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Public Health Final
Terms in this set (64)
"3 core functions" of public health
2. Policy Development
3. Quality Assurance
Public Health vs Medical Care
-patient = the individual
-focused on treating sick patients
-goal = to cure
In public health:
-patient = the community
-focused on preventing illnesses
-goal = prevent disease and disability
Define "public health"
The science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.
Essential Public Health Services
1. Monitor health status to identify community health problems
2. Diagnose and investigate health problems and health hazards in the community
3. Inform, educate, and empower people about health issues
4. Mobilize community partnerships to identify and solve health problems
5. Develop policies and plans that support individual and community health efforts
6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable
8. Assure a competent public health and personal health care workforce
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services
ALL THREE CORE FUNCTIONS
10. Research for new insights and innovative solutions to health problems
6 sciences of public health
3) Biomedical Sciences
4) Environmental Health Science
5) Social and Behavioral Sciences
6) Health Policy and Management
-Basic science of public health
-Focuses on human populations, usually starting with an outbreak of disease in a community
-Aims to control the spread of infectious diseases
-Seeks causes of chronic disease and ways to limit harmful exposures.
Government collects health data on population
-Used to calculate risks and benefits
Infectious diseases are pathogens
Biomedical research is important to understanding control of new diseases and noninfectious diseases
Environmental Health Science
A classic component of public health:
-Much of the public health improvement in the U.S. in the 20th century was due to improved environmental health.
-Health is affected by exposure to environmental factors:
Solid and hazardous wastes
Safe food and drugs
Global environmental change
-Thousands of new chemicals enter the environment every year
Social and Behavioral Sciences
-Behavior is now the leading factor in affecting people's health
-Theories of health behavior: social environment affects people's behavior
-Major health threats: tobacco, poor diet and physical inactivity, injuries
Health Policy and Management/Health Administration
-Examines the role of medical care in public health.
-Cost of medical care in the U.S. is out of control.
U.S. has a high percentage of population without health insurance
-These people often lack access to medical care
-Quality of medical care can be measured and is often questionable
-Medical care has eaten up profits that could be used more beneficially for education, housing, and the environment.
-Prevent illness/injury from ever occurring
-Prevent exposure to risk factors
Primary Prevention Examples
-Providing HIV awareness
-Promotion of bicycle helmet use
-Educating on heart disease risk factors
-Use of condoms among healthy couples
-Reduce severity of illness/injury
-Prevent disability/death by early detection/treatment
Secondary Prevention Examples
-Eye exams in diabetic patients to limit complications of diabetic retinopathy
-Use of low-dose aspirin in a cardiac patient to prevent a heart attack
-Liver function monitoring in patients on TB medications
-Provide medical care and rehabilitation services
Tertiary Prevention Examples
-Physical therapy for a patient post-stroke
Role of Government in Public Health
U.S. Constitution states that a fundamental purpose of the government is "to promote the general welfare."
Reserve clause is interpreted to mean that, since health is not mentioned in the Constitution, responsibility for public health primarily belongs to the states.
Interstate commerce provision justifies the activities of the Food and Drug Administration (FDA).
Power to tax and spend is widely used by federal government to control public health policy.
The federal government provides 50%-80% of the funding for Medicaid.
The new federalism limited Congress's powers and returned authority to the states.
What is the CDC? What is it responsible for?
Centers for Disease Control and Prevention (CDC)
-Main epidemiologic and assessment agency for the nation
-Publishes Morbidity and Mortality Weekly Report
-Collects data on the U.S. population concerning all aspects of health
-Has centers to address infectious diseases, chronic disease, injury prevention, and other issues
Branches of Goverment
Legislative- passes statutes
Executive- public health agencies carry out the law; may issue regulations consistent with statutes
Judicial- laws and regulations can be challenged in court
APHA (focus and difference from APhA)
American Public Health Association
-Support the influx of more pharmacists trained in public health
-Urging Congress to have the Centers for Medicare and Medicaid Services recognize pharmacists as health care providers to function in public health capacities and be eligible for reimbursement in such capacities
Role of Pharmacy (as a profession) in public health
-Health education and promotion
-Advocates to public health policies
-Designing and providing evidence-based medication therapy management (MTM) programs
-Emergency disaster preparedness
1) Health screenings
The study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems
-Occurs before analytical
-Examines the distribution of a disease in a population, and observes the basic features of its distribution
-Key variables: person, place, and time
-Cross-sectional study design
-Tests an specific hypothesis about the relationship of a disease to a suspected cause by conducting an epidemiologic study that relates the exposure of interest to the disease of interest
-Cohort study design
-Case-control study design
-the usual prevalence of a disease within a given geographic area
i.e. baseline level of the disease (not necessarily zero)
-an increase in the frequency of a disease above the usual and normally expected rate
an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population
A worldwide epidemic
Importance of surveillance systems in the context of epidemiology
-Measure endemic disease levels
-Transition from an endemic to epidemic can happen at any time
-Is a major line of defense in protecting the public against disease
-Created to control spread of known disease but also aids in recognizing new disease
-Importance has increased with threat of bioterrorism
Focuses on new cases
a/(a+b) x 100
a = # of new cases
(a+b) = total # of people at risk in the population
Focuses on existing cases
prevalence = a/(a+b) x 100
a = # of existing cases
(a+b) = total # of people in the population
I exposed = a / (a + b)
I unexposed c / (c + d)
Risk Ratio Value
RR = 1 no difference
>1 exposure is harmful
<1 exposure is NOT harmful
OR = odd exposed a x d
-------------------- = -------
odds unexposed b x c
Sensitivity = a / (a+c)
-proportion of people with disease who were correctly identified
-the ability of a screening test to avoid false negatives
Specificity = d / (b+d)
-proportion of people without disease who were correctly identified
-the ability of a test to avoid mistaken identifications or false positives
A mistake identifying a patient as healthy when they in fact have the disease or condition being tested
A mistake identifying a patient as affected by a disease/condition when they in fact are healthy
Healthy People 2020
A strategic 10 year public health plan managed by the US Dept. of Health & Human Services to promote health & disease prevention
Healthy People 2020 Goals
Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.
Achieve health equity, eliminate disparities, and improve the health of all groups.
Create social and physical environments that promote good health for all.
Promote quality of life, healthy development, and healthy behaviors across all life stages.
Health Belief Model (HBM)
The classic frame of reference that assumes people act in rational ways.
Several factors that determine a change in behavior include: Vulnerability to threat, severity of threat, perceived barriers to reduce risk, & perceived effectiveness to prevent/minimize the problem.
The sense of having control over one's life. People are more likely to be healthy if they are confident in their ability to do so.
Often the 5th factor in the HBM.
Transtheoretical Model (TTM)
Includes 5 stages of change: Pre-contemplation, contemplation, preparation, action, maintenance.
5 levels of influence that determine health-related behavior: Intrapersonal, interpersonal, institutional, community, & public policy.
This model looks at the social environment.
Individual health level of health determinant
An individual, physical characteristics, socioeconomic status, education attainment, psychological factors, & behaviors.
Community health level of health determinant
Economics, food supplies, water & sanitation, housing, physical environment, social environment, education & social services, local government, & primary care.
State/national health level of health determinant
Communication networks, government, public health system, health insurance, & health systems.
Global health level of health determinant
Communications, public health organizations, violence, & global climate change.
Determinants of health
Factors associated with health that are internal to the person or characteristic of their external environment.
WHO framework that measures health & disability, classifies health & health related domains, & provides a common language for descriptions of health & functioning.
"Health literate" abilities
Read, comprehend, & analyze information.
Decode instructions, symbols, charts, & diagrams.
Weigh risks & benefits.
Make decisions & take action.
Access needed health information & capability of using said information.
"Pharmacy health literate" abilities
Understand instructions about medications.
Be aware of alternate treatments.
Evaluate effects of medications.
Motivated to take medication as directed.
Negotiate healthcare systems for follow-up & further treatment.
Actions affecting one or more determinants of health to maintain or improve physical, mental, or social well-being.
Avoiding preventable disease, injury, & premature death.
Activity intended to produce changes in knowledge or ways of thinking that facilitate skill acquisition or behavior change related to health.
An occurrence of a natural catastrophe, technological accident, or human-caused event that has resulted in severe property damage, deaths, &/or multiple injuries.
FEMA (Federal Emergency Management Agency )
Dedicated to a rapid response to man-made & natural disasters.
They provide financial assistance to rebuild homes, businesses, & public facilities. They also train firefighters & emergency medical professionals.
Strategic National Stockpile
Contains large quantities of medicine & medical supplies to protect the American public in the event of a national public health emergency severe enough to cause local supplies to run out.
Better health for the population.
Better care for individuals.
Lower cost through improvement.
Team-based approach that decreases medical errors, allows for continuity of care, improves quality of care, cuts healthcare costs, & results in better patient outcomes.
Possible bioterrorism agents
Smallpox, anthrax, Ebola, plague, & botulism (Clostridium botulinum toxin).
10 major public health achievements
Routine use of vaccination, improvements in motor vehicle safety, safer workplace, control of infectious diseases, decline in deaths from heart disease & stroke, safe/healthier foods, healthier mothers/babies, access to family planning/contraceptives, fluoridation of water, & recognition of tobacco as a health hazard.
Challenges for the 21st century
Renewed threats from infectious diseases, climate change, rising costs of medical care for aging population, understanding & altering human behavior, need to strengthen public health system, & persistent disparities in health.
Public health resources
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