Intro to public health quiz 1

Population health

All we do together to promote and preserve health and prevent disease, disability, and death.

Healthcare systems

Traditional public health

social policy

Health care

systems of delivering one on one individual health services, including those aimed at prevention, cure, palliation, and rehabilitation

clinical preventive services- vaccination, behavioral counseling, screening for disease, and preventative medication

Traditional public health

Group and community-based interventions directed at public promotion and disease prevention

Communicable disease control, control of environmental hazards, food and drug safety, reduction in risk factors for disease

Social interventions

Interventions with another non-health-related purpose, which have secondary impacts on health

Interventions that improve the built environment, increasing education, alter nutrition, or address socioeconomic disparities through changes in tax laws; globalization and mobility of goods and populations

Health protection

antiquity-1830

miasma

authority-based control of individual and community behaviors

religious and cultural practices and prohibited behaviors

quarantine for epidemics, sexual prohibitions to reduce disease transmission; dietary restrictions to reduce food-borne diseases

Hygiene movement

1840-1870

Sanitary conditions as a basis for improved health

Environmental action on a community-wide basis, distinct from health care

snow on cholera, Semmelweis and puerperal fever, collection of vital statistics as emperical foundation for public health and epidemiology

Contagion control

1880-1940

Germ theory- demonstration of the infectious origins of disease

Communicable disease control through environmental control, vaccination, sanatoriums, and outbreak investigation in general population

Linkage of epidemiology, bacteriology, and immunology to form tuberculosis sanatoriums, outbreak investigation- e.g., Goldberger and pellagra

Filling holes in the medical care system

1950-mid 1980

Integration of control of communicable diseases, modification of risk factors, and care of high-risk populations as part of medical care

Public system for control of specific communicable diseases and care for vulnerable populations distinct form general healthcare system, beginning of integrated healthcare systems with integration fo preventative services into general healthcare system

Antibiotics, randomized controlled trials, concept of risk factors, surgeon general report on cigarette smoking, Framingham study on cardiovascular risks, health maintenance organizations and community health centers with integration of preventative services into general healthcare system

Health promotion/disease prevention

mid 1980-2000

focus on individual behavior and disease detection in vulnerable and general populations

Clinical and population-oriented prevention with focus on individual control of decision making and multiple interventions

AIDS epidemic and need for multiple interventions to reduce risk, reductions in coronary heart disease through multiple interventions

Population health

2000

coordination of public health and healthcare delivery based upon shared evidence-based systems thinking

Evidence-based recommendations and information managament, focus on harms and costs as well as benefits of interventions, globalization

Evidence based medicine and public health, information technology, antibiotic resistance, global collaboration, e.g., one health, tobacco control, climate change, and a full life cycle approach to improving community health

Historical

physical

geographically limited

communicable diseases

high-risk maternal and child, high-risk occupations

Current

physical and mental

local, state, national, global, governmentally defined

toxic substances, product and transportation safety, communicable diseases, costs of health care

Disabled, frail elderly, individuals with pain, uninsured

Emerging

cosmetic, genetic, social functioning

Defined by local, national, and global communications

Disasters, climate change, technology hazards, emerging infectious diseases

Immunosuppressed, genetic vulnerability

High-risk approach

Focuses on those with the highest probability of developing disease and aims to bring their risk close to the levels experienced by the rest of the population

Improving the average approach

Focuses on the entire population and aims to reduce the risk for everyone

Reducing high risk while increasing low risk

Reducing high risk by spreading the risk broadly and thereby increasing the risk of previously low risk individuals

Behavior

Individual actions that increase exposure to causes of disease or provides protection from disease

Infection

Exposure to infections may act as underlying determinants of disease coming many years earlier or producing consequences in organ systems far removed from the location of infection

Genetics

Even when not a direct cause of disease, genetics can be an underlying determinant, severity varies

Geography

location, may affects the probabiltiy of exposure to a disease including small scale or local and large scale effects such as climate or altitude

Environment (physical environment)

1) natural- unaltered exposure/deficiencies

2) altered- occupational and non-occupational toxic exposures

3)Built environment- indoor air pollution or close contact with humans/animals leading to infectious disease transmission

Medical care

access to medical care may influence the development as well as the course of disease

cure of infections/improved outcomes

Socio-economic

education, income, professional status, cultural, and religion may influence disease above and beyond other influences

economic stability

help people earn steady incomes that allow them to meet their health needs

Educational access and quality

increase educational opportunities and help children and adolescents do well in school

health care access and quality

increase access to comprehensive, high-quality health care services

Neighborhood and built environment

Create neighborhoods and environements that promote health and safety

Social and community context

increase social and community support

Health equity

providing health care for everyone at a equal level depending on their needs rather than a societal standard

evidence-based public health

uses quantitative methods to establish what is happening and what can be done

problem

what is the problem

etiology

what causes it

recommendations

what should be done

benefit and harms

implementations

doing something about it

evaluation

seeing whether what you thought would work does

case definition

formal definition with a set of criteria that need to be fulfilled

incidence rate

probability of developing an event over a period of time (usually one year

# of cases of a disease per year/ # at risk of developing the disease at the beginning of the time period

prevalence

probability that a condition exists in the average person in a population at one point in time

# with the disease at one point in time/ # at risk of the disease

mortality rate (incidence of death)

Probability of dying from the disease over a period of time, usually one year

# who die from the disease per year/ at risk of dying

Case-fatality

probability of dying from a disease once it has been diagnosed

# of deaths for a disease/ # of diagnoses of the disease

prevalence

incidence/ average duration

person

characteristics of individuals with and without a condition/disease

place

geographic location

Time

clinical course of disease including timing of exposure, occurrence, and outcome of dissease (mortality/morbidity)

Artifactual

1. changes in the definition of the disease

2. changes in effort to detect the condition, may or may not lead to changes in the course of the disease

3. changes in ability to detect the condition

Real (differences in age)

need to be age adjusted

Differences in age or other factors strongly associated with development of disease may explain differences or changes in rates

Real (after adjustment)

reflect changes or differences in the frequency of the disease that require explanation

contributory cause and efficacy

use of incorrect language could impply cause-effect relationship where there is none

Group association

a group relationship between a cause and an effect

individual association

individuals with a disease also have an increased chance of having a potential risk factor

individual association

Individuals with a disease also have an increased chance of having a potential risk factor

prior association

the potential risk factor precedes in time the outcome

altering the cause alters the effect

active intervention to expose one group to the risk factor results in a greater chance of the outcome

Strength of the relationship

the relative risk of those with the risk factor is greatly increased compared to those without the risk factor

Dose-response relationship

Higher levels of exposure and/or longer duration of the exposure are associated with increased probability

consistency of the relationship

studies at the individual level produce similar results in multiple locations in wide variety of populations

biological plausibility

known biological mechanisms can convincingly explain a cause and effect relationship

A

implies a strong recommendation

B

in general the intervention should be used unless good reasonsor contraindications for not doing so

C

the use of judgement often on an individual by individual basis, individual recommendations depends on the specifics of an individual’s situation, risk taking attitudes and values

D

stong evidence against the intervention

I

the evidence is inadeqate to make a recommendation for or against use of the intervention

Good

high quality studies

relevant to the recommendations

clinically important outcomes

primary

before the disease is present

secondary

after the disease (or risk factor) is present but before the occurrence of clinical consequences

Tertiary

after the disease is clinically apparent but before the occurrence of irreversible consequences

Primary interventions

remove basic causes

reduce exposure

strengthen resistance

secondary interventions

intervene as soon as possible after exposure

identification and treatment of risk factors

screen for asymptomatic disease

tertiary interventions

reverse the course of the disease (cure)

prevent complications

restore function

primary

advantages:

the disease or condition never occurs avoiding the impact and cost of illness

does not require diagnosis which may not always be correct and successful, treatment may not always be available

disadvantages:

large numbers of individuals who would never experience the condition may need to receive the intervention who would never experience the condition

Issues of cost and safety

May be difficult to implement if long standing behavior or policy requires change

Secondary

advantages:

individual never becomes ill

outcome my be improved compared to later diagnosis and treatment

disadvantages:

usually requires identification of subgroup of the population in order to be feasible

large number of conditions need to be fulfilled before secondary interventions work

if unsuccessful might just identify outcome earlier or increase cost or produce side effects or anxiety from the process

tertiary

advantages:

only requires attention to those with the disease

can be integrated with treatment of other conditions through clinical care

individuals often seek services and if successful appreciate the improvement in outcome

disadvantages:

often more costly per individual

diagnosis may not be correct and treatment may not be successful

often requires interventions with greater harms, more costs and greater time and inconvenience

levels of intervention

individual

high risk group

general population

Education/ information

provide information (including advice or recommendation by a health professional) to individuals, at risk groups or general population

motivation/ incentives

provide tangible incentive to change behavior for individuals, high risk groups, or general population.

Not merely persuasion

Innovation/ technology

changes in technology or organizational approaches that can be applied to individuals, high risk groups, or the general population

Education

advantages:

preserved freedom of choice

often least expensive

often needed even if not effective on its own

Disadvantages:

often ineffective when used alone

requires message understandable and tailored to range of individuals

motivation

advantages:

preserves some freedom of choice

may be more effective than information alone

disadvantages:

possible “victim blaming” if behavior does not change

may be very costly

obligation

advantages:

may be most effective if clear cut behavior and relatively easy to enforce

disadvantages:

removes freedom of choice

if not effectively implemented may undermine respect for the law

may be expensive to enforce

innovation in technology

advantages:

may minimize required or difficult changes in behavior

disadvantages:

may be expensive

may create health disparities based on cost and access

may create its own problem or addictions

may require computer skills to use

reach

who is using the intervention in practice

effectiveness

how well is the intervention working to improve outcome for those who use the intervention in practice

adoption

how well is the intervention accepted in practice

implementation

does the intervention need to be modified for use in practice

maintenance

what is needed to ensure long-term success of the intervention