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Public Health Final
Terms in this set (85)
A public health term to describe the symptoms produced by a disease or other conditions; at times distinguished from disability, which is defined in terms of function
A public health term to describe the frequency of deaths produced by a disease or other condition
Health Protection (Antiquity - 1830s)
Authority-based control of individual and community behaviors
Hygiene movement (1840-1870s)
sanitary condition as basis for improved health
Contagion Control (1880-1940s)
germ theory: demonstration of infectious origins of disease
Filling Holes in the Medical Care (1950s - mid-1980s)
integration of control of communicable disease, modification of risk factors, and care of high-risk populations as part of medical care
Health Promotion/Disease Prevention (Mid-1980s - 2000)
focus on individual behavior and disease detection in vulnerable and general populations
Population Health (2000s)
coordination of public health and healthcare delivery based upon shared evidence-based systems thinking
social determinants of health and health disparity
Social status, social support/Alienation/food/housing/Education/work/stress/Place/Access to health services/Health Disparity
Societies place value on certain characteristics that form a hierarchical structure like income, education, occupation.
Being apart of a social network has benefits to health, including emotional effects associated with feelings of inclusion and tangible benefits such as having someone to go jogging with or having someone to provide a ride to the doctor's office
Food: an inadequate or insecure food source remains an issue for disadvantaged populations.
Homelessness can lead to malnutrition, lack of medical care, drug use, and violence. Having affordable, stable housing can influence health.
Education: those with more education tend to experience better health compared to hose with less education
those with more education tend to experience better health compared to hose with less education
being employed tends to be better for health compared to being unemployed. Having an income assists a person's ability to secure resources that may protect and promote health. Some jobs are hazardous than others and can negatively affect health. Those who are unemployed also face psychological consequences due to the anxiety and stress with lack of job security and inability to provide for family
sustained periods of stress can negatively impact physical health due to the body;s fight or flight response which increase the heart rate and cortisol levels
Where you live affects your health. Living in an urban place with lots of air pollution or vehicles and living in a rural place with lack of health care facilities.
Access to Health Services
Having access to preventive health services and medical care contributes to overall health.
Social determinants of health contribute to a wide variety of illnesses and diseases rooted in lifestyle, environmental, and social factors. Recent increased attention on social determinants of health has been driven by their connection with health disparities. A health disparity is a type of difference in health that is closely linked with social or economic disadvantage.
: risk an individual knowingly or willingly takes on through his or her own actions, such as choosing to not wear a motorcycle helmet while riding a motorcycle
risk to individuals and populations that is out of their direct control
represents a wide range of diseases, from cardiovascular disease, cancers, and depression, to Alzheimer's and chronic arthritis. They represent the majority of causes of death and disability in most developed countries.
How can you control those disease:
screening for early detection and treatment for disease, multiple risk factor interventions, identification of cost-effective treatments, genetics counseling and intervention
screening for early detection and treatment for disease:
Screening for disease implies the use of tests on individuals who do not have symptoms of a specific disease
multiple risk factor interventions:
this strategy intervenes simultaneously in a series of risk factors, all of which contribute to a particular outcome, such as cardiovascular disease or lung cancer
identification of cost-effective treatments:
Cost-effectiveness is a concept that combines issues of benefits and harms with issues of financial costs.
genetics counseling and intervention:
three categories of genetic testing:
Predicting the risk of the disease:predictive genetic testing identifies gene variants that increase an individual's risk of developing a disease
Incomplete penetrance: genes associated with diseases may only slightly increase the chance of developing the disease.
Pharmacogenetic testing: provides information about how individuals will respond to drugs
Reproductive genetic testing: aims to identify people who are at increasing risk for having a child who has a genetic disease.
may be caused by a wide variety of organisms, ranging from bacteria to viruses, to a spectrum of parasites, including malaria and hookworm
Tools available to address the burden of communicable diseases:
Barrier protections, including isolation and quarantine, Immunizations designed to protect individuals as well as populations, Screening and case findings, Treatment and contact treatment, Efforts to maximize the effectiveness of treatments
Barrier protections, including isolation and quarantine:
Barriers include: condoms, masks, handwashing, insecticide-impregnated bed nets.
Isolation: occurs when individuals with symptoms of a disease are separated from those who do not have symptoms.
Quarantine occurs when those suspected of having a disease but without current symptoms are separated from others
Immunizations designed to protect individuals as well as populations
Immunization: refers to the strengthening of the immune system to prevent or control diseases
Ideally, vaccination occurs before exposure. However, when an outbreak occurs, vaccination of large numbers of potentially exposed individuals living in the surrounding areas may be key to effective control
Screening and case findings
Case finding: implies confidential interviewing of those diagnosed with a disease and asking for the recent close physical or sexual contacts.
Treatment and contact treatment
Treatment of symptomatic disease may in and of itself reduce the risk of transmission.
Epidemiological treatment: treatment of contacts with the disease, has been effective in controlling a number of communicable diseases
Three types of environment:
Built environment, Altered environment, Unaltered environment
is relatively new and includes all the impacts of the physical environment as a result of human construction
Ex: injuries and exposures in homes, transportation system, where we work and play
impact of chemicals, radiation, and biological products that we introduce into the environment
Ex: pesticides, medical & nuclear waste
is the natural environment - Radon is a common naturally occurring breakdown product of uranium, increases the risk of lung cancer.
Ex: radon, what is found in the natural environment
Route of exposure
The consequences of exposures to heavy metals including mercury, lead, and cadmium, for instance, depend on whether the exposure is via the skin of the respiratory or gastrointestinal tract
Timing of exposure
Short-term high-dose impacts often will not be the same as long-term low-dose impacts, even if the total exposure and the routes of exposure are the same
stage of life
The impact on the very young and the very old is likely to be different than the impact on people at other stages of life
The presence of other diseases will affect how the body is impacted by an environmental exposure
A few individuals will be hypersensitive to specific environmental exposures that have no measurable impact on the vast majority of individuals
Where it comes from: Addition to lead in gasoline, demolition & renovation of homes, workers that are mining, smelting, metal repair, or foundry work
Ways to reduce exposure: occupational controls, phase out lead in gasoline
Where it comes from: normal ingestion of dirt or dust by infants,
Ways to reduce exposure:
Where it comes from: pipes, in older homes, often contain lead
Ways to reduce exposure: regulation of levels of lead in public water supply, run home water before use, use cold water for cooking
Where it comes from: pregnant women absorb higher percentage of ingested lead compared to children to children and lead can cross the placenta
Ways to reduce exposure: special effort to reduce exposure by pregnant women, including special care with home renovations during pregnancy
implies a process of setting standards for educational and training institutions and enforcing these standards using a regulatory scheduled institutional self-study and an outside review
implies that the individual, rather than the institution, is evaluated
generally a profession-led process in which applicants who have completed the required educational process take an examination
Infection control specialists
avoid the development of antibiotic resistant bacteria, control local outbreaks of infection, and manage the increasing number of immunologically compromised patients
New incentives such as those designed to avoid hospital readmission has provided new opportunities for nurses to incorporate health navigation into their practice responsibilities
Nurse care managers
nurses are often well suited for these roles due to their experience working with patients, physician, and administrators
Patient safety: investigating safety issues and identifying and implementing approaches to reducing the risk
nurses are increasingly playing important roles in designing, implementing, and evaluating health information systems
Disaster & Emergency management
nurses can play important roles in preparation and response to disasters and emergencies
the increased availability and use of technology has increased the need for technically skilled nurses
the aging baby boomer generation is expected to have a major impact on the need for nursing service
Image of nursing as a female profession:
Until recently, nursing has been overwhelmingly a woman's profession, which has historically limited its attractiveness to men
Restrictions on Entry
until recently, nursing education was self-contained - to become a nurse, you needed to complete an undergraduate nursing degree and the only way to pursue a graduate nursing degree was to already have a bachelor's degree in nursing
Shortage of nursing faculty:
A shortage of nursing faculty and training facilities has also contributed to the shortage of nurses and the ability to rapidly expand the size of colleges of nursing
traditionally refers to the first contact providers of care who are prepared to handle the great majority of common problems for which patients seek care
refers to specialty care provided by clinicians who focus on one or a small number of organ systems of on a specific type of service, such as obstetrics, and gynecology, or anesthesiology
subspecialty care - usually defined in terms of the type of institution in which it is delivered, often academic or specialized health centers
Different type of public professional
It was expanded to include disabled persons eligible for Social Security disability benefits and those with end stage renal disease. Today, nearly 50 million Americans are eligible for Medicare, and the number is expected to increase to over 60 million in the near future.
Medicaid is a federal plus state program designed to pay for health services for specific categories of poor people and other designated categories of individuals. It is now the largest federal health insurance system covering nearly 50% of births in the United States, nearly 40% of children, and well over half of all custodial nursing home care
Cap-A limit on the total amount that the insurance will pay for a service per year, benefit period, or per lifetime
An amount that the insured is responsible for paying even when the service is covered by insurance
In contrast to copayment, the percentage of the charges that the insured is responsible for paying
A service for which health insurance will provide payment or coverage if the individuals
What are the steps in foodborne outbreak investigation
Detecting a possible outbreak, Defining and finding cases, Generating hypothesis about likely sources, Testing the hypothesis, Finding the point of contamination and the source of the outbreak, Controlling the outbreak, Deciding that an outbreak is over
Provides direct health care and public health services to federally recognized tribes.
Services provided to approximately 550 federally recognized tribes in 35 states. Only comprehensive federal agency responsibility for healthcare plus public health services
Works to improve quality and availability of prevention, treatment, and rehabilitation for substance abuse and mental illness.
Research, data collection, and funding of local services
Research agenda to improve the outcomes and quality of health care, including patient safety and access to services.
Supports U.S. Preventive Services Task Force, evidence-based medicine research, and Guidelines Clearinghouse.
Seeks to ensure equitable access to comprehensive quality health care.
Funds community health centers, HIV/AIDS services, scholarships for health professional students
Consumer protection agency with authority for safety of foods and safety and efficacy of drugs, vaccines, and other medical and public health interventions.
Divisions responsible for food safety, medical devices, drug efficacy, and drug safety pre- and post-approval.
Lead research agency; also funds training programs and communication of health information to the professional community and the public.
17 institutes in all—the largest being the National Cancer Institute. The National Library of Medicine is part of NIH Centers, which also include the John E. Fogarty International Center for Advanced Study in the Health Sciences. NIH is the world's largest biomedical research enterprise, with intramural research at NIH and extramural research grants throughout the world.
Key Federal Health Agencies of the Department of Health and Human Services
CDC and the Agency for Toxic Substances and Disease Registry
The CDC is the lead agency for prevention, health data, epidemic investigation, and public health measures aimed at disease control and prevention. The CDC administers the ATSDR, which works with the Environmental Protection Agency (EPA) to provide guidance on health hazards of toxic exposures.
The CDC and ATSDR work extensively with state and local health departments. The CDC's Epidemic Intelligence Service (EIS) functions domestically and internationally at the request of governments
Governmental Public Health Agencies
Research for new insights and innovative solutions to health problems
This service includes continuous linkage with appropriate institutions of higher learning and research and an internal capacity to mount timely epidemiologic and economic analyses and conduct needed health services research.
Example(NIH, CDC, Agency for Healthcare Research and Quality (AHRQ), other federal agencies)
Evaluate effectiveness, accessibility, and quality of personal and population-based health services
This service calls for ongoing evaluation of health programs, based on analysis of health status and service utilization data, to assess program effectiveness and to provide information necessary for allocating resources and reshaping programs.
Example(Development of evidence-based recommendations)
Ensure the provision of a competent public and personal healthcare workforce
This service includes education and training for personnel to meet the needs of public and personal health services; efficient processes for licensure of professionals and certification of facilities with regular verification and inspection follow-up; adoption of continuous quality improvement and lifelong learning within all licensure and certification programs; active partnerships with professional training programs to ensure community-relevant learning experiences for all students; and continuing education in management and leadership development programs for those charged with administrative/executive roles
Example(Licensure of physicians, nurses, and other health professionals)
Link people to needed personal health services and ensure the provision of healthcare when otherwise unavailable
This service (often referred to as "outreach" or "enabling" services) includes ensuring effective entry for socially disadvantaged people into a coordinated system of clinical care; culturally and linguistically appropriate materials and staff to ensure linkage to services for special population groups; ongoing "care management"; and transportation.
Example(Community health centers)
Enforce laws and regulations that protect health and ensure safety
This service involves full enforcement of sanitary codes, especially in the food industry; full protection of drinking water supplies; enforcement of clean air standards; timely follow-up of hazards, preventable injuries, and exposure-related diseases identified in occupational and community settings; monitoring quality of medical services (e.g., laboratory, nursing home, and home health care); and timely review of new drug, biological and medical device applications.
Example:Local: Fluoridation and chlorination of water State: Regulation of nursing homes Federal: FDA drug approval an
Develop policies and plans that support individual and community health efforts
This service requires leadership development at all levels of public health; systematic community- and state-level planning for health improvement in all jurisdictions; tracking of measurable health objectives as a part of continuous quality improvement strategies; joint evaluation with the medical/healthcare system to define consistent policy regarding prevention and treatment services; and development of codes, regulations, and legislation to guide public health practice.
Example(Newborn screening and follow-up programs for phenylketonuria (PKU) and other genetic and congenital diseases
Mobilize community partnerships and action to identify and solve health problems
This service includes convening and facilitating community groups and associations, including those not typically considered to be health-related, in undertaking defined preventive, screening, rehabilitation, and support programs; and skilled coalition-building to draw upon the full range of potential human and material resources in the cause of community health.
Example (Lead control programs: testing and follow-up of children,reduction of lead exposure, educational follow-up and addressing underlying causes.)
Inform,educate and empower people about health issues
This service includes social marketing and media communications; providing accessible health information resources at community levels; active collaboration with personal healthcare providers to reinforce health promotion messages and programs; and joint health education programs with schools, churches, and worksites
Examples( Health education campaigns, such as comprehensive state tobacco programs)
Diagnose and investigate health problems and health hazards on the community
This service includes epidemiologic identification of emerging health threats; public health laboratory capability using modern technology to conduct rapid screening and high-volume testing; active communicable disease epidemiology programs; and technical capacity for epidemiologic investigation of disease outbreaks and patterns of chronic disease and injury
Examples(Epidemic investigations CDC's Epidemic Intelligence Service, State public health laboratories)
Monitor health status to identify and solve community health problems
This service includes accurate diagnosis of the community's health status; identification of threats to health and assessment of health service needs; timely collection, analysis, and publication of information on access, utilization, costs, and outcomes of personal health services; attention to the vital statistics and health status of specific groups that are at a higher risk than the total population; and collaboration to manage integrated information systems with private providers and health benefit plans.
Examples( Vital statistics Health surveys surveillance, including reportable disease)
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