PUBLIC HEALTH 200 FINAL UMICH

US HEALTH SYSTEM: BIG IDEAS

Several components (patients, facilities, providers, etc), Access (5 As) and Quality (6 parts), nurse and primary care shortages, medicare and medicaid, healthcare vs. health status disparities, we spend too much $ on individual care instead of bigger health efforts and thus we have a very ineffective system, flaws include excess vs. deprivation and fee-for-care payment system and insurance system flaws

ACA: BIG IDEAS

Triple aim, ACA reduced uninsured rates a lot, individual mandate requires you to buy insurance, insurance marketplaces installed, insurance industry reforms (no lifetime caps, no exclusion bc of preexisting conditions), medicaid is for low income folks, medicare is for old folks, increased funding for other public programs (CHIP, IHS, Medicaid, etc), prevention and public health fund

ENVIRONMENTAL HEALTH: BIG IDEAS

Exposure-disease model, biological vs. physical vs. chemical hazards, public/occupational hierarchy of controls (what is most and least effective?), vulnerable populations, risks from built environment (city level and house level)

SAFE FOOD AND DRUGS: BIG IDEAS

Food borne illness is a public health issue (it is common, dangerous, and costly), USDA (meat, poultry, eggs, daily inspections, way more employees, very few foods) vs. FDA (all other foods, A LOT of foods, way fewer employees, inspections of plants every 10 years, bigger budget than USDA), HACCP (food safety protocol/hazard prevention), Food, Drug, and Cosmetic act, food additives, food safety modernization act

MENTAL HEALTH: BIG IDEAS

Mental illness vs. mental health, barriers to treatment, diagnosis, populations with highest prevalence (homeless, incarcerated, youth in juvie), mental health indicators (emotional, psychological, social well-being), social determinants of mental health (the typical ones--housing, education, employment status, etc)

POPULATION GROWTH/PLANNING: BIG IDEAS

J Curve (exponential) vs. S Curve (restricted/logistic), major growth trends globally, reasons for rapidly declining death rates, reasons for rapidly declining birth rates, carrying capacity, climate change, population control measures

LGBT YOUTH HEALTH DISPARITIES: BIG IDEAS

What makes sexuality a social determinant of health (minority stress, intersectionality, life course, etc), violence (LGBT youth more likely to experience it), HIV, coming out to providers (barriers and benefits)

MATERNAL AND CHILD HEALTH: BIG IDEAS

High comparative maternal mortality rate in the US, rates highest among black women, rate is INCREASING, infant mortality has gone down in last fifty years, breastfeeding prevents disease (in mother and child), groups that are least likely to breastfeed (rural, under age 20, black women, women in poverty), contraception and birth spacing, upstream and downstream intervention efforts, community based participatory research,

GLOBAL HEALTH: BIG IDEAS

Differences in causes of death between high and low income countries, "big three" infectious diseases (mortality rates for all three have fallen since 2000), big spending does not equal good population health, behaviors transferred from high to low income countries (smoking, alcohol, obesity), problems, progress, tools, challenges

AGING: BIG IDEAS

Elderly population is increasing, 65 is age of eligibility for medicare and social security, some health issues are unique to the elderly, compression of mortality and morbidity (more people doing at the end of their lives, compression of morbidity is rly just a thing for rich people at this point), problems with medicare (it is not sustainable!), elderly people are healthier than before (big decrease in smoking)

THE FUTURE: BIG IDEAS

examples of progress (vaccines, smoking decline, 66% increase in life expectancy, etc) over 20th century, current and future challenges (obesity, antibiotic resistance, new diseases, aging, SES disparities, etc), solutions (lobbying groups, journalists, public, effective use of resources, connecting with non-PH groups such as schools and unions, etc)

Exposure-disease model

source - movement of pollutants - human exposure - dose - adverse health effect

examples of biological hazards

bacteria, virus, parasites, salmonella, animals

examples of physical hazards

UV radiation, noise, vibration, musculoskeletal issues, other radiation

examples of chemical hazards

greenhouse gases, cleaning products, lead, cigarette smoke

Globally, how much of disease is caused by environmental factors? (percentage)

25 percent !!!

public and occupational hierarchy of controls (most to least effective) (used to mitigate environmental hazards)

elimination/substitution, engineering controls, warnings, training and procedures, protective equipment

Food, Drug, Cosmetic Law act of 1938

gave FDA power over food and food regulation, defined requirements for truthful labeling of ingredients

why do we use food additives?

to boost nutritional value, for color, for taste, preservatives

Food Additives Amendment and Delaney Clause

FDA must approve all food additives; this clause prohibits additives that cause cancer in humans or animals

Diagnosing mental health conditions

Individual must meet certain criteria, usually determined through interviews, way more subjective than other diagnosis processes

Major population growth trends

1. 95% of births during next 25-50 years will be in world's poorest countries,

2. urban migration (majority of people live in cities 3. some countries face negative population growth (AIDS, war and famine, reduced fertility in high income countries)

Percentage of HIV diagnoses 2010-2014 that were due to MSM sexual contact

about 60%

Maternal mortality trends from 1900-2013

went down by 99% from beginning of century to 1990, started increasing again in 1990 to now

5 As of Access

Availability, Accommodation, Accessibility, Affordability, Acceptability

6 components of Quality (SPTripleE)

Safe, patient-centered, timely, effective, equitable, efficient

why are there primary care physician shortages?

Med school is expensive af! People don't want to go into debt. Demand has risen due to aging baby boomers (baby boomers ruin everything! just remember that)

why are there nursing shortages?

population is aging so demand is higher for nurses, as a whole the age of nurses is going up these hoes are gonna start retiring real soon

number of people that depend on public health insurance (2014)

120 million people depend on public health insurance

who is eligible for both medicare and medicaid?

low income people age 65 and older, low income people who are disabled and cannot work

who is eligible for medicaid?

LOW INCOME PEOPLE: pregnant women, children under 19, the blind, the disabled, those who need nursing home care, some parents, the elderly

who is eligible for medicare?

anyone over 65 years old, people with kidney failure or kidney disease, people who are disabled and cannot work

What is the triple aim of healthcare reform?

Improve health, reduce costs, improve quality

How much of their premiums must health insurance companies spend on healthcare services under the ACA?

80-85%

Limit on annual out of pocket spending (individual and family)

Individual: 6,600; Family: 13,200

What part of the ACA are people RLY trying to "repeal and replace"

the individual mandate

Under the ACA, Medicaid will cover everyone under what percentage of the poverty line?

being under 133% of the poverty line qualifies people for medicaid

Nation's first dedicated fund for prevention (in the ACA)

Prevention and Public Health Fund

Population drop in city of Detroit from 2000-2010

25% drop

Some health challenges Detroit faces

high unintended pregnancy rate, high infant mortality rate, high lead poisoning levels, high poverty rates

Community Based Participatory Research (CBPR)

partnership approach to research that involves community members, medical practitioners, academic researchers

Health problems that rly affect the elderly more than other populations (or are just plain old UNIQUE to the elderly)

heart disease, dementia, Alzheimer's, osteoporosis, arthritis, falls, social isolation, interaction of multiple prescriptions

"Perfect storm" of Medicare

high/rising costs of healthcare, aging population is increasing, elderly dependence ratio is increasing

"Big 3" global health diseases

HIV/AIDS, malaria, Tuberculosis

how much did global life expectancy increase over the 20th century?

life expectancy increased by 66% !!!