Community Health Chapter One

health

a dynamic state or condition of the human organism that is complete physical, mental, & social well-being, not merely the absence of disease & infirmity; resource for living

determinants of health

genetics, medical care, social circumstances (i.e. education, income, poverty), behavioral choices (i.e. exercising), environmental conditions

community

collective body of individuals identified by common characteristics like geography, interests, or values; adequate allocating of resources & support make a healthy community

elements that characterize communities

membership - sense of identity & belonging, common symbol systems - similar language, rituals, ceremonies, shares values & norms, mutual influence on each other, shared needs & commitment to meeting them, shared emotional connection

public health

actions that society takes collectively to ensure that the conditions in which people can be healthy can occur; controlled by government

public health system

activities undertaken within the formal structure of government & the associated efforts of private and voluntary organizations and individuals

community health

the health status of a defined group of people and the actions & conditions to promote, protect, and preserve their health

population health

the health outcomes of a group of individuals, including the distribution of such outcomes within the group; health outcomes

global health

health problems, issues, and concerns that transcend national boundaries that are best addressed by cooperative actions & solutions; lead by WHO

personal health activities

individual actions & decision making that affect the health of an individual or their immediate family members or friends

community & public health activities

aimed at protecting or improving the health of a population or community (i.e. maintenance of accurate birth & death records, protection of food & water supply, participating in fund drives)

factors the affect health of a community

physical - geography, environment, community size, industrial development, social/cultural, & community organizing - community groups help identify problems & solve them

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tropical countries

warm, humid temps & rain makes parasitic & infectious diseases a leading community health problem; survival from these diseases more difficult due to poor soil, leads to lack of food

built environment

design, construction, management, & land use of human-made surroundings as a connected whole, including their relationship to human activities over time; transportation systems, urban design features (i.e. bike paths), parks, etc.

community size

larger the community, the greater its range of health problems & the greater its number of health resources

industrial development

can bring added resources, but also pollution & occupational injuries/illness; must regulate industries for safety

economy

an economic downturn means lower tax revenues to the state & contributions to charitable groups; means less money for assistance programs & people that qualify for them

socioeconomic status (SES)

a division of population based on occupation, income, & education; individuals in lower SES groups, regardless of other characteristics, have poorer health status

community organizing

process where community groups are helped to identify common problems or change targets, mobilize resources, & develop & implement strategies to reach their collective goals

herd immunity

resistance of a population to the spread of an infectious agent based on the immunity of a high proportion of individuals; gotten from vaccinations or acquired immunity; 94%-95% of the population must be immune to interrupt the chain of infection

Early Civilizations

Ancient Societies (before 500 BCE) \n - prior to 2000 BCE: evidence of sewage disposal & written medical prescriptions \n \n - circa 1900 BCE: earliest written public health record, Code of Hammurabi: laws of physicians & health practices \n \n - Circa 1500 BCE: Book of Leviticus includes guidelines for personal cleanliness

Classical Cultures (500 BCE - 500 CE)

\- 5th & 6th centuries BCE: Greek men participated in games of strength & skill & swam in public facilities \n \n - Greeks involved in practicing community sanitation; involved in obtaining water from sources far away & not just local wells \n \n - Romans improved Greek's community sanitation, built aqueducts to transport water, built sewer systems; created regulation for building construction, stressed cleaning & repair, created hospitals as infirmaries for slaves \n \n - Christians created hospitals \n \n - 476 CE: Roman Empire fell & most public health activities ceased

Middle Ages (500-1500 CE)

\- spiritual era of public health (500-1000 AD) \n \n - rejection of science for spiritual solutions \n \n - deadliest epidemics: plague (543 CE - 1348 CE), smallpox, diphtheria, measles, influenza, tuberculosis, anthrax, etc. \n \n - 1200 CE: more than 19,000 leper houses \n \n - since 1492 CE: syphilis epidemic was last epidemic of the period

Renaissance & Exploration (1500-1700 CE)

\- belief that disease was caused by environmental, not spiritual factors \n \n - observation of illness led to more accurate descriptions of symptoms & outcomes of diseases \n \n -1662: John Graunt published the Observations on the Bills of Mortality, beginning of vital statistics

Eighteenth Century (1700s)

cities overcrowded, water supplies inadequate & often unsanitary, dirty, unkept streets; workplaces unsafe & unhealthy, forced to work in textile factories & mines

Nineteenth Century (1800s)

\- predominant theory: "miasmas theory" that said vapors or miasmas were the source of many diseases; John Snow said a cholera outbreak was caused by the water instead \n \n - 1850 Lemuel Shattuck: recommended establishing boards of health, collection of vital statistics, sanitary measures, & disease research; marks beginning of modern era of public health; father of public health \n \n - 1862: Louis Pasteur disproved spontaneous generation & proposed his germ theory of disease \n \n - Robert Koch: said a particular microbe, and no other, causes a particular disease through use of anthrax

American Health Advances

\- 1856: adulteration of milk banned \n -1864: first sanitary survey conducted in New York City \n - 1872: American Public Health Association founded \n - 1890: pasteurization of milk introduced \n - 1891: meat inspection began \n - 1895: septic tanks introduced for sewage treatment

Twentieth Century (1900s)

leading causes of death were communicable diseases (influenza, pneumonia, tuberculosis); vitamin deficiencies & poor dental health extremely common, pregnancy & childbirth death high; average life expectancy 50 years

health resources development period

1900-1960 a time of great growth in health care facilities & providers

Reform Phase (1900-1920)

social & moral, as well as health issues, were involved; illness noticed to be prevalent in poverty; public health nursing started during this time; by 1900, 38 states had state health departments

The 1920s

slow growth of public health; first professional preparation program for health education specialists began at Columbia University in 1922 by Thomas D. Wood (father of health education)

Great Depression & World War II

social & medical services were dependent on relatives or charities; Franklin D. Roosevelt enacted New Deal, where much of the money was used towards public health \n \n - Social Security Act of 1935: marks beginning of government's major involvement in social issues, including health \n \n - War medical discoveries translated into daily life, like the antibiotic penicillin & insecticide DDT \n \n - CDC (Centers for Disease Control and Prevention) established during WWII

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Postwar Years

hospitals built rapidly, but little thought given to planning; national health priorities or establishing national health agenda nonexistent \n \n - 1950s: development of a vaccine to prevent polio & President Eisenhower's heart attack made Americans focus on the #1 killer in the U.S. - heart disease; Eisenhower's doctor recommended regular exercise, Americans heeded that advice

Period of Social Engineering (1960-1973)

1960s is when the government became involved in health matters again; in 1965, Congress passed the Medicare & Medicaid bills; improved standards in healthcare facilities

Medicare

federal level; payment of medical bills for older adults (65+) and certain people with disabilities; part A (hospital), part B (clinic), part C (private), & part D (drugs)

Medicaid

assists in the payment of medical bills for the poor; state-run, reduced people with no health insurance

Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention

brought together much of what was known about the relationship of personal behavior & health status; presented a "personal responsibility" model that provided Americans with tips for reducing their health risks & increasing their chances for good health

Promoting Health/Preventing Disease: Objectives for the Nation

1979; followed release of Healthy People; first set of health goals & objectives for nation

Healthy People

A set of national health promotion and disease prevention objectives for the U.S. population; goals provide general focus, objectives measure progress

National Prevention Strategy

Prioritizes prevention by integrating recommendations & actions across multiple settings to improve health and save lives

ACA

Affordable Care Act, passed in March of 2010; made to expand Medicaid & lower healthcare costs; 15% or 50 million Americans were uninsured, then by 2016 only 5% were

NPC

National Prevention Council; provided leadership for the strategy, which promotes lower healthcare costs, improved quality of care, & coverage options for the uninsured

goal of the Strategy

increase the number of Americans who are healthy at every stage of life

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Four strategic directions of the Strategy

Healthy and Safe Community Environments, Clinical and Community Preventive Services, Empowered People, and Elimination of Health Disparities

example of healthy and safe community environments

injury and violence free living, tobacco-free living

clinical and community preventative service examples

tobacco-free living, preventing drug abuse and excessive alcohol use

Empowered People

reproductive and sexual health, mental and emotional well-being

Elimination of Health Disparities

active living, healthy eating

key indicators for strategic health directions & priorities

be used to measure the progress toward the overarching health goals based on I0 year targets.; used to plan & implement future prevention efforts; reported for overall population & subgroups

21st century public health problems in the U.S.

rise in healthcare costs, growing environmental concerns, lifestyle diseases, emerging & reemerging communicable diseases, substance abuse problems, & natural & human-made disasters

most expensive healthcare in the world

United States

Four leading causes of death in the U.S.

heart disease, cancers, stroke, & chronic lower respiratory diseases; obesity is associated with diabetes & hypertension

environmental problems in the U.S.

millions of Americans live in communities where the air is unsafe to breathe, the water is unsafe to drink, or solid waste is disposed of improperly; rate at which we pollute our environment increases

More than two-thirds of all deaths among Americans each year are from one or more of these five chronic diseases:

heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes

more than 75% of healthcare spending in the US is….

for people with chronic diseases

chronic diseases

most preventable health problems; four modifiable risk behaviors - lack of physical activity, poor nutrition, tobacco use, & excessive alcohol use - are responsible for much of the cases

first case of AIDS reported in the U.S.

June 1981

diseases crossing from other animals to human

includes avian flu, Escherichia coli, hantavirus, mad cow disease, & SARS

recently discovered illnesses

Legionnaires' disease, Lyme disease, acquired immunodeficiency syndrome (AIDS), severe acute respiratory syndrome (SARS), Zika virus, & 2019 Novel Coronavirus

bioterrorism

the threatened or intentional release of biological agents for the purpose of influencing the conduct of government or intimidating or coercing a civilian population to further political or social objectives

drug statistics

\- 2014: more than 18,000 people died from an opioid pain reliever overdose; nearly 50 people per day, & over 10,000 died from heroin-related overdoses, a rate that has more than quadrupled since 2002 \n \n - total overall costs of substance abuse in the United States, including lost productivity, & health and crime-related costs, exceed $740 billion annually

intranasal naloxone

approved by FDA that rapidly reverses the effects of an opioid overdose

CDC recommendations for prescribing opioids

recommends prescribing opioid pain medication for patients age 18 years & older in primary care settings

health disparities

difference in health among different populations; the health of minorities is not as good as the white populaces'; thought to be caused by lack of access to health care & inadequate healthcare for minority groups

disasters that have caused health issues in the U.S.

wildfires, the BP Gulf oil spill, Hurricanes Katrina and Harvey, severe flooding, and the bombings in Sri Lanka, Mogadishu, & at the 2013 Boston Marathon

preparedness for natural disasters

is the foundation for preparedness for human-made disasters

Health and Human Services

HHS; works to protect the health of all Americans and offers medical and other basic services to people in need

Department of Homeland Security

DHS; created as a result of the 9/11 attacks; coordinates the efforts of federal agencies fighting terrorism

public health preparedness

capability of public health & health care systems, communities, and individuals, to prevent, protect against, quickly respond to, and recover from health emergencies, especially unpredictable ones

Ten Great Public Health Achievements: Worldwide

reductions in child mortality, vaccine-preventable deaths, access to safe water & sanitation, malaria prevention & control, prevention & control of HIV/AIDS, tuberculosis control, control of neglected tropical diseases, tobacco control, increased awareness & response for improving global road safety, improved preparedness & response to global health threats

leading causes of death in the world

heart disease & stroke

five of the 10 leading causes of death in the world (broken down by the wealth of countries)

infectious diseases (e.g., lower respiratory infections, HIV/AIDS, diarrheal disease, malaria, and tuberculosis) affect low to middle income countries

high income countries

are affected by more noncommunicable diseases (i.e. heart disease)

nearly one out of every five deaths in children under

the age of 5 years is due to water-related diseases; approximately 80% of all illnesses in developing countries are linked to poor water quality & unsanitary conditions

one in nine people worldwide

do not have access to safe and clean drinking water, with over 1/3 of those people living in sub-Saharan Africa; an estimated 2.4 billion people (more than 32% of the world's population) lack basic sanitation

an estimated 1.8 billion people were

food insecure in 2015; malnutrition remains the underlying cause of death in an estimated 35% of all deaths among children under 5 years of age

migration and health

refugees and asylum seekers find it difficult to seek help & access resources; countries find it difficult to gather resources to deal with influx of refugees

amount of suicides a year

48,000/yr commit suicide, with the main cause being depression & loss of hope; older people more likely to commit suicide due to isolation; psychiatrists have highest suicide rate in medical field; females & dentists commit suicide more

largest branch of government

HHS (Human Health Service); which spends $1 trillion/yr ($100,000 per person)

deaths from drug abuse

more than 150,000 died in 2022; fentanyl causes 70,000 deaths a year, takes 1 gram or less to cause death

community health issues

pollution, trash, disease (influenza), vaccinations, drug abuse, diabetes & hypertension, smoking, alcohol, obesity

higher income people

live 3 years longer

first nurses hired

in 1895

public health core areas

protection (environmental hazards, workplaces, etc.), prevention, & promotion (of good health practices)

lunch in schools

regulated by USDA

bubonic plague

Black Death; caused by the bacteria Yesenia pestis spread by rodent fleas; killed 30%-50% of all Europe (75-200 million people)

smallpox (after 1200)

emerged 3,000-4,000 years ago; 300-500 million deaths; December 1979 was the last reported case of smallpox (in Africa) by the WHO

Edward Jenner

developed a vaccine for smallpox in 1796 by using and observing cowpox

Laissez Faire

few health regulations or health departments in rural areas due to government noninterference approach to health problems

London Cholera Epidemic

food & water contamination from mixing sewage & drinking water together; caused by the bacteria Vibrio chlorae; John Snow seperated sewage & drinking water & ended epidemic

bacteriological period of public health

the period of 1875-1900, during which the causes of many bacterial diseases were discovered

National Association for the Study & Prevention of Tuberculosis

formed in 1902; the first national-level volunteer health agency

first nursing program

started in 1902 in New York

Pure Food and Drug Act

Passed in 1906, the first law to regulate manufacturing of food & medicines; prohibited dangerous additives & inaccurate labeling

Edward T. Devine

noted “ill health is perhaps the most constant of the attendants of poverty”

Reform movement

Workman's Compensation Act

New York passes in 1910; compensates for workplace injury

HIV in the 1980's

brought back tuberculosis due to low immunity caused by HIV

Alexander Fleming

Discovered penicillin in 1928, clinical use began in 1945

CDC

During World War II, the Communicable Disease Center was established in Atlanta, Georgia. Now called t he Centers for Disease Control and Prevention (CDC), it has become the premier epidemiological center of the world.

Vaccine for Polio

1950 Jonas Salk