Review : EXAM #1 [ SLIDE NOTES ]

“The science and art of

preventing disease, prolonging

life, and promoting health through

the organized efforts and

informed choices of society,

organizations, public and private

communities, and individuals.”

—CEA Winslow

The landmarks of political,

economic and social history are

the moments when some

condition passed from the

category of the given into the

category of the intolerable. I

believe that the history of public

health might well be written as a

record of successive re-

definings of the unacceptable.”

—Sir Vickers

“Fulfilling society’s interest

in assuring conditions in

which people can be

healthy.”

—Institute of Medicine

“Public health aims to provide

maximum benefit for the

largest number of people.”

—World Health Organization

Major Achievements

1900-1999

• Vaccinations

• Motor-Vehicle Safety

• Safer Workplaces

• Control of Infectious Diseases

• Decline of Deaths from Heart Disease and Stroke

• Safer Foods

• Healthier Mothers and Babies

• Family Planning

• Fluoridation of Drinking Water

• Recognition of Tobacco Use as a Health Hazard

Motor-Vehicle Safety

•Alcohol-Impaired Drivers

•Young Drivers and Passengers

•Pedestrians

•Occupant-Protection Systems

•Safety Belts

•Child-safety and Booster Seats

Safer and Healthier Foods

•Decreases in microbial contamination

•Increased nutritional content

•Ability to preserve perishable foods

•Pasteurization

•Identification of food borne pathogens

Family Planning

Average Family Size

• 1800: 7.0 Children

• 1900: 3.5 Children

• 2000: 2.0 Children

Fluoridation of Drinking water

•Population Served

• 10,567 public water systems

• 135 million people

• 8,573 communities

•Cost Effective

• $0.31 to $2.12 per person

Ten Great Public Health Achievements ---

United States, 2001--2010

• Vaccine-Preventable Diseases

• Prevention and Control of Infectious Diseases

• Tobacco Control

• Maternal and Infant Health

• Motor Vehicle Safety

• Cardiovascular Disease Prevention

• Occupational Safety

• Cancer Prevention

• Childhood Lead Poisoning Prevention

• Public Health Preparedness and Response

Public Health =

Your Invisible Guardian

Life expectancy has improved to an additional 30 years since 1900; 25 of those years are due to efforts of …..

public health.

Public Health isn’t everything…

is ABSOLUTELY everything

Unique Features of Public Health

• Culture

• Social Justice

• Political Nature

• Dynamic Agenda

• Link with Government

• Science

• Prevention

• Culture

Core Functions of Public Health

• Assessment

• Policy Development

• Assurance

Essential Services: Assessment

• Assess and monitor population health

• Investigate, diagnose, and hazards and root causes

Essential Services: Policy Development

• Communicate effectively to inform and educate

• Strengthen, support, and mobilize communities and partnerships

• Create champion, and implement policies, plans, and laws

• Utilize legal and regulatory actions

Essential Services: Assurance

• Enable equitable access

• Build a diverse and skilled workforce

• Improve and innovate through evaluation, research, and quality improvement

• Build and maintain a strong organizational infrastructure for public health

Leading Causes of Death : 1900

• Pneumonia/ Influenza / Bronchitis

• Tuberculosis

• Diarrhea and Enteritis

• Heart Diseases

• Bright’s Disease ( Chronic Nephritis )

Leading Causes of Death : 1930

• Heart Diseases

• Pneumonia/ Influenza / Bronchitis

• Cancer

• Nephritis

• Cerebral Hemorrhage

Leading Causes of Death : 1970

• Heart Diseases

• Malignant neoplasm

• Cerebrovascular diseases

• Pneumonia/ Influenza / Bronchitis

• Accident, except motor vehicle, suicide

Leading Causes of Death : 2007

• Heart Diseases

• Malignant neoplasm

• Cerebrovascular diseases

• Chronic lower respiratory disease

• Accidents ( unintentional injuries )

Leading Causes of Death : 2015

• Heart Diseases

• Malignant neoplasm

• Chronic lower respiratory disease

• Accidents ( unintentional injuries )

• Cerebrovascular disease

Leading Causes of Death : 2022

• Heart diseases

• Malignant

• Accidents ( unintentional injuries )

• COVID

• Cerebrovascular disease

Ecological Fallacy

• Occurs when inferences or conclusions are made at the individual level based on relationships observed at the group level

Aggregation Fallacy

• Occurs when inferences or conclusions are made at the group level based on relationships observed at the individual level

Population Heath Drivers

• Clinical Care

• Genes and Biology

• Health Behaviors

• Physical Environment

• Social and Economic Factors

Health Drivers with the greatest impact

• Social and Economic ( 40% )

• Health Behaviors ( 30% )

Health Drivers with the least impact

• Physical Environment 10%

• Genes and Biology 10%

• Clinical Care 10%

Determinants of Health

• Biological

• Behavioral

• Socioeconomic

• Environmental

Determinants of Health : Biological

• Age

• Sex

• Genetics

• BIochemistry

Biological : Sex and Genetics

• Longevity

• Hormones

• Reproduction

• Susceptibility or protective factors related to certain conditions or diseases

Determinants of Health : Behavioral

• Tobacco use

• Alcohol consumption

• Substance abuse/misuse

• Physical activity

• Dietary behavior

• Secual practices

Determinants of Health : Socioeconomic

• Education

• Income and Wealth

• Employment

• Housing and Neighborhood

Housing Influences Health

• Conditions within the Home

• Neighborhood Conditions

• Housing Conditions

• Housing Affordability

Determinants of Health : Environmental

• Physical

• Built

Environmental : General Physical

• Outdoor air quality

• H20 quality

• Toxic substances

• Hazardous waste

Environmental : General Built

• Homes

• Communities / Infratructure

Physical Environment

Climate

• Water shortages

• Extreme weather events

• Natural phenomenon or disasters

Natural pollution

• Seepage

• Fires

• Vog

Anthropogenic pollution

• Cars

• Effluent

• Energy production and use

How the environment impacts our health

• Air Pollution

• Inadequate water, sanitation

• Chemicals

• Radiation

• Community Noise

• Occupational Risks

• Agricultural practices

• Built Environments

• Climate Change

Built Environment

Homes

• Indoor air pollution

• Structural soundness

• Lead-based paints

Communities/Infrastructure

• Sanitation

• Transportation

• Green Spaces

• Food access

Governmental Public Health : Three Levels of Government

• Federal

• State

• Local

Federal Governmental Infrastructure

• Policy Making

• Financing

• Public Health

• Protection

• Collection and dissemination of information

• Capacity building

• Direct management of services

Health and Human Services : Federal Government

• Centers for Disease Control and Prevention (CDC)

• Food and Drug Administration (FDA)

• National Institutes of Health (NIH)

State Governmental Infrastructure

• Communicable Disease Screening, Treatment, and Prevention

• Public Health Surveillance

• Laboratory Services

• Immunizations

• Registry Maintenance

• Maternal, Child, and Adolescent Health Services

• Worksite Wellness

• Injury and Violence Prevention and Services

• Chronic Disease Screening, Treatment, and Prevention

• Environmental Health

• Behavioral Health

• Clinical Health Services

• Other Public Health Activities

• Cancer Screening, Treatment and Prevention

• Regulation, Inspection and/or Licensing

• Professional Licensure

• Correction System

Local Governmental Infrastructure : Local

• Epidemiology and surveillance

• Population-based primary prevention

• Regulation, Inspection, and/or licensing

• Other environmental health services

• Other population-based services

• Immunization\

• Screening of disease/conditions

• Treatment for communicable disease maternal and child health services

• Other clinical services

Types of Local Public Health Agencies

• County

• City

• City County

• Township

Public Health Governance Types

• Centralized

• Decentralized

• Mixed/Shared/Hybrid

Public Health : Centralized Government

A structure where local health units operate as direct employees and units of the central or state government

Public Health : Decentralized Government

A system where decision-making authority, planning, budgeting, and service delivery transferred from a central national government to regional, state, or local authorities

Social Ecological Framework

• Individual

• Interpersonal

• Institutional/Organizational Community

• Social Structure, Policies and Systems

Social Ecological Framework and Determinants of Health Are…

Linked

Life expectancy has improved to an additional…

30 years since 1900; 25 of those years are due to efforts of public health

Public Health

• Biostatistics

• Environmental Health

• Occupational Health

• Epidemiology

• Health Policy and Management

• Health Promotion and Community Health Sciences

The majority of leading causes of death in the US are…

Non-Communicable Diseases/Conditions

Practice Question: During this stage of the epidemiologic transition infectious disease outbreak would still occur, but usually not widespread, and the overall crude death rate began to drop

A. Age of Pestilence and Famine

B. Age of Declining Pandemics

C. Age of Degenerative and Man-Made Diseases

D. Age of Delayed Degenerative Disease and Emerging Infectious Disease

B. Age of Declining Pandemics

Practice Question: Which phase of the epidemiologic transition is characterized by people living longer with chronic conditions due to improved environmental, appearance of diseases such as Zika?

A. Age of Pestilence and Famine

B. Age of Declining Pandemics

C. Age of Degenerative and Man-Made Diseases

D. Age of Delayed Degenerative Disease and

Emerging Infectious Disease

D. Age of Delayed Degenerative Disease and

Emerging Infectious Disease

Practice Question : The leading cause of death for young adults, including college-aged students is…

A. Cancer

B. Diabetes

C. Heart Disease

D. Unintentional Injuries

D. Unintentional Injuries

Under the US Constitution who is responsible for health?

The State

Practice Question: Which of these clauses best aligns

or is associate with the federal government's role in health?

A. Establish justice

B. Ensure domestic tranquility

C. Provide for the common defense

D. Promote the general welfare

E. Secure the blessings of liberty

ALL OF THEM!!!

Practice Question : The essential service of "build

and maintain infrastructure" falls under

which core function?

A. Research and Innovation

B. Policy Development

C. Assessment

D. Assurance

Assurance

Practice Question : Which of the following are major

public health achievements from the last

century (1900-1999)? (Select all that apply )

A. Fluoridation of Drinking Water

B. Cancer Prevention

C. Public Health Preparedness and Responses

D. Safer Workplaces

A. Fluoridation of Drinking Water

D. Safer Workplace

Practice Question: The essential service of "build

and maintain infrastructure" falls under

which core function?

Assurance

Practice Question : A large company wants to improve

workplace wellness options for employees. A small

committee visits several similar sized companies to

identify best practices. What essential service best

describes these actions?

A. Create, champion, implement policies, plans,

laws

B. Build a diverse and skilled workforce

C. Assess and monitor population health

D. Improve and innovate through evaluation,

research and QI

D. Improve and innovate through evaluation, research and QI

Which of the following best exemplifies “ communicate effectively to inform and educate”?

A. Tracking number of speeding tickets

B. Speed limit sign on University Drive

C. Police ticketing speeders on game day

D. Businesses asked to sign petition about

speed limits

B. Speed limit sign on University Drive

Practice Question : A local health department director

notices an increase in smoking related health

concerns in her community. What examples of

determinants of health could she explore to

better understand this issue?

• Behavioral

• Socioeconomics

The Epidemiologic Transition Model ( ETM )

• Was created by Abdel Omran in 1971, marking a significant contribution to public health and epidemiology.

• The model explains the transition of disease patterns as societies progress through different stages of development.

• It highlights the relationship between socio-economic development and health outcomes, particularly mortality rates.

ETM Stage 1 [ Pre ] : Pestilence and Famine

• Characterized by high mortality rates due to infectious diseases, epidemics, and food shortages.

• Life expectancy during this stage ranges from the 20s to 40s, reflecting the harsh living conditions and lack of medical care.

• Historical context: This stage was prevalent in pre-industrial societies, where diseases like the plague and famine were common.

ETM Stage 2 [ Early ] : Receding Pandemics

• Marked by a decline in mortality rates due to improvements in sanitation, nutrition, and medical advancements.

• Life expectancy increases to the 40s-50s as infectious diseases become less common.

• Example: The introduction of vaccines and antibiotics significantly reduced the impact of diseases such as smallpox and tuberculosis.

ETM Stage 3 [ Late ] : Degenerative and Man-Made/Chronic Diseases

• In this stage, the primary causes of death shift to degenerative diseases such as heart disease, cancer, and diabetes.

• Life expectancy rises to the 60s-70s, reflecting better healthcare and lifestyle changes.

• Case study: The rise of lifestyle-related diseases in developed countries due to sedentary lifestyles and dietary changes.

ETM Stage 4 [ Post ] : Delayed Degenerative Diseases and Emerging Infections

• Characterized by chronic illnesses occurring at older ages, with a focus on lifestyle diseases.

• Life expectancy extends to the 70s-80s, as medical advancements allow for better management of chronic conditions.

• Example: Increased awareness and treatment options for diseases like hypertension and diabetes contribute to longer life spans.

• This stage is marked by the resurgence of infectious diseases, such as HIV/AIDS, due to factors like antibiotic resistance and global travel.

• Life expectancy may fluctuate as new health threats emerge, challenging previous advancements in public health.

• Historical context: The emergence of new pathogens and the reemergence of diseases previously thought to be under control highlight the ongoing challenges in global health.

Practice Question : A cyclist commits to a virtual charity ride

across Texas to improve physical activity. At which

level of the Social Ecological Framework does this

intervention take place?

Individual

Practice Question : To improve worker health, a company

CEO implements standing desks for all employees.

What level of the Social Ecological Framework is

responsible for creating this intervention?

Organizational

Practice Question : To ensure proper disposal of hazardous

waste a neighborhood board hosts collection events

two times per year. What level of the Social Ecological

Framework is involved with managing this

intervention?

Community

SEF Level : Individual

Knowledge, attitudes, personal skills,

personal choices.

Example : Cyclist committing to virtual charity ride for fitness;

personal choice to stop smoking.

SEF Level : Interpersonal

Family, friends, social networks, peer

influences.

Example:Bystander intervention programs ('Step In Stand Up' against sexual violence); peer exercise groups.

SEF Level: Organizational / Institutional

Workplaces, schools, churches, health

facilities.

Example: CEO installing standing desks for employees;

mandatory hospital employee flu shots.

SEF Level : Community

Neighborhoods, local organizations, built

environments.

Example:Neighborhood hosting hazardous waste collection

2x/year; municipal trail network expansion.

SEF Level : Policy / Societal

Local, state, federal laws, regulations, taxes.

Example:Speed limit enforcement on University Drive; national cigarette taxes; clean air legislation.

Piano Stairs:

Transforming subway stairs into playable piano keys encouraged 66% more people to take stairs over escalator (Individual/Built Environment).

Bottle Bank Arcade:

Turning recycling bins into arcade games increased glass recycling dramatically in one night

(Community/Behavioral).

Speed Camera Lottery:

Reinvesting speeding fines into prizes for safe drivers reduced average driving speeds significantly (Policy/Behavioral).

Governance Type: Shared / Hybrid

LHDs are governed jointly by both state and local

authorities.

Governance Type : Mixed Model

Multiple governance types operate simultaneously

Texas Infrastructure:

Texas uses a decentralized/mixed system. Unserved counties without local health departments are covered directly by DSHS Regional Public Health Coverage Offices (11 Health Service Regions).

Local Health Departments [ LHD ] Revenue Sources

• Federal pass-through (26%)

• Direct Federal (25%)

• State funding (21%)

• Local funding (14%)

• Fees/Fines (4%), Medicaid/Medicare (4%)

• Over 51% of local funding originates federally.

Sandbox Partners:

Governmental public health relies on non-governmental partners: schools, hospitals, employers, faith-based groups, law enforcement, civic groups, and tribal health.

Life Expectancy

The average number of years a person is expected to live based on statistical mortality data.

Mortality Rate

• A measure of the frequency of occurrence of death in a defined population during a specified interval.

Infectious Disease

• A disease caused by pathogenic microorganisms that can be spread, directly or indirectly, from one person to another.

Non-Communicable Disease (NCD)

A medical condition or disease that is non-infectious and non-transmissible among people

Tobacco Disparities

E-cigarette usage among youth rose dramatically while traditional cigarette smoking declined.

Upstream Interventions

Strategies that alter policy, social structures, or environmental defaults to prevent health problems across entire populations.

Fun Theory

Modifying environmental choices to make healthy behaviors easier, intuitive, or more engaging

Speed Camera Lottery

Utilizes a policy/community-level strategy. Cameras record drivers; those driving under the speed limit are entered into a financial lottery funded by fines collected from speeders.

• Goal: Reduce vehicle speed and road traffic injuries.

• SEF Level: Policy / Community / Systemic level.

Walk Across Texas

A community-wide program encouraging team-based physical activity across local environments.

• (Community / Organizational Level)

Centers for Disease Control and Prevention (CDC)

Lead federal agency for disease surveillance, epidemiological investigation, prevention, and outbreak response.

Department of Health and Human Services (HHS)

The primary federal agency overseeing health policy and human services.

Food and Drug Administration (FDA)

Federal regulatory body ensuring the safety and efficacy of foods, pharmaceuticals, biological products, and medical devices.

National Institutes of Health (NIH)

Primary federal agency conducting and funding biomedical and behavioral research.