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Aspects of health

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physical, mental, social, emotional, spiritual, environmental

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public health

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the science/art of promoting health and extending life on an aggregate level

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population

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refers to a collection of individuals who share one or more personal or observational characteristics from which data may be collected and evaluated

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Three core functions of public health

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assessing and monitoring the health of communities and populations at risk to identify health problems and priorities; formulating public policies designed to solve identified local and national health problems and priorities; ensuring that ALL populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluating the effectiveness of that care

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epidemiology

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the study of the distribution and determinants of health-related states or events in specified populations and the application of this study to control of health problems

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study

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implies sound methods of scientific investigation

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distribution

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refers to the frequency and pattern of a health-related state or event

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frequency

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number of occurrences of a health-related state or event; relationship of that number to the size of the population

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pattern

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involves presenting the distribution by person, place, and time characteristics

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determinant

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the causes and other factors that influence the occurrence of disease and other health-related events; may be physical stresses, chemicals, biological, or psychosocial

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exposures

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pertain either to contact with a disease-causing factor or to the amount of the factor that impinges upon a group or individuals

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morbidity

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illness due to a specific disease or health condition

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mortality

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death

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disease

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an interruption, cessation, disorder of body functions, systems, or organs (ex. cholera, cancer, influenza)

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event

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something that takes place (ex. vehicular collisions, workplace injuries, drug overdose, suicide)

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behavior

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manner of conducting oneself (ex. physical activity, diet, safety precautions)

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condition

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an existing circumstance (ex. unhealthy state, state of fitness)

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clinical focus

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health of the individual; treating and caring for the patient; treating the patient based on scientific knowledge, experience, and judgement

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epidemiological focus

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collective health of the people in a population of interest; identifying the source or exposure that caused an adverse health outcome, the number of persons exposed, the potential for further spread, and interventions to prevent additional cases or recurrences; using descriptive and analytic epidemiologic methods to provide info that will ultimately help determine appropriate public health action to control and prevent the public health problem

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epidemic

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the occurrence in a community or region of cases of an illness, specific health-related behavior, or other health-related events clearly in excess of normal expectancy

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endemic

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the habitual presence of a disease within a given geographic area or the usual occurrence of a given disease within such an area

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common source epidemic

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tend to result in more cases occurring more rapidly and soon than host-to-host epidemics; identifying and removing exposure typically causes the epidemic to rapidly decrease (ex. botulism)

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propagated epidemic

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arise from infections being transmitted from one infected person to another; transmission can be through direct or indirect routes; host-to-host epidemics rise and fall more slowly than common source epidemics (ex. influenza)

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mixed epidemics

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occurs when a common source epidemic is followed by person-to-person contact and the disease is spread as a propagated outbreak (ex. Shigellosis)

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pandemic

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an epidemic occurring worldwide, or over a very wide area, crossing international boundaries, and usually affecting a large number of people (ex. HIV, Spanish influenza)

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Objectives of epidemiology

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identify the etiology (health related event) of a disease and relevant risk factors; determine the extent of the disease found in the community; study the natural history and prognosis of the disease - define the baseline; evaluate both existing and newly developed preventative and therapeutic measures and modes of health care delivery; provide the foundation for developing public policy relating to environmental problems, genetic issues, and other considerations regarding disease prevention and health promotion

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case definition

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a standard set of criteria; assures that cases are consistently diagnosed, regardless of where or when they were identified and who diagnosed the case

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quantification

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refers to counting the cases of illness or other heath outcomes; denotes the use of statistics to describe the occurrences of health outcomes and measure their association with exposures; suspected, probable, or confirmed

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prepathogenesis

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time period before the disease agent has interacted with a host

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pathogenesis

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after the agent has interacted with a host

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three types of disease prevention

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primary (before the disease occurs, general health promotion and specific prevention against disease, immunization), secondary (during progression of disease, activities that limit the progression of disease, programs for cancer screening), and tertiary (during the later stages of the disease, programs for restoring the patient's optimal functioning, physical therapy)

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descriptive epidemiology

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refers to epidemiologic studies concerned with characterizing the amount and distribution of health and disease within a population. The 4 W's (what, who, where, when), aim to delineate the patterns and manner in which disease occurs in populations, focused on development of hypothesis

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analytic epidemiology

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examines causal hypotheses regarding the association between exposures and health conditions. (the 5th W: why/how)

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natural experiments

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naturally occurring circumstances in which subsets of the population have different levels of exposure to a supposed causal factor in a situation resembling an actual experiment, where human subjects would be randomly allocated to groups. take form of laws/policy or other events (bombing, Chernobyl, E coli outbreak)

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types of observational studies

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cohort, case-control, cross sectional, ecological

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cohort

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investigator records whether each study participant is exposed or not then tracks the participants to see if they develop the disease of interest (takes lots of time and money)

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case-control

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investigators start by enrolling a group of people with a disease, then enrolls a group of people without the disease and compares previous exposures between the 2 groups

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cross sectional

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a sample of persons from a population is enrolled and their exposures and health outcomes are measured simultaneously (tends to assess the presence of the health outcome without regard to duration. like a snapshot)

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ecological

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units of analysis are populations or groups rather than individuals (usually countries)

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experimental studies

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investigator determines through a controlled process, the exposure for each individual or community then tracks over time to detect the effects of the exposure

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clinical trial

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usually to do with pharmaceuticals and diseases that don't have many other options for treatment

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community trial

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example: fluoridated water

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goals of the contributors in the history of epidemiology

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to understand and explain illness, injury, and death from observational scientific perspective; to provide information for the prevention and control of health-related states and events in the population

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key events in history of epidemiology

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bubonic plague epidemics, development of toxicology and biostatistics, development of smallpox vaccine/eradication of smallpox, 1918 influenza pandemic, identification of smoking as cause of cancer

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uses of epidemiology

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historical, community health, health services, risk assessment, disease causality

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historical use of epidemiology

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documents the patterns, types, and causes of morbidity and mortality over time; note decline in infection disease mortality

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epidemiologic transition

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describes a shift in the patterns of morbidity and mortality from causes related primarily to infections and communicable diseases to causes associated with chronic, degenerative diseases

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demographic transition

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the epidemiologic coincides with the demographic transition, which is a shift from high birth rates and death rates found in agrarian societies to much lower birth and death rates in developed countries

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community health

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the condition of the people; to measure the true dimensions and distribution of ill-health in terms of incidence, prevalence, disability, and mortality; to set health problems in perspective and define their relative importance; to identify groups needing special attention

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operations research

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a type of study of the placement of health services in a community and the optimum utilization of such services

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disease management

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method of reducing healthcare costs by providing integrated care for chronic conditions

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risk

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the probability that an event will occur

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risk factor

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an exposure that is associated with a disease, morbidity, mortality, or adverse health outcome

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risk assessment

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methodology used to provide quantitative measurements of risk to health

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disease causality

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to search for causes of health and disease by computing the experience of groups defined by their composition, inheritance, and experience; their behavior and environments

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ethics

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norms for conduct that distinguish between acceptable and unacceptable behavior

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importance of adhering to ethical norms

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promotes the aims of research; promotes values that are essential to collaborative work; researchers held accountable to the public; builds public support; promotes other important moral and social values

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U.S. Public Health Service Syphilis Study at Tuskegee

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ethical violation; syphilis investigation from 1932 to 1972; purpose was to "record the natural history of syphilis in hopes of justifying treatment programs for blacks"; despite discovery of penicillin, men were never offered treatment; class action law suit filed in 1973

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Ethics Guidelines for Epidemiology

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developed by the American College for Epidemiology (ACE); include minimizing risks and protecting the welfare of research subjects, obtaining the informed consent of participants, submitting proposed studies for ethical review, maintaining public trust, and meeting obligations to communities

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