Untitled Flashcards Set

For the remaining parts of the exam, you should be able to: 

1. Identify the six eras of public health, their focus of attention, and notable events within each 

2. High-Risk Approach (Goal, Examples, Advantages and Disadvantages) 

High-Risk Approach: focuses on those with the highest probability of developing disease and aims to bring their risk close to the levels experienced by the rest of the population

Advantages:

• Strategy is tailored to the individual

• There can be motivation on the side of the patient and provider

• Can be cost-effective when resources are scarce

Disadvantages:

• Palliative and temporary – may not produce sustainable change

• Limited potential for the individual and population – may not be addressing the

• underlying problem; within population – cases may arise from those outside the

• high-risk group

Examples of High Risk Strategy (Often the traditional approach to prevention within medicine)

What would be an example of high-risk strategies that we can use in the case of the

twins?

• Dengue fever prevention: Not playing outside at dawn/dusk in mosquito

• infested areas, Use mosquito repellant

• Flu prevention: Flu vaccine for children, Washing hands, Coughing to sleeve

3. Population Approach (Goal, Examples, Advantages and Disadvantages) 

The Population Approach = Focuses on the entire population and aims to reduce the risk for everyone

(Improving the Average)

• Advantages

• Large potential for societal impact

• Can lead to sustainable change

• Can impact a range of health outcomes by targeting societal norms or environments

• Disadvantages

• Can have minimal benefit to the individual

• Limited motivation on part of patients and providers

• Can be hard to implement – too radical or expensive

• Examples of Population Strategy (Often the traditional public health approach to prevention)

• Assume children of Queens, New York (including the twins), have these two conditions at a significantly more frequency than other children in the region. Ex of pop strategies:

1.  Dengue fever prevention: Removing stationary water near residential areas, Ecological interventions with natural predators, Screens for windows

2. Flu prevention: Flu vaccine policy for children in public schools, Flu prevention education campaign

4. Mnemonic BIG GEMS (Determinants of Population Health) – examples of each 

Behavior (e.g. smoking, physical activity)

Infection – can directly or indirectly cause some diseases

Genetics – rarely the most important factor

Geography –frequency and presence of disease

Environment - can be physical, built, or social 

Medical care – includes access and quality

Socio-economic-cultural- resources

Example Scenarios of BIG GEMS:

Jennifer, a teenager living in an urban rundown apartment in a city with high levels of air pollution, develops severe asthma. Her mother also has severe asthma yet both of them smoke cigarettes. Her clinician prescribed medications to prevent asthma attacks but she takes them only when she experiences severe symptoms. Jennifer is hospitalized twice with pneumonia due to common bacterial infections. She then develops an antibiotic resistant infection. On this hospitalization she requires intensive care on a respirator. After several week of intensive care and every known treatment to save her life she dies

suddenly

Behavior → Cigarette smoking, Medication adherence and overuse

Infection → Infection precipitates asthma, Resistant infection complicate treatment

Genetics → Genetic plays a role in development; Genetics play a role in response to medications

Geography → Allergies, Air pollution affected by geography

Environment → Mold, Dust mites, Cockroaches

Medical care → Treatment to control symptoms and reduce inflammation, Potential for overdose,

vaccinations

Socio-economics → Lower income associated with increased asthma and poor outcome; Lower

education associate with increased asthma and poor outcome

5. Describe the general ways in which SDoH can give rise to different health outcomes 

• differences in the quality of care received within the health care system

• differences in access to health care, including preventive and curative services

• differences in life opportunities, exposures, and stresses that result in differences in underlying health status

• neighborhood/social environments SDOH to health

6. Describe how major social determinants of health (socioeconomic status, race, racism) are commonly measured in the United States, advantages and disadvantages, and the five ways in which work can influence health 

Socioeconomic Status: an individual's position within a hierarchical social structure in relation to others, typically based on income, education, and occupation

• Reveals differences in access to resources, exposure to toxic substances and hazards, and issues related to privilege and control

• We still measure SES even though challenging because it is most robust social determinant of health with respect to evidence; in general evidence shows lower an individuals SES is the worse their health (social gradient)

How Socioeconomic Status is Measured:

• Education: Years of schooling, highest degree obtained

• Advantages of measuring education: Pretty easy to measure, fairly stable over time, people usually report it accurately

• Disadvantages of measuring education: tells you nothing about economic resources, what about highly educated individuals without employment/minimal

• Income: total income (yearly, monthly, weekly), individual of household, receipt of certain types of income

• Advantages of measuring income: can tell you about material resources, especially if you ask about sources

• Disadvantages of measuring income: really complicated to measure, hard for people to

accurately report, can be highly variable

• Occupation: title, place of employment, category of employment

• Advantages of measuring occupation: can tell you about material resources, psychosocial demands of job, and potential environmental exposures ; easier for people to report

• Disadvantages of measuring occupation: potential for title bias; differential economic returns for same occupation by race/ethnicity and gender

Race is only poor proxy for SES, culture, or genes; Race measures social social classification of people in our race conscious society; able to investigate racism as fundamental cause of racial disparities in health

How is Race Measured?

• Self-identification → census

• Identification by others through skin color → death certificates

• Classification of race on birth certificates (currently can do multiple-race reporting, but not multiple ethnicity reporting)

• Limitations: MENA (classifying MENA individuals as white can mask disproportionate discrimination and health disparities they experience)

• LATINX debate

Racism: a system of structuring opportunity and assigning value based on social interpretation of how we look (“race”) ; racism is multidimensional

• Unfairly disadvantages and advantages some individuals and communities

• Saps strength of whole society through waste of human resources

How is Racism Measured?

• Discrimination scales → Everyday Discrimination Scale (Williams), Experiences of Major

Discrimination Scale (Williams), Experiences of Discrimination Scale (Krieger)

• Can be chronic or acute

• Domains where racism can occur: health care, housing, employment, criminal justice, education

Three Levels of Racism

• Institutionalized - systematic distribution of resources, power and opportunity in our society where groups are targeted and/or excluded on the basis of race

• Initial historical insult; structural barriers; inaction in face of need; societal norms; biological determinism; unearned privilege

• Personally-mediated (interpersonal):

• Prejudice means differential assumptions about the abilities, motives, and intentions of others according to their race

• Discrimination means differential actions towards others according to their race

• Intentional; unintentional; acts of commission; acts of omission; maintains structural barriers; condoned by societal norms

-Internalized: acceptance by members of stigmatized races of negative messages about their own

abilities and intrinsic worth

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Reflects systems of privilege; reflects societal values; erodes individual sense of value;

undermines collective action

5 Ways Work Can Influence Health

Social Status & Prestige

-Physical & Chemical Hazards

-Work Organization (e.g. safety culture, workplace social capital)

-Work Insecurity and Unemployment

-Psychosocial Job Stressors (e.g. demand, control, reward)

-Job demands (e.g. psychological, but also physical)

-Control - the extent to which an individual has latitude to meet those demands

-Rewards received for meeting job-related efforts (e.g. monetary, prestige, career

opportunities)

-Differences by gender and also race

7. Study articles: Clougherty, 2010; Dr. Camara Jones’ article 

Cougherty, 2010 Article → “Work and its role in shaping the social gradient in health”

• Job title was the social gradient metric first used to study the relationship between social class and chronic disease etiology

• poorer health status, or adverse health risk profiles, lead to lower job status, through a compromised ability to work as effectively or consistently as healthier workers (Bartley 1988).

  • There is some longitudinal evidence that poor childhood health leads to lower professional achievement in adulthood

  • workers from more privileged backgrounds, already on a better health trajectory, are more likely to seek and achieve better jobs

(1) the role of status in a hierarchical occupational system

Job status translates to more tangible benefits/hazards, including income and benefit

• levels, and degree of control over work, support and, typically, likelihood of exposure to noxious physical environments.

• Low job grade increases risk of hypertension across the spectrum of grades,

(2) the roles of psychosocial job stressors

• Increased risks of hypertension/elevated ambulatory blood pressure (hypertension linked with psychosocial work conditions - chronic stress, irritation, suppression of anger/problems) have been associated with chronic job strain, low job control, and stressful work conditions including low promotion potential, little participation in decision-making, communication difficulties, unsupportive co-workers and overall job dissatisfaction-

(3) effects of workplace physical and chemical hazard exposures

• exposures to all of these agents are negligible among the better-educated salaried workforce, which comprises about 1/3 of all company employees

(4) evidence that work organization matters as a contextual factor

• the context of the workplace (and/or other work unit) has been increasingly revealed to be an important predictor of health. Variation in the work environment – safety culture, work organization, etc – may be more salient to occupational health outcomes, though research will reveal more

(5) implications for the gradient of new forms of nonstandard or “precarious” employment such

as contract and shift work

• stably employed adults experience better health and survival than those who are less stably or never employed

(6) emerging evidence that women may be impacted differently by adverse working conditions,

and possibly more strongly, than men

• men and women have historically differed, on average, in job-related chemical exposures, ergonomic demands, accidents, and psychosocial stressors

women get injured 40–60% more often, with greater injury severity

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observed that the women in hourly jobs tended to be from lower SES background, have

greater financial need (e.g. single mothers), and were more likely to hold lower-grade

(e.g., lower-skilled) hourly jobs, than were hourly men

-

Women still comprise a small proportion of blue-collar workers, but are overly

represented in low-grade jobs, and earn less than men in the same job category

-

This gendered stratification is important because low job grade has been linked

to heart disease, hypertension, and injury

Dr. Camara Jones’ Article → Levels of Racism: A Theoretic Framework and a Gardener’s Tale

-

presents an allegory about a gardener with 2 flower boxes, rich & poor soil, and red & pink

flowers. This allegory illustrates the relationship between the 3 levels of racism and guides our

thinking about how to intervene to mitigate the impacts of racism on health. Also serves as a

tool for starting a national conversation on racism

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race-associated differences in health outcomes are in fact due to the effects of racism

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Institutionalized racism defined as differential access to the goods, services, and opportunities of

society by race; is normative/ legalized, and manifests as inherited disadvantage ; codified inn

our institutions of custom, practice, and law, so there need not be an identifiable perpetrator

-

Manifests in material conditions and access to power

-

Material conditions → differential access to quality of education, sound housing,

gainful employment, appropriate medical facilities, and a clean environment

-

Access to power → resources (wealth) and voice (voting and representation in

government)

-

Personally mediated racism defined as prejudice and discrimination (what most people think of

from the word “racism”); can be intentional/unintentional; acts of commission or omission; lack

of respect; suspicion; everyday avoidance; scapegoating; purse clutching; dehumanization-

-

Internalized racism defined as acceptance by members of the stigmatized races of negative

messages about their own abilities and intrinsic worth; not believing in others who look like

them; embracing “whiteness” hopelessness

Flower Pot Allegory

-

2 pots (one with rich soil, other with poor soil) and 2 types of flowers (pink and red) →

Gardener planting red in rich soil because he prefers it and pink flowers never grow very

strong or tall; gardener later says he was right to prefer red over pink

-

Institutionalized racism → Acts of omission in not addressing the differences

between soils; initial preference of gardner for red over pink (intrinsically thinks

red is better than pink)

-

Personally mediated racism → gardner disdaining pink flowers because they

look poor; gardener plucks pink flower seed blown from rich soil before establish

itself

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Internalized racism → bee comes along to pollinate pink flower and pink flower

says “stop- don't bring me pink pollen - I prefer red” showing pink flower has

internalized belief that red is better when it sees its flourishing

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Gardener = Government ; is the one with the power to decide, the power to act, and the

control over resources

8. Identify and describe the theory of fundamental causes of disease 

• Fundamental Cause Theory (FCT) - explains how socioeconomic status, race, and social capital serve as persistent determinants of health disparities overtime. 

• Argues that even when diseases/risk factors change, structural inequalities continue to impact health b/c some have more resources to health knowledge than others. 

9. Identify and describe intersectionality and minority stress theory 

• The minority stress theory is a theory that emphasizes the psychosocial and physical challenges endured by minorities. 

• Intersectionality refers to the interconnectedness of social factors; places emphasis on how different disparities can be traced back to one source or even be worsened through their interaction with other social factors. 

10. Identify and understand LGBTQIA + healthcare needs 

• Gender Identity

• Gender Expression

• Sex

• Gender

• Sexual Orientation

• Sexual Identity

• Pan

• Demi

• Non Binary

• Transgender

11. Study the elements and examples of Biopsychosocial Model, Social Ecological Framework, Life Course Theory 

Biopsychosocial Model – biological, sociological and psychological health perspectives. Examples of study designs: chronic pain management studies researchers might examine how biological factors like nerve image, psychological factors like coping mechanisms, and social factors like family support interact to influence chronic pain outcomes.

• Biological factors: includes genetics, physiology, hormones, immune system, and overall physical health

• Social Factors:

• Psychological Factors:

Social Ecological Framework/model the way in which individuals own beliefs and behaviors interact with and are influenced by social geographic and cultural context. 

Five levels of influence: 

• intrapersonal, 

• interpersonal, 

• organizational/institutional,

• community, 

• societal (policies).

Individual Level – Focuses on targeted education and skill-building to influence personal behavior.

Example: National Child Passenger Safety Certification Training Program (educates individuals on child safety measures)

Example: Responsible beverage service training programs (educates servers on preventing overconsumption and underage drinking)

Interpersonal Level – Addresses social norms and group influences, often through social marketing campaigns.

Example: “Buckle Up America” and “Click It or Ticket” (public campaigns promoting seatbelt use)

Institutional Level – Involves policies and practices within organizations or industries to promote safety.

Example: Responsible beverage service training programs (implemented in bars and restaurants)

Example: Automobile industry safety innovations (such as airbags, seat belts, and crash prevention technology)

Community Level – Focuses on advocacy and community-based efforts.

Example: Mothers Against Drunk Driving (MADD) (advocates for stricter DUI laws and victim support)

Example: Families for Safe Streets (advocates for traffic safety measures and policy changes)

Societal Level – Encompasses laws and policies that create a safer environment for everyone.

Example: DUI and DWI laws (criminalizing drunk driving)

Example: Texting and driving laws (banning phone use while driving)

Life Course Theory –  Health status at any given age reflects the embodiment of prior living circumstances, linking biological and social factors throughout life independently, cumulatively and interactively to see how health and disease are in adult life. Brings in time dimension. 

Accumulation of risk model exposures gradually build up in our bodies through episodes of illness and injury, environmental conditions, and behaviors. 

Chain of risk model - sequence of linked exposures that raise risk because one experience leads to another and another. 

Critical period model - suggest certain exposures occurring at a critical developmental moment can strongly or singularly influence future health outcomes, for example pregnant mothers who drink alcohol risk infants may be born with FASD. 

Sensitive periods - periods in the lifespan when exposures have a greater impact than others, for example exposure to lead as a child, always toxic but as a child during brain development can lead to permanent cognitive impairments.

12. Study the life course epidemiology article and the differences among the different models and periods 

A life course approach to chronic disease epidemiology explicitly recognizes the importance of time and

timing in understanding causal links between exposures and outcomes within an individual life course,

across generations, and on population level disease trends.

• The importance of timing is illustrated by knowledge that the particular stage of life when an exposure occurs can be important in understanding its later effects

• A life course perspective on chronic disease epidemiology relies on a multidisciplinary framework for understanding how early- and later-life biological, behavioral, social, and psychological exposures affect adult health

  • One of the more ambitious applications of the life course approach to chronic disease epidemiology is to integrate knowledge from individual level studies to help explain population-level trends in different diseases → understanding the array of life course risk factors, such as birth weight, height, diet, etc. are configured across successive birth cohorts, long-term trends, and how these trends map onto trends in different diseases

  • Ex → smoking is the most powerful risk factor for lung cancer

Critical period model emphasizes the timing of exposure, such that an exposure at a specific period in

the life course has long-lasting effects on anatomical structure or physiological function that may

eventually result in disease.

• term critical period is usually reserved for exposures occurring during known periods of unalterable biological development.

• Ex: Limb development in relation to maternal thalidomide use; fracture across growth plate when bone is growing in childhood, postnatal infection with Hepatitis B 

Sensitive periods where the effect of an exposure is magnified more than the effect of the same

exposure in another time period

• The influence of exposures acting during critical or sensitive periods of susceptibility may also be modified by later-life exposures.

RIsk Models → focuses on the total amount and/or sequence of exposure

• suggest that effects accumulate over the life course, although they also allow for developmental periods during which susceptibility may be greater so that the sequence or trajectory of accumulation may also be important

• the simplest model is dose-response, where health damage increases with the duration and/or number of detrimental exposures → additive effects of experiencing low socioeconomic position across different stages of life ; clustering of exposures

13. Identify the ways the healthcare system in the US is organized and the role of the significant health agencies 

14. Interpret graphs and percentages in the same ways we did during class sessions.

15. Types of studies (advantages + disadvantages)

Methods to Measure Epi:

• Surveillance Data- ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a public health event. (not representative of entire pop)

• Observational Studies- observe populations under prevailing conditions

  • Cohort (longitudinal study)- research study that follows large groups of people over a long time. (compares exposed group to non-exposed group).

  • Cross-sectional study- collects information from different population groups over a single point in time. 

    • +: quick and easy to conduct, data on all variables is collected once, etc.

    • -: difficult to determine outcome, unable to measure incidence, etc.

  • Case control- compares groups who either have or don’t have a health problem to identify when the group was exposed and determine if that accounts for the condition. 

    • +:cost effective, good for examining multiple exposures

    • -: prone to bias, limited to examining one outcome, etc.

• Casual Design studies- assess whether an independent variable causes a change in dependent variable.

• Randomized Clinical Trial- an experimental study in which people are allocated at random to receive one of several interventions. 

  • +: eliminates bias, provides the most substantial evidence

  • -: ethical constraints, expensive and time consuming, etc. 

  • Key Difference: One design that actually looks at causality