Public Health Module 1 Exam

public health

the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts

health

state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

spiritual, physical, social, emotional, intellectual, environmental, and financial

7 domains of health

disease

any impairment of health or abnormal condition

result of damage to cells or tissues (pathology)

symptom, sign, and syndrome

manifestations of disease

symptom

patient complaint (ex, nausea, diarrhea, pain, etc.)

sign

examiner searches (ex. redness, swelling, etc) to diagnose disease

syndrome

collection of signs and symptoms

acute disease

arises rapidly

lasts a short time (days—weeks)

often distinct symptoms

sometimes this leads to chronic

chronic

usually begins slowly

persists a long time (months-years-decades)

often vague signs and symptoms

generally difficult to prevent and treat

communicable disease

infectious

contagious (easily transmissible)

caused by pathogens

transmitted directly or indirectly between individuals

non-communicable disease

cannot be spread from person to person (ex. cardiovascular disease, cancers)

mix of genetic, environmental, and lifestyle factors

why non-communicable diseases?

etiological agent

substance of phenomenon causing disease

risk factor

an underlying cause

predisposing factor

increases susceptibility

pathogens and toxins

examples of exogenous agents

genes and immunity

examples of endogenous agents

exogenous agents

external substances, forces, or organisms that originate from outside the human body that can cause disease, injury, or alter hearth outcomes

endogenous agents

internal biological molecules, metabolites, or processes originating from within the human body that influence health or disease

complex etiology

most disease has ______ due to exogenous and endogenous factors

clinical medicine

focuses on diagnosis and treatment of disease in individuals

public health 2

encompasses a broader range individual, social, and environmental influencers of health

physical, social, biology, and behavior

4 types of determinants of health

air quality, water and sanitation, chemical exposure, built environment, and climate change and weather

examples of environmental determinants of health

genetics, immune responses, pathophysiology, diet and nutrition, infectious organisms, and interventions

major biological determinants of disease

diet and nutrition, physical activity, substance use, and safety practices

behavioral determinants of disease

education access and quality, healthcare access and quality, neighborhood and built environment, social and community context, and economic stability

social determinants of health

health disparities

differences in the incidence, prevalence, mortality, disease burden, or other adverse health conditions between population groups

race, ethnicity, age, sex, sexual orientation, socioeconomic status, and disability

common population groups

healthcare disparities

differences in access to, use of, and quality of medical care

health equality

even distribution of resources

health equity

fair distribution of resources

ancient world

-rudimentary understanding of health such as importance of hygiene, safe water, drugs, and surgery

-this practical knowledge coexisted with mystical beliefs such as ‘evil spirits’

china

• 21st-11th centuries BCE dug wells for drinking water

• destruction of rats and rabid animals

• 2nd century BCE, sewers and latrines

india

• city building codes

• Ayurvedic medicine—> medical schools and hospitals

egypt

• cities had stone masonry gutters for drainage

• personal hygiene highly emphasized

ancient Maya

• latrines

• middens (refuse heap)

• water purification

• water storage

ancient greeks

-placed high emphasis on healthful living habits in terms of personal hygiene, nutrition, physical fitness, and community sanitation

-hippocrates

hippocrates

• father of medicine

• shifted the practice of medicine away from superstition and religious beliefs towards a more rational and scientific approach

• emphasis on prognosis and observation

• clinical documentation

• holistic approach including diet, environment, and lifestyle

• popularized miasma theory

miasma theory

disease caused by bad air emanating from decaying organic matter

galen

prominent physician whose writings influenced medicine for centuries

roman empire

• continued the advancements of the Greeks

• extremely skilled in engineering of water supple, sewerage and drainage systems, public baths and latrines, town planning, sanitation of military encampments, and medical care

• regulated businesses and medical practice

• influence of this empire spread these ideas throughout much of Europe and the Middle East

western empire

• fragmented into small kingdoms

• loss of centralized governance—> feudalism

• medieval period

• prominent role of Catholic church

eastern empire

• maintained Roman highly centralized government

• shift to Constantinople

• Eastern Orthodox christianity

byzantine empire

• was the eastern empire

• continuity of greek and roman teachings in health (Galen)

• gradual loss of territory to Muslims—>Ottoman Empire

• 5th-10th centuries CE)

• cities declined

• public health functions ceased

• dominance of the Roman Catholic church

• most physicians were monks

• hospitals associated with monasteries

• integrated christian and pagan cultures

the crusades

• exposed Europe to eastern medical concepts

• initiated reforms

  • papal rulings increasingly restricted clerics from doing medical work

  • monastery hospitals gradually replaced by secular hospitals

  • establishment of medical training and licensing requirements

  • medical care insurance provided by guilds

• brought leprosy to Western Europe

black death

• due to Yersinia pestis

• spread by flea bites/rodents and by person-to-person via respiratory droplets

• originated in central Asia

• brought to Europe by Mongol invasions and trade routes by sea and overland

• 1/3-1/2 of world’s population may have died

• concept of isolation and quarantine to control

John Graunt

-founder of demography and vital statistics

-distributed weekly reports and annual summary of births and deaths

-distinguished deaths as acute or chronic

-published landmark analysis of mortality data in 1662

Edwin Chadwick

-produced the report The Sanitary Conditions of the Laboring Population

-used quantitative methods to show a direct link between poor living conditions and disease and life expectancy

-advocated for taxation and government intervention to improve sanitary conditions

-led to the passage of the Public Health Act (1848) establishing a General Board of Health

James Lind

-conducted one of the first clinical trials

-12 sailors with scurvy given one of six different dietary regimens

-2 sailors fed oranges and lemons recovered and were fit for duty within 6 days

-in contrast, all other sailors remained sick

-scurvy eliminated in the Royal Navy by end of 18th century

Bernardino Ramazzini

-father of occupational medicine

-first comprehensive book on industrial medicine, De Morbis Artificum Diatribe (The Diseases of Workmen)

microscope

examining his own diarrhetic feces, Van Leeuwenhoekhoek observed Giardia (intestinal parasite)

Louis Pasteur

-proved the germ theory

-invented the process of pasteurization

Joseph Lister

-chemical disinfection for surgery

Carlos Finlay

mosquito transmission of yellow fever (virus)

Robert Koch

-discovered Bacillus anthracis

-cultured Mycobacterium tuberculosis (White Death)

-identified Vibrio cholera

-Koch’s postulates: method to correlate pathogen to disease

germ theory

what replaced miasma theory

Edward jenner

who created first vaccine (for smallpox)

Peter Ludwig Panum

-assigned to investigate measles outbreak

-able to demonstrate person-to-person transmission via contact tracing, contrary to miasma theory

John snow

-one of the founders of modern epidemiology

-removed pump handle of Broad Street and stopped cholera outbreak

promotion

encouragement of activities that facilitate health and well-being

protection

safeguarding the public’s health against threats (ex. outbreak)

prevention

assessment of health risks and development of interventions that halt disease progression

primary prevention

-health promotion and addressing risk factors, social and genetic factors

-prevents the disease

secondary prevention

-screening of at risk individual, control of risk factors and early intervention

-minimizes severity or slows progression

tertiary prevention

-rehabilitation, preventing complications and improving quality of life

-minimizes disability

assessment, communication, policy development, and assurance

public health core functions

assessment

collects, assembles, analyzes health information

medical analogy: disease diagnosis

communication

effectively inform and educate people

medical analogy: consultation with patient

policy development

develop strategic approaches to improve community health

medical analogy: a prescribed treatment plan

assurance

provide essential services to ensure health of all in the community

medical analogy: actual treatment

Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and Food and Drug Administration (FDA)

3 federal agencies primarily associated with public health

Department of Health and Human Services (HSS)

oversees most public health services

CDC

-established 1946

-traditionally focused on infectious disease and therefore crisis-oriented (ex. outbreak investigation)

-as importance of infectious disease declined, mission expanded to include chronic diseases, injury, and environmental health

-monitors diseases and health conditions

-focus on disease prevention and health promotion

NIH

-roots traces back to Marine Hospital Service (1887)

-one of the world’s foremost biomedical research centers

-mission is to seek fundamental knowledge about living systems and to apply that knowledge to enhance health and reduce illness

-focus is on basic, clinical, and translational biomedical research

-comprised of 27 institutes and centers with specific research foci (ex. National Cancer Institute)

FDA

-established in 1931)

-role is to protect public health by overseeing drugs, biological products (ex. vaccines), medical devices, food, cosmetics, and tobacco products

-evaluate product safety and effectiveness before market entry approval

-monitor approved products to ensure continued safety

-inspect manufacturing facilities

-issue public advisories

-often under attack for being too restrictive or too lenient

Environmental Protection Agency, Department of Agriculture, Department of Education, Department of Transportation, and Department of Labor

other federal agencies with ties to public health

department of agriculture

-inspection of meat and eggs

-oversees SNAP and school lunches

department of education

supervises health education and school health

department of transportation

traffic safety and injuries

department of labor

occupational safety and health administration (OSHA)

World Health Organization (WHO)

-founded in 1948

-specialized agency of the United Nations which coordinates responses to international public health issues and emergencies

• promoting the control of epidemic and endemic diseases

• providing and improving the teaching and training in public health and the medical treatment of disease

• establishing international standards for biological products

state

public health is primarily a _____ responsibility

federal

______ government has the right to regulate interstate commerce (and to collect taxes)

professional membership, specific health concern, organizations of citizens, and foundations

nongovernmental organizations (NGO)

American public health association

example of professional membership NGO

american cancer society

example of specific health concern NGO

Americans for nonsmokers rights

example of organization of citizens NGO

bill and Melinda gates foundation

example of foundation NGO

academia, employers and businesses, and media

other partners in public health

academia

-education

-training

-research

-public service

employers and businesses

-employer-sponsored health insurance

-wellness initiatives and benefits

-healthy workplaces and communities

media

-vehicle for public discourse

-health communication, education, and promotion

-acceleration and amplification by social media (ex. catalyst)

local health departments

-varies from state-to-state and even within states

• typically, at county (parish) level

• large cities may have their own

• rural areas may have multi-county agencies

-responsible for day-to-day public health matters

• collecting health stats

• disease control and immunizations

• health care access

• sanitation

• inspections

community, clinical care delivery system, employers and businesses, media, academia, and government public health infrastructure

ALL partners in the public health system

property taxes, sales taxes, fees, and state and federal mandates

revenue for local health departments

state health departments

-primary constitutional responsibility and authority for protecting health, safety, and general welfare

-some states are strongly centralized whereas other delegate to local health departments

-states are usually charged with licensing and certification

-funding mostly from state taxes and federal grants

-joint state-federal programs (ex. Medicaid)

microbiology and immunology

the late 19th and early 20th century saw a rapid advance in __________

-identification of specific pathogens—>disease (pioneering work of Koch and Pasteur)

-description of viruses

-expansion of vaccine development

-description of elements of the immune system

-chemotherapy and antibiotics