Public Health final study guide

Nursing 150: Introduction to Public Health Study Guide Final Exam 

The final exam covers all aspects of the course. The exam includes 35 questions for a total of 75 points; it contributes to 23.3% of your grade. The questions include true/false, matching, and multiple choice. 

• Be familiar with the terms: 

• Epidemic - When cases exceed the normal amount (endemic level) for a given area

• Pandemic - when an epidemic goes global, crosses national borders and spreads across nations and territories (Clusters on different parts of wide area, multinational)

• Endemic - the normal level of disease for an area

• Prevalence - The total number of cases in a defined population (expressed as a proportion, and is more commonly used for chronic diseases)

• Know and be able to describe the five social determinants of health. 

• Healthcare access and quality

• Education access and quality

• Social and community context

• Economic stability

• Neighborhood and built environment

• Be familiar with the three elements of the epidemic triangle and be able to explain. 

• Agent

  • Size and morphology

  • Growth requirements (what does it need to grow/reproduce)

  • Ability to survive outside of host (can it live on surfaces for a while, for example, and spread more easily that way)

  • Spectrum of suitable hosts (how vulnerable is the general population? If there’s a wide spectrum of suitable hosts, it will likely spread more quickly and easily, as the hosts are more readily and widely available)

  • Virulence (how bad/severe is the agent - how strong of an effect does it have on health, how harmful is it?)

  • Ability to produce toxins

  • Ability to develop antibiotic resistance (this becomes a big problem, harder to treat because traditional medicines won’t work)

• Host

  • Age

  • Sex

  • Race/ethnicity (might matter for geography or social determinants of health)

  • Nutritional status

  • Genetics

  • Susceptibility/immunity

  • Pre-existing disease

  • Human behavior

• Environment

  • Temperature

  • Humidity

  • Crowding

  • Ventilation

  • Social as well as physical factors

• Review the following health care programs: 

• Medicaid - 

  • “aid to the poor”

  • 1965 welfare program to aid poor with healthcare costs, split between federal and state funding,

  • eligibility varies by state, 

  • states or local governments pay medical bills to providers at a low fixed rate for each service. 

• Medicare - 

  • “care for the elderly”

  • 1965 mandatory insurance program for citizens 65 and older, and individuals with disabilities eligible for SS benefits. 

  • Part of SS, workers pay to program throughout life through deductions from their paychecks

  • Two main parts: part A: hospitalization [automatic], part B: outpatient services—health care provider visits [pay additional premium]

  • Part C: Medicare advantage added in 1997 more flexibility in what health plan used [additional premium] 

  • Part D: prescription drug plan added in 2006 [additional premium]

• Affordable Care Act

  • Obamacare

  • Free preventive screenings

  • Expanded coverage so dependents can stay on parents health insurance until 26

  • Required affordable exchange rates so people can shop for insurance plan that’s right for them

  • Can’t cancel someone’s insurance when their costs rise (no lifetime ceiling)

  • Can’t deny someone insurance because of pre-existing conditions

  • No discrimination on the basis of sex, race, sexuality, gender identity, disability, national origin, color, age

  • Requires most insurers to cover the 10 essential health benefits including prescription drugs and mental health

  • Allowed states to expand medicaid coverage up to 138% of Federal poverty level and remove categorical requirements that were a barrier for many low-income people in need of coverage

  • Required coverage of women’s preventive health services. 

  • Required people have a right to full set of vaccinations recommended for them, and made vaccinations part of routine medical visits

  • Created the Maternal, Infant, and Early Childhood Home Visiting Program to support home visiting services to pregnant people and parents with young children who live in communities that face greater risks and barriers to achieving positive maternal and child health outcomes. 

• Community Health Centers 

  • Private non-profit organizations that directly or indirectly (contracts, cooperative agreements) provide primary health services to residents of a defined geographic area that is medically underserved. 

  • usually use a combination of federal, state, and private grants and funding, and federal and private insurance

  • Serve 20% of low-income persons, which is about 8% of the U.S. population

  • 1400 community health centers in the US

• Know the 10 essential public health services. 

1. Assess and monitor population health

2. Investigate, diagnose, and address health hazards and root causes 

3. Communicate effectively to inform and educate

4. Strengthen, support, and mobilize communities and partnerships

5. Create, champion, and implement policies, plans, and laws

6. Utilize legal and regulatory actions

7. Enable equitable access

8. Build a diverse and skilled workforce

9. Improve and innovate through evaluation, research, and quality improvement

10. Build and maintain a strong organizational infrastructure public health

• Be able to describe the three levels of prevention and give examples 

• Primary - prevent risk factors (prevent the disease before it happens)

  • Ex: nutrition, exercise, vaccinations

• Secondary - Early detection or a cure (identify the disease before problems become serious)

  • Ex: Preventative screenings (mammograms, pap smears, colonoscopies, etc.), physical exams, BP tests

• Tertiary - Reduce impact of disease; maintain/improve quality of life (preventing complications of the disease)

  • Ex: Disability limitation and rehabilitation (stroke, CVD), Substance Abuse Treatment, comfort measures (hospice and palliative care), physical therapy (scoliosis? Not a disease, but I think it still works as an example in my case)

• Be familiar with the role of public health laboratories. 

• Do some diagnostic testing, but more reference testing

• Surveillance and monitoring

  • Public health laboratories monitor and detect health threats ranging from rabies and dengue fever to radiological or chemical contaminants, genetic disorders in newborns, and terrorist agents

• Emergency Response support 

  • Part of a 24/7 laboratory network ​to respond to novel strains of disease, natural disasters, chemical spills, foodborne outbreaks, and other health emergencies. 

• Applied Research

• Workforce Development and Training

• They are equipped with specialized instrumentation and staffed by highly trained scientists to deliver services that may be unavailable or cost-prohibitive elsewhere.

• The goal of public health laboratories is to protect and improve public health by: 

  • testing samples

  • providing expertise

  • communicating scientific information

• Know and be able to describe at least 3 public health milestones 

• Genome mapping

• Smallpox vaccine

• John Snow - cholera

• Other options if you forget those:

  • Antonie van Leeuwenhoek 

    • First dude to see bacteria. Cool. 

  • John Graunt

    • Bills of mortality, early statistical analysis - tracked early diseases in london and categorized it by cause 

  • Edwin Chadwick 

    • Involved with the public health act in England - big sanitation reform

  • Dr. Charles Nathaniel Hewitt

    • Realized that sanitation matters. Poor sanitation led to infection led to death in civil war troops. 

• Understand the current investment in public health versus health care and the relative return on investment for public health 

• Much less investment in public health than health care. Much greater return on investment for public health, but this isn’t always obvious…

• We spend more than any other country on healthcare but have some of the worst health outcomes in the world

• Be familiar with the 6 principles of CERC, objectives of risk communication, and general risk communication concepts. 

• CERC Principles

1. Be first: the first source of information often becomes the preferred source

2. Be right: Accuracy establishes credibility

3. Be credible: Honesty and truthfulness should not be compromised in a crises

4. Express Empathy: Addressing what people are feeling builds trust

5. Show respect: Respectful communication promotes cooperation

6. Promote action: Giving people things to do calms anxiety 

• Objectives of Risk Communication

• Risk Communication concepts

• Be able to explain herd immunity 

• Most people are immune so we protect the people who can’t get immune!

• Review the Watersedge assignment 

• Review the various branches of government and their responsibility [and legal roles] in public health. 

• Legislative/congress: Create laws that promote public health, like safe drinking water laws

• Executive (governors, mayors, president): execute the laws that were made, police power, create agencies and organizations that oversee the laws made by legislatures and ensure they are being followed/carried out (like the FDA, USDA, etc.)

•  Judicial (courts): Interpret the laws, help determine the balance between safety of the general public and rights of individuals

• Legislation vs. Regulations

  • Both have the power of law

  • Legislation is made by congress and approved in congress

  • Regulations are made by President/executive branch, approved by the public?

• Be familiar with the impact of cigarette smoking. 

• Bad. Cancer. Neonatal problems. Death. 

• Secondhand smoke. Also bad. Cancer. Respiratory problems. 

• Tars not only cause cancer but also contribute to other lung diseases by damaging cilia, the tiny hairs on the linings of the respiratory tract that sweep the lungs and bronchi clear of microbes, irritants, and toxic substances. Damage to cilia and irritation of respiratory tract linings by components of smoke increase susceptibility to infectious diseases such as bronchitis, influenza, and pneumonia as well as to diseases brought on by chronic irritation such as emphysema and asthma.

• In contrast to the long-term processes leading to cancer and emphysema, smoking can have very rapid effects on the cardiovascular system. The nicotine in cigarette smoke raises blood pressure and heart rate. It may also cause spasms in the blood vessels of the heart, especially if damage already exists, increasing the risk of sudden cardiac death. Carbon monoxide in cigarette smoke interferes with the oxygen-carrying capacity of red blood cells, leading to oxygen shortages in the hearts of patients suffering from coronary artery disease. Smoking increases the risk of stroke and heart attacks by altering the clotting properties of blood. Components of cigarette smoke also have been shown to raise total blood cholesterol levels and reduce levels of high-density lipoprotein (HDL), the “good” cholesterol.

• In summary:

  • Increases risk/causes cancer

  • Tar leads to tumor growth

  • Damages cilia and irritates respiratory tract linings, increasing risk of respiratory diseases:

    • Bronchitis

    • Influenza

    • Pneumonia

    • Emphysema

    • Asthma

  • Raises blood pressure and heart rate

  • Can cause spasms in blood vessels of heart, increasing risk of sudden cardiac death

  • Carbon monoxide in cigarrette smoke interferes with oxygen-carrying capacity of red blood cells

• Review the history of environmental health in the U.S. [creation of agencies] and legislation to create standards for healthy air, water and food and drug safety—as examples. 

• Clean Air Act

  • Passed in 1970 for the purpose of protecting human health

  • Major Sources – power plants

  • Stationary Sources – generators, businesses, etc.

  • Mobile Sources 

• Clean Water Act

  • 1972

  • Regulate discharges of pollutants into “waters of the United States”

  • National Pollutant Discharge Elimination System (NPDES) permitting

  • Authorizes water quality standards for surface water bodies

  • Uses effluent limitations as a primary device for compliance of water discharges by municipal wastewater treatment facilities, industry and specific categories of water pollution

  • Point Sources – a specific point of pollutant discharge to waters, includes an industry, a wastewater treatment facility, etc.

  • Non-point Sources – diffused sources of pollutant discharges to waters, unregulated. Runoff from forested or agricultural land, rainfall, some stormwater, etc. 

• Safe Drinking Water Act (SDWA)

  • 1974, regulating all public water systems that serve at least twenty-five people

• Resource Conservation and Recovery Act (RCRA) aka Solid waste disposal act

  • 1965, added on 70s

  • Create a national policy framework

  • Protect human health and environment from the potential hazards of waste disposal

  • Conserve energy and natural resources

  • Reduce the amount of waste generated

  • Ensure that wastes are managed in an environmentally sound manner

• Know terms and concepts related to study design in epidemiology

• Cohort study: starts with a healthy population, looks forward

  • A cohort study begins with a population without disease. Exposures are  monitored (exposed, non-exposed) over time to see who develops disease. The Relative Risk is the measure of the strength of association. 

• Cross-sectional design

• Case-control study: Starts with the disease, looks backward at exposures

  • A case-control study begins with people who have disease and looks back to identify their exposures. The Odds Ratio is the measure of the strength of association. 

• Odds ratio (case-control) and relative risk (cohort study)

• Review the history of environmental health in the U.S. [creation of agencies] and legislation to create standards for healthy air, water and food and drug safety—as examples. 

• Be familiar with the concept of secondary hazard [emergency prep] and the phases of a disaster 

• Be familiar with the range of public health careers 

• Lots of careers. What else do I say…

• Nursing, biology, environment, medicine, graphic design, community health, policy making, nonprofits and NGO’s, Government, lobbying, politics, community organizing, social work, case management, mental health, emergency response, statistics, technology, epidemiology, lab work, healthcare administration, etc. 

• Understand and describe evidence-based public health practice. 

• making decisions based on the best available scientific evidence by using sound data collection and research methods while engaging with the affected community in decision making.

• Combines practitioner expertise, scientific knowledge/best available evidence, and the voice, values, and knowledge of the community/population you are working with 

•  “conscientious, explicit, and judicious use of 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)”

• Be able to describe the concept of harm reduction and be able to provide examples of strategies to promote harm reduction. 

• Clean needle programs, pREP, Never Use Alone hotlines, safe sex education, free condoms, etc. 

• Know the players in the public health system (e.g., federal, state, non-profit, etc.) 

• Federal: policing powers, Federal organizations - HHS (health and human services) NIH (National Institute of Health), CDC (centers for disease control and prevention) EPA (Environmental protection agency), FDA (Food and Drug administration), Federal funding. No health in the constitution!

• State: State health departments, primary constitutional power to protect health (all powers not enumerated by the constitution for the Federal government reserved for the states)

• Local: County health departments, responsible for their jurisdiction, power given by state

• NGO’s - special interest groups and activism orgs like American Cancer Society, Bill and Melinda Gates foundation, APHA, The Aliveness Project, NAMI, etc. 

• Healthcare, education, tribal health, media, academia, businesses/employers (health and wellness programs, insurance?), communities and community organizations

• Review the epidemiology of injuries chapter. 

• Injuries are unintentional (or intentional), but not accidental. 

• Be familiar with the role diet and exercise play in health. 

• Diet and exercise (behavior!) play a huge role in health

• Behavior like physical activity and diet can increase or decrease risk (and prevalence, if the behavior is a population-wide trend) of developing chronic diseases like CVD, Diabetes, some forms of cancer, etc. 

• Risky behaviors/activities can increase the prevalence of injuries (or occupational behaviors), and behavior can also influence mental health. 

• Seven of the 9 leading causes of death are rooted in behavioral choices, and many could be prevented. 

• Be familiar with the hazard analysis critical control point or HACCP and how it is used in preventing illness. 

• Know the four stages of risk assessment in environmental health.