Exam I PHRM 709

Lecture 1 and 2

Parsons (1972) Definition of health

state of optimum capacity for effective performance of valued tasks

SAEM (1992) Definition of health

a state of physical and mental well-being that facilitates the achievement of individual societal goals

WHO (1948) definition of health

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

What does health not only lack apart from disease?

mental and social dimensions

Disease

objective, biological phenomenon characterized by abnormal functioning of the body

Disease

a state of being that a healthcare worker finds

Illness

a subjective, psychosocial phenomenon in which people perceive themselves as being sick

Illness

a state of being that the ill person feels

Cassell’s definition of disease vs illness

let us use the word “illness” to stand for what the patient feels when he goes to the doctor and “disease” for what he has on the way home from the doctor’s office. Disease then is what an organ has; illness something a man has.

Cassell’s definition extended

One can have a disease w/o feeling ill, one can be ill w/o being diseased

Overall (crude) death rate and infant moratlity rate from 1900 to 2024

decreased around 70% for crude death rate

decreased over 90% infant mortality rate

How much as life expectancy increased from birth since 1900?

greater than 50%

Leading causes of death (1900)

Influenza/pneumonia

TB

Gastritis

Leading causes of death (2024)

Heart disease

Cancer

Unintentional injuries / accidents

How is healthcare governed in the US?

By the medical (biomedical model)

Medical Model

focuses on individuals and on the facts most immediately linked to pathophysiology underlying a person’s disease. It searches for mechanisms at the cellular level that help explain how specific factors produce illness

What is the therapeutic goal?

to find the “silver bullet” that will stop or reverse those mechanisms and cure the current medical problem(s)

What does the medical model presupposes?

The existence of illness or disease and emphasizes clinical diagnosis and intervention in the treatment of disease or it symptoms

Why is healthcare considered reactive?

It responds to abnormality, disease or injury, and as a result has been characterized as a “sick or sickness care system”

Definition of heath in the medical model

the absence of disease. Prevention and health promotion regulated secondary status

What is/are health care system and education health professionals concerned with?

diagnosis and treatment of disease (model model) vs protection and promotion of health

What does the population health model seek?

to explain and intervene in the causes of the systematic differences in health between different groups (Kindig/Stoddart, 2003)

What does the population health model analyze?

the patterns or distribution of health between different groups of people in order to ID and understand the factors leading to poorer outcomes

What does the population health model employ?

an integrative model: defined as different factors that are highly likely to intersect and combine to produce good or poor health and should be assessed in tandem

What is the point of determinants of health?

to describe the determinants (factors) that arise from five important domains

What are the 5 Important Domains?

Genetic/Hereditary

Behavior/Lifestyle

Physical Environment

Social Environment/Social determinants

Medical care

Genetic/Hereditary

key determinant to health as genetic factors predispose individuals to certain diseases

Examples of genetic/hereditary

Cancer, sickle cell anemia, rare genetic diseases

Epigenetics

study of gene-environment interactions

Behavior/Lifestyle

individual lifestyles and behaviors are a key determinant of health

Examples of behavior/lifestyle

diet, exercise, smoking, STDs

Physical environment

physical environmental factors such as air pollution, food, and water contamination, radiation, toxic chemicals

Social environment / social determinants

social determinants go beyond the individual to society as a whole. Relationship between many social characteristics, such as nationality, social class, race, occupation, geography, and states of health and illness

Example of social environment / social determinants

The greater the economic gap between the rich and poor within a given area, the worse the overall health status of the population of that are will be

Medical care

access to medical care is key determinant of health. Individual and population health closely related to access to adequate preventive and curative health care services

Examples of medical care

Prevention, treatment, and disease management

What is health conceptualized as?

the result of the exposure to different patterns of these multiple health determinants. Although the determinants are listed independently, they have substantial and complex interactions over the life of and individual or group

What does the medical model not ask?

WHY an epidemic of obesity has occurred over the past 20 years or investigate why there are higher rates of obesity in low income and minority populations

Population health model asks..

IDing a wide variety of causes over time to produce the epidemic and the differing patterns for obesity among population groups

Health care services

Personal

Community

Personal

deal directly w/ individuals for maintenance of health or cure of disease

Community

directed toward population groups

Combined health care services ___

have aspects of both personal and community

Examples of combined health care services

Mass immunization programs, TB, and venereal diseases

What are the two competing theories about equitable access concern?

market justice

social justice

Market Justice

propose that market forces in a free economy can best achieve a fair distribution of healthcare. Medical care and its benefits are best distributed on the basis of people’s willingness / ability to pay

What does a free market imply?

giving people something they have not earned would be morally and economically wrong

Assumptions about Market Justice

health care can be governed by free market forces of supply and demand

people make rational choices in their decisions to purchase healthcare products and services

people, in consultation w/ their doctors, know what best for themselves

the marketplace works best w/ minimum interference from the govt

Market justice implications

In a pure market individuals w/o sufficient income or who are uninsured face a financial barrier to obtaining healthcare
emphasizes individual rather than collective responsibility for health

proposes private rather than government solutions to the social problems of health

Social Justice

at odds w/ principles of capitalism and market justice

espouses that the equitable distribution of health care is a societal responsibility

can be best achieved by letting a central agency, generally the govt, take over the prod. and dist. functions

regards health as a social good-as opposed to an economic good.

under a social justice system, inability to obtain medical services bc of a lack of financial resources is considered unjust

Social justice assumptions

Healthcare is different from most other goods and services. Health seeking behavior is governed primarily by need rather than by how much it costs

Responsibility for health is shared

Society has an obligation for the collective good

Govt, rather than the market, can better decide thorugh rational planning how much healthcare to produce and how to distribute among its citizens

Social justice implications

Everyone is entitled to a basic package of benefits

public solutions to social problems

planned rationing of health care. Govt controls how medical technology will be dispersed and who will be allowed access to that technology

Why are population health indicators useful?

population health indicators are useful for understanding the nature and health status of the population

What are the 3 Quantification Perspectives?

Demographics and socio-economic characteristics

Health status measures

Health services and resource utilization

Demographics and socio-economic characteristics

age, gender, socioeconomic status (SES)

Health status measures

morbidity (sickness) and mortality (death)

infant mortality rates and life expectancy rates

Health services and resource utilization

Who uses the services?

What types of services are being used: hospital, medical, pharmacy, etc.?

What are the two indicators for quantification?

Number

Rate

Number

count of conditions, individuals, events, etc.

Rate

estimated as numerator/denominator customary to give over a particular time period

ex: death rates

description

describes numbers and characteristics of a population

program planning

data can ID problems, be used to design solutions, be used for evaluation after program implementation

Vital statistics

births, deaths, marriages, and divorces

Who is responsible for collecting vital statistics?

states (state departments of health), rates calculated by National Center for Health Statistics (NCHS)

Mortality

end of life or death

Mortality rate

number of deaths occurring in a specified time period for a specific population

Overall mortality rates

death rates; highlight the major clinically apparent health and illness problems in the population

Crude death (mortality) rates

number of people that die per a given populationa

age-adjusted death (mortality) rates

death rate that controls for the effects of differences in population age distributions

cause-specific death (mortality) rates

death rates due to a specific cause

infant mortality calculated as

# of deaths < 1 yr of age among children born alive / number of live births

Infant deaths broken down to 2 categories

Neonatal deaths

Post-neonatal deaths

Neonatal deaths

less than 28 days (2/3 deaths)

Post-neonatal deaths

at least 28 days, but less than a year

US infant mortality rate in US (2023)

5.6 infant deaths / 1,000 live births

US infant mortality rate in US (2021)

5.4 infant deaths / 1,000 live births (historic low)

US infant mortality rate in US (2017)

5.7 infant deaths / 1,000 live births

Life expectancy

age to which the average individual can be expected to live. given that the person has reached a specified age; often used as an overall measure of health for a population

2024 Life expectancy US

79.0 yrs

2024 Life expectancy for men

76.5 yrs

2024 Life expectancy for women

81.4 yrs

1900 life expectancy at birth

48 yrs

2019 life expectancy at birth

78.8

Morbidity data

sickness, illness and disease rates; extremelt important in characterizing the health status of the population.

Morbidity

a morbid state or quality; rate of sickness

Morbid

gruesome, grisly

suggesting an unhealthy mental state or attitude; affected by, caused by, causing, or characteristic of disease

incidence

number of new cases of the disease in question occuring during a specified time period, usually a year

prevalence

total number of existing case (i.e.; cases diagnosed previously AND newly diagnosed) in a population during a specified time period, or at one point in time (latter called “point prevalence”)

Utilization of health services

Reliable utilization data is regularly reported ONLY services provided by licensed medical professionals; NOT for '“alternative therapy” providers