POP HEALTH

Session 1:

Is having equal access to live a healthy life a right or privilege?

• Health in the United States is a privilege awarded to those with the ability to afford it and the sociodemographic standing to be treated equally. 

Health Equity- Ensures an equal opportunity to a health outcome

• Achieved by eliminating health disparities, addressing SDOH, developing solutions to incorporate social justice

Social Justice- Ensures everyone has equal rights and opportunities; includes right to healthy outcomes

• Disparities and inequities are the result of many social injustices that occurred throughout USH. 

HEALTH EQUITY IS RELIANT ON SOCIAL JUSTICE

• Intersectionality theory

• Examines social impacts of health

Population Health

• The study of the conditions that shape distributions of health within and across the population; how all individuals are affected by health issues and how they respond to them

• Tells us what we need to know to understand what causes health

  • We then take this and use it in public health to intervene and make health better.

• Determinants:

  • Biological (genetic, immune system structure, etc.)

  • Social (occupation, race, sexual orientation, gender expression, religion, etc,)

  • Environmental (habit, built environment, work environment). 

  • Behavioral (smoking, physical activity, etc,)

  • Cultural (Language preference, dietary patterns, etc.)

POP Health is composed of three categories (the double arrows indicate that these categories influence each other).

1. Healthcare System- A system that provides healthcare services to people that contributes to their overall health.

   1. It is controlled by the Dept of Health and Human Services (HHS) of the executive branch.  

   2. The goal is to enhance and protect the health and well-being of all Americans by providing health and human services, promoting research advances, and carrying out aspects of health policy. 

2. Traditional Public Health- The science of preventing disease, prolonging life, and promoting physical health through organized community efforts.

   1. Today, the goal is to improve the health of families and communities through the promotion of healthy lifestyles, research for disease and injury prevention, and detection and control of infectious diseases.

3. Social Policy- The ways in which societies meet human needs for security, education, work, health and wellbeing. 

   1. Focuses on how states respond to global challenges of social, demographic and economic change, and of poverty, migration, and globalization. 

   2. SUMMARY- The role of the government in providing services and support to citizens from childhood to elderly. 

Why are politics inseparable from our health?

• Politics decide which policies are implemented and when

• Shape economic and living conditions, which directly correlate to our health

• Define who gets what and when they get it. 

  • Illness and health reflect the following social gradient: The lower socioeconomic status, the poorer health outcomes.

• Through this, government can influence health of populations through:

1. Policies that establish public health measures

2. Policies that regulate healthcare

3. Policies that affect health of populations and health equity (e.g: Housing, employment, and transportation). 

Roses articles:

Asks two questions:

1. Why do some individuals have a condition?

2. Why do some populations have much more of a condition, whilst in others it's rare?

Rose identifies two determinants of Health Conditions:

1. Individual cases- determinants focus of susceptibility and risk factors

   1. Genetic factors

   2. Lifestyle and behavioral factors (smoking, diet, etc)

   3. Metabolic and physiological differences (e.g: variations in metabolism, blood pressure, cholesterol levels, etc.)

   4. Environmental and Occupational Exposures

Rose identifies the individual centered approach as the basis of traditional epidemiological research, such as case-control and cohort studies. 

She also critiques this method; case-control studies cannot detect if everyone is exposed to a harmful factor (if everyone smokes, then this approach would identify lung cancer as genetic). 

2. Population Incidence Rates- determinants focus on the differences in disease frequency across populations. 

   1. Social and cultural factors

   2. Economic and policy factors

   3. Environmental influences

   4. Dietary Patterns

   5. Public Health Infrastructure

Two Approaches:

1. High Risk (Individual Level)- focuses on identifying and treating those of high risk through screenings

   1. A temporary solution that requires continuous intervention

2. Population (Societal Level)- Aima to shift the entire populations risk distribution

   1. More effective in reducing overall disease, but takes a while to implement and feel effects. 

EFFECTIVE PUBLIC HEALTH REQUIRES A MIX OF BOTH (STOP POINT D1

Session Two:

What Impacts Health? Depicts significance of physicians relations with community

Community Oriented Primary Care (COPC)- A systematic approach to healthcare derived from epidemiology, primary care, preventive medicine, and health promotion.  Main Features:

1. Relationship between practitioner and patient

2. Understanding the community is essential for the health team; focusing on the community as a whole and its subgroups when expressing needs, planning, providing services, and evaluating the effects of care. 

COPC is composed of four principles: 

1. providing comprehensive care for a defined population

2. supplying care based on health needs and determinants

3. Implementation of health programs that integrate promotion, prevention, and treatment (PPT).

4. Community Participation

Focused on providing care to a defined population, based on specific assessed needs to improve health status. 

Determinants include: (BIG GEMS)

Behavior- can either increase susceptibility to disease or decrease susceptibility

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

Social determinants of health (SDOH)- the conditions in which people are born, grow, live, work, and age; allows us to understand what influences health decisions and actions of individuals/populations.

Five main SDOH:

1. Economic Stability

2. Education

3. Social and Community Context

4. Health and Healthcare

5. Neighborhood and Built Environment

SDOH causes differences in:

1. Quality of care

2. Access to healthcare

3. Life opportunities, exposures, and stresses

The root cause of differential in health outcomes is Structural Discrimination. This was deposited into several laws/policies throughout history which impact various societal systems and the overall health and wellbeing of citizens. 

RACE IS A SOCIAL CONSTRUCT

• Classification of races pre 1990; the race of the child of mixed descent was always assigned to the parents who were not white.

What is Racism- Jones Article 

• Racism- A system of structuring opportunity and assigning value based on social interpretation of how we look (race).

Three Levels:

1. Institutionalized- systemic distribution of resources, power and opportunity in our society where groups are targeted/excluded on basis of race

   1. Structural barriers, societal norms, redlining, etc.

2. Interpersonal- differential assumptions about abilities, motives, and intentions of others according to their race.

   1. Intentional, maintains structural barriers, acts of omission, racial profiling, etc.

3. Internalized- acceptance by members of the stigmatized races of negative messages about their abilities and intrinsic worth. 

   1. Reflects systems of privilege, societal values, erodes individual sense of value, imposter syndrome, doubting capabilities, etc.

• The gardener in Jones Allegory represents the government, who possesses the ability to decide, act, control resources, etc.

• Discrimination Scales:

  • Williams: everyday discrimination/experiences of major discrimination

  • Krieger: Experiences of discrimination 

• Racism can be chronic or acute and can occur in:

  • Healthcare

  • Housing Employment

  • Criminal justice

  • Education 

• Historical Racism:

  • Home Owners Loan Corporation Act- low risk areas marked green, while neighborhoods marked red (redlining) were hazardous (neighborhoods graded based on communities racial makeup).  

  • Fair Housing Act- prohibited discrimination based on race, religious, ethnicity, sex, disability, and family status in housing sales, rentals, and financing. 

    • Racial disparities in homeownership and wealth and housing segregation have continued. 

Pop Health vs Public Health:

• Population Health focuses on specific groups of people, while public health focuses on the community as a whole. 

ARTICLE: Adler et al. (1994)

• Explored the gradient between Socioeconomic status and health.

• Established that health disparities exist across all SES, not just high and low

• Factors that contribute to this gradient:

  • Material resources- access to nutritious food, safe housing, and healthcare services

  • Psychosocial- stress levels, social support, and sense of control

    • Stress exposure- higher chronic stress in lower SES

    • Control and Autonomy- Lower SES have less control over life circumstances which impacts health.

  • Health behaviors- variations in smoking, exercise, and dietary habits

    • Lower SES have limited access to health related information and resources. 

• Implications for Policy and Intervention:

  • Comprehensive approaches- policies addressing these factors

  • Early interventions- target early life stages to mitigate long-term health disparities

  • Call to Action- emphasize multifaceted strategies to reduce health disparities associated with SES. 

• SES is measured through three methods:

1. Education- years of schooling/highest degree

   1. Advantages: 

      1. Easy to measure

      2. Fairly stable overtime

      3. People report it accurately

      4. Can have implications for health literacy and health education

   2. Disadvantages:

      1. Tells you nothing about economic resources

      2. How do we consider highly educated unemployed individuals?

2. Income- total income, individual or household, 

   1. Advantages:

      1. Can tell you about material resources

   2. Disadvantages:

      1. Complicated to measure

      2. Hard to measure accurately

      3. Can be highly variable 

3. Occupation- title, place of employment, category of employment

   1. Advantages:

      1. It can tell you about material resources, psychosocial demands of a job, and potential environmental exposures

      2. Easier for people to report

   2. Disadvantages:

      1. Potential for title bias

      2. Differential economic returns for the same occupation by race, ethnicity, or gender. 

QUESTION OF THE HOUR: So why do we measure SES if it's so challenging?

• The reasoning is because of the socioeconomic gradient in health.

• A social gradient in health runs from the top to the bottom of the socioeconomic spectrum. 

Session 3:

• Race- a made up/artificial social construct that categorizes people based on visual differences. 

Structural Racism and Health Inequities (Bailey et al.)

• A system of interconnected institutions reinforcing racial discrimination in housing,education, employment, healthcare, and criminal justice.

  • Argument- structural racism is a fundamental cause of racial health inequities

• Institutionalized racism has shaped health outcomes from colonial times to the present

Structural vs Institutional Racism:

• Structural racism refers to the overarching system reinforcing inequities

  • Ex: housing, education, employment, earnings, benefits, credit, media, etc. 

• Institutional racism refers to specific policies and practices within organizations that disadvantage racial groups.  

  • Home Owners’ Loan Corporation Act of 1933

  • Indian Removal Act of 1830

Empirical Evidence on Structural Racism and Health:

• Statistical Disparities

  • Black Americans have higher infant mortalities, lower life expectancy, etc. 

• Scientific Studies

  • Research linking structural racism to stress biomarkers and adverse health outcomes

How does structural racism affect health:

• Residential Segregation

  • Redlining

  • Increased exposure to environmental hazards, poor living conditions, and lack of access to quality health services. 

• Economic Inequities

  • Disparities in income, employment opportunities, and financial security

  • Occupational segregation into lower-paying, high risk jobs.

• Health Care Disparities

  • Racial biases in medical treatment and diagnosis

  • Limited access to health insurance and preventive care

• Criminal Justice System Disparities 

  • Racial Profiling, higher incarceration rates, and legal penalties 

• Psychosocial Stress and Health Outcomes

  • Chronic stress from systemic discrimination leads to hypertension, mental health issues, and increased mortality. 

Systemic Racism- combination of laws, policies, and rules that are embedded within society and organizations that generate and reinforce inequities.

Interventions to Dismantle Structural Racism:

1. Policy reforms and anti-discrimination laws

2. Health Equity Initiatives (expanding medicaid and community health programs). 

3. Criminal Justice Reform (addressing sentencing disparities and policing biases). 

4. Educational and Economic Investments (equitable funding for schools in marginalized communities)

5. Community- Based Approaches (grassroots advocacy and participatory policymaking).

Clougherty et al. article 

• Occupational status is a key determinant of health; better job = better health outcomes

• Higher job status directly associated w/ lower chronic illness prevalence and mortality %

• Two causation factors

  • Reverse Causation- poor health leads to low job status

  • Social Selection- privileged backgrounds lead to better health and higher job status

• Pathways linking work and health:

  • Occupational Hierarchy and status- professionals enjoy greater job security and social prestige which confers health benefits or risk.

  • Psychosocial Job Stressor- High job demands, with low control leads to stress related illness

  • Physical and chemical exposure- blue collar workers face greater exposure to hazardous conditions

  • Work Organization- job stability, flexibility, and social capital at work affect long term health

  • Precarious Employment- contract, shift, and gig work increase stress, job insecurity, and health risks

  • Gender and Occupational health- Women in blue collar jobs face unique risks including greater injury rates and job strain.

• There are several challenges that make linking work to health difficult

  • Separating job related stress from overall SES influences

  • Longitudinal studies are needed to track cumulative work related health effects

  • Workplace interventions must consider psychosocial and physical risk factors

    • May include: policies that promote job security, fair wages, better work conditions, address physical and psychosocial hazards, etc.

  • Future research should integrate social, economic and biomedical factors to fully understand work related health disparities. 

• Neighborhoods are key determinants of health; refers to the immediate residential environments; more specifically the material and social characteristic related to health

  • Hazardous substances

  • Air quality

  • Treatment of water supply

  • Food Quality and availability 

• Neighborhoods are marked by racial, ethnic, and socioeconomic differences

• Health behaviors (diet/physical activity) and stress pathways are key mediators 

• Early studies linked neighborhood socioeconomic indicators to health outcomes

  • Limitations: lacked direct measures of neighborhood attributes

• Modern Studies:

  • Improved methods: Geographic Information Systems (GIS), systematic social observations, and surveys

  • Examined

    • Physical activity: walkability, access to recreational spaces

    • Diet: availability of supermarkets and fast food proximity

    • Obesity and Chronic Disease: relation b/w environments and chronic illness prevalence

    • Mental health: association of physical disorder, violence, and depression rates

  • Challenges: selection bias, defining neighborhoods, measurement issues, etc.

  • Future Directions:

    • Longitudinal and Life Course Studies: understand cumulative life exposures

    • Intervention Research

    • Natural Experiments: evaluate health impacts of policy change (grocery store opening, gentrification, etc.)

    • Systems Thinking + Simulation models- understanding dynamic neighborhood health relationships

    • Gene-environment interactions- how genetics and environmental exposures interact. 

Lecture 4 (end of module 1)

• SES- an individual's position within a hierarchical social structure in relation to others, typically based on income, education, and occupation

• Vast majority of health disparities are due to social, behavioral, and environmental components 

Social Justice:

• Presence of deliberate systems to achieve and sustain racial equity through proactive and preventative measures.

Health inequity vs disparity:

• Often used interchangeable b/c disparities are inequitable but they are different.

• Health Disparity- difference in the incidence and prevalence of health conditions and health status b/w groups that are closely linked w/ economic, social, or environmental disadvantage. 

• Health inequities- systematic and unjust distribution of social, economic, and environmental conditions needed for health. 

• SUMMARY: disparity implies a difference of some kind, inequity implies unfairness. 

Health Equity:

• The goal; health disparities are the metrics used to measure progress towards achieving.

Depicts Sexism in health

• Biological and Social Determinants of Health differences: 

  • Females outlive males in almost all countries but suffer from more chronic and non life threatening illnesses

  • Males have higher mortality from conditions like CVD and cancer

  • Women's risk for CVD increases after menopause; historical bias towards men has delayed understanding of females’ CVD risk

  • Immune Function and Disorder

    • FM have stronger immune response, but higher risk for autoimmune disease

    • Hormone differences contribute to immune function variations

  • Mental health:

    • FM have higher rates of depression; men have more externalized disorders (aggression, addiction, etc.)

• Limitations in current health disparities models

  • Biological models fail to incorporate social determinants effectively

  • Need for an interdisciplinary approach combining biomedical and social sciences

Medical Exploitation of Enslaved Black Women:

• Dr Francois Marie Prevost- experiment on at least 30 enslaved women to perfect his cesarean surgical technique 

• Dr Ephraim McDowell- developed surgical therapies for ovarian cancer using enslaved women

• These physicians believed enslaved women did not feel pain, leading to them not using anesthetics

  • This racial bias in pain perception still exists today

    • Black and American Indian women have higher rates of pregnancy related death compared to white women.  

• American Eugenics movement and Forced Sterilization of low income women, individuals with disabilities, and women of color. 

Gender Bias- form of prejudice that favors one gender over another

• Everyone has some form of gender bias, whether conscious or unconscious.

• Explicit bias- bias that a person recognizes

• Implicit bias- bias a person is unaware of and comes from the messages that people absorb throughout their lives.

Consequences of Gender Bias in Healthcare:

• Knowledge gap- less known about one gender since less research is funded.

• Lack of women in leadership

• Delayed diagnoses- if a physician doesn’t take a patient's symptoms seriously. 

• Avoidance of healthcare

• Abuse,neglect, and death

State bans on abortion throughout pregnancy were countered through proactive policies:

1. Abortion- four states (NM, OH, OR, MN) made abortion a legal right

2. Contraception- Plan B like medications, condoms, etc. 

3. Gender Affirming Care

Intersectionality refers to the interconnectedness of social factors.

Benefits of applying intersectionality in public health:

• Unifying language and theoretical framework

• Promotes the conceptualization and analyzation of disparities and social inequalities in health 

• Encourages researchers to look beyond individual factors on health.  

• Facilitates well targeted and cost-effective health promotions.

LGBTQ Section 

• Intersectionality Theory- focuses on how multiple identities within an individual combine in ways that can have a profound impact on health. 

• SEX IS NOT GENDER:

• Sex- biological identity

• Gender- psychosocial aspects of being male or female 

  • Biological approach is limited (only considers hormones and chromosomes)

• Intersex- term used for a variety of conditions in which a person is born with sexual anatomy that doesn’t seem to fit the typical definitions of FM/M. (30 variations, known as Differences in Sexual Development DSD)

• Gender Identity- individuals language for their self expression

• Gender Expression- an individual's physical characteristics, behaviors, and presentation

• Transgender- those who identify with a different sex than the one assigned at birth

• Non Binary- Identify as a gender that is not male or female.

• Cisgender- individuals who identify with the gender they were assigned at birth. 

• Gender Diverse- a person's gender, identity, role, or expression differs from cultural norms prescribed for people of a particular sex.

• Sexual Identity- how one describes themself 

• Sexual Orientation- who you are attracted to 

• Romantic Orientation- any preferences a person may have towards the genders of romantic partners. 

• ACE- an individual w/ a lack of sexual attraction

• Demi- people who feel sexually or romantically attracted to people with whom they have formed an emotional bond

• Pan- a person whose attraction towards others is not limited by sex or gender.

• Two spirit- person who identifies as having both masculine and feminine spirit.

EVERY PERSON HAS A SEX ORIENTATION, GENDER IDENTITY, AND GENDER EXPRESSION

Gender identity and sex orientation are not the same. 

LGBTQIA+ are a vulnerable population:

• Youth is 2-3x more likely to attempt suicide

• Youth are more likely to be homeless

• Lesbians are less likely to seek preventive services for cancer

• Gay men are at higher risk of HIV and other STI, especially among communities of color. 

But why?

• There is a lack of research and data, which limits the ability to effectively treat individuals a part of this community for chronic illness such as CVD.

• Microaggression- brief verbal or non verbal insults

• Stereotype- oversimplified held belief about a group

• Prejudice- expressing negative attitudes toward a different social group

• Stigma- mark of shame or disgrace associated with a particular person.

Implicit Bias and stigma may undermine health outcomes for LGBTAIA+ community

• Provider bias may lead to poorer patient provider interaction, which can impact the patients follow-up and adherence to treatment plans.

Sexual and Gender Diverse Patients’ Concerns:

• Being turned away, refused care, or treated differently

• Having to teach providers about their sexual and/or gender identity

• Being asked unnecessary questions, being ridiculed, misgendered, or even assaulted. 

Gender and Sexual Minority (GSM)- term used to refer to individuals who identify with a gender identity other than cisgender and/or a sexual orientation other than heterosexual. 

GSM Health:

• Social and systemic effects of oppression and discrimination

• Inter/Intra-personal barriers to health decision making

• Traditionally, health of GSM has been focused on risk

• Transvestite- term used to refer to a person who dressed in clothing other than what the gender society would expect

• MSM- men sleeping with men; term used to describe AIDS

• Minority Stress Theory- a framework used to understand the psychological and physical health disparities experienced by minority groups.

Current state of LGBT Health:

• More likely to be diagnosed with chronic illness

• Very little research still outside of STDs, substance use, and mental health

  • Inherent complication of evolving definitions and terminology

  • Geographic dispersion

  • No traditional sampling method to draw a representative sample

  • Distrust in research from history

Affirming care:

• Care that acknowledges and affirms the identity, culture, and levied experiences of the patient, and provides safety in which to explore how these unique identities and experiences have impacted the health of the patient and communities they belong to. 

Ways to provide Culturally Affirming care:

• Use respectful terminology

• Think beyond the binary

• Stay up to date on LGBTQ health issues and disparities

• SRY gene- sex determining gene- if SRY gene has Y chromosome, testes will develop. 

Development does not always occur “normally”:

• Individuals with atypical chromosomes develop differently than individuals with typical chromosomes- socially, physically, and cognitively. 

  • Turner Syndrome- affected females often short and infertile; experience learning delays and physical problems

  • Klinefelter Syndrome- affected males have round and enlarged breasts, along with little facial or body hair.

  • Androgen Insensitivity Syndrome- an individual born with male reproductive gonads internally, but externally has female genitalia; caused by abnormality of x chromosome, which leads to body's inability to respond to male appearance hormones 

  • Guevedoces- boys are born looking like girls with no testes and what appears to be a vagina. 

Lecture 5:

• Prevalence- The total # of cases of a disease in a population at a given time

  • A measure of disease that allows us to determine a person's likelihood of having a disease → (total number of cases/ total population)

  • Helps measure disease burden

• Incidence-  # of new cases in a given population at a specific time (measures risk)

  • Allows us to determine a person's probability of being diagnosed with a disease 

  • (# of new cases/ # of people at risk of disease) x time 

  • Helps track new cases and risk

• High incidence, but low prevalence indicates the disease is short lived. 

• Mortality Rate-  # of deaths/ total population

• Case Fatality Rate (CFR)- proportion of people diagnosed with a disease who die from it

  • Percentage or ratio between 0-1; (deaths from disease/total cases) x 100

  • High CFR suggests a severe disease; high mortality rate suggests high disease

  • Biases: low #s of tests = higher CFR

• Federal Poverty Level (FPL)- measure of income used to determine eligibility for medicaid and the Children’s Health Insurance Program (CHIP). 

• Epidemiology- study of distribution and determinants of health-related states in specified populations, and application of this study to control health problems.

• Descriptive Epidemiology- data used to describe the distribution of a health condition or event in a community. ‘

Noncommunicable Diseases (NCDs) = chronic diseases

• Risk factors include: alcohol consumption, diet, genetics, lack of physical activity, and tobacco use.

Types of risk factors: (opposite of risk factors are protective factors)

• Modifiable- can be changed

• Nonmodifable- cannot be changed

Purpose of Epi

• Measure frequency of disease (quantify disease)

• Assess distribution of disease

• Identify determinants

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 

• P-value

  • How certain we are the statistical finding occurred without chance

    • Less than 0.05, we reject null and accept alternative hyp.

• GINI Index:

  • Measure of income inequality in a population; ranges 0 to 1

  • 0 represent perfect equality, 1 represents perfect inequality

>>Countries with low Gini scores often have high social welfare programs.

>>Countries with high Gini scores have significant wealth gaps and socioeconomic disparities.

Lecture #6:

• Social epidemiology- focuses on effects of social and structural factors on state of individual and population health. 

  • Goal is to identify the societal characteristics that affect the pattern of disease and health, along with understanding the mechanisms. 

  • HEAVILY INFLUENCED BY THEORY OF FUNDAMENTAL CAUSES

Link and Phelan (195)

• 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. 

• Central Role of Flexible Resources in SES as a fundamental cause

  • Refers to how SES influences health outcomes through access to resources (known as flexible resources):

    • Money- able to access better healthcare, nutritious food, safer housing, etc.

    • Knowledge- education and awareness encourages individuals to seek preventive measures

    • Power- ability to influence policies, social environments, and health decisions. 

    • Social Connections- provide emotional support, access to health related information, and connections to influential institutions

    • Prestige- High social status = more respect, trust, and better treatment

  • Considered a persistent determinant of health disparities b/c these resources can be used in a variety of ways across various health threats. 

  • If the problem is _________ epidemic/condition, a person with greater resources is better able to avoid areas where the disease is rampant. 

  • Essential features of fundamental social cause

    • Multiple disease outcomes

    • Multiple risk factors

    • Access to resources

    • Reproduces health inequalities over time

• Clinical Epidemiology- application of epidemiology to conduct, appraise, or apply research studies

  • Diagnosis- study of screening and diagnostic tests

    • Example: Among patients presenting with dyspnea in primary care: Does the novel rapid BNP test improve diagnosis of heart failure, when used in addition to signs and symptoms?

  • Prognosis- study and prediction of the course of disease; studies of survival

    • Example: Among children with a recent history of bacterial meningitis: which measures of disease severity best predicts future school performance?

• Prevention- actions that forestall the occurrence of disease in populations

  • Primary Prevention- aiming to avoid the development of a disease in healthy people

    • Ex: Diabetes prevention would involve adjusting diet + other behaviors or vaccinations for a disease

  • Secondary Prevention- focus on early disease detection and/or intervention, making it possible to prevent the progression of a disease

    • Ex: Screening tests/ regular examinations to detect medical conditions

  • Tertiary Prevention- focus to reduce the negative impact of an already established disease by reducing disease related complications

    • Ex: Rehabilitation, interventions to manage complex health issues 

Prevention principles:

1. Identify health problem

2. Identify cause of problem

3. Develop and test interventions to control these determinants

4. Implement and monitor these interventions to assess effectiveness 

WE STUDY EPIDEMIOLOGICAL STUDIES IN POP HEALTH B/C OF HEALTH EQUITY

Lecture #7 

Fundamental Premise:

• In the USA Constitution and Amendments, there is no right to health or the right to healthcare. Recall from Lecture 1, that it is a privilege to have healthcare in the USA.

• Consumers like to get the best satisfaction or value from the least amount of money - Utility Maximization 

• Providers determine the most output given price level that will yield the greatest amount of money - Profit Maximization 

• The MPB curve (Marginal Private Benefit) is downward sloping, meaning that as more healthcare is consumed, the additional benefit individuals receive decreases.

• The MPC curve (Marginal Private Cost) is upward sloping (red line), meaning that as more healthcare is provided, the cost of producing each additional unit increases.

• The intersection of MPB and MPC represents the market equilibrium, where the quantity of healthcare demanded by individuals equals the quantity supplied by providers at a given price.

QUESTION: If the healthcare system is just markets, why would the government intervene? 

1. Public Interest Theory - The government intervenes as a neutral arbiter to promote efficiency in the market and serve the best interests of society. 

2. Special Interest Theory - 

1. Legislators act as suppliers, creating laws to gain votes.

2. Special interest groups act as demanders, seeking laws that benefit them financially

Forms of Gov Intervention in Healthcare: (to promote efficiency, equity, and public interest.) This includes regulating markets to - preventing monopolies and ensuring fair competition, advancing health research and innovation , regulating for safer and better healthcare services, providing direct healthcare services  and offering social insurance programs.

United States Department of Health Services (HHS) - responsible for overseeing the numerous agencies that manage public health, disease prevention and human services programs.
Agencies under HHS include:

1. Center for Disease Control and Prevention (CDC) - responsible for disease prevention, public health and surveillance and health promotion. LEads efforts to manage major public health threats and implement science-based approaches to enhance community health. 

2. National Institute of Health (NIH) - the primary agency conducting and supporting medical research. Includes multiple institutes that focus on specific health conditions (eg: heart conditions) aiming to improve health through research. 

3. Food and Drug Administration (FDA) - ensures the safety, efficacy and security of drugs, biological products, medical devices and food supplies. 

4. Substance Abuse and Mental Health Services Administration (SAMHSA) - focuses on improving access to treatment and services for mental health and substance use issues. Reduce the impact of substance abuse and mental health on communities. 

5. Health Resources and Services Administration (HRSA) - provide healthcare to vulnerable populations, including those who are economically and geographically isolated. Manages programs for maternal and child health, and HIV/AIDs patients. 

The United States lacks a universal healthcare system, so individuals access healthcare services largely through private insurance or government programs such as Medicare and Medicaid. 

Know the diff 

• Medicare: A national program providing healthcare coverage primarily to individuals aged 65 and older, as well as some younger individuals w/disabilities.

• Medicaid: A joint federal and state program that helps cover medical costs for individuals and families with low income, often covering services that Medicare does not.

Affordable Care Act (2010) - aimed at increasing insurance coverage, improving healthcare quality and reducing healthcare cost + expanded Medicaid eligibility in many states and introduced subsidies to make insurance more affordable. 

• Prevention and Public Health Fund - first mandatory funding dedicated to improving public health. 

National Prevention Strategy - focuses on prevention and wellness, this strategy involves cross-section collaboration to improve health across the lifespan and reduce preventable disease through efforts like promoting tobacco-free living, healthy eating, and active living, violence free.

Four Strategies: 1.Elimination of health disparities, 2.empowered people, 3.healthy and safe community environments and 4. Clinical and community preventive services → increase the number of Americans who are healthy at every stage of life. 

• Key Challenges: Despite these organization efforts, healthcare costs in the U.S. have risen dramatically, and disparities in access to care persist. Factors driving costs include unnecessary procedures, inefficient management and rising pharmaceutical 

Guidelines for preschool aged children is a POPULATION APPROACH → physically active throughout the day for 3 hr/ day.

We don’t want to go back to 1960s healthcare… 

In 1960 was healthcare=3% federal government spending and in 2017 healthcare=18% federal government  → infant mortality has decreased throughout the years (good thing)