PUBH Exam 2

Public health in daily life

Safe drinking water, seatbelt laws, restaurant inspections, vaccinations, air quality regulation, fluoridated water, smoke-free laws.

Paleolithic age (230,000 - 10,000 BC)

human evidence

Mesolithic age 9000 BC

agriculture food production
domestic animals

hammurabi code 1700 BC

rules of medical conduct

Chinese, Egyptian, Indian, Hebrew 1000 BC

personal hygiene as religious principles

hippocrates 460 BC

First to use EPIDEMIC

environment and lifestyle = cause of sickness

roman empire 23-475 BC

Public taxation, plumbing, aqueducts

Black death 1346-1350 BC

24-50 million deaths

Middle ages

quarantine, communicable disease control

the enlightenment 1650-1800 BC

Scientific method
Anatomical study

Industrial revolution

Sanitary awakening

occupational disease surveillance (Ramazzini)

vital statistics registration (Graunt)

disease outbreak investigation (Snow, cholera in drinking water)

health care delivery (Nightingale)

social determinants of disease (Virchow)

Public Health Services 1950-1980

Risk factor system (Doll and Hill first study of smoking on health)

cohort studies (Framingham, Alameda Co, healthy people exposed to risk factors would cause heart issues)

population screening (Papanicolau, pap smears to prevent cervical cancer)

vaccination (Salk, polio)

chronic disease control 1980-2000

behavior change theory (modify habits and actions)

systems theory 2000-present

personal and public healthcare services
evidence-based practices
info tech
one health
global orientation

Population health

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

Personal health

individual focus (doctor-patient)

public health vs traditional healthcare

public health- prevention, population-wide, systems/policies

traditional-- diagnosis, treatment, individual focus

BIG GEMS (factors that contribute to causes of disease and wellness)

Behavior
Infection
Genetics
Geography
Environment
Medical care
Socioeconomic factors

Direct causes

immediate trigger (HIV-->AIDS) The actual biological or physical agent responsible for the onset of the disease (e.g. a virus or bacterium)

Contributory causes

the underlying factors, environmental conditions, or lifestyle behaviors that set the stage for the disease or make an individual more susceptible (sharing needles —> increased risk of HIV)

What is the demographic transition in the world right now

shift from high birth and death rates--> low birth and death rates

leads to an aging population, chronic disease burden

population changes

aging, migration, urbanization, fertility changes

older populations = more chronic diseases

migration = new exposures

High risk approaches to disease prevention

target those at highest risk

Improving the average approaches to disease prevention

applied to the entire population regardless of individual risk status, shift entire distribution of risk factors across the entire society

Steps of evidence-based PUBH (PERIE)

Problem: What is the issue?

Etiology: What are the causes?

Recommendations: what works?

Implementation: How can we do it?

Evaluation: Did it work?

Mortality vs Morbidity vs Burden of disease

Mortality = death

Morbidity = illness/disease

Burden = impact on population

Descriptive Epidemiology

understanding where, when, who, and, what disease occurs (distribution). Gives us rates of incidence and rates of prevalence.

Case reports (descriptive)

identifies patterns across health events/emerging diseases/unusual presentations of known diseases, describes ONE patient with a RARE condition.

Case series (descriptive)

Collection of reports for multiple patients with a common characteristic (rare disease, treatments, or adverse drug event) identifies patterns across health events/emerging diseases/unusual presentations of known diseases. Characterizing clinical features and clinical outcomes

Cross-sectional study (descriptive)

observation research, measures both exposure and health outcomes in a pop. at a single point in time

Ecological studies of populations (descriptive)

correlations among variables. Studying population-level exposures, large samples

Ecological fallacy

assuming that a relationship observed at the group level also holds true for the individuals within this group

Descriptive epidemiology can

Provide a baseline understanding, generate hypotheses, support recourse planning, facilitate public health interventions, produce relatively quick and easy to conduct studies

descriptive epidemiology cannot

Establish cause and effect, often relies on existing data, prone to selection biases, difficulty determining temporal sequence, challenges with rare or short duration diseases, potential for overstepping the data, data interpretation challenges

Analytic Epidemiology

the comparison of persons, places, and times for the purpose of identifying the underlying causes of health events

Case control (analytic)

observational design, compares people who have a specific disease (cases) to a similar group who does NOT have the outcome (controls), looking to examine past exposures or risk factors

Cohort

observational/longitudinal, group of individuals share a common characteristic or exposure followed over time to observe and measure development of a health outcome.

INCIDENCE of events

New case frequency- how many persons initially free of a trait or health outcome develop the trait or health outcome within a defined period of time

Incidence rate= New Cases / Population at Risk

Prevalence

Existing case frequency- how many persons with a trait or health outcome are present at a given point in time

POINT prevalence (cases at 1 point in time)

PERIOD prevalence (cases during a range of times)

all existing cases at a point in time

Prevalence rate= Total Existing Cases / Total Population

Risk

 absolute difference in risk between an exposed group and an unexposed group

Risk=Incidence rate (exposed group)- incidence rate( not exposed group)

rate

relates number of traits or health conditions in a pop. to the number of individuals in that pop. who have a non-zero possibility of having that trait or health condition (e.g., mortality, birth, breast cancer)

Rate=(# of health events of interest / Population at risk of that event) X 10^n

Relative risk

the ratio of risk specific to an exposed group, in relation to the risk specific to the unexposed group

Relative risk= risk in exposed group / risk in unexposed group= (exposed new cases/exposed pop. at risk) / (not exposed new cases/ not exposed population at risk)

• relative risk=1 no association of exposure to risk

• Relative risk> 1 exposure increases risk

• Relative risk<1 exposure decreases risk

Cohort pros

Establish temporal relationships
Study multiple outcomes
Valuate multiple exposures
Necessary for study or rare and uncommon exposures
Estimate incidence rates and relative risks

cohort cons

Time-consuming and expensive
Prone to follow-up bias
Susceptible to selection bias
May present an ethical concern
Not appropriate for study of rare disease (cohort needs to be VERY LARGE)

case control pros

EFFICIENT for studying rare diseases- fewer subjects needed
Less time-consuming and more cost-effective
Ability to study multiple exposures

case control cons

Limited to single outcomes
Cannot measure incidence or risk
Recall bias can distort results
Subject selection bias can distort results
Inefficient for rare exposures
Difficulty selecting appropriate controls
Survivor bias may distort results

Establishing causation (HILL'S CRITERIA)

Strength of association
Consistency
Dose-response
Biological plausibility
Temporality (cause precedes effect)

Primary interventions

Take place before the onset of the disease, aim to prevent disease from occurring

Secondary interventions

Occur after the development of a disease or risk factor but before symptoms appear. Aimed at early detection of disease or reducing risk factors while asymptomatic

Tertiary interventions

Occur after the initial occurrence of symptoms, but before irreversible disability

3 core functions of public health (APA)

assessment- obtaining data

policy development- evidence-based reccs

assurance- ensuring effectiveness

10 services of public health

monitor health

diagnose, investigate, empower

mobilize community partnerships

develop policies

enforce laws

link to and provide care

assure a competent workforce

evaluate

research

Federal vs State vs Local systems of Healthcare

Fed- national policy, funding (CDC, NIH)

State- licensing, statewide programs, Medicaid, collect stats, drinking water regulation

Local- day-to-day implementation (tobacco control programs, local clinics)

Importance of collab between government and non-governmental agencies

Partnerships expand reach, resources, and expertise

NGOs (Red Cross, advocacy groups) fill gaps gov't can't-- non profit!