Introduction to Population Health (Exam Pt.1)

6 Eras of Public Health:

Health protection - (antiquity - 1830s) focused on individual behaviors; utilized religion and culture to prevent certain practices

• Ex: quarantined during epidemics, sexual prohibitions to reduce transmission, dietary-restrictions to restrict food-borne disease

Hygiene movement - (1840s-1870s) improved sanitary conditions as basis for public health; community wide environmental action

• Ex: John Snow tackled Cholera, Semmelweis identified the importance of hand washing, vital statistics became empirical foundation for epidemiology

Contagion control - (1880-1940) germ theory; demonstration of infectious origins of disease; conducted an outbreak investigation in general population, controlled disease through vaccination, environmental factors, sanatoriums

• Ex: linkage of epidemiology, bacteriology, and immunology to form TB sanatoriums

Filling holes in medical care system - (1950s-mid 1980s) integrated control of communicable disease with modifying risk-factors and caring for high-risk populations; public system for control of specific communicable diseases, care for vulnerable populations, beginning of integrated healthcare systems with preventative services

• Ex: antibiotics, concept of risk factors, surgeon general report on cigarettes

Health promotion/disease prevention - (mid 1980s-2000) focused on individual behavior and disease detection; clinical and population-oriented prevention, focused on individual decision making

• Ex: AIDS epidemic and need for interventions, reductions in coronary heart disease

Population health - (2000s) coordination of public health and healthcare delivery due to evidence-based thinking; focus on harms and costs as benefits of interventions, globalization

• Ex: evidence-based medicine and public health, new approaches to avoid medical errors, tobacco control, climate change

Population Approach - focuses on entire population, aims to reduce risk for everyone

• Assumes everyone is at some degree of risk and the risk increases with the extent of exposure

Disadvantages

• Minimal benefit to individual

• Limited motivation

• Hard to implement (too expensive)

Advantages

• Large potential for societal impact

• Can lead to substantial change

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

High risk approach - focuses on those with a higher probability of developing a disease, aiming to bring their risk level closer to those of the normal population

Disadvantages

• Temporary, may not produce sustainable change

• Limited potential for individual and population

• May not address underlying issue

Advantages

• Strategy is tailored to individuals

• Motivation from patient and provider

• Cost-effective

• Both approaches are important for the success of public health

Big Gems ( health determinants)

Behavior - can increase or decrease disease susceptibility (smoking cigarettes)

Infection - can directly or indirectly cause some diseases (HIV positive)

Genetics - rarely most important (history of addiction)

Geography - frequency and presence of disease (ebola in Africa)

Environment - physical, built, or social (air pollution, access to food)

Medical care - access and quality (hospital location and resources)

Socio-economic-cultural - resources available (money, family)