Public Health 101

What is Health? Institute of Medicine (IOM) - the fulfillment of society’s interest in assuring conditions in which people can be healthy, focusing on collective action for population well-being.

  • Local Agencies/Initiatives:

    • Food Banks: Address food insecurity and provide nutritional support.

    • Vaccine Clinics: Offer immunizations to prevent infectious diseases.

    • Charity Organizations: Provide various health and social services to vulnerable populations.

    • Community Health Centers: Offer primary care and preventive services.

    • School Health Programs: Promote health education and provide basic health services to students.

  • State Agencies/Initiatives:

    • State Dept. of Public Health: Oversees public health programs, disease surveillance, and health education.

    • Medicaid: Provides health coverage to low-income individuals and families.

    • Vital Statistics: Collects and analyzes data on births, deaths, marriages, and divorces.

    • Environmental Health Regulations: Establish standards for air and water quality, and waste disposal.

  • Federal Agencies/Initiatives:

    • CDC (Centers for Disease Control and Prevention): Protects public health and safety through the control and prevention of disease, injury, and disability.

    • FDA (Food and Drug Administration): Ensures the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and ensures the safety of our nation's food supply, cosmetics, and products that emit radiation.

    • AHRQ (Agency for Healthcare Research and Quality): Produces evidence to make healthcare safer, higher quality, more accessible, equitable, and affordable.

    • NIH (National Institutes of Health): A primary agency of the U.S. government responsible for biomedical and public health research.

    • HRSA (Health Resources and Services Administration): Improves access to health care services for people who are uninsured, isolated, or medically vulnerable.

  • International Agencies/Initiatives:

    • World Health Organization (WHO): A specialized agency of the United Nations responsible for international public health, coordinating global health efforts and setting health standards.

Miasma Theory: An outdated theory that illness is transmitted via "bad air" (miasma) or noxious fumes arising from decaying organic matter. It primarily focused on environmental factors like poor sanitation, rather than microorganisms, as the cause of disease.

  • Cholera Broad Street Pump: Associated with the London Cholera outbreak of 1854. John Snow, a physician, critically challenged the Miasma Theory by mapping the locations of cholera cases and identifying a pattern radiating from a specific public water pump on Broad Street. He hypothesized that the disease was waterborne and, by famously removing the pump handle, effectively stopped the outbreak, demonstrating an early triumph in epidemiology.

Ten Great Public Health Achievements (20th Century, United States):

  • Vaccination: Led to the eradication of smallpox and significant control of diseases like polio, measles, and diphtheria.

  • Motor Vehicle Safety: Improvements in vehicle design, road engineering, and safety laws (e.g., seatbelt use).

  • Safe Workplaces: Reduction in work-related deaths and injuries through regulations and improved practices.

  • Control of Infectious Diseases: Advances in sanitation, antibiotics, and surveillance systems.

  • Decline in Deaths from Heart Disease and Stroke: Due to risk factor modification, early detection, and improved treatments.

  • Safer and Healthier Foods: Through food safety regulations, pasteurization, and nutritional improvements.

  • Healthier Mothers and Babies: Improvements in maternal and infant care, leading to reduced mortality rates.

  • Family Planning: Increased access to contraception and reproductive health services, empowering individuals to plan families.

  • Fluoridation of Drinking Water: Significantly reduced dental caries (cavities) across populations.

  • Recognition of Tobacco Use as a Health Hazard: Public health campaigns and policy changes led to a decline in smoking and associated diseases.

Assessment

  • Regular and systematic collection, assembly, analysis, and
    reporting of information important to public health

  • Collecting mortality rates of different age groups

  • A local health department investigates reports of rodent
    infestations

  • CDC uses real-time data to identify an outbreak of
    salmonella across multiple states, resulting in the
    recall of eggs from Country Eggs

Policy Development

  • creation of comprehensive public poliviys that promote use of knowlege in decicion amking

  • developing a local policy to decrease to likelihood of vector born diseases

example: the government creating a loaw requireing vaccinations before school enroolment

Assurance

  • Providing services that are need to achieve public health goals

  • providing funding to clinics in rual areas

    Example - The farmers maket doubles snap dollars at the bloominton farmers market.

Health Equity

  • The attainment of the highest level of health for all people.

  • Achieving health equity requires valuing everyone equally
    with focused and ongoing societal efforts to address
    avoidable inequalities, historical and contemporary
    injustices, and the elimination of health and health care
    disparities

Social and community context
• Healthcare access and quality
• Education access and quality
• Economic stability
• Neighborhood and built environment

Correlation vs. Causation

Correlation does not imply causation, which means that just because two variables appear to be related, it does not mean that one causes the other. Understanding this distinction is crucial for accurately interpreting public health data and making informed decisions that affect community health outcomes.

  •  EBPH is the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement (health promotion).  

  • It is the process of systematically finding, appraising, and using contemporaneous research findings as the basis for decisions in public health 

The P.E.R.I.E
Approach

1. Problem: What is the health problem?

2. Etiology: Cause of the problem?

3. Recommendations: What works to reduce the health impacts?

4. Implementation: How can we get the job done?

5. Evaluation: How well does/do the intervention(s) work in practice?

1. Problem:

  • Burden of disease

    • The occurrence of disability (morbidity) and death (mortality) due to a disease.

  • Course of disease

    • How often the disease occurs, how likely it is to be present currently, and what happens once it occurs.

  • Distribution of disease

    • Who? 

    • When? 

2. Etiology:

  • Contributory cause

    • “Cause” is associated with “effect” at the individual level. They occur more frequently in the same individual than would be expected by chance.

      • Individuals with cholera used the Broad Street Pump more frequently than those without cholera.

    • “Cause” precedes “effect” in time

      • Lack of insurance -> inability to receive preventative care

    • Altering the “cause” alters the “effect”

      • Increasing mask wearing reduces COVID19 infections.

3. Recommendations:

  • Based on two criteria

    • Quality of evidence

      • Evaluation of literature

    • Magnitude of impact

      • How much of the negative consequence related to the disease can be potentially removed by intervention

      • Benefit – harm = net benefit

4. Implementation: When

  • In the course of the disease, when should the intervention occur?

  • Who

    • Audience (everyone in community or specific individuals)?

  • How (Strategies)

    • Education

    • Incentives

    • Requirement

  • Age restrictions on alcohol purchase - Requirement

  • Gift card for reporting potential workplace safety hazard. - Incentive

  • Pamphlet on safe sex practices - Education

Step 5. Evaluation

  • Public health problems are rarely completely eliminated with one intervention. 

    • Whether an intervention or combination of interventions has been successful in reducing the problem

    • How much of the problem has been eliminated by the intervention(s)

    • The nature of the problem that remains

The PERIE Approach to Lung Cancer Among Non-Smokers

1. Problem: Lung Cancer among non-smokers

2. Etiology: Non-Smokers are more likely to be exposed via working or living with smokers.

3. Recommendations: We should make work-places safe so that employees are no longer expose to secondhand smoke. 

4. Implementation: Smoking bans in work-places

5. Evaluation: Yes!

What is a theory?

A theory presents a systematic way of understanding events or situations. 

It is a set of concepts, definitions, and propositions that explain or predict these events or situations by illustrating the relationships between variables. 

Theories must be applicable to a broad variety of situations. 

Why do we need theory?

  • Guide research

  • Step back and consider the larger picture

  • Tools for moving beyond intuition to design and evaluate health behavior and health promotion interventions based on an understanding of behavior.

    Stages of Change Model 

  • Precontemplation – No recognition of problem

  • Contemplation – recognition of the problem and thinking about changes in the next six months

  • Preparation – Taking small steps toward changes, planning big steps in the next 30 days

  • Action – Active change, has changed behavior for the past six months

  • Maintenance – Ongoing change, has changed behavior for more than six months

Community Organization Model

  • Process through which community groups are helped to identify common problems, mobilize resources, and develop and implement strategies to reach collective goals.

  • Communities can be geographical, but also based on identities

The Ecological Model

  • Emphasizes the interaction between, and interdependence of, factors within and across all levels of a health problem. 

  • Behavior both affects, and is affected by, multiple levels of influence

  • Individual behavior both shapes, and is shaped by, the social environment (reciprocal causation). 

Prevention: Definition

  • Activity or intervention that deters the incidence of a disease, or stops, slows or reverses the progress of an acute condition.

  • Three types of prevention

    • Primary

    • Secondary

    • Tertiary

Three Types of Prevention: Primary Prevention

  • Intervening before health effects occur

  • Preventing the health effect

    • Decrease risk factors

    • Promote protective factors

Race: 

  • False biological category

  • There are no biological justifications for racial divisions.

Ethnicity:

A shared common identity, distinct language or dialect, and distinct culture, often tied to land resources, modes of production, animals and plants, oral and written history, world view, and a common origin among members of a group within a broader society

Ethnic Categories

  • Hispanic or Latino

Racism 

Prejudice, discrimination, and disdain directed against a person or a group of people on the basis of their membership in a particular racial group, typically one that is a racial minority or marginalized.

Colorism

  • Bias, prejudice, and judgement based solely on ones skin color and hair color.

  • Happens in all racial and ethnic groups

Life expectancy

Asians: 85.7 years

Latinos: 82.2 years

Whites: 78.9 years

Blacks: 75.3 years

Natives: 73.1 years

Mircoagression

  • thinly veiled, everyday instances of racism, homophobia, sexism, and more

  • everyday sights, insults, putdowns, invalidations, and offensive behavior.

As time goes on, microaggressions can be devastating to a person’s mental health

  • stress

  • sleep

  • hypertension

  • anxiety

  • depression

  • suicidality

Weathering

Chronic Exposure to social and economic disadvantage microassaults- the most overt from. which come in the form of slights and insults that can be verbal or behavioral

micro insults-

Catch 22- I have a (blank) friend they said its okay