sp 380 quiz 1

Definition of health (WHO, 1948)

A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

Definition of public health (Winslow, 1920)

The science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society

Definition of public health (IOM, 1988)

What we, as a society, do collectively to assure the conditions in which people can be healthy

Mission of public health

Fulfilling society's interest in assuring the conditions in which people can be healthy (IOM 1988)

Key difference between public health and clinical care

Public health = population-level, prevention-focused, community/society is the "patient"; Clinical care = individual-level, treatment-focused, one patient at a time

Determinants of health (definition)

Factors that influence the health of individuals and populations; include genetics/biology, behavior, social environment, physical environment, health services, and policies

Social determinants of health (Healthy People 2030 five domains)

Economic stability; Education access and quality; Health care access and quality; Neighborhood and built environment; Social and community context

McGinnis & Foege: contributors to premature death (approx.)

Behavior ~40%; Genetics ~30%; Social circumstances ~15%; Environmental exposures ~5%; Health care ~10% (medical care contributes relatively little to premature death)

Upstream vs. downstream (parable)

Parable of pulling drowning people out of a river: DOWNSTREAM = treating/rescuing people after harm occurs (medical care, individual-level); UPSTREAM = finding who is throwing people in and stopping it (root causes, policy, social determinants, prevention)

Upstream interventions (examples)

Policies, laws, taxes, housing, education, income support, safe environments; they address root causes and affect whole populations

Downstream interventions (examples)

Treatment and care after illness occurs: hospital care, medications, surgery, rehabilitation

APHA Principles of Ethical Public Health Practice (what is it?)

A set of 12 principles/Code of Ethics from the American Public Health Association guiding public health practice; emphasizes community, equity, rights, evidence, trust, and prevention

APHA Ethical Principle 1

Address principally the fundamental causes of disease and requirements for health, aiming to prevent adverse health outcomes

APHA Ethical Principle 2

Achieve community health in a way that respects the rights of individuals in the community

APHA Ethical Principle 3

Develop and evaluate policies, programs, and priorities through processes that ensure an opportunity for input from community members

APHA Ethical Principle 4

Advocate for and work for the empowerment of disenfranchised community members so basic resources and conditions necessary for health are accessible to all

APHA Ethical Principle 9

Seek the information needed to implement effective policies and programs that protect and promote health

APHA Ethical Principle 5

Provide communities with the information needed for decisions on policies/programs and obtain the community's consent for their implementation

APHA Ethical Principle 9

Act in a timely manner on the information available, within the resources and mandate given by the public

APHA Ethical Principle 8

Incorporate a variety of approaches that anticipate and respect diverse values, beliefs, and cultures in the community

APHA Ethical Principle 10

Implement programs and policies in a manner that most enhances the physical and social environment

APHA Ethical Principle 6

Protect the confidentiality of information that could bring harm to an individual or community if made public; exceptions require a high likelihood of significant harm

APHA Ethical Principle 7

Ensure the professional competence of public health employees

APHA Ethical Principle 8

Engage in collaborations and affiliations in ways that build the public's trust and the institution's effectiveness

APHA ethics themes to remember (big picture)

Prevention and root causes; community participation and consent; equity and empowerment; evidence and timely action; respect for individual rights and cultural diversity; confidentiality; competence; trust and collaboration

Public health disciplines (examples)

Epidemiology; Biostatistics; Environmental health; Health policy and management; Social and behavioral sciences/health promotion; Global health; Maternal and child health; Nutrition; Public health informatics; Occupational health; Community health; Health communication

Epidemiology (discipline)

The study of the distribution and determinants of health-related states/events in populations and the application of that study to control health problems

Biostatistics (discipline)

Application of statistical methods to design studies and analyze data on health and biology

Environmental health (discipline)

Studies how physical, chemical, and biological factors in the environment (air, water, food, housing, workplace) affect health

Health policy and management (discipline)

Focuses on organizing, financing, delivering, and regulating health services and designing health policy

Social and behavioral sciences (discipline)

Studies how social, cultural, and behavioral factors influence health and designs health promotion/behavior change programs

Ten Great Public Health Achievements in the U.S., 1900-1999 (CDC)

Vaccination; Motor-vehicle safety; Safer workplaces; Control of infectious diseases; Decline in deaths from coronary heart disease and stroke; Safer and healthier foods; Healthier mothers and babies; Family planning; Fluoridation of drinking water; Recognition of tobacco use as a health hazard

Why public health achievements matter (20th century)

Most of the ~30-year gain in U.S. life expectancy in the 20th century is attributed to public health advances (~25 of the 30 years), not just medical care

Investment in public health (U.S.)

Roughly 90% of U.S. health spending goes to medical care and only a small share (~3-5%) to population-level public health/prevention, despite prevention's large impact; funding is also inconsistent (boom-bust after emergencies)

Health disparities (definition)

Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health experienced by socially disadvantaged populations

Health equity (definition)

Everyone has a fair and just opportunity to attain their highest level of health; requires removing obstacles such as poverty, discrimination, and lack of access

Health inequity vs. disparity

Disparity = difference in health outcomes between groups; Inequity = difference that is unfair, avoidable, and rooted in systemic social/economic disadvantage

Equality vs. equity

Equality = giving everyone the same resources; Equity = giving people what they need based on their circumstances to reach the same outcome

Sources of health disparities (examples)

Race/ethnicity, income, education, geography/neighborhood, gender, disability, sexual orientation, immigration status, and structural racism

Types of information/evidence (research writing)

Data/statistics, expert opinion, research studies, laws/policies, reports, personal experience/narratives; evidence supports claims, builds credibility, informs decisions, and allows others to verify

Why evidence matters in public health

Decisions affect populations, so claims must be supported by credible, verifiable, current evidence; it builds credibility and guides practice and policy

Popular sources

Written for the general public (news sites, magazines, blogs); easy to read, often lacks citations, not peer reviewed; good for context/public perception, not strong evidence

Scholarly (academic) sources

Written by experts for experts; peer reviewed, with citations, methods, and data (journal articles, academic books); most credible for evidence

Gray literature

Material produced outside traditional commercial/academic publishing and often not peer reviewed (government reports, agency/NGO reports, white papers, policy briefs, conference proceedings, theses); very important in public health (e.g., CDC, WHO, health department reports)

Peer review (definition)

Evaluation of a manuscript by independent experts in the field before publication to assess quality and validity

Primary source

Original, first-hand material: original research articles, raw data, surveys, interviews, legal documents, speeches, historical documents

Secondary source

Interprets, analyzes, or summarizes primary sources: review articles, systematic reviews, textbooks, commentary

Tertiary source

Compiles/summarizes primary and secondary sources: encyclopedias, handbooks, databases, indexes

Why and when to cite

To give credit to original authors, avoid plagiarism, support claims, let readers locate sources, and show credibility; cite whenever using someone else's ideas, data, words, figures, or findings (including paraphrases and summaries)

Plagiarism (definition)

Presenting someone else's words or ideas as your own without proper attribution

Common knowledge and citing

Widely known, undisputed facts generally do not need citation; when unsure, cite

Why and when to use database searches

Databases (PubMed, CINAHL, Web of Science, Scopus, Google Scholar) provide organized, searchable, credible, peer-reviewed sources; use them when you need scholarly evidence, current research, or comprehensive coverage rather than a general web search

Database search tips

Use keywords and synonyms, Boolean operators (AND, OR, NOT), filters (date, study type, peer reviewed), and subject headings (e.g., MeSH in PubMed)

Boolean operators

AND narrows results (both terms); OR broadens (either term); NOT excludes a term

Why and when to use direct quotes

Use sparingly when exact wording matters: definitions, legal/policy language, distinctive or powerful statements, or when you will analyze the wording; always use quotation marks and cite (page/paragraph)

Summarizing

Condensing the main ideas of a source (or section) into a much shorter form in your own words; broad overview; still cite

Paraphrasing

Restating a specific idea in your own words and sentence structure at similar length to the original; still cite

Synthesizing

Combining ideas from multiple sources to show relationships, patterns, agreements, or gaps and to build your own argument; goes beyond summary

Summarize vs. paraphrase vs. synthesize (quick compare)

Summarize = short overview of one source; Paraphrase = reword a specific passage at similar length; Synthesize = integrate multiple sources into a new point

APA style (what is it?)

American Psychological Association citation style commonly used in public health and social sciences

APA in-text citation format

Author-date: (Author, Year) or Author (Year); for 3+ authors use (First Author et al., Year); direct quotes add page number (Author, Year, p. #)

APA reference list

Alphabetical list at the end of the paper by first author's last name with full source details (author, year, title, journal/publisher, DOI/URL); hanging indent

UW writing resources

Odegaard Writing & Research Center (tutoring and writing/research help); UW Libraries (research help, databases, Health Sciences Library, subject librarians); Writing guides and citation help

Ancient public health (themes)

Early societies addressed sanitation, water supply, waste, food safety, and isolation of the sick; examples include Roman aqueducts and sewers (Cloaca Maxima), Hippocrates' Airs, Waters, and Places linking environment and disease, and Mosaic/Biblical hygiene laws

Hippocrates and public health

Greek physician who connected disease to environment (air, water, place) rather than gods; early environmental/epidemiologic thinking

Roman contributions to public health

Aqueducts for clean water, sewer systems, public baths, and sanitation infrastructure

Black Death and quarantine

Plague pandemic (1347 on) killed a large share of Europe; port cities such as Ragusa (1377) and Venice isolated ships/people for 40 days ("quaranta giorni") = origin of the word quarantine

Quarantine vs. isolation

Quarantine = restricts movement of people exposed to a contagious disease who may become sick; Isolation = separates people who are already sick from healthy people

Edward Jenner (1796)

Developed the first vaccine (smallpox) using cowpox; origin of the word "vaccination" (from vacca = cow)

Smallpox eradication

Only human disease eradicated; declared eradicated by WHO in 1980 after global vaccination campaigns

John Snow (1854)

Father of modern (field) epidemiology; mapped cholera cases in London's Soho, traced outbreak to the Broad Street pump, and had the pump handle removed; showed disease spread via contaminated water before germ theory

Edwin Chadwick (1842)

British sanitary reformer; Report on the Sanitary Condition of the Labouring Population linking poverty/filth to disease; led to the Public Health Act of 1848 and sanitary movement

Lemuel Shattuck (1850)

Massachusetts Sanitary Commission report; proposed state and local health boards, vital statistics, sanitation, and other foundations of the modern U.S. public health system

Germ theory (Pasteur, Koch)

Microorganisms cause infectious disease; Pasteur and Koch identified bacteria and developed vaccines/methods (Koch's postulates), shifting public health toward targeted prevention

Ignaz Semmelweis (1840s)

Showed handwashing by physicians dramatically reduced childbed fever deaths; early infection control

Epidemiology as a tool

Studying patterns, causes, and effects of health conditions in populations; used to investigate outbreaks, identify risk factors, and evaluate interventions

Development of public health tools (summary)

Quarantine (plague, 14th century); Vaccination (Jenner 1796, Pasteur); Epidemiology (John Snow 1854); Sanitation/infrastructure (19th century); Surveillance and laboratory science (20th century)

Public Health 1.0

Late 1800s to mid-1900s; focus on infrastructure, sanitation, clean water, vaccines, infectious disease control; government public health departments established; the "Sanitary movement" era

Public Health 2.0

Emerged around 1988 (IOM report The Future of Public Health); focus on governmental public health agencies, three core functions, categorical programs, chronic disease and services delivery, and the 10 Essential Public Health Services; often siloed and categorically funded

Public Health 3.0

Emerged ~2016 (DeSalvo et al.); public health leaders act as Chief Health Strategists; emphasizes cross-sector partnerships (housing, education, transportation), social determinants/upstream causes, data and metrics, accountability, and sustainable funding

Chief Health Strategist (PH 3.0)

Local public health leader who partners with community sectors to address the social determinants of health and improve population health

PH 1.0 vs 2.0 vs 3.0 (quick compare)

1.0 = infrastructure and sanitation; 2.0 = government agencies, core functions, programs and services; 3.0 = cross-sector partnerships, social determinants, equity, and data-driven strategy

Public health approach: P.E.R.I.E.

Problem (define and monitor via surveillance); Etiology (identify risk and protective factors); Recommendations (develop and test interventions); Implementation (put into practice/scale up); Evaluation (assess effectiveness and impact)

Public health approach: why use P.E.R.I.E.?

Systematic, data-driven, population-focused process for identifying and solving health problems; it is cyclical, with evaluation informing the next round

Surveillance (definition)

Ongoing, systematic collection, analysis, and interpretation of health data to guide public health action

Increase in U.S. life expectancy during the 20th century

From about 47 years (1900) to about 77-78 years (late 1990s/2000), roughly 30 years, largely due to public health measures

Leading causes of death in 1900 vs. today (U.S.)

1900: infectious diseases (pneumonia, tuberculosis, diarrhea); Today: chronic diseases (heart disease, cancer)

Ten Great Public Health Achievements 2001-2010 (CDC)

Vaccine-preventable diseases; Prevention and control of infectious diseases; Tobacco control; Maternal and infant health; Motor vehicle safety; Cardiovascular disease prevention; Occupational safety; Cancer prevention; Childhood lead poisoning prevention; Public health preparedness and response

Recent trends in U.S. life expectancy

Rose to ~78.8 years in 2019; fell to ~77.0 (2020) and ~76.4 (2021) during COVID-19 (largest drop in decades); partial rebound afterward; the U.S. still lags peer high-income countries despite higher spending

Vaccine-preventable diseases (VPDs) (definition)

Diseases that can be prevented by vaccines (e.g., measles, polio, pertussis, diphtheria, tetanus, rubella, mumps, hepatitis B, HPV, influenza)

Rationale for vaccination

Prevents illness, disability, and death; protects communities through herd immunity; cost-saving; safe and effective; enables elimination/eradication of diseases

Herd (community) immunity

Indirect protection of unvaccinated people when a high enough proportion of the community is immune, reducing disease spread; threshold depends on disease (about 95% for measles)

Disease eradication vs. elimination

Eradication = permanent global reduction to zero cases (smallpox); Elimination = absence of continuous disease transmission in a region (e.g., measles declared eliminated in the U.S. in 2000)

Polio progress

Vaccines (Salk 1955 inactivated, Sabin oral) led to near-global eradication; wild poliovirus remains in a few countries; global eradication initiative is ongoing

Measles (VPD example)

Highly contagious; eliminated in the U.S. in 2000 but outbreaks recur when vaccination coverage drops; needs ~95% coverage with 2 doses of MMR

Vaccines for Children (VFC) Program (1994)

Federal program providing free vaccines to eligible children (uninsured, Medicaid-eligible, American Indian/Alaska Native) to improve access

ACIP

Advisory Committee on Immunization Practices; advises CDC on vaccine use and the immunization schedule

School vaccination requirements

State laws requiring vaccines for school/childcare entry (with varying exemptions) to maintain high coverage

National Childhood Vaccine Injury Act (1986)

Created the National Vaccine Injury Compensation Program (no-fault compensation) to protect access to vaccines and manufacturers

Vaccine hesitancy (definition)

Delay in acceptance or refusal of vaccines despite availability of vaccination services; named by WHO as a top global health threat (2019)