PHLT 301 Final Exam- mendez

Texas A&M- college station

Leading Actual Causes of Death

1) poor diet and physical inactivity

2) tobacco

3) alcohol consumption

4) microbial species

5) toxic agents

6) motor vehicles

7) firearms

8) sexual behavior

9) illicit drug use

what are the actual leading causes of death? (describe what this means)

\- these account for almost half of all deaths

\- most are preventable

\- most are premature

\- most are caused by individual behavior

\- these are targets for public health intervention

poor diet and physical inactivity lead to:

obesity, heart disease and stroke, diabetes, and cancer

Tobacco causes:

\-cancer

\-cardiovascular disease

\-chronic obstructive lung disease

\-infant deaths due to low birthweight

\-burns due to accidental fires

Misuse of alcohol can lead to:

\- motor vehicle fatalities

\- chronic liver disease and cirrhosis

\-home injuries

\-drownings

\-fire fatalities

\-job injuries

\-cancer

\-underage drinking

\\______________ encompassed the top three killers of 1900

microbial species

Have microbial species been conquered?

no

why are the toxic agents listed fifth?

the fact that toxic agents are only listed fifth is evidence of successes in environmental health

public health interventions

education, regulation, prohibition

education

education informs the public about healthy and unhealthy behavior

\- smoking's bad effects

\- recommended dietary allowances

effective approaches include:

\- health education in schools (sex education is controversial)

\-physicians' recommendations

\-use of advertising

\-social norms approach

regulation

regulation is warranted when its intent is to restrain people from harming others

public health laws include:

\-laws against murder and assault

\-traffic regulations

\-restrictions on alcohol, drugs, and tobacco-laws to prevent minors from unhealthy behaviors

\-laws requiring vaccination

Prohibition

the 18th amendment, which banned alcohol, was effective in reducing diseases caused by alcohol

Prohibition (drugs)

prohibition against drugs such as heroin, marijuana, and cocaine is generally accepted

"the war on drugs" may not be working:

\- it is expensive

\- it empowers criminals at home and terrorists abroad

\- it sends thousands to prison for minor offenses

The organization/ motivation behind social forces + individual behavior=

Improve the lives of individuals + improve society as a whole

How are Social systems related to health? : complex interactions with our surroundings

\- other people

\- institutions

\- communities

\- policies

How are Social systems related to health?

Efforts aimed at improving population health require an understanding of the complex relationship between social systems and health

How are Social systems related to health? : influencing behavior

\- shaping norms

\- enforcing patterns of social control

\- providing or not providing opportunities to engage in certain behaviors

\- reducing or producing stress for which certain behaviors may be an effective coping strategy (at least in the short term)

Can health behavior be changed?

\- Some health behaviors are intentional, whereas others are not motivated by health concerns- Behavioral change is possible

\- For both the better and for the worse

\- Examples of behavioral changes:

\+ Reduction in cigarette smoking

\+Seatbelt use

\+Back-to-Sleep practices for infants

\+Some behaviors are easier to change than others

Why Are Some Individual Health Behaviors Easier to Change?

\- behavior substituted for similar one that is considered acceptable and convenient

\- incentives can encourage rapid acceptance and motivate behavioral change

\- the most difficult behaviors to change are those that have a physiologic component or addictive element

\- physical, social, and economic barriers can stand in the way of behavior change

Downstream factors

those that directly involve an individual and can potentially be altered by individual interventions. Ex: addiction to nicotine

Mainstream factors

those that result from the relationship of an individual with a larger group or population, such as peer pressure to smoke

Upstream factors

Grounded in social structures and policies, such as government sponsored programs that encourage tobacco production

Behavior change requires more than individual determination and motivation:

Encouragement and support from groups, such as friends, family, coworkers, and peers are required

\- social policies and expectations may also need to be changed in order to reinforce individual efforts

How can health behavior be explained and predicted? : Theory

A set of interrelated concepts that presents a systematic view of relationships among variables in order to explain and predict events and situations

How can health behavior be explained and predicted? : Model

Combination of ideas and concepts take from multiple theories and applied to specific problems in particular settings

Socioecological model: intrapersonal

Focusing on individual characteristics

\- knowledge, attitudes, beliefs, motivations, self-concept, past experiences, skills

Socioecological model: Interpersonal

Focusing on relationships between people

\- other people influence behavior by sharing their thoughts, advice, feelings, and emotional support

Socioecological model: Organizational

Focusing on organizational characteristics

\- organizational characteristics that support behavior change; the importance of organizational change; organizational context

Socioecological model: Community

Focuses on relationships among organizations and groups within a defined area, such s voluntary agencies, political entity, networks, neighborhoods

Socioecological model: Policy

Rules, regulations, laws

What are some key theories and models used to address health behavior?

\- health belief model

\-theory of planed behavior

\- stages of Change

\- social cognitive theory

\- diffusion of innovation theory

Health belief Model

\- Intrapersonal model focuses on individuals' perceptions and thought processes prior to taking health related action

Health belief model: people are more likely to take action if they believe:

\- they are susceptible to the condition and it has serious consequences

\- taking action would benefit them, and the benefits outweigh the harms

\- they have the ability to successfully perform the action

Theory of planed behavior

\- Intrapersonal model

\- the intention is the main predictor of behavior

theory of planed behavior: behavior intention is influenced by:

\- individuals’ attitude toward performing a behavior

\- his or her beliefs about whether people important to him or her approve or disapprove of the behavior

\- his or her beliefs about their control over performing the behavior

Precontemplation stage of change model

In this stage, people do not intend to take action in the foreseeable future (defined as within the next 6 months). People are often unaware that their behavior is problematic or produces negative consequences.

Contemplation stage of change model

In this stage, people are intending to start the healthy behavior in the foreseeable future (define as within the next 6 months) people recognize that their behavior may be problematic

preparation/determination stage of change model

In this stage, people are ready to take action within the next 30 days. People start to take small steps toward the behavior change, and they believe changing their behavior can lead to a healthier life

Action Stage of Change Model

In this stage, people have recently changed their behavior (defined as within the last 6 months) and intend to keep moving forward with that behavior change.

Maintenance stage of change model

In this stage, people have sustained their behavior change for a while (defined as more than 6 months) and intend to maintain the behavior change going forward.

Termination stage of change model

In this stage, people have no desire to return to their unhealthy behaviors and are sure they will not relapse.

Social cognitive theory : interpersonal model

Interaction between individuals and their social systems

Social cognitive theory : reciprocal determinism

The dynamic interaction of the person, behavior, and the environment in which the behavior is performed

\- Changing one of these factors will change them all

diffusion of innovation theory

\- population and community level model;

\- how a new idea, product, or social practice is disseminated and adopted in a population

diffusion and adoption/ rejection are affected by attributes of the innovation, such as:

\-relative advantage

\-Compatibility

\-complexity

\-trialability

\-observability

diffusion of innovation theory: early adopters

those who seek to experiment with innovative ideas

diffusion of innovation theory: early majority adopters

often opinion leaders whose social status frequently influences others to adopt the behavior

diffusion of innovation theory: late adopters

those who need support and encouragement to make adoption as easy as possible

choosing a theory/model

\-Identify the health issue or problem and the population affected

\-Gather information on the issue, population, or both

\-Identify possible reasons or causes for the problem

\-Identify the level of interaction under which the reasons or causes most logically fit

\-Identify the theory or theories that best match the level of interaction and the reasons or causes

how theories can be applied in practice: social marketing

\-use and extension of traditional product marketing to approach behavioral change

-the truth campaign, national youth anti-drug campaign, the verb campaign

\- structured by the 4 P's -- product, price, place, promotion

\-relies upon branding

Diagnostic phase: PRECEDE

1\. Social assessment

2\. Epidemiological assessment

3\. Behavioral and environmental assessment

4\. Educational and organizational assessment

5\. Administrative and policy assessment

Social Assessment

Assess people's perceptions of their own needs and quality of life through data collection activities such as surveys, interviews, focus groups, and observation

epidemiological assessment

Determine which health problems are most important for which groups in the community, often by analyzing data from vital statistics, state and/ or national surveys, etc. \- assists in identifying subpopulations at high risk\-provide data to set measurable objectives

behavioral and environmental assessment

identify risk factors, internal and external to the individual, that contribute to the health issue of interest. literature searches and theory application provide guidance

educational and organizational assessment

Preceding and reinforcing factors that initiate and sustain behavior change are identified, such as an individual's knowledge, skills and attitudes, social support, peer influence, and availability of services

administrative and policy assessment

Identify policies, resources, and circumstances that may help or hinder implementation of the intervention

implementation and evaluation phase: proceed

6\. Implementation

7\. Process evaluation

8\. Impact evaluation

9\. Outcome evaluation

the P.E.R.I.E approach

Problem (what is the health problem?)

Etiology (what is/are the contributory causes?)

Recommendations (what works to reduce the health impacts)

Implementation (how do we get the job done?)

Evaluation (how do we evaluate the results?)

how can we describe a health problem?

\- the burden of disease: the occurrence of disability (morbidity) and death (mortality) due to a disease

\- course of disease: how often the disease occurs, how likely it is to be present currently, and what happens once it occurs

\-distribution of disease: who? when? where?

How Can Understanding the Distribution of Disease Help Us Generate Hypotheses About Disease Causation?

\-assists epidemiologists in finding group associations or patterns in the frequency of a disease

\-to gain a greater understanding, we examine:

How Do Epidemiologists Investigate Explanations For Changes in the Distribution of Disease?

three basic reasons that changes in rates may be artifactual rather than real:

1) differences or changes in the interest in identifying the disease

2) differences or changes in the ability to identify the disease

3) differences or changes in the definition of the disease

what is the implication of a group association?

\-group associations are established by investigations that use the information on groups or a population without having information on the specific individuals within the group

- group associations can be misleading if they suggest relationships that do not exist at the individual level (why?, confounding variables)

etiology: how do we establish contributory cause?

\-The evidence-based public health approach relies on epidemiological research studies to establish a contributory cause
\-Three definitive requirements are established using three different types of studies, all of which relate potential "causes" to potential "effects" at the individual level

strength of the relationship

how closely related the risk factor (ex: cigarette smoking) is to the disease (lung cancer)

\- absolute risk

\-relative risk

\-odds ratio (an approximation of relative risk in case control studies)

dose-response relationship

whether smoking more cigarettes is associated with a greater change of developing lung cancer

\- protective factor

consistency of the relationship

implies that studies in different geographic areas and among a wide range of groups produces similar results

biological plausibility

occurrence of disease can be based upon known and accepted biological mechanisms (ex: toxic chemicals in cigarettes)

absolute risk

The risk of developing the disease in the presence of a risk factor (Ex: cigarette smoking).

relative risk

\-the probability of developing the disease if the risk factor is present compared to the probability of developing the disease if the risk factor is not present.

what does contributory cause imply?

\-Existence of a contributory cause implies that the "cause" increases the chances that the "effect" will develop

recommendations: what works to reduce the health impact?

\-the quality of the evidence is scored based on the types of investigations and how well the investigation was conducted

\- the magnitude of the impact is the benefits minus the harms- evidence-based recommendations combine the score for the quality of the evidence with the score for the impact of the intervention

implementation: how do we get the job done?

•To examine the options for implementation, we use the "When-Who-How" approach

\-Deciding when, who, and how to intervene depends in large part upon the available options, the evidence that they work, and our attitudes toward different types of interventions

A new framework, called the RE-AIM framework, is increasingly being used to evaluate how well specific interventions work and are accepted in practice

\-RE-AIM stands for reach, effectiveness, adoption, implementation, and maintenance

How do we evaluate the results?

•Critical to measure how much of the problem has been eliminated by the intervention(s) and what is the nature of the problem that remains

What is the scope of health law, policy, and ethics?

a wide range of tools that society uses to encourage and discourage behaviors by individuals and groups (affect a full range of issues that confront us in population health)

:What is the scope of health law, policy and ethics? : components

\-health care

\-public health

\-bioethics

what legal principles underlie public health and health care?

\-the US constitution is a fundamental document that governs the issues of public health and healthcare law (however it does not mention health)

what legal principles underlie public health and health care?: police power

allows states to pass legislation and take actions to protect the common good (limited by the rights afforded to individuals)

what legal principles underlie public health and health care? : constitutional law

the type of law not only includes the US constitution but also the constitutions of the 50 states. provisions of state constitutions are important because responsibilities for health lie with the states unless the federal constitution grants authority to the federal government. due to the common clause, and due process clauses of the constitution, it has provided extensions of federal authority into areas of health. the majority of this body of law has developed from state and federal Supreme Court rulings

what legal principles underlie public health and health care?: legislative law (statutes)

written by legislative bodies at local, state, and federal levels. federal statues, preempt, or overrule, conflicting state statutes, as long as consistent with the limitation placed on the federal government by the US constitution. it may place requirements or prohibition on future activities. they can also authorize government regulation such as licensure, restaurant inspections, smoking in public pays, funding to pay for government services, or reimburse those who provide the services

what legal principles underlie public health and health care?: administrative regulations

produced by executive agencies of the federal, state, and local governments, in order to implement legislative statutes, which are often written in general language. executive agencies must follow legally defined processes and stay within what is called the legislative intent of the statute.

what legal principles underlie public health and health care?: judicial law (common law)

made by the course when applying constitutional, statutory, or administrative law to specific cases. common law may fill in the holes when statutory law does not provide guidance

interstate commerce clause of the US constitution is the major source of federal authority in public health and health care:

\-can tax, spend, and regulate interstate commerce

\-authority exerted through incentives to the states

The US constitution grants individual rights

\-Inferred rights are often the basis for individuals' protections in public health and health care

\-Existence of rights implies that state and/or federal courts are expected to uphold and enforce the right

health policies can be made by

\-private groups

\-commercial trade associations

\-government organizations

health in all policies approach

private and public entities work towards common goals to achieve improved health for all while reducing health inequities

healthy people priorities the issues that affect the health of the US population

\-collaboration of private and public organizations to set evidence

\-based national objectives aimed at improving the health of the population

\-large number of specific objectives organized into topic areas

How do philosophies toward the role of government affect health policies?

\-the types of health policies favored depend greatly on one's philosophies about the role that public and private institutions should play in public health and health care (the appropriate role of government is often controversial)

market justice

\-views healthcare as an economic good

\-assumes free market conditions for health services delivery

\-assumes that markets are more efficient in allocating resources equitably

\-production and distribution of health care determined by market based demand

\-medical care distribution based on people's ability to pay

\-access to medical care viewed as an economic reward for personal and achievement -individual responsibility for health

\-benefits based on individual purchasing power

\-limited obligation to the collective goof

\-emphasis on individual well-being

\-private solutions to social problems

\-rationing based on ability to pay

social justice

\-views healthcare a social resource \-requires active government involvement in health services delivery \-assumes that the government is more efficient in allocating health resources equitably \-medical ressource allocation determined by central planning \-ability to pay inconsequential for receiving medical care \-equal access to medical services viewed as a basic right \-collective responsibility for health \-everyone is entitled to a basic package of services \-strong obligation to the collective good \-community well-being supersedes that of the individual \-public solutions to societal problems \-planned rationing of health care

is there a right to health care?

In 1948, a right to health care was incorporated into the Universal Declaration of Human Rights and the Constitution of the World Health Organization (WHO)\-A right to health care in the United States has not be generally established\-It can be created within a state via its constitution or throughout the country by legislative action\-This issue has not been definitively settled

imposed risk

risk to individuals and populations that is out of their direct control (exposure to environmental toxins from a factory)

self imposed risk

risk an individual knowingly and willingly takes on through his or her own actions (wearing a helmet on a motorcycle)

what bioethical principles are used to address public health issues?

a code of ethics has been prepared through the public health leadership society to guide public health practitioners when making decisions and taking action

The Belmont report defines the rights of research subjects and outlines three basic ethical principles:

\-respect for persons \-beneficence\-justice

respect for persons

autonomy, protect those with diminished autonomy

Beneficence

do no harm, maximize possible benefits and minimize possible harms