Pub Health Exam 2

socioecological model

1) intrapersonal (biological factors, beliefs, knowledge, personal finances, skills, attitudes, preferences, self-efficacy)

2) interpersonal (role modeling, peer pressure, social support, family, partners, friends)

3) institutional/organizational (school, workplace, social/religious groups)

4) community (neighborhoods, relationships with organizations, community norms)

5) societal/public policy (media, social norms, laws, law enforcement)

major health behavior risks

tobacco, poor diet, ad lack of exercise together account for 1/3 of avoidable premature deaths

direct pathway of stress

biological effects of stress

indirect pathway of stress

coping using negative health behaviors

3 categories of strategies for health behaviors

education (improve people’s knowledge on unhealthy behaviors)

financial incentives (higher taxes on tobacco/alcohol, higher life insurance rates)

laws and policies (most acceptable=to protect children or people from the consequences of others behaviors, least acceptable=maternalistic or morality challenging)

health consequences of tobacco smoking

500,000 deaths per year in US

leading cause of cancer death (90% of all lung cancers)

introduces of 700 chemicals and 70 known carcinogens

policy interventions to change smoking behavior

info/education: surgeon general reports, warning labels, school health education, media anti-smoking campaigns

incentives: tax increases, lower insurance for nonsmokers

laws/regulations: banning advertisements, smoke free workplaces, restricting sales to minors

most effective: media antismoking campaigns, banning advertisements, smoke free workplaces

least effective: school health education, restricting sales to minors

family smoking prevention and tobacco control act (2009)

gave the FDA authority to regulate tobacco products and to restrict advertising and promotion

overall public health goal regarding vapes

discourage young people from using them but encourage smoking adults to switch with the intention of quitting

barriers to FDA regulating tobacco

opposition from tobacco industry and congress

legal action against regulations

emergence of black markets

philosophical/moral objections

bureaucratic hurdles of implementing regulations

2 main features of FDA Nicotine Product Continuum of Risk Plan

reduce nicotine in cigarettes to non-addicting levels

encourage innovation in non-combusted nicotine-delivery products and extended timelines for new product review

trends of obesity in US

rate of overweight individuals have remained relatively stable but rates of obesity and extreme obesity have increased

why is losing weight difficult?

obesity is a complex condition that results from the interplay of genetic, personal, cultural, and social factors

health impacts of obesity

cardiovascular and endocrine system diseases

psychosocial implications: body dissatisfaction and depression, dieting, unsuccessful weight control methods, binging, weight gain

causes of obesity

energy balance: consuming too many calories and not burning enough (energy intake > energy expenditure)

energy expenditure: calories burned through breathing, calories burned through digestion, calories burned through everyday activity and purposeful exercise

after weight loss, metabolism is lower and makes it more difficult to maintain weight loss or lose more

injury

harm, damage, or impairment to the body

can be intentional or unintentional, but are not accidents

influenced by a person’s behavior and physical/social environment

leading cause of death for americans age 1-44

unintentional injury

primary prevention

preventing illness or injury before it ever occurs (reducing risk factors and promote protective factors)

secondary prevention

detecting illness at its earliest stage to prevent progression to serious disease

tertiary prevention

when an illness or injury is already present, avoiding death or further disability

The Great Molasses Flood

considered a turning point for safety regulation in construction

reactions to the exploding tank led to class-action lawsuit against the company that owned the tank, policies that engineers and architecs needed to approve plans and conduct inspections on building and commercial structures, engineers need to be certified

changes in policy/law that have contributed to decreases in work-related injury and deaths

basic laws on child labor and workplace exposures, regulation/enforcement agencies (OSHA), legal liability, nature of work (less physical)

poisoning trends

opioid related deaths have increased dramatically over recent years

men are more likely to die from opioid use than women

environmental health

the search to discover how the environment affects people in order to promote healthier lives

biological hazards (microorganisms, animals)

chemical hazards (lead in water, smoke)

physical hazards (nuclear radiation, musculoskeletal diseases)

Exposure-Disease Model

source of hazards (where did it come from?): nature (natural disasters) area, stationary (power plants, factories), mobile (transportation methods)

movement of hazard (where does it go and how long does it persist?): direct contact, water/air transmission, gets into animals/crops, present in nature

human exposure (how does it get into the body?): 4 primary routes of exposure - ingestion, inhalation, skin contact, skin absorption

dose (amount entering the body)

adverse health effects (depend on the hazard)

toxicology

the relationship between varying exposures and adverse effects

environmental justice issues

issues where environmental hazards have not been spread equitably among the population

environmental justice

the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies

controls

most effective: elimination/substitution (banning a hazard or substituting for a less harmful alternative)

engineering controls (changing the environment to reduce exposures)

warnings/education (regarding changing your behavior to reduce exposures)

how are mental illnesses diagnosed

clinical assessment (focuses on distinguishing transient symptoms from illness)

screening tools (depression patient health questionnaire, anxiety GAD-7)

8 dimensions of wellness

emotional, occupational, social, intellectual, financial, physical, spiritual, environmental

when do mental illnesses typically develop

adolescence and young adulthood

social determinants of mentall illness

factors exist at individual, family, school, and community levels

causes of mental disorders are viewed as a product of the interaction between biological, psychological and sociocultural factors

mentall illness treatment

medication and/or therapy

nearly 50% receive no treatment

barriers to treatment: individual level - stigma, mistrust of providers, lack of knowledge, social/community level - stigma, culture, access/system level - insurance, cost, limited availability, lack of culturally competent providers

why is addressing collegiate mental health important

college age coincides with mental illness onset ages, very high prevalence, can affect educational achievement and future economic productivity

maternal mortality ratio

number of maternal deaths per 100,000 live births

maternal death

death of a woman while pregnant or within 42 days of termination of a pregnancy from any causes related to or aggravated by pregnancy, not from accidental or incidental causes

pregnancy-related death

death of a woman while pregnant or within 42 days of termination of a pregnancy (regardless of cause)

chronic diseases is the primary cause

maternal morbidity

temporary or permanent disability resulting from pregnancy or termination of the pregnancy

has higher rates than maternal mortality

maternal mortality trends

has decreased significantly over the last century but has been increasing in the US in the past decades

Black women suffer from disproportionately higher maternal mortality rates

national efforts to improve maternal mortality rates in US

defining and monitoring morbidity

using cocurrent interventions to prevent primary causes of maternal mortality

provide obstetric care providers with education and resources needed

identify high risk women for maternal mortality and ensure access to risk-appropriate care

infant mortality

the death of a baby who was alive at birth but died before reaching their first baby

infant mortality rate

number of infant deaths per 1000 live births

infant mortality trends

has decreased in the last 70 years but the US is ranked much lower than other wealthy countries

Black babies are more likely to die, be premature, or have low birth weight

benefits of breastfeeding

improves mother’s health by reducing rates of breast cancer, heart attacks, maternal death, type 2 diabetes, and hypertension

improves child’s health by lowering rates of GI infections, ear infections, severe lower respiratory infections, childhood obesity, and infant death

women least likely to breastfeed

from rural areas, living below poverty line, under 20, Black women, only have high school education

factors contributing to lower breastfeeding rates

underwiming women, short maternity leave, formula companies, lack of education, early hospital discharge, limited support at home

Patient Protection and Affordable Care Act

employers must provide breastfeeding place for first year after birth

no nationwide protection against breastfeeding discrimination

ways to increase breastfeeding rates

extensive support and outreach to women during pregnancy and 1st week postpartum, improve education for health professionals, legislate increased maternity leave to 12 weeks, national legislation to protect BF rights, prioritizing baby friendly hospitals

long acting reversible contraceptives (LARCs)

implants (3 years), IUDs (copper - 12, hormonal 3-5)

barriers to LARC use

provider education, training for post-placental/post-abortion LARC use, lack of information, side effects and risks, financial access

premature baby

baby born live before 37 weeks (primary cause of infant death)

preconception health

access to healthcare to manage health issues before pregnancy

screening and treatment for STIs

promoting optimal health (healthy habits)

10 essential public health services

1) monitor health status to identify commnity health problems

2) diagnose and investigate health problems and health hazards in the community

3) inform, educate, and empower people about health issues

4) mobilize community partnerships to identify and solve health problems

5) develop policies and plans that support individual and community health efforts

6) enforce laws and regulations that protect health and ensure safety

7) link people with needed personal health services andassure the provision of health care when otherwise unavailable

8) ensure a competent public health and personal health care workforce

9) evaluate effectiveness, accessibility, and quality of personal and population-based health services

10) research for new insights and innovative solutions to health problems

4 goals of the healthcare system

optimum quality of life (live longer and healthier lives)

system performance (how the system is functioning) - 6 elements of quality care are safe, effective, patient-centered, timely, efficient, equitable

cost/benefit (weigh cost and provision of care with the benefits that are gained)

reducing structural flaws (allocation of services and providers, finances)

4 main problems of the healthcare system

cost of care (biggest challenge facing US healthcare system)

access to healthcare coverage and care (ability to afford/access care is particularly problematic for those of lower SES or those of marginalized groups)

quality and accountability are inconcsistent and poorly measured

racial and economic disparities are increasing, as are the number of vulnerable populations

components of the healthcare system

patients, providers, facilities, services, administration and staff, governance, oversight

providers, administration, and staff: clinical - physicians, nurses, specialists, social workers, nonclinical - executives, administrators, technicians, board members

services/facilities: primary care, speciality care, pharmaceuticals, emergency care, mental health care, hospitals, clinics, nursing homes, rehab centers, hospice centers

US healthcare system is a multipayer system

private insurance: employer-sponsored, individual market, health savings account

public/government sponsored programs: medicaid/medicare, veterans

uninsured: out of pocket

largest source of health care insurance in US

employer-sponsored plans

6 major government healthcare insurance programs

medicare (to cover those who had retired or aged out of workforce)

medicaid (to cover low-income people unable to work)

State Children’s Health Insurance Program

veteran’s administration

department of defense tricare (military personnel and families)

indian health service (native americans)

challenges regarding the US healthcare system

high costs yet questionable quality

increase in medicare dependent 65+ adults

growth of government funded programs is not sustainable

shortage of primary care physicians

prevalent health disparities

purpose of the affordable care act

PRIMARY GOAL: to address insurance coverage and access to care

basics of the ACA

signed into law March 2010

expanded insurance access for young adults (could be excluded from parents insurance after 19-22 yrs), those with pre-existing conditions (could be denied insurance if they had health conditions prior to the start of a new insurance plan), childless adults (not eligible for medicaid regardless of income), very sick individuals (could face limits on coverage)

components of the ACA

did not fundamentally change the structure of the health care system