Know the W.H.O. definition of health and how that definition compares with the ones by the Ottawa Charter for Health Promotion, Parsons and Turnock.
WHO: Health is a state of complete physical, mental or social well-being and not merely the absence of disease
1988 Ottawa Charter for Health Promotion: Health is seen as a resource for everyday life, not the objective of living
Parsons: Health is the ability to perform certain valued social roles
Turnock: Disease is a relatively objective, pathologic phenomenon, whereas health and illness are subjective experiences
Be familiar with the theories of disease causality throughout history, including models to address infectious disease (The Germ Theory, Epidemiologic Triangle, and Web of Causality).
Sins and the Wrath of Gods (theory of disease causality throughout history)
earliest explanations of disease spread focused on the wrath of gods, decline of morality and religious belief.
Evidence of these theories of disease causation can be found in Exodus and the Iliad.
Origins of Environmental Theory (theory of disease causality throughout history)
Recognition of the role the environment plays in disease causation has its origins in antiquity
first stated in the Hippocratic work On Airs, Waters and Places, circa 400 BC) which stresses importance of considering variety of environmental influences on diseases in humans.
Humoral Theory (theory of disease causality throughout history)
Rather than evil spirits, the Greeks developed a humoral theory of illness.
Disease was seen as due to an imbalance in the 4 circulating fluids of the body (blood, black bile phlegm, yellow bile). The function of treatment was to restore balance among the humors.
Mysticism and the Church (theory of disease causality throughout history)
In the Middle Ages, mysticism and demonology dominated concepts of disease. Therapy was by torturing the body. This was later replaced with penance through prayer and good works.
Influence of the Renaissance and Scientific Revolution on Concepts of Health and Disease (theory of disease causality throughout history)
The body was conceived as a machine. Mind and body were seen as separate but linked through the pineal gland. Prescriptions on dissection were removed leading to advances in the study of anatomy and physiology.
Germ Theory (model to address infectious disease)
Louis Pasteur (associated with the pasteurization of milk) is considered the "father of modern microbiology". He clarified the germ theory of disease and pointed out behavioral practices That influenced the transmission of illness. Set the stage for belief in 1 agent-1 disease relationship; the inadequacy of this led to enlargement of causal theories.
1 Agent ------------------------- 1 Disease
1. The organism must be found in every case of the disease
2. The organism must be isolated from a diseased animal and grown in pure culture
3. The cultured organism should cause disease when introduced into a healthy animal
4. The organism must be re-isolated from the experimentally infected animal
WEB OF CASUALITY
Multi-causal Theory or Etiology of Disease: The notion or requirement that more than one factor must be present for disease to develop, referred to as multiple causation or multi-factorial etiology, has gained prominence in this century. A basic tenet of epidemiology is that an ecological approach is necessary to explain the occurrence of disease.
Be able to identify current health issues that were not previously seen as diseases or public health problems.
concept of health and illness are largely socially constructed
inequities of health care are a reflection of unequal distribution of social and political power
changed from a biometical view -------> socioecological view
global health, health and development, "community based" vs. "community placed"
Be familiar with the Illness-Wellness Continuum.
Know the definition of the mission of public health. Be able to discuss the elements that comprise this definition, i.e. fulfillment, society's interest, conditions, health.
Public Health's Mission definition
"The fulfillment of society's interest in assuring the conditions in which people can be healthy."
mission of public health is not complete until the goal has been achieved
implies there is a means to measure and evaluate success at achieving this national agenda (Healthy People 2010/2020)
What constitutes society?
What are society's interests?
What is the role of government?
conditions of where we live - the "natural" environment - air, water, soil, climate, geography, topography
the "built" environment -
public health infrastructure -
schools, business -
green space, safe places
what conditions must be assured?
-conditions of where we live-
conditions that affect how we behave-
how behavior is shaped and reinforced
Substance of public health:
all the organized community efforts aimed at preventing disease and promoting health
a cadre of public health professionals mobilized to engage in prevention activities
Know what Healthy People 2010 represents and its 2 main goals. Be able to identify the 5 disciplines that comprise the professional field of public health and what each discipline focuses on.
What is Healthy People?
national prevention initiative
identifies opportunities to improve Americans' health
scorecard for monitoring health status
U.S. contribution to W.H.O's "Health for All" strategy
Goal 1 of Healthy People
increase quality and years of healthy life
emphasis on health quality, not just longevity
quality of life = overall sense of well being (individual), pleasant and supportive environment (community)
Goal 2 of Healthy People
eliminate health disparities
within 6 areas:
cancer screening and management
childhood and adult immunizations
5 disciplines that comprise professional field
the study of the distribution and determinants of disease and injury in human populations
Biostatistics (inferential statistics):
making inferences from a small group to a larger population
Health Policy and Administration:
focus on organization, access, quality, financing, affordability, types of services, service delivery, marketing
Environmental Health Sciences:
focuses on the natural and built environment
Social and Behavioral Sciences:
focuses on factors that shape and reinforce individual and collective behavior
Be able to discuss the meaning of the proverb "It takes a village to raise a child", i.e., what constitutes the "village", "villagers", and how this relates to the concept of "society".
Be familiar with the IOM model of "Determinants of Population Health", including the different spheres of influence.
definition of Population-based:
total population (key health indicators - life expectancy, infant mortality, top 10 causes of mortality
person level factors = age, gender, race/ethnicity, religion, sex (sociodemographics)
defined by place = urban/rural/suburban, temperate/tropical/arctic, mountains/desert/ocean
definition of Evidence-based:
- rigorous methods, objectivity
- evidence to inform policy & practice
rigor, dispassionate, observer, objectivity, vigor, passionate, advocate, subjectivity
definition of Prevention focused:
primary vs. secondary vs. tertiary prevention
founding principle of health
"assuring the conditions..." - implies eliminating disparities
Involves examination of how society is organized and how this organization affects the health status of the public
Understand what is meant by "When Public Health is Working, Nothing Happens".
we measure our success by the absence of "symptoms"
Understand the meaning and application of primary, secondary and tertiary prevention.
ON FINAL FOR SURE...KNOW IT!!
Primary Prevention =
Secondary Prevention =
Tertiary Prevention =
Be able to explain the philosophy of social justice.
factors within society that interfere with the fair distribution of public health benefits and create inequities in the shouldering of burdens
Social Justice Philosophy:
Social justice is bedrock of public health
•Social justice argues that public health is a public matter
•Justice in society dictates fairness in distribution of benefits and burdens
•Health itself, and the conditions that promote health are societal benefits
•Social justice argues that factors within society impede the fair distribution of public health benefits and create inequities in the shouldering of burdens
•Resolution of inequities requires collective action:
We need to do more with the tools we already possess
The challenge is to overcome social and political barriers
Be able to discuss the differences between medicine and public health in terms of: unit of interest/intervention, locus of activity/place of work, level of activity, disciplines
definition of health equity
"When everyone has the opportunity to attain their full health potential and no one is Is disadvantaged from achieving this potential because of their social position or other socially determined circumstances".
conventional vs. health equity questions:
Conventional question: How can we promote healthy behavior? Health Equity question: How can we target dangerous conditions and reorganize land use and transportation policies to ensure Healthy spaces and places?
definition of health disparities
definition of health inequity
"But health (in)equity concerns those differences in population health that can be traced to unequal economic and social conditions and are systemic and avoidable - and thus inherently unjust and unfair."*
Top Ten great public health accomplishments of the 20th century:
• Motor-Vehicle Safety
• Workplace Safety
• Control of Infectious Diseases
Declines in Deaths from Heart Disease and Stroke
• Safer and Healthier Foods
• Healthier Mothers and Babies
Fluoridation of Drinking Water
Tobacco as a Health Hazard
Be familiar with contemporary public health challenges.
the resurgence of infectious disease = globalization, drug resistant microbes, bio terrorism
past successes give rise to new threats = industrialization, deforestation, global warming
challenge of understanding and altering behavior = "behavioral pathogens", reformulation of "risk"
continued emphasis on curative medicine
Be able to define and discuss the term, class (socioeconomic status), and its relationship to health- i.e., its definition, measurement, potential pathways by which it influences health outcomes.
class has been an ignored determinant of the Nation's Health
celebration of victories must be tempered because the in health between "haves" and "have nots" has largely been ignored
concentrating on race has been a way of eliminating disparities downplaying the importance of socio economic class
it is often uncomfortable
class Influencing health outcomes (Pathways):
pathways explaining relationship are not clear
bring prestige and income
offers access to healthcare
low income is most important predictor of mortality
inequitable distribution of income and wealth = potent factor
opens doors of opportunity
key to economic and social advancement
instills values and understanding of health information
lack of control
social isolation and anxiety
chronic physiologic arousal
Be able to discuss 21st century public health challenges.
describe, model mechanisms
tie mechanisms to health outcomes
what the study of epidemiology is
the study of the distribution and determinants of disease and injury in human populations and the application of this study to the control of health problems
technical definition of epidemiology and its greek roots
distributions of health determinants/outcomes (statistical concept)
determinants of disease (patho-physiologic concept)
application in control of health problems (biological and social concepts)
epi = upon
demos = the people
ology = study of
literally - "study of epidemics"
2 major areas within epidemiology (descriptive and analytic epidemiology)
descriptive epidemiology =
examining the distribution of a disease in a population, and observing the basic features of its distribution in terms of person, place, and time. (e.g. childhood asthma)
who, what, where, when
testing a specific hypothesis about the relationship of a disease to a hypothesized cause, by conducting an epidemiologic study that relates the exposure of interest to the disease of interest
epidemiological sources of data
need to collect and analyze data
household surveys: NHANES, NHIS, NCVS, BRFSS
medical records (HMO's, ambulatory care)
what is required to measure disease frequency in a population
epidemiologists compute rates
morbidity = disease
incidence - the # of new cases of a disease (over a period of time)
population at risk
prevalence - the # of existing cases of a disease (at a point/period of time)
average total population
mortality = death
(crude, adjusted, all cause, disease, or sociodemographic-specific)
crude death rate = number of deaths per year
average total population of that year
PMR = number of deaths from a specific cause/disease (over a period of time)
total number of deaths in the population
what epidemiology can do
determine the impact of disease in groups of people
detect changes in disease occurrence in groups of people
measure relationships between exposure and disease
evaluate the efficacy of health interventions and treatments
what epidemiology cannot do
cannot tell an individual the cause of his/her disease
cannot prove a particular exposure caused an illness based on a single study
cannot provide credible science without good measurement of exposure and disease
Know what incidence and prevalence measure and the formulas used to compute these estimates.
Have some familiarity with the article: Health and Societies: Changing Perspectives Book Review and the issues we raised in class in relation to the Book Review, i.e., the importance of social, political, context.
Have some familiarity with the article: Health, Disease and Illness: Matters for Definition Article and the issues we raised in class in relation to the Article, i.e. differences in definition of health illness and disease.
Have some familiarity with the essay: Left Behind, by Clarence Page of the Chicago Tribune.
In relation to the film, Is Inequality Making Us Sick: In Sickness and In Wealth know the definition of the term 'social determinants'; how 'social determinants' are interrelated, and how they affect health through stress pathways.
You are also responsible for required readings from the text, Introduction to Public Health.