Introduction to Public Health Midterm – Flashcards

actions that the society takes collectively to ensure that the conditions that occur best promote and protect people's health; purpose: promote, protect, maintain health and welfare.

assessment: monitor health, diagnose, and investigate policy development: inform, educate, empower, mobilize community, and develop policy assurance: evaluate, enforce law, assurance of competent workforce

In medicine, the patient is the individual; in public health, the patient is the community. Public health diagnoses the health of the community using public health sciences. Treatment of the community involves new policies and interventions. Goal of medicine is to cure; goal of public health is prevention of disease and disability.

Epidemiology: basic science of public health, control spread of disease Statistics: collection of data, diagnostic tools for the health of the community Biomedical Sciences: infectious diseases, chronic diseases, genetics Environmental Health Sciences: environmental exposures, air/water quality, global warming Social and Behavioral Sciences: tobacco, poor diet, physical inactivity, class, race, gender Health Policy and Management: medical care in public health, US has highest percentage without health insurance

Define the health problem Identify risk factors associated with the problem Develop and test community-level interventions to control or prevent the cause of the problem Implement interventions to improve the health of the population. Monitor interventions to assess their effectiveness

Primary prevention-Prevents (forestalls) illness or injury from occurring by preventing exposure to risk factors. Secondary prevention- tries to minimize severity of illness or injury once the event has occurred. Tertiary prevention-tries to minimize disability by giving medical care and rehab services.

Social good, requires active gov't, equal access to healthcare viewed as a basic right, assumes gov't is more efficient in allocating health care resources equitably.

Market Justice: powerful forces on environment, heredity, and social structure prevent fair distribution of the burdens and benefits of society. Social justice: suggests that minimal levels of income, basic housing, education, employment, and health care should be seen as fundamental rights.

Capitalism signifies a policy of only minimal intervention by the state in the economy, with the state confined mostly to protecting property rights rather than exercising control over the means of production. Three characteristics are private ownership, profit, and growth.

Economic base includes forces of production such as capital (money and machinery), nature, workers and relations of productions such as competition and wage labor. Social/political/cultural superstructure: government, civil society, education, ideology, and media.

Progressive Era: period of reform that flourished from the 1890s to the 1920s. Keeping corruption out of politics was a main goal of the progressive era, with many Progressives trying to expose and undercut political machines and bosses. Many Progressives supported prohibition in order to destroy the political power based in saloons. New Deal: massive job program, women's rights, banking and financing regulations. Great Society/Civil Rights: set the stage for other social movement reforms.

Laissez-Faire: the government leaves the people alone regarding all economic activities. It is the separation of economy and state. In terms of public health, ** 1798 - Creation of US Public Health Service ** Lemuel Shattuck's public health report, 1850: launching of local, state public health programs. Keynesian: intervention of Fed gov't in economy, civil and worker rights. In terms of public health, ** urban sanitation ** establishment of medical schools ** hospital construction ** food safety system ** workers compensation systems ** Taft Hartley Act (employer responsibility for health care) Neoliberalism: deregulation of industries, privatization of public-sector. In terms of public health, ** Health Information and Health Promotion Act (1976) ** Healthy People reports ** Unsuccessful attempts by Nixon and Clinton at national health care program ** Affordable Care Act (2010)

Bacteriologic: huge advances in medical research, disease control. Health Resources: urban sanitation, medical schools, food safety system. Social Engineering: medicare and medicaid acts. Health Promotion: Health Information and Health Promotion Act.

Great Depression: Social Security act of 1935, first entry of federal gov't into welfare World War 2: medical advances, hospital construction Medicare: assists in payment of medical bills for elderly and people with disabilities Medicaid: assists in payment of medical bills for poor

Ancient Greeks: sanitation, running water, physical health Romans- aqueducts, sewer systems, hospitals Middle ages: turned to spiritual health, little progress in public health Renaissance: interest in cause/cure of disease, advances in natural sciences, examined sick 18th: poor sanitation, unsafe workplaces, child labor, poor workers 19th: laissez-faire approach, beginning of modern public health era

Diseases were caused by demons sent to torment human spirit; most Christians believed it was a punishment for sin.

Discovered epidemic from drinking water from street pump, took the handle off the pump and the disease began to disappear.

Created boards of health, disease research, sanitary measures, and health education.

Health care delivery- greatest community health care challenge Environmental problems- both economic and health issues Lifestyle diseases- leading killers of Americans Communicable diseases- serious community health problem Alcohol/Drug Abuse- cost thousands of lives and billions of dollars per year Terrorism- threat of biological warfare Natural Disasters- rebuilding public health after destruction Poverty and inequality- wealth gap widening, unequal health between different populations

Positive: discover causes of problems. Negative: political decision needed.

-Costs are usually short term, benefits are usually long term. -Those who pay usually aren't the ones who benefit. -It's hard to put a number on health. (Like if spending was increased to decrease river pollution, it would be hard to figure out how many people would have been impacted by the river in the first place)

It's generally accepted for public health measures to restrict people's freedom for the common good. For example, if too many people are fishing in a lake, the fish might die out, so public health measures can limit the freedom of the fishers by limiting amount of fish that fishers are allowed to fish for the common good of the people and the fish.

Limiting the freedoms or responsibilities of people for their own best interest.

The federal government's constitutional role public health is to "promote the general welfare". Aside from that, the U.S. Constitution does not mention public health. The tenth amendment states that "the powers not delegated to the United States by the Constitution...are reserved to the states respectively", meaning that public health is primarily responsibility of the states.

Executive - the executive branch (the President, governor, mayor, county executive and agencies such as departments of public health) may issue rules and regulations based on authority delegated by the legislature through statutes. Local boards of health are administrative bodies whose members are appointed or elected to lead, guide and oversee the delivery of public health services and activities in their local communities. The role boards of health play in public health generally depends on their legal authority and powers as defined in state statutes. In addition, executive branch officials are authorized to issue legally binding executive orders. Regulatory decisions, and the laws governing executive branch actions, are known collectively as "administrative law. Legislative - The legislative branch (Congress, state legislatures and city councils and other local legislative bodies) creates policies and distributes public funds by enacting statutes, which are commonly called ordinances at the local level. Judicial - The judicial branch, through courts, resolves disputes and interprets laws, including balancing community needs with constitutionally- protected rights of individuals.

The Surgeon General - nation's leading spokesman on matters of public health. The National Institute of Health - nation's medical research agency. The Centers of Disease Control and Prevention - leading national public health institute in the U.S. to protect America from health, safety, and security threats.

Local public health agencies have the day-to-day responsibility for public health matters in their jurisdiction. These include collecting health statistics, conducting communicable disease control programs, running school health programs, and delivering maternal and child health services and public health nursing services.

Health care costs in the US have risen dramatically since the 60's because of greater interest and use of health insurance as well as third party payments.

The purpose of Medicare and Medicaid is to provide health insurance to low income populations and individuals over the age of 65. They are both financed through taxes.

Medicaid

First party: person that is in need of care Second party: provider of care (hospital) Third party: insurance companies who will help pay the medical expenses.

The US has one of the best health care systems in the world because of the competitiveness of the free market economy. Only 83% of the population has complete access to care because not everyone can afford insurance and the affordable care act hasn't been fully implemented yet.

cost, poverty, lack of health insurance, and hospitals denying health insurance payments

Direct out of pocket payments is when there is no insurance involved, the patient pays the entire medical bill. Third party payments are when a third party (insurance) helps cover a medical bill.

People pay regular insurance bills to private insurance companies and then the insurance companies will help pay with medical bills when they are needed. People over 65, with disabilities, or with very low income are covered through medicare and medicaid, and everyone else pays for their own health insurance.

Employers provide health insurance in exchange for no strikes.

People over 65, people with disabilities, and people with very low income.

A system of administrative controls intended to reduce costs through managing the utilization of health services.

Health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. It is enforced by law.

Pros: Everyone gets universal care and coverage for veterans in elder years. Cons: Long wait times, fee limits prevent medical care providers from earning a lot of money.

Bismarck Model:Insurance plan covers everybody, not for profit. Beveridge Model: Government pays for and provides health care through taxes National Health Care Model: uses private sector models, but payment comes from a gov't run insurance program that everyone pays into. Out of pocket model: Patients pay for their own medical care, rich get healthier, poor get sicker.

(Total guess) There is no national health insurance and that there is disparity between those with insurance and those without. Also, doctors actually get bonuses if they save the insurance companies money.

"It is hoped that the ACA will make a big difference in reducing the number of people who lack health insurance" (Schneider, Pg 465) "ACA requires new health insurance plans to cover birth control without a deductible or co-payment, a measure that should help prevent many unintentional and unwanted pregnancy" (Schneider, pg 314) "The new law does not require employers to provide insurance, but any business with 50 or more workers that does not provide coverage will be required to pay assessment of $2000 per employee." "Individuals mandate requires states to set up affordable insurance exchanges, whereby individuals can shop for a plan that fits their needs." "Law included a requirement to expand medicaid" "No cost screening cancer, diabetes, and other chronic diseases" "Seniors will benefit from savings in the medicare prescription drug plan"( Schneider Pgs 472-3) Will not benefit anyone who is already covered by business insurance or any individual on welfare.

aimed at reducing cost of health care; PASS OBAMACARE. #stopbeingbitches

They need to pay out of the pocket; hospitals just stabilize them and kick them out.

Health Information and Health Promotion Act (1976) Healthy People 2020 Reports Affordable Care Act (2010)

Essentially when medical care fails to perform on a large scale for people it becomes a public health responsibility to reform the way medical care functions.

The study of determinants of disease, injury, health conditions in a population, and the application of this study to control health problems.

Endemic Diseases- diseases that occur regularly in a population as a matter of course. Epidemic- an unexpectedly large number of cases of an illness, specific health-related behavior, or other health-related event in a particular population.

an outbreak of disease over a wide geographical area such as a continent (influenza, HIV/AIDS, TB)

Public health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice. Such surveillance can: -serve as an early warning system for impending public health emergencies; -document the impact of an intervention, or track progress towards specified goals -monitor and clarify the epidemiology of health problems, to allow priorities to be set and to inform public health policy and strategies

Non-modifiable risk factors: things you cannot change -age, gender, family history Modifiable risk factors: things you can control, change, modify -Biological factors (smoking, cholesterol, blood pressure, physical inactivity) and psycho-social factors (depression, stress, anxiety) Risk factors are important because those who are within the risk factor group have higher chances of getting the chronic disease, so when these risk factors are determined, it helps epidemiologists target what population to study/ warn.

The objective of the Framingham Heart Study was to identify the common factors or characteristics that contribute to CVD by following its development over a long period of time in a large group of participants who had not yet developed overt symptoms of CVD or suffered a heart attack or stroke. Since 1948, the subjects have continued to return to the study every two years for a detailed medical history, physical examination, and laboratory tests, and in 1971, the Study enrolled a second generation - 5,124 of the original participants' adult children and their spouses - to participate in similar examinations.

British Physician Study- In the 1950s, retrospective cohort studies of smoking status and lung cancer outcomes showed "more heavy smokers and fewer non-smokers among patients with lung cancer than among patients with other diseases. The investigators chose UK practicing panel doctors as their population of interest and in October, 1951 mailed them questionnaires on demographics, smoking status, and medical history. The association between smoking and incidence of lung cancer and coronary disease was examined in the men of the cohort after 29 months follow-up and for both diseases was highly significant and strongly related to the amount smoked. The authors stated, that despite the short follow-up and under-reported physician deaths, "we thought it necessary, in view of the nature of the results, to lay these preliminary observations before the survivors of the 40,000 men and women who made them possible." Hammond-Horn Study: In 1952, epidemiologists at the Society launched the Hammond-Horn Study, a large, long-term follow-up study designed to examine the association of cigarette smoking with death rates from cancer and other diseases. For that study, 22,000 volunteers recruited a cohort of 188,000 men who provided detailed information on their smoking habits. These men were followed for mortality through 1955. This study helped to establish cigarette smoking as a cause of death from lung cancer and coronary heart disease. The study also demonstrated the Society's ability to conduct very large prospective cohort studies, and paved the way for subsequent Cancer Prevention Studies.

number of events in a given population over a given period of time or given point in time such as natality (birth), morbidity (sickness), mortality or fatality (death) rates

Incidence rate: the rate of new cases of a disease in a defined population of a defined period of time & Prevalence rate: the total number of cases existing in a defined population at a specific time

most reliable indicator of health status of a population

they fought the virus by educating the public about eliminating standing water where mosquitoes breed, wearing long sleeves, and using repellant.

The influenza occurred extremely rapidly; there were multiple types of the influenza, it was affecting those in their "prime."

Since 1960, mortality reductions have been associated with two newer factors: the frequent conquest of cardiovascular disease in the elderly and the prevention of death caused by low birth weight in infants.

Local health departments: summarize birth, death, disease records -> report to state health departments which report to CDC via National Electronic Telecommunication System. Local, state, fed. Govt. maintain vital and disease records used by epidemiologists, health professionals to track disease

death or mobidity

Communicable diseases spread from one person to another or from an animal to a person. The spread often happens via airborne viruses or bacteria, but also through blood or other bodily fluid. Examples are hepatitis, HIV/AIDS, influenza, malaria, and tuberculosis. Non-communicable diseases are the opposite of that; they include chronic diseases such as cancer, hypertension, etc.

Cohort studies include large numbers of people who do not have a specific disease for a period of time and are therefore observed to see who develops the disease (see what risk factors the participants used/were exposed to in order for the disease to develop). Case-control studies is the comparison between people with the disease to healthy people who are similar in age, sex, and background with respect to prior exposure to potential risk factors.

host agent environment agent: the element that must be present in order for the diseases to occur. host: any susceptible organism invaded by an infectious agent. environment: all other factors that inhibit or promote disease transmission.

pathogen: the disease-causing agent reservoir: the habitat in which an infectious agent normally lives and grows portal of exit: the path by which an agent leaves the source host transmission: how pathogens are passed (either direct or indirect) portal of entry: agent enters susceptible host new host: final link is a susceptible host

primary: forestalling onset of illnesses, injury (i.e. implementing preventive measures such as hand washing for communicable diseases and health education or implementing a healthy diet for noncommunicable diseases) secondary: early diagnosis or prompt treatment before disease becomes advanced or severe (i.e. self-treatment or quarantine for communicable diseases or regular check-ups and screenings for noncommunicable diseases) tertiary: retraining, rehabilitating patient following significant pathogenesis (i.e. recovering to full health after infection for communicable diseases or lifestyle changes for noncommunicable diseases)

overpopulation overconsumption of resources easier transmission of disease with globalization