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Foundations of Public Health Ch. 1- 4

Terms in this set (197)

vulnerable populations
people who have higher than average risk of disease or bad outcomes of disease
definition of public health
the totality of all evidence-based public and private efforts throughout the life cycle that preserve and promote health and prevent disease, disability, and death
systems thinking
the way issues intertwine and interact with each other
threats to public health
globalization, climate change, over use of technology, opiod over prescription, obesity
ways public health is changing in 21st century (7 ways)
quality of life focus, new technology, public & private care collaboration, evidence based, full life cycle approach, complex health issues viewed as part of the larger health and social systems
Health Protection (1830) focus
authority based control (church)
Health Protection (1830) notable events (3)
sexual prohibitions, dietary restrictions, quarantine for epidemics
Hygiene Movement (1840-1870) focus
sanitary conditions as basis for improved health
Hygiene Movement (1840-1870) notable events (2)
John Snow cholera, development of vital statistics
Contagion Control (1880-1940) focus
germ theory & infectious origin of disease
Contagion Control (1880-1940) notable events (3)
link between epidemiology and bacteriology, advancement of vaccines, development of microscope
Filling holes (1950-mid 1980) focus (2)
control of communicable diseases, modification of risk factors
Filling holes (1950-mid 1980) notable events (3)
antibiotics, surgeon general warnings, community health centers
Health Promotion (mid 1980-2000) focus
individual behavior and disease detection
Health Promotion (mid 1980-2000) notable events (2)
AIDS epidemic, reductions in coronary heart disease
Population Health (2000s) focus
evidence-based practice and systems thinking
Population Health (2000s) notable events (3)
full life cycle approach, climate change, global collaboration
ONE Health
connections between human health, animal health, and ecosystem health
3 collaborators of population health
healthcare systems, traditional public health, social policy
4 components of public health
health issues, populations, society's shared health concerns, society's vulnerable groups
2 approaches to addressing public health problems
high-risk approach, improving-the-average approach
high-risk approach
focuses on those with the highest probability of developing disease and aims to bring their risk closer to that of average population
improving-the-average approach
focuses on the entire population and aims to reduce risk for everyone
3 approaches to population health
health care, traditional public health, social interventions
examples of health care (5)
clinics, vaccinations, screening, preventative medications, counseling
examples of traditional public health (2)
control of communicable diseases and environmental hazard, food and drug safety
examples of social interventions (4)
increase education, improve built environment, alter nutrition, address SES disparities
contributory causes definition
immediate causes of disease
definition of determinants
underlying factors that ultimately bring about disease
determinants of health (BIGGEMS)
behavior, infection, genetics, geography, environment, medical care, socioeconomic-cultural
B in BIGGEMS
behavior
I in BIGGEMS
infection
G #1 in BIGGEMS
genetics
G #2 in BIGGEMS
geography
E in BIGGEMS
environment
M in BIGGEMS
medical care
S in BIGGEMS
socioeconomic-cultural
3 changes in population health
demographic transition, epidemiological transition, nutritional transition
demographic transition
impact of falling childhood death rates and extended life spans on the size and age distribution of a population
epidemiological transition
as social and economic development occurs different types of disease becomes more prominent
nutritional transition
countries frequently move from poorly balanced diets to diets of highly processed foods
etiology
the cause
5 questions of evidence-based health approach (P.E.R.I.E. process)
problem, etiology, recommendations, implementation, evaluation
burden of disease
the occurrence of disability and death due to a disease
morbidity
disability
mortality
death
3 steps to describing a health problem
burden of disease, course of disease, distribution of disease
course of disease
how often the disease occurs, how likely to be present currently, what happens once it occurs
distribution of disease
who, where, when
2 types of rates
incidence and prevelance
incidence rate
chances of developing a disease over a period of time
prevalence rate
the proportion of individuals who have the disease at one point in time
prevalence rate equation
number of people living with disease / number of people in at risk population
incidence rate equation
number of new cases of the disease in a year / number of people in the at risk population
CASE-fatality
relationship between the incidence rate and the mortality rate
epidemiologists
investigate factors to see if they can find patterns or associations int he frequency of a disease
risk indicators
factors that occur more frequently among groups with the disease than without
artifactual
differences or changes that are not real
3 reasons why results may be artifactual: difference in...
interest in identifying, ability to identify, the definition of the disease
age adjustment
looking at the rates of the disease in each group and the age distribution
age distribution
number of people in each age group in the population
standard population
the combining of the rates in each age group using the age distribution
population comparisons
investigations that use information on group or a population without having information on individuals within the group
confounding variable
a factor that explains two factors that are not the cause of one another
how to establish etiology (contributory cause)
through epidemiological research studies
3 requirements of etiology
the cause is associated with the effect at an individual level, the cause precedes the effect in time, altering the cause alters the effect
3 basic types of investigations
case-control studies, cohort studies, randomize controlled trials
case-control studies
good for establishing that the cause is associated with the effect
cohort studies
used to determine that the cause precedes the effect
randomized controlled trials
used to determine if altering the cause alters the effect
ancillary criteria
additional evidence that can be used to establish the existence of a contributory cause
efficacy
implies that intervention works
4 ancillary criteria widely accepted
strength of relationship, dose-response relationship, consistency of the relationship, biological plausibility
strength of relationship
how closely related the risk factor is to the disease
relative risk equation
probability of disease for at risk people / probability of disease for non at risk people
dose-response relationship
more at risk behaviors equals increased change of developing disease
consistencey
same results produced in different geographical areas and in a wide range of groups
biological plausability
can explain occurrence of disease based upon known and accepted biological mechanisms
sufficient cause
cause does not happen all the time
necessary cause
everyone gets disease by doing it
recommendations
must incorporate evidence, should influence actions
recommendations should take into account (3)
efficacy, benefits, harms or safety
evidence-based recommendations combine the scores of (2)
quality of evidence, impact of intervention
A recommendation
strong recommendation, must
B recommendation
should be used unless good reasons not to
C recommendation
may be used, judgment needed on an individual basis
D reccomendation
don't use
I reccomendation
insufficient evidence for
implementation requirements
when, who, how
behavior is changed in 3 ways
information, motivation, obligation
implementation when
timing of intervention
primary interventions
occur before onset of disease, aim to prevent disease
secondary interventions
occur after development of disease or risk factor, aimed at early detection or reducing risk factors
tertiary interventions
occur after symptoms of the disease appear, aim to prevent irreversible consequences
victim blaming
making it seem as though the consequences of disease is the patient's own fault
RE-AIM framework
evaluation process that aims to to address how well specific interventions work and are accepted into practice
R in RE-AIM
reach
E in RE-AIM
effectiveness
A in RE-AIM
adoption
I in RE-AIM
implementation
M in RE-AIM
maintenance
health communications
the methods for collecting, compiling, and presenting health information
public health surveillance
ways of collecting public health data
6 aspects of health communication
collect, compile, present, perceive, combine, decision making
single case or small series
useful for dramatic, unusual, new conditions
statistics and reportable diseases
very complete, frequent delays in reporting
surveys-sampling
useful for drawing inferences about large populations
self-reporting
useful when dramatic unusual events closely follow initial use of a drug or vaccine
sentinel monitoring
used for real time monitoring
syndrome surveillance
used for early warning , may have false positives
social media
immediate data can be obtained
2 standard measurements of population health
infant mortality rate, life expectancy
infant mortality rate
number of deaths of infants within first year of life
life expectancy
overall death experience
Health Adjusted Life Expectancy (HALE)
measures life expectancy and quality of health
under-5 mortality
standard measurement used by WHO to summarize the health of children
6 key components of HALE
mobility, cognition, self-care, pain, mood, sensor organ function
Disability-Adjusted Life Year (DALY)
designed to examine the impacts that specific diseases and risk factors have on population
health literacy
the degree to which an individual has the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
3 effects that greatly influence perceptions of public health information
dread effect, unfamiliarity effect, uncontrollably effect
dread effect
very visual, feared consequences
unfamiliarity effect
degree of familiarity with potential harm
uncontrollably effect
less control equals more feared
quality standards for health info on internet (7)
overall site quality, authors, information, relevance, timeliness, links, privacy
decision analysis
computers formally combine info on benefits and harms to reach quantitative decisions
utility scale
measures and compares the value or importance that different people place on different outcomes
zero on utility scale means
immediate death
expected utility
multiplying the probability by the utility to obtain a probability that takes in account the utility
discounting
a quantitative process in which greater emphasis is given to events that are expected to occur int he immediate future compared to events in the distant future
risk-taking attitude
greatly influence the choices made in the prevention and treatment of disease
certainty effect
guarantee a tolerable level health
long-shot effect
when quality of life is bad enough you take the chance and go for it
3 types of decision making
inform of decision, informed consent, shared decision-making
inform of decision
clinician has all the essential information and can make decisions that are in the patient's best interest
informed consent
patients need to give their permission or consent before major inteventions
shared decision-making
the clinician's job is to provide information to the patient with which he or she can make a decision
shared belief
understanding the organization and motivation behind social forces
19th century significance
development of social and behavioral sciences, and public health
social justice
implies a society that provides fair treatment and a fair share of the rewards of society to all
integral part of social justice
public health
3 levels of social influences on health
individual life style factors, social and community networks, general SES, cultural, and environmental conditions
individual life style factors
characteristics, knowledge, beliefs, age, sex
social and community networks
interaction with others
interpersonal
family, friends, peers
institutional
rules and regulations
community
social networks and norms
general SES, cultural, and environmental conditions
living and working conditions, education
4 ways social systems influence behavior
shaping norms, enforcing patterns of social control, providing opportunities to engage in health behaviors, encouraging selrction of health behaviors as a coping strategy
3 key components of social systems and relationship to health
SES status, culture, religion
Gini index
measure that calculated economic inequity across populations
Gini index 0
income equal for everyone
Gini index 1
one individual receives all the income for the population
social determinants
conditions in which people are born, grow, live, learn, work, play, worship, and age and the systems put in place to deal with illness
10 social determinants of health
social status, social support, food, housing, education, work, stress, transportation, place, access to health services
health disparity
type of difference in health that is linked to SES disadvantages
easier to change behaviors if (4)
acceptable and convenient substitute is available, reduced cost, increased availability, improvements in ease of use
difficult to change behaviors if (3)
physiological component involved, addictive element, psychical, social, and economic barriers
3 forces at work to mold individual behavrio
downstream factors, mainstream factors, upstream factors
downstream factors
directly involve individual and can be altered by individual interventions
mainstream factors
result from relationship of individuals with a large group
upstream factors
social structures and policies
3 levels of influence
intrapersonal, interpersonal, population and community
intrapersonal
characteristics of individual
interpersonal
relationships between people
population and community
social structures
Health Belief Model
personal beliefs influence health behavior
Stages of Change Model/Trans-theoretical model
people go through a set of incremental stages when changing behavior
1 stage of trans-theoretical model
pre-contemplation
2nd stage of trans-theoretical model
contemplation
3rd stage of trans-theoretical model
preparation
4th stage of trans-theoretical model
action
5th stage of trans-theoretical model
maintenance
Theory of Planned Behavior
intention is the main predictor of behavior
Social Cognitive Theory
interaction between individual and social systems
3 things must be understood to change behavior
individual characteristics, influences in environment, interaction of both
reciprocal determinism ideal
if you change one component you will change all
reciprocal determinism components
behavior, environment, person
Diffusion of Innovation
how new ideas etc. are disseminated and adopted in a population
5 things determining why something is accepted or rejected
relative advantage, comparability, complexity, trial ability, observeability
3 types of adopters
early adopters, early majority adopters, late adopters
early adopters
seek innovation
early majority adopters
opinion leaders who influence change
late adopters
need support and encouragemnet
4 Ps of social marketing
product, price, place, promotion
PRECEDE-PROCEED phases (3)
planning, implementation, evaluation
PRECEDE
diagnostic phase
Step 1 of PRECEDE
social assessment
Step 2 of PRECEDE
epidemiological assessment
Step 3 of PRECEDE
behavioral and environmental assessment
Step 4 of PRECEDE
educational and organizational assessment
Step 5 of PRECEDE
administrative and policy assesment
PROCEED phase
implementation
Step 1 of PRECEDE phase
implementation
Step 2 of PRECEDE phase
process evaluation
Step 3 of PRECEDE phase
impact evaluation
Step 4 of PRECEDE phase
outcome evaluation
behavioral economics
seeks to utilize new understandings about human behavior to change the behavior of clinicians and patients
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