Public Health Chapters 1, 2, & 12

Systems theory

present day, coordination of personal and public healthcare services

One health:

connections among human health, animal health, and ecosystem health

Population health

broad concept that stresses collaboration among traditional public health professions and healthcare delivery professionals; comprehensive way of thinking about modern scope of public health

High risk approach

focuses on those with the highest probability of developing disease and aims to bring their risk level close to the average

Improving the average approach

assumes everyone is at some degree of risk and aims to reduce risk for everyone

Birth rate:

going down

Fertility rate:

going down

Age at first marriage

going up

Direct cause

directly leads to or produces a disease (HIV causes HIV infection and can lead to aids)

Contributory cause

Increases the risk of or contributes to a disease (smoking contributes to the development of lung cancer)

3 things to establish causation

1. existence of an association between the ‘cause’ and the ‘effect’

2. the ‘cause’ precedes the ‘effect’ in time

3. altering the ‘cause’ alters the probability of the ‘effect’

Demographic transition

Birth rate is going down, people aren’t dying off like they used to

Built environment

physical environment built for use by humans

BIG GEMS

determinants in that they increase or decrease the chances of developing conditions that threaten the quantity or quality of life

B

Behavior: actions such as smoking or eating a particular diet

I

Infection: early or long-standing exposure may contribute to development of or protect against disease

G

Genetics: very occasionally are they the most important factor

G

Geography: some infectious diseases like malaria or Lyme occur only in defined geographic areas

E

Environment: natural disasters, iodine deficiencies in soil, built environment produces things like indoor air pollution or infant proofed homes

M

Medical Care: access to and quality of; vaccines

S

Socioeconomic-cultural: education, income, occupational status can affect things, cultural and religious factors

Microbiome

gastrointestinal tract, infection has an impact on the microbial environment

Home Rule / Local Autonomy Model

authority is delegated from the state to the local health department, has a great deal of autonomy in setting its own structure and function

Branch office model

local health department can be viewed as a branch office of the state agency with little or no independent authority or funding

Federal public agency roles:

Department of health and human services is central public health agency of the federal gov

CDC

agency most closely identified with public health, connects federal, state, and local public health efforts

Nongovernmental organizations: NGOs

like American Red Cross, central role in blood donations

Community based participatory research

community members are involved in all stages of the research process, contribute their expertise while sharing ownership and responsibility over the research, and asset to build trust, knowledge, and the skill to facilitate the research as well as development and implementation of interventions

3 functions of a public health agency

Assessment, Policy development, and assurance

essential services of assessment

1. monitor health

2. diagnose and investigate

essential services of policy development

3. inform, educate, and empower

4. mobilize community partnerships

5. develop policies

essential services of assurance

6. enforce laws

7. link to and provide care

8. assure a competent workforce

9. evaluate

10. research

P.E.R.I.E. Approach

P: problem

E: etiology

R: recommendations

I: implementation

E: evaluation

approach is circular

Etiology

the study of the causes, origins, or reasons behind a disease/condition

Burden of disease

occurrence of disability and death due to a disease

Mortality

death

Morbidity

disability

Course of disease

how often a disease occurs, how likely it is to be present currently, what happens once it occurs

Descriptive epidemiology

who, what, when, where

Cross-sectional study

snapshot of a population at a time; descriptive epidemiology

case report

descriptive epidemiology

ecological study

studying a population; descriptive epidemiology

ecological fallacy

assuming that something observed of a population will hold true for an individual

case definition

standard criterion that is needed to ensure everyone is measuring using the same yardstick so counts are comparable across time, place, and persons

population at risk

people capable of getting the disease

prevalence rate:

(new + old cases at a point in time) / total population at that time 

incidence rate

(new cases during a period) / population at risk at start of period 

Health and disease rates

(# of health events of interest) / (population at risk of that event)

attributable risk

incidence rate of exposed group - incidence rate of not exposed group

absolute burden

what proportion of a population will be affected

period prevalence rate

the proportion of at risk persons who have been defined as a case within a specific time period

point prevalence rate

the proportion of at risk persons who have been defined as a case at one specific time 

absolute risk

what is the overall probability that someone will be diagnosed within a time period?

incidence:

counted: new cases

time frame: week, month, year

denominator: PAR

prevalence

counted: existing cases (new+old)

time frame: specific point

denominator: total population

analytic epidemiology

why and how

case control

analytic epidemiology; researchers start with the outcome and look backward to investigate past exposure

cohort study

analytic epidemiology; researchers start with groups defined by exposure and examine whether they develop the disease 

relative risk

(risk in exposed group) / (risk in unexposed group)

risk:

exposed new cases / exposed PAR

temporality

causal agent precedes anticipated outcome

specificity

one observed factor associated with outcome

consistency

repeated observation across studies

reversibility

reduced exposure associated with fewer outcomes

primary interventions:

prevent it

secondary interventions:

detect it early

tertiary interventions

reduce its impact

necessary condition:

must be present for outcome to occur

sufficient condition:

guarantees outcome will occur