Public Health Final

John Snow

• English physician (1813–1858), pioneer of epidemiology. 

• Proved cholera spread via contaminated water, not air. 

• Used mapping/data to trace London outbreak to one water pump. 

• His work led to modern sanitation and clean water systems. 

Poor Law of 1601 (elizabethan poor law)

• England’s first welfare system; parishes cared for the poor, sick, and elderly. 

• Funded by local taxes (“poor rate”). 

• Early foundation for public health and social responsibility. 

Ada Mayo Stewart

• First US occupational (industrial) nurse (1870-1945)

• Worked for Vermont Marble Company; cared for workers and families. 

• Expanded nurse’s role to workplace health and safety. 

• Inspired the growth of occupational health nursing. 

clara barton

• Founder of the American Red Cross; “Angel of the Battlefield.” 

• Provided wartime relief and pioneered disaster response. 

• Promoted first aid readiness and preventative care. 

Lemuel Shattuck

• Author of 1850 Massachusetts Sanitary Commission Report. 

• Advocated public health data collection, sanitation, prevention. 

• Laid groundwork for modern public health departments. 

Dorothea Dix

• Reformer for mental health and prison conditions. 

• Superintendent of Army Nurses (Union, Civil War). 

• Set professional standards for nurses and humane care. 

Mary Breckinridge

• Founded Frontier Nursing Service in rural Kentucky. 

• Pioneered nurse midwifery, prenatal, and child health care. 

• Greatly reduced maternal and infant mortality. 

Lilliam Wald

• Founder of public health nursing. 

• Created Henry Street Settlement in NYC for community care. 

• Promoted accessible home health and social services. 

boom and bust

describes a pattern of panic and neglect. Massive spikes in crisis-driven funding (e.g., during the COVID-19 pandemic) lead to rapid hiring, only to be followed by brutal budget cuts, workforce layoffs, and infrastructure erosion as public attention wanes

Dr Chokshi Podcast

• boom and bust

• misinformation units

• making the invisible visible

Social determinants of health

• Economic stability (income, employment, poverty) 

• Education access and quality 

• Health care access and quality 

• Neighborhood and built environment (housing, safety, transportation, pollution) 

• Social and community context (social support, discrimination, social cohesion) 

Health Disparities v. Health Equities  

• Health disparities = the unequal differences in health outcomes between groups.

• Health equity = the effort to eliminate those differences by ensuring fair access to opportunities and resources for health.

A group of researchers conducted a study on a particular population and found that individuals from lower-income neighborhoods had higher rates of cardiovascular disease compared to those from wealthier neighborhoods. What term best describes this situation?

Health disparities

A nurse, aware of the social injustices related to healthcare access in her city, collaborates with local stakeholders to develop a free city-wide vaccination program that specifically targets underserved neighborhoods. This nurse's actions primarily demonstrate a commitment to:

Heath Equity

A city government implements initiatives to improve access to healthy food options in low-income neighborhoods, build safe recreational spaces, and promote educational opportunities. What term best describes these efforts? Select all that apply.

health equity and social determinates of health

Windshield Survey

• Driving through a community to observe it firsthand 

• Strengths: descriptive overview of community 

• Limitations: requires 2 people, time-consuming, only visual — no direct community input 

Community Health Needs Assessment

• Views the community as the client, not individuals 

• Goal: provide benefit to the community/population as a whole 

• Foundation for all program planning and change 

• Uses the nursing process or Plan-Do-Study-Act (PDSA) cycle — assessment always comes first 

Community Health Nurse Role

• Establish contacts with community partners 

• Witness interactions between community programs and client responses 

• Identify future services based on the visible needs of community members 

Data collection methods

• informant interviews

• open public meetings

• secondary data

• focus groups

• surverys

• windshield survey

informant interviews

• Strengths: low cost, builds participant buy-in/future supporters, may elicit unexpected details 

• Limitations: possible bias, difficulty finding willing participants 

Open Public Meeting (community Forum)

• Strengths: community input, low cost 

• Limitations: difficult to find a venue, focus can drift with too many ideas, less vocal members may not speak up, and participation varies 

Secondary Data

• Strengths: existing databases, can identify trends 

• Limitations: may not reflect current trends, time-consuming

focus groups

• Small group discussions to gather community perspectives 

Surveys

• Strengths: aggregate data, random sampling, written format, anonymous, no direct contact required 

• Limitations: low response rate, expensive, time-consuming, requires reading ability 

After the assessment (process)

1. Analysis (diagnosis) 

2. Planning intervention/program 

3. Implementation 

4. Evaluation 

Components of the Epidemiological triad

1. Agent 2. Host 3. Environment

Agent (epidemiology)

• The biological, chemical, or physical cause of a disease or injury. 

• In the provided examples, this includes specific bacterial strains responsible for gastrointestinal illness. 

Host (epidemiology)

• The human or animal that harbors the disease or is susceptible to it. 

• This component is associated with the mode of transmission, such as human-to-human spread via respiratory droplets. 

• Organisms that harbor and transmit disease, such as mosquitoes serving as vectors for malaria, are also classified as hosts in this model. 

Enviornment (epidemiology)

• The external factors (physical, biological, or social) that allow the agent and host to interact. 

• Examples include crowded living conditions, climate, or contaminated water sources that facilitate the spread of an agent. 

Three Levels of Prevention

• Primary

• Secondary

• Tertiary

Primary Prevention

• Goal: Prevent disease or injury before they occur. 

• Methods: Preventing hazard exposure, altering unsafe behaviors, and increasing resistance to disease. 

• Examples: Immunizations, health education (tobacco use, safe sex), seat belt laws, and creating safe environments in schools or workplaces. 

Secondary Prevention

• Goal: Reduce the impact of a disease or injury that has already occurred. 

• Methods: Early detection and treatment to slow progress, and implementing programs to return individuals to original health/function. 

• Examples: Screenings (mammograms, blood pressure tests), low-dose aspirin or diet/exercise to prevent further heart attacks, and modified work duties for injured employees. 

Tertiary Prevention

• Goal: Soften the impact of an ongoing illness or injury with lasting effects. 

• Methods: Helping people manage long-term, complex health problems to improve function, quality of life, and life expectancy. 

• Examples: Cardiac or stroke rehabilitation programs, chronic disease support groups, and vocational rehabilitation to retrain workers. 

endemic

constant presence or usual prevalence of a disease or infectious agent in a population within a specific geographic area 

epidemic

an increase, often sudden, in the number of cases of a disease above what is normally expected in apopulation in a specific area 

Pandemic

an epidemic that has spread over several countries or continents, usually affecting a large number of people

Outbreak

sudden increase in the number of cases of a disease above what is normally expected in that population in a specific area; can be a single community or school 

Compondents of Epidemiology

1. public health survelence

2. field investigation

3. analytical studies

4. evaluation

5. linages and collaboration

6. policy development

public health surveilance (compondents of epidemiology)

• Ongoing, systematic collection, analysis, interpretation, and sharing of health data to guide public health decision-making 

• Acts as an early warning system for reportable diseases, behaviors, violence, etc. 

• Detects health problems/trends quickly to allow prompt intervention 

Examples: COVID-19 case monitoring, tracking TB/HIV/AIDS/malaria, cancer reporting, air pollution levels, water quality testing, lead exposure monitoring 

 

Field Investigation (compondents of epidemiology)

• Collecting data to identify the source of an illness and understand the occurrence and spread of disease 

• Begins creating methods to control outbreaks 

• Includes studying outbreaks, identifying sources of infection, devising strategies to prevent further transmission 

Examples: E. coli food contamination studies, interviews of ill individuals, animal migration tracking, STI contact tracing 

Analytical Studies (compondents of epidemiology)

• Examines relationships between exposures and health outcomes to understand why diseases occur 

• Fills gaps between surveillance and field investigation 

• Identifies causes, modes of transmission, and validates epidemiologic hypotheses 

• Focuses on risk factors, causes of disease, and effectiveness of interventions 

• Supports evidence-based nursing practice and public health policy 

Examples: Epidemiologic triad, chain of infection, case-control studies, cohort studies, randomized controlled trials 

Evaluation (compondents of epidemiology)

• Determines the relevance, effectiveness, efficiency, and impact of public health activities 

• Helps identify what works, what doesn't, and where improvements can be made 

Examples: Assessing proportion of target population immunized and impact on vaccine-preventable disease rates; during COVID-19 — evaluating vaccine effectiveness, masking, treatment trends, mortality rates, and booster potential 

Linkages and Collaboration (Compondnets of epidemiology)

• Epidemiology is a team sport — involves labs, infection control nurses, clinical staff, and computer information specialists 

• Spans local, state, federal, global, academic, and clinical sectors 

• Sharing information across all areas is essential for effective outcomes 

• Examples: 

  • AIDS epidemic — lack of collaboration among scientists delayed discovery of antivirals and knowledge about transmission 

  • Opioid epidemic — surveillance data (ED visits, EMS calls, overdose deaths) was linked with healthcare interventions (naloxone distribution, harm reduction education) to target highest-risk areas 

Policy development (components of epidemiology)

• Uses epidemiologic data to create laws, regulations, and guidelines 

• Supports public health mandates and funding decisions 

• Translates evidence into actionable rules that protect population health 

Examples: Meningococcal ACWY vaccine mandate for college students, mask mandates during outbreaks, FDA food safety regulations 

Healthcare Policies

• Health in All Policies (HiAP): Integrates health considerations into decision-making across all sectors. 

• Focus: Recognizes health as shaped by social, economic, and environmental factors, not just healthcare access. 

• Collaboration: Involves sectors like transportation, education, housing, and agriculture to promote health equity. 

• Goal: Create healthy, sustainable communities and reduce health disparities through shared responsibility. 

• Vision Zero: Strategy to eliminate all traffic fatalities and severe injuries. 

• Principle: Views crashes as preventable events caused by system design, not just individual error. 

• Approach: Promotes safe, equitable, and healthy mobility for all. 

• Collaboration: Requires participation from both public and private sectors using a multidisciplinary approach. 

Pathogen

the infectiious agent that causes disease (bacteria, fungi, virus)

Chain of Infection

Reservoir

where the pathogen naturally lives and multiplies (people, animals, soil, food, water)

Portal of Exit

how the pathogen leaves the reservoir (coughing, bodily, feces)

mode of transmission

how the pathogen tracels to a new host (direct contact, factors, indirect)

portal of entry

how the pathogen enters the new host (mouth, nose, eyes, cuts)

Suseptible host

A person able to be infected by the pathoegn (elderly, infants, immunocompromised,)

Elder abuse and Neglect

• Limited data on prevalence 

• Females abused at higher rates than males 

• The older you are, the more likely you are to be abused 

• Most commonly reported type: financial abuse/mismanagement 

Signs of elder abuse: 

• Unexplained or repeated physical injury 

• Physical neglect, unmet basic needs, poor hygiene/appearance 

• Financial mismanagement 

• Withdrawal, passivity, depression 

Mandatory reporting (MA)

• Nurse suspects abuse → immediately report orally to supervisor/employer 

• Supervisor must immediately notify Department of Public Health (DPH) 

• Written report must follow within 48 hours to DPH 

Intimate parter violence

• Nursing barriers: lack of knowledge/training on warning signs, how to ask, legal options, and social services 

• First-line support: attentive listening, nonjudgmental care, referrals to trusted resources, legal protection, housing 

• Lethality/Danger Assessment: developed by J. Campbell PhD, RN — assesses women's risk for homicide 

• Greatest risk factor for homicide: partner has a gun in the home 

Human Trafficing - red flags

• Does not speak English OR someone accompanying them supervises and resists leaving them alone 

• Doesn't know their location, has no address or job information 

• No ID or money — someone else is holding it 

• Signs of physical abuse/neglect, malnutrition, dehydration, drug use, poor hygiene 

• Tattoo that may signify "branding" by trafficker 

Nursing care for victems of violence

• Build trust and confidence 

• Focus on the client, not just the situation 

• Assess for immediate danger 

• Provide emergency care as needed 

• Develop a safety plan with the client 

• Make referrals for community services and legal options 

• Complete mandatory reporting following state and agency guidelines 

specialized models of care

• SANE: Certified Sexual Assault Nurse Examiners — forensic nursing specialty 

• Forensic nursing: formal education pathway for nurses working with victims of violence/trauma 

• Most children's hospitals have multidisciplinary maltreatment teams (doctors, nurses, social workers, advocates) 

Community resources

Women's shelters, law enforcement, advocacy/justice centers, WIC, mental health agencies (DMH, BEST), food banks, support groups (AA/NA), forensic nursing, unemployment offices, churches/faith communities

therapuetic attidute (SUD)

• Any drug/substance can be used in an unhealthy way 

• Anyone can develop Substance Use Disorder (SUD) 

• No one chooses to have a SUD 

• People can be successfully treated 

• Accept the client where they are in their recovery process 

• Reflect on your own attitudes, triggers, and frustrations when working with SUD clients 

• Key phrases: "I'm here to help you, not judge you" / "You're here now, and that's a big first step" 

stigma reduction (language matters)

Say This

Person with a substance use disorder

Drug use/misuse

Person living in recovery

Person arrested for a drug violation

Reoccurrence/setback

Maintained recovery

Not That

Addict, junkie, druggie

Drug abuse

Ex-addict, clean

Drug offender

Relapse

Stayed clean

Most Common SUDs

Alcohol use disorder, Tobacco use disorder, Opioid use disorder, Cannabis use disorder 

SBIRT Model (screening, breif intervention, referral to treat)

• Purpose: Identify individuals at risk for SUD, provide early intervention, and connect them with treatment 

SUD screening tools

• Quickly assess severity of substance use and identify those needing further intervention 

• CAGE quentioneer (alcohol deoendence screening)

• CRAFT (teen screening)

CAGE questioneer (alc dependence screening)

• C – Ever felt the need to Cut down on drinking? 

• A – Have people Annoyed you by criticizing your drinking? 

• G – Ever felt Guilty about drinking? 

• E – Ever had a morning Eye-opener to steady nerves or cure a hangover? 

• 2+ "yes" answers → suggests potential alcohol dependence, warrants further evaluation 

CRAFT teen screening tool

• C – Ridden in a Car driven by someone (or yourself) who was high/drinking? 

• R – Used substances to Relax, feel better, or fit in? 

• A – Used substances while Alone? 

• F – Forget things done while using? 

• F – Family or Friends told you to cut down? 

• T – Gotten into Trouble while using? 

Breif intervention (SUD)

• Short, focused conversation providing feedback and advice 

• Increases awareness, motivates the person to reduce or stop unhealthy use 

• Encourages reflection on substance use and its consequences 

• Referral to Treat —> Connects the person to specialized care 

Harm reduction model (SUD)

• Public health approach that minimizes negative consequences of substance use rather than requiring abstinence 

• Pragmatic, compassionate, nonjudgmental — meets people where they are 

core principles of SUD

1. Accepts that drug use exists — people use substances for complex reasons; abstinence not required for support 

2. Prioritizes safety and dignity — reduce health, legal, and social harms (overdose, infection, incarceration); emphasizes human rights 

3. Respects individual autonomy — supports informed choice; encourages incremental change, not all-or-nothing 

4. Focuses on reducing harm, not necessarily use — e.g., continued heroin use but with sterile needles to prevent HIV/Hep C 

Harm reduction practices

Practice	Goal
Needle exchange programs	Prevent HIV/HCV & abscesses
Naloxone distribution	Prevent opioid overdose deaths
Safe consumption sites	Medical oversight & link to care
Fentanyl test strips	Avoid unintentional overdoses
Medication-Assisted Treatment (MAT)	Reduce cravings & overdose risk (buprenorphine, methadone)
Safer sex education & supplies	Prevent STIs
Housing First programs	Prioritize housing stability over sobriety requirements

take aways and barriers to treatment (SUD)

• Easier access to illegal drugs than to treatment programs 

• Hard to get help 

• Lack of insurance coverage for SUD programs 

• Programs often low quality, not evidence-based 

• Unproven approaches (scams) exploit desperate families 

The Opiod Epidemic

• U.S. opioid crisis unfolded in waves: prescription opioids → heroin → synthetic opioids (fentanyl) 

• Sackler family / Purdue Pharma: 

  • Developed and launched OxyContin in 1996 

  • Aggressively marketed it as safe, downplaying its addictive nature

  • Promoted to doctors and influenced the FDA 

  • Aggressive promotion and over-prescribing were major drivers of the crisis 

  • Family amassed billions in profits 

  • Faced numerous lawsuits; reached multi-billion-dollar settlements with states 

Behavioral Red Flags with SUD in healthcare workers

• Frequent absences from the unit, frequent bathroom trips, medication errors 

• Tardiness (especially after breaks or before shifts) 

• Mood swings, irritability, unexplained emotional outbursts 

• Isolation from colleagues; avoiding patient/staff interactions 

• Confusion, memory lapses, difficulty concentrating 

• Erratic behavior (euphoric one moment, lethargic the next) 

• Defensiveness/secrecy about work performance or medication handling 

CM of SUD in healthcare workers

• Shakiness, unsteady gait, slurred speech 

• Dilated or constricted pupils; red or glassy eyes 

• Frequent nosebleeds (possible sign of snorting substances) 

• Sudden weight changes 

• Unusual body odor, sweatiness, poor hygiene 

• Tremors or involuntary movements 

Drug Diversion

• Occurs daily in healthcare settings 

• Example: MGH paid $2.3 million to resolve drug diversion allegations 

• Hospitals implement drug diversion prevention programs and compliance measures 

• Support resources: MA Nurses Association Peer Assistance Program, AANA Helpline 

• URAMP (Unified Recovery and Monitoring Program): In MA, the Board of Registration in Nursing's SARP transitioned to URAMP in 2024 — supports healthcare professionals in recovery 

Enviornmental health nursing - key roles

• Health Impact Assessment — assess potential health risks from environmental changes (new industries, climate change, new housing developments) 

• Disease Prevention — reduce risks from environmental factors (ex: poor air quality → asthma); intervene through policy and direct action 

• Regulation & Policy Development — develop, implement, and enforce environmental health policies (ex: industrial emissions regulations, waste management policies) 

• Health Education & Promotion — educate the public and stakeholders on environmental health issues; promote protective behaviors 

• Research — study how environmental changes impact human health and how those impacts can be mitigated 

climate change and health impacts

• heat related

• vector borne disease

• food security and malnutrition

• air quality

• population displacement

Heat related illnes and death

rising temperatures increase heat-related illness and death; exacerbates chronic cardiovascular and respiratory conditions 

vector borne diseases

warmer/wetter climates expand mosquito and tick habitats → increased spread of malaria, dengue, Lyme disease 

food security and malnutrition

changes in temperature and rainfall affect crop yields and livestock → food insecurity, malnutrition, altered nutrient content in crops 

air quality

warmer temperatures increase ground-level ozone → worsens smog, triggers respiratory illness 

Popultion displacement

extreme weather events and rising sea levels displace populations → cascading health issues: poor sanitation, limited healthcare access, social dislocation 

enviornmental exposures process visual

enviornmental health overview

• Field of public health science focused on how the environment influences human health 

• Key areas: water quality, toxics/waste, outdoor air quality, global environmental health, healthy homes & communities, infrastructure/surveillance 

exposure pathway

• Source → Release Mechanism → Environmental Medium → Exposure Point → Exposure Route 

• Release mechanisms: volatilization, spills, leaching 

• Environmental media: air, soil, soil gas, groundwater 

• Exposure points: food chain, direct contact 

• Exposure routes: inhalation, ingestion 

• Exposure pathway: Describes how people are exposed to an environmental contaminant that originates from a specific source.  

bioavailability

• The amount of a substance that is absorbed or becomes available at the site of physiologic activity 

• Not just how much contaminant is present — it's how much the body actually absorbs 

• Example — Lead in soil: 

  • Child ingests contaminated soil → risk depends on how much lead is absorbed through the GI tract 

  • Lead tightly bound to minerals = low bioavailability = lower risk 

  • Lead in easily dissolved form (e.g., lead acetate) = high bioavailability = higher risk 

• Helps public health officials prioritize remediation and assess actual health risk 

risk assessmen for enviornmeal contaminants

Risk = Hazard × Exposure 

common contaminants

lead, mercury, radon, PCBs, mold, benzene, asbestos, pesticides, arsenic 

GOAL of enviornmental justice

• no group bears a disproportionate share of negative environmental consequences 

  • Public health nurses must understand diverse communities and the varying vulnerabilities and adaptive capacities of different populations 

climate change inpact on health

Climate Issue	Health Impact
Intense heat waves	Heat exhaustion, heatstroke, dehydration (high risk: older adults, outdoor workers, infants, chronic illness)
Ozone / air quality / fires	Worsening asthma & COPD; urban & vulnerable populations most affected
Warmer climates	Increased vector-borne diseases — Lyme, West Nile, Dengue, Zika (mosquitoes/ticks)
Droughts, flooding, changing climate	Disrupted food supply, reduced crop yields, food insecurity, increased costs
Climate-related disasters (hurricanes, wildfires, flooding)	Stress, anxiety, depression, PTSD — especially in those with prior trauma

Types of disasters

natural, accidental, terrorism, emergency

natural disasters

Earthquakes 

Flooding 

Hurricanes 

Tornadoes 

Wildfires 

Blizzard (1978) 

accidental disasters

Chemical spills 

Nuclear accidents 

Industry explosions 

Oil spills 

terrorism

9/11 (2001) 

Boston Marathon (2013) 

Sarin gas attack, Tokyo (1995) 

Emergency disasters

Housing fire 

Local power outage 

Water main break 

direct effects of natural disasters

• Physical injury or death (falling debris, floods, fires, structural collapse) 

• Loss of shelter 

• Interruption of basic services (power, water, roads) 

• Displacement / forced evacuation 

• Property damage 

Indirect effects of natural disasters

• Mental health issues — anxiety, depression, PTSD 

• Loss of livelihood — businesses destroyed, jobs lost 

• Educational disruption — school closures affecting child development 

• Increased disease risk — poor sanitation, overcrowded shelters → outbreaks (cholera, respiratory infections) 

• Social disconnection — separation from family/community 

• Economic hardship — rebuilding costs, loss of income, lack of insurance 

• Delayed healthcare — interrupted care for chronic conditions or pregnancy 

are nurses mandated to report IPV

NO

purpose of the danger assessment tool for IPV

• A validated screening tool used to assess the risk of severe intimate partner violence (IPV) and femicide (homicide of a woman by an intimate partner).

• Developed by Jacquelyn Campbell.

• Helps healthcare providers identify individuals at high risk and develop safety plans.