Introduction to public health test 1

chapters 1, 4 and 9

assessment

is one of the three functions of public health. The process by which a public health agency regularly and systematically collects, assembles, analyzes, and makes available information on the health of a community, including statistics on health status, community health needs, epidemiologic and other studies of health problems.

Assurance

One of the three core functions of public health. The process by which the public health agency ensures its constituents that services necessary to achieve agreed-upon goals are provided, either by encouraging actions by other entities (private or public sectors), by requiring such action through regulation, or by providing services directly.

BIomedical sciences

is the study of the biological basis of human health and disease. Includes genetics, immunology, infectious disease, chronic diseases and molecular approaches to treatment.

Environmental health science

those aspects of human health, diseases, and injury that are determined or influenced by factors in the environment. This includes the study of the direct pathological effects of various chemical, physical, and biological agents, as well as the effects on health of the broad physical and social environment, which encompasses housing, urban development, land use, transportation, industry, and agriculture.

Epidemiology

• basic science of public health

• the study of populations to seek the causes of health and disease; the study of the distributions and determinants of disease frequency in human populations

Infectious disease

diseases caused by a microorganism (such as bacteria, protozoans, fungi, or viruses) that enter the body and grow and multiplies there.

Life expectancy

the number of additional years of life expected at a specified point in time, such as at birth or at age 65

mainstream medicine

scientific healthcare systems that use evidence based medicine to treat illnesses

policy development

One of the three core functions of public health. The process by which a public health agency exercises its responsibility to serve the public interest in the development of comprehensive public health policies by promoting use of scientific knowledge in decision-making about public health and by leading in developing public health policy. Agencies must take a strategic approach, developed based on a positive appreciation for the democratic poltiical process.

primary prevention

activities that are intended to prevent the onset of a disease or injury

Secondary prevention

Activities intended to minimize the risk of progression of or complications from a disease or to minimize damage from an injury

Social and behavioral sciences

the study of human behavior, including how people relate to each other and ow their actions affect society

statistics

as a scientific discipline or method, a way of gathering and analyzing data to extract information, seek causation, and calculate probabilities.

Health definition (WHO 1945)

a state of complete physical, mental, and social well being and not merely an absence of disease or infirmity

Health definition (WHO 1986)

Has been considered less as an abstract sate and more as a mean to an end which can be expressed to functional terms as a resource which permits people to lead an individually, socially, and economically productive life, not an object of living

C.E.A Winslow Public health definition 1920

the science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventative treatment of disease and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of healt .

IOM- future of public health- 1988

organized community efforts to ensure conditions in which people can be healthy. Activitites that society undertakes to prevent, identify, and counter threats to the health of the public

4 key parts of public health

• Mission

• Substance

• Organizational framework

• functions

Mission of public health

• The goal: Is the fulfillment of society’s interest in assuring the conditions in which people can be healthy

Substance of public health

the what: the organized community efforts aimed at the prevention of disease and the promotion of health

Organizational framework

• the who

• formal actions of government and associated private and voluntary organizations and individuals

Functions

• The how

• 3 core functions: assessment, policy development and assurance

Assessment: essential public health functions

• Monitor health

• diagnose and investigate

Policy development essential public health services

• inform, educate and empower

• mobilize community partnerships

• develop policies

Assurance essential public health services

• Enforce laws

• link to/provide care

• assure competent workforce

• evaluate

Public health as medical care

• In medicine, the patient is the individual while in public health the patient is the community

  • public health diagnoses the health of the community using public health science (assessment)

  • treatment of a community involves new policies and interventions (policy development)

  • goal of medicine is to cure ; goal of public health is to prevent disease and disability (assurance)

Social determinants of health

• education access and quality

• economic stability

• health care access and quality

• neighborhood and built environment

• social and community context.

The study of epidemics

• focuses on human populations and usually with an outbreak of disease in a community and is looking for a common exposure, seeking the causative factor/

• Deciphers causes of new diseases and prevents spread of old, well-understood diseases.

morbidity

rate of disease and is usually in a percent

mortality

rate of death, usually in per 1,000 or 100,000 per year

Statistics

• health data collected by government and partner agencies

  • these data are diagnostic tools for the health of the community

  • used to calculate risks and benefits

• uses

  • statistical analysis and epidemiology

  • statistical analysis and clinical studies (testing the effectiveness of a new drug)

Biomedical sciences

• research remains important to understanding and control of new infectious and noninfectious diseases.

disease

any harmful deviation from the normal structural or functional state of an organism, generally associated with certain signs and symptoms and differing in nature from physical injury.

• can be infectious or noninfectious, communicable, or noncommunicable.

Communicable infectious diseases

• covid 19

• Flu/pneumoni

• lyme disease

• mumps

• measles

• cholera

chronic infectious communicable disease

• covid 19 in some cases

• leprosy

• polio

• syphillis

• tuberculosis

Noncommunicable infectious disease

• tetnus

• legionaires

• anthrax

Noninfectious, non communicable disease

• accidents

• drug abuse

• homicide

• stroke

• suicide

Chronic noncommunicable noninfectious disease

• alcoholism

• cancer

• diabetes mellitus

• heart disease

• paralysis

• arthritis

infectious disease

• you can get from a microorganism

noninfectious disease

disease that does not result from ajn outside microorganism

communicable disease

transmitted from person to person (direct or indirect)

noncommunicable disease

are not transmitted from person to person

acute disease

come on pretty quickly > treatment plan → manage or resolve the diease

chronic disease

takes longer to develop and has a lot of causes

Environmental health science

• Classic component of public health

  • much of the public health improvement in the US in the 20th century was due to improved environmental health

• Health is affected by exposure to eviormental factors like

  • air quality, water quality, solid and hazardous waste, safe food and drugs and global environmental change

Social and behavioral sciences

• studying people and their social environment

• behavior is now the leading concern of factors that affect people’s health

• not only are individual factors key in health, but the social environment also plays a role (social ecology)

  • major health threats are tobacco, poor diet, and physical inactivity and injuries

  • various subpopulations (education, race/ethnicity, income, gender) have health disparities that are a major focus of public health today

Health policy and management or health administration

• This are of study examines the role of medical care in public health

• cost of medical care in the US is very high

• US has a high percentage of people without health insurance

  • lack access to medical care

  • quality of medical care can be questionable

  • medical care cost have eaten up profits that could be used more beneficially for education, housing and the environment

Levels of prevention

primary, secondary and teritary

Chain of causation

• Agent

• host

• environment

primary prevention

preventing the illness/injury from happening in the first place

secondary prevention

actions that we can take early to prevent problems from progressing

• before activities in daily life

• Identify problem

tertiary prevention

minimize disability, lack of function, lowers chance of death

Host

• infectious disease: person or animal with the disease

agent

bacteria, virus. causal

environment

where the diseased tissue lives and operates.

Host - person

knowledge, skills, attitudes, beliefs, vaccination

causal

cigarretes, viruses

environment

sanitary spaces air, water

Public health is tied to social reform

• sanitary science and public hygiene were key to reducing infectious disease spread and death

• Reformers also campaigned for

  • improved housing, trade unions, abolition of child labor, maternal and child health, temperance

Social Justice

minimal levels of income, basic housing, employment, education, and health care are seen as fundamental rights

Market justice

Emphasizes individual responsibility, minimal obligation to the common good, and the fundamental freedom to all individuals to be left alone

Sources of controversies

• economic impact

• individual liberty

• moral and religious concerns

• political concerns

Economic impact

• Most public health measures have a negative economic impact on some segments

  • Businesses often resist public health measures when they affect profit

• those who pay may not be ones who benefit

• perceptions of cost

  • costs may be short-term. while benefits may be long term

  • costs are easier to calculate than benefits

Individual liberty

• The Constitution calls for promoting the general welfare of US citizens

  • where can individual freedom be limited to improve the community’s health?

• Tragedy of the Commons

• paternalism and libertarian tradition

• Do we view death and disability as collective problems or individual ones

public health 5 step process

1. Identify the health problem

2. Identify risk factors associated with the problem

3. develop and test community-level interactions to control or prevent the cause of the problem

4. Implement interventions to improve the health of the population

5. monitor those interactions to asses their effectiveness

Main task of prevention

Develop interactions designed to prevent specific problems identified by an assessment, process initiated by a public health agency or through community concerns raised by an unusual course of events

Epidemiological triad

• an approach to design interventions. Is considering an illness or injury as a chain of causation

• involves an agent, a host and environment

• traditionally applied to infectious diseases.

Moral and religious concerns

• sex and reproduction

  • AIDS, STDs, teenage pregnancy, and low birth weight babies are a major US public health concern

• Public health solutions are often viewed as promoting immoral behavior.

  • alcohol and drugs

• such opposition may discoruage scientists and funding agencies from conducting research on many important health problems

Poltiical concerns

• public health regulation informed by the scientific research

• Funding often comes from politically-appointed entities (CDC, NIH)

• misinformation and disinformation

• relationship to politics not always negative- balance is key

Governmental role

• Confusion about where health should be regulated - US constitution

  • State and Federal governemnt

    • federal oversight of interstate commerce

    • federal tax and spend powers influence states

• How the law works

  • legislature passes statute —→ can be challenged in courts

  • If upheld ——> legislature establishes an agency to set rules about how to accomplish legislation. Courts can review agencies’ activities

  • OSHA

Local health department responsibilities

• Health statistics

• infectious disease control programs

• screening and immunizations

• health education services and chronic disease control/prevention programs

• conducting sanitation/inspections

• school health programs

• maternal and child health

• public health nursing services

State level public health

• Responsible for the health, safety, and general welfare of the population

• some potential conflict with other agencies

• epidemiologists and data analysis

• oversight of local health departments

• administer medicaid programs

Federal level

• Department of Health and Human services (HHS) is the overarching federal public health agency

  • key operating divisions

    • CDC (centers for diease control and prevention) - Epidemiology and asssesment and has a virus/bacteria lab

      • publishes morbidity and mortality weekly report (MMWR)

    • NIH- National institue for health- largest biomedical reseasrch complex in the world- also provides grants to scientissts at universities and research centers

    • FDA

NGOs

• Nongovernmental organizations

  • play a key role in education, lobbying, and research

  • disease focused organizations

  • professional membership organizations

  • philanthropic orgaizations

  • consumer groups

  • collaboration across sectors is key (IOM report_)

CDC

• the main assessment and epidemiological agency for the nation, directly serving the population as well as providing technical assistance to states and localities

Department of Health and Human services

Government agency that is dedicated to improving the healh and well-being of all americans by offering effective healh and human services. Also has a goal of promoting scientific advances in social services, public health and medicine.

Economic impact

• total costs and benefits that a particular event or situation can have on the overall.

Environmental protection agency

• EPA

• federal government responsible for prevention and cleanup of water pollution and air pollution, control of toxic substances and other issues of environmental contamination

Federal role in public health

• fundamental purposes of government to provide general welfare

FDA- Food and drug administration

the federal agency that ensures the safety and nutritional value of the food supply’; evaluates all new drugs, food additives, and colorings; regulates medical devices, vaccines, diagnostic tests, animal drugs and cosmetics

Libertarians

are advocates of a particular political philosophy

Local public health agencies

government agencies in the united states on the front line of public health

misinformation

is false or inaccurate information. especially information that has been given with the intention to deceive

Moralism

when certain acts or policies are promoted or discouraged based on the person’s moral beliefs (opposition to a condom-distribution public health program because of moral opposition to certain types of sexual activity.

Morbidity and mortality weekly report

A weekly publication issued by the CDC that is widely distributed in print and electronically via the internet. MMWR reports on timely public health topics that the CDC deals with, such as outbreaks of infectious diseases and new environmental and behavioral health hazards

NIH

• National institues of health

• primary federal agency for biomedical research. NIH has its own laboratories and provides funding to biomedical scientists at universities and research centers.

NGO

• nongovernmental organization

• an organization that is neither a part of a government nor a conventional for profit business

Occupational safety and health act

• a law passed by Congress in 1970 that established OSHA within the Department of Labor. OSHA was authorized, among other things, to set standards regulating employees’ exposure to hazardous substances

Paternalism

restriction of people’s individual freedom with the aim of protecting their health and safety

Tragedy of the Commons.

The overuse of a shared resource, such as a fish or timber stock, or pollution of a shared resource, suchs s air or water, because each individual cares more about their interests than the interests of the population as a whole.

state health department

states have the primary constitutional responsibility and authority for the protection of the health, safety, and general welfare of the population, and much of this responsibility falls on the state health department.

Surgeon general

Operational head of the US public health service commissioned corps (PHSCC) and is the leading spokesperson on matters of public health in the federal government of the united states

Basics of epidemiology

• diagnostic discipline of public health

• investigates causes of disease

• studies of the distribution and determinants of disease

• IDs trends in disease that may require medical and public health services

• evaluate the effectiveness of public health interventions

Descriptive epidemiology

• What: symptoms, signs, diagnoses. reported disease

• Who: demographic characteristics

• Where: geographic location, characteristics of place (urban, rural, etc), home, workplace, vacation, cruise ship

• When: trends, patterns, epidemics

  • often used when little is known about a disease, and to monitor outbreaks/disparities

Analytic epidemiology

• Why: experimental and observational studies to explore causes, risk factors, and ways that diseases are transmitted

  • more complicated in the design and process of the study

Descriptive epidemiology

• gives us a sense of the frequency and distribution of a problem

• allows us to compare subpopulations where frequency of a condition is especially high

  • comaprision points

    • demographic (age, ethnicity, gender, Socioeconomic status (SES) - Who

    • TIme- (month, year, decade) - when

    • Geographic (local, county. state, national, global) -Where

Endemic

• the usual and expected rate of disease

  • Little change over time

• constantly present in a certain population or region, with a relatively low spread (or there may be periods when it doesn’t affect people at all, if it is only present in the enviornment

Epidemic

• increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.

• Geographic where comparison

• Is when there is a sudden increase in cases spreading through a large population like a country (an outbreak is similar, but usually covers a smaller geographic area)

Pandemic

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

• is when there is a sudden increase in cases spreading through several countries, continents of the whole world

Epidemiological surveillance

• ongoing and systematic collection, analysis, and interpretation of health data