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is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 1948

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Health

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what we, as a society, do collectively to insure the conditions for people to be healthy

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Public health is...

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True

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T/F A right to the highest attainable standard of health is not assured in the US

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PH: Patient is the community (minimal funding) Medical Care: Patient is the individual (lots of funding)

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PH vs Medical Care

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1. Age, sex 3. Individual lifestyle factors 4. Social and community networks 5. Living and working conditions (education, heal care, housing) 6. General socio-economic, cultural and environmental conditions.

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Determinants of public health

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1. Vaccinations 2. Motor-vehicle safety 3. Safer workplaces 4. control of infectious disease

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Notable achievements of PH

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Highest annual health expenditure, lowest life expectancy

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Annual health expenditure vs life expectancy in US

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1. Assessment - Identify health problems 2. Policy Development -Inform, educate, and empower people about health issues 3. Assurance - Enforce laws and regulations

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3 core functions of PH

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1. Epidemiology and stats 2. Biomedical sciences 3. Environmental Health Science 4. Social and Behavioral Sciences 5. Health Policy and Management/Administration

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Parts of PH

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1. The basic science of PH 2. The study of patterns, causes and effects of health conditions in defined populations 3. Aims to understand the spread of health problems 4. Looks for common exposure/risk

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Epidemiology

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1. Epidemiology relies heavily on statistics 2. Collection of data on the population 3. Diagnostic tools for the health of the community or population 4. Used to calculate risks, benefits

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Stats

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1. Infectious diseases -foodborne illness 2. Chronic diseases 3. Genetics

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Biomedical Sciences

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1.Health effects of environmental exposures 2. Air/Water Quality 3. Solid and hazardous wastes 4. Safe food and drugs 5. Global environmental change

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Environmental Health Science

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1. Physical and social environment's affect on health. 2. Race, income, education, gender

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Social and Behavioral Sciences

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1. Role of medical care in public health -cont, access, quality 2. public health policy and management/administration

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Health Policy and Management

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Something that promotes health or buffers against risk; reduces the probability of a particular health problem (e.g. resilience, higher income, folic acid).

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Protective Factor

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Something that increases the likelihood/probability (risk) of a particular health problem (disease or injury).

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Risk Factor

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Generic term used in PH to describe a program or policy designed to have an impact on a health problem (reduce risk factors and/or increase protective factors).

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Intervention

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1. Primary 2. Secondary 3. Tertiary

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Levels of prevention

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Activities intended to prevent the onset of a disease or avoid an injury i.e. not having sex

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Primary

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Activities intended to minimize the risk of progression of (or complications from) a disease or to minimize damage from an injury. i.e. screaming for HIV

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Secondary

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Activities intended to minimize disability caused by a disease or injury. i.e. therapy treatment for individuals with HIV

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Tertiary

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Individuals in a community may benefit by agreeing as a group to limit each person's freedom to act

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Tragedy of the commons

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(form an increasing in population impact) 1. Education 2. Clinical Intervention 3. Long-term Protective Interventions 4. Changing the environment/context to make healthy choices the default 5. Changing socioeconomic conditions/factors (reverse order for increasing individual effort.)

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Impact Pyramid

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How we understand threats to health, who is at risk, and how we determine what interventions might work (eventually evaluating whether the interventions worked)

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Science in PH

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How we as a society make decisions about what strategies/policies to implement. -Resource decisions -Values decisions

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Politics in PH

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The common good vs. individual liberty. Individual responsibility vs social justice

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Social Justice vs. Market Justice brings up the issues of

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A wide range of factors operating at different levels. Negative/risk factors can contribute to poor health - Positive/protective factors can contribute to good healt

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What is public health determined by?

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"Upstream" interventions are often the most difficult to implement; but can be most effective - Greatest impact often comes from multiple interventions targeting different levels simultaneously

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PH intervention effectiveness.

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1. Economic impact: -Businesses often resist public health measures because they affect profits 2. Paternalism: 3. Moral & religious concerns: -Sex and reproduction -Alcohol and drugs

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Sources of controversy

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".... promote the general welfare......"

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Preamble of the Constitution

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You're on your own Individualism..."Every man for himself," "pull yourself up from your bootstraps..." -Individualism is a dominant orientation in the United States and profoundly restricts the content of public health programs and policies (McKinlay ; Marceau, 2000).

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YOYO

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We're in this together Collectivism... "no man is an island," "it takes a village..." -More common outside the US -Characteristic of PH orientation and roots of the field (Fairchild et al, 2010)

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WITT

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Primarily (though not exclusively) grounded in values of social justice and collectivism

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PH work is...

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1. County and city based 2. Collective health stats, school health programs, screenings, sanitation. 3. Provide medical care for the poor 4. Funding sources vary

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Local Public Health Agencies

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1. Coordinate activities of local health agencies & provide funding. 2. Collect and analyze data 3. Laboratory services. 4. Manage medicaid 5. License and certify medical personnel, facilities, and services 6. Environment, mental health, social services, and aging may be handled by separate agencies

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State Health Departments

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1. To prevent harm to others 2. Paternalism for children 3. For the common good 4. Change beyond power of individuals (e.g. misleading advertising; spread of infectious diseases, etc.) 5. Influence individuals' choices; promote healthy choices 6. Ethical/moral reasons 7. Set social standards; change social/cultural norms

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When can government restrict individual freedom?

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1. Environmental Protective Agency 2. Department of Ag. (USDA) 3. National Highway Traffic Safety Administration

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Other top non-DHHS federal agencies

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Head of US Public Health Service

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The Surgeon General

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1. Community 2. Health care delivery system 3. Employers and business 4. The media 5. Academia 6. Public health infrastructure

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Parts of the Public Health system

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Department of Health and Human Services (HHS) 1. Centers for Disease Control and Prevention (CDC) 2. National Institutes of Health (NIH) 3. Food and Drug Administration (FDA) 4. Centers for Medicare ; Medicaid Services (CMS) 5. Agency for Healthcare Research and Quality (AHRQ) 6.Health Resources and Services Administration (HRSA) 7. Indian Health Service (IHS) 8. Agency for Toxic Substances and Disease Registry (ATSDR) 9. Substance Abuse and Mental Health Services Administration (SAMHSA) 10. Administration for Children and Families (ACF) 11. Administration for Community Living (ACL)

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Federal Agencies

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1. Main EPIDEMIOLOGIC and assessment agency for the nation. 2. Publishes Morbidity and Mortality Weekly Report (MMWR) 3. Center for Health Statistics - collects data on U.S. population concerning all aspects of health 4. Centers on infectious diseases, chronic disease, injury prevention, and others

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CDC

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1. BIOMEDICAL research agency 2.Institutes on cancer, heart and lung disease, diabetes, aging, child health and human development, and others. 3. National Library of Medicine - reference library for medical centers worldwide 4. Has laboratories in Bethesda, MD; conducts clinical research 5. Provides grant funding to researchers in universities and research centers.

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NIH

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true

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T/F PH is inherently political nature

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1. Basis in social justice philosophy 2. Inherently political nature 3. Dynamic, ever expanding agenda 4. Link with government 5. Grounding in the sciences 6. Use of prevention as a prime strategy 7. Aims to promote health for all/community-focused 8. Uncommon culture and bond

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Unique features of PH

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The study of distribution and determinants of disease/conditions in specified populations in order to prevent disease and promote health.

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What is Epidemiology

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Sudden increase in occurrence of disease.

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Outbreak

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Occurrence of disease that is higher than expected.

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Epidemic

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An epidemic that spans a large region (across continents; worldwide)

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Pandemic

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Usual/expected level of disease in a given area (background level)

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Endemic level

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Idea you can make some sort of assumptions on an individual from looking at a large group

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Ecological fallacy

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Making assumptions on groups based on one indiviudal

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Exception fallacy

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Patterns 1. who 2. where 3. when Then we can figure out why and intervene

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Key elements in Epi.

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The father of epi 1850 London

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John Snow

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Total population exposed to the risk

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Population at risk

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Number of new cases- how fast the disease is spreading #of new cases of disease/#of persons at risk

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Incidence

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Number of existing cases- to what extent has the disease spread #of cases/#of people in the population

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Prevalence

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Exposure status is assigned by investigators 1.Intervention Studies -uses randomized, double-blind, placebo-control

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Experimental studies

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Exposure status is not assigned 1. Cross-sectional study 2. Cohort study 3. Case-control study

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Observational studies

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Exposure and outcome status are determined at the same time "snapshot" -Surveys, opinion polls

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Cross-sectional

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Choose a large number of healthy people and collect data on their exposures, and track outcomes over time. -When an intervention study would be unethical -considered the next most accurate to intervention study -Often used to study chronic disease

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Cohort Study

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Study population is grouped by outcome. -Choose people who already have the disease -choose people who are as similar as possible as control -Faster and cheaper than cohort, but often less accurate

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Case-control Study

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Used with Cohort Studies

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Relative Risk

question

Used with Case-control studies

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Odds Ratio

question

Exposure has no association with disease

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RR or OR =1

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Exposure may be positively associated with disease

answer

RR or OR greater than 1

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Exposure may be negatively associated with disease

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RR or OR less than 1

question

Ratio of exposed to non exposed/ratio of exposed to non-exposed controls.

answer

Calculating Odds Ratio

question

Risk in exposed/Risk in non-exposed

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Calculating Relative Risk

question

1. Intervention study: subjects may not follow prescribed behavior throughout study period 2. Cohort study: sometimes hard to isolate which of many factors are responsible for health differences 3. Case-control study: control group may not be truly comparable; also errors in reporting or recall

answer

Problems with Studying Humans

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Factors that are associated with the exposure and may independently affect the risk of developing the disease

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Confounding Variables

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Selection of individuals or groups for analyzing in such a way that proper randomization is NOT achieved, thereby ensuring the sample obtained is not representative of the population intended to be analyzed

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Selection Bias

question

Selective revealing or suppression of information

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Reporting/ Recall bias

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Refers to patients who at one point in time were actively participating in clinical research trial, but have become lost at the point of follow-up in the trial

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Loss to follow-up bias

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Harmful side effects are sometimes suppressed or de-emphasized

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Conflicts of interest in drug trials

question

1. Strong association (high RR or OR) 2. Dose-response relationship 3. Known biological explanation 4. Large study population 5. Consistent results from several studies

answer

Factors that lend validity to results

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1. Respect for person: Protect autonomy of all people and treat them with respect. 2. Beneficence: Philosophy of "do no harm" while maximizing benefits 3. Justice: Ensure reasonable, non-exploitative, and well-considered procedures are administered fairly

answer

3 Fundamental ethical principles for using any human subjects for research after Tuskegee

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Describes the health of a population

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The use of Statistics

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What usually happens based on past findings.

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Probability

question

Small studies are at risk for random variation.

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Law of small probabilities

question

The probability of finding an effect if there is one.

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Power of a study

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Tb, cholera, typhoid,tetanus,syphilis

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Bacteria linked diseases

question

smallpox, hepatitis, measles, rabies, AIDS, yf

answer

Virus linked diseases

question

malaria, any kind of worms

answer

Parasites

question

1. Aerosol 2. Touching contaminated object and putting hands to mouth or nose 3. Eating/Drinking 4. Vectors 5. Sexual contact

answer

Means of transmission

question

1. Pathogen 2. Reservoir 3. Place of exit 4. Method of transmission 5. Port of entry 6. Susceptible host

answer

Chain of Infection

question

No non-human reservoir exists and a vaccine exists

answer

Eradication possible if...

question

Sanitation, better nutrition, and occupational safety

answer

Public health measures that contribute most to people being healthier today than they were a century ago are:

question

Assessment, policy development, and assurance

answer

The core functions of public health are:

question

Politics is an essential element of democratic governance.

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Which of the following is true of politics in relation to public health?

question

Prevention of exposure to risk factors

answer

Primary prevention refers to:

question

Members of a community have collective responsibility for their common welfare.

answer

Which of the following statements best expresses the social justice view of public health?

question

Safe housing for all -; Immunizations Minimum income levels Safe labor and employment practices

answer

The early history of U.S. public health was closely tied to social reform movements. Which of the following public health issues would not be considered social reform? Safe housing for all Immunizations Minimum income levels Safe labor and employment practices

question

The State

answer

According to the Constitution, the level of government that has the primary responsibility for the health of the population is:

question

-;1. Placing an excise tax on soda to reduce obesity is unconstitutional. 2. Police powers are sometimes needed for public health. 3. The government has the authority to limit individual freedom for the common good. 4. Courts can invalidate regulations that legislatures have mandated public health agencies to create.

answer

Which of the following statements is false? 1. Placing an excise tax on soda to reduce obesity is unconstitutional. 2. Police powers are sometimes needed for public health. 3. The government has the authority to limit individual freedom for the common good. 4. Courts can invalidate regulations that legislatures have mandated public health agencies to create.

question

False

answer

The government is solely responsible for promoting the health of the public.

question

State health departments

answer

Which of the following is responsible for licensing and certifying medical personnel and medical facilities?

question

False

answer

In Public Health, we define "health" as the absence of disease.

question

An increased emphasis on modern medicine in relation to other health determinants

answer

According to Lindsay et al. (2014), the public's failure to accurately attribute the reasons for improved life expectancy in the United States has led to

question

Individual responsibility

answer

Market justice emphasizes:

question

Removing soda vending machines from schools

answer

According the "Health Impact Pyramid" described by Dr. Frieden, Director the CDC, which of the following strategies would likely be most effective in reducing childhood obesity: -Providing nutrition education to children -Removing soda vending machines from schools -Increased funding for gastric bypass surgery -Providing nutrition education to parents

question

Assess public perceptions of the intervention

answer

Which of the following is not one of the five steps in the public health approach? -Develop and test community-level interventions to control or prevent the cause of the problem -Assess public perceptions of the intervention -Identify risk and/or protective factors associated with the problem -Define the health problem

question

Changing the environment to make healthy choices the default choice.

answer

According to Dr. Frieden, Director of the CDC, which of the following is likely to have the greatest impact on public health?

question

Was the problem intentional or voluntary?

answer

Which of the following questions is not necessarily part of an epidemiologic investigation?

question

Incidence of encephalitis

answer

An epidemiologist investigating an outbreak of encephalitis in New York City reports that there have been 17 new cases this week. Which of the following terms best describes the number she reports?

question

Increased

answer

The incidence of breast cancer remained constant. What happened to the prevalence of breast cancer?

question

Intervention

answer

Scientists at the National Institutes of Health are collaborating with the government of Thailand to test the effectiveness of a new vaccine in preventing HIV infection among prostitutes. Half the women receive the experimental vaccine and half receive an injection of salt water, and the women are then monitored for development of HIV infection. What kind of epidemiologic study is this?

question

-It has a large number of subjects -It finds a dose-response relationship -There is a known biological explanation for the finding

answer

Which of the following factors makes an epidemiologic study more likely to be valid?

question

The subjects were not told the true purpose of the study

answer

Which of the following statements about the Tuskegee syphilis study is true?

question

True

answer

A small number of cases of rubella may be considered an epidemic in an area where measles are not endemic

question

All clinical trials are required by law to be registered at the outset in a public database

answer

Which of the following statements about clinical trials of new drugs is true?

HLPR211 Argumentative Essay

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