Principles of Public Health Final

Health People Initiative

national public health intiative, consisting of many objectives, is in fifth iteration/cycle

future of public health

document created in 1988, polled public health experts nationwide to critique the profession

three core functions

The concept in planning and delivering public health services consists of assessment, policy development, and assurance

autonomous board of health

local board that has ability to create policy without approval or interference of mayor or council

Regional Health commission

provides services to number of towns, each of which statutorily has an equal vote in the department’s budget and policies

salmonella

bacertium leading cause of foodborne illnesses and deaths each year in the US

licensed pesticide applicators

pesticides may be sprayed in food establishments by these individuals

biological

type of food hazard, leading cause of foodborne diseases

facultative bacterium

name for a bacterium that may grow with or without oxygen

danger zone

range of temperature, from 41F to 135F, that is to be minimized to prevent potential foodborne illness

FATTOM

food, acidity, time, temperature, oxygen, and moisture

hydrologic cycle

process for the generation, transport, and replenishment of the Earth’s water contains five transfer mechanisms

septic system

Typically includes a tank, distribution box, and a disposal field, otherwise known as a leach field, and is dependent upon by 25-30% of residents

non-point source pollution

water contamination that comes from many diffuse sources

flocculation

addition of a substance like aluminum bisulfate to raw sewage, designed to bind small suspended particles so they may settle and be removed.

cryptosporidiosis

waterborne protozoan, causes chronic diarrhea, sometimes spreads person to person, responsible for 400,000 illnesses during a 1993 water contamination event in Michigan

anthrax

potential agent of biological warfare, used to kill and injure a number of people in the US in 2001, considered comparatively easy to mass produce, high in lethality, and relatively durable and stable in the environment

botulinum toxic

when weaponized and aerosolized is considered the most harmful substance known to mankind

line source dissemination

Weaponizing and distributing a biological in this way would require the creation of microscopic particles, release of the agent as an aerosol, a large target, and “cooperative” weather conditions

salad bars

the type of location targeted with salmlonellosis by the rajneeshees, followers of the bhagwan shree rajneesh, in their attempt to influence an election in the Dallas, Oregon

plague

pathogen. produces fever, respiratory symptoms, and sometimes gastrointestinal distress, and can be transmitted by direct contact with infected animals, or on rarer occasions, directly from other people via contagion

radon

this environmental exposure can be insidious or hard to detect, seeping into the basements of buildings and presenting a particular risk to those who occupy bedrooms or other living spaces below

5 micrograms/liter

the level of lead in a child's blood, measured in micrograms per liter, would prompt a local health department investigation to stop the exposure and help the child

lead dust

primary, specific cause of elevated blood lead levels in children

temperature inversion

atmospheric phenomenon that causes a cold dome of air to suppress pollutants in our airspace

National Ambient Air Quality Standards (Criteria Pollutants acceptable)

part of the Clean Air Act Amendments of 1990, provided stringent controls over six particularly harmful pollutants, including SO2, Ox, CO, particulate matter, lead, and ozone.

Public Health

the art and science dedicated to maintaining, protecting, and prolonging the health of people through organized effort.
focuses on prevention, population health, and community-level action (not individual)

incubation periods of
anthrax
botulism
plague
smallpox

anthrax: 1-7 days
botulism: 2 hours-8 days
plague: 1-4 days
smallpox: 7-17 days

Different forms of botulism

infantile, wound, foodborne

Anthrax attacks of 2001

Letters filled with anthrax were sent out in the mail to Florida, New York, and DC

Aum Shrinrikyo

Tokyo cult released gas in subway and contaminated air with anthrax and botulinum spores

Unit 731

Branch of Japanese Army that conducted chemical experiments on Chinese civilians, sought to develop biological and chemical weapons

effects of air pollution

human health
visibility
agriculture
weather
property

the effects of acid raid and deposition

human health
visibility
lake and stream acidification
tree damage
materials

5 areas of concern for housing

crowding
indoor air
heating
water
fire safety

Sequence sewage treatment

preliminary
primary
secondary
tertiary
disinfection
final disposal

3 different types of chemical exposures

1) mutagens: chemicals or radiation that cause mutations or increase their frequency
2) teratogens: chemicals that cause harm of birth defects to a fetus or embryo
3) carcinogens: chemicals, types of radiation, or certain viruses that can cause cancer

4 types of septic systems

cesspool
outhouse
seepage pit
septic tank

name 5 causes of illness and exposure related to water

bacteria
protozoa
viruses
parasites
chemicals

sources of well/groundwater contamination

septic system
waste storage/disposal facilities
non-point-source pollution

sequence the hydrologic cycle

evaporation -> transpiration -> transport -> precipitation -> runoff

program planning

a process in which an intervention is planned to help meet the needs of a specific group of people

3 parts of the epidemiological triangle

research -> theory -> practice

positions of local health boards

health officer
epidemiologist
health educator
certified environmental health
specialist
public health nurse
physicians

types of NJ health departments

municipal: town
regional: 2+ towns
county: countywide

name and describe the 2 types of local health departments

autonomous: policy-making powers, usually has a health official
advisory: no policy-making power, answers to board of elected officials

ecological perspective

intrapersonal: individuals characteristics
interpersonal: friends, family
institutional: rules, regulations, policies
community: social networks within groups, organizations
public policy: local, state, federal policies

SMART objectives

simple, measurable, achievable, realistic, timely

sequence the stages of change/transtheoretical model

precontemplation -> contemplation -> decision/determination -> action -> maintenance

what is the health belief model centered around?

concept of self-efficacy

early 20th century

focused on sanitation, clean water, sewage disposal, food safety.
control of communicable diseases.
rise of health departments and vital statistics.

national health objectives

healthy people (1979): first national prevention agenda.
health people (2000/2010): measurable goals to improve health, reduce disparities
focus on prevention, access to care, health equity

Institute of Medicine

(1988)
Declared public health system "in disarray"
defined core functions of public health
most notable product: THE THREE CORE FUNCTIONS OF PUBLIC HEALTH

three core functions

assessment: collect and analyze data on health status and risks
policy development: develop public health policies and plans
assurance: ensure services are provided, laws enforced, and workforce is competent.

vision

Healthy people in healthy communities

Federal Infrastructure

DHHS oversees health agencies:
CDC
FDA
NIH
EPA
CMS

State Infrastructure

Enforce public health laws
disease surveillance
licensing and regulation
support and oversee local health departments

local infrastructure

primary focus of public health activity
inspect food establishments
control communicable disease
provide maternal, child, and environmental health services

difference between local health departments

size and population served
funding sources
scope of service
staffing levels

Health Officer

administers department, enforces laws

administers department, enforces laws

inspects food, water, housing, environment

public health nurse

disease control, clinics, education

health educator

community education and prevention programs

Implementation of Public Health Laws

1. Sponsored and passed as a bill
2. Becomes a statute
3. Implemented through administrative code/regulations

five core areas (minimum standards of perfomance)

1. Administration: planning, staffing, budgeting
2. communicable disease: surveillance, immunization, outbreak control
3. adult health/ chronic illness: screening, prevention
4. maternal and child health: prenatal care, child health
5. environmental health: food safety, water, housing

Practice standards for performance

1. updated regulations for NJ local health dept
2. emphasis on outcomes, accountability, and consistency
3. more flexible than minimum standards

Food safety stats

Foodborne illness remains common
increased reporting and detection
high impact on children, elderly, immunocompromised

reasons for food safety concerns

consumer trends:
eating out more, raw and minimally processed foods, global food supply
product and processing:
mass production, long distribution chains, centralized processing

types of food contamination

physical: hair, glass, metal
chemical: pesticides, cleaners
biological: bacteria, viruses, parasites

Select foodborne bacteria

salmonella: 6-48 hr incubation, diarrhea, fever
staphylococcus: 1-6 hr incubation, toxic mediated, vomiting
botulism: neurological symptoms, paralysis
e.coli: bloody diarrhea, HUS

sanitization

chemical: approved sanitizer at correct concentration
manual: wash, rinse, sanitize, air dry

HACCP (hazard analysis and critical control point)

preventative food safety system
identify hazards and critical control points
emphasizes prevention rather than inspection

Steps in HACCP (7)

1. conduct a hazard analysis
2. identify crucial control points (CCPs)
3. establish critical limits for each CCP
4. establish monitoring procedures
5. establish corrective actions
6. establish verification procedures
7. establish record keeping and documentation procedures.

Hydrologic Cycle

evaporation, condensation, precipitation, infiltration, runoff

uses of water

domestic, industrial, agricultural, recreational

well water

drilled wells are modern and acceptable

septic systems

soil testing determines suitability
modern system: septic tank + leach field
contaminants from waste, chemical, runoff

waterborne disease implications

rapid spread
high morbidity
severe impact on vulnerable populations

waterborne pathogens

giardia: diarrhea, cyst
cryptosporidium: chroline resistant
cholera: severe watery diarrhea, dehydration

safe drinking water act

primary standards: health based
secondary standards: taste, odor, appearance

sewage treatment

1. primary: physical removal of solids
2. secondary: biological treatment
3. tertiary: advanced treatment and disinfection
purpose: remove organic load and pathogens

characteristics of biological weapons

stealthy
hard to detect
delayed effects

methods of dispersion

aerosol
food or water contamination

plague

flea born, rapid progression

smallpox

highly contagious, eradicated but high fatality

detection of outbreaks

unusual disease patterns
sudden spikes in illness
reports from clinicians and labs

housing effects

physical
chemical
biological
psychological
safety

lead

used in paints, pipes, gasoline
symptoms: developmental delays
prevention: abatement, hygiene, diet
mitigation (4) methods: enclosure, removal, encapsulation, and replacement
hygiene: washing hands often, wet cleaning of floors and removing shoes before entering home

food in prevention: adequate intake of calcium, iron and vitamin C

radon

leading cause of lung cancer after smoking
enters through foundations
detected through kits + radon monitors (professionals)
remediation: sub-slab depressurization, sealing cracks and openings in foundations, increasing ventilation

air pollution

memorable air emission episodes: donora (1948) and london (1952) smog
inversions trap pollutants
natural: volcanoes, sea sprays
manmade: vehicles, factories

acid rain

causes: SO2 and NOx emissions
effects: damages ecosystems, buildings

global warming

leading greenhouse gases: CO2 and methane
effects: sea level rise, extreme weather

urbanization

growth of megacities (10million +)
environmental stress
infrastructure challenged

temperature inversions

when a cold dome of air suppresses air contaminanents closer to the ground, causing poor visibility and sometimes health concerns