PHP320 Exam 1

What is the U.S. Census?

A comprehensive assessment of all U.S. households conducted every ten years by the census bureau

What is age-adjusted mortality rate?

A method of standardizing mortality rates across demographic groups and reducing confounding by age Allows for comparisons of demographic events at different times, places, or populations

What is "Healthy People?"

A science-based, 10-year national list of objectives for improving the health of Americans

What is health?

A state of complete physical, mental, and social well-being and not simply the absence of disease or infirmity A fundamental human right

What is the American Community Survey?

A yearly survey given to a sample population in the U.S. in place of the long version of the census form

How do structural inequalities influence health outcomes?

Access to Resources (employment, health care, education) Neighborhood Conditions (segregated housing, air quality, food, public transportation, built environment)

What are the current effects of redlining?

Access to financial resources accumulate over time and are passed down through generations 74% white vs 45% Black home ownership 97K white vs 5K avg. family wealth

What are causes of health?

Accumulation of risk factors and behaviors Risk burdens increase as you age and accumulated risks impact health outcomes

How do we address health inequalities?

Acknowledge that health inequalities do not occur randomly Understand the underlying causes and upstream determinants Act on situational inequalities in health in order to work toward health equity

What is a public health intervention?

Act of intervening in the process of development and change so as to maintain, enhance, or interrupt behavior patterns or conditions of living that's linked to improved health or to increased risks for illness, injury, disability, or death

What are the pros of upstream interventions?

Affects the most number of people Most efficient form of intervention Sets the tone for more micro-level interventions

What is a health disparity?

Any health outcome that is seen to a greater or lesser extent between populations A particular type of health difference closely LINKED by social, economic, or environmental disadvantages

What is the standard population?

Anyone in the population counted by the census within a specific age group in a given year

What is the threshold age of death?

Arbitrarily put at 75 WHO uses 84 based on Japan Adjusted upward as people live longer

What does the National Center for Health Statistics do?

As part of the CDC, the NCHS collects, analyzes, and reports U.S. health statistics

What is health equity?

Attainment of the highest level of health for all people. Requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities Core principle of public health, driven by social justice and human rights

What are health inequities?

Avoidable, unnecessary, and unfair health inequalities

How did the FHA create redlining?

Barrios were color-coded and ranked to determine eligibility for mortgages and home loans Neighborhoods that weren't predominately white were outlined in red and denied loans Approvals were concentrated in white barrios Led to racially segregated housing units

What is a benefit of the eco-social perspective and a downfall?

Benefit: Contextualizes a person's health status Downfall: Difficult to implement given a lack of a coordinated public health system in the U.S.

What is a benefit of the life course perspective and a downfall?

Benefit: Focuses on an individual and is more specific and specialized Downfall: Fails to take in social determinants of health

What are vital statistics in the U.S.?

Births Deaths Marriages Divorces

What was the focus of public health from 1850-1949?

Building state/local infrastructure: health departments, healthcare facilities, and sanitation reform Lemuel Shattuck, a MA legislator, developed the first recordings of US vital stats, such as birth, death, marriage, immunizations, smoking status, and alcohol abuse Public health professionals also began looking at mortality across age, sex, occupation, socioeconomic status, and geography

What are the pros of downstream interventions?

Builds trust More intimacy Tailored to the person More accountability

What are the pros of midstream interventions?

Can take advantage of existing organizations and their infrastructure Larger outreach Allows for community building Demographic tailoring

What are examples of morbidities?

Cancer, asthma, diabetes, Alzheimer's disease

What is the role of local entities in Public Health?

Carry out the critical public health responsibilities Funded by property and sales tax Supported by the National Association of County and City Health Officials

What is the CDC and what are they responsible for?

Centers for Disease Control and Prevention Founded in 1946 Responsible for epidemiological assessments in the United States (global outbreaks, bioterrorism, and local health concerns)

What are disease registries?

Centralized databases for collection of data about diseases Coding algorithms maintain patient privacy Ex: Patient tracking, case control studies, identifying trends in disease rates

What are the limitations of mortality data?

Certification of cause of death Errors in coding Changes in coding (ICD) Stigma surrounding certain ailments

How do you compute age-adjusted mortality rates?

Compute age-specific death rate per 100K for each age group in chosen sub-population Multiply by proportion of population in the age group in the standard population Add them to get the age-adjusted rate

What is the Public Health mandate for states?

Constitutional responsibility and authority to protect health, safety, and welfare of their constituents

What's the significance of and limitation of birth certificate data?

Contains info about congenital malformation, birth weight, length of gestation Nearly complete data Used in studies of enviro-influence on CMs Requirements for info on fetal death certificates varies by state Mother's recollection can be inaccurate

What are some models of exposure?

Critical Period Sensitive Period (susceptible or vulnerable Period) Chains of Risk Accumulation of Risk

What is the difference between a critical period and sensitive period, and similarly what is the difference between a chain of risk and accumulation of risk?

Critical period and chain of risk --> shorter, narrower time span Sensitive period and Accumulation of risk --> longer period of time or long-term

What are some mortality-based indicators?

Crude Mortality Rate Age-Specific Mortality Rate Age-Adjusted Mortality Rate Life Expectancy Years of Potential Life Lost

How is mortality measured?

Death Certificates Linked to ICD-10 by WHO

What are premature deaths?

Deaths that occur before the average age of death in a given population Ex: overdose deaths, fatal injuries, untreated chronic or infectious illnesses

What are some professions in the PHSCC?

Dentist Nurse Pharmacist Scientist Health Health Services Physician Veterinarian Environmental Engineer Dietician

What is the role of Public Health in Health Equity?

Despite significant improvements overall in PH, health inequalities have increased between certain populations Sometimes working toward health equity can exacerbate health inequalities

What are DALYs?

Disability Adjusted Life Years The most common measure of disease burden

What are the most closely monitored characteristics being monitored in "Healthy People 2020?"

Disability Status Gender Geographical Location Race and Ethnicity Sexual Identity and Orientation

What are some of the challenges of national health surveys?

Dishonest answers Limited Access to Health Care and Delayed Diagnoses People don't understand or remember diagnoses

What does the U.S. Public Health Service do?

Division of DHHS concerned with public health efforts Implements federal mandates by civilian and commissioned personnel Tasked with policymaking issues like universal health promotion, funding, addressing health needs, law implementation, oversight, and regulation

What are the three levels of public health intervention?

Downstream Midstream Upstream

What other federal agencies have roles in Public Health?

EPA DOJ DOE DOT USDA

What frameworks do we use to think at a population level?

Eco-social perspective Life Course Perspective

What are the benchmarks for "Healthy People?"

Encourage collaboration across communities and sectors Empower individuals to make informed health decisions Measure impact of prevention activities

What are the cons of downstream interventions?

Expensive Time Consuming Ensuring Access Socially Isolating Doesn't address root causes of problem

What is an accumulation of risk?

Exposures accumulated throughout the life course that increase risks of disease later in life

What is a critical period?

Exposures occurring at critical development periods are highly influential

What are chains of risk?

Exposures that occur in a series

What is the role of government in public health?

Federal --> promote equality and minimum standards State --> Carry out primary responsibilities for health concerns Local--> point of contact between communities and higher levels of government

What are two other types of health-related organizations?

Federally-Qualified Community Health Centers Free Clinics

What are reportable disease statistics?

Federally/State required data on reported cases of diseases classified as reportable and notifiable by health care professionals Includes infectious ad communicable diseases endangering populations

What was the focus of public health from 1950-1999 aka "The Social Engineering" Era?

Filling gaps in Medical Care Delivery Medicare and Medicaid were developed, along with USDHEW, OSHA, EPA, and the USDHHS

What are some problems faced by family caregivers?

Financially and socially unsustainable Need for community-based long-term care Smaller families/separated families cannot afford to stay home and take care of loved ones

What are some pitfalls of the U.S. Census?

Hard to reach people People fear answering it due to citizenship status Despite this, the census is the basis for most health statistics

What are some upstream determinants of health?

Health care access and quality Food Education Neighborhood and Physical Environment Economic Resources Community and Social Context

What are some examples of the government's influence on Public Health?

Health care provision Public Health Measures Housing Employment Transportation

What are the public health values?

Health is a state of well-being Health is a human right Trust & Collaboration Interdependence Participation Power of Knowledge Scientific Method Responsibility for what we know Action Based on Principle

What is the life course perspective on health?

Health is produced through the sequential phases of our lives Time--> trajectory of life produces health or disease Logic--> Positive or negative exposures influence the future likelihood of attaining optimal health

How do politics influence health?

Health of populations depends on social and economic structures Politicians determine what if any investments will be made in health

What is HALE?

Healthy Life Expectancy? The average number of years a person can expect to live in full health offset by years lived in less than full health due to disease or injury

What is the Hispanic Paradox?

Hispanic/LatinX people living in the US have higher life expectancies even though they tend to be poorer with harsher jobs and less access to education and health services

What is a crude mortality rate?

How many people died in a given period of time/ number of people in the population Measures the avg. death rate for an entire population with no sensitivity to sub-groups

What are the operating divisions of DHHS?

Human Service Agencies The U.S. Public Health Services Agencies

How did the NHA help people buy homes?

Improved housing standards and conditions Provided system of mutual mortgage insurance Made mortgages more affordable and attainable Helped stimulate home ownership to build wealth for families

What are the downsides of a market justice approach to public health?

In unregulated markets, there's imperfect competition, imperfect information, and imperfect and unequal conditions

What are the limitations of reportable disease statistics?

Incompleteness of population coverage Failure of physician to fill out required forms Unwillingness to report cases that carry a social stigma

What's the significance of the US mortality rate?

Increase in mortality rates since 2015 after decades of decline Rises among low-educated, rural, middle-aged white men for both intentional and unintentional death, although middle-aged black men still have higher mortality rate

What are some indicators of health inequalities?

Increased mortality rates Decreased life expectancies Increased Morbidity and Disability Increased rates of Pain and Suffering

What are deaths of despair?

Increases in mortality rates that increase in parallel with reports of pain, poor health, and distress

How does the social-ecological model fit within the three streams of intervention?

Individual and Interpersonal --> Downstream Neighborhood and Community--> Midstream State and Country --> Upstream

What is a downstream intervention?

Individual-level interventions made with the intention of altering personal behavior

What are the four main time periods included in a life course perspective?

Infancy/Childhood ---> 0-14 Adolescence/Young Adulthood--> 15-24 Adulthood--> 25-64 Older Adulthood--> 65+

How do state/national politics shape determinants of health?

Influence starts with governance Life expectancies are higher in democratic states as opposed to authoritarian ones Legislation and budget allocations can create, regulate, and maintain public goods impacting health

What is a midstream intervention?

Interventions made my groups and organizations that strattle between individual actions and population-level actions

How does population health science help us?

It gives us the science to understand what causes health, so that public health professionals can work to improve health outcomes for communities

What is the social justice approach to public health?

It places greater emphasis on the social determinants of health and how social factors can increase or decrease the distribution of burdens and benefits of health

What are some considerations to make when interpreting PH data?

Know the specific population Understand the calendar period used and the frequency with which the data is updated Recognize that every data collection system has some incomplete or inaccurate information

What are some of the functions of state-level Public Health programs?

Licensing and Certification Standards Setting Vaccine Requirement Medicaid Program Implementation Receipt and Disbursement of federal funds Laws and regulations Police Power

What were the consequences of redlining?

Limited wealth accumulation for Blacks Stifled property values and lowered tax revenues for Black homes Limited access to barrio public goods like parks, public transportation, and health centers

What is compression of morbidity?

Living as long and healthy of a life as you possibly can and minimizing the number of years spent with illness or infirmity

What is the role of NGOs in Public Health?

Lobbying and Advocacy Funding and Advocacy Funding and Programming Service Delivery Health Promotion Research and Programming Actions and Advocacy

What are four examples of an upstream intervention?

Mask Mandates Stay-at-home orders Affordable Care Act Regulation of Food Quality Work Safety Rules Food fortification

What is the PH approach (WHO) to mitigating threats to health for old people?

Meet basic needs Learn and make decisions Be mobile Build relationships Contribute

What are two examples of a downstream intervention?

Meeting with a dietician One-on-one therapy

What are some disease patterns among older adults?

More NCDs More functional impairments, mobility limitations, and sensory issues More likely to have 1+ co-morbidities Require more health care, social support systems, and assisted living facilities Risk factors can accumulate, cluster, interact, and synergize

What is the difference between mortality and morbidity?

Mortality = death Morbidity = Illness

What is the eco-social perspective on health?

Multi-level, intersecting approach to public health Health is produced through: Individual Behavior Family and Social Networks Neighborhoods and Cities States and regions Countries and Global Influences

What is person-first language and why do we use it?

Naming the person before their condition or characteristics Meant to avoid marginalization or dehumanization

What agency is most responsible for U.S. health data?

National Center for Health Statistics

What is NHIS?

National Health Interview Survey General household survey of non-institutionalized civilian population Studies comprehensive range of conditions such as diseases, disabilities, and impairments

What are some examples of surveys used by the federal government to track morbidity data?

National Health Interview Survey National Health and Nutrition Examination Survey Behavioral Risk Factor Surveillance System Youth Risk Surveillance System National Health Care Survey

How is morbidity measured?

National Health Surveys

What is NHANES?

National Health and Nutrition Examination Survey Direct info about morbidity through exams, measures, and clinical tests Identifies conditions that are often under-diagnosed or underreported Provides info that was previously unavailable for a defined population

What type of data does the NCHS collect?

National Vital Statistics Reports National Health Statistics Reports Data Briefs Health United States (trends on health stats)

What's the criteria for assessing the quality and utility of PH data?

Nature of the data--> source of data Availability of the data--> investigators ability to access the data Completeness of population coverage--> representativeness Value and Limitations--> there are inherent factors in data that limit its utility (case duplication or incomplete diagnostic information)

What is age-specific mortality rate?

Number of deaths to persons within a specific age group Allows for comparisons between age groups Uses the avg. population in an age group bc people are always leaving and entering age groups

What are the cons of upstream interventions?

Often politicized Paternalistic Resistance from citizens Hard to pass Hard to enforce regulation

How do people age differently in richer versus poorer countries?

Pace of aging transition is influenced by a country's affluence versus poverty 1/6 of the world lives in wealthy countries and these people are living longer lives and have greater proportions of older adults

What are age-specific causes of deaths trends?

People under 45: Unintentional deaths People between 45-65: Cancer People over 65: Heart Disease

What's the difference between period life expectancy and cohort life expectancy?

Period LE assumes people experience the same mortality rates in the future as they do now Cohort LE is the actual avg. death of a historical cohort

What is a sensitive period?

Periods when exposures have greater impact than at others

What types of factors affect the health of a community?

Physical Factors Social and Cultural Factors Community Organizing Individual Behavior

Why are politics inseparable from Public Health?

Politicians define who gets what, when, and how Politicians dictate priority policy areas Politicians shape economics and social living conditions

What is an upstream intervention?

Population-wide interventions

How has the U.S. Census changed over time?

Pre-2010 The census had a short and long version (1/6 Americans) Post-2010 The long version of the census was replaced by the American Community Survey

What was the focus of public health post-1999 aka "The Health Promotion" Era?

Preparing for and responding to community health threats Community-driven public health practice

Describe the aging demographics?

Proportion of older adults will increase, which reflects healthier populations and longer lives Decline in death and steep recent decline in births 65+ considered old, 85+ considered very old

What is public health philosophy?

Protect the health of, prevent harm to, and promote community health through communal efforts that address needs that individuals cannot meet alone. Must balance community interests and individual rights

What is the significance of persistent health inequalities?

Reflects structural inequalities that unconsciously and systemically perpetuate social disadvantage Affected by social determinants of health (intersectionality)

What are the cons of midstream interventions?

Relies on trust People can slip through the cracks Exclusivity Limited access to the person's entire history Hard to get organizations to change

What are three examples of a midstream intervention?

Religious organizations School Health Education Food Banks

What are some examples of reportable diseases?

STDs, measles, foodborne illnesses, Covid-19

What are some types of questions included on national health surveys?

Self-Reported Health Self-Reported Activity Status Diagnosed Disease

What is the role of states in Public Health?

Serve as identifiable lead agencies of health reporting to the Governor or the Board of Health Agencies are funded by income taxes Programs and services vary by state

What is the significance of insurance data?

Social security--> gives info about disabilities and Medicare Health Insurance--> gives info about care received through prepaid medical programs Life Insurance--> gives info on the causes of mortality, as well as physical examinations It does not contain info on the uninsured population unfortunately

What is the public health approach?

Step 1: Identify the problem Step 2: Identify Underlying Causes of the problem Step 3: Develop, test, and implement interventions to control or prevent causes of problem Step 4: Monitor interventions to assess effectiveness

Why are DALYs useful?

Summing DALYS across all members of a population gives a measure of population burden of disease Able to assess burden of disease globally (WHO Burden of Disease Project) Can inform public health priority setting, allows for comparisons across different populations and regions, and monitoring of progress

What is SEER?

Surveillance Epidemiology & End Results Program Conducted by the National Cancer Institute, it collects cancer data from cancer registries across the U.S.

What are morbidity surveys?

Surveys collecting info on the health status of a population More comprehensive than routinely collected data

What are screening surveys?

Surveys conducted to identify people who may have infectious or chronic illness Incomplete population coverage info Highly selective clientele

How do we measure morbidity and mortality?

The MMWR, which is released by the CDC and details different scientific publications' research and monitoring of illness and death

What is life expectancy?

The average number of years a person from a specific cohort is projected to live from a given point in time

What is life expectancy?

The avg. # of years a person from a specific cohort is projected to live from a given point in time Life expectancy tells us about the present, not the future Life expectancies are educated guesses because mortality rates change over time

What was the focus of public health during the 1850s?

The avoidance and acceptance of epidemics Edwin Chadwick advocated for improved living conditions such as clean water and waste disposal. He asserted that public health should be an economic priority. Quarantine and isolation developed out of this era

What does representativeness mean in PH data?

The generalizability of findings to a population from which you gathered your data

What is a rate?

The number of events in a given population over a given period Allows for comparison of events occurring at: Different times Different places Different populations OR Within sub-groups of populations: Age Groups Racial/Ethnic Groups

What does Years of Potential Life Lost measure?

The relative impact of different causes of death

What is public health?

The science and art of preventing disease, prolonging life, and promoting health through community efforts A successive re-defining of the unacceptable

What is population health science?

The study of conditions that shape distributions of health and its manifestations within and across populations

How do you calculated YPLL?

The sum of the number of deaths at each age group x number of years of life lost up to threshold age

What are some challenges to public health efforts?

Vested Interests Invisibility to Benefits Success means problems lose urgency Universality/non-excludability of benefits Rule of Rescue

What are the top priorities for local health departments?

Vital Records Communicable Disease Control Children's Health Environmental Health Other mandated services

How do you calculate DALYs?

Years of Life Lost Due to Premature Mortality + Years Lived in a Disability or Disease 1 DALY = 1 lost year of healthy life