N309 Exam 1
Terms in this set (67)
What is the difference between public health and clinical care?
Public health- population focused
-greatest good for greatest number
-preventing disease and promoting health of communities
-interventions target environment, behavior lifestyles, and medical care
Clinical care- individual focused
--individual is more important than needs of a group
-emphasis on diagnosing and treating diseases
-interventions are medical
What is health?
Here is the main definition we will use: Health is "a state of complete physical, mental, and social well-being and not merely the absence of infirmity."
What is public health
health care is vital to all of us some of the time but public health is vital to all of us all the time
-improving health of a community, as by preventative medicine, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards
What is global health
health problems issues, and concerns that transcend national boundaries and may best be addressed by cooperative actions
*transcend national boundaries
What are different ways that people view health?
-Clinical- absence of disease
-Functional- to perform as expected in social/work roles
-Adaptive- adapt to environment and stressors
-Eudaimonistic- ideal state of human nature. exuberant well being
-Being in balance- ying and yang
Why should we study global health?
-Understand the progress made and remaining global health problems
-Many health problem require global solutions and international cooperation
-Diseases cross borders
-Ethical responsibility to address health disparities
-health is basis of economic and social development
-health promotes global security and freedom
-learn how to improve US health
How many Millennium Development Goals (MDGs) are there and by what year should they be met?
There are 8 MDGs with 15 core targets
Established in 2000 and pledge to meet MDGs by 2015
What are some of the types of problems covered in the MDGs?
1. Hunger and poverty
3. Gender equality and empower women
4. Reduce child mortality
5.improve maternal health
6. combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
What made smallpox eradication successful?
- no animal vector
-vaccine available- no refrigeration needed
-available technology- bifurcated needle allowed easy application, small amount of vaccine
- lifetime immunity
Lessons learned from small pox
-success depends on a single persons responsible for education
-ability to motivate large numbers of staff people
-frequent exchange of information
-flexibility to adapt to new solutions
- use existing healthcare systems
-good publicly helps
What are the 5 most populous countries in the world?
Determinants of health
contributes directly or indirectly to many health conditions, diseases, and disabilities
Give examples of determinants of health
-physical environment (water, sanitation)
-employment and working conditions
-access to health services
-individual characteristics ( genetic make up, age, sex)
-health prenatal and child development
-social environment(education, culture)
how many deaths/in a group for what time
how much sickness/in a group for what time
all cases in that time period
How is prevalence calculated
all ill from the population/ population given
How is incidence calculated
new cases/ total population- old cases
how are they different?
prevalence- (all cases)
Incidence- (new cases)
What are DALYs
(Disability- adjusted life years)
- most used measure of disease burden
- health lost due to particular illnesses and disabilities in a particular year in a particular population compared with the healthiest possible population
-lower DALY is better
what "losses in health" are considered in DALYs versus mortality rates?
Higher DALY=a society with more premature death, illness, and disability. DALY is considered disabilities plus mortality. Mortality is just deaths. The lower the DALY the better.
What are the demographic and the epidemiologic transitions?
-Population growth- birth exceed deaths
-Population pyramid- % of each age group making up the population
-Demographic divide- shrinking population size of rich vs growing size of poor ones
-Urbanization and mega cities- which most popular (JAPan, Tokyo)
-Demographic transition- age shifts in populations
-epidemiological transition- shifts from communicable to non- communicable disease
What are examples of leading causes of death shared in low/middle- and high-income countries?
-lower resp. infections
- lung disease
What are examples of areas where these differ?
lower middle class
-HIV/AIDS, malaria, road injuries, TB, diarrheal diseasses
-chronic kidney disease
What regions of the world have the shortest life expectancy?
south Asia and sub-saharan Africa
What are the 3 broad groups of causes of death used by WHO?
Group 1 Communicable, maternal, perinatal, nutritional- young people deaths
Group 2- non-communicable- most common among wealthier populations- death at older ages
Group 3- Injuries- unintentional prevent from engineering and education and intentional self- directed, interpersonal or collective
What are some of the factors that explain the differences in health of people in Kerala relative the rest of India?
- high emphasis on education for all
-primary healthcare services for all
-focus on nutrition, family, planning, immunization
-elevated status of women
How is poverty defined globally
= Living on the equivalent of $1-$1.25 US
= (earning ~17¢ per hour for an 8-hour
day working 5 days a week)
= (earning ~13¢ per hour for an 8-hour
day working every day)
what regions of the world have the largest percent of people living in poverty?
1.sub-saharan africa and
2. south asia
How do wealth and education affect each other
-Education helps you get a better job...that pays
-Richer parents can afford school costs for
How does health and education affect each other
-parents health and education of affects their children's health and development
-learning and school attendance depends on health
-disease prevention increases with education
How do wealth and health affect each other
-access to clean water
-reduces financial barriers to health care
-increases access to education
What do equity and health disparities mean?
Health disparities- differences among populations in measures of health and healthcare
Equity- fairness in distributing a resource
What are two broad areas of unfairness affecting health inequities?
- access to care
- ethnic or gender discrimination
What are measures of the income status of a country
- Gross domestic product (GDP)
what do they measure?
GDP- total amount of good and services produced within a country by its own
GINI- Index of income inequality. half the average of the absolute differences between all pairs of incomes within a distribution normalized on mean income
What are some of the reasons that some countries are poorer yet have good health, and others are wealthier and yet have poor health?
higher countries have higher DALY from poor eating to lack of physical activity, smoking, alcohol, and driving
Does the health and well-being of all income groups benefit equally from economic development in a country?
Urban vs. Rural-
Urban dwellers- tend to enjoy better health status and access to services then rural dwellers
Male vs. Woman
What does the term "indigenous people" refer to?
Indigenous populations are communities that live within, or are attached to geographically distinct traditional habitats or ancestral territories, and who identify themselves as being part of a distinct cultural group, descended from groups present in the area before modern states were created and current borders defined
What groups are most likely to face inequities in access to care?
• Poor people (cost of services too high)
-Less educated (underuse health care)
• Minorities, Indigenous (poorer quality,
disregard cultural aspects),
-Rural: lack of transport to urban areas
• Sexual minorities; Disability groups
What percentage of the national income do high and low income countries spend on health?
Most high income countries:
• spend 9-12% of national income on health and have high life expectancy (Germany and Iceland)
Most low income countries:
• spend 3-6% of national income on health and have low life expectancy (Kenya)
What are public, private, and out-of-pocket expenditures for health?
Public expenditure- expenditure by any level of government or government agency
Private expenditure- expenditure other than from government ex. non governmental organizations
Out of pocket expenditure- expenditure by people that is not covered or reimbursed by an insurance program or public sources
What is cost effectiveness
cost of an intervention relative to amount of health purchased with that investment -is something that is a good value, where the benefits and usage are worth at least what is paid for them.
what are the top 4 cost effective interventions to improve global health according to the Copenhagen Consensus?
- micronutrient interventions to fight hunger and improve education
-malaria combination treatment
-deworming school kids
how can it be helpful in deciding how to spend money to promote health of a population?
- compare alternative treatments for a disease
- compare different goals
-help to set priorities
What are key factors that made the eradication of Guinea worm (dracunculiasis) effective?
Clean water sources
-use of water filters
-avoid recontamination of water supply
-surveillance and reporting local solutions
What are the four types of technology (and examples of each) that can answer global health needs?
1. Biomedical technologies
2. Education and motivation (motivational interviewing)
3. Food and agricultural (plumpy nut)
4. Public health innovations (sanitation)
What are three underlying factors that affect whether technologies solve global health needs?
1.Poverty & low education underlie much poor health in low-income countries
2. Health may not be a priority to national & local leaders
3. Poorly functioning health infrastructures
What are barriers to development of new technologies for global health?
For- profit entities- the major development of new technologies
Major profits- derived from drugs sold in high income countries
Only 10% of expenditures for research development is related to diseases of developing countries
What are the ideal characteristics of a new health product for global health? Be able to apply this to an example.
-easy to use and convenient
-requires little skill or training to use
-easy to transport
What is "jugaad" and who is developing it?
Jugaad- frugal innovations that are invented by entroponuers -think of the ted talk
Definition of culture
"A set of rules or standards shared by members of a society, which when acted upon...."produce behaviors that are acceptable.*
-behaviors and beliefs that are learned and shared
Definition of society
a group of people who occupy a specific locality and share the same cultural traditions
How do collectivist and individualistic cultures differ?
What are components that culture encompasses?
- family and social values
-practices ex diet
-art and music
-politics and law
How do ethnocentrism, cultural relativism, and cultural humility affect how a person views another's culture?
Ethnocentrism- is judging another culture solely by the values and standards of one's own culture
Cultural relativism- individual human's beliefs and activities should be understood by others in terms of that individual's own culture. Their beliefs shouldn't be seen as good or bad by others
Cultural humanity- awareness of knowing anothers culture is along, evolving process
Why is it important to study the relationship between culture and health?
Because it influence:
- perceptions of health and illness
-utilization of health services
-health practices and medical treatment
What were beliefs in rural Mauritania that supported forced feeding of girls?
- fat was a sign of beauty -force fed the girls when they were young milk -since they cant afford education they do this for her beauty instead
How do the concepts of illness and disease differ?
illness- reactions to disease or discomfort
Disease- malfunction of biological processes in the body
- Illness may not be caused by disease
What are the 3 broad categories of health care providers in global health?
Indigenous- midwives, witches, priests
western biomedical - nurses and physicians
other medical systems- Chinese medical system- chemist practitioners
What are the key concepts of the ecological perspective
focus on multiple levels of change
1. Individual (knowledge)
2. Interpersonal (family/friends)
3. Organizational- rules, policies
4. Community - social network, standards
5. Public Policy- local state and federal policies and laws that regulate healthy actions
What are the key concepts of the health belief model
Perceived susceptibility (fear of getting HIV for not using a condom), Perceived seriousness (how serious he sees this disease),
Perceived Benefits (the extent that the condom will prevent HIV) and Perceived Barriers (how easy it is to buy a condom)
What are the key concepts of the stages of change
1.Pre contemplation ignoring the problem)
2.Contemplation (just considering change)
3.Decision/determination (decision point)
4. Action (needs support for efforts)
5.Maintenance (part of daily living)
What are the key concepts of the diffusion of innovation
-communication promotes social change
-differences in users
- innovators and early adopters to laggard
success depends on use of opinion leader and a product that easy, fits with culture
What were key ideas in the video about Torres Strait Islanders and health?
- nurse worked went to islands where there was no primary doctor -looked after idiginous people - a patient had a culture thing happen to her. Black magic. instead of thinking that its the flue etc. they thought someone casted a spell on them nothing will help them if they dont believe in western med
How did culture affect spread of the Ebola virus (Brief at the end of Chapter 6)?
burial practices, caregiving practices, and societal stigma -burial practice by washing the dead and direct touches with the body -Women are most likely to get ebola because they take care of sick relatives -societal stigma can lead to hiding the sick family member so they wont get shunned from the community or international travel bans or returns
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