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Public Health Exam 1
Terms in this set (66)
Preventing Disease,Prolonging Life, Promoting physical health
PREVENT, PROLONG, PROMOTE
1800s in England and Wales
Two or three infants out of 10 died before age 1
five or six died before age 6
about 3 in 10 lived beyond age of 25
1800 England and Wales leading cause of Death
cholera, typhoid, and small pox
20th century average life expectancy increase
45 to 75
Leading cause of death today
cancer, accidents, suicide
Three Core functions of Public Health
1. Monitor peoples health status, identify community problems
2. Diagnose and investigate health problems and hazards in the community
1. Educate and empower
2. Mobilize communities to identify and solve health problems
3.Develop policies and plans to support community/self health
6. Enforce health laws and regulations
7. Link people to health services and assure availability
8. Assure competent public health workforce
9. Evaluate effectiveness of ph efforts
Serving all functions
10. Research for new insights and solutions to health problems
Public Health v.s Medical
Medical- concentrates on the health of an individual. (CURE) $$$
Public Health - the publics health and Organized community efforts aimed at the prevention of disease and the promotion of health (PREVENTION)
Preventing illness more abstract than medicine
public health prevents illnesses and it is harder to show what is being prevented. 3% of nations total health spending is on Public Health
Public Health Disciplines
Social and Behavioral sciences
Health Policy and Management
• The basic science of public health
• Aims to control spread of infectious diseases
• Seeks causes of chronic disease and ways to limit harmful exposures.
• Collection of data on the population
• These numbers are diagnostic tools for the health of the community
• The science of statistics is used to calculate risks, benefits.
• Infectious diseases - pathogens
• Chronic diseases
• Health effects of environmental exposures
• Air Quality
• Water Quality
• Solid and hazardous wastes
• Safe food and drugs
• Global environmental change
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
• Maternal and child health - a social issue
Health Policy and Management
• Role of medical care in public health
• Cost of medical care in 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
Public Health Approch
1. define health problem
2.identify risk factors associated with problem
3. develop and test community level interventions to control or prevent the cause of the problem
4. implement interventions to improve health population
5. monitor those interventions to assess their effectiveness
The 3 levels of Prevention
• Primary prevention
• Secondary prevention
• Tertiary prevention
Any intervention that prevents a disease or condition from occurring.
early detection/treatment screening
treatment and/or rehabilitation efforts after a health related state has happened.
Cause of Causation
•Interventions can focus on any of these targets.
the susceptible human being
disease causing bacteria
means of tranportation
Public Health & Terrorism
-The public health response to disasters, both natural and man-made, helps to control the damage and prevent further harm to survivors and rescuers.
-Bioterrorism is recognized primarily through classical public health measures similar to those used in natural epidemics.
suggests that minimal levels of income,basic housing, employment, education, and health care should be seen as fundamental rights.
suggests that powerful forces of environment, heredity, and social structure prevent a fair distribution of the burdens and benefits of society. .
Sources of Controversy
-Moral and religious concerns
-Politics vs. science
-Businesses often resist public health measures because they affect profits
-Those who must pay may not be the ones who benefit
-Costs may be short-term, while benefits may be long-term -Costs easier to calculate than benefits
• To prevent harm to others- generally acceptable
• Paternalism - acceptable for children & young adults • To protect individuals from their own actions?
• For the "common good" -lots of room for controversy.
Moral and religious concerns
• Sex and reproduction
• Alcohol and drugs
• Assisted suicide and other end-of-life decisions
Politics vs. Science
-There is always the possibility of tension
-Conservative control of federal government intensifies the conflict
-Criticism of Bush administration for going too far in misrepresenting science to support its policies
-Efforts by the Obama administration to inform policy decisions based on honest science
Federal vs. State
-U.S. Constitution: To promote the general welfare
-Reserve clause: Since health is not mentioned in the Constitution, primary responsibility belongs to the states
-Interstate commerce clause justifies federal role in some cases
-Power to tax and spend is widely used by federal government to control public health policy
Branches of Government (federal, state, local)
-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
Local Public Health Agencies
-County and city health departments
-Core public health functions
-Often also have responsibility for providing medical care for the poor
-Funding sources are variable; city or county legislatures may not understand importance of core functions.
-Mandates may be funded from state or federal governments.
State Health Departments
-Coordinate activities of local health agencies and provide funding
-Collect and analyze data
-License and certify medical personnel, facilities, and services
-Environment, mental health, social services, and aging may be handled by separate agencies
primary organizations for public health in government
center for disease
national institute of health
CDC (Centers of Diseases Control & Prevention)
observation. action people. educating people.
collaborating to create the expertise, information, and tools that people and communities need to protect their health
-Main epidemiologic and assessment agency for the nation
-Publishes Morbidity and Mortality Weekly Report (MMWR)
-Center for Health Statistics - collects data on U.S. population concerning all aspects of health
-Centers on infectious diseases, chronic disease, injury prevention, and others
national institute of health
testing. research people.
mission is to seek fundamental knowledge
-Biomedical research agency
-Institutes on cancer, heart and lung disease, diabetes, aging, child health and human development, and others.
-National Library of Medicine
-Has laboratories in Bethesda, MD and provides grant funding to researchers in universities and research centers.
-Clinical center where medical researchers test experimental therapies
Nongovernmental Public Health Organizations
-American Cancer Society, American Heart Association, American Diabetes Association, Alzheimer's Disease and Related Disorders Association, and others
-American Medical Association, American Nurses Association, American Public Health Association, and others
-The diagnostic discipline of public health
-A major part of public health's assessment function
-Investigates causes of diseases
-Identifies trends in disease occurrence
-Evaluates effectiveness of medical and public health interventions
-An observational science
-Father of epidemiology
-Found by John Snow
-The cholera epidemic of London in 1854 was concentrated in the neighborhoods using the Broad Street water pump.
-Endemic(regular found among particular people)
-Epidemic ( widespread occurrence in a community at a particular time)
-Notifiable diseases reported as soon as diagnosed
-Recognition of new disease
-Increased importance with threat of bioterrorism
-Verify the diagnosis
-Construct a working case definition
-Find cases systematically - active surveillance
-Ask the who, where, and when questions to describe the epidemic by person, place, and time. Consider the incubation period
-Look for common source of exposure
Epidemiology and Chronic Diseases
-Identify risk factors
-Observe long-term trends
-Heart disease - leading cause of death in U.S.
Framingham Study - started in 1948
-Lung cancer and smoking - early 1950s
British Physicians' Study
Hammond-Horn study in U.S.
How does Epidemiology Relate to Chronic Disease?
Helps identify the risk factors and/or causes of chronic disease by measuring factors and exposure and comparing that to the incidence rates in people who had those factors or were exposed. When relationships are successfully identified other public health programs can be instituted to help prevent exposure or delay onset of disease.
studies the patterns of disease occurrence in human populations and the factors that influence these patterns.
"the study of the distribution and determinants of disease frequency in human population"
Define the Disease
-Death is easy to determine - death certificates have cause of death
-Some diseases need blood tests or stool cultures to verify diagnosis
-Some diseases are hard to define - e.g., EMS, SARS
-Sometimes definition changes as more is learned - e.g., AIDS
-Other health outcomes - injuries and risk factors
Two ways to measure frequency:
Incidence - number of new cases (studying causes of disease)
Prevalence - number of existing cases
Population at Risk (PAR)
-Count number of people with disease and relate to the population at risk (PAR)
- The denominator may be total population or exposed population, or one gender or age group; often comes from census
Distribution of Disease
-Who - sex, age, occupation, race
-When - season, year (long-term trends), elapsed time since an exposure (epidemic curve)
-Where - neighborhood (e.g. clusters), latitude (climate), urban vs. rural, national variations
causes of causes
Epidemiology - human
Biomedical sciences- may be animals
Retrospective- studies past
-Closest thing to an experiment
-Start with two groups: experimental group (gets the intervention or exposure) and control group
-Watch them over time and compare outcomes
-Experimenter chooses who is in which group
-Two groups should be as similar as possible so that intervention is the only difference
cohort (group with something in common) of healthy people is followed through time to see if they develop a specific disease of interest
- also called incidence studies
- incidence rate can be commuted
- allow comparisons of incidence rates between people who report a specific behavior (exercise) and those who report they do not engage in the behavior
a specific disease is generally the focus of the research
objective: discover how/why the disease occurs
-group of people with the disease = case
- group of people without the disease = control
(should be similar on other characteristics)
- groups recall behavior or use medical records to study how the groups differ
-least accurate approach
Problems of Epidemiology
Confounding factors may influence the results, suggesting an association where none exists. Bias may be introduced in the selection of cases or controls, in the reporting of exposures or outcomes, or in the disproportionate loss to follow-up of exposed and unexposed groups.
Limitations of Epidemiology
Studies cannot prove cause and effect.
A branch of philosophy that deals
with the systematic approach to understanding morality.
A better way to word it the questions is: when taking account morbidity and mortality for community health services, what information should the nurse integrate in planning?
True or False. In your analysis of a community-based health promotion program, you obtain a probability (p) value of 0.63, which means you should declare a significant effect for the program.
What are sugars, starch and fiber?
How does the capitalist market economy affect health care in the U.S.? Give several examples.
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