Public Health Exam 1

What is public health? — definition + 4 different focuses

Public health is the organized, collective effort to prevent disease, prolong life, and promote health for communities and populations. Its defining feature is its focus on preventing harm before individuals become ill, rather than primarily treating illness after it occurs.

• Population focus: public health looks at groups, neighborhoods, cities, states, and nations–not only individual patients

• Prevention focus: it uses vaccination, clean water, sanitation, food safety, injury, prevention, health education, and policy

• Collective action: government agencies, community organizations, schools, health systems, researchers, and residents all contribute

• Equity focus: it asks not only whether health improves on average, but also who benefits and who continues to experience worse outcomes

Public health versus health care

• Who is treated + when

  • PH: prevents disease and injury across populations

  • HC: diagnoses and treats illnesses in individual patients 

• Examples 

  • PH: restaurant inspections, immunizations, clean-air laws, tobacco taxes 

  • HC: physician visits, surgery, medications, hospital care

• When issue is addressed 

  • PH: often works upstream by changing conditions that shape risk 

  • HC: often works downstream after someone has symptoms or disease

• Can you see the results 

  • PH: success is sometimes invisible (ex: an outbreak that never happens)

  • HC: success is often visible in an individual patient's treatment or recovery

• After a disaster such as a hurricane, public health may work to prevent secondary harms—such as infectious disease, unsafe water, injury, or interrupted access to medication—even after the initial event has occurred.

Describe the roles of public health and health care in preventing deaths and increasing life expectancy

• Both are necessary 

  • HC: can save a person experiencing a heart attack

  • PH: can reduce the number of heart attacks by improving food environments, reducing smoking, making physical activity safer, and addressing barriers to preventative care

• Public health contributed substantially to the 30-year increase in U.S. life expectancy during the 20th century: course notes attribute about 25 years to public-health efforts and about 5 years to medical care. Important achievements included vaccination, safer roads and workplaces, infectious-disease control, safer food and water, maternal/infant health, family planning, water fluoridation, and tobacco control.

Explains reasons for the imbalance in spending and support for public health v. health care

The United States spends disproportionately on health care rather than public health because medical care is dramatic and visible: it rescues identifiable people after emergencies. Prevention often succeeds invisibly, because people do not see illnesses, injuries, or outbreaks that were avoided. This reflects the rule of rescue—people are more willing to pay to save someone already in danger than to invest in reducing a future risk. Market incentives also favor services and products that generate revenue rather than prevention strategies whose benefits may appear much later.

Identify and explain the three core functions of public health

1. Assessment: Gather credible data, analyze it, and communicate findings to the public and decision-makers.

   1. Example: Tracking a rise in overdoses and identifying the neighborhoods most affected.*

2. Policy development: Use scientific evidence, community participation, and political processes to develop policies that protect health.

   1. Example: Collaborating with residents and legislators to create a smoke-free indoor-air policy.*

3. Assurance: Ensure that essential health services exist and reach people who need them. This can involve encouraging other organizations, requiring action through laws or regulations, or directly providing services such as vaccines.

Explain reasons why public health is contentious

• Public health is contentious because it can limit individual liberty, regulate businesses, create costs, and involve moral or political disagreements.

• Examples include vaccination requirements, tobacco restrictions, calorie labeling, seatbelt laws, reproductive health, sex education, firearm violence, needle-exchange programs, and taxes on sugary beverages.

• Businesses may oppose regulations that reduce profits or increase costs, while public-health advocates emphasize population-level health benefits.

Explain the legal authority by which the government (at the federal, state, and local levels) has the authority to intervene in regulating public health issues

• Gov has the authority to act in public health primarily through its policy power the power to protect residents’ health, safety, welfare, and morals 

• States hold the broadest policy power, although local govs often implement state delegated powers through health departments, ordinances, inspections, and local regulations 

• The federal gov has more limited enumerated powers, especially involving interstate commerce, spending, taxation, and national defense 

  • Fed gov: fund programs, conducts research, regulates across state lines, sets national standards, and coordinates during national emergencies 

  • State gov: has the most significant legal authority over PH; licenses professionals, regulates many health and safety matters, and can delegate authority to localities 

  • Local gov: implements programs closest to communities; restaurant inspection, local disease control, sanitation, and community health initiatives 

Name which level of government has the most significant role in regulating public health

• State gov has the most power

• State governments hold primary authority over public health because the U.S. The Constitution grants them inherent "police powers" to protect the health, safety, and welfare of their residents.

• Constitutional Basis: Under the 10th Amendment, any powers not specifically delegated to the federal government are reserved for the states. Public health is not explicitly listed as a federal power in the Constitution.

• Inherent Authority: States possess broad sovereign "police powers" allowing them to mandate quarantines, license medical professionals, and regulate sanitary conditions.

• Legal Supremacy over Local Entities: Local governments are legal creatures of the state. They only possess the authority delegated to them by state constitutions or statutes (such as home rule or legislative grants), meaning states can override or preempt local public health rules.

Describe the roles of various federal agencies in the public health landscape

• CDC: Disease surveillance, outbreak investigation, prevention guidance, and public-health funding.

• NIH: Biomedical and public-health research.

• FDA: Safety and regulation of food, drugs, medical devices, tobacco products, and cosmetics.

• EPA: Environmental protections involving air, water, chemicals, and pollution.

• CMS: Administers Medicare and Medicaid and influences care through payment rules.

• USDA: Food safety and nutrition programs.

• OSHA: Workplace safety and health standards.

Gostin’s criteria for intervention (before gov uses public-health power, it should show these things):

• A significant health risk exists and is supported by evidence 

• The proposed policy is likely to work 

• The policies costs are reasonable compared with benefits 

• Limits on liberty, privacy, or autonomy are justified and no more restrictive than necessary

• Benefits and burdens are distributed fairly 

  • Ex = soda tax: a soda tax illustrated these criteria 

  • Evidence must connect sugary drinks to preventable health harms 

  • The tax should plausibly reduce consumption or fund beneficial programs 

  • Officials should consider the financial burden on lower-income households 

  • Revenue can be reinvested in communities most affected by health inequities 

Define population health and what population health involves

• Pop health = the health outcomes of a group of ppl, including how those outcomes are distributed within the group 

  • It is not just a communities average health, it asks whether some groups experience systematically worse health than others 

• Pop health involves 3 connected areas:

1. Outcomes: mortality, life expectancy, disease rates, disability, quality of life, and functional health 

2. Determinants: social, economic, environmental, behavioral, biological, and healthcare factors 

3. Policies and interventions: actions intended to change determinants and improve health outcomes 

Name key measures of population health

• Life expectancy

• Infant mortality

• Maternal mortality

• Death rates

• Incidence and prevalence of disease 

• Disability 

• Self-rated health

• Quality of life

Describe population health trends in the United States in the 20th and 21st centuries, including public health contributions to these trends

• During the 20th century, life expectancy in the US rose greatly due to sanitation, safer food and water, vaccinations, workplace safety, improved maternal and infant health antibiotics, and medical advances 

• The the 21st century, US life expectancy has faced setbacks

  • COVID-19, drug overdoses, firearm deaths. Suicide, motor-vehical crashes, and chronic disease are all important contributors, with unequal exposure to housing, food, transportation, income, and care shaping who is most affected 

Differentiate and provide examples of health inequalities v. health inequities

• A health inequality is a measurable difference in health outcomes or death rates between a group and the general population, while a health inequity is an unfair, avoidable, unnecessary, and unjust difference in health or health resources that arises from unequal social conditions 

  • Inequality: a higher infant mortality rate among black infants than white infants 

  • Inequality: the unequal rate is inequitable when it reflects avoidable differences in living conditions, environmental exposures, stress, wealth, access to quality care, and the effects of racism

• Health equity means social justice in health: reducing and ultimately eliminating unfair disparities in health and in the conditions that shape health 

  • PH must address inequalities because pop health cannot meaningfully improve if some groups systematically experience preventable illness and early death

Explain ways various social determinants of health (SDOH) influence health outcomes

• Social determinants of health are the social and physical conditions influencing health 

  • Economic stability and ability to meet daily needs 

  • Education

  • Occupation and job security 

  • Housing and neighborhood safety 

  • Transportation

  • Availability of green space and walkable environments 

  • Food access

  • Po;lition and environmental conditions 

  • Healthcare aces 

  • Special support, power, and control over one's life 

• Socioeconomic status (SES) = person’s or group’s social standing, commonly measured through income, education, and occupation

  • Lower SES is associated with fewer resources, less control over life circumstances, more chronic stress, and worse health outcomes 

Explain connections between race, racism and the social determinants of health

• Race is socially constructed: physical traits used to categorize ppl do not have inherent biological meaning

• Ethnicity refers to groupings based on common descent and culture and is also socially constructed 

  • Race still has powerful health consequences because racism shapes resources and opportunities 

• Racism can operate:

  • interpersonally : prejudiced beliefs, language, or actions between individuals 

  • Institutionally: discriminatory policies and practices within organizations or government 

  • Structurally: interlocking systems that repeatedly distribute resources and opportunities unequally across racial groups 

Unnatural Causes: In Sickness and in Wealth

The documentary’s main argument is that social class strongly shapes health. In Louisville, people in wealthier neighborhoods had longer life expectancies than people in lower-income neighborhoods, even though health is not determined by personal choices alone. Education, income, occupation, job security, debt, neighborhood conditions, power, and control over one’s life all influence health

The documentary also emphasizes that racism adds a health burden beyond socioeconomic status. Thus, an essay should avoid blaming individuals for their health; instead, connect behavior to the opportunities, constraints, stressors, and conditions created by policy and social systems.

Whitehall studies

The Whitehall studies showed a social gradient: lower employment rank was associated with greater risk of heart disease and other causes of death. Chronic stress helps explain this pattern. When people have low control, unstable work, financial insecurity, or repeated exposure to disadvantage, stress hormones such as cortisol can remain elevated, contributing to high blood pressure, high glucose, cardiovascular disease, accelerated aging, and other health harms.

Name the most significant health crisis in human history, and explain how the illness spread

The Black Death was one of the most devastating health crises in human history. It spread through trade routes, reduced the global population by about one-fifth, killed nearly half of Europe’s population, and took Europe more than a century to recover from. European exploration also brought smallpox to North America, where it killed many Indigenous people.

Describe challenges to the environment where Americans worked and lived during the industrial revolution

Industrialization created crowded cities and workplaces, dangerous machinery, toxic work conditions, poor sanitation, inadequate clean water, and polluted factory air. These conditions increased infectious-disease transmission and contributed to chronic disease, leading to stronger attention to sanitation, housing, clean water, and workplace safety.

Explain reasons why the The Tuskegee Study of Untreated Syphilis was an ethical disaster

The Tuskegee Study of Untreated Syphilis was an ethical disaster because the U.S. Public Health Service enrolled 600 Black participants, failed to tell approximately 400 men with syphilis that they had the disease, and withheld treatment even after penicillin was known to cure it. Participants experienced preventable harm, including death and transmission to wives and children. The study continued until 1972 and led to stricter protections for human research participants.

Explain ways in which the 1980s were a turning point in public health in the United States.

The 1980s were a turning point because HIV/AIDS emerged as a major public-health crisis. Public education clarified how HIV spread and did not spread, while advocates, public-health officials, and affected communities demanded research, treatment, and resources. This period showed the importance of community advocacy, stigma reduction, and public communication in responding to an emerging epidemic.

Describe ways in which public health was politicized during the COVID-19 pandemic.

COVID-19 further politicized public health because people disagreed about masks, vaccination, school and business closures, and the balance between personal liberty and collective protection. Trust also suffered when guidance changed as evidence developed and when political pressures affected perceptions of agencies such as the CDC.

Name early strategies for managing public health in the United States in the 18th century

Early strategies for managing public health in 18th-century America focused primarily on containing maritime arrivals, isolating the sick, and implementing rudimentary immunizations. During the 1918 flu epidemic, American cities deployed non-pharmaceutical interventions (NPIs) that successfully reduced transmission rates and lowered peak mortality where implemented early.

List public health measures that helped reduce death rates during the 1918 flu epidemic in the United States

• Bans on Public Gatherings: Cities closed schools, theaters, churches, dance halls, and public venues to enforce social distancing and limit contact.

• Isolation and Quarantine: Local health departments forcibly isolated known flu patients and quarantined their immediate contacts.

• Anti-Spitting and Anti-Coughing Laws: Public health campaigns and police departments heavily penalized public spitting and promoted covering coughs and sneezes.

• Hygiene and Sanitation Ordinances: Authorities banned common drinking cups, shared utensils, and common towels in public spaces, requiring boiling water and strict disinfection.

• Staggered Business Hours: Officials altered work schedules and staggered opening times for stores and factories to reduce overcrowding on public streetcars and sidewalks.

• Public Education and Mask Ordinances: Health departments distributed educational pamphlets on droplet transmission, and several municipalities enacted mandatory face-mask laws.