PGH 200 - Exam

Intro to Pers, Publ, and Glbl Health

How does the WHO define health?

Health is a state of complete physical, mental, and social wellbeing, and not merely the absence of disease.

Health as a Human Right

Enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being w/o distinction of race, religion, political belief, economic or social condition

Health as a Responsibility:

Being responsible for health is personal, public and global

Health as a Privilege:

Not all people have the privilege of healthy food, safe homes, schools, communities, job security, or access to essential goods and services for health.

Knowledge

facts, evidence-based practice, recommendations, literacy, etc.

Access

To care, education, water, sanitation, healthy foods, medicines, etc.. to meet health needs

Culture

Values, beliefs, historical and geographical context, privilege, discrimination, etc.

Pathophysiology

(Personal) examines the physiological mechanisms of health failure & disease

disease incidence, prevalence, impact of interventions

Etiology

(personal & public) examines the associated exposures to determine proximal predisposing risk factors or precipitating causes of health failure or disease

Connects pathophysiology and epidemiology to inform medical interventions and prevention

Epidemiology

(public & global) examines health and disease distributions and various exposures, analyzing for association or cause-effect

Disease incidence, prevalence, impact of interventions

Homeostasis

dynamic balance of all essential variables for health: water, temperature, OXYGEN, and more. A SET POINT necessary for health and wellbeing.

Failure to maintain oxygen homeostasis

Respiration fails to increase enough to deliver adequate O2; it may cause excessive cerebral vasodilation (edema, Acute Mountain Sickness, High altitude cerebral edema).

What is the purpose of inflammation?

Mobilize, organize and remodeling

Mobilize

Activate immune and repair system

Classic Signs: redness, swelling, heat, pain, decreased function

Organize

Isolate & prepare injured areas for repair

angiogenesis- establishes new blood vessels

Fibroblasts - activated to connect tissues

Remodeling

depending on tissue and extent of damage

Regenerate: restore to OG capacity

Innate Immunity

Body seeks and destroys any foreign invaders. phagocytes, macrophages, etc.

Has barriers - skin, mucous membranes,

How might the inflammatory process harm health?

Chronic meta inflammation

Under what conditions this might be ‘provoked’?

Inslunt, injury or inflammation (has to mobilize)

Overused a joint (athlete) provoked

metaflammation

mini small flames that create a big one inflammation

allostatic loads.

Chronic stress - person not okay but not bad. mental, physical, social

Health consequences of metaflammation and allostatic loads.

Low level insults - aka “stressors” alert inflammation

Compromised health means less anti-inflammatory/anti-oxid and “self” protection

Chronic stress create “metaflammation & damage

Altering health trajectories

Normal immunosuppression

Immune tolerance is normal during pregnancy.

Medical muted: Organ and tissue transplant (muting the immune system)

Abnormal (Acquired) Immunosuppressions

HIV, Type 1 diabetes, Lupus, Crohn’s disease, Graves’ disease, Psoriasis, Multiple Sclerosis, Rheumatoid arthritis, Hasimoto’s thyroiditis .

What happens if there is autoimmune dysfunction?

Acquired immunosuppression will compromise immune function → increase risk from infections

Give an example of an autoimmune disorder.

HIV (Acquired Immunodeficiency Disease) - AIDS

LMIC

Low and Middle Income Countries

HIC

High Income Countries

What are other terms we can use to describe the developmental status of countries around the world?

• By Stage of development: developed or developing

• By relative location: Global North (mostly HIC) and Global South (mostly LMIC)

• NOT y hierarchy: First, second, and Third World

  • outdated from Cold War Era and political/post colonial alignment

GDP

Worth of all national goods and services made/performed domestically - in country - by citizens and noncitizens (Gross domestic product)

GNI

Income from all goods and services produced by citizens both home and abroad (Gross national income)

• Most used for comparing economic development between countries

• Includes ‘remittances’ - which can be vulnerable economic indicators

GNP

Goods and services made/performed by citizens both home and abroad (Based on Gross National Product)

Gini Coefficient

Measures wealth inequality (0-1 or 0-100)

• 0 would indicate that every person does in fact make the average per capita income…

• 1 or 100 means all the wealth in few hands, everyone else is poor…or wealth is totally inequitable

PPP

Aka “Big Mac Index” - how much can my $1.00 buy in USA, Ethiopia, and Nepal? (Purchasing Power Parity)

HDI

(Human Development Index)

Shifts away from money and economics; focus on human development.

• Health (Long and healthy life)

• Knowledge (Education/Schooling)

• Decent Standard of Living

What is meant by DAILY?

Disability Adjusted Life Years

How is DAILY measured?

(YLL + YLD + Disability factor = DAILY)

YLL

Years of Life Lost (Mortality)

YLD

Years of Life Disabled (Morbidity)

Demographic Transitions

birth rates, death rates, ethnicity, employment, etc (describe the people)

Epidemiological Transitions

Changes of the disease burdens (many cause of death and disabilities)

NCD

Non-Communicable Diseases

(CVD, Cancers, Diabetes, COPD)

CMNN

Communicable, Maternal, Neonatal, Nutritional

Omran’s 3 Level of Epidemiological Transitions

• age of pestilence and famine: Countries most burdened by CMNN diseases

• age of receding pandemics: Mortality declines as epidemics become less frequent and severe.

• degenerative disease: Mortality stabilizes at a low level as chronic and non-communicable diseases become the main causes of death.

Why did Middle Income Countries transition quicker than Low Income Countries?

Transition quicker by gaining access to High Income technology

Health Trajectory

ideal health status from birth to very old age in respect to death at the outcome. Aka dying at a very old age.

Burden trajectory

Having compromised health impacts an individual to have a premature death.

Primary Prevention

• create healthy people

• prevent diseases

• Vaccines, supplementation, clean water, education

Secondary Prevention

• screening people for disease

• Give medication

Tertiary prevention

• hospitalized for disease

• Try to return to back to a health state

• Prevent from dying too soon

(MDGs)

Millennium Development Goals (MDGs)

Spelled out eight major goals for significantly reducing global poverty by 2015.

8 Goals 🡪 Indicators (progress towards goal) 🡪 targets (criteria for meeting goal)

(SDGs)

(Sustainable Development Goals)

Spelled out 17 goals for sustainable qualities for life.

Precipitating Factors

(cause something. If I don’t have it ..im not going to get it)

• Proximal exposures

• Definitive – only cause of disease/injury

• Necessary Cause for given disease/injury

trigger the onset of the current problem

Predisposing Risk Factors

(risk is higher than someone else but it doesn’t mean ill have it)

• personal behaviors

• family or inherited characteristic

• environmental exposures

• associated with increased risk for developing a disease

put a person at risk of developing a problem.

Is infection with HIV a precipitating or predisposing factor to AIDS

Precipitating factor

Epidemiology

Studies the context and environment

• Community disease cases and associated environmental conditions

• Informing and Informed by pathophysiology & etiology

GBD

Global burden of disease

what are the three groups into which it classifies all health conditions?

CMNN, NCDS, and Injuries/Accidents

(SDI)

• Socio-Economic Development Index

• Gross Domestic Product (GDP) proxy for wealth

• Education years proxy for literacy

• Fertility Rates proxy for social status of women

why might the SDI be a better measure of a country’s health capacity than the Gross Domestic Product?

SDI is measuring the country’s health capacity while the GDP is about the national goods and services.

What infectious diseases have created ‘hiccups’ in the general reduction of CMNN burdens globally?

HIV

Macronutrients

Proteins, Carbohydrates, Lipids

Most Critical Macronutrient

Protein

Micronutrients

Vitamins and Minerals

What are essential amino acids?

8 - 10 amino acids are essential - are from dietary sources.

Give 2-3 examples of what foods vegetarians need to eat in combination to get enough essential amino acids.

• Grains + Legumes

• Grains + Milk products

• Seeds + Legumes

What percent of a person’s diet should consist of protein?

About 10-35 %

How does this change if caloric intake is restricted?

Restricted → 35% should be protein

Why are children and women of childbearing age more vulnerable to nutritional deficiency diseases?

They need more nutrients to grow and develop

Underweight

Low weight for age

Stunted

Low height for age

Wasted (in terms of nutrition, not illicit substances)

low weight for height

Kwashiorkor

• Swelling of the stomach

• High mortality rate (0 -5 in children)

• Acute Protein deficiency

• protein problems

Marasmus

• Skin and bones

• Chronic caloric & protein deficiency

• severe wasting

• Life long complications

• energy and protein problems

GHI

Global Hunger Index

Monitoring

Food Supply, rates of Child undernutrition, and child mortality rates

Is food insecurity a problem only in LMIC?

NO. It can be anywhere.

What are the two leading causes of infectious disease deaths, globally?

Pneumonia and diarrhea

Pneumonia

Chronic exposure to tobacco smoke or air pollution, Age: < 5 or >65, Compromised immune system

Diarrhea

Poor water, sanitation, hygiene

What are some predisposing risk factors for pneumonia?

viruses, bacteria, some fungal or mycoplasma

What are some predisposing risk factors for diarrhea?

Osmotic , Motility ,Infectious- Secretory

How can pneumonia cause death?

Inflammation → fluid leaks into alveoli

How can diarrhea cause death?

By severe dehydration and electrolyte imbalance

What is the care and treatment of a child/infant with diarrhea?

WASH

What are recommendations to reduce risk and improve nutritional health in the first 2 years of life?

Eat as normally as possible, Continue breastfeeding infants, Antibiotics for parasites

Gravidity

Number of pregnancies - includes stillborn, miscarriage, abortion, live births

Parity

number of live births - population statistics

Fertility rates

average number of children born to a woman

Explain the physiological changes of pregnancy.

Uterus : size increase 15x and volume > 500x

Cardiopulmonary: blood volume and cardiac output increase as much as 60%

Endocrine-metabolic: Insulin sensitivity

What are the three most common Pathophysiologies of pregnancy?

• Placental Placement

• Pre-eclampsia

• gestational diabetes

Describe the 3 stages of labor and delivery.

Stage 1

• Cervical effacement and dilation (longer in nulliparous (first time) moms)

  • Takes the longest

Stage 2

• Birth or parturition (up to 4 hours)

  • Pushing the baby out/birthing

Stage 3

• Delivery of Placenta

  • 5-30 minutes

What are the three most common Pathophysiologies of labor and delivery?

Failure to progress or Obstructed Labor

• Require C - Section to save mother and baby

Non-Reassuring Fetal status

• Fetal distress caused by maternal anemia, hypertension, or placental complication —> C - Section required

Maternal Hemorrhage

• Due to placental anomalies of HELLP, can threaten mother and baby

• Post - Partum: up to servel weeks after delivery - may require surgical intervention or hysterectomy

HELLP

Hemolysis

Elevated Liver enzymes

Low Platelets

what are the 3 most common risks to the newborn (neonate)

Fetal distress, aspiration of amniotic fluids, asphyxia

what are the most common risk to the newborn (post-natal)

Sepsis

MMR

Maternal Mortality Rates

What region in the world has the highest MMR levels?

Sub-saharan africa

What are some predisposing etiologies increasing risk for MMR?

• First pregnancies + Adolescent

• Short/long spacing between pregnancies

• Maternal health

• History of gestational diabetes; abortion or uterine surgeries

Related to this, what are the best ways to reduce MMR and neonatal mortality and morbidity?

Preconception, Ante-natal, delivery and postnatal