Public Health

what is public health

science of protecting ppl and health, organized effort to protect promote and restore the health of its citizens

functions of public health

• monitoring of health of communities at risk of health problems

• formulation of public policies

• access to care

• promote healthy practices

whats the goal of public health

reduce discomfort and disease + attaining highest well-being using knowledge and resources

• protect health by preventing and maintaining it

• control morbidity by fighting disease

  • restore health status

sources of demographic data

direct - census, statistics registers

indirect - estimation methods, surveys

10 essential public health services

1. monitor health status

   1. diagnose health problems and hazards

   2. inform ppl

   3. partnerships to solve community problems

   4. support policies

   5. enfore laws

   6. link ppl to needed services

   7. ensure skilled health workforce

   8. evalute health services

   9. apply innovative solutions

domains of PH

• biostat

• demography

• epidemio

• ethics

• occupational health

• law and human rights

• social and behavioural sciences in health

  • social and healthcare service management

levers of control

• regulation (immunizations, hygiene conditions, laws)

• institutional capacity (structures, normative frames)

intervention levels - prevention types

primordial

primary (to reduce incidence)

secondary (to reduce prevalence)

tertiary

which prevention type avoids which - risk factors, disease, postponing death

primordial and primary - risk factors

secondary - disease

tertiary - postpone death

which prevention is for which target population

primordial - all

primary - susceptible

secondary - asymptomatic

tertiary - symptomatic

what is quaternary prevention

aim is to protect from overmedicalisation - avoid harm

_______ prevention focuses on creating conditions that reduce risk

primordial prevention

________ prevention’s goal is to prevent the onset of disease before it happens

primary

what kind of prevention is early dg and prompt ttt

secondary

what prevention is disease management and rehab

tertiary

health

state of complete physical mental and social wellbeing 

the ability to adapt and to self manage

health criteria take into consideration

functional well being, abaility to self manage and adapt, human conditions

health status

individual’s overall level of health

biological generations

0-14 y

15-50 y

50+ y

economic generations

0-15 (pre productive)

15-64 (productive)

65+ (post productive)

________ is statistical study of human populations

demography

demographic event vs phenomena

event - birth, death, marriage, divorce

phenomena - intensity of an event, calculated in rates (natality, mortality, marriage/divorce rate)

young dependency ratio

1 BG X 100/2 BG

determinants of demography

birth 

death

migration

types of population (age) pyramid

progressive 1 BG > 3 BG

stationary 1 BG = 3 BG

regressive 1BG < 3 BG

old dependency ratio

3 BG X 100/ 2 BG

total dependency ratio 

Bg 1 + 3/2

demographic stages 

high stationary

early expansion 

late expansion 

low stationary

declining srage IV

demography is the study of populations which includes changes in population..: ______, __________, ______, affected by 3 processes _____ ______ ________

sizes

composition

distirbution

fertility, mortality, migration

in which stage do we bave no change in population size

higb stationary stage

what happens in late stage III

slow growth - death rates low, fertility rates decrease sharply

what stage has low birth and mortality rates

low stationary stage IV

what happens in declinign stage

birth rate lower than death rate, neg growth

population static vs dynamic

static - size, composition, distirbution/density

dynamic - natural, mechanic

pyramid of developed vs developing countries - median age

developed is high

pyramid un vs developed - shape

undeveloped - narrow base, straight, tall and wide apex

developed opposite

old and young dependency ratios in developing vs devrloped country pyramids

developing - old high, young low

composition of population

age, sex, marital status, education, occuption, economic status

demographic tools of migration

immigration rate, emigratino rate, net migration rate

demographic tools of population change

rate of natural increase, growth rate, intercensus pop change

why do we use indicators

• analyse present situation

• make comparisons

  • measure changes

demographic tools of trends

world pop, annual growth rate, relation bw growth rate and doubling time of pop

indicators

standardized measures of structured info, monitoring and assessing health status, its determinants and dynamics related to diff interventions

frequency of events rate calculation

# of events of a specific type in a given time / # ppl at risk of experiencing that type of event in a given time

rate= occurence/exposure

incidence

measure of the number of new cases of a characteristic that develop in a population in a specified time period; rate = nr new cases x 1000 / pop at risk

prevalence

proportion of a population who have a specific characteristic at a defined time (regardless of when they first developed the characteristic). rate = nr new cases + old cases x 100/# ppl at risk

calculation of prevalence

(incidence) x (disease duration)

mechanical vs natural movement

mechanical - migration

natural - births, deaths

laws of migration

• most migrants travel short distance (most international - yougn men, most internal - female)

• migrants travelling long distasnces settle in urban areas

• migration is in steps

• migration is rural to urban

• each migration flow produces counterflow

• most migrants are adults

falling death rates are due to

better nutrition and higher standards of living

falling birth rates are due to

social and economic changes - women in school, marry later, postpone childbearing, fever kids, work outside home

birth rate/crude natality rate

birth/population x1000

fecundity rate

pregnants / women ages 15-49 × 1000

capacity of woman to produce child

total fertility rate

average of children born to a woman over her lifetime

birth/women 15-49 × 1000

marital status calculation

nr marriages/ nr pop x1000

divorce rate

nr divorces/nr pop x1000

fatality rate

deaths x / dg with disease x

general fertility rate

annual # live births per 1000 women of childbearing age

age specific fertility rates

annual number live births per 1000 women in an age group

proportional mortality rate

deaths due to x cause / total deaths

% of all deaths due to a specific cause

measure of proportion of deaths from specific cause out of all deaths, represents relative importance of cause of death in a pop

case fatality rate

proportion of diangosed cases of disease resulting in death = dividing number deaths from a dfisease by total # confirmed cases

represents severity of disease

natural increase

(births - deaths/nr pop x 1000) OR

birth - death / 10

excess of births over deaths

vital index

births/deaths x 1000

crude birth rate

anuual number live births per 1000ppl

__________ is the actual reproductive performance of a woman

total fertility rate

life expectancy

avega enumber yrs expects to live at present mortalit levels

doubling time

•Nr of years while a population doubles ...   easily computed by dividing a growth rate into seventy.

ex 70/growth rate

health indicators

incidence, prevalence, life expectancy, health adjusted life expectancy, burden of disease, disability adjusted life years

burden of disease

impact of a disease in relation to amount of healthy life lsot to illness or death, provides info to where most gain can be made so resources allocated effectively

disability adjusted life yrs

unit of measure to compare impact of diff diseases and injurties on an equal basis

1 DALY = 1 healthy yr of life lost due to mortality/illness

= years of life lost + yrs of life living with disability

years of life lost

measure of how many yrs of expected life are lost due to premature death

uses of DALYs

quantitative analysis of burden of disease

analysis of cost effectiveness of interventions

selection of package or list of interventions deliverable within a budget

how are DALYs constructed - 2 components

quality of life reduced due to disability, lifetime lost due to premature mortality

growth rate does not take into account

disease

as population growth rate increases, the doubling time :

decreases

what pyramid shape does developing country have

expansive

_______ is transformation of resoures into utility

management

__________ is getting the most output from the least input, things are right

efficiency

efficacy

producing the intended result under ideal conditions (things done_

effectiveness

completing activites so goals are attained (right things)

characteristics of manager vs leader

manager - ratinoal, analytical, organiser, persistent

leader - flexible, creative, inspiring, visionary

leadership styles

authoritarian (autocratic), participative (democratic), delogative (hands off, employee autonomy)

managerial roles types

interpersonal (figurehead, leaderl, liason), informational (monitor, disseminator, spikesperson), decisional (entreperneur, disturbance handler, resource a

core skills use in diff levels

lower - technical skills

middle - human

top - conceptual

fayol’s principles of management

• division labor

• authority

• unity of command

• line of authority

  • centralization

administrative management

formal system organization to promote fairness and efficiency, but too much bureaucracy

hawthorne effect by Mayo

study of worker efficiency and productivity → workers enjoy attention → more productivity

contingency theory

no best way to manage, strategies depend on situation

classical management functions

classical - planning, organizing, leading, controlling

scientific management

defined by Taylor late 1800s, systemic study of relationships bw ppl and tasks to redesign the work for higher efficiency

observation of all jobs, exclude all time =-outs

mechanic system of management

measurement > efficiency, but didn’t understand human-social needs

problems of scientific management

managers implemented only the increased output side of Taylor’s plan, but it didn’t allow workers to share in increased output, specialized jobs boring, workers distrust it and could under-perform on purpose → management responded with increased use of machines

key points of bureaucracy

• authority - power to hold ppl accountable for their actions

• positions in the firm should be held based on performance

• position duties clear

• lines of authority identified

• rules, operating procedures and norms used to determine how the firm operates

behavioral management

focuses on a way a manager should manage to motivate employees, by Follett, the worker knows the best way to improve the job

contingency (situational) theory by Fiedler

ther'e’s no unique principle, no optimal leader-type, managers must change to adapt to techno environments

strategic planning

organization’s systemised and organised process of defining and planning its future

goal is to adapt an organization to the constantly changing ext enviro, and to understand possibilities linked to these changes

strategic vs operational planning

strategic - positioning the organization in the enviro and orientation to the desired future

operational - current guide of the operations, help implement the strategy

vison/mission : intention, oriented to a value, defined in sentences:

values - guiding principles and philosophy

strategic plan - road map, leads us to accomplish vision

vision

a picture of the future you’re working to create

mission

defines the fundamental purpose of an organization, succinctly describing why it exists