Population Health Midterm

Terms you need to know for Population Health and Epidemiology

Population Health

The health outcomes of a group of individuals and distribution of health outcomes within communities

Community-Oriented Primary Care (COPC)

focused on providing care to a defined population (combines primary care and population health)

Public Health

to promote and protect the health of people and the communities where they live, learn, work, and play

How many eras of public health?

Six eras

Health Protection Era (Antiquity-1830s)

Authority-based control

Hygiene Movement Era (1840-1870s)

sanitary conditions

Contagion Control Era (1880-1940s)

germ theory

Medical Care System Era (1950s-mid-1980s)

modification of risk factors

Health Promotion/Disease Prevention Era (mid-1980s-2000)

individual behavior and disease detection

Population Health (2000s)

coordination of public health and healthcare delivery

Three subsets of Population Health

Healthcare systems, traditional public health, and social policy

High Risk Approach

Focuses on those with the highest probability of developing the disease

Advantages of High Risk Approach

Strategy is tailored to the individual, patient and provider motivation, cost effective

Disadvantages of High Risk Approach

Temporary, doesn’t address underlying problem, more cases may arise

Population Approach

Focuses on entire population and aims to reduce the risk for everyone (improving the average)

Advantages of Population Approach

Large potential for societal impact, sustainable change, impact a range of health outcomes

Disadvantages of Population Approach

minimal benefit to individual, limited motivation, hard to implement, expensive

Social Determinants of Health (SDOH)

the conditions in which people are born, grow, live, work, and age

BIG GEMS

Behavior (smoking, physical activity)

Infection (can directly or indirectly cause some diseases)

Genetics (rarely the most important factor)

Geography (Malaria)

Environment (can be physical, built, or social)

Medical care (includes access and quality)

Socioeconomic-cultural

Three ways that SDOH can lead to different health outcomes

1. Quality of care

2. Access to healthcare

3. Life opportunities, exposures, and stresses

Socioeconomic Status

An individual’s position within a hierarchical social structure in relation to others, typically based on income, education, and occupation

Socioeconomic Gradient in Health

The poorest of the poor, around the world, have the worst health

Three ways Socioeconomic Status is measured

Education, Income, Occupation

Ways in which work can influence health (Clougherty, 2020)

social status and prestige, physical and chemical hazards, work organizations, work insecurity and unemployment, psychosocial job stressors, job demands, control, rewards received for efforts, gender and race differences

Racism

A system of structuring opportunity and assigning value based on the social interpretation of how we look (“race”)

Three levels of Racism

Institutionalized, Personally-mediated, Internalized

Six mechanisms linking Racism and Health

1. Institutional discrimination can restrict socioeconomic attainment and group differences in SES and health

2. Segregation can create pathogenic residential conditions

3. Discrimination can lead to reduced access to desirable goods and services

4. Internalized racism can adversely affect health

5. Racism can create conditions that increase exposure to traditional stressors

6. Experiences of discrimination may be a neglected psychosocial stressor

Health Disparities

Differences in the incidence and prevalence of health conditions and health status between groups

Health Disparities based on

Race or ethnicity, religion, SES, gender identity, sexual orientation, can think of others

Health Equity

the goal; the opportunity for everyone to attain his or her health potential

Difference between Health Disparities and Health Equity

Health equity is the goal and health disparities are the metrics we use to measure progress towards that goal

Health Inequities

Systematic and unjust distribution of social, economic, and environmental conditions needed for health

Epidemiology

The study of the distribution and determinants of health-related states in specified populations, and the application of this study to control health problems

Incidence

Counts new cases, measures risk

Prevalence

Counts all cases, measures burden

Risk Factors

Determinants increase the likelihood of a negative health outcome OR decrease the likelihood of a positive health outcome

Protective Factors

decrease the likelihood of a negative health outcome OR increase the likelihood of a positive health outcome

Salutogenesis

Factors that support human health and well-being

Pathogenesis

Factors that cause disease

Four uses of clinical epidemiology

Diagnosis, Prognosis, Prevention, Treatment

Diagnosis

screening and diagnostic tests

Prognosis

prediction of the course of disease (studies of survival)

Primary Prevention

prevent disease (addressing risk factors)

Secondary Prevention

early disease detection and/or intervention

Tertiary Prevention

reduce impact of diagnosis

Three elements of Biopsychosocial Model

Biological, Psychological, Sociological

Biological examples

physical health, disability, genetic vulnerabilities

Social examples

peers, family circumstances, school

Psychological examples

social skills, coping skills, self-esteem

Biosocial examples

drug effects

Biopsychological examples

temperament, IQ

Psychosocial examples

family relationships, trauma

5 levels of Social Ecological Model

Individual, Interpersonal, Institutional, Community, Societal

Individual level

targeted education (knowledge, attitudes, beliefs)

Interpersonal level

social marketing to change social norms (influence of family/friends)

Institutional level

policies and education (local politics, major regional employers)

Community level

advocacy groups (schools, churches, sports, clubs)

Societal level

policies and laws (cultural values, norms)

Life Course Theory

Health status reflects current and prior living conditions

The Life Course Theory includes

Chains of Risk, Accumulation of Risk, Critical and Sensitive Periods

Accumulation of Risk Model

Exposures or insults gradually build up

Chains of Risk Models

Sequence of linked exposures that raise or reduce disease risk

Chains of Risk: Additive Model

Each exposure increases the risk of subsequent exposure and has an independent effect on disease

Chains of Risk: Trigger Effect

Earlier exposures have no effect on disease risk without the final link in the chain

Critical Period

A limited time window in which an exposure can have adverse or protective effects on development and subsequent disease outcome

Sensitive Period

A time period when an exposure has a stronger effect on development and subsequent disease risk than it would at other times

Affordable Care Act - 2010

Aimed to lower health care costs, cover the uninsured and improve quality of care

Prevention and Public Health Fund

First mandatory funding dedicated to improving the public health system by improving health outcomes, enhancing healthcare quality, and restraining the growing healthcare costs

Four elements of National Prevention Strategy

1. Healthy and Safe Communities

2. Clinical and Community Preventive Services

3. Empowered People

4. Elimination of Health Disparities

Physical Activity Guidelines for Adults

150-300 minutes a week of moderate intensity aerobic physical activity or 75-150 minutes a week of vigorous intensity physical activity

Physical Activity Guidelines for School-Aged Children and Adolescents

60 minutes or more of moderate or vigorous intensity physical activity daily, muscle and bone strengthening at 3 days a week