Public Health 101 Riegelman Kirkwood Improving Community Health Chapter 1

vulnerable populations

those at higher than average risk of disease and/or bad outcomes of disease, either directly or through the healthcare system

how has public health change since the 1900s?

-goal of prolonging life is being complemented by an emphasis on the quality of life. protection of health when it already exists is becoming a focus along with promoting health when it is at risk
-use of new technologies is redefining community and offering new ways to communicate
-expansion in the options for intervention, increasing awareness of potential harms and costs of intervention programs requires a new science of evidence-based public health
-public health and clinical care are coming together in new ways to produce collaborative efforts
-complex public health problems need to be viewed as a part of larger health and social systems
-multiple problems and solutions at the same time
-pay attention to pay attention to the full range of health issues, not just mothers, children, and working-age population but also the prevention of disability in the elderly. full life cycle approach

21st century public health definition

the totality of all evidence based public and private efforts throughout the life cycle that preserve and promote health and prevent disease, disability, and death

health protection era (antiquity to 1830s)

-integrated concepts of prevention into their culture, religion, and their laws through prohibition of specific food, methods of cooking, prohibition of cannibalism, sexual norms, etc.
-quarantine
-citrus to prevent scurvy (James Lind)
-cowpox to prevent smallpox vaccine

hygiene movement era (1840s-1870s)

-social justice
-early public health efforts emerged
-attention to vulnerable populations but also to hazards that effected everyone, such as contamination of the environment
-JOHN SNOW= father of epidemiology, Broad Street pump-removed handle to reduce cholera rates
-IGNAZ SEMMELWEIS= handwashing by doctors to reduce puerperal fever (docs went from autopsy to deliver room)
-birth and death records = vital statistics, formed the basis of population wide assessment of health status

contagion control era (1880s-1940s)

-Louis Pastuer = germ theory
- American Public Health Association formed
-TB detection
-vaccinations
-investagation of pellagra determined to be caused by a nutrional deficiency that could be prevented or cured with niacin, not an infectious disease

filling the holes in the medical care system era (1950s-mid1980s)

-active era of effective medical intervention against active began in force after WWII
-role of public health was seen as assisting clinicians to effectively deliver clinical services to those without the benefits of private medical care and helping to integrate preventative efforts into the practice of medicine
-eradication of polio often seen as solely as victory for medicine but public health played a big role
-Medicaid and Medicare
- regulation by FDA

Health Promotion/Disease Prevention era (mid1980s-2000)

-focus on individual responsibility of health and interventions at individual level
-interventions targeted individuals to effect behavioral change and combat the risk factors for disease
-HIV/AIDS
-worldwise use of pap smears
-newborn screening for genetic disease
-environmental movement

population health era (2000s)

-has begun to transform professional and public thought about health and the relationship between traditional public health and the health care system
-bioterrorism
-high cost of healthcare
-control of pandemic influenza, AIDS, Ebola
-global perspective
-climate change

health protection (antiquity-1830s)

-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 disease

Hygiene Movement (1840-1870s)

-Sanitary conditions as basis for improved health
-environmental action on community-wide basis distinct from health care
-Snow on cholera, semmelwise and puerperal fever, collection of vital statistics as empirical foundation for public health and epidemiology

Contagion control (1880-1940s)

-Germ theory: demonstration of 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 TB sanatoriums, outbreak investigation
-Goldberger and pellegra

Filling holes in the medical care system (1950s-mid 1980s)

-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 disease and care for vulnerable populations distinct from general healthcare system, beginning of integrated healthcare systems with integration of preventative services in general healthcare
-antibiotics, randomized controlled trials, concept of risk factors, surgeon general reports on cigarette smoking, farmingham study on cardiovascular risks, health maintenance organization and community health centers

health promotion/disease prevention (mid1980s-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 (2000s)

-Coordination of public health and healthcare delivery based upon shared evidence-based systems thinking
-evidence based recommendations and information management, focus on harms and costs as well as benefits of interventions, globalization
-evidence-based medicine and public health, information technology, antibiotic resistance, global collaboration

interventions

the full range of strategies designed to protect health and prevent disease, disability, and death
-preventative efforts, curative efforts, and efforts to prevent complications and restore function

four components of public health

health issues, populations, society's shared health concerns, society's vulnerable groups

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

health care

-systems for delivering one-on-one individual health services, including those aimed at prevention, cure, palliation, and rehabilitation
- vaccinations, counseling, screening for disease, preventative medications

traditional public health

-Group and community based interventions directed at health 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
-improvement to built environment, increase education, alter nutrition, address socioeconomic disparities through changes in tax laws, globalization and mobility of goods and populations

contributory causes

immediate causes of disease

morbidity

disability

mortality

death

determinants

underlying factors that ultimately bring about disease

BIG GEMS (determinants of disease)

Behavior
Infection
Genetics
Geography
Environment
Medical care
Socioeconomic-cultural

demographic transition

impact of falling childhood death rates and extended life spans on the size and the age distribution of populations

epidemiological transition

as social and economic development occurs, different types of diseases become prominent

nutritional transition

countries frequently move from poorly balanced diets often deficient in nutrients and calories to a diet of highly processed food including fats, sugars, and salt