PH 3000 Study Outline
PH3000: Community and Public Health - Exam 1 Study Outline
Introduction and Public Health History
Definition of Public Health
Public Health: The science and art of preventing disease, prolonging life, and promoting health through organized efforts of society.
Health: The overall state of physical, mental, and social well-being, not merely the absence of disease or infirmity.
Differences from Other Healthcare Professions: Public health focuses on population health and prevention, while other healthcare professions typically focus on individual patient care.
Disciplines within Public Health:
Epidemiology examples: Cases and Deaths, Social distancing, and school closures
Mental Health: Unemployment stigma
Environment
Health Behavior: face masks, hand washing in the public
Health Policies: politics & policies, Health Insurance, Stimulus package
Health Hierarchy:
Global Health
Population Health
Community Health
Individual Health
Public Health History
Significant Theories:
Spiritual Era: Emphasis on supernatural explanations of health issues.
Miasma Theory: Belief that diseases were caused by noxious vapors or "bad air."
Germ Theory: Established that specific microorganisms cause specific diseases.
Historical Periods:
Ancient Societies: Focus on sanitation and community health rituals.
Classical Cultures: Advancements in medical understanding and public health practices (e.g., Hippocrates).
Middle Ages: Decline in public health due to superstition and lack of understanding; prevalence of plagues.
Eighteenth Century: Shift towards modern public health with vaccination and sanitary reforms.
Twentieth Century: Development of public health infrastructure, emergence of epidemiology, and notable diseases control efforts.
21st Century: Focus on global health issues, chronic diseases, and technology in public health.
Name of Period | Period | Key focus/theories about health |
Ancient | <500 BC | •Many practices went unrecorded •Evidence of toilets, sewers, flushing water systems •Theory: personal cleanliness and sanitation |
Classical (Greek and Roman) | 500B.C to <500 CE | •Water systems, hospitals, waste removal •Theory: personal cleanliness and sanitation |
16th Century and Middle Ages (Spiritual era of public health) | 500 to 1500 AD; | •Many plagues: Bubonic plaque, Black death (25 million dead in Europe; wiped out 25-75% of the population) •Theory: Illness caused by spiritual forces and not physical and biological agents of diseases) |
Name of Period | Period | Key focus/theories about health |
Renaissance and Exploration (Environmental Etiology of health era) | 1500 To <1700 C.E. | •Epidemics still common •Detailed observations about disease symptoms (e.g. malaria, typhoid) •Theory: Belief that disease was caused by environmental (bad air; bad odors) factors, an not spiritual factors; miasma theory |
Eighteenth Century (Environmental Etiology of health era) | 1700 to 1799 | •Science of vaccination developed •Edward Jenner pioneers concept of vaccination and creates small pox vaccine •Theory: Belief that disease was caused by environmental factors persist; concept of spontaneous regeneration emerges |
Name of Period | Period | Key focus/theories about health |
Nineteenth Century (Bacteriology period of public health | 1800 -1899 C.E. | •Many scientific discoveries: germ theory; microbes per disease; cause of yellow fever •Cholera epidemic and John Snow •Theory: Germ theory emerges (Pasteur and Koch): Disease is caused by germs and not environmental factors(bad air or spontaneous regeneration); |
Name of Period | Period | Key focus/theories about health |
20th Century 1)Era of Human resource development, 2) Social Engineering, 3) Health promotion | 1900 to 1999 | •Microbiology didn’t improve health •Focus on germs undermined discovery in nutritional deficiencies—Cicely Williams •Serious ethical violations: Tuskegee Experiment •Period of government involvement (e.g. Hill Burton Act—creation of modern hospitals), Medicare •Theory: Persistent focus on germs (1900-1960), but later shift to lifestyle choices (1974-) as cause of disease |
Essential Personalities and Events in Public Health
Robert Koch: Introduced methods for studying pathogens and formulated Koch's postulates.
John Snow: Pioneered epidemiology through his work on cholera, demonstrating waterborne transmission.
Louis Pasteur: Developed pasteurization and vaccines, foundational to microbiology and immunology.
Cicely Williams: Advocated for maternal and child health, focusing on the nutritional needs of children.
Tuskegee Study: Notorious ethical violation in research involving syphilis treatment among African American men.
Leena Wen: Advocated for public health policy reforms and accessibility in healthcare.
Lisa Cooper: Focused on health disparities and the importance of patient-provider relationships.
Epidemiology
Definition of Epidemiology
Epidemiology: The study of how, when, and where diseases occur and are distributed in populations, and what factors influence their spread.
The study of the distribution and determinants of health-related states or disease in populations. Epidemiology is referred to as population medicine
Epidemiologists: Study the course of disease in populations.
Collect information about the disease status of a community
Provide data and information that enable public health people to make decisions and take actions to improve health
Study multiple issues: disease, injuries, quality of life, social justice
Differences from Other Disciplines: Focus on populations rather than individuals, utilizing statistical methods and observational studies.
Father of Epidemiology
John Snow is often credited as the father of epidemiology due to his work in tracing the source of cholera outbreaks.
Cholera, disease that causes heavy diarrhea. loss of water from the diarrhea cause electrical imbalances in the heart and can cause failure to pump.
John snow saw that the pump where people got there water from became a perfect ground for the microbe to be passed on and infect others
Types of Diseases
Acute Diseases: Develop quickly and last a short time (e.g., influenza).
Chronic Diseases: Develop slowly and last for a long time (e.g., diabetes).
Communicable Diseases: Transmitted from person to person (e.g., tuberculosis).
Non-communicable Diseases: Not transmitted between people (e.g., heart disease).
Key Definitions
Years of Potential Life Lost (YPLL): A measure of premature death; reflects the number of years lost due to early mortality compared to a standard age.
Leading Cause: Heart disease is often the leading cause of YPLL.
Disability-Adjusted Life Years (DALY): A measure of overall disease burden; combines years of life lost due to premature death and years lived with a disability.
Leading Cause of DALYs: Conditions such as mental health disorders commonly rank high in DALYs lost.
Surveillance
Surveillance: Systematic collection, analysis, and interpretation of health data.
Passive vs. Active Surveillance:
Passive Surveillance: Relies on existing data sources, more likely to underestimate disease prevalence and incidence.
Active Surveillance: Health officials actively seek out information about disease outbreaks.
Types of Surveillance:
Syndromic Surveillance: Monitoring symptoms to identify potential outbreaks.
Active Surveillance: Direct outreach to healthcare providers for information.
Passive Surveillance: Reports received from healthcare providers without soliciting.
Sentinel Surveillance: Specific sites or populations monitored to provide early warnings of outbreaks.
Rumor Surveillance: Monitoring public conversations for signs of potential outbreaks.
Experimental Studies
Causality Criteria:
Hill’s Criteria: A set of guidelines to establish a causal relationship between a risk factor and a disease.
Must be able to match requirements to specific scenarios.
Temporality: Refers to the requirement that the risk factor must precede the disease outcome to establish causation. This is considered the most fundamental criterion of causality.
Levels of Prevention
Types of Prevention:
Primordial Prevention: Aimed at preventing the emergence of risk factors (e.g., health education programs).
Primary Prevention: Aimed at reducing the risk of disease (e.g., vaccinations).
Secondary Prevention: Aimed at early detection and treatment (e.g., screening tests).
Tertiary Prevention: Aimed at managing existing diseases to limit further deterioration (e.g., rehabilitation).
Examples:
Vaccinations: Primary prevention.
Screening for diseases: Secondary prevention.
Preventing a relapse: Tertiary prevention.
Definitions of Terms
Prevention: Stopping the disease before it manifests (e.g., vaccines).
Intervention: Controlling disease after it has occurred (e.g., treatments).
Control: Managing disease that cannot be eliminated (e.g., chronic disease management).
Eradication: Complete elimination of a disease; in public health terms, disease prevalence is considered eliminated at below 1%.
Modes of Transmission
Direct Transmission: Disease transmitted through direct contact (e.g., touching, kissing).
Indirect Transmission: Disease transmitted via intermediaries (e.g., air, water, vectors).
Definitions of Epidemiological Terms
Sporadic: Occurs infrequently and irregularly
Endemic: Constant presence of a disease within a certain population.
Outbreak: An increase in the number of cases of a disease above what is normally expected in a population.
Epidemic: An outbreak of a disease that spreads quickly and affects a large number of people.
Pandemic: An epidemic that has spread over multiple countries or continents.
Measures of Morbidity and Mortality
Incidence Rate: The rate of new cases in a population.
Prevalence Rate: The total number of existing cases in a population at a specific time.
Mortality Rate: The rate of deaths within a population.
Case Fatality Rate: The proportion of persons diagnosed with a specific disease who die from that disease.
Calculations:
Incidence Rate: New cases ÷ population at risk.
Prevalence Rate: All cases ÷ total population.
Mortality Rate: Deaths ÷ total population.
Case Fatality Rate: Deaths ÷ total cases.
Relationship between Incidence and Prevalence: If incidence increases while the death rate is slow, prevalence will increase.
Relative Risk: Ratio of the probability of an event occurring in exposed group versus a non-exposed group.
Risk Difference: Difference between the risk in the exposed group and the risk in the non-exposed group.
Calculations:
Relative Risk (RR) = [Incidence in exposed] ÷ [Incidence in unexposed]
Risk Difference (RD) = [Incidence exposed] – [Incidence unexposed]
Disease Frequency and Level
Frequency: Focus on the number of cases. Cases could be disease occurrence, injury, deaths, events
E.g. The number of women with breast cancer
The number of households with lead poisoning
The larger the number of cases the bigger the problem, but …
Typically, the thing with the most cases/ events ends up taking priority
Public Health Policy and Health Care Delivery
Types of Healthcare Delivery
Public Health Practice: Community-based services aimed at prevention and education.
Medical Practice: Individual health services focused on treatment and management.
Long-term Care Practice: Services provided for chronic conditions or disabilities over an extended period.
End-of-life Practice: Focused on palliative care and support for terminal illnesses.
Health Insurance
Key Terms:
Premium: Amount paid for health insurance coverage.
Deductible: Amount paid out-of-pocket before insurance coverage begins.
Co-pay: A fixed amount paid for a specific service at the time of care.
Types of Health Insurance Programs
Self-funded Care Programs: Insurance plans self-administered by employers.
Government Health Insurance: Provided by the government (e.g., Medicare, Medicaid).
Differences Between Medicaid and Medicare:
Medicaid: State and federal program assisting low-income individuals.
Medicare: Federal program providing health coverage primarily for individuals aged 65 and over.
Supplemental Health Care: Additional insurance providing extra coverage (e.g., dental, vision).
Managed Health Care: Insurance plans that aim to reduce healthcare costs while enhancing quality of care.
Insurance Coverage Around the World
Types of Insurance:
Compulsory Insurance: Mandatory health insurance coverage enforced by law.
Single-payer Insurance: A system in which a single public agency manages financing for all healthcare.
Social Health Insurance: Funded by contributions from employers and employees.
Community Health Insurance: Voluntary schemes where community members pool resources.
Private Health Insurance: Offered by private companies based on individuals' needs and choices.
Reasons for Inability to Afford Health Insurance in the US
High premiums relative to income.
High out-of-pocket costs leading to affordability issues.
Healthcare Cost Statistics
Average Cost: Approximately $12,000 per person per year in the USA.
US Ranking in Health Care Costs: Highest in the world compared to other nations.
Significant Factors in Healthcare Expenditure:
Administrative costs and high prices for services.
Uniquely high pharmaceutical costs.
Hospital care and physician and clinical services account for the largest share of health care costs.
The leading factor resulting in the largest increase in healthcare expenses is the price and intensity of services.
Medicaid Usage
Largest User Population: Low-income families, children, and disabled individuals.
Largest Spending Population: Elderly individuals typically account for the largest spending on Medicaid due to chronic illnesses.
Iron Triangle of Medicine (Kissick Dilemma)
Concept: Health care quality, cost, and access are interconnected; improving one affects the others.
Importance in Understanding Health Care Costs: As coverage increases, the balance between quality and costs becomes crucial.
Patient Protection and Affordable Care Act (ACA) (Obamacare)
Original Components: Expanded healthcare (Medicaid) coverage, mandated insurance purchase, prohibitions against denial of coverage due to pre-existing conditions.
Individual Mandate: Requirement for all individuals to have health insurance or pay a penalty.
Affordable Care Act (ACA)
Key components: Expanded Medicaid, insurance exchanges, coverage for preexisting conditions.
Individual Mandate: Required all individuals to have insurance or pay a penalty (repealed federally in 2019).