BPH 1010 Foundations of Public Health Flashcards

Practice Q&A flashcards based on Foundations of Public Health lecture notes covering epidemiology, biostatistics, public health history, levels of prevention, and study designs.

How is health defined according to the Alma-Ata declaration?

A state of complete physical, social, and mental wellbeing.

What are 'wicked problems' in public health?

Complex problems with no definitive formulation, no stopping rule, no trial and error allowed, no true/false answers, and significant consequences (e.g., COVID-19).

How do clinical care and public health differ in focus and approach?

Clinical care focuses on diagnosis, treatment, individuals, and downstream interventions. Public health focuses on prevention, population health, upstream interventions, and creating healthy environments.

Example of a public health approach to a health condition

Implementing a community-wide nutrition education campaign and healthy food policies to prevent diabetes across an entire population.

Example of a clinical care approach to a health condition

Diagnosing an individual patient with type 2 diabetes and prescribing medication during a one-on-one clinic visit.

What is the primary mission of public health?

To provide maximum benefit for the largest number of people.

What are the 10 great public health achievements of the 20th century listed in the lecture?

1. Vaccination; 2. Control of infectious diseases; 3. Motor-vehicle safety; 4. Specific regulations in the workplace; 5. Decline in deaths from heart disease; 6. Safer/healthier food; 7. Healthier mothers and babies; 8. Family planning; 9. Fluoridation of drinking water; 10. Recognition of tobacco/health standards.

What is morbidity?

The state of living with a disease, condition, or disability (e.g., cardiovascular disease, diabetes).

What is the difference between the high-risk approach and the average approach in population health?

The high-risk approach focuses on individuals with the highest probability of developing disease to bring their risk closer to average. The average approach focuses on the entire population to reduce overall risk for everyone.

What are the five core disciplines of modern public health?

1. Epidemiology; 2. Biostatistics; 3. Environmental and Occupational Health; 4. Health Policy and Management; 5. Social and Behavioral Sciences.

What are the five steps in the circular P.E.R.I.E. approach to evidence-based public health?

Problem, Etiology, Recommendations, Implementation, Evaluation.

In the bathtub model of disease dynamics, what do the faucet, bathtub water level, evaporation/overflow, and drain represent?

The faucet represents Incidence (new cases), the bathtub water represents Prevalence (existing cases), evaporation represents Recovery, and the drain/spill represents Death (Mortality).

What is the formula for calculating disease prevalence?

\text{Prevalence}=\n\frac{\text{number of people living with the disease}}{\text{total number of people in the population}}

What is the formula for calculating disease incidence?

$$\text{Incidence} = \frac{\text{number of new cases of disease}}{\text{number of people in the at-risk population}}$$

What are three reasons changes in disease prevalence or incidence may be artifactual rather than real?

1. Differences or changes in interest in identifying the disease; 2. Differences or changes in the ability/technology to identify the disease; 3. Differences or changes in the definition or diagnostic threshold of the disease.

According to Rothman's Causal Pies model, what are necessary, contributing, and sufficient causes?

A necessary cause is found in all cases. A contributing cause is needed in some cases. A sufficient cause is a constellation of necessary and contributing causes that makes disease inevitable in an individual.

What is the hierarchy of evidence from highest strength to lowest strength?

1. Meta-analyses / Systematic Reviews; 2. Randomized Controlled Trials; 3. Cohort Studies; 4. Case-Control Studies; 5. Cross-Sectional Studies; 6. Case Studies and Reports.

What requirements must be fulfilled to establish a contributory cause in public health?

1. Individual association (established via case-control studies); 2. 'Cause' precedes 'effect' / temporality (established via cohort studies); 3. Altering the 'cause' alters the 'effect' (established via randomized controlled trials or natural experiments).

What is the formula for Relative Risk (RR)?

$$\text{Relative Risk} = \frac{\text{Probability of disease among those with exposure}}{\text{Probability of disease among those without exposure}}$$

What are the three levels of prevention strategies?

1. Primary Prevention: Avoid development of disease and remove risk factors prior to disease onset; 2. Secondary Prevention: Early detection, screening, and treatment to prevent progression before symptoms appear; 3. Tertiary Prevention: Reduce complications and disability of established disease.

How do the three levels of prevention map to the stages in the natural history of disease?

Primary prevention occurs during the stage of susceptibility; Secondary prevention occurs during the stage of subclinical disease; Tertiary prevention occurs during the stage of clinical disease and stage of recovery/disability.

What was the Humoral Theory of disease in ancient medicine?

The belief that body health depends on a balance of four humors: blood, phlegm, yellow bile, and black bile. An imbalance was thought to cause disease, often treated with bloodletting.

What were the 1601 Elizabethan Poor Laws?

A framework assigning state and parish responsibility for the poor, classifying them into the 'impotent/deserving poor' (aged, sick, orphans) who received relief, and 'able-bodied/sturdy beggars' (unemployed).

What were the major contributions of John Snow, William Farr, Florence Nightingale, and Ignaz Semmelweis in 19th-century public health?

John Snow mapped cholera cases to identify contaminated water (Broad Street pump); William Farr collected cause-of-death vital statistics ('Compiler of Abstracts'); Florence Nightingale introduced hospital hygiene and systematic record-keeping; Ignaz Semmelweis demonstrated that handwashing prevents post-childbirth infections.

What are Koch's Postulates for linking a microbe to a specific disease?

1. The suspected causative agent must be absent in healthy organisms but present in diseased organisms; 2. The agent must be isolated and grown in pure culture; 3. The cultured agent must cause the same disease when inoculated into a healthy organism; 4. The same agent must be reisolated from the inoculated organism.

Governmental health agencies

Health organizations funded primarily by tax dollars, managed by government officials, and possessing legal authority for public health policy making, emergency preparedness, and disease surveillance (e.g., CDC, WHO, local health departments).

Quasi-governmental health agencies

Organizations that possess official legal mandates or charters and receive government funding, but operate independently of government management (e.g., American Red Cross, National Science Foundation).

Nongovernmental health agencies (NGOs)

Private health organizations funded through donations or membership dues that operate entirely free from government control to fulfill specific public health goals (e.g., American Heart Association, American Public Health Association).

Religious or supernatural theories of disease

Ancient belief systems asserting that illness is caused by moral failings, evil spirits, or divine punishment, focusing on spiritual cures rather than physical root causes.

Miasma theory

The historical medical belief, popular from ancient times through the mid-19th century, that diseases were caused by breathing noxious or poisonous air arising from decaying matter.

Hippocratic approach to health

An ancient medical perspective introducing medical ethics and holistic health, emphasizing that environmental factors like air, water, and location shape health outcomes.

Humoral theory

An ancient medical doctrine postulating that health depends on maintaining a balance among four bodily fluids—blood, phlegm, yellow bile, and black bile—often treated through bloodletting when imbalanced.

Germ theory of disease

The scientific principle, developed by Louis Pasteur and expanded by Robert Koch, stating that specific microorganisms such as bacteria, viruses, and fungi are the causative agents of infectious diseases.

Secular hospitals era

Emerged in the 1700s as healthcare institutions operating independently of religious influence, focusing on scientific standards, specialized care, and medical ethics.

Renaissance era in public health

Spanned roughly from the 14th to 17th centuries, marked by a rebirth of scientific inquiry, humanism, and a shift toward systematic observation of the human body.

Sanitation Movement

A major 19th-century public health movement driven by urbanization that led to clean water infrastructure, sewage systems, and landmark laws like the Public Health Acts of 1848 and 1875.

John Graunt

17th-century statistical pioneer who analyzed mortality records, distinguished chronic from epidemic diseases, and laid the foundation for modern demography and vital statistics.

Andreas Vesalius

Renaissance anatomist who revolutionized medical knowledge by conducting direct human dissections, refuting long-held anatomical errors in Galenic and Hippocratic texts.

William Harvey

Physician who demonstrated the systemic circulation of blood in De Motu Cordis, providing physical evidence that contradicted the ancient humoral theory.

John Snow

Considered the 'father of epidemiology' for mapping cholera cases during the 1854 London outbreak to the Broad Street pump, proving waterborne disease transmission.

William Farr

Known as the 'Compiler of Abstracts,' he systematically collected and analyzed population cause-of-death vital statistics to evaluate public health patterns.

Florence Nightingale

Founder of modern nursing who introduced systematic health record-keeping, hospital hygiene, and environmental sanitation during the Crimean War.

Ignaz Semmelweis

Obstetrician who demonstrated that handwashing by doctors moving between autopsies and maternity wards drastically reduced post-childbirth (puerperal) fever.

Louis Pasteur

Scientist who disproved the theory of spontaneous generation, established the germ theory of disease, developed pasteurization, and created early vaccines.

Robert Koch

Microbiologist who identified specific bacterial causes of diseases like tuberculosis and formulated Koch's Postulates to experimentally link specific microbes to specific illnesses.

Public Health Core Function Scenario: A municipal health department continuously collects, analyzes, and publishes data on local childhood asthma rates to identify high-risk neighborhoods. Which core function of public health is being performed?

Assessment

Public Health Core Function Scenario: A state advisory board uses epidemiological data to draft clean indoor air legislation and partner with community groups to pass smoke-free ordinances. Which core function of public health is being performed?

Policy Development

Public Health Core Function Scenario: A health department manages vaccine distribution programs, inspects food establishments, and ensures local clinics have licensed medical staff to guarantee community care. Which core function of public health is being performed?

Assurance

Essential Public Health Service Scenario: Epidemiologists trace a multi-county outbreak of E. coli back to a specific regional water facility and issue an immediate containment protocol. Which essential service does this scenario represent?

Investigate, diagnose, and address health hazards and root causes

Essential Public Health Service Scenario: A city public health team creates a multi-language social media and radio campaign to inform residents about heat exhaustion prevention during a severe heatwave. Which essential service does this scenario represent?

Communicate effectively to inform and educate people about health

Essential Public Health Service Scenario: A state agency operates mobile healthcare vans in rural areas to provide free diabetes screenings and preventive consultations to uninsured workers. Which essential service does this scenario represent?

Enable equitable access to care

Essential Public Health Service Scenario: Local health officials systematically inspect public swimming pools and enforce sanitation codes to prevent waterborne disease transmission. Which essential service does this scenario represent?

Create, champion, and implement policies, plans, and laws that impact health

Public Health Discipline Scenario: A public health team conducts surveillance to map the geographic distribution, demographic risk factors, and spread of a viral outbreak across counties. Which core discipline of public health is primary here?

Epidemiology

Public Health Discipline Scenario: A research team uses mathematical models to compute $p\text{-values}$ and confidence intervals to evaluate whether a new drug treatment produces a statistically significant reduction in disease mortality. Which core discipline of public health is primary here?

Biostatistics

Public Health Discipline Scenario: Specialists test municipal water systems for toxic lead contamination and monitor local air quality near industrial sites to prevent population exposure to hazards. Which core discipline of public health is primary here?

Environmental Health

Public Health Discipline Scenario: Researchers analyze how cultural norms, social stigma, and peer influences affect individual choices regarding smoking cessation and vaccine acceptance. Which core discipline of public health is primary here?

Social and Behavioral Sciences

Public Health Discipline Scenario: Administrators evaluate healthcare financing structures and draft state legislation to expand health insurance coverage to low-income populations. Which core discipline of public health is primary here?

Health Policy and Management

Social Determinants of Health Scenario: A family struggles with sudden job loss, high debt, and inability to afford basic household necessities due to low family income. Which domain of social determinants of health is illustrated?

Economic Stability

Social Determinants of Health Scenario: A community lacks early childhood language programs and accessible high school completion resources, leading to low health literacy across generations. Which domain of social determinants of health is illustrated?

Education Access and Quality

Social Determinants of Health Scenario: An uninsured rural resident cannot access primary care or preventive disease screenings due to a local medical provider shortage and lack of transportation. Which domain of social determinants of health is illustrated?

Healthcare Access and Quality

Social Determinants of Health Scenario: Families live in an area with substandard housing, high ambient pollution, no sidewalk infrastructure, and no local grocery stores carrying fresh produce. Which domain of social determinants of health is illustrated?

Neighborhood and Built Environment

Social Determinants of Health Scenario: An elderly individual experiences severe social isolation, lack of civic support networks, and community-level discrimination. Which domain of social determinants of health is illustrated?

Social and Community Context

genetics, health behavior, social circumstances, environmental conditions, and medical care (BROAD)

determinants of health

If there was an increase in asthma cases in a hospital, what would be a public health approach?

regulation of policies

when would CDC be able to intervene

When health problems cross state lines or states ask for help