Public Health FINAL

Final on Tuesday 5/5 @ 8AM

Body mass index

The ratio of a person’s weight in kilograms by the square of his or her height in meters. For most people, a BMI over 25 is considered overweight and BMI over 30 is obese

Dietary Guidelines for Americans

Created by the U.S. Department of Health and Human Services; renewed every 5 years since 1980; MyPlate (fruits, grains, protein, vegetables)

Food Insecurity

a social determinant of health of limited access to adequate food for healthy living often the result of living in poverty, unemployment, or living in a food desert (an area with few or no full-service supermarkets or grocery stores)

Obesity

a complex condition influenced by genes and many individual, social, and structural factors; Public health advocates, therefore, seek to promote access to healthy foods and safe places to be active to reduce the number of people who are overweight or obese; obesity as a BMI of 30 or greater, and severe obesity as a BMI of 40 or higher; increased dramatically over recent decades

Overweight

overweight as a BMI between 25 and 29.9

Environmental health (definition)

centers on the relationships between people and their environment. When people are exposed to hazards like polluted air and lead in their drinking water, they can develop serious conditions, such as asthma, heart disease, cancer and dementia.

Role of government (3 ways that government ensures environmental safety)

Identification of Hazards (Clean Air Act and the Safe Drinking Water Act); Consumer Product Safety Improvement Act (imposed regulations and testing requirements for toys and children’s furniture on manufacturers, importers, distributors, and retailers); OSHA & EPA

6 criteria air pollutants (what they are, what health impacts they have, where they come from or how humans are exposed)

The Clean Air Act and its amendments require monitoring and regulation of six common air pollutants, called criteria air pollutants, known to be harmful to health and the environment: particulates, sulfur dioxide, carbon monoxide, nitrogen oxides, ozone, and lead; All of these substances enter the air as a result of combustion—for energy in power plants or motor vehicles, or for solid waste disposal or industrial processes.

Major sources of air pollution in the US (what they are, what health impacts they have, what have we done to control them)

Vehicle emissions, fuel oils and natural gas to heat homes, by-products of manufacturing and power generation, particularly coal-fueled power plants, and fumes from chemical production are the primary sources of human-made air pollution; 2015 the Obama administration implemented the Clean Power Plan; Emergency Planning and Community Right-to-Know Act (EPCRA)-companies to voluntarily restrict their discharge of air pollutants

Clean Air Act

The primary federal law in the United States governing air pollution (mercury is regulated under this)

Safe Drinking Water Act

The principal federal law in the United States intended to ensure safe drinking water for the public (mercury is regulated under this)

Clean Water Act

set national goals that lakes and rivers should be “fishable” and “swimmable” and that all pollutant discharges should be eliminated;

Threats to drinking water (Types and sources of contamination) 

½ drinking water in US is from rivers and lakes ( likely to be contaminated by the point-source and nonpoint-source pollutants;) // other ½ is from underground aquifers (generally of better quality but are increasingly susceptible to contamination by leaching from landfills, leaky oil and gas storage tanks, and other sources of toxic chemicals); to ensure that the treatment process is working effectively, regular laboratory tests are generally done on the final product

Greenhouse gases (what they are, what health impacts are, how are they caused)

Gases that absorb radiation of specific wavelengths within the infrared spectrum of radiation emitted by the Earth’s surface and clouds. The effect is a local trapping of part of the absorbed energy and a tendency to warm the Earth’s surface. Water vapor, carbon dioxide, nitrous oxide, methane, and ozone are the primary greenhouse gases in the earth’s atmosphere.

Non point VS. point pollution (examples, definition, where it comes from, health impacts, how addressed)

Point-source pollution: Water pollution that comes from a single, discrete place, typically a pipe; non point-source pollution: Diffuse contamination of air or water that does not only come from one source

Environmental Protection Agency (what it is, role, mission)

The federal agency responsible for prevention and cleanup of water pollution and air pollution, control of toxic substances, and other issues of environmental contamination; established in 1970 to carry out programs dealing with water pollution, air pollution, toxic substances control, and other issues of environmental contamination. The EPA is one of the most controversial federal public health agencies. It has often been attacked by Congress, and its policies were often watered down during conservative administrations, putting people’s health at risk;

What other federal agencies have a role in protecting EH

American Heart Association, the American Cancer Society, the Alzheimer’s Association, and the American Diabetes Association, lobby Congress for resources and policies to benefit their causes; Professional membership organizations, such as the American Public Health Association, the American Medical Association, and the American Nurses Association, also are active in lobbying Congress in support of public health issues such as research related to the health effects of smoking; Institute of Medicine

Major environmental health hazards discussed in class: what health problem does it cause, how are humans exposed to it, what can we do about it

Look @ class slides

Indoor Air pollution (what it is, common pollutants, what health impacts they cause)

most common indoor air pollutants are tobacco smoke, other products of combustion, radon gas, consumer products that release chemicals into the air, and biological pollutants, including bacteria, mold, dust mites, and animal dander. Secondhand smoke has been banned in many public places; others include formaldehyde, a possibly carcinogenic gas that irritates the respiratory system and is contained in insulation, particleboard, plywood, some floor coverings and textiles, and tobacco smoke

CAFOs (what they are, how they impact human health)

AKA: concentrated animal feeding operations; produce an estimated 1 million tons of manure every day, three times the total waste produced by the U.S. human population; People living near CAFOs suffer from symptoms caused by the lagoon gases: headaches, runny noses, sore throats, coughing, respiratory problems, nausea, diarrhea, dizziness, burning eyes, depression, and fatigue. Seepage from the lagoons pollutes groundwater that feeds wells used for drinking water

Risk-benefit analysis

The question, “How safe is safe?” has been debated in connection with one potential health threat after another. Increasingly, policy analysts have come to agree that absolute safety is an impossible goal and that attempting to avoid risk of one sort may increase risks of other kinds. Furthermore, as one analyst asks and answers in the affirmative, “Does overregulation cause underregulation?”

Climate

The long-range weather pattern in a specific region. The timespan is typically over a 30-year period

Climate change (definition, causes, health impacts)

is the long-term change in the climate of the planet, also called global warming due to historical increases in the average temperature of the planet;

Mitigation

The action of decreasing the seriousness, severity, or painfulness of something

Global Warming

A gradual increase in the overall temperature of the earth’s atmosphere generally attributed to the greenhouse effect caused by increased levels of carbon dioxide, chlorofluorocarbons, and other pollutants

Paris Agreement

committed countries to “holding the increase in the global average temperature to well below 2°C (3.6ºF) above pre-industrial levels and pursuing efforts to limit the temperature increase to 1.5°C (2.7ºF) above pre-industrial levels, recognizing that this would significantly reduce the risks and impacts of climate change; approved by 196 countries and became effective in 2016

One Health

A collaborative approach involving multiple stakeholders that tries to improve the health of people, animals, and ecosystems by understanding the connections among them.

Atherosclerosis

Hardening of the arteries/is part of the development of cardiovascular disease

Modifiable risk factor

Diet, physical activity/sedentary behavior, and sleep are modifiable risk factors that play a role in the etiology and prevention of many chronic diseases, including overweight/obesity, diabetes, cardiometabolic diseases, and cancer

4 major modifiable risk factors for chronic disease

Diet, physical activity/sedentary behavior, and sleep

2 major PH approaches for chronic disease

promoting physical activity, improving access to healthy, affordable foods

Alzheimers disease

most common cause of dementia; causes brain cells to die over time and the brain to shrink due to build up of proteins in brain

Arthritis

Inflammation of joints; condition

Life expectancy (definition, trends)

The number of additional years of life expected at a specified point in time, such as at birth or at age 65; for people living in the United States increased from 47 to 77 years over the course of the 20th century, only 5 of those 30 additional years can be attributed to the work of the medical care system

Osteoporosis

condition characterized by porous bones, which tend to break easily. Bone loss among women is most significant in the years following menopause. Smoking and alcohol consumption increase the risk of osteoporosis, whereas obesity reduces the risk (one of the few health benefits of being overweight). Non-Hispanic White women have the greatest risk for the condition, Black men have the lowest risk, and Asian people have an intermediate risk.

Role of chronic stress

Chronic exposure to stressful situations can have physiologic consequences, causing or worsening illnesses and increasing the use of health-compromising behaviors in an attempt to adapt; directly affects one’s health

Lifecourse perspective (cumulative effect of risks/exposures)

A public health approach that examines how various factors, such as biological, behavioral, social, and environmental influences, interact across an individual’s life span to shape health outcomes. It emphasizes the cumulative impact of these influences from conception through old age, recognizing that early life experiences and exposures can have long-term effects on health and well-being

Unintentional injury in adulthood: common causes

prominent cause of death among adults; harm or damage inflicted upon individuals without any intention or purposeful infliction; include opioid overdoses (unintentional poisoning), motor vehicle crashes, and unintentional falls (elderly)

Determinants of health in older adults

lifestyle choices, preventive care, and managing chronic conditions; regular exercise and physical activity, appropriate nutrition and healthy eating patterns, and avoiding tobacco and excessive alcohol consumption, are foundational for preserving well-being in adulthood; Access to healthcare services, including routine screenings and timely interventions, is crucial for detecting and managing health issues effective; socioeconomic factors, environmental influences, specific responsibilities prevalent during the adult phase; all promote overall well-being

Care at end of life

more dependence on Medicare

Benefits of universal healthcare

Healthier society (more people have access to healthcare), reduced financial burden on individuals, positive societal change// CONS: less QUALITY care, increased taxes, etc.

Mechanisms for paying for healthcare in the US

Public v. privately paid healthcare

Affordable Care Act (what it is, what was the intent)

Often called “Obamacare” and also known as the Patient Protection and Affordable Care Act. A law passed in 2010 and fully implemented by 2015 that was designed to provide health insurance to all Americans; ensured that all Americans are covered by medical insurance

3 legged stool (what they are, how they work together)

3 legs of the US Healthcare system:

ACCESS: ability to acquire and use the health insurance & health services

COST: cost to individuals, providers, and the government

QUALITY: degree to which healthcare is adequate and acceptable; and promotes (+) healthcare outcomes

**all three need to pull their weight for this system to be effective

Health Insurance (what it is, how it works (basic premise) and benefits of having it)

A type of insurance coverage that pays for medical, surgical, and sometimes dental expenses incurred by the insured; Each month, you make a payment to a health insurer, such as Medicare or your insurance company. Some employers chip in for this payment. In return, your insurer covers all or some of your medical costs, as long as you follow the insurer's rules.

Employment-based insurance

health coverage that's provided to employees (and their dependents) by their employer. Nearly half of the American population has employer-sponsored health coverage, and it's by far the most common type of coverage in the country.

Community health center

provide primary, preventive, and dental care as well as mental health, substance use disorder, and other community-based services to anyone in need regardless of their insurance status or ability to pay.

Managed Care – HMO, PPO,ACO. In general, what are managed care organizations, why did they come about, and basic premise about how they work

Managed Care: healthcare delivery system organized to manage cost, utilization, and quality; aim to increase access to care, lower costs, improve treatment quality

HMO (health maintenance organization): acts as both an insurer and a provider; can only use a specific network of providers you can use to get care

PPO (preferred provider organizations): patients must seek care from participating providers who have agreed to provide services at lower rates; a type of managed care health insurance plan that provides maximum benefits if you visit an in-network physician or provider, but still provides some coverage for out-of-network providers.

ACO (Accountable Care Organizations): groups of doctors, hospitals and other health care providers who work together to coordinate your care. In an ACO, your primary care provider (PCP) and their team work with you and your ACO's network of providers.

Medicaid – basics of what it is, who pays for it, who can get services/who it is for

A federally aided, state-operated and state-administered program that provides medical services to eligible low-income populations.

Medicare – basics of what it is, who pays for it, who can get services/who it is for

A national health insurance program for persons over age 65 and certain younger persons who are disabled

Trends in healthcare expenditures in the US

growth in medical care expenditures in the United States since 1960; HAS INCREASED/TRENDS UP

Trends in cost of healthcare

HAS INCREASED/TRENDS UP- even though there is no evidence that Americans are healthier due to the greater expenditures.

Strategies to contain costs

limiting spending on new facilities and technology; limit the length of hospital stays; Contain growth in prescription drug prices; Limit coverage of services, and more

Barriers to insurance coverage

Generally, mental health insurance coverage is inferior to physical health insurance; financial barriers, provider-related barriers (HMO plan); access barriers, family and work barriers

Confounding

Confounding: can arise when the control group is insufficiently similar to the treatment group
BIAS: systematic error, may be introduced into a study in several ways

National Center for Health Statistics – what they do, what national studies do they manage

the nation's source for official health statistics; collect, analyze, and share data and statistics to guide programs and policies that improve the health of people across the US; EX.) unhealthy dietary patterns and physical activity has displaced tobacco as the leading actual cause of death

Vital Statistics

Systematically collected statistics on births, deaths, marriages, divorces, and other life events. More broadly, the statistics of life, health, disease, and death—the statistics that measure progress, or lack of it, against disease.

US Census

a national survey that provides data not only on the geographic distribution of the population and its sex, age, and ethnic characteristics, but also on a wide variety of social and economic characteristics, including education, housing, and health insurance status

Types of national surveys used for PH – general idea of what they are and what type of information

uses polls and surveys and other sources of data such as birth and death records, immigration and emigration records, and school statistics

Institutional Review Board

an administrative body established to protect the rights and welfare of human research subjects recruited to participate in research activities conducted under the auspices of the institution with which it is affiliated

Randomized control trial

considered “gold standard” b/c they offer the best answer on the efficacy of a treatment or intervention; participants are randomly allocated to receive a new treatment (experimental group) or a standard treatment (comparison group), or no treatment at all (placebo group)

Mixed Methods

simultaneous use of both qualitative and quantitative research methods, aiming to provide a comprehensive understanding of complex health issues

PICOT approach – def of each P-I-C-O-T

another approach that provides guidance and helps to frame a research question, particularly for clinical-based research aiming to establish or progress evidence-based practice and improve the quality of the research design; serves as a guide for the research design

**Patient, population, or problem: Who or what is the patient or population and problem to be addressed?

**Intervention: What is the intervention (action or treatment) that will be tested?

**Comparison or control: What will the intervention be compared to (population or intervention)?

**Outcome: What is the desired or expected outcome of interest?

**Time frame: How long will it take to reach your desired outcome?

Generalizability -definition

the capacity of a study’s methods to produce comparable results across different populations and contexts, extending beyond the study’s specific conditions outlined by fixed parameters and inclusion criteria

Vulnerable populations -identify and describe protection in research

Groups of individuals who are at an increased risk of poor health outcomes due to factors such as economic disadvantage, social marginalization, limited access to healthcare, or exposure to environmental hazards. These populations often include, but are not limited to, the elderly, low-income individuals, racial and ethnic minorities, people with disabilities, and those experiencing homelessness or chronic illness

Bioterrorism - definition

Terrorism involving the release of toxic biological agents.

Category A agents and risk assessment

High-priority agents include organisms that pose a risk to national security for the following reasons: They can be easily disseminated or transmitted from person to person; They cause high mortality, with the potential for major public health impact;They might cause public panic and social disruption..

These include: Anthrax (Bacillus anthracis), Botulism (Clostridium botulinum toxin), Plague (Yersinia pestis), Smallpox (Variola major), Tularemia (Francisella tularensis), Viral, hemorrhagic fevers (filoviruses [e.g., Ebola, Marburg] and arenaviruses [e.g., Lassa, Junin])

PH Role in emergencies

reparedness for bioterrorism requires that the public health system carry out its normal surveillance functions. A biological attack might be recognized only after patients start showing up in hospitals and doctors’ offices, but even then, their symptoms may not be unusual—most of the pathogens that might be used as bioweapons first cause flu-like symptoms

US response to COVID-19: weaknesses and successes

Weaknesses: lack of sustained planning and investment in this infrastructure led to hundreds of thousands of preventable cases, deaths, and disability from COVID-19; people still have LONG COVID and have not been treated/not enough research has been done to understand this condition

Successes: mostly after 2020- US activated its biomedical innovation ecosystem to quickly develop new diagnostic tests, therapeutics, and vaccines; health workers showed great dedication to creating information-sharing networks and providing much-needed urgent care; Most people in the United States followed public health guidance regarding mask-wearing, social distancing, and avoiding unnecessary risks.

Healthy People 2030

data driven national objectives to improve health and well-being; provides a list of SDoH that include the following: Safe housing, transportation, and neighborhoods, Racism, discrimination, and violence, Education, job opportunities, and income, Access to nutritious foods and physical activity opportunities, Polluted air and water, Language and literacy skills

Be able name/describe at least one major PH achievement (OPEN RESPONSE Q)

Cardiovascular Disease Prevention,Tobacco Control, Maternal and Infant Health

Be able name/describe at least one challenge facing PH in the future (OPEN RESPONSE)

Climate crisis and environmental sustainability, mental health in the modern age, substance use and addiction, reproductive and sexual health equity

3 core functions of PH

Assurance, Assessment, Policy development

Describe the mission and philosophy of PH

clarifying its significance and functions while delineating what it encompasses.

REVIEW: Three core functions of public health:

Assessment, Assurance, policy development

REVIEW: 5 step process to address health problems- Rank in order:

-              Define the health problem

-              Identify risk factors

-              Develop interventions

-              Implement interventions

-              Evaluate interventions

REVIEW: Describe epidemiological trends in obesity in the last 50 years:

-              Increasing trends

-              More prominent among younger population

-              Has gone down since 2022

-              Minorities/racial minorities have higher rates of obesity

REVIEW: What are the contributing factors to rising obesity rates in the US:

-              SES (socioeconomic status)

-              Food insecurity

-              Marketing

-              Processed foods that are readily avaliable

REVIEW: Eating vegetables to reduce the risk of diabetes is what level of prevention

-              Primary

-              Review all types of prevention (primary, secondary, tertiary)

REVIEW: An example of regulation is:

- Hands-free driving law

REVIEW: A program or policy designed to have an impact on a health problem is:

-              Intervention

REVIEW: MEMORIZE / ON EXAM: Framingham Heart Study found the biggest risk factors of CVD to be:

-              Smoking

-              Hypertension

-              High cholesterol

REVIEW: MEMORIZE / ON EXAM: The Framingham Heart Study was:

-              Cohort Study (group of subjects, followed during these lifetime)

REVIEW: MEMORIZE / ON EXAM: Health Equity

look @ midterm knowt

REVIEW: Health is complete absence of disease or infirmity

-              FALSE

REVIEW: If a person has been immunized through vaccination, they are no longer susceptible:

-              TRUE

REVIEW: What factors contribute to the health of infants:

-              Environment

-              Maternal health (education level, mental health, exposure to substance abuse)

-              Prenatal care

-              Financial stability (access to clean water)

REVIEW: MEMORIZE / ON EXAM: What are the 6 criteria air pollutants:

-              Particulates

-              Sulfur dioxide

-              Carbon monoxide

-              Nitrogen oxides

-              Ozone

-              Lead

REVIEW: What are the three main ways the government protects environmental health - Think about EPA (what do they do?)

1.)     Identify hazards

2.)     Direct services

3.)     Set standards

REVIEW: Mercury is a naturally occurring element that has negative health impacts on humans when ingested. How do humans get exposed to Mercury?

-              Mercury = byproduct of industrial

o   Pollutes water & accumulates in fish

§  Humans ingest mercury when they eat fish

REVIEW: The health effects of exposure to mercury are:

-              Primarily affect the brain

-              Are a big concern for a developing fetus and children

-              Take a long time to develop (SX’s don’t show for a while)

• Effects are not reversible (effects are primarily cognitive/behavioral-related

REVIEW: **Know the health effects and exposure for:

Lead:

PCBs:

Radiation

BPA:

Pesticides:

REVIEW: What are some health impacts related to CAFOs- concentrated animal feeding operations:

-              Spread of disease (zoonotic disease transmission to humans)

-              Runoff that impacts water quality (contamination), air quality, and therefore food quality

-              Noise, smell, air pollution

REVIEW: KNOW GENERAL IDEAS OF THIS ACT: Clean Air Act of 1970 did what:

-              Limited motor vehicle emissions

-              Established air quality standards

-              Set limits on industrial emissions

REVIEW: What are the health impacts (on humans) from climate change?

-              Increased respiratory diseases

-              Increase in food, water, and vector borne illnesses, mental health issues, stress, cardiopulmonary conditions

REVIEW: What is one example of climate change mitigation (efforts to reduce greenhouse gases)?

-              Solar energy

-              Carpooling

-              Updating old air conditions

REVIEW: KNOW: What are the four major modifiable risk factors for chronic disease?

-              Poor diet

-              Lack of physical activity

-              Alcohol Use

-              Tobacco Use

REVIEW: The US pays for healthcare through:

-              Private Insurance (EX. BCBS, Signa, Etna)

-              Government programs

-              Public Insurance (Medicare, Medicaid, State children’s health Insurance program-CHIP)

-              Charity Care (Nonprofit Hospitals, small portion)

REVIEW: Medicaid is a public insurance program that:

-              Funded by federal and state

-              Variable in eligibility (each state has different levels)

-              Covers over 70-million people

-              For low-income individuals