GPH Exam 3

what does step 4 (share PD findings with community and design activity) of the positive deviance inquiry process mean?

community validation of finding and creating of a PD informed activity in order to enable other community members to ACCESS and ADOPT new demonstrably successful behaviors (BCC strategy) basically what that ^ means is: why are some betters than ours? share the information so it can help everyone, and then promote those findings so every child can thrive

what does it mean when tobacco companies "use front groups to create illusion of support"?

keep up controversy not everyone supports smoking bans

what are some HSW interventions?

*cost effectiveness is best* 1. intervention in one or more of hygiene, sanitation, water supply or water quality, where preexisting conditions are poor - to reduce diarrheal disease (or with water piped to one or more taps on poverty) 2. to prevent ascaris (intestinal worm) hand wash to prevent transmission 3. trachoma treated by facial hygiene and hand washing 4. trachoma treated by latrines 5. hand washing 6. proper disposal of children stools 7. health professionals make slogans (clean hands feel good, first hands cause disease) - tailor to local people's beliefs and aspirations 8. ORT - oral rehydration therapy 9. hygiene promotion (is cost effective) 10. sanitation promotion (is cost effective)

what are the 4 policies regulating the study of gun violence through federal funds in the US?

1. 1993 - study finding that people were much more likely to die of gun violence if there was a gun in the home 2. 1996 - Dickey Amendment was included in the 1996 Omnibus Consolidated Appropriations Bill for Fiscal Year 1997 - cannot use federal dollars to conduct research on gun violence (can use private) 3. 2018 - congress clarified that the amendment did not ban public health research on gun violence, but just that the funds cannot be used to lobby for gun control 4. 2019 - congress passed funding for CDC and NIH to study gun violence

what are the symptoms of active schizophrenia/psychoses?

1. Delusions 2. Hallucinations 3. Disorganized speech 4. Lack of motivation 5. Catatonic behaviors 6. Social withdrawal 7. Distortions in thinking, perception, emotions, language, sense of self and behavior

explain the three private mechanisms to increase health insurance coverage through the ACA

1. Dependent coverage provision - Ex. an stay on parents insurance until 26 2. Individual mandate: everyone must have coverage, or pay a penalty (in 2019 the penalty was removed) 3. Employer mandate: employers with more than 50 employees must provide coverage or pay penalty (>$2,000 per employee)

what are some of the successes/benefits of the ACA?

1. Ambulatory patient services (outpatient services) 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance use disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices (those that help patients acquire, maintain, or improve skills necessary for daily functioning) 8. Laboratory services 9. Preventive and wellness services and chronic disease management 10. Pediatric services, including oral and vision care

within a NY Times article, what were the subcategories of spending on "demand focused solutions" in addressing the opioid crisis?

1. Community development - ex. Child care, family services, job training to revitalize communities and strengthen social safety net 2. Post-incarceration support - Get former inmates reintegrated into society 3. Education - Educate in schools, but also educate doctors and general public 4. Pain research (research into alternative pain therapies) - Ex. advil or ibuprofen - Would now focus on researching underlying causes of addiction

why didn't they recommend something else for MDRTB?

1. Cost effective 2. In accordance with emphasis on selective primary health care

7 steps to reduce interpersonal violence recommended by WHO

1. Developing safe, stable and nurturing relationships between children and their parents and caregivers 2. Developing life skills in children and adolescents 3. Reducing the availability and harmful use of alcohol 4. Reducing access to guns, knives, and pesticides 5. Promoting gender equality to prevent violence against women 6. Changing social and cultural norms that support violence 7. Victim identification, care and support programs

explain some reasons that health care in the U.S. is so expensive (from "A short parody about US health care" movie)

1. Doctors want to make money so test for everything possible Insurance companies - hire more people to look at bill so more expensive - pay to government 2. Pharmaceutical aspect - spend money in research and development - copays high - patents - no cheap generic drugs 3. Us spends more on healthcare than any other country

what are some of the issues/critiques of the ACA?

1. Health insurance premiums, in many cases, have gone up - Have deductibles - typically have to pay monthly to buy into insurance plan you have 2. Some people still cannot afford to get health care - Because premiums may be more expensive 3. Difficulty getting young, healthy individuals to sign up for individual insurance - Healthcare so expensive in US 4. Difficulties with roll-out of the websites for purchasing insurance 5. President Obama's original assurance that "if you like your plan, you can keep it" did not hold true 6. Some physicians won't accept plans for the exchanges - decreases health care provider access even if now have insurance access

what are 2 pieces of evidence where the regulation of the tobacco industry would not significantly cause economic losses?

1. If consumption declines, tobacco related job losses are more than offset by increases in employment in other industries with no negative impact on the overall economy 2. A recent publication highlights how the tobacco industry lobbied against cigarette taxation and tariffs on the pretext that reduced production costs would preserve jobs. Despite obtaining tax advantages, the industry still reorganized and consolidated its production processes, leading to job losses in the sector. In fact, even if its demands are met, it is not uncommon for the industry to threaten to close a factory or department and move elsewhere, despite its claims to social commitment and responsibility.

what are the goals of the ACA?

1. Increase access to health insurance: - Medical expansion, health insurance marketplaces and subsidies (compare plans and pick one you are going to purchase), and insurance reforms (people can stay on parents insurance until 26; cannot exclude people with disabilities) + individual and employer "mandates" (need insurance or will pay a fine; if company employed more than 50 people need to provide insurance) 2. Decrease health care costs 3. Improve delivery of care

within a NY Times article, what were the subcategories of spending on "treatment" in addressing the opioid crisis?

1. Medication-assisted treatment - medications to combat other substances 2. Medicaid - Reduced uninsured population 3. Treatment for prisoners - Almost all of inmates with addiction get no medical treatment - prone to relapse and overdose when they get out of prison 4. Attaining other research - Which treatments are most effective and which public policy interventions can have the most impact 5. Pre-trial diversion - Designed to keep people out of prison system by sending low level drug offenders into treatment and social services

what policies are a part of MPOWER?

1. Monitor tobacco use and prevention policies - Need data on tobacco use to know if its decreasing or increasing 2. Protect people from tobacco smoke - Public bans on smoking, etc. 3. Offer help to quit tobacco use - Provide people with counseling or anti-drug programs 4. Warn about the dangers of tobacco - Effective public health messaging or warning labels on cigarettes 5. Enforce bans on tobacco advertising, promotion and sponsorship 6. Raise taxes on tobacco

within a NY Times article, what were the subcategories of spending on "harm reduction" in addressing the opioid crisis?

1. Naloxone - Overdose antidote 2. Surveillance 3. Syringe exchange 4. Supervised consumption spaces - Use drugs under medical supervision to reduce likelihood of overdose 5. HIV/hepatitis treatment 6. Drug checking - Allows to test drugs for the presence of fentanyl or other contaminants

what are the four factors that affect drug use?

1. Pharmacological factors: how does a particular drug affect the body? (biology/developmental factors) - ex. When drug abused repeatedly changes your brain - makes it so your brain craves that positive hit over and over again 2. Cultural factors: how do societal views, determined by culture, custom and tradition, affect our approach to drug use? - ex. Certain drugs are more stigmatized etc. - influences what drugs you use 3. Social factors: what are the specific reasons why a drug is taken (peer groups, family upbringing, membership in social group/subcultures, etc.)? How they use dugs with - ex. People you surround yourself with use the drug - it becomes more normalized 4. contextual factors: how does the environment influence use - i.e., places people take/use drugs? (aka, the social context) - ex. How easy is it to acquire the drugs

examples of improved water sources

1. Piped household water connection 2. Public standpipe 3. Borehole 4. Protected dug well 5. Protected spring 6. Rainwater collection

what are some of the structural factors that are associated with neighborhoods that have high rates of violence?

1. Poverty 2. Lack of jobs 3. Exclusion 4. Racism 5. Segregation * lives could be saved by changing the behavior of individuals and shifting group norms

within a NY Times article, what were the subcategories of spending on "supply focused solutions" in addressing the opioid crisis?

1. Prescription monitoring (monitoring opioid prescriptions - electronically) - To reduce opioid prescribing, and identify those at risk of opioid addiction to guide them into treatment 2. Interdiction (international interdiction) - Screening of border traffic and international mail, increased staffing/support at customs checkpoints and the development of enhanced narcotics detection techniques 3. Local police - Screening of border traffic and international mail, increased staffing/support at customs checkpoints and the development of enhanced narcotics detection techniques 4. Reducing diversion - Drug take back initiatives - Development of secure prescription containers

what are the commercial determinants of health? (5)

1. Private sector activities can affect people's health positively or negatively 2. Business actions (e.g., labor conditions, product design and packaging, shaping consumer's preferences, lobbying, funding research) can influence social, physical, and cultural environments 3. Commercial determinants of health affect everyone, but young people are especially at risk 4. Unhealthy products can worsen pre-existing economic, social and racial inequalities 5. Low and middle income countries face greater pressure from multinational commercial interests

what should governments do to combat the tobacco industry in their compliance with Article 5.3 of the WHO's Framework Convention on Tobacco Control (FCTC)?

1. Raise awareness about the addictive and harmful nature of tobacco products and about tobacco industry interference with tobacco control policies. 2. Establish measures to limit interactions with the tobacco industry and ensure the transparency of those interactions that do occur. 3. Reject partnerships and non-binding or non-enforceable agreements with the tobacco industry. Not accept funds or help from the tobacco industry. Not support or endorse tobacco industry attempts to organize, promote, participate in or implement youth, public education or other initiatives that are directly or indirectly related to tobacco control. 4. Require that information provided by the tobacco industry be transparent and accurate. Require the tobacco industry and those working to further its interests to submit regular, truthful, complete and precise information on tobacco production, manufacture, market share, marketing expenditures, revenues or any other activity, including lobbying, philanthropy and political contributions, as well as the disclosure or registration of tobacco industry entities, affiliated organizations and individuals acting on their behalf, including lobbyists. 5. Denormalize and, to the extent possible, regulate activities described as "socially responsible" by the tobacco industry, including but not limited to activities described as "corporate social responsibility". 6. Avoid giving preferential treatment to the tobacco industry. 7. Treat state-owned tobacco companies in the same way as the rest of the tobacco industry. 8. Avoid conflicts of interest for government officials and employees. - Governmental action in this area should include: a) mandating policy on the disclosure and management of conflicts of interest, binding on all government officials, employees, consultants and contractors; b) implementing a code of conduct for public officials which prescribes the standards with which they should comply in their dealings with the tobacco industry; c) prohibiting contributions by the tobacco industry or any entity working to further its interests to the coffers of political parties, candidates or campaigns, or at least requiring full disclosure of such contributions.

a metric the WHO uses to measure UHC is: the proportion of a population that can access essential quality health services by looking at specific health services in 4 categories. what are these 4 categories?

1. Reproductive, maternal, newborn and child health: - Family planning - Antenatal and delivery care - Full child immunization - Health-seeking behavior for pneumonia 2. Infectious diseases: - Tuberculosis treatment - HIV antiretroviral treatment - Hepatitis treatment - Use of insecticide-treated bed nets for malaria prevention - Adequate sanitation 3. Noncommunicable diseases: - Prevention and treatment of raised blood pressure - Prevention and treatment of raised blood glucose - Cervical cancer screening - Tobacco (non-) smoking 4. Service capacity and access - Basic hospital access - Health worker density - Access to essential medicines - Health security compliance with the International Health Regulations

what does "DOTS-Plus" entail?

1. Second line medications 2. Monitoring with sputum culture 3. Drug susceptibility testing 4. Directly observed individualized therapy to the existing DOTS regimen 5. Observed the ingestion of medications 6. Provided nutritional and financial support 7. Attended to other medical and psychosocial needs

examples of improved sanitation

1. Sewer connections 2. Septic system connections 3. Pour-flush latrines 4. Ventilated improved pit latrines and pit latrines with slab or covered pit

what are the 4 critiques of the global mental health movement?

1. The medicalization of social suffering - People who previously would have been thought to have a "problem" are now considered mentally ill - Mental health treatment might not take into consideration local practices and traditions (west needs to understand how people perceive symptoms and such) - Diagnoses may not present the same in different cultures 2. Ignores local knowledge and practice - Only gives value to westernized medical treatment - Someone else in a different culture may be receiving local treatment but not according to western treatment, hence ignoring this local knowledge and practice 3. Not a true collaborative partnership between North and South - Does cross reference definitions and how to treat mental health 4. Anthropologically and socially naive - Doesn't look at structures of different cultures - Doesn't get to the root of many mental health issues (Ex. poverty, abuse, etc.) - Ignores social conditions (Ex. wars, poverty, inequality, structural)

what are the two metrics the WHO is using to measure UHC?

1. The proportion of a population that can access essential quality health services 2. The proportion of the population that spends a large amount of household income on health

what drugs kill the most people annually?

1. Tobacco (all forms) (NUMBER ONE KILLER) 2. Alcohol (ethanol)

what are the four steps to the public health approach to violence?

1. Uncover as much basic knowledge as possible about all aspects of violence 2. Investigate why violence occurs - looking at causes, correlations and risk factors 3. Explore ways to prevent violence using this information 4. Implement these strategies

explain why the U.S. has employer-provided health insurance (from "A short parody about US health care" movie)

1. World war 2 needed workers so got insurance through jobs 2. Doctors and government want more money

how do frequent infections increase risk of malnutrition?

1. children undernutrition because when kids do not eat, they can't absorb any nutrients that will help them get better 2. intrauterine growth restriction 3. diarrhea (can lead to dehydration, and decreased eating) 4. Zinc, Vit A, Iron, and Iodine deficiencies are needed to absorb nutrients from food

what contributed to a decline in tobacco use in the US since the 1960s?

1. found there was a correlation between smoking and many cancers 2. warning labels on cigarette packages 3. public health messages on TV and then ban of cigarette ads on TV 4. non smokers rights movement 5. 1986 = surgeon general's report on secondhand smoke - Talked about dangers of secondhand smoke to protect the people who don't smoke 6. increasing taxes on cigarettes 7. bans on smoking in public places 8. public health messaging 9. improved methods to help people quit

what are the equity issues which are inherent to the intersection of climate change and health?

1. geographical inequities 2. socioeconomic inequities/ differential vulnerabilities 3. intergenerational inequities 4. occupational inequities

what are the 3 specific risk factors for NCDs according to WHO

1. harmful use of alcohol 2. physical inactivity 3. tobacco use

what are the top 5 chronic diseases that have shared risk factors?

1. heart disease and stroke 2. chronic respiratory disease 3. diabetes 4. cancer 5. mental health

what are the impacts of long term alcohol use?

1. high blood pressure, heart disease, stroke, liver disease, and digestive problems 2. cancer of the breast, mouth, throat, esophagus, liver, and colon 3. learning and memory problems, including dementia and poor school performance 4. mental health problems, including depression and anxiety 5. social problems, including lost productivity, family problems, and unemployment 6. alcohol dependence, or alcoholism

to combat the obstacles in reducing tobacco use on a population level, what are the 6 ways that tobacco companies have interfered with tobacco control?

1. hijacking the political and legislative process 2. exaggerating the economic importance of tobacco 3. manipulating public opinion 4. using front groups to create illusion of support 5. discrediting proven science 6. intimidating governments with litigation

what are the most cost effective interventions (aka best buys) per WHO guidance for physical activity?

1. implement community wide public education and awareness campaign for physical activity which includes a mass media campaign combined with other community based education, motivational and environmental programs aimed at supporting behavioral change of physical activity levels 2. provide physical activity counseling and referral as part of routine primary health care services through the use of a brief intervention 3. ensure that macro level urban design incorporates the core elements of residential density, connected street networks that include sidewalks, easy access to a diversity of destinations and access to public transport 4. implement whole of school program that includes quality physical education, availability of adequate facilities and programs to support physical activity for all children 5. provide convenient and safe access to quality public open space and adequate infrastructure to support walking and cycling 6. implement multi component workplace physical activity programs 7. promotion of physical activity through organized sport groups and clubs, programs and events

what are the most cost effective interventions (aka best buys) per WHO guidance for harmful use of alcohol?

1. increase exercise taxes on alcoholic beverages 2. enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media) 3. enact and enforce restrictions on the physical availability of retailed alcohol (via reduced hours of sale) 4. enact and enforce drunk-driving laws and blood alcohol concentration limits via sobriety checkpoints 5. provide brief psychological intervention for persons with hazardous and harmful alcohol use 6. carry out regular reviews of prices in relation to level of inflation and income 7. establish minimum prices for alcohol where applicable 8. enact and enforce an appropriate minimum age for purchase or consumption of alcoholic beverages and reduce density of retail outlets 9. restrict or ban promotions of alcoholic beverages in connection with sponsorships and activities targeting young people 10. provide prevention, treatment and care for alcohol use disorders and comorbid conditions in health and social services 11. provide consumer information about, and label, alcoholic beverages to indicate, the harm related to alcohol

what are the most cost effective interventions (aka best buys) per WHO guidance for tobacco use?

1. increase taxes and prices on tobacco products 2. implement plain/standardized packaging and/or large graphic health warnings on all tobacco packages 3. enact and enforce comprehensive bans on tobacco advertising, promotion, and sponsorship 4. eliminate exposure to secondhand tobacco smoke in all indoor workplaces, public places, public transport 5. implement effective mass media campaigns that educate the public about the harms of smoking/tobacco use and secondhand smoke 6. provide cost-covered, effective and population wide support (including brief advice, national toll free quit line services) for tobacco cessation to all those who want to quit 7. implement measures to minimize illicit trade in tobacco products 8. ban cross border advertising, including using modern means of communication 9. provide cessation for tobacco cessation to all those who want to quit

what are the impacts of short term alcohol use?

1. injuries (can be minor - falling down or serious - car crash because driving drunk) 2. violence (alcohol poisoning, sexual violence, etc.) 3. miscarriage 4. risky sex 5. alcohol poisoning

what are the factors that put a child at risk for malnutrition?

1. lack of exclusive breastfeeding for the child's first 6 months 2. inappropriate supplementation 3. adverse weaning practices 4. no re-feeding after infection

what are the 5 results of malnutrition?

1. linear growth retardation 2. anemia 3. increased susceptibility to diarrhea, pneumonia, and malaria 4. immune system depression (x 6 months) 5. even if treated, long term effects on cognitive and motor function

what are the 4 most common health problems caused by tobacco use (these aren't the only problems)?

1. lung cancer 2. COPD - Umbrella term so has 3 different within it: a) Chronic bronchitis b) Refractory asthma c) Episimeia 3. heart disease 4. other cancers

6 categories of the tobacco industry's interference in health policies

1. maneuvering to hijack the political and legislative process 2. exaggerating the economic importance of the industry 3. manipulating public opinion to gain the appearance of respectability 4. fabricating support through front groups 5. intimidating governments with litigation or the threat of litigation 6. discrediting proven science acronym: MEM FID

what is one additional reason that the epidemiological transition model doesn't necessary hold related to. the COVID-19 pandemic?

1. theory that as countries become wealthier, transition from communicable to non communicable (due to lifestyle choices) (does not hold true to the COVID-19 pandemic) 2. theory cannot explain new infectious diseases 3. does Not account for how chronic and infectious diseases may interact with one another

what are the 6 risk factors that contribute the most to chronic disease (shared risk factors)?

1. tobacco use and exposure to secondhand smoke 2. high blood pressure 3. obesity (high body mass index) 4. physical inactivity 5. excessive alcohol use 6. poor diets (low in fruits and veggies, high in sodium and saturated fats)

what are the four main categories of spending to address the opioid crisis discussed in a NY Times article?

1. treatment 2. demand focused solutions 3. harm reduction 4. supply focused solutions

what two values are in tension?

1. want to reward work, ingenuity, and self-reliance 2. want to protect the weak and the vulnerable - at any point we could become weak and vulnerable, so why not protect the weak right now

what are the health impacts of ozone?

2nd hazardous to particulate matter breathe can irritate the lungs bad for people with respiratory diseases

what are the 3 main prongs of stopping infectious disease transmission according to the WHO?

3 main prongs: 1. Interrupt transmission 2. Prevent future spread 3. Change group norms

what % of global deaths are attributable to the lack of HSW?

4.2% of all deaths

how many people does dementia affect?

47.5 million people

what are the outcomes of the Nurse Family Partnership?

59% reduction in child arrests at age 15 * reduction 39% fewer injuries among children 56% reduction in emergency room visits for accidents and poisoning 48% reduction in child abuse and neglect * reduction

what % of global DALYs are attributable to the lack of HSW?

6.6% of DALYs

example of developing life skills in children and adolescents to reduce interpersonal violence (recommended by WHO)

CU center for the study and prevention of violence

what are the differences between active and latent TB?

Active TB: - Have symptoms - Usually feel sick - May spread TB bacteria to others - Usually has a skin test or blood test result indicating TB infection - May have an abnormal chest x-ray, or positive sputum smear or culture - Needs treatment to treat TB disease - can be transmitted latent TB: - Has no symptoms - Does not feel sick - Cannot spread TB bacteria to others - Usually has a skin test or blood test result indicating TB infection - Has a normal chest x-ray and a negative sputum smear - Needs treatment for latent TB infection to prevent TB disease - can not be transmitted

using India as an example, how is air pollution an externality of industrial processes and driving?

Air pollution has a direct correlation to causes of death in India Affects health of people and economy - Huge economic cost of people dying - 2013 lost a lot of GDP because of air pollution Government trying to implement - Clean air programs - Electric cars Need to integrate air quality into national policies Have started selling special masks to wear

maneuvering to hijack the political and legislative process of the tobacco industry's interference in health policies

Conspiring with lobbyists to promote self interested decisions in preference to those that serve the public good Ex. WHO FCTC - Enticing of controversy between financial, trade and other ministries on one side of the health ministry on the other side - Use of business associations and other front groups to lobby on the industry's behalf - Securing of industry access to WHO FCTC negotiations through its well established links with the International Organization for Standardization Sought to weaken legislation in many countries across the world Involves: - Creating and exploiting legislative loopholes - Demanding a seat at government decision making tables - Promoting voluntary regulation instead of legislation - Drafting and distributing sample legislation that is favorable to the tobacco industry Enter industry partnerships with different branches of government to fund joint projects

what is DOTS?

Directly observed treatment, short course

example of victim identification, care and support programs to reduce interpersonal violence (recommended by WHO)

Doctors Without Borders in Liberia medical legal response was offered: - STI prevention - pregnancy prevention - medical certificate - crisis counseling gender based violence task force led by the gender minister in 2005: women and children's protection unit was formed, also a revision of law related to sexual violence was put in place

why are environmental determinants of health related to emerging infectious diseases?

Environmental degradation is part of these spillover events Environmental changes can lead to... - Humans going further into natural lands to find food - Needing more foods due to other economic, population forces - Animals having higher viral loads because of stress from environmental changes because they have higher viral loads due to human invasion, most novel infectious agents will come from animal to human spillover events: - HIV from Chimpanzees to humans - Zika virus from a Rhesus monkey in Uganda

in what countries are the highest firearm suicide, and why?

Europe and North America because of the culture and policies

fabricating support through front groups of the tobacco industry's interference in health policies

Front groups = organizations that purport to serve a public cause while actually serving the interests of a third party, sometimes obscuring or concealing the connection between them. Uses phony grassroot groups -> ex. citizens rights or smokers rights groups Business front groups argue that tobacco control policies cause economic damage to the businesses they claim to represent. - Their role is to insist that banning smoking would cost them business and to create an aggressive mentality in legitimate restaurant and bar operators against government smoke- free policies. The tobacco industry has also created front groups to oppose consumer regulation, depicting it as an attack on individual freedom.

example of promoting gender equality to prevent violence against women to reduce interpersonal violence (recommended by WHO)

Grameen Bank loans to women's groups micro - crediting

what are the health impacts of indoor air pollution in developing countries?

Health impacts include: 1. Pneumonia (hits children the hardest) 2. Ischemic heart disease 3. Chronic obstructive pulmonary disease (COPD) 4. Stroke 5. Lung cancer

what does it mean when tobacco companies "manipulate public opinion"?

Hired public relation firms to help with their image and manipulate public opinion Fund ineffective youth smoking prevention groups Fund unrelated campaigns - ex. Domestic violence awareness against women

what does step 1 (defining norms) of the positive deviance inquiry process mean?

Identifying current feeding, caring and practices in the community (How often are kids fed? What do moms do when kids experience diarrhea? What are the kids eating? Do people practice hand washing techniques?) Target groups: primary caretakers and decision makers

exaggerating the economic importance of the industry of the tobacco industry's interference in health policies

Industry ignore negative economic impact on tobacco use - drain on public money caused by the need to treat millions of people with tobacco caused disease Claims to generate a high level of direct and indirect employment

what is climate change mitigation?

Interventions to reduce the sources and enhance the sinks of climate active pollutants (aka greenhouse gasses) lessening climate change itself

how does the tobacco industry use corporate social responsibility (CSR) to block anti-tobacco legislation?

It uses CSR to claim that it cares for society and the environment and to present itself as a responsible member of society - "Care for society" because CSR also combats disaster relief efforts and domestic violence against women, etc. Get in good with other industries and therefore when someone wants to do something anti-tobacco the industry has a bunch of organizations that are well disposed towards it or in debt to speak on their behalf

the DOTS program in Peru was cited as an example of why cost-effectiveness isn't always the best guide for decision making. Why was it problematic to use cost-effectiveness to make decisions about TB treatment in Peru?

Just because these second line drug prices were reduced, other drugs were still expensive Fueled epidemics of drug resistant disease Kept practitioners from responding easily when drug resistant disease ensued

in what countries are the highest firearm homicides, and why?

Latin America and the Caribbean these places are part of drugs (transporting, making)

example of changing social and cultural norms that support violence to reduce interpersonal violence (recommended by WHO)

MSF (Doctors Without Borders) in Papua New Guinea

explain the one public mechanism to increase health insurance coverage through the ACA

Medicaid: everyone covered whose income is less than 138% ($17,774 for an individual in 2021) of federal poverty level if state agrees (it is a state by state decision - all states are different - state decides whether you get it or not) Before the expansion, states determined eligibility levels for Medicaid Important for working parents, parentless children, etc.

example of developing safe, stable and nurturing relationships between children and their parents and caregivers to reduce interpersonal violence (recommended by WHO)

Nurse Family Partnership and Positive Parenting Program

what disorders are included under anxiety disorders?

OCD, PTSD, and generalized anxiety disorders

why is violence like an infectious disease?

both violence and infectious diseases can be prevented and its impact reduced

what is Vikram Patel's solution to the treatment gap in mental health?

SUNDAR! s = simplify the message un = unpack the treatment d = deliver it where people are a = affordable and available Human Resources r = reallocation of specialists to train and supervise

what do all the panelists agree on how to spend money to deal with the opioid crisis in the US?

Spend more money on treatment programs than anything else That there was no need for a border wall with mexico (like Trump wanted) Change comes from cultural shifts - Reducing stigma about addiction and changing how we think about pain Change federal law - Increasing addiction training for physicians - Reforming pharmaceutical industry - Removing federal restrictions on prescribing buprenorphine

what are the sources of indoor air pollution in developing countries?

Spend time collecting solid fuels - less time for other work and school Going long distances to get the fuels has risks to safety Doing the cooking or spending time indoors in high air pollution

what is the biggest disagreement between panelists on how to spend money to deal with the opioid crisis in the US?

The best way to divide up the money they were considering spending on the 4 categories (above) AND Whether to focus on treating addiction or trying to prevent addiction by addressing underlying social issues that allow opioid addiction to thrive

what are some possible human rights violations experienced by someone with mental illness>

The dignity of many people with mental health conditions is not respected Sometimes they are locked up in institutions - Institutions make them isolated from society, harmed, which is a violation of their human rights Many are subjected to physical, sexual and emotional abuse and neglect - In communities, prisons, hospitals, etc. They are very often deprived of the right to make decisions for themselves Denied access to general and mental health care Deprived of access to education and employment opportunities - Because of stigma - they face discrimination Prevented from participating fully in society

discrediting proven science of the tobacco industry's interference in health policies

The industry hired scientists and briefed journalists, government officials and members of the scientific community in order to keep them confused about the hazards posed by tobacco and secondhand smoke. The majority of tobacco companies continue to deny that secondhand smoke kills Say that real science is actually "junk science"

intimidating governments with litigation or the threat of litigation of the tobacco industry's interference in health policies

The tobacco industry, employing a veritable army of lawyers, threatens legal action against governments over tobacco control policies that threaten its profits. Intimidation tactics are deliberately designed to deter other countries from introducing similar tobacco control measures

how does reducing access to guns, knives, and pesticides reduce interpersonal violence (WHO)?

There is evidence to suggest that jurisdictions with restrictive firearm legislation and lower firearm ownership tend to have lower levels of gun violence Restrictive firearm licensing and purchasing policies - including bans, licensing schemas, minimum ages for buyers, background checks - have been implemented and appear to be effective in countries synch as Australia, Austria, Brazil, and New Zealand Studies in Columbia and El Salvador indicate that enforced bans on carrying firearms in public may reduce homicide rates

what are the different types of bipolar disorder?

bipolar 1, bipolar 2, and cyclothymic disorder

what are the sources of indoor air pollution in developed countries?

Tightly sealed houses trap air pollution from indoor sources Many modern products emit hazardous air pollutants (e.g., formaldehyde) Radon

what is an example of a method that worked to reduce violence in Scotland?

Violence Reduction Unit (VRU): - help with both psychological trauma and physical injury - run by police force with support from Scottish government

can different people with depression experience different symptoms?

YES

can depression have a variety of severity levels?

YES can have different levels of functionality as well, depending on its severity

what is the difference between a drug and a psychoactive drug?

a psychoactive drug specifically impacts the central nervous system

what does structure lead to?

agency!

what is an example of a method that worked to reduce violence in Chicago?

an interrupter (person that interrupts)!: - they intervene in aftermath of incidence and calm people down before a dispute escalates to violence - techniques they use: 1. constructive shadowing: echoing peoples words back to them 2. babysitting: staying with someone until they have cooled down 3. emphasizing consequences - they get to know the people - on a long term basis - so they gain trust

how does developing life skills in children and adolescents reduce interpersonal violence (WHO)?

by building life skills early on in life (social relationships, school enrichment programs, etc.) it teaches children how to respond to challenges in life in a positive way

how does reducing the availability of harmful use of alcohol reduce interpersonal violence (WHO)?

by regulating hours and days that liquor can be sold, and increasing prices and taxes on alcohol it reduces the consumption of alcohol, therefore decreasing violence should have long term treatment programs available for alcoholics

what are some potential structural reasons why COVID-19 is affecting the health of people of color in the US more than of white individuals?

certain areas can prevent people from making health choices - many minorities live in poverty stricken areas it is not always an individual behavioral decision

why do some people say that cervical cancer and liver cancer blur the line between infectious disease and chronic disease?

certain cancers are caused by cancer - cancer causing infections, such as hepatitis and human papilloma virus (HPV), are responsible for up to 25% of cancer cases in low and middle income countries

what are the 3 harmful experiences of childhood that increase one's risk for chronic mental disorders?

children living in poverty! 3 harmful experiences stemming from malnutrition: 1. Lack of education 2. Child labor 3. Child prostitution

what is an example of a method that worked to reduce violence in Boston?

choose to renounce violence to get an education or face tough penalties

what are the sources of ozone?

created through photochemical reaction of other air pollutants (tailpipe emissions from cars or natural emissions from trees, but also other forms of combustion of industry) need sunlight to occur

how has the criminalization of drug use harmed those suffering from a substance use disorder?

criminalization has harmed those suffering from a substance use disorder by: Putting in people that are associated to overdoses in jail for "homicide" - giving them these harsh prosecutions and sentences (ex. Second-degree murder) Usually when you call 911 for help you wont get in trouble. This doesn't apply to drugs, so if people are overdosing they cannot call 911 for help out of fear for going to jail for life

example of occupational inequities

deaths of agricultural laborers in the US, because they are not given shade or rest pregnant women and those with pre-existing conditions are more vulnerable workers in unventilated or crowded working conditions chronic kidney disease of unknown origin some places are getting too hot for people to work during daytime hours in the hottest times of the year (because of climate change, more places will become this way)

how is HSW a problem in both developing and developed countries?

developing countries: - ex. In bangladesh they use hand pumps on tube wells (improved sanitation) that provide water laced with arsenic developed countries: - People do not wash their hands enough - Sewage treatment is not universal or fully effective (discharged into rivers and coastal areas constitutes a health risk to bathers and others) - Small community systems are difficult to run properly but are far more common than often perceived - Surveillance does not always work

examples of tertiary prevention

diagnosed with cancer? give them chemotherapy

what health outcome is the leading contributor to HSW-attributable DALYs?

diarrhea (diarrhea in early childhood contributes to more DALYs than do deaths)

why do we need to change social and cultural norms that support violence in order to reduce interpersonal violence (WHO)?

different cultures have different rules and expectations concerning violence, some may even encourage violence

what are the common infectious disease transmission routes?

direct: - direct contact (kissing, touching (hand-shaking), sexual contact) - droplet spread (close (within 6 feet) spreads of droplets from breathing sneezing, coughing) indirect: -airborne - vehicle borne (through inanimate objects such as food, water, fomites) - vector borne (through animate objects - insects, rodents, etc.)

how is climate change linked to health outcomes through the many pathways discussed in class?

direct: - severe weather - air pollution - environmental degradation indirect: - asthma - cardiovascular disease - malaria these are just a few examples

what is the agency approach to health prevention?

education/information approach ex. 1. providing information on the importance of eating well and exercising focus on individual choices, assuming people have full agency/power to make all of their choices

which health interventions are focused on structural determinants of health rather than individual behaviors?

ex. encouraging someone to eat a healthier diet incentives for supermarkets to cite in lower income neighborhoods taxes on sugary beverages subsidies for fruits and vegetables rather than for corn and soybeans expanding SNAP and WIC benefits enacting laws that require a living wage (raising the minimum wage)

how have the social determinants of health play into data on COVID-19 disparities and health?

examples: being exposed to it related to your job (if you don't have a job that you can do remotely) being exposed to multiple family members with different lives - all living in the same household if you don't live near a place with healthcare access or vaccination access physical determinants - how crowded and where you live

what does it mean when tobacco companies have "hijacked the political and legislative process"?

exciting controversy use front groups to lobby for them get involved in tobacco legislation in some countries

what does step 3 (what to look for?) of the positive deviance inquiry process mean?

finding out why they are successful! is it because of: 1. feeding practices - frequency of feeding - supervision of feeding (active feeding) - variety of food in the child's diet - amount of food and consistency - appropriate feeding of child during and after illness 2. caring and hygiene practices: - experiences secondary caretaker (mom + dad) - positive interactions with child -psycho-social care - gender equity in childcare (some cultures value males more) - good body, food, and environment hygiene 3. home care practices like home management and health seeking: - appropriate home management of childhood illness (knowing when to take them to the hospital) - identification of danger signs - timely seeking qualified help when chid is sick - complete immunization

what are the purposes of MPOWER?

gives countries specific recommendations and tools to measure how they are doing in these 6 areas: 1. Monitor tobacco use and prevention policies 2. Protect people from tobacco smoke 3. Offer help to quit tobacco use 4. Warn about the dangers of tobacco 5. Enforce bans on tobacco advertising, promotion and sponsorship 6. Raise taxes on tobacco

example of a women in India experiencing expression

her symptoms: - Feels "unwell" - Stays in bed all day - Unable to work - Fatigue - No interest in sex - Despairing in the west, she would be diagnosed with major depressive disorder, however, she lives in India. her family life: - she is malnourished - lives in poverty - fights with her husband - her husband is an abusive alcoholic - she is raising her two children on her own does she fit depressive disorder criteria? or is she just having a reaction to her situation? why does it matter? it matters because it changes the way we address the problem

HSW stands for?

hygiene, sanitation, and water

what are the health impacts of fine particulate matter (PM2.5)?

impacts: respiratory systems nose trachea bronchus diaphragm lungs

why did Socios en Salud implemented "DOTS-Plus"?

implemented DOTS-Plus because: Problem patients (said did not comply with treatment) - Those treated with DOTS who still had active TB - Tested positive for strains of MDRTB

what is the problem with utilizing the Diagnostic and Statistical Manual of Mental Disorders in populations other than Europe and North America?

in areas other than Europe and North America the DSM has uncertain validity because it did not originate in these countries mental disorders are presented differently throughout cultures: - the phenomenological variation in psychiatric presentation and the culture-specific rhetoric used to signal distress is different

is the HSW intervention, "hand washing," structural or individual?

individual

is this HSW intervention, "to prevent ascaris (intestinal worm) hand wash to prevent transmission," structural or individual?

individual

is this HSW intervention, "trachoma treated by facial hygiene and hand washing," structural or individual?

individual

what do people with bipolar disorder experience?

intense emotional states that typically occur during distinct periods of days to weeks, called mood episodes these mood episodes are categorized as manic/hypomanic (abnormally happy or irritable mood) or depressive (sad mood) will have neutral moods as well

what does it mean when tobacco companies "exaggerate the economic importance of tobacco"?

it claims that without the tobacco industry there will be extreme job losses (there is no evidence to support this)

how does promoting gender equality to prevent violence against women reduce interpersonal violence (WHO)?

it gives women the autonomy (educational and financial support) to leave bad situations

how is TB spread?

it is airborne: When someone with TB coughs, speaks, or sings, TB bacterial droplets can get into the air and someone nearby can inhale these droplets and become infected.

from the Ted Talk, why does the speaker state that violence is an infectious disease?

it is an infectious disease because it spreads like a disease from person to person

why is it important to use non stigmatizing language in relation to drug use?

it is important because it impacts the way the person is thought of and how they think about themselves. should use person first language, like person with a substance use disorder vs. a druggie. - this is a less stigmatizing term, and a clinical/diagnostic term

in which regions of the world and in which regions of any country are there more people who lack access to sanitation?

people in rural areas people in African countries (they have a clean water and water supplies)

what is the agency portion of the structure/agency debate?

people make their own choices on their behaviors that influence their own health do we have the confidence, knowledge, resources, able to control aspects of our lives when it comes to health?

americans agree broadly on one topic about who the rules should apply to when it comes to getting heath care - who do these rules apply to?

people who contribute to healthcare costs and contribute to society

what is the structural approach to health prevention?

policy approach ex. 1. taxing sugar-sweetened beverages or tobacco 2. providing incentives for grocery stores to put in locations where there are food deserts 3. requiring PE in schools focus on the societal structures that influence individual decisions

why did officials initially recommend use of regular DOTS for MDRTB (even if it was drug resistant)?

officials initially recommended because: 1. patients were to be observed taking their medications 2. recommended by CDC guidelines

example of intergenerational inequities

older generations fail to protect the younger generations from climate change people who experience climate change the worst are not the ones that are responsible for it

what are the health impacts of unsafe water, sanitation, and hygiene?

possible diseases: gastrointestinal problems - linked to poor nutritional intake - hard for child to absorb nutrients from food diarrhea - dehydration and death can affect childhood stunting

what are some of the reasons hypothesized for the racial and ethnic disparities in COVID-19 infections, hospitalizations, and deaths?

racial disparities: cases = People of color have disproportionate number of cases in the US deaths = People of color have disproportionate number of deaths in the US hypothesized: - Bias and racism in healthcare - Inequalities in money - Distrust in the medical system - receive bad treatment - Nonessential workers - more likely to be exposed - do not work from home - Multigenerational families - Where they are living: - - Air pollution in colored communities has impacts on how you react to covid - can cause you to have a worsened impact of disease

manipulating public opinion to gain the appearance of respectability of the tobacco industry's interference in health policies

uses CSR

examples of secondary prevention

screening for noncommunicable diseases - mammograms, regular blood pressure testing, colonoscopies

from the Ted Talk about gun violence, how does this shift the paradigm of how we think about violence?

shift away from racist norms there are not just bad people we have to treat everything: poverty, education, alcohol abuse, etc.

example of a front group within the tobacco industry

smokers rights groups

what are the sources of fine particulate matter (PM2.5)?

solid and liquid particles that are so small that they get suspended in the air - what you see when you see haze in the sky (this is particulate matter in high concentrations) so small that they get into your lungs created through combustion of smoke from heating and cooking and fossil fuel combustion

what infectious disease transmission route seems to be the dominant pathway for COVID-19?

spreads through: - breathing in air when close to an infected person who is exhaling small droplets and particles with virus - having small droplets land on eyes, nose, and mouth - touching the eyes, nose, or mouth with hands that have virus on them as it is air borne: - that is why people need to avoid crowded places and need to wear masks - people who are asymptomatic or pre symptomatic can still pass the virus onto others what to do: if airborne - increase ventilation - reduce time indoors and reduce crowding - wear masks indoors if direct through develops and fomites: - stay 6 feet apart - reduce direct contact - clean surfaces and physical barriers - wear masks when within 6 feet of each other

what are the 4 steps of the positive deviance inquiry process?

step 1: defining norms step 2: identifying positive deviant children step 3: what to look for? step 4: share positive deviance findings with community and design activity

is the HSW intervention, "ORT," structural or individual?

structural

is the HSW intervention, "hygiene promotion," structural or individual?

structural

is the HSW intervention, "proper disposal or children stools," structural or individual?

structural

is the HSW intervention, "sanitation promotion," structural or individual?

structural

is this HSW intervention, "intervention in one or more of hygiene, sanitation, water supply or water quality, where preexisting conditions are poor - to reduce diarrheal disease," structural or individual?

structural

is this HSW intervention, "trachoma treated by latrines," structural or individual?

structural

is the HSW intervention, "health professionals make slogans to tailor to local people's beliefs and aspirations," structural or individual?

structural stemming into behavioral

symptoms of depression

symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of depression 1. Feeling sad or having a depressed mood 2. Loss of interest or pleasure in activities once enjoyed 3. Changes in appetite - weight loss or gain unrelated to dieting 4. Trouble sleeping or sleeping too much 5. Loss of energy or increased fatigue 6. Increase in purposeful physical activity (e.g., inability to sit still, pacing, handwriting) or slowed movements or speech (these actions must be severe enough to be observable by others) 7. Feeling worthless or guilty 8. Difficulty thinking, concentrating or making decisions 9. Thoughts of death or suicide

what data supports the benefits of the ACA?

that most people should be covered by insurance plans but that doesn't mean that they don't have to and won't have to pay for copays.

who is most affected by indoor air pollution in developing countries?

the poor who only use solid fuels disproportionately affects women and children who use solid foods, while working in kitchen with little to no ventilation solid fuels = wood, crop waste, coal, dung, etc.

what is the structure portion of the structure/agency debate?

the rules and resources of society that give rise to social practices that influence their health what society gives them that determines their health

from the Ted Talk, what does he refer to as an interrupter?

they are people that: 1. Detect and find first cases - ex. Find person that is angry 2. Prevent further spread - Find who else is being exposed - someone who has not done anything yet but probably will 3. Shift the norm - Community activity, public education, etc. they are people that are tightly knit within the community. they have credibility, trust, and access to. the community. they can persuade people.

what does it mean when tobacco companies "discredit proven science"?

they pay scientists to publicly claim that they doubt evidence between a link of cancer and smoking and secondhand smoke

what is the Nurse Family Partnership?

to reduce maltreatment and therefore childhood aggression later on in life they do home visits: giving child advice, parenting advice, parenting support, and child education they stick with the family for years - following up

what are the purposes of the Framework Convention on Tobacco Control (FCTC)?

to strengthen coordination to decrease tobacco use on a global scale set global framework for tobacco initiatives (an overarching guide or framework)

what is one reason that specific ethnic/racial groups have higher levels of tobacco use?

tobacco industry specifically targets hispanics, native Americans, native Alaskans, African Americans, and asian communities in their marketing

what is meant by universal health coverage (UHC) by the WHO

universal health coverage: 1. Universal health coverage is defined as ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation, and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user to financial hardship. Universal health coverage has therefore become a major goal for health reform in many countries and a priority objective of WHO 2. Making sure people people have access to health care when and where they need it 3. Needs to be provided to people without causing serious financial issues to them (does not mean it has to be free)

what does it mean when tobacco companies "intimidate governments with litigation"?

use lawyers to threaten expensive litigation against policies that will ban smoking

examples of primary prevention

vaccinations noncommunicable diseases - helping people alter risky behavior (ex. healthy eating habits) policy prevention (ban alcohol or something like that)

what does step 2 (identifying positive deviant children) of the positive deviance inquiry process mean?

weigh all children in target area select well nourished children identifying well nourished children from poor families (as defined by community wealth ranking)

example of geographical inequities

which region/country emits the most carbon emissions and which region/country is affected most by this emission