Define and explain the 3 core functions of public health
1. assessment: find the issue, assess the issue
2. policy development: keep it local, make your
... [Show More] situation a plan
3. assurance: make it work, testing of it to make sure it works
science vs. politics
SCIENCE: knows real success rates and when to test for stuff
POLITICS: politicians falsely informing/distorting infof to improve their reputations
ie. mammograms
cost of medical care
$3 trillion
Public health gets 3% of that
IN THE US, QUALITY OF MEDICAL CARE IS OFTEN QUESTIONABLE AND STIL HAS A PERCENTAGE W/O HEALTH INSURANCE
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5 steps to assessing a public health problem
1. define the problem
2. identify risk factors
3. develop and test community level interventions to control/prevent the cause of problem
4. implement interventions
5. monitor intervention and its effectiveness
define and explain the 3 levels of prevention
1. PRIMARY: prevents an illness or injury from occurring at all ie. vaccines
2. SECONDARY: seeks to minimize severity of illness/injury once event has occurred ie. mammogram, seatbelt
3. TERTIARY: help once event has occurred ie. PT, OT
chain of causation
host : susceptible
agent : thing that does the killing
Environment : where host is
vector : facilitator to get agent to host
~if you fix one, all will benefit b/c all connected
identify the chain of causation in ZIKA
host : person
agent : Zika virus
environment : miami, africa
vector : mosquito
what is "The Future of Public Health?"
published by the institute of medicine. showed public health people how they werent perfect
gave suggestions : 3 CORE FUNCTIONS OF PUBLIC HEALTH
how has public health changed in the past 150 years?
(5)
1. changes in death rates
2. vaccines
3. accidents and injuries
4. waste and sewage disposal
5. water quality
25 YEARS OF THE 30 YEAR LIFE EXPECTANCY INCREASE IS ATTRIBUTED TO PUBLIC HEALTH INTERVENTIONS
45 --> 75
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public health vs. medical care
med: patient is individual
pub: patient is community
med: goal = cure
pub: goal - prevention of disease&disability
SES IS THE #1 DETERMINING FACTOR OF YOUR HEALTH
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social justice vs. market justice
social justice : common good. should be a fundamental right. bernie sanders
market justice : individual responsibility. right to be left alone
4 reasons why public health is so controversial
every single life matters!!!!
politics are almost always controversial
"parenting"
SES is important
biggest example of bioterrorism in epidemiology
anthrax letters in the mail
what are the 2 biggest examples of public health and terrorism
9/11 & anthrax letters
public health response to disasters?
both natural and man made
helps to control damage, prevent further harm to survivors and rescuers
FOR ALL STUDIES WE MUST CONSIDER HONESTY ERRORS AND DROP OUTS
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case control study
choose people who already have disease for the case group.
ALWAYS RETROSPECTIVE
fastest and cheapest
cohort study
for situations where an intervention would be unethical or too difficult
people who are healthy start
intervention study
closest thing to an experiment
mortality rate
number of deaths from a disease in a defined population over a defined period of time
prevalence rate
total number of cases in a defined population at a specific moment in time
incidence rate
rate of NEW cases in a defined population over a defined period of time
rate
a measure of disease frequency
step 1 of epidemiology
define disease/health outcome
-sometimes easy, gunshot
-sometimes hard, HIV
explain possible "who's" in epidemiology
age, sex, race, SES
epidemiology and chronic disease
identify risk factors, then observe long term factors
how to determine patterns of disease occurrance
1. WHO is getting disease
2. WHEN did they get disease?
3. WHERE is disease occurring
ALL = WHY it's ocurring
what actually is epidemiology?
the diagnostic discipline of public health
an observational science
investigates cause of diseases
john snow
father of modern epidemiology
-cholera
-shoe leather
-H2O supply --> handle of pump
FDA
Food and Drug Administration
does not test vitamins and supplements
NIH
National Institutes for Health
CDC
center for disease control and prevention
local public health agencies
have to provide care for the poor
begins and ends with locals
police powers in public health
preventing people from hurting themselves, each other, and to defend the rights of incompetent persons
medicare vs. medicaid
medicare : elderly 100% funded by govt.
Medicaid : AID for at risk people, low income, 50%-80% funded by govt
what is the federal govt's role in regulating public health
regulate interstate commerce, COLLECT TAXES
who regulates public health?
THE STATE
union of concerned scientists
signed by 60 scientists
-documented instances of hidden info to "look better"
-ie. abortion = breast cancer (false), abstinence only programs, climate change
GEORGE W. BUSH IS A LYING PIECE OF SHIT
moral and religious issues with public health
sex and reproduction
alcohol and drugs
assisted suicide and other life ending/EOL decisions
individual liberties, when does public health step in?
-to prevent harm to others
-paternalism: laws to protect kids
-to protect individuals from own actions ie. helmet laws
-tragedy of the commons
economic impact on public health
businesses often resist public health because they affect profit
those who must pay are usually not the ones who benefit
cost easier to calculate than benefit
define health
state of complete physical, mental, and social wellbeing - not just the absence of disease
Health is a fundamental right of every human regardless of race, religion, political belief, economic or social condition
define public health
the science and art of preventing
the river metaphor
river = disease
bridge = public health
health disparities
Inequalities that exist when members of certain populations do not benefit from the same health status as other groups
common divides where we see health disparities
race
SES
age
gender
education
geographical location
endemic
what is normally occurring ie. flu
epidemic
significantly higher than normal within a community ie. ebola in KY, mumps on campus
pandemic
when an epidemic exceeds borders ie. Zika
Leigonnaire's disease
people at a conference were getting really sick and they discovered the disease was spreading through the air vents
sources of error in studies
random variation
confounding variables
bias
factors that lend validity to study results
strong association
dose-response relationship
known biological explanation
large study population
Tuskegee syphilis studies
poor, uneducated, black men were gathered and tested on without being told what for or that they had syphilis
SCIENCE IS ONGOING, STUDIES MAY CONTRACT EACH OTHER
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probability
what usually happens, but the most improbable things are bound to happen eventually
p-value
if p is greater or equal to 0.05, result is significant
law of small probabilities
the rarest things are sometimes ocurring
power
probabilities of finding an effect, if there is an effect
best way to increase power is to have TONS of participants
why screening?
to catch it before it creates more harm
sensitivity vs. specificity
sensitivity : anything that has even the smallest chance of being positive is flagged... lots of false positives
specificity : being as detailed as possible in tests. flags things that are absolutely definitely positive... lots of false negatives
birth rates
we are the best at recording birth rates than any other rate
crude rates
how many people died
adjusted rates
how many women died vs. how many men died
age adjusted rates
alaska vs. florida mortality rates
group specific rates
ie gender specific
years of potential life lost (YPLL)
accidents, cancer, heart disease
risk assessment and risk perception
-for well known risks, can be calculated from historical data, but from poorly understood risks, must make many assumptions
-risk perception involves psychological factors
example: being terrified of flying but not of driving even though driving is far more dangerous
cost-benefit analysis
cost is easier to calculate than benefits
what monetary value can we put on a saved life?
often controversial
cost-effective analysis
when you have a program in place, and you run another program to compare
why do we need data?
-so we know what is going on
-asses the health of a community
-raw material for research
vital statistics
local records, of birth, death, and notifiable diseases
local --> state --> federal
census
serves as a denominator for tons of studies
every 10 years
every American must be accounted for
short form vs. long form
American community survey
began in 2005
asks more detailed questions than the census does
is there too much data?
no
confidentiality
govt has safeguards to protect individuals
use of data may include removal of identifying information
review boards
what is the number 1 infectious killer today?
TB
what kills us then and now?
over half of us died if infectious diseases in 1900, now, less than 3% of us die from infectious disease. public health has been extremely effective in preventing infectious diseases
how did we conquer infectious diseases
water purification
waste disposal
milk pasteurization
immunizations
antibiotics
Edward Jenner
smallpox, 1796
Discovered that the milkmaids weren't getting smallpox, they said it was because they had cowpox. So he took a servant-level child and gave him the cox pox, and waited for child to recover. The child recovered and then Jenner infected him with smallpox to see if the cowpox made him
Jonas Stalk
polio, 1952
People asked him if he would patent the polio vaccine, since everyone would want/need it. Polio devastated families and killed tons of people, so he could make a lot of money off of patenting it. He said "why would I patent it? It would be like patenting the sun." He recognized that people needed it, not just wanted it, and didn't want to take their money, and instead just GAVE people the vaccination.
means of transportation for disease
water
food
vectors such as insects or animals
air/aerosols
means of transmission for disease
fomite
fecal-oral transmit
bodily fluid
when are things contagious?
symptomatic phase.
tb, common cold, you look nasty, people already know to stay away from you. you're contagious when you look sick
pre-symptomatic phase
measles, mumps, you are contagious before you show signs of being sick
carrier state
tyhpoid mary, you are contagious although you are perfectly healthy
chain of infection
pathogen, reservoir, means of transmission, susceptible host
public health measures to stop infectious diseases
epidemic surveillance
contact tracing
immunization and treatment of identified patients
quarantine
is eradication possible?
only if there is no non-human reservoir
factors tat lead to emergence of new infections
modern agricultural practices
international travel
international distribution of food and exotic animals
break down of social restraints on sexual behavior
HIV/AIDS stats
first recognized in the US in 1981
now a worldwide killer
-US- 50,000 new cases/year
-78 million infected world wide - 39 mil have died
-1 in 20 are HIV positive in sub saharan africa
HIV/AIDS screening
recognized antibodies, not present until 3-6 weeks after initial infection
HIV/AIDS transmission and treatment
transmission:
-sexually & needles
-mother to infant
-blood transfusions
HIV is kind of chronic because of long term effects
many drugs now available, but no cure. price is skyrocketing, which affects you SES and your ability to live or die with it
how many people died of influenza in the 1918-1919 flu?
20-40 million
what is the mortality rate for untreated TB?
50%
the shift from infectious to chronic diseases
loss of a specific agent
complexity increases
leading cause vs. root cause
importance to public health
Leading causes of actual deaths. characteristics and top 3
top 3:
-smoking
-poor diet and physical inactivity
-misuse of alcohol
characteristics:
-account for almost half of all deaths
-most are preventable, premature, and caused by individual behavior
-targets for individual health intervention
what can we do about the leading actual causes of death and will it work?
EDUCATION --> tobacco, sex ed, play 60 --> eh
REGULATION --> taxes, bans, prison --> yes
PROHIBITION --> alcohol, drugs --> no
behavior and social environment
humans are social creatures and their behavior is strongly affected by their social environment
focusing on individuals leads to BLAMING, however focusing on social environment leads to BIG PICTURE THINKING :)
health is affected by SES , gender, marital status, race, and ethnicity
the effects of SES
SES is the most important predictor of health
health gradient hold at all levels of social scale bc
- nutrition
- sanitation
- conditions of physical environment
- high SES = healthier behaviors, educated, and health literate
health of minority populations
in the US, racial and ethnic minorities have poorer health than the white population does
-life expectancy
-infant mortality
-diabetes
-cancer
-hiv/aids
psychological factors of health
stress
social support
change in the environment
self efficacy
effects of stress
mortality increases after divorce, death of a family member, job, etc...
increases risk of heart disease
stress increases as SES increases
childhood stress = lifetime consequences --> ACES
social support on health
alameda study
people with more social support had lower mortality
define disaster
disasters can cause death, injury, disease, and property damage on a scale beyond the routine emergencies to which the health system accustomed
types of disasters
natural --> predictable
technological --> not predictable
response for all types of disasters
search and rescue
treatment and evacuation of injured
food, water, shelter for survivors
minimize environmental hazards
ALL TYPES REQUIRE RESPONSE PLANNING
9/11
north tower hit first, then pentagon, then south tower.
communication really lacked, which killed a lot of people.
people killed vs. saved from 9/11 towers
2,801 killed in terrorist attacks
13,000 - 15,000 saved
failure to protect clean up crews and rescuers fro environmental hazards continues to kill people
world trade response: routine public health functions
- Issued death certificates and burial permits
- Monitored safety and food and drinking water served to emergency workers
- Cleaned up food in abandoned restaurants
- Sampled dust and debris to assess risk
- Surveillance of cleanup workers and area residents for symptoms
- Arranged for mental health counseling
- Victim location services
changes made after 9/11
• Money provided fed. Govt. to improve county, city, and state emergency preparedness
o 9 billion dollars since 2002
o used for planning, training, improving communication and coordination, strengthening hospitals and labs, and improving epi surveillance
• CDC set up a Strategic Nationwide Stockpile that can be delivered anywhere in the country within 12 hours
what is in the Strategic Nationwide Stockpile?
medical supplies, antibiotics, antidotes, vaccines.
hurricane katrina
New Orleans located below sea level, category 5 storm
people evacuated to the Super Dome, but way too many people showed up and there weren't enough supplies. tons of low SES people had no means of escape--> very bad. canadian troops showed up before America's did, 1800 deaths. no directions of what to do. race and SES played a big factor in who lived and who died
after hurricane katrina passed
damaged housing
contaminated FEMA trailers
large displaced population
what was the most deadly disaster
2004 Indian Ocean Tsunami
230,000 deaths
current national threats
tsunami -->2004 Indian Ocean
hurricanes
floods
forest fires
tornadoes
earthquakes --> 2010 Haiti
volcanoes
snow/ice storms
current technological threats
domestic vs. international terrorism in the US
unrest abroad
mass shooting
EMP
nuclear disaster
infrastructure & engineering disasters
bioterrorism
who has the best emergency planning??
the mormons hahahahahhahahaha
principles of emergency preparedness`
-practice and drill are key!!!!!!
-importance of advance planning involving all agencies
-importance of good communication
-incidence command system
-fed. govt. has provided funding to states and metropolitan areas for planning
-fed. govt. needs to find emergency planning
-Strategic national stockpile needs to actually be used
what is the incident command system
put a single person in charge at scene
bioterrorism preparedness
-same as preparedness for epidemics
-surveillance is important
-need for laboratory capability
-need for public health laws enabling authorities to take action
-problem of whether uninsured will seek care
-need for coordination between public health and law enforcement
surveillance activities
• Emergency room visits
• Calls to 911 and poison control
• Veterinarian diseases
• Pharmacy records
• Uninsured and undocumented immigrants
3 basic requirements for human life
food
water
air
ENVIRONMENT IS BEYOND THE CONTROL OF INDIVIDUALS
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what were the first known public health measures
as early as 2000 BC, cities in India, Egypt, Greece, and S. America had clean water and sewage drainage
role of govt. in environmental health
local govts provide clean water and disposal of wastes
as populations grew, environmental problems transcended local govt.
in the 60's and 70's govt. took more responsibility.
as urbanization/suburbanization grew, the number of environmental concerns have grown
Environmental Protection Agency (EPA)
Radiation
-UV light from the sun
-Radium girls
- Gas
-early scandals: xrays and radioactive ingredients in med.
-Radon girls
-lessons on health effects of radiation learned from atomic bombings in Japan
Mercury
-neurological damage --> mad hatter
-japan in 1950's
-iraq in 1972
-current cause of mercury levels: coal burning power plants
-concern about fever thermometers and school lab equiptment
lead
MOST IMPORTANT ENVIRONMENTAL THREAT TO AMERICAN CHILDREN
-harmful to brain and nervous system
-was used in paint until 1977
asbestos
-was widely used bc of fire resistance
-was required in schools
-lung cancer
-world trade centers --> clean up and rescue workers
pesticides and industrial chemicals
-Rachel Carson's Silent Spring - 1962 --> beginning of environmental movement
-DDT and other pesticides banned in 1972
-PCB's: hudson river, most widespread chemical contaminant in the world
-skin rash, discoloration of newborns, headaches, fatigue, etc...
what is the effect of endocrine disruptors
FDA had declared them safe but now reconsidering.
potentially affect reproduction, nervous system, immune system, maybe cancer
risk-benefit analysis
-absolute safety is impossible
-over-regulation can cause under-regulation
-must balance risk against other societal goals, including economic well-being
-political groups sometimes favor economic and business interests over environment and public health
carrying capacity
number of organisms that can be supported without degrading environment
thomas mathus
predicted that human population growth would outgrow food supply
what is the current world population
7 billion
what does the UN predict the world population will be in 2050?
9.3 billion
where does excess population settle?
cities
how has public health contributed to population growth
by reducing death rates in developing countries, especially among children
how much of the world is living with water shortages?
1/3
what global resources are being depleted
fresh water
fuel
food
what percent of the world's pop are chronically or acutely malnourished?
14%
what percent of the major marine fish stocks are exploited or significantly depleted
75%
what percent of the earth's vegetated surface is at least moderately degraded?
10%
POPULATION STABILIZATION COMES WITH MODERIZATION AND ECONOMIC VIABILITY
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who is opposed to contraception?
catholics and muslims
what countries blame each other from population growth?
rich and poor countries
1994 UN Conference: 20 year program of action
-education for women
-empowering women to choose fewer children and providing family planning options
-reducing infant mortality rates
major countries associated with high greenhouse gas emissions
China is #1 greenhouse gas emitters.
20% of the world pop, 24% of greenhouse gases
US is #2 greenhouse gas emitters
18% of world pop, 20% of greenhouse gases
smaller percentage than china, but higher per capita
define carrying capacity
the number of organisms that can be supported without degrading the environment [Show Less]