining us this morning by telephone as we talk with the two guests. You're certainly welcome to call us and ask questions make comments. The number here in Champaign Urbana 3 3 3 9 4 5 5. We do also have the toll free line that means that it would be a long distance call for you. Use that number 800 to 2 2 9 4

5 5 3 3 3 wy L.L. and toll free 800 1:58 w whilom. Well here in studio is director. Good morning. Thanks for being here. Good morning thank you for inviting me. And here on the telephone with us Dr. Young Hello. Good morning. Thanks for talking with us. It's a pleasure. To what I think maybe to begin we really ought to talk a little bit about what we mean when we buy public health. You know what really that is. It may be that different people have different ideas or some people have no idea. Let me maybe I'll start with Dr. Young here. One of the things out about you I mentioned was that you were the you have served as president of the American Public Health Association So what really is is is the mission of public health. What is it about. Well the best definition I'm agreement with there are several but this one captures that. It's what society as a whole does collectively together to enhance the health status of a people. They have obviously means that it's. A

function that's not individual but is general that done by government by and large and they just want to take the moment to extend very good analysis of the role of public health of recent centuries. My favorite starting point is that in the last century and a half since the middle of the 19th century human life in the US has doubled from roughly 40 years life expectancy then to nearly 80 years right now. And as you pointed out vividly that is almost entirely the work product of public health science things like separations drinking water from sewage. Very big mass immunization early prenatal care clean air clean water safe food all public health activities. And I think you can say without cavil that doubling of the life expectancy is unprecedented in all of human experience from the very beginning

and yes laterally as you pointed out there's been a sense that the thing I do as a doctor give penicillin or operate hide says other of my colleagues do is the sea. Good health and of course it isn't. We let our public health system get into disrepair and we're having a wake up call now and I'm sure we'll be talking about it you know. Well then let me then turn here to Jack MacIntyre in the studio and I don't know what you would like to add. Certainly it's from the way the doctor youngest has defined it and very nicely in just a few words. You realize that here we're talking about an area that's extremely broad. Everything from let's say educational efforts directed at people to try to persuade them in that that smoking is not good all the way over to making sure that people who otherwise couldn't afford it could get vaccinations for their children. I

mean this really covers an enormous amount of ground. Yes it does. I mean one of the really important things when you think about public health is that the people within the public that you're serving whatever government agency it is at need to be actively involved. And it kind of reminds me of the Chinese proverb that I've read in the past as if it. Tell me. I forget. Show me I remember. Involve me I understand that public health requires public participation. It's not something that a group here a government agency here or there can do without having the support of their constituents. Well it also I think Dr. Young makes me think about the fact that in recent years it seems that we have shifted away if we think of why

people get sick. It seems that in recent years what we've done is that we have gone more and more into a mindset that says if people get sick it's their fault. It's their fault they get sick. And is there and it's their responsibility to get well and somehow that that that's the the perhaps older mindset the one that was more prevalent in the time of when public health was very strong and making a big impact was. Well yes but that there's really much more more to it than that and the conditions under which people live often conditions that they don't have a lot of control over that does indeed have a big impact on people's health. And it's not always simply a matter of saying to somebody look you know you know what to do. You know what you should be doing. You do it and you'll be healthy. That's an excellent point because I think it underscores. A profound ideological and even political reality in our country and you state it well. Public health major premises and

all of its activities presume that you have a societal problem that the water that everybody drinks is a danger. It's not pure to everybody that contagion next door can infect your house tomorrow and therefore it is a forced group effort. And the notion that that is the distortion that individual responsibility resides in personal responsibility for health is a misnomer of course. There is lifestyle habits like smoking and excessive use of alcohol in the even the overeating which is emerging. Perhaps our biggest addiction but are clearly personal decisions. But it is a societal responsibility to create conditions for people to correct those problems whether it's smoking. We were in the mid century not as a nation

of grappling with the tobacco. Epidemic and the consequent dreadful health outcomes. And that takes a strategy for example to end the rush of young girls literally girls age 11 and 12 are the fastest growing group of smokers new smokers. That can't be done by saying to the 11 year old your social responsibility is to not smile of course you say that you have to do a lot more as a society using public health efforts as Mr. Mc just pointed out to educate and to constantly change the reality. If I may I'd like introduce my thoughts on why public health is in such disarray at the beginning of the 20th century and the other comment. It turns out that up until mid 90s 20th century post-World War Two public health enjoyed enormous popularity because people could see the results not only

better life expectancy but better life. And the public supported vigorously all of the rules and regulations that were necessary to make it happen. Meat Inspection compulsory immunization water purification fluoridation. I don't want to give and the endless lists but these are the real findings and applications of Public Health that the public really liked and that was a period that same century before 1950 when there was a general growth and development of the public health infrastructure at the local level the state level and nationally. And we'll get into those those institutions that emerge. But what happened in 1950 I argue three things happen. One public health was a victim of its own success. People really believe that the public health problems notably in sections were conquered. The transformation took place in American life when polio

which was the dread annual Reaper of death and terror. This is a particularly children was just was made to disappear by a vaccine. Smallpox was literally ended. This is probably the most important source of death the humans in the preceding centuries was eliminated. So people understandably but wrongly said it's all over. Celebrate and let the doom of public health started to underfunded and degraded. The second thing that happened was always there but became very manifest. If you think a moment all public health officials were talking about the surgeon general the director of Public Health in the state of the commission of Health in Chicago each of these people are appointed by the elected public officials subordinate to him or her and therefore requiring the end of the day to support that public

officials health policy. They can object but if they persist in their objection they get to lose their job and they're replaced by somebody more malleable. That's. An undesirable situation in an area that needs independence and it's the subordination of the health officials and many of them are standing. Korean surgeon general is a giant. And yet you notice he's in the first few weeks of this anthrax that he was muzzled. You always see former Governor Thompson who knows nothing about the issue as the only spokesman and David said to muscle that's not a figure of speech he was not allowed to speak. I utterly they've given him a little more leeway but that's a beautiful example of the subordination of public health policy and leadership to the political process. The last thing is is very interesting and has a lot of pertinence to our current situation following World War 2 a question into a phase where we were a giant

superpower worried mostly about the Soviet Union but other enemies. And we we shifted almost all of our new energies in public to bacteriological science and literally anticipating bacteriological warfare bioterrorism if you please. And there was a sharp reduction in the funding of public health facilities. At the same time. And the irony is that a half century later we have a great capacity to selves to develop. Liesel organisms in other words we could if we were vile enough and I'm civilized I don't think we are use these weapons I sowed but we haven't learned how to defend themselves. Witness the emphatic excitement and it's very hard to to solve the problem by a bacteriological research alone. I guess they close by saying those

three elements brought public health down and we find ourselves in the sudden panic as we have new demands on the system and I'm pleading that we don't make those mistakes again. Let me hear a real quick and with an I'm sure Jack McIntyre would like to end on there but I'm thinking for people who might have tuned in I should say who the guests are here one more time Dr. Quinn Young speaking with us by telephone he's physician. He's past president of the American Public Health Association for a number of years was chairman of medicine at Cook County Hospital in Chicago and actually Dr. Young you're still practicing Are you some would say it's time to. But I know I practice so much 3 days a week I go in and join my very very intelligent younger partner in the practice of Internal Medicine. Very good and here in the studio with us Jack MacIntyre who is director of community health nursing and clinical services at the Champaign-Urbana public health district. For people who are listening questions comments are welcome. He'd like to join us you can call here in Champaign Urbana 3

3 3 9 4 5 5 toll free 800 2 2 2 9 4 5 5. Mr. Rector you've been real like to add anything on to what Dr. Young said. Well I I think he's entirely right. One of the other thing you know in regarding to the victim of our own success I think one of the things that public health had to grapple with that as the communicable diseases particularly childhood communicable diseases were being eliminated we we looked for OK what do we do next. And some people had the foresight to look at chronic illnesses because as people lived longer we were getting more people with chronic illnesses and how do you prevent that. And so that's been an evolutionary process and we're finding new things every day. Number of genetic diseases that are in the forefront now that we didn't know even back in the 50s and those kinds of things and how do we address those those problems. So I

think that yes that the public health was a victim of its own success and then once they had reached that you know where do you go from there. I want to revisit if I may David Mr. McIntyre's earlier a very important point about the Civic the public participation and public health activities. You are absolutely right about nothing. Without that you have a public that is energized and supportive and cooperative and in need demanding of the system. You will not get where you want to go and you come to you. Both of you know you are in a county where there's been an extraordinary example of this kind of activism literally by a group of friends of Public Health. It's kind of hard to believe that at the end of the 20th century you still didn't have in parts of your county being county basic public health

services and it took the citizen initiative to vote on the ballot and make it come to pass and I'm once thrilled by the vigor of the leadership that made that happen but also a part of that in a county that hosts world class university and you know is for its scientific grounding to mention its civic grounding that they would have to fight a late date for elementary public health services. It's a good example of our plight. Champaign County is not the only county in America that doesn't have basic public health services. And it saved me beyond the absence of basic services there are tremendous deficits now public health capacity many health departments don't have computers. They literally can't communicate in a modern way. Very few have an email an email capacity and that

that's also very serious and I present them. Let me make my point and I'm sure Mr Mick and I will affirm the survey and the estimates of prevention is detection the way we stay as good as we're doing with all the defects is that the Centers for Disease Control are the most advanced system for detecting beginnings of epidemics breaks that we want to get our hands around and without that defends the Center for Disease Control and Prevention is the federal government's Landa based entity that we all depend on and it's our first line of defense. And it's we do believe they work in buildings where the roof leaks and they are enjoying the support at this moment. It's never been adequate to a nation of our wealth and and multiple problems. We have a caller to bring into the conversation when we do that and make them wait their on line

number one. In Champaign. Right here. Well yes thank you. Yeah. And having been involved in that fight to get the public health district established in this county I've got to say the battle still continues I mean not I mean you know we won that battle and initially the Republican county board continued to fight it and did everything they could to keep from implementing it. And then the last act of the Republican county board before they were replaced is a majority by the Democrats was to deny an increase in the budget before the tax caps that were voted in completely you know locked down the possibility of adequately funding the county board. I mean the health district and so they're still somewhat hobbled and you know it's just been a continuing battle here.

Yes that's true. Tonight they're going to the county board will meet to vote on the budget. It's the amount of money that they've been able to. The Democrats would like to add to the budget is not entirely not completely adequate but it certainly is more than what what the Republicans would like to add to it. And I would just say that any of you hearing this. You know it's not too late to call your representative to the county board and and and tell them of your support of the. Of the health department and what they can do in the county. We're trying very hard we get that calls every day from people in the county who need either don't care primarily or even home visiting so that they can continue to live in their homes to

assist with it. Medication management are doing such the simple things as a blood draw that doesn't take very long to do and in that for us but for the person to get out of their home with their disability it's an all day event and then they're exhausted at the end of the day. Those kinds of things that they County Health Department the County Board of Health would like to keep it you reinstate keep keep going for us. You know David this is obviously a dispiriting conversation that the filaments are things that come very close to what defines a civilized society should be and debate. But it's fair to generalize that distance of Champaign County here in Chicago that over the centuries of the development of public health every public health discovery an advance

did confront some vested interests whether it was finding out workplace hazards and requiring higher higher protections for workers or as we've been talking about water and sewerage in tow. Body have to change their way of doing things and there is a cost associated and it's fair to say that every one of these things have been resisted. Sometimes you know for very sectarian reasons fluoridation which is such a spectacular solution to the problem of dental caries in children and adults has been fought across this country by different groups because of special incest immunizations Likewise I'm not arguing there are no controversies surrounding these forms but that the resistance has always been there and hear from the caller that it's to continue. And I'm just arguing that this time round.

As a nation we have to find a way to unify the strong strong public system including in my book a system operating in the country that has universal health care because they tried to say earlier say it one more time. Health is not in that sense a personal matter. Contagion or a social dependency. These become the saddle burdens. Our guest here this morning in this part of focus 580 Dr Quentin Young he is the past president of the American Public Health Association continues to practice medicine in Chicago he was for a number of years chairman of medicine at Cook County Hospital also here in studio Jacques MacIntyre from the Champaign-Urbana public health district he is the director of community health nursing and clinical services. We're talking about public health questions are welcome 3 3 3 9 4 5 5 toll free 800 2 2 2 9 4 5. I have another colicky I want to get onto in a second but what I want to do here is give Jack MacIntyre the opportunity to talk for a couple of minutes about the

public health district in Champaign-Urbana. As we were talking before the show I suspect that there are many people who live in Champaign-Urbana who who either don't even have any idea of the Public Health District exist or if they do and you ask them Well what is. What do they do there. They really wouldn't have much of an idea. What does the public health district of Champaign-Urbana do. We have a number of programs that are divided in kind of groups. There's we have an environment health division that does all the food inspection water. All of those environmental kind of things lead assessments in homes that sort of thing. We have another one called Community Health planning and education they do looking at the statistical data regarding the health status of the whole county. And do some analysis of that

and also do education in a variety of areas they do education regarding. Tobacco cessation. They work with schools community organizations and in injury prevention. One of those particularly has to do with the Safe Kids Coalition. And in this side from you know just and we try to partner with other groups in the community to provide a number of these services. We do in the nursing and clinical services. We actually have some clinics immunization wild child school physical integration physical. STV clinics. We have a very active program for providing in-home nursing services to seniors and the disabled to help them age in place so that they are less likely to go

to a nursing home. For every one of the seniors we keep out of a nursing home for a year. We say that because of mostly school. Clients are low income clients. We save the state probably about $35000 a year in Medicaid funding for nursing home placement. And so when you look at it from that perspective you know we're we're actually saving ourselves some money for that in the we have grants in genetics we have grants in diabetes we have grants and a hearing a vision screening in the schools in the two cities. We have another section that has the whip program which is the Women Infants and Children program supplemental food program for low income women who are pregnant breast feeding and for children up to age five. We have a case management

unit that helps to monitor low income women when they're pregnant to make sure that they get all of the needed services that are that they should have to have a healthy outcome in their pregnancy and in those. And those are some of the major things that we we do in our. And then where does the money come from to operate the health district. A lot of it comes from within the Health District which is the two townships of Cunningham and. The city of champagne townships which are almost grown with the two cities. And then we have a number of grants that are from the state. Now since almost all the grants that we get from the state are for county services as well. So services going to the county and some of the some of the grants that we get are multi-cam. We have one for breast and cervical cancer prevention and that one is multi County It includes McLean County

and Vermilion County as well. Let's talk with another caller here. This person is in Champaign airline number two. Hello. Hi I was calling I'm. I'm in a same situation as the previous caller in terms of being somebody who has worked for the past five years to try to ensure that we have public health services for our county residents. And I was interested with what Dr. Quentin Young said earlier about the subordination of Public Health to the political process. And certainly we have seen that to be true locally. And what Jack McIntyre was talking about a few minutes ago regarding the county board vote tonight on funding for public health is very much a result of the local political process. Many of us in the community are advocating for the full funding for the health department. The board tonight will be voting on approve. One hundred and fifty of the two hundred and ninety some thousand dollars that the health department wanted. And I guess one of the points that I wanted

to make is that the services that are being proposed the new services that would be created the child dental care services the need is just indisputable in Champaign County. But the main point that I wanted to make is that the other service the home nurse visits that the Board of Health would like to reinstate for county residents. Those services are very important in terms of meeting current needs of county residents in Champagne County we have 10 rural townships that have been declared by the federal government as medically underserved areas. And that designation as a result of two factors poverty in those communities as well as distance from health care providers. And so the home nurse visits are very vital right now and county residents would benefit from those but I guess I was wondering if Jack McIntyre and Dr. Quentin Young could maybe comment on the second aspect. One of the things that we're trying to say is that the home nurse visits

would require the hiring of public health nurses to meet immediate needs. But. Public health nurses would also be a very important investment for champagne county in the event that we would ever have a disaster or an emergency because in fact public health nurses are the front line people who would respond to disasters or emergencies. And I just want to wonder if Jack McIntyre or Dr. quite young could sort of talk about the importance of public health personnel not just in providing current services but in terms of addressing emergencies or disasters. And I'll hang up and listen. OK. Well thanks for the call. Oh no he wants to go first. Mr. Rector you want to go first. Well I think in the county them that the public health nurses would be on the front line of any kind of bioterrorism attack that sort of thing to assist in a number of ways identifying people who are greatest

risk who need what kind of services the fastest those kinds of things. And they're very key. If we don't have the number of people available to us to do that then. That's going to be more difficult to respond and maybe even be an ending a contributor to the morbidity and mortality that would occur in in in a emergency kind of situation. Doctor you know you want to add something I do indeed David the caller highlights one of the great resorts is that were developed under public health namely the public health. Not too many years ago. Newborns were visited invariably by the way where they had a good health department. Apparently something that's just happening in stamping County but I can remember in

Chicago how vigorously the public health nurse played a role in controlling him food and maternal mortality. Literally home visits and instruction and taking the precautions that would change the rays of the illness and death from the contagious diseases accident prevention nutrition that was just. Her way of transmitting knowledge scientific skills to a public and I think the earlier point about the changed spectrum of illnesses that we now confront as we have an aging population. The kindness of the diabetes hypertension is to name a few. These are debilitating diseases that need support systems to keep a person in their home in the community. The cost is something you can do is take such a person and put them in three or $4000 a month nursing home. Not to

mention the often inhumanity and isolation that costly solution brings. We have to turn to Community and Public Health is one of the central features. It's essence I tried to make that point when you asked me to define it that it is a total society does it is in the best traditions of our religious and political beliefs of being your brother's keeper of doing the whole society has some level of the responsibility than the civic group. So I look forward to a rebirth of that home to be directed. You know community based service it's very much in attenuation and disarray that the nursing profession as a whole has suffered desperately in the last 20 years of disarray in the health care system as a whole I'm speaking of the corporate delivery of health care and the effort in

cost and maximize profits of all but destroyed the laggard nursing profession. An earlier casualty was the public health nurse for other reasons. And to answer the question directly I think we need the strongest. Just expansion of this capacity. It would not only be decent public health but it would save the society literally millions if not billions of dollars. We've certainly had as we have discussed one of the things that we have seen in past years is a resurgence of infectious disease. We have seen some things that we knew before that have been making a comeback like tuberculosis. We've seen new diseases that we think probably had existed somewhere in the world but we're localized. And then as people became much more mobile suddenly we realized how easily they could spread. We've even seen non infectious diseases like West Nile. We've seen it now here in the United States and something that until a couple of years ago when it was first reported in New York

no one had ever reported it in the United States before. So we know we've got these things to contend with and I think a lot of people would argue that our first line of defense really is going to be our our state and local public health agencies and they are saying no you're turning to us you're expecting us to to do this important work. We don't really have the resources the administration has talked about new funding hundreds of millions of dollars. But it seems like that that. It's not enough. I think the Bush administration has said it has talked about 300 million dollars this year additional money for state and local public health programs. And the people who are dealing with all things like the anthrax threat that we've seen here in the last few weeks are saying we already have spent hundreds of millions of dollars dealing with that. What's the funding picture look like and if if there is some additional funding forthcoming from the government is that really going to be enough. Well Mack take the first bite yeah yeah you're absolutely

right. Dreadfully underfunded one way of looking at it. We just we have a huge health expenditure in this country. The last year for which we have final numbers 1999 we spent as a nation 1.4 trillion dollars that's fourteen hundred billion dollars. That's forty two hundred dollars for every person in the country. I'm half of that huge amount less than 2 percent went for public health functions. I'm talking about state and local health departments I'm talking about the Center for Disease Control federally and the National Institutes of Health. It is. Astounding disproportion considering the benefits investments in public health and life expectancy quality of life freedom from preventable diseases. So on the growth side it's a tiny fraction of the money we'll allocate in this country to health. Beyond that as you suggested in your questioning the amounts

available are not enough and you have thirty four hundred counties you have 50 states the last time we counted and we have a huge federal responsibility. The kinds of monies we're talking about given our overall capacity are 50 0. Certainly not huge. And the last thing I'd say in the. These proposals that are coming from the Bush administration there is the hugest possible emphasis for it for obvious reasons. Bio warfare bio terror protection. Now that's very exciting. Anthrax tragedies killed several people and exposed hundreds of more. I'd be the last person to men to minimize that event. But when all is said and done it is to feel compared to huge challenges and the infectious disease side. You mention new things like West

Nile hanta virus a bowl of fever. These are words that are not familiar to most listeners but these are dangerous developments. Let me point out that the biggest single infectious disease killer is not a. It's tuberculosis. Three million people worldwide die from TB annually. It's estimated by the people who know what it takes to control TB that an investment of about 5 to 10 billion dollars worldwide would do to TB what we were able to do with smallpox eliminated. When are we going to as a people and indeed in cooperation with other nations meet those challenges rather than react to brief terrorist threats important as they may be. You want to add to that. Well I think you're absolutely correct. You know when you mentioned about in the 50s we were a victim of our own success. One of the

things that probably had been done then was really an active very active. The effort toward eliminating those same childhood communicable diseases throughout the world the way we were conquering TB. You know why wasn't there a greater effort in then and we wouldn't be having the numbers die in the world due to TB that we have today. Before when when the antibiotics were much more the longer they're used of course the greater the chances are that to regularly organises an organism to develop resistance to it so you know certain things work should have been a real a very broad worldwide effort to eliminate TB at that time as opposed to now that we have TB organisms that are resistant to a lot of the antibiotics that are.

We're in some instances almost very desperate about how this person to be treated because of the resistance of the organism. And so it's really complicated things much more. We have about five minutes left and then we have one I think actually to call or see one try to get him in in the time that remains will go first to Urbana only number one. Hello I'm. I did read in the paper about the county board meeting tonight and I was intrigued at the juxtaposition between the request for funding for dental care in the county for children and county board member complaining that the money was going to come out of roadwork account for road work which the county roadwork people so they didn't need. And at the same time in the paper.

I don't know if it was today this yesterday or whether the day before but there been a couple of anti-abortion letters talking about how we have the right to life and how we need to protect innocent children and unborn children it seems to me that what we should be doing is protecting the children who are already here. And that's what public health is doing it's also protecting as you said the people who are elderly. It seems to me that we need to be standing up and saying hey if we really care about human beings what we should do is be doing is funding public health and quickly and roads are important. But I haven't noticed that the roads are in terrible shape in Champaign County and they do get out there and. But my other comment too is it seems to me from watching the difficulties in getting that the county public health department established that with that hard part of the opposition came from farmers who lose large amounts of farmland that are being

taxed. Is there some way to fund things like this so that residences are taxed or so it's based on the number of people that are being served in and in the area as opposed to land. I don't know. I'm not sure that either of my guess is probably the guy to answer that question I don't know. Well and then divide time. Thanks for the dog that remarks. Amen to the last question it is a technical one our tax structure I think in many ways whether it's for school school or education or for public health is very aggressive in fact it's probably separately. We need to meet all of these things. One I think a book a progressive income tax where people can participate according to their ability to pay. That would solve these problems overnight. It seems like that would be the kind of thing that would have to be addressed by the state legislature. It would require it would require change in state law.

Yes. We're almost at the point here where we're going to end up at a time I think what we have now the caller and I'd like to try to get him in. Well in Chicago in line for THANK YOU are other countries doing better or are they all were not warning of any information about other countries the benefit to have public health. Well I can answer number miss Yes. Tara can as well I emphatic. Yes other countries do better by the usual criteria life expectancy infant mortality prevention of preventable disease and cancer. No country of course has a huge national income per capita and it's interesting that third world countries for obvious reasons rely on public health far more than they do and what you could call the therapeutic health system and some of them have stayed the approach that some of the best public health systems in the Third World poverty

nations have infant mortality that is close to what is. It's true. Where I think probably that we're at the point we're going to have to finish two things OT before we go I guess one thing I want to mention is for people who are here in Champaign-Urbana if they're interested in finding out any more information about the Champaign-Urbana Public Health District services offered and so forth can they just call you. Yes they can call the number is 3 5 2 7 9 6 1. And if you want to talk to me that is fine. There are other personnel who can and can field questions as well. But if it's an environmental question I'll probably send you over to environmental health and that number is 3 7 3 7 9. 0 0 0 right. And I'd also note that for people who are interested maybe a little bit more of a national perspective on public health one thing that they could do would be to go

to the website if you have internet access you can go to the website of the American Public Health Association. That may be but be one place that you could start. It's an easy address it's w w w a P H A for American Public Health Association or gee could I mention you have a resource in your own county. The friends of public campaign County health care consumers I'm acquainted with them first and their number is 3 5 2 6 5 3 3. OK well there we must leave it with our thanks to our two guests Dr. Quentin Young. Thank you very much for talking with us today we appreciate it very much. He's a physician are you again fair. Among other things is past president of the American Public Health Association here in the studio with me. Jack McIntyre he's director of community health nursing and clinical services at the Champaign Urbana public health district. Thank you thank you very much.