Public Health Midterm

Years of Potential Life Lost (YPLL)

Number of years lost when death occurs before one’s life expectancy

• Difficult to determine because life expectancy changes at different ages

• Weighs death of young people as counting more than deaths of old peoples

Disability-Adjusted Life Years (DALYs)

Measures burden of disease

• One DALY= One lost year of healthy life

Health-Adjusted Life Expectancy (HALE)

Number of years of healthy life expected, on average, in a given population or region of the world

Incidence Rate

Number of new health related events or case of disease, divided by the population at risk

• Diseases in which the peak severity symptoms occur and subside within days or weeks

Prevalence Rate

Number of new and old cases in a given period of time, divided by total number of that population

• Diseases that usually last 3 months or longer

What are the 10 Essential Public Health Services

1. Asses + monitor population health status, factors that influence health, the community needs + assets

2. Investigate, diagnose, + address health problems + hazards affecting the population

3. Communicate effectively to inform + educate people about health, factors that influence it + how to improve it

4. Strengthen, support, + mobilize communities + partnerships to improve

5. Create, champion, + implement policies, plans, + laws that impact health

6. Utilize legal + regulatory actions designed to improve + protect the public’s health

7. Assure an effective system that enables equitable access to the individual services + care needed to be healthy

8. Improve + innovate public health functions through ongoing evaluation, research, + continuous quality improvement

9. Build + maintain a strong organizational infrastructure for public health

What is the World Health Organization (WHO)?

The most widely recognized international government health organization

What roles does the WHO play?

• Policy Development

• Coordination of Services

• Data Collection + Standardization

• Director can declare “public health emergency of global concern”

What are the three core functions of public health?

• Assessment 

• Policy Development 

• Assurance

What is the importance of rates in epidemiology?

• Describes, summarizes, + compares the health of a population

• Allow for comparison of outbreaks at different times or in different places

• Number of events in a given population over a given point in time

What are the commonly used rates in epidemiology?

• Incidence

• Prevalence

• Attack

What are sources of secondary data used by epidemiologists? 

• U.S. Census

• Vital Statistics Report

• Morbidity + Mortality Weekly Report (MMWR)

What type of data is available from the U.S. Census?

• Gathers data on race, age, income, employment, education, dwelling type, other

• Enumeration of the population

• Taken every 10 years

What type of data is available from the Vital Statistics Report?

• Summaries of records of major life events: birth, death, marriage, divorce, infant deaths

• Calculates death rates by race + age

What type of data is available from the Morbidity + Mortality Weekly Report?

• Reports morbidity + mortality data by state + region of U.S.

• Reports outbreaks of disease, environmental hazards, unusual cases, or other public health problems

Health Status-Life Expectancy

• Average number of years a person from a specific cohort is projected to live from given point in time

Describe the 2 main types of epidemiological studies?

• Observational Studies

• Experimental (Interventional) Studies

Observational Studies

• Note exposed vs. unexposed

• Observe natural course of events — i.e., disease development

Experimental (Interventional) Studies

• Identify risk factors

• Determine effectiveness of interventions

Acute Diseases

• Diseases in which peak severity of symptoms occurs + subsides within 3 months

  • Can be communicable or noncommunicable

    • Example: Bronchitis + Pneumonia

Chronic Diseases

• Diseases or conditions in which symptoms continue longer than 3 months

  • Can be communicable or noncommunicable

    • Example: Asthma + Diabetes

Primary Prevention

Prevention measures that forestall the onset of illness or injury during the prepathogenesis period

• Individual: Hand washing

• Communities: Solid waste disposal

Secondary Prevention

Prevention measures that lead to an early diagnosis + prompt treatment of a disease or injury to limit disability + prevent more severe pathogenesis

• Individual: Antibiotics prescribed by a physician

• Community: Isolation + quarantine

Tertiary Prevention

Measures aimed at rehabilitation following significant pathogenesis

• Individual: Recovery to full health after infection

• Community:  Reapplication of primary + secondary measures

Evidence

Is the body of data that can be used to make decisions

Evidence-Based Practice

Systematically finding, appraising, + using evidence as the basis for decision-making

Socio-Ecological Perspective

Individuals influence + are influenced by their families, social networks, the organizations in which they participate (workplaces, schools, religious organizations), the communities of which they are a part + the society in which they live

Community Building

An orientation to practice focused on community, rather than a strategic framework or approach + on building capacities, not fixing problems

Communicable Disease

An illness caused by some specific biological agent or its toxic products that can be transmitted from an infected person, animal, or inanimate reservoir to a susceptible host

• Example: Common cold + Lyme Disease

Noncommunicable Disease

A disease that cannot be transmitted from infected host to susceptible host

• Example: Appendicitis + Diabetes

What are the assumptions that underlie the process of community organization?

• Communities of people can develop the capacity to deal with their own problems

• People want to change + change

• People should participate in making, adjusting, or controlling the major changes taking place within their communities

• Changes in community living that are self-imposed or self-developed have a meaning + permanence that imposed changes do not have

• A ‘holistic approach’ can successfully address problems with which a ‘fragmented approach’ cannot cope

• Democracy requires cooperative participation + action in the affairs of the community, + people must learn the skill that make this possible

• Frequently, communities of people need help in organizing to deal with their needs, just as many individuals require help in coping with their individual problems

What are the approaches to control noncommunicable disease control in a community

• Prevention levels

  • Primary

  • Secondary

  • Tertiary

• Application of preventive measures

• Supportive environment

• Individual’s role

What are the important measures for preventing + controlling the spread of communicable diseases? 

The chain of infection

• Step by step model to conceptualize the transmission of communicable disease

• Agent, Host, + Environment

State Health Agencies

• Each state has their own health department

• To promote, protect, + maintain the health + welfare of their citizens

• Usually have a medical director that is appointed by the governor

What are the State health departments?

• Organized into divisions or bureaus

• Many different roles:

  • Can establish health regulations

  • Provide link between federal + local health agencies

  • Serve as conduits for federal funds aimed at local health departments

  • Have laboratory services available for local health departments

What are the State health department roles?

• Collecting vital statistics

• Running a public health lab

• Licensing health professionals

• Administering nutrition program

• Regulating health facilities

• Drinking water regulation

• Administration of the state medicaid program

• Office of the medical examiner

Local Health Departments

• Responsibility of city or county governments

  • Jurisdiction often depends on size of population

• State mandated services provided locally

  • Restaurants, public buildings, + public transportation inspections

  • Detection and reporting of certain diseases

  • Collection of vital statistics

What are the Local health department roles?

• Immunization for those not covered by the private system

• Communicable disease surveillance + initial investigation of outbreaks

• Communicable disease control 

• Inspection + licensing of restaurants

• Environmental health services

• Coordinating public health screening programs

• Tobacco control programs

• Public health preparedness + response to disasters

International Health Agencies

• World Health Organization (WHO)

  • Attainment of highest possible health by all peoples

  • Work financed by member nations

National Health Agencies

• Each nation has department or agency within its government responsible for protection of health + welfare of its citizens

  • U.S. primary national health agency → Department of Health + Human Services (HHS)

• Other federal agencies contribute to health → Department of Agriculture, EPA, OSHA, DHS

Department of Health + Human Services

• Headed by Secretary of Health + Human Services

  • Appointed by president, member of cabinet

• Organized into 11 operating agencies, 10 regional offices

What are the operating agencies of the Department of Health + Human Services?

• Administration for Children + Families (ACF)

• Administration for Community Living (ACL)

• Agency for Healthcare Research + Quality (AHRQ)

• Agency for Toxic Substances + Disease Registry (ATSDR)

• Centers for Disease Control + Prevention (CDC)

• Food + Drug Administration (FDA)

• Centers for Medicare + Medicaid Services (CMS)

• Health Resources + Services Administration (HRSA)

• Indian Health Services (IHS)

• National Institutes of Health (NIH)

• Substance Abuse + Mental Health Services Administration (SAMHSA)

Why is a school health program important?

It supports a students physical, mentally, and socially which has a direct impact on their ability to learn and succeed

What services are offered as a part of school health services?

• Wellness promotion

• Preventive services

• Education

• Access +/or referrals to medical home or private healthcare provider

• Support connecting school staff, students, families, community, + healthcare providers to promote the health care of students + a healthy + safe school environment

• Remediation of detected health problems

Why are schools a logical place to offer such services?

• Due to poorer health status of youth

• The involvement of youth in high-risk behaviors (like smoking, drinking, substance abuse, and unprotected sexual intercourse)

• Such barriers to health care as inadequate health insurance + lack of providers

What factors influence a community’s health?

• Income

• Education

• Physical Environment

• Behavior + Lifestyle

• Genetics

• Access to Health Services

Overview of the current health status

American’s face a number of serious public health problems:

• Raising in healthcare costs

• Growing environmental concerns

• Very present lifestyle diseases

• Emerging + reemerging communicable diseases

• Substance abuse problems

• Disasters both natural + human made

What major community + public health problems facing the U.S.?

• Communicable Diseases

• Poor Sanitation + Unsafe Drinking Water

• Hunger

• Migration + Health