Population Health Midterm

spring 2026

What is the definition of population?

Groups of ppl who may/may not interact w each other but have common health concerns & needs

• ppl experiencing eviction

• ppl w the same occupation (nurses, migrant farmers, waiters)

• ppl of same age

• ppl living in the same county

• ppl w disabilities

• ppl of the same race/ethnicity

• ppl w the same medical diagnosis (HIV, cancer, DM)

• LGBTQ community

population examples

Aims of Healthy People 2030

• Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death.

• Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.

• Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all - “Vital Conditions”

What are the core functions of public health?

1.) Assessment

2.) Policy Development

3.) Assurance

Assessment

Monitoring health status, diagnosing and investigating health problems, & identifying community needs

Policy Development

Informing, educating, empowering ppl, mobilizing community partnerships, and developing policies & plans to support health 

Assurance

Enforcing laws, linking ppl to services, ensuring a competent workforce, & evaluating services

What is health outcome?

Anything that might indicate health or well-being of a population

(could include measures of illness, aspects of health, quality of life, etc.)

• CVD

• HIV

• Depression

• Measles

• Infant mortality

• Childhood lead poisoning

• Asthma

health outcome examples

Why are health outcomes important?

• To know how to prevent, tx, or cure 

• Many populations are experiencing high burdens of diseases that are PREVENTABLE.

• These are DISPARITIES!!

What is population health?

• Focuses on the health needs of a specific group of ppl

• Identifies and addresses societal factors that may hinder or enhance their access to health care

How do you assess a group of ppl for health needs?

affected by factors influencing individuals, families, neighborhoods, communities, & society at large

What does a pop-health nurse do?

• Determine the need for advocacy & factors that prevent clients from acting on their own behalf

• Determine the point at which advocacy will be most effective

• Collect facts r/t the problem

• Present case to appropriate decision makers

• Empower clients to speak for themselves

Microaggression

• Unintentional, daily, quick statements or actions of a discriminatory nature based on dominant culture ideology 

• Racial microaggression are daily commonplace insults & racial slights that cumulatively affect the psychological well-being of ppl of color

• Can be directed at any marginalized group & be multi-layered

• “You’re so smart, why didn’t you become a doctor?” (nursing student)

• “Your hair looks so interesting. How do you keep it clean?” (black person)

• “That’s so gay” (LGBTQ community)
  

microaggression example

Prejudice

• Beliefs about groups of ppl based on specific characteristics or identities that make one group better than another 

• The groups have hierarchical differences that are measured or judged

• “I assumed the older adult wouldn’t understand how to use a computer before I even assessed their baseline knowledge”

• “I dismissed the patient’s pain because of their hx of substance use influenced my judgement”

• “The staff assumed the pregnant teen was irresponsible w/o learning anything about her situation”

prejudice examples

Structural Racism

• Focuses on institutions like education, housing, healthcare, and criminal justice.

• Refers to how these institutions are built and maintained in ways that disadvantage certain racial groups.

• Rooted in historical injustices that created long-term disparities.

Ex: segregated buses/schools for blacks vs whites

• Slavery

• Segregation

• Jim Crow

• redlining

• Apartheid

• Holocaust

structural racism examples

Systemic Racism

• Encompasses the entire system of society, including cultural norms, beliefs, and behaviors.

• It's broader than structural racism—it includes both institutional practices and societal attitudes that perpetuate inequality.

• Think of it as the network of racism that runs through everything: laws, media, traditions, and even unconscious/implicit bias.

Discrimination

Actions taken (implicitly or explicitly) based on prejudiced beliefs that result in treating groups of ppl differently or creating systems that advantage certain groups over others

• Individual (micro)

• Institutional (macro)

• “I provided less detailed explanations to the immigrant family because I know they wouldn’t understand anyway.”

• “The nurse denied the learning disabled patient additional time to process instructions.”

• “I offered fewer treatment options to the patient with Medicaid because I’m pretty sure they can’t afford the expensive ones.”

discrimination examples

Intersectionality

• The ways that class, race, gender, ethnicity, sexual orientation, ability, status and other markers of difference intersect to inform individual realities and lived experiences

• Brings attention to the ways that power operates in society to create marginalization of multiple groups, while maintaining power of other groups

• “I assumed the Black woman was being ‘difficult’ when she questioned her treatment plan, instead of recognizing how her race and gender shaped her past experiences with healthcare.”

• “I dismissed the concerns of the young Latino man because I unconsciously associated his race and gender with aggression.” 

• “The staff prioritized wealthier patients for specialized services while delaying care for those with disabilities and limited income.”

intersectionality examples

Strategies for addressing discrimination & reducing implicit bias in nursing

• Counter-stereotypic imaging

• Emotional regulation

• Individualization

• Mindfulness

• Perspective-taking

• Partnership building

Counter-stereotypic Imaging

Replace an image of a stereotypical group member with the image of someone who is in that group but does not fit that stereotype

Emotional Regulation

Recognize negative reactions (fear, anxiety, frustration) to patients from vulnerable groups and intentionally strive to be empathetic, patient and compassionate

Individuation

Mindfully seek to see the patient as an individual instead of as a member of the stigmatized group. Address any assumptions that are coming up about the group so they are not impacting care of the individual

Mindfulness

Calm our thoughts, take a deep breath, pause before speaking

Perspective-taking

Purposely and empathetically think about what the patient is thinking and feeling, stimulating feelings of caring and compassion. Put yourself in their shoes

Partnership Building

Intentionally frame the clinical encounter as one where the nurse and patient are equals, working collaboratively toward a shared goal

What is Epidemiology?

• The study of causes, distribution, and control of diseases in a population

  • the distribution and determinants of disease or other health-related outcomes in human populations, and the application of that study to controlling health problems

• Looking at cause and effect.

  • How does a disease/illness spread?  Who gets sick?  Why do they get sick?

SARS COV2 virus causing the disease we now call “COVID-19”

epidemiology example

Causality

1 event = result of another event

Links between contributing factors & resulting states of H&I

E.coli in the lettuce at work —> everyone eats the salad —>  everyone ends up w GI s/s —> everyone ends up in the ED

causality example

Risk

• Probability that a given individual will develop a specific condition

• Risk may be absolute or relative

Absolute Risk

Probability that anyone in a given population will develop a particular condition

“Absolute risk of developing lung cancer in smoker is 3.5%.”

absolute risk example

Relative Risk

Probability that someone in a group of people with a particular characteristic will develop the condition when compared to people without that characteristic

“Smokers are 6-7 times more likely to develop lung cancer than nonsmokers.”

relative risk example

Rates of Occurrence

• Statistical measures that indicate the extent of a health problem within a group

• Allows comparison between groups of different sizes or divide the instances of an event by the population at risk

• Multiply these proportions by 1,000 or 100,000 to make them easier to understand

• Commonly used as morbidity & mortality rates

Morbidity

Another term for illness. A person can have several co-morbidities simultaneously. Morbidities are NOT deaths.

• Measure of disease RISK (proportion of population who will get the disease)

• Number of new cases of a particular condition in a specified time period

• aka “disease-burden”

Mortality

Actual deaths that occur

• Cause-specific death rate

Case Fatality

The number of people who develop a health problem and will die as a result of it

• Shows how deadly a disease is

• Ebola case fatality rate is very high

• HIV/AIDS case fatality rate used to be very high and could’ve theoretically be zero if people had access to treatment

case fatality examples

What is surveillance in public health?

It’s DATA!!! Systemic collection, analysis, & interpretation of data in order to protect the public’s health AND the timely dissemination of the data to those who need to know (to protect public health)

Prevalence

Total number of people affected by a particular condition at a specific point in time

• Impacted by incidence (how many ppl got the disease), duration (do ppl get cured or live w it forever), & deaths (how many ppl actually die of the disease)

• tells you how many resources you’ll need to take care of ppl

• tells you how well tx are working

• need to determine causes of changes in prevalence (cures? deaths? lower incidence?)

Prevalence Rate

A statistical measure that tells you the proportion of a population that is affected by a particular condition at a specific point in time

prevalence rate example

Incidence

Alerts you to change of how quickly something is spreading and how well you are doing at preventing a disease

Incidence Rate

The measure of how often new cases of a disease or condition occur in a specific population over a defined period.

• Texas reported 803 new cases of measles in 2025

  • Divide by total population 31 million then multiply by 100,000 = 2.59

• Wisconsin reported 23 new cases of measles in 2025

  • Divide by total population 5.9 million then multiply by 100,000 = 0.39

  • Let’s pretend Wisconsin had the same number of new cases as Texas did…

  • Incidence rate would be MUCH HIGHER because the population is MUCH LOWER – 13.61

incidence rate example

How do nurses use surveillance data?

•  Responsible for collecting and reporting on nationally notifiable diseases to public health officials (filling out a form, making a phone call, or completing information into an online database)

• Monitor diseases in certain settings (hospital, community, population)

• To track the point of origin of some diseases, manage an outbreak, or investigate disease patterns

• To design and conduct population-level interventions (policy, environmental interventions) & to evaluate the effectiveness

Types of Immunity

• Herd immunity

• Natural immunity

• Acquired immunity (active or passive)

Herd Immunity

• Protection d/t the immunity of most community members, making exposure unlikely (previous infection / vaccination)

• It is the level of disease resistance of a community or population

Natural Immunity (aka Innate)

ALWAYS PRESENT! READY TO FIGHT! RESPOND IMMEDIATELY! 

First 2 hrs: Phagocytes (neutrophils & macrophages) release = Engulf bacteria phagocytosis

Inflammation 4 hrs: Mast cells release histamine, immune cells & fluid leak out of blood vessels into tissues —> Macrophages release cytokines (either attract more immune cells or active immune cells) = Fever & Swell

Antiviral Defense 6hrs: Natural killer cells (apoptosis)

Activate adaptive immunity

Adaptive Immunity

NOT ALWAYS PRESENT! TAKES 7-10 DAYS TO BE ACTIVATED! “SHARPSHOOTERS”

• When pathogens bypass our innate immune system, the adaptive immune system will step in and fight those pathogens.

• “Sharp shooters”: “more specialized,” making cells unique to specific pathogens in order to attack them. (Covid-19)

• Remembers previously encountered pathogens to destroy them

• Produces B-cells & T-cells

Naturally Active Immunity

natural exposure (ex: kids getting sick in school from contact) & then makes their own antibodies to never have the disease again (ex: chicken pox)

Artificial Active Immunity

Induced by vaccines

ex: after exposure to tetanus, botulinum, HBV, or rabies

Naturally Passive Immunity

Maternally passed down —> transfer of IgA antibodies found in breast milk

ex: mom to baby by feeding breast milk

Artificially Passive Immunity

Healthcare CREATED immunizations to prevent illness

ex: recovering serum/plasma from COVID-19 pts

Chain of Infection (ARPMPS)

agent —> reservoir —> portal of exit —> mode of transmission —> portal of entry —> susceptible host

Causative Agent (infectious)

A biological organism capable of being directly or indirectly transmitted from person to person, animal to animal, animal to person, or the environment (air, water, food etc) to person

• bacteria

• fungus

• virus

• parasite

How do we break causative agent part of the chain of infection?

• Diagnosis and TX

• Antimicrobial stewardship- is the systematic effort to educate and persuade prescribers of antimicrobials to follow evidence-based prescribing, in order to stem antimicrobial overuse, and thus antimicrobial resistance.

Resevoir

Hosts or environments where causative agent lives and reproduces

• Dirty surfaces/equipment

• Soil

• Food

• Water

• People

• Animals/Insects

How do we break reservoir part of the chain of infection?

• Cleaning, disinfection and sterilization

• Infection prevention policies

• Pest control

Portal of Exit

Route that the agent takes to leave the reservoir

• For humans, can include blood, respiratory secretions and anything exiting from the GI or GU tracts

How do we break portal of exit part of the chain of infection?

• Hand Hygiene

• PPE

• Control of aerosols and splatter

• Respiratory etiquette

• Waste disposal

Mode of Transmission

How the causative agent makes it’s move

What are the modes of transmission?

• Direct contact

• Indirect contact

• Droplet

• Airborne

• Vector-borne (mosquitoes (malaria, west nile, zika), ticks (lyme disease), fleas (plague))

• Vehicle-borne (food, water, med, blood products (ex: salmonella from contaminated food))

How do we break mode of transmission part of the chain of infection?

• Hand hygiene

• PPE

• Personal hygiene

• First Aid

• Removal of catheters and tubes

Susceptible Host

A person who is potentially vulnerable to that particular causative agent

Host factors that influence the outcome of an exposure include:

• the presence or absence of natural barriers

• the functional state of the immune system

• the presence or absence of an invasive device.

How do we break susceptible host part of the chain of infection?

• Immunizations

• TX of underlying disease

• Health Insurance

• Patient Education

What is a communicable disease?

A disease that can spread from one person or animal to another in several ways: directly, through physical contact with bodily fluids or secretions; indirectly, through contaminated items like drinking glasses, toys, or water; or via vectors such as flies, mosquitoes, ticks, and other insects.

Stages of Infection (IPIC)

1.) Incubation Period

2.) Prodromal Stage

3.) Illness Stage

4.) Convalescent Stage

Incubation Period

Pathogen begins replication but does not yet cause symptoms

Prodromal Stage

Symptoms begin to appear but can be non-specific

Illness Stage

Pathogen reproduces and disseminates rapidly causing s/s

Convalescent Stage

Affected tissues are repaired & manifestations resolve

Level of Spread (communicable diseases)

• Endemic

• Epidemic

• Pandemic

Endemic

Moderate ongoing occurrence in a given location

• Chicken pox that occurred at a predictable rate among school age children before we had the varicella vaccine.

• Malaria, which is endemic to Africa, Asia, Latin America, and the Middle East. 

• COVID-19 now that it is past the acute phase.

endemic examples

Epidemic

Infectious disease that spreads rapidly, or the rate of disease is exceeding the usual endemic level

Measles– currently spreading in the US beyond recent endemic levels.

epidemic example

Pandemic

Spreads beyond continents, across the entire globe, & takes more lives & affects more ppl than an epidemic

• COVID-19

• HIV/AIDS

pandemic examples

Prevention & Control (communicable diseases)

• Immunity

• Vaccines

• Surveillance

What are the steps for a community health assessment?

1.) Define the community

2.) Collect data

3.) Analyze data

4.) Establish community diagnoses

5.) Plan programs

6.) Implement programs

7.) Evaluate program interventions

Define the Community

• What group will you be focusing on?

• Can be broad or specific

• Use data to help describe the population

Collect Data

• Primary (you collect)

• Secondary (others have collected)

• Quantitative (measured & written w numbers)

• Qualitative (info that describes something in character)

Analyze Data

• Gather data

• Assess completeness of data

• Identify missing data

• Synthesize data & identify themes

• Identify community needs & problems

• Identify community strengths & resources

Establish community diagnoses

• Identify and prioritize needs of the community

• Work with community members, local health professionals, administrators to develop priorities and establish outcomes

• Consider:

  • Community awareness of the problem

  • Community readiness to acknowledge and address the problem

  • Available expertise/fiscal resources

  • Severity of problem - # of people, morbidity/mortality impacts

  • Amount of time needed for problem resolution

Plan programs

• What are possible solutions to the diagnosed problem?

• What resources are required for each possible solution?

• Establish goals and objectives for the chosen solution

  • Include measurable objectives with a target date for achievement

• Select strategies to achieve the objectives

• Identify who is responsible to complete the strategy

• Find funding

• Plan for evaluation

Evaluate program interventions

• Strengths and weaknesses

• Did you achieve desired outcomes

• Recommend any modifications to better meet community needs

• Share findings with the community members and stakeholders

• Ongoing evaluation is necessary

• Sustainability plan

Helpful strategies for program interventions

• Through assessment

• Accurate interpretation of data

• Collab w community partners

• Effective outreach & communication patterns

• Sufficient resources

• Logical planning

• Skilled leadership

Barriers for program interventions

• Inadequate assessment

• Inadequate/misconstrued data

• No involvement w community partners

• Impaired communication

• Inadequate resources

• Lack of planning

• Poor leadership

Primary Data

Data that you collect yourself & are hearing directly from the interviewee

Secondary Data

Data that others have collected that you are not collecting yourself

• you are gathering the data & reporting what OTHERS found

Quantitative Data

Info that can be measured & written w numbers (ex: temp, BP, pain score)

Qualitative Data

Info that describes something in character