Public Health 101 flashcards

Health Protection Era (Antiquity–1830s)

• time when communities used quarantine, isolation, dietary rules, sanitation practices, and regulation of behavior (e.g., taboos, religious restrictions).

• Goal: protect society from disease without scientific understanding of causes.

• Example: quarantine for plague, Mosaic dietary laws.

Hygiene Movement (1840–1870s)

• Sparked by industrialization and urban crowding.

• Based on belief that disease came from “miasma” (bad air).

• Innovations: development of sewer systems, clean water, street cleaning, and garbage collection.

• Famous figures: Edwin Chadwick (UK), Lemuel Shattuck (US).

Contagion Control Era (1880–1940s)

• Based on germ theory of disease (Pasteur, Koch).

• Introduction of vaccinations, outbreak investigations, lab science.

• Public health became a scientific discipline.

• Example: tuberculosis sanatoriums, vaccination campaigns.

Filling Holes in the Medical Care System (1950s–1980s)

• Post–World War II, expansion of antibiotics, vaccines, and access to medical care.

• Creation of programs like Medicare & Medicaid (1960s).

• Public health filled the “holes” in the healthcare system for vulnerable groups (maternal/child, poor, elderly).

Health Promotion/Disease Prevention Era (1980s–2000)

• Recognition that behavior (smoking, diet, inactivity, alcohol) drives chronic disease.

• Rise of health education, lifestyle interventions, anti-smoking campaigns, seatbelt laws.

• Greater focus on individual responsibility.

Population Health Era (2000s–present)

• Acknowledges broad determinants of health.

• Uses systems thinking and combines:

  • Healthcare systems (diagnosis, treatment, prevention in individuals)

  • Traditional public health (population-wide prevention and health protection)

  • Social policy interventions (education, poverty reduction, housing, environment).

• Goal: address health inequities and improve outcomes at the population level.

Ecological Model of Health

• Sees health as influenced by multiple factors at different levels:

  • Individual (genetics, behavior)

  • Interpersonal (family, peers, networks)

  • Community (neighborhoods, schools, workplaces)

  • Societal (laws, policies, culture, economics).

• Key idea: interventions at multiple levels simultaneously are most effective.

Population Health Model

• Expands beyond healthcare to address determinants of health.

• Incorporates:

  • Healthcare delivery

  • Traditional public health efforts

  • Social interventions (education, housing, employment, transportation).

• Focuses on outcomes across populations (e.g., lowering infant mortality, increasing life expectancy).

High-Risk Approach

• Focuses on groups/individuals at the highest risk.

• Goal: bring their risk down to the average.

• Example: targeted screening for BRCA mutation in women with strong family history.

Improving-the-Average Approach

• Focuses on shifting the entire population’s risk curve.

• Goal: reduce risk across all people, not just the vulnerable.

• Example: reducing salt in processed foods to lower average blood pressure in society

B – Behavior(determinat of health)

Actions that increase/decrease risk (smoking, exercise, diet, seatbelts).

I – Infection(determinat of health)

Microorganisms cause disease but can also protect (e.g., microbiome).

G – Genetics(determinant of health)

Inherited traits influence disease susceptibility (e.g., cystic fibrosis, BRCA).

G – Geography(determinant of health)

Location impacts risk (e.g., malaria in tropics, heart disease in food deserts).

E – Environment(determinant of health)

Natural (air, water) and built (housing, roads, pollution exposure).

M – Medical Care(determinant of health)

Access to screening, treatment, and preventive services.

S – Socioeconomic & Cultural(determinant of health)

• Education, income, occupation, cultural beliefs, discrimination.

Demographic Transition

• Shift from high birth/mortality rates → low birth/mortality rates.

• Results in aging populations, fewer children.

Epidemiological (Public Health) Transition

• Shift from infectious disease dominance → chronic, non-communicable diseases.

• Example: US now faces heart disease, diabetes more than TB or polio.

Nutritional Transition

• Shift from nutrient-deficient traditional diets → highly processed, calorie-dense diets.

• Leads to obesity, diabetes, and metabolic diseases.

Vulnerable Groups

Populations at greater risk due to health, economic, or social disadvantage (e.g., poor, elderly, disabled, immunocompromised).

Built Environment

Human-created surroundings (roads, parks, sidewalks, housing) that influence activity levels, safety, and health.

Society-Wide Shared Health Concerns

Broad risks that affect all populations (climate change, antibiotic resistance, natural disasters).

Systems Thinking

Framework that examines how different sectors (healthcare, education, economy, environment) interconnect to produce health outcomes.

Epidemiology

he study of the distribution and determinants of health-related states or events in populations, and the application of this study to prevent and control health problems.

Epidemiological Transition

The shift from infectious and nutritional diseases dominating in pre-modern societies to chronic/noncommunicable diseases dominating in modern societies.

Incidence

The number of new cases of a disease in a defined population during a specific period of time; measures risk.

Prevalence

The total number of existing cases (new + old) of a disease in a population at a given time; measures burden.

Crude Mortality Rate

Total deaths in a population divided by the total population.

Cause-Specific Mortality Rate

Deaths from a specific disease divided by the total population.

Case Fatality Rate

The percentage of people with a disease who die from it.

Infant Mortality Rate

Deaths of children under one year per 1,000 live births.

Years of Life Lost (YLL)

Years lost due to premature death compared to expected life expectancy.

Health-Adjusted Life Expectancy (HALE)

Life expectancy adjusted for years lived in poor health or with disability.

Disability-Adjusted Life Year (DALY)

A measure of overall disease burden combining years of life lost (YLL) and years lived with disability (YLD); one DALY equals one lost year of healthy life.

Years Lived with Disability (YLD)

A measure of the burden of disease based on duration of condition and severity weighting.

Case-Control Study

Retrospective study comparing people with a disease (cases) to people without (controls) to identify prior exposure.

Cohort Study

Prospective study following exposed and unexposed groups over time to measure disease outcomes.

Randomized Controlled Trial (RCT)

Experimental study where participants are randomly assigned to intervention or control groups; strongest evidence for causation.

Bradford Hill Criteria

Set of guidelines for establishing causation: strength of association, consistency, dose-response, biological plausibility, temporality, coherence, analogy, experimental support.

Chain of Causation

Model of disease causation showing the interaction of agent, host, and environment; interventions break the chain.

Primary Prevention

Interventions that prevent disease before it occurs (e.g., vaccines, education).

Secondary Prevention

Early detection and treatment of disease (e.g., screening programs).

Tertiary Prevention

Actions to reduce complications or disability in established disease (e.g., rehabilitation, chronic disease management).

Relative Risk (RR)

The ratio of disease risk in the exposed group compared to the unexposed group.

Attributable Risk

The amount of risk in exposed individuals that can be attributed to the exposure.

Population Attributable Risk (PAR)

The proportion of disease cases in a population due to a specific exposure.

Vital Statistics

Government-collected data on births, deaths, marriages, and divorces; key public health data source.

Surveillance System

Continuous, systematic collection and analysis of health data (e.g., CDC notifiable diseases).

Registry

Organized system for collecting data on individuals with a specific disease or condition (e.g., cancer registry).

Survey

Data collection method from representative samples of a population (e.g., NHANES, BRFSS).

Evidence-Based Public Health (EBPH)

The integration of scientific evidence, community values, and available resources into public health decision-making.

Evidence Hierarchy

Ranking of study designs by strength of evidence: systematic review/meta-analysis → RCT → cohort → case-control → case series → expert opinion.

PERIE Framework

A systematic public health process:

Problem(PERIE)

Define the burden of disease (incidence, prevalence, DALYs, HALE).

Etiology(PERIE)

Identify causes and risk factors.

Recommendations(PERIE)

Develop evidence-based intervention options.

Implementation(PERIE)

Apply strategies (information, motivation, obligation).

Evaluation(PERIE)

Assess effectiveness, efficiency, and equity