UCLA PUBLIC HEALTH 150 FINAL EXAM

approximately how many workers die each year from work-related traumatic injuries?

5,200

urban population

50.5% of total population (2010)

zika incubation period:

3-7 days, clinical disease = 1:5 infections

how many deaths were caused by the disease in 2015?

3.17 million deaths (5% of all deaths globally that year)

what percentage of patients with mental disorders receive no treatment in the U.S?

59%

U.S. population on 10/31/19

329,916,453

stress is the basic cause of ___ of all human illness and disease

60% 75% of doctor's visits are for stress-related issues

health care spending per capita, 1980-2014

- U.S. highest compared ($9,364) to other high-income countries (mostly European) - other countries' increases in spending are clustered closer together

prices for hospital/physician services

- bypass surgeries cost about $75k: a lot more than other countries - appendectomy is the most expensive: $13k (sometimes it is 3x more expensive) - diagnostic imaging is the most expensive in the U.S. - UK improved the most, national health service made commitment to improve primary care

top 5 poorer countries based on nominal GDP per capita (2019)

1. Burundi 2. Malawi 3. Central African Republic 4. Madagascar 5. Mozambique

population growth rate

1.06% (2016 est.)

average american uses ___ gallons of water at home everyday

100

globally, tobacco is responsible for....

16% of deaths among men 7% of deaths among women

how many of these deaths were due to NCDs?

40.5 million (71.3%)

diabetes

422 million adults have diabetes (1 out of 11 people) 1.5 million deaths caused by diabetes

physicians

1960s-1970s = standard billing codes, fees (UCR = usual, customary, reasonable), and relative value scales 1980s-2000s = standardized payments (RBRVs = resource based relative value scale) contemporary = value based payment, bonuses and penalties, low cost/high quality, adoption of EMRs

how much of the U.S. population currently suffers from mental disorders?

22%

mental and substance use disorders cause...

23% of all years lost because of disability

what percentage of all disability-adjusted life years lost is due to neuropsychiatric disorders?

24%

zika in the U.S:

4800+ travel-related cases - CA: 414 - NY: 1008 - FL: 855 local transmission - FL: 214 - TX: 6 states and territories - PR: 35,421 - VI: 958 - AMERICAN SAMOA: 119

how many countries have no laws specifically protecting women from domestic violence?

49

prevalence of COPD

251 million cases of COPD globally

polio cases in october 2019

afghanistan = one wild-virus type 1 case pakistan = one-wild virus type 1 case, 12 environmental wild-type 12 samples central african republic = 3 vaccine type 2 cases: one environmental vaccine type 2 sample angola = 11 vaccine type 2 cases philippines = 1 vaccine type 1 case, 1 vaccine type 2 case, 2 environmental type 2 samples 9 other countries report vaccine type cases

africa and world population

africa is going to have the highest increase in population, current highest growth rate

factors influencing the response to H1N1

age pre-existing immunity smoking concurrent other health conditions immunosuppression pregnancy

factors in promotion of infectious disease

agent = virus, bacteria, parasite, prion, etc. host = genetic profile, immune capacity, poverty, nutritional status environment = biologic and chemical pollution, climate change, deforestation

uninsured rate by single year of age, 2013-2016

ages 65+ = almost everyone insured kids starting age 15 begin to be more likely uninsured group of highest uninsured rate = age 26 - at 26, you get kicked out of your parents' health insurance policy

which states have the highest suicide rates?

alaska and native americans

alcohol-related deaths

alcohol is responsible for more than 5% of all deaths worldwide

causes of depression

alterations in brain chemistry hormonal imbalance genetic predisposition and family history low self-esteem anxiety disorders physical or sexual abuse substance abuse certain medications

depression

an illness that involves the body, moods, thoughts function, and affects the way a person eats, sleeps, feels about themselves, and thinks about things SAD major depression persistent depressive disorder bipolar disorder psychotic depression

west nile virus

an infectious disease that first appeared in the U.S. in 1999 spread by infected mosquitoes no symptoms or mild symptoms: fever, headache, body aches, skin rash, and swollen lymph glands (can last a few days to several weeks and usually go away on their own) older people and those with weakened immune systems are most at risk no specific vaccines or treatments best way to avoid WNV is to prevent mosquito bites

depression treatment

anti-depressive medications (over-used) psychologic counseling transcranial magnetic stimulation electroconvulsive therapy

genetic changes in influenza

antigenic drift antigenic shift

global prevalence by mental and substance use disorder

anxiety disorders (3.76%) depression (3.44%) alcohol use disorders drug use disorders

elements of evaluation

are the appropriate risk groups and areas identified and targeted? is the intervention strategy culturally and economically appropriate? how is the effectiveness of the intervention strategy measured (process variables) vs. outcome is the existing public health system and community structure a part of the evaluation scheme? cost-effective can it be scaled up?

probability of dying from the 4 main NCDs between the ages of 30 and 70 is the highest in

asia and parts of africa

clinical outcomes of influenza infection

asymptomatic symptomatic: - respiratory syndrom - gastrointestinal symptoms - involvement of major organs - death

highest lifetime prevalence rate of mental illness around the world

australia (45.0%) south korea (27.6%) japan (20.3%)

diagnostic imaging prices

U.S. spends the most

nicotine

addictive agent affects the nervous system and the heart easier for children and teens to become addicted

H1N1 epidemic mostly affected...

ages 25-49

lifetime probability of developing cancer for males and females

all sites = 1 in 3

5 major categories of mental health disorders

anxiety disorders mood disorders schizophrenia and psychotic disorders dementia eating disorders

plasmodium falciparum resistance

developed resistance to many other anti-malarial drugs

cardiovascular diseases

diseases of the heart, vascular diseases of the brain and diseases of blood vessels

risk factors for obesity

energy imbalance genetics metabolism behavior environment culture socioeconomic status

chain of infection

etiologic agent reservoir (humans, animals, environment) portal of exit mode of transmission (direct, indirect, intermediate host) portal of entry susceptible host

primary issues for vaccine evaluation

evaluation/testing procedures level of efficacy against infection level of efficacy against transmissibility level of efficacy against clinical disease acceptability

health disparities within countries

gender ethnic minorities economic educational health and health care access

event-based reports

global public health intelligence network health map project epiSPIDER regional

what country has the largest population of people age 65 and over?

japan

diabetes prevalence has been rising more rapidly in...

middle and low income countries

ebola symptoms

occur 2-21 days after exposure, but 8-10 days is most common

poultry workers

poultry workers process 8.5 billion chickens/year 4 companies dominate workers = > 20,000 motions/day

chronic injuries and illnesses

repetitive stress injury skin disease respiratory conditions hearing loss bone disease eye disease reproductive disease neurological disorders occupational cancer mental health disorders

what drives an epidemic?

reproductive number = number of secondary infections from one case transmission probability per contact contact rate/frequency duration of infectiousness available susceptibles agent characteristics

legislative change

requires political will requires enforcement requires constant vigilance

safety hazards

slippery floors unsafe machines inadequate lighting cluttered work areas hot surfaces

medicare part A

social insurance modeled on Blue Cross financed through payroll taxes

aging: adult development

what changes over time

obesity

worldwide obesity has nearly tripled since 1975 most of the world's population live in countries where overweight and obesity kills more people than underweight

premature declarations of eradication of infectious diseases

"middle of the 20th century is the end of one of the most important social revolutions in history" 1967 = "war against infectious diseases had been won and we should focus our efforts on other areas of research and public health"

how much does the global economy lose per year in productivity due to depression or anxiety?

$1 trillion

total annual economic cost of cancer in 2010

$1.16 trillion

how much do mental health disorders cost the U.S. annually?

$150 billion

global cost of mental health conditions

$2.5 trillion

how much were treatment costs for mental and substance use disorders in 2014?

$203 billion for mental disorders $35 billion for substance use disorders

the nation's health dollar: where does it come from?

$3.492 trillion, most is private insurance

cost of suicide deaths annually

$44 billion

every $1 invested to tackle NCDs will have a return of at least...

$7 by 2030

global aging

% less than 60 years old = 10% in 2000 and 21+% in 2015 effect of aging: - health care use 3 to 5x greater - 50% have two or more chronic condition

intimate partner violence

- 1 in 5 women and girls aged 15-49 reported experiencing physical and/or sexual violence by an intimate parter within a 12 month period

ACA works:

- 11.4 million enrolled in Exchanges as of March 2019 (85% with subsidies, 50% with cost-sharing reductions) - 17.0 million newly enrolled in Medicaid as of 2017 (Q3) (12.4 million through expansion, 4.6 million previously eligible) - 19.1 million total newly insured compared to 2010 (7.4 percentage point reduction (17.8% to 10.4%) among those under age 65, 46.5 million uninsured non-seniors in 2010 compared to 27.4 million in 2017, largest reduction in the number and percentage of uninsured since the implementation of Medicare and Medicaid in 1966)

women exposed to intimate partner violence are:

- 2x as likely to experience depression - 2x as likely to have alcohol use disorders - 16% more likely to have a low birth-weight baby - 1.5x more likely to acquire HIV and 1.5x more likely to contract syphilis infection, chlamydia or gonorrhoea - 42% of women who have experienced physical/sexual violence at the hands of a partner have experienced injuries as a result - 38% of all murders of women globally were reported as being committed by their intimate partners

prevalence rates of intimate partner violence by WHO region

- 37.7% = South East Asia - 37.0% = Eastern Mediterranean region 36.6% = Africa

if the world were 100 people:

- 51 urban, 49 rural - 78 electricity, 22 no electricity - 87 safe drinking water, 13 unsafe drinking water - 15 would be undernourished - 48 would live on less than $2 USD a day - 1 out of 2 children will live in poverty

WHO Global Health Observatory (GHO) data

- 71% of the world's population used safely managed drinking water services in 2015 - 2.3 billion people still lacked basic sanitation services in 2015 - 15% of people in sub-Saharan Africa had basic hand washing facilities with soap and water at home in 2015 - 5.4 million children under age 5 died in 2017 - 1 million children under 5 died due to prematurity in 2016

half of the population growth will take place in 9 countries (2017 to 2050)

- India - Nigeria - Democratic Republic of the Congo - Pakistan - Ethiopia - Tanzania - USA - Uganda - Indonesia

1960s: social insurance for the aged

- PL 89-97 signed into law on July 30, 1965 and was effective July 1st as Title 18 of the Social Security Act (culmination of 8 years of effort)

rural vs. urban

- Poorer health - Less access to health care - Poorer quality of health care - Higher proportion of elderly, due to industrialization and migration of young workers to urban areas - Slower epidemic potential (population density), but lower rates of immunity - Higher cost of providing services; e.g., water, electricity, waste disposal

conclusions from demographic studies

- The majority of the world's population lives in developing countries - Although fertility is declining, increases in population will occur primarily in developing countries in coming decades - Developed countries must cope with a shrinking productive age population and a burgeoning elderly population - The majority of the global population live in urban areas - The world's wealth is concentrated in a minority of countries - Poor sanitation and hunger are concentrated primarily in countries in sub-Saharan Africa and South Asia - Population density (which promotes emerging diseases) is greatest in developing countries, particularly China, India, and Bangladesh - Global inequity remains a major problem

health care spending as a percentage of GDP, 1980-2014

- U.S. highest (16.6%), will approach 20% in the next few years - U.S. grew at a much faster rate - 1 out of 5 dollars is spent on the health care system - spending is almost 2x as much as other countries but quality of health care is not necessarily 2x as good

why does the U.S. spend so much more on health care?

- U.S. pays more for most health care personnel: higher prices - U.S. also provides more services within each of the units of service measured in the Anderson et. al study - more intensive hospital days: more tests which are more frequent and expensive - more intensive office visits

health care spending per capita by source of funding

- U.S. spends most on private spending compared to other countries

conclusions

- aging is complex - reject age stereotypes - they're bad for your and others' health - growing ethnic diversity - wide variety of ways for public health to promote healthy aging - it's a lifelong process - early and midlife influences are influential, but never too late to intervene - not just about preventing disease, instead promoting health - must pay attention to aging population for public health - growing proportion of the population - ignoring has consequences: rising rates of STIs, potential health care burden - public health key role in intervention and improving health span (physical activity interventions effective and may reduce caregiver burdens)

complexities of aging

- biological, psychological, and social changes at varying rates - linear vs. stage based changes - not just genes, environment matters a lot - age is positively associated with heterogeneity in a population (substantial individual differences in rates of change and diversity among older adults)

strategies to prevent the spread of the flu

- cover mouth and nose when sneezing - wash hands frequently with soap and water or alcohol - avoid touching eyes, nose, and mouth - avoid contact with sick people - avoid crowded congested environments - if sick, stay home and don't expose others - follow public health advice - get flu shots - take antiviral drugs if physician recommends

H5N1 intervention strategies

- culling (killing of infected flocks) - innovative surveillance strategies: identification and analysis of human to human clusters, characterization of strains, and necessity for vaccine development - vaccination of bird handlers (vaccine being developed) - vaccination of commercial bird flocks

poor versus rich countries

- deaths of children under 5 years of age = 20:1 - malnutrition = 10:1 - life expectancy = -16 years - internal country disparities

positives of aging

- declines in addictive behaviors and crime, reduction in severe psychiatric disorders, and stability in psychological wellbeing - continuing increases in vocabulary - greater selectivity in friendship and increased contact with close family - increases in leisure time and altruistic behaviors

negatives of aging

- decreased reaction time, psychomotor speed, and verbal memory - declines in strength and walking speed - loss of skeletal muscle - greater mortality

aging is a lifelong process

- early and mid life influences: birth weight, education, physical activity and other health behaviors determine the degree to which enter later life with cognitive and physical reserves

value of promoting physical activity in late life

- exercise training (especially aerobic) increases cognitive function (even for people with dementia and related cognitive impairments) - can promote physical function and reduce risk of falling

more negative expectations about aging leads to

- fatalism - less frequent preventative health behaviors

consequences of rapid population growth

- food supply - education system - resources and energy - economy and jobs - natural environment - social structure - political system - international relations

what can we do to reduce ageism in health care?

- formal education (increasing and improving geriatrics training) - informal education (changing exposure) - policies (incentivizing working with older patients, improving reimbursement, age-friendly community initiatives)

most common causes of death for population age 65+

- heart disease - cancer - stroke - lung conditions - Alzheimer's disease - diabetes

most prevalent conditions for population age 65+

- hypertension - arthritis - heart disease - cancer - diabetes - vision limitation

reference pricing

- identify providers with good outcome/quality profile - select providers at or below median or other standard (reference price) - for patients using select providers = full payment for service - for patients not using select providers = payment limited to reference price and patient responsible for balance bill above reference price

employers who offer health insurance in the U.S.

- if work for large firms (200+ workers), almost guaranteed health insurance - small companies less likely to offer health insurance benefits - even smaller companies (fewer than 10 workers) = 50% chance of getting health insurance benefits - way we recruit and retain workers by offering benefits and including health insurance helps to make a better workforce

essential factors for disease eradication

- knowledge of its epidemiology and transmission patterns/mode - availability of effective tools for diagnosis, treatment and prevention - knowledge of local cultural and political characteristics - community acceptance and mobilization - political will and leadership - adequate and sustained funding

ageism in health care

- lack of geriatricians due to low pay - lack of representation in clinical trials - attributing problems to aging instead of disease - risk of both under-treatment and overtreatment - case study: misconceptions about older adults' sexual activity

public insurance in the U.S.

- medicare (1965) - medicaid (1965) - children's health insurance program (CHIP) (1997) - affordable care act (2010)

most debilitating conditions for population age 65+

- mental distress - stroke - vision limitation - hearing limitation - diabetes - lung conditions

america and most of the world is aging

- population aging = shift in the age distribution of the population toward older ages - increases in the percentages of the population reaching old age - change in population's distribution across age groups - changes in ratios of older to young population

aging is complex

- positive and negative changes with aging - lots of diversity in aging and among older adults - negative age stereotypes appear to undermine healthy aging - watch out for harmful age assumptions in health care settings

falls: a public health approach

- primary: promote physical activity, reduce polypharmacy, universal housing design (for all older adults) - secondary: strength training, environmental modifications (for at-risk older adults) - tertiary: counseling to decrease fear of falling, improve primary care ID/treatment of falls, social support interventions

evolution of private health insurance

- prior to 1929, no private or public health insurance (except Workers' Compensation for injured workers) - between 1929 and 1945, most private health insurance was purchased from non-profit Blue Cross (hospital) and Blue Shield (physician) plans, which grew rapidly despite the Great Depression (health insurance also grew rapidly as an employment-based benefit during WWII, because it was exempt from the general wage freeze in effect for the entire economy) - starting in 1946, for-profit commercial insurance companies expanded rapidly into the private health insurance market

demography is not destiny

- proportion of population age 65+ does not necessarily determine health care spending - while elderly do have higher rates of illness and disability, continued health improvements can counter increased needs caused by growing population - public health approaches can improve health outcome of older adults - improve health span (amount of time without disease and disability), not just life span

barriers to H5N1 control

- reservoir in wild birds and ducks - economic impact of culling of poultry stocks - popularity of "wet markets" promotes transmission within poultry and to other species - resistance to antivirals and vaccines - mistrust of rich nations

longitudinal evidence: more positive age-beliefs

- social engagement - likelihood and timing of cardiovascular events - recovery from heart attack - longevity - functional health - memory - hearing

changing focus from disease to health

- supportive care and services are key to maximizing functioning and well-being across the life span - focus on prevention rather than retroactive treatment of disease - promotion of function and well-being (too much/low value health care might harm quality of life and function)

impact of poor water and sanitation

-Causes 88% of diarrhea cases; 1.5 million deaths annually -High infant mortality due to dehydration resulting from diarrhea -No access to improved water - 884 million (13% of the global population)

evolution of US payment methods

...

age structure

0-14 years: 25.44% 15-24 years: 16.16% 25-54: 41.12% 55-64: 8.6% 65 years and over: 8.68%

ratio of women throughout the world that will experience physical and/or sexual violence by a partner or sexual violence by a non-partner

1 in 3 women

top 5 largest countries by population

1. China 2. India 3. U.S.A 4. Indonesia 5. Pakistan

value of sentinel surveillance

1. early warning of epidemic (incidence and prevalence in high-risk groups/areas) 2. identification of size and scope of epidemic (incidence and prevalence in high and low-risk groups by time and geographic region) 3. short-term evaluation of control efforts (change in EFFECT variables in high and low-risk groups) 4. long-term evaluation of control efforts (incidence and prevalence in high and low risk groups) 5. stimulate political and social action

characteristics of H5N1 avian influenza

1. highly infectious and pathogenic for domestic poultry 2. wild fowl, ducks asymptomatic reservoir 3. now endemic in poultry in Southeast Asia 4. proportion of humans with subclinical infection unknown 5. case fatality in humans is >50%

how public health promotes healthy aging

1. prevent epidemics and the spread of disease 2. protect against environmental hazards 3. prevent injuries 4. promote and encourage healthy behaviors and mental health 5. respond to disasters and assist communities in recovery 6. ensure the quality and accessibility of health services

daily flow of GPHIN information

1. scanning global news 2. filtering and sorting process 3. review for relevancy

major elements of the ACA of 2010

1. to reduce the number of uninsured in 2014: - mandates = to prevent cost-shifting and free riders from opting out of insurance until they need it - subsidies = to make insurance more affordable to low and middle income individuals and families so they can comply with the mandate, plus expansion of medicaid to make health care accessible to those with the lowest incomes - insurance market reforms = to prevent private insurers from avoiding "high risk" members and to encourage competition based on standard insurance policies 2. to protect everyone with insurance: - provide new federal protections to those w/ private insurance - eliminate pre-existing condition exclusions for children (2010) and adults (2014) - protect anyone who loses their employment based-insurance

how many deaths were directly caused by diabetes in 2016?

1.6 million deaths

rate of urbanization

1.85% annual rate of change

in 2016, more than ____ billion adults were overweight

1.9 billion, of these over 650 million were obese

impact of infectious diseases

14th century = EUROPE: plagues kills 20-45% of the world's population 1831 = CAIRO: 13% of population succumbs to cholera 1854-56 = CRIMEAN WAR: deaths due to dysentery were 10x higher than deaths due to casualties 1899-1902 = BOER WAR: deaths due to dysentery were 5x higher than deaths due to casualties 2016-2017 = SAUDI-AMERICAN WAR: against Yemen, 500,000 cholera cases, 5,000 deaths

WHO guidelines on ethical issues related to public health surveillance

17 separate guidelines as a framework to help policymakers and practitioners navigate the ethical issues presented by public health surveillance 1. develop appropriate, feasible, sustainable public health surveillance systems 2. develop appropriate, effective mechanisms to ensure ethical surveillance 3. data is collected only for a legitimate public health purpose 4. sufficient quality 5. guided by transparent governmental priority-setting 6.obligation to support countries that lack adequate resources 7. values and concerns of communities should be taken into account 8. monitoring for harm should be continuous 9. avoid the imposition of unnecessary additional burdens 10. must ensure that identifiable data are appropriately secured 11. under certain circumstances, the collection of names or identifiable data is justified 12. an obligation to contribute to surveillance 13. results must be effectively communicated to relevant target audiences 14. an obligation to share data with other national and international public health agencies 15. share data in a timely fashion 16. use or share surveillance data for research purposes 17. identifiable surveillance data should not be shared to take action against individuals

CVDS are responsible for how many deaths per year?

17.86 million deaths per year (31.4% of all deaths) leading cause of death in the world

cancer statistics

18.1 million new cases in 2018 in the world 9.6 million deaths from cancer in 2018

birth rate

18.5 births/1,000 population (2016 est.)

hospitals

1960s-1970s = charges (discounted), per diem, allocated costs 1980s-2000s = standardized per discharge payment (DRGs) contemporary = value based payment, bundled payment by diagnosis

drugs

1960s-1970s = retail prices 1980s-2000s = formularies contemporary = formularies, negotiated prices, tiered copayment, stepped therapies, pathways

bundled payment

1960s-1970s = risk-based capitation, HMOs 1980s-2000s = risk-adjusted per patient contemporary = accountable care orgs (ACOs), bundled payment by diagnosis

newly identified infectious diseases and pathogens

1993 Hantavirus pulmonary syndrome (Sin Nombre virus) 1992 Vibrio cholerae O139 1991 Guanarito virus 1989 Hepatitis C 1988 Hepatitis E; human herpesvirus 6 1983 HIV 1982 Escherichia coli O157:H7; Lyme borreliosis; human T-lymphotropic virus type 2 1980 Human T-lymphotropic virus 2018 Acute flaccid myelitis 2017 Resurgent measles 2015 Zika virus 2012 MERS-CoV 2009 H1N1 2004 Avian influenza (human cases) 2003 SARS 1999 Nipah virus 1997 H5N1 (avian influenza A virus) 1996 New variant Creutzfelt-Jacob disease; Australian bat lyssavirus 1995 Human herpesvirus 8 (Kaposi's sarcoma virus) 1994 Savia virus; Hendra virus

increasing burden of NCD and injuries for DALYS

1999: unipolar major depression ranks 5th 2020: unipolar major depression ranks 2nd

total fertility rate

2.42 children born/woman

of all the illiterate adults in the world, how many are women?

2/3

WHO survey on mental health

2/3 of countries have a policy/plan and 1/2 have a stand-alone mental health law mental health workers account for only 1% of the global health workforce 45% of the world's population lives in a country with less than one psychiatrist per 100,000 people low and middle income countries spend less than $2 per capita per year on mental health, whereas high-income countries spend more than $50

mental disorders in children

20% of children will develop mental health disorders that impair function half of all mental illness begins by the age of 14, but most cases go undetected and untreated

WNV incidence report

2002, 2003 and 2012 = outbreaks

mental health disorders comprise ___ of total disability in U.S, Canada, and Western Europe

25%

cancer causing infections (hepatitis and HPV) are responsible for...

25% of cancer cases in low and middle income countries

diarrheal diseases

2nd leading cause of death in children under 5 years old can be prevented through safe drinking-water and adequate sanitation and hygiene leading cause of malnutrition in children younger than 5 years older oral-fecal route of infection leads to rapid dehydration and inability to absorb nutrients from food

poliomyelitis

3 strains very infectious few symptoms for the majority of infected individuals probability of paralysis increases with age paralysis risk is one per 500-1,000 infections probability of death is high among those with paralysis polio vaccines: salk (killed) vaccine = no secondary infections sabin (live) vaccine = high secondary infections and risk of reversion to pathogenesis most current infections are secondary to the Sabin vaccine

how many CVD deaths take place in low and middle income countries?

3/4 of all CVD deaths

bacteria reproduces every ... minutes

30

how many occurred in low and middle income countries?

31.5 million

how many children and adolescents aged 5-19 were overweight or obese in 2016?

340 million

how many countries exempt rape perpetrators from prosecution if they are married to or subsequently marry the victim?

37

suicide (U.S.)

3rd cause of years of life lost 10th leading cause of deaths in the U.S. youth suicide rates increased between 2006 and 2016 by 70% among white males and 77% among AAs 2x as frequent among males

approximately 1 person dies every ____ seconds because of tobacco use

4

education expenditures

4.4% of GDP

how many children under the age of 5 were overweight or obese in 2016?

41 million

how many people globally suffer from mental health problems

450 million

smoking causes one in every ____ deaths in the U.S.

5

fewer than ___ with diagnosable mental illness receive treatment

50%, limited and inadequate coverage by health insurance

approximately how many workers die each year from work-related illness?

50,000

what is the total annual number of projected NCD deaths?

52 million

how many deaths occurred globally in 2016?

56.9 million

CDC has how many Global Disease Detection Regional Centers?

6

death rate

7.8 deaths/1,000 population (2016 est.)

how many deaths from cancer occur in low and middle income countries?

70% of deaths

current average population (globally) increase is estimated at

83 million people per year

what percentage of COPD deaths occur in low and middle income countries?

90%

water sources and usage

97% of planet's water = salt water 2% of earth's water is frozen in polar ice sheets and glaciers only a fraction of 1% is available for drinking, irrigation, and industrial uses agriculture accounts for 70% of all water uses

treatment of alcohol abuse

AA psychological counseling taxation 12-step and other short-term residential treatment programs

gender ratio

At birth: 1.03 male(s)/female 0-14 years of age: 1.07 15-24 years: 1.07 25-54 years: 1.02 55-64 years: 0.95 65 years and over: 0.81 Total population: 1.02

misconceptions about older adults' sexual activity

CDC: the number of new HIV infections is growing faster in individuals over 50 than in people 40 years and under disease rates age 45-64 - syphilis in 2010 = >2,500 reported cases - chlamydia = >19,000 reported cases

resistance to M2 inhibitors in H3N2

H3N2 strains around the world are rapidly losing their sensitivity to amantadine and rimantadine, a trend that started in Asia

leading causes of death in the U.S.

MALE: other heart disease cancer FEMALE: other heart disease cancer

does the U.S. regulate the prices people pay doctors/hospitals?

NO regulation, contributed to why health care expenditures are so high - people are more likely to use higher priced services than other countries when hospitalized

active vs. passive surveillance

PASSIVE = REPORTING (hospitals, labs, clinics, physicians) ACTIVE = SEARCHING

strategies to prevent mental illness

Prevent school-based violence (reduces risk by 25-33%) Improve family functioning and promote positive parenting Treat parental depression Research underlying biologic processes, including genetics and epigenetics Modify environmental factors; e.g., reduce poverty Evaluate interventions Train more professional personnel Expand community resources for prevention Coordinated national, state, local and community efforts to prevent mental illness (individuals, families, the justice system, health care and relevant community-based programs) Identify and target high risk kids, families, and communities Increase funding for research on prevention Increase awareness of prevention strategies and resources

reproductive number

R = number of secondary infections from a single infected individual Ro = number of secondary infections at the beginning of an epidemic R > 1 epidemic spreads R < 1 epidemic dies out R subject to changes in presence and levels of determinants of epidemic spread changes as epidemic progresses

zika diagnosis:

RT-PCR, ELISA, IgM (cross-reactivity)

surveillance vs. finding the reservoir

SURVEILLANCE needs a REPRESENTATIVE sample RESERVOIR needs to find INFECTED individuals

surveillance vs. screening

SURVEILLANCE uses data collection to measure magnitude, changes, and trends in POPULATIONS objective = intervention in defined populations SCREENING tests to identify INDIVIDUALS with infection or disease objective = personal intervention and protection of the public

total revenue = total expenditures = total income

T + R + C = P x Q = W x Z T = taxes R = private insurance premiums C = direct charges to patients P = average price fo health care services Q = quantity of health care services provided W = average wage Z = total inputs used (labor and capital)

conclusions of health care financing and expenditures in the U.S.

The U.S.: - is the only advanced economy that tolerates having a significant portion of its citizens uninsured - has the largest private market for health care financing of any nation - spends more per capita on health care services than any other high-income nation, but has some of the poorest health outcomes -supports incremental changes, based on market-oriented solutions, rather than fundamental reform - although public support for Medicare for All indicates that there is broader support for single payer than many analysts thought

health care spending as percentage of GDP

U.S. has the highest (17.1%)

total health expenditure per capita and GDP per capita

U.S. is about $7,500/$48,000

virology of influenza

a = causes outbreak b = causes outbreaks c = does not cause outbreaks

public policy

a decision by government about what it will or will not do, or what it will or will not allow to be done by others - policy can include and should take into account the reactions and behavior of those affected by the policy (intended and unintended effects)

autism spectrum disorder

a neurodevelopmental condition present from early childhood characterized by difficulty in communicating and forming relationships and in using language and understanding abstract concepts prevalence ranges from 06.% to 2% males at a greater risk than females risk increases with socio-economic status risk increases with parental age at conception prevalence increased 37% from 2002-2008 risk determined by both genetic and environmental factors

positive mental health

a state of wellbeing in which an individual realizes their own abilities, can cope with the normal stresses of life, can work productively and are able to make a contribution to their community mental health is the foundation for individual wellbeing and the effective functioning of a community

mental disorder

a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning usually associated with significant distress in social, occupation, or other important activities

4. not eligible for above, or not offered or cannot afford ESI

a. private insurance in the individual (non-group) market or b. uninsured and reliant on free (charity) care - by federal law, hospitals cannot turn away emergency cases, regardless of insurance status

successful aging

absence of disease and the risk factors for disease, maintenance of physical and cognitive abilities, and engagement in productive activities: unrealistic - updated definition: minimal interruption of usual activities and maintenance of social participation in the face of disease (still implies "failure" if don't meet these criteria)

waterborne illnesses and parasites

account for an estimated 3.6% of the totally DALY global burden of disease cause about 1.5 million human deaths annually

optimal aging

acknowledges people can age optimally in one domain but not another, norm driven

medicare (1965)

65+, disabled, end-stage renal disease, amyotrophic lateral sclerosis (ALS)

world population on 10/31/19

7,608,048,125

white males account for how many of all suicides?

70%

what percentage of patients develop schizophrenia between the ages of 15-25?

75%

hunger map 2019

821 million people (more than 1 in 9 of the world population) do not get enough to eat

alcohol-related deaths in the U.S.

88,000 people die annually 3rd leading preventable cause of death in the U.S. can increase the risk of cancer

motivations and resources

actions of individuals and organizations in policy process is influenced by: interest and values = goals powers and resources (power to coerce, convince, trade) institutions which create and constrain power personal relationships (ongoing relationships and repeated interactions)

prevalence of mental illness in the U.S. (2017)

adults = 18.9% males = 15.1% females = 22.3% 13-18 years = 49.5% 18-25 years = 25.8% 26-49 years = 22.2% 50+ = 13.8% proportion who received services = 42.6%

what governments can do to promote health:

advance universal health coverage access to quality services access to affordable services protection from financial risk implement policies to engage the public ensure healthy diets make health risks clear leverage taxes generate data for health tighten laws and regulations create healthy cities and environments

social circumstances

adverse factors: loneliness, neglect/family conflict, exposure to violence/abuse, low income/poverty, difficulties or failure at school, and work stress/unemployment protective factors: social support of family and friends, good parenting/family interaction, physical security and safety, economic security, scholastic achievement, satisfaction and success at work

individual attributes

adverse factors: low self-esteem, cognitive/emotional immaturity, difficulties in communicating, medical illness, and substance use protective factors: self-esteem, confidence, ability to solve problems and manage stress/adversity, communication skills, and physical health/fitness

environmental factors

adverse factors: poor access to basic services, injustice and discrimination, social and gender inequalities, and exposure to war or disaster protective factors: equality of access to basic services, social justice, tolerance, integration, social and gender equality, and physical security and safety

zika virus vector:

aedes mosquitoes, especially aides aegypti, whose range is spreading (extrinsic incubation period is 10 days)

under-five mortality_______ in all WHO regions between 1990 and 2017

declined

goal = compress morbidity

decrease the time between the onset of disease/disability and death - increase health span and not just lifespan

selecting the population

defining the selection criteria (human or zoonotic populations) gaining access to target populations (NGOs/support groups) obtaining and maintaining compliance

literacy

definition = age 15 and over can read and write total population: 86.2% male: 89.8% female: 82.6%

strategies to reduce threats

develop political will and funding improve global early response capacity improve global surveillance use of vaccines new drug development decrease inappropriate drug use improve vector and zoonotic control better and more widespread health education development of predictive models (based on epidemiological data, climate change surveillance, human behavior) establish priorities reduce potential for rapid spread develop more feasible control strategies develop new intervention strategies requiring low-cost technology social and political mobilization of communities greater support for research reduce poverty and inequality

developing vs. developed countries and population growth

developing = large proportion of young people developed = population pyramid is uniform throughout, aging population

majority of population growth occurs in:

developing countries

health disparities between countries

developing countries transitional countries developed countries

5. respond to disasters and assist communities in recovery

development and implement response strategies that address unique concerns of older adults

6. ensure the quality and accessibility of health services

development of indicators training medical professionals about aging

requirements for surveillance

diagnostic algorithm staff members sampling frame access/network competent laboratory

health care delivery

direct delivery (VA, LA County hospitals and clinics) funding delivery systems (federally qualified health centers) regulation of entry, qualifications, scope of practice, standards of practice for healthcare institutions, workforce pharmaceuticals

health care financing and insurance

direct provision (medicare and medicaid) regulation of private insurers

exposure to negative age stereotypes is a...

direct stressor with impact on cardiovascular responses

treatment of drug abuse

drug substitution and rehabilitation programs needle exchange programs contingency management drug treatment programs short and long term residential treatment programs outpatient treatment programs

causes of schizophrenia

early causes = genetic, obstetric complications vulnerability abuse of drugs or social stress/isolation psychosis

key factors impacting mental health

early life family structure and function school experience workplace community

effective depression prevention strategies

educational psychotherapeutic cognate problem-solving social skills training pharmacological lifestyle nutritional coping skills

treatment modalities

educational psychotherapeutic pharmalogic lifestyle nutrition

hierarchy of controls

eliminate substitute isolate use engineering control use administrative controls use personal protective equipment

1. workers and dependents = employer-sponsored insurance (ESI)

employers were not required to offer insurance prior to the ACA except in 2 states - private insurance is subject to state regulations which can vary considerably across the U.S.

medicaid (1965)

enacted at the same time as medicare to provide health insurance coverage for low-income families or individuals who are categorically eligible title 19 of social security act

part c = medicare advantage

enacted in 1997 and revised in 2003 encourages beneficiaries to join HMOs and other private insurance arrangements medicare pays a monthly premium to the health care organization

part d = prescription drug benefit

enacted in 2003, effective in 2006 subsidizes beneficiaries to purchase prescription drug coverage from private insurers

scope of health policy

environment health care delivery health care financing and insurance social determinants of health

eradication

eradicated: smallpox and dracunculus targeted: polio and measles

role of the public health professional

establish surveillance for unusual diseases and drug resistant agents assure laboratory capacity to investigate new agents develop plans for handling outbreaks of unknown agents implement effective intervention strategies inform and educate the public develop plans for handling outbreaks of unknown agents inform physicians about responsible anti-microbial use promote vaccination

defining a surveillance case

establishing a functional case criteria (quickly and easily defined) selecting the right test or definition (easy and specific) clinical versus epidemiological diagnostic criteria (function over precision) disease versus infection (AIDS and HIV infection)

how often does a suicide occur in the U.S?

every 12.8 minutes

sentinel surveillance

example: HIV/AIDS sentinel surveillance sentinel groups: homosexual/bisexual commercial sex workers returning overseas workers intravenous drug users males at STD clinics other groups

physician supply

expenditure (spending) = prices x quantity - practicing physicians per 1,000 population (2.6) is well below the median (Norway is the highest) - annual physician visits per capita (4.0) well below median (Japan is the

3. prevent injuries

fall prevention programs wander prevention programs for dementia interventions to reduce motor vehicle crashes among older adults

which month has the highest rate of influenza?

february

2. age 65+ = medicare

federal program

most common methods for suicide (female and male)

female: firearm poisoning suffocating other male: firearm suffocating poisoning other

fertility changes over the past century

fewer babies

biomechanical (ergonomic) hazards

fit between workers and their jobs

zika treatment:

fluids to avoid dehydration acetaminophen for fever avoid ASA or non-steroidal anti-inflammatories until dengue is ruled out

what people can do to protect health

follow medical advice get vaccinated breastfeed stay physically active avoid: tobacco use harmful use of alcohol consumption of food and drinks high in salt, sugar or unhealthy fats air pollution

social determinants of health

food and nutrition policy, programs, and regulation anti-discrimination policy

CalPERS reference pricing

for privately insured, copayments and deductibles are the same regardless of choice of in-network provider reference pricing

WHO comprehensive mental health action plan 2013-2020

four major objectives: 1. strengthen effective leadership and governance for mental health 2. provide comprehensive, integrated and responsive mental health and social care services in community-based settings 3. implement strategies for promotion and prevention in mental health 4. strengthen information systems, evidence, and research for mental health

number of people with diabetes has risen...

from 108 million in 1980 to 422 million in 2014

causes of disease emergence and re-emergence

genetic and biologic factors: host and agent mutations, increased survival of susceptibles human behavior: political, social, and economic physical environmental factors: crowding and sanitation ecologic factors: climatic changes, deforestation, etc.

global decline in fertility, 1950-2010

global fertility rate has dropped from 5 to 2.5 in roughly 50 years average woman in developing countries (outside of China) now has 3 children, down from 6

poverty

globally: 1.2 billion (17.4%) of the world's population live on less than $1 USD per day

examples of policy in the area of payment

goals of payment: - appropriately reimburse for needed, quality services - assure services available - create incentives for higher quality and lower cost reference pricing model for value based payment MIPS

3rd UN high-level meeting on NCDs

heads of state commit to lead response to beat noncommunicable diseases and to promote mental health

ways to prevent or delay the onset of type 2 diabetes

healthy diet regular physical activity maintaining a normal body weight avoiding tobacco use

1 in 3 deaths from cancer are due to 5 leading behavioral and dietary risks:

high BMI low fruit and vegetable intake lack of physical activity tobacco use alcohol use

highest risk factors for NCDs in the WORLD

high blood pressure tobacco use high blood glucose physical inactivity

highest risk factors for NCDs in MIDDLE-INCOME COUNTRIES

high blood pressure tobacco use overweight and obesity physical inactivity

world fertility rates

highest numbers of children per woman is in africa

suicide prevention

hotline psychiatric hospital walk-in clinics hospital emergency rooms urgent care centers reduce access to firearms (down 30x) student health centers treat mental disorders (cause of 90% of suicides) identify and focus on high-risk families for early prevention

origin of the H1N1 virus

human and animal flu viruses two most important genes = hemagglutinin and neuraminidase (both originated in pigs)

factors contributing to emergence or re-emergence of infectious diseases

human demographic change urbanization breakdowns of sanitary and other public health measures economic development and changes in the use of land changing in human behaviors international travel and commerce changes in food processing and handling evolution of pathogenic infectious agents development of resistance of infectious agents global warming resistance of the vectors immunosuppression of people due to medial treatments or new diseases that result in infectious diseases caused by agents not usuallyy pathogenic in healthy hosts deterioration in surveillance systems illiteracy lack of political will biowarfare/bioterrorism war and civil unrest famine manufacturing strategies

zika virus host:

humans/monkeys

major products of a sentinel surveillance program

identity and location of the core transmitters (reservoirs) trends in prevalence in risk groups, the surrogates of the general population and geographic areas (spread) trends in incidence estimates that can be used for advocacy messages estimates of the number, location and characteristics of cases can be used to anticipate future needs to cope with the epidemic (predictive models)

biological strategies

immunizations prophylaxis (e.g. PreP) improved nutrition and food quality mother and child health programs microbicides improved sanitation improved water quality (including oceans, etc.)

what is one of the largest problems of the global epidemic of violence against women and girls?

impunity: the exemption from punishment of a crime

alcoholism

in 2012, 3.3 million deaths (5.9 percent of all global deaths) 5th leading risk factor for premature death and disability

zika vaccine:

in development

women and alzheimers

in her 60s, a women's lifetime risk for developing alzheimers is 1 in 6 almost 2/3 of americans with alzheimers are women 2.5x more women than men providing intensive "on-duty" care 24 hours a day for someone with alzheimers more than 60% of alzheimers and dementia caregivers are women

role of public health in mental health

incorporate mental health promotion into chronic disease prevention efforts improve evidence base on mental health collaborate with partners to develop comprehensive mental health programs

COPD is most likely to...

increase in coming years due to higher smoking prevalence and aging populations in many countries

levels of risk factors for mental health

individual attributes social circumstances environmental factors

national coalitions/alliances

industry/occupation coalitions product/market supply chain alliances employment structure coalitions labor-environmental justice

epidemiological transition

infectious diseases persist and diseases of affluence increase

1. prevent epidemics and the spread of disease

influenze immunization screen for chronic diseases

public health concerns regarding drug dependence

injection drug use is a major cause of HIV and HCV globally loss of productivity disruption of families increased crime rates over-prescribing of anti-depressive and mood elevation drugs

total number of deaths by cause (globally)

injuries = 50 mil communicable, maternal, neonatal, and nutritional disease = 30-40 mil non-communicable diseases (NCDs) = 0-30 mil

basic elements in preparedness

international health regulations international = WHO global outbreak alert and response network global public health information network (GPHIN)

top 3 global causes of death

ischemic heart disease stroke chronic obstructive pulmonary disease

isolation and quarantine

isolation of cases (SARS, ebola) quarantine of exposed individuals (yellow fever, SARS, H1N1, ebola) culling (murder) of diseased flocks and herds (H5N1)

if WNV enters the brain...

it may cause encephalitis (inflammation of the brain) or meningitis (inflammation of the tissue that surrounds the brain and spinal cord)

3. poor plus another "appropriate" qualification = medicaid

joint federal/state funding, but state administration and eligibility criteria

1st stage: 7-9 days

joint pain, sore throat, fever, headache, weakness, and muscle soreness

dirty water and a lack of hygiene

kills 3.3 million people around the world annually, most of them under the age of 5

the uninsured

large percentage of those uninsured are those under medicaid (income) and adults without dependent children (family type)

racial makeup of the planet

largest group = south asian (23.48) east asian = 21.23 european = 16 african = 13.93

the nation's health dollar: where does it go?

largest percentage on private insurance (33%), next largest is medicare 2017: $3.497 trillion largest percentage is on hospital care

severe stage of alzheimers

lasts 1 to 3 years incapacitated, retreat into themselves, and will not eat unless fed may not speak or recognize people loss of bodily function control violent episodes and aggression

moderate stage of alzheimers

lasts 2 to 10 years experience withdrawal, confusion, increasing difficulty in self-care and daily tasks, poor judgment, and difficulty communicating behavioral changes include anger, anxiety, frustration, and restlessness caregiver assistance becomes increasingly necessary

mild stage of alzheimers

lasts 2 to 4 years minor memory loss, difficulty learning and remembering new information long-term memory and some reasoning remains intact patients may be aware of their decline and hide it well

health policy is made with input from:

legislators and their staffs executive agency elected, appointed officials, and career civil service outside parties: governments at other levels, courts, interest groups and knowledge generators

total health care investment in the US is...

less - in OECD, for every $1 spent on health care, about $2 is spent on social services - in the US, for $1 spent on health care, about 55 cents is spent on social services - about 75-80% of health is produced outside of health care system

improved standard of living

less crowding decreases respiratory spread better quality of food decreases gastrointestinal and chronic diseases year-round access to vegetables and fruit refrigeration allows fewer preserved foods which may reduce some cancers improved nutrition and access to healthy foods promotion of access to education reduced poverty better methods of primary, secondary, and tertiary prevention

health policy can be made at any:

level: federal, state, and local branch: legislative, executive, independent agency, courts

tobacco use causes premature death

life expectancy for smokers is at least 10 years shorter than for non smokers quitting smoking before the age of 40 reduces the risk of dying from smoking-related diseases by about 90%

biological hazards

living organisms that can cause infectious diseases and allergies (viruses, bacteria, insects, animals)

extreme poverty definition

living with per capita household consumption below 1.90 international dollars per day

political strategies

lobby legislators promote healthy and safe communities promote and enforce appropriate health laws and regulations promote universal access to health case and preventative health care improve standard of living reduce poverty and inequalities

children's health insurance program (CHIP) (1997)

low-income children above eligibility for medicaid

uninsured rate among the elderly population

major provisions became in effect in 2014 from ACA = start to see dramatic decreases in share of population uninsured

languages

mandarin = 12.2% spanish = 5.8% english = 4.6% arabic = 3.6% hindi = 3.6% the six UN languages: arabic, chinese (mandarin), english, french, spanish, and russian - are the mother tongue or second language of about half of the world's population, and are the official languages in more than half the states in the world

goal for most debilitating conditions

maximize function and minimize disability: target most debilitating conditions

goal for most common causes of death

maximize life expectancy: target high-mortality conditions, aka the most common causes of death

differences between medicare and medicaid

medicaid is a welfare program, not social insurance medicaid has 56 separate programs that are jointly funded by each state and the federal government but administered at the state level subject to federal requirements federal assistance matching percentage (FMAP) ranges from 50% to 76%

NCDs

medical conditions or diseases which are not communicable or infectious longer duration and relatively slow progression chronic diseases

treatment of autism

medication to improve functions (e.g., focus, high energy levels) early intervention services - assistance in talking, walking, and personal relationship skills behavior and communication approaches (e.g., applied behavior analysis)

zika symptoms:

mild and include fever, rash, joint pain, conjunctivities, muscle pain, and headache

secondhand smoke

mixture of side stream smoke (80%) and mainstream (20%) smoke side stream has higher concentrations of carcinogen exposure to secondhand smoke killed more than 1.2 million non-smokers worldwide increases the risk of lung cancer by 30%

uses of surveillance systems

monitor changes or trends in health factors: - prevalence/incidence of disease and/or risk factors - emerging diseases - geographic distribution - risk group distribution detect outbreaks/early warning systems: - human disease - zoonotic diseases - food safety - drug-resistant organisms provide health information that can be used to design rational intervention programs evaluate the effectiveness of intervention strategies

structural strategies

monitoring and surveillance of diseases and health hazards safe drinking water safe water disposal regulations to protect workers regulate driving legislation and regulations for safety laws to ban smoking, require helmets, etc. regulate air and water quality enforcement of health and safety laws establish safe communities and parks establish universal medical access taxation task shifting regulations of drugs and food

zika control:

mosquito precautions protective clothing

requirements for a vaccine

must be safe easy to administer elicit a protective immune response stimulate both humoral and cellular immunity protect against all variants of the agent provide long-lasting immunity practical to produce, transport, and administer

selecting the appropriate strategy

need for cultural sensitivity understanding the implications and limitations of different strategies selecting the appropriate surveillance strategy timely data processing results and action

changes in the brain in alzheimer's disease

neurons lose their ability to function and communicate with each other and eventually die very early to mild to moderate to severe as the disease progresses, neurofibrillary tangles spread throughout the brain, as well as plaques = shrinking brain tissue

microbial threats

newly recognized agents (SARS, MERS, ZIKA) mutation of zoonotic agents that cause human disease (H5N1, H1N1) resurgence of endemic diseases (malaria, tuberculosis) persisting disease (measles, polio) development of drug-resistant agents (tuberculosis, gonorrhea) recognition of etiologic role in chronic disease (chlamydia causing sexually transmitted diseases, respiratory and heart disease, HIV and heart disease) use of infectious agents for terrorism and welfare (anthrax) resistance of vectors to control

physical hazards

noise vibration extreme temperatures radiation

zika manifestations:

none (80%) mild flu-like illness microencephaly and other neurologic lesions in fetuses Guillam-Barre syndrome multiple other neurologic defects (in utero)

population, 1900-2050

number of older adults expected to double over 30 years 2010 = 40.2 mil age 65+ 2040 = 79.7 mil age 65+

concentration of death in old age

of children born in 1900, 41% lived to age 65 - in 2010, 84.3% expected to live to age 65

political implications regarding cost containment

one person's cost is another person's income: - if we cut taxes, we have to cut prices or services provided to deal with reduced revenue most changes to payment incremental to avoid conflicts with provider organizations

physician incomes, orthopedic surgeon vs. primary care doctor (U.S.)

orthopedic surgeons = $442,450 primary care doctors = $186,582

number of cancer deaths (highest to lowest)

other = 35.8% lung = 18.4% colorectal = 9.2% stomach = 8.2%

new cancer cases (highest to lowest)

other = 42.9% lung = 11.6% breast = 11.6% colorectal = 10.2%

suicide (global)

over 800,000 people die due to suicide every year 2nd leading cause of death in the world for those aged 15-24 years 2.8% = median amount of the health budget allocated to mental health in 2011 10.5 suicides per 100,000 population globally young adults and elderly women in low and middle income countries have much higher suicide rates than their counterparts in high-income countries middle-aged men in high income countries have much higher suicide rates than middle-aged men in LMICs 90% of suicides are associated with mental disorders

zika virus (flaviviridae) range:

pacific islands, south asia, central and south america, caribbean

common problems across borders

pandemics environmental issues surveillance and control immunization programs regulations migration refugees war global warming natural disasters food safety and security

types of schizophrenia

paranoid (best prognosis for recovery) disorganized = disorganized speech and behavior are prominent catatonic = catatonic (bizarre, immobile, or relentless) motor behavior are prominent undifferentiated = symptoms do not clearly fall into any of the above 3 subtypes

expansions of medicare since 1965

part c and part d

age stereotypes are a public health hazard

perceiving age as a primarily negative process seems to lead to worse outcomes - ageism in health care settings (if a doctor attributes symptoms to aging rather than diseases, they are less likely to treat it)

strategies to improve working conditions

players = worker advocacy groups, coalitions, partnerships, alliances, state and local health departments strategies = public awareness, worker outreach/education, worker organizing, union contract negotiations, community based participatory action research, health care services, and policy change

acute injuries and illnesses

poisoning from accidental ingestion, inhalation or skin absorption of harmful substances heatstroke or frostbite traumatic work injury

core frameworks for understanding the policy process

policy process motivations and resources of policy actors framing

prevention of substance abuse

policy/regulatory = taxation, reduced availability, bans on advertising, and severe penalties employment of youth community programs education of clinical practitioners

causes of mental disorders

poor nutrition (iodine deficiency) alcohol use during pregnancy trauma during birth maternal depression parental neglect sexual and physical abuse lack of stimulation in early life violence and war (PTSD) poverty poor education unemployment social isolation rapid social changes residential dislocation

what demographic is disproportionately affected by NCDs and mental health conditions?

poorer people

yearly growth rate for the world's population

population in the world is currently (2018) growing at a rate of around 1.09% per year growth rate is declining as fertility rate is declining

leading cause of poor health globally is

poverty

barriers to a healthy lifestyle globally

poverty low levels of education inadequate health systems corruption urbanization and growth of urban ghettos cost and access to healthy foods wealth disparities

strong predictors of high fertility rates

poverty low levels of educational attainment

policy process

presentation in "civics" and policy analysis texts is linear and rational problem - goals/criteria - solutions (options) - analyze against criteria - choose - evaluate kingdon "three streams"

objectives of vaccination

prevent infection prevent disease prevent transmission

goal for most prevalent conditions

prevent morbidity/onset of chronic conditions: target most prevalent conditions

sentinel sites

previous reports of high prevalence exposure to high-risk individuals suspected concentration of high-risk groups susceptible/vulnerable groups cross-border regions trade centers

types of prevention

primary = prevent problem form happening (ex. immunizations) secondary = detect problem early and treat before serious harm results (ex. blood pressure or breast cancer screening) tertiary = after a health problem has happened, maximize independence and quality of life (ex. rehab, in-home supportive services)

risk factors for COPD

primary cause = tobacco smoke indoor air pollution outdoor air pollution occupational dusts and chemicals frequent lower respiratory infections during childhood

school life expectancy

primary to tertiary education total: 12 years male: 12 years female: 12 years

3 streams

problem solution political policy successfully adopted when 3 streams integrated to support specific solution

chronic obstructive pulmonary disease (COPD)

progressive, chronic, and usually irreversible condition in which air flow to and from lungs is decreased

4. promote and encourage healthy behaviors and mental health

promote engagement enhance chronic disease self-management

behavioral strategies

promote good health habits school health programs promote immunization programs and other interventions tv, radio, internet and social media public health messages promote safe sexual behavior incentives for good behavior

public mental health

providing an environment that promotes mental health of populations and healthy societies promoting and creating the resources to identify and treat mental health problems

physician fee for hip replacement, public vs. private (U.S.)

public = $1,634 private = $3,996

how does the CDC choose its GDD Regional Centers?

public health significance established regional scope established CDC presence international partner presence

antigenic shift

reassortment of genetic materials when concurrent infection of different strains occurs in the same host

2. protect against environmental hazards

recognize/reduce risks in homes develop age friendly communities that promote physical activity

poverty vs. disparity

redistribute wealth vs. alleviate poverty

prevention of suicides

reduce access to lethal means: pesticides (asian females), firearms in homes (down 30x), increase guard rails, restrict access to high buildings, etc. recognition of suicidal intent by health professionals referral and counseling of high risk individuals hotlines

other lifetime costs of mental disorders

reduced employment increased disability violence child abuse marital instability reduced work productivity increased absenteeism motor vehicle accidents teenage pregnancy homelessness

portals of entry/exit of infectious agents

respiratory: influenza, common cold agents, measles genitourinary = sexually transmitted agents alimentary track (gut) = campylobacter, cholera, salmonella skin = streptococci percutaneous = vector borne diseases (arboviruses) eye = C. trachomatis transplacental = cytomegalovirus, HIV

antigenic drift

results of errors in replication and lack of repair mechanism to correct errors

factors to consider when investigating body weight change

reverse causality confounding variables ethnic differences self-report validity/information bias energy balance collinearity

steps to reduce waterborne diseases

safe disposal of human waste hand washing education about sanitation piped, treated water food safety

food services

safety = injury from sharp objects, fires/burns physical = heat and cold conditions, biological, bacteria and viruses biological = bacteria chemical = cleaning products biomechanical/ergonomic = heavy lifting, awkward postures, repetitive movements psychosocial = stress, violence, harassment

evaluation of a surveillance system

sensitivity: what proportion of cases are identified and does the system give an accurate picture of trends and magnitudes? timeliness: is information disseminated rapidly enough to permit timely action based on the surveillance system? representativeness: do reported cases differ from unreported cases? predictive value positive: what proportion of those testing positive actually have the disease or factor? acceptability: does the system stimulate the cooperation of respondents or does the process discourage participation? flexibility: can changes be easily made in the system to reflect changes in trends, magnitude, and other relevant factors? simplicity: can the system be simplified and still obtain the necessary information? cost/benefit: is the system worth the cost and can costs be reduced without sacrificing the essential quality of the system? dissemination of results: to decision-makers, data collectors, and the general public appropriate action taken: does surveillance lead to effective intervention?

schizophrenia: definition and facts

severe mental disease whose patients experience illogical and confused thought patters, hearing internal voices not heard by others, or beliefs that other people are reading their minds, controlling their thoughts, or plotting to harm them affects men and women equally 150/100,000 will develop the disease approximately 10% will commit suicide

where are 3/4 of the world's 758 million illiterate adults found?

south asia and sub-saharan africa

hospital supply

spending on hospital care continues to be the largest component of spending for many high-income countries - U.S. = 2.5 acute care hospital beds per 1,000 population (Japan is the highest) - U.S.: 126 hospital discharges per 1,000 population (Germany is the highest)

Cal/OSHA 1973

standard board compliance and consultation appeals board

barriers to mental health

stigma (internal and external) failure to respect human rights (inability of sufferers to demand rights) lack of public understanding and resulting unease (political malaise and disparity with physical health)

chemical hazards

substances that can enter the body and cause disease or affect the environment (gas/vapor, liquid, solid, lung disease, etc.)

immunogenic components of the influenza virus

surface glycoproteins, 15 hemagglutinin (H1-H15), nine neurominidases (N1-N9) H1-H3 and N1N2 established in humans influenza characterized by combination of H and N glycoproteins: 1917 pandemic - H1N1 2004 avian influenza - H5N1 2009 H1N1 antigenic mix determines severity of disease human response specific to hemagglutinin and neurominidase glycoproteins

child poverty in developed countries

the U.S. ranks 2nd to last: high number of children that live in households with incomes below 50% of median national income

in 2015, the current cigarette smoking among U.S. high school students was...

the lowest in 24 years

growing proportion of minority older adults

the numbers of the minority population age 65+ will triple 2012 = 8.8 million 2060 = 32.6 million

demography

the study of populations, especially with reference to size and density, fertility, mortality, growth, age, distribution, migration, vital statistics and the interaction of these with social and economic conditions

tobacco use/smoking

tobacco kills up to half of its users kills more than 8 million people each year (7 mil smokers, 1 mil secondhand smoke)

chemicals in tobacco smoke

tobacco smoke contains more than 7,000 chemical compounds 81 are cancer-causing

what is the most preventable cause of death?

tobacco use

highest risk factors of NCDs in HIGH-INCOME COUNTRIES

tobacco use high blood pressure overweight and obesity physical inactivity

most cardiovascular diseases can be prevented by addressing behavioral risk factors such as

tobacco use unhealthy diet and obesity physical inactivity harmful use of alcohol

what is the most important risk factor for cancer?

tobacco use, responsible for approximately 22% of cancer deaths

life expectancy at birth

total population: 69 years male: 67 years female: 71.1 years

median age

total: 30.4 y/o male: 29.6 y/o female: 31.1 y/o

infant mortality rate

total: 34.1 deaths/1,000 live births male: 36.1 deaths/1,000 live births female: 32.1 deaths/1,000 live births

ebola virus (ebola hemorrhagic fever)

transmitted to people from wild animals and then spreads in the human population through direct contact with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials contaminated with these fluids average fatality rate is 50% first outbreaks occurred in remote villages in Central Africa near tropical rainforests 2014-2016 outbreak in West Africa was the largest and most complex Ebola outbreak since the virus was first discovered in 1976

framing

underlying issue elements: rhetoric, tools, levels, trust

5 main NCD risks

unhealthy diet tobacco use air pollution harmful use of alcohol physical inactivity

risk factors for type 2 diabetes

unhealthy diet (1 in 3 overweight) physical inactivity (1 in 10 obese)

U.S. per capita health spending, 2012

unless premature birth, very non-costly when you are a kid as you enter teens, costs increase with age costs go down at 97

who is eligible for medicare?

virtually all individuals age 65+: - workers who have paid into social security during lifetime (40 quarters of employment) or the spouse of a worker automatically qualify for part A - workers with less than 40 quarters can buy into part A - legal residents age 65+ may elect to enroll in part B, even if they don't have part A, but everyone in part B must pay a monthly premium disabled individuals who qualify for social security benefits (1972) end-stage renal disease patients (1972) ALS patients (2001) 55.3 million enrolles in 2015, 46.3 million seniors

medicare part b

voluntary health insurance modeled on Blue Shield and Aetna plans financed through monthly premiums and general tax revenue

2nd stage: 10th day

vomiting blood, diarrhea, high fever, extreme fatigue

environment

water and sewage air, water, and environmental pollution work place safety

75% of global secondhand smoke deaths occur among

women and children

psychosocial hazards

workplace violence harassment stress

urbanization

world = 54.9% largest urban populations: - Tokyo = 38.34 mil - New Delhi = 27.197 mil - Shanghai = 25.2 mil - Beijing = 22.063 mil - Mumbai = 21.69 mil - Sao Paulo = 21.52 mil - Mexico City = 21.32 mil

UN population prediction

world population will grow by almost a billion people in the next 13 years and will reach almost 10 billion by 2030

healthy aging (our goal)

balance prevention of disease and injury with promotion of behaviors and environments in a way that maximizes functioning and well-being across the lifespan

medicaid (1965)

before the ACA, had to be either: - low-income and categorically eligible - medicinally indigent = elderly in LTC NOW: income <139% of FPL, and living in a state that agreed to expand medicaid

public health intervention strategies

biologic (vaccines) behavioral (individual, community) political (lobbying) structural (laws and regulations)

health care/home care

biological = infections from contact with patients infected blood or body fluids biomechanical/ergonomic = heavy lifting and awkward positions safety = trips/slips/falls, pets psychosocial = violence. harassment, stress/long work hours without breaks chemical = secondhand cigarette smoke, strong cleaning chemicals

type 1 diabetes

body does not produce enough insulin

ergonomists and their study

body movements and positions tools and equipment used physical environment organizational environment risk of injury or illness

type 2 diabetes

body produces insulin but can't use it well

3rd stage: 11th day

brain damage, bleeding from nose, mouth, anus

mental disorders cause more disability than...

cancer and HIV

major NCDs in 2016

cardiovascular diseases (31.4% of all deaths) cancers (15.8% of all deaths) chronic lung diseases (3.9% of all deaths) diabetes (2.8% of all deaths) mental health condition deaths of these 4 diseases account for 77.6% of NCD deaths and 55.32% of overall deaths

what racial groups have the highest suicide rates?

caucasians and native americans

public health concerns regarding alcohol abuse

causes 1/3 of all motor vehicle accidents in the U.S. increases use of drugs and unsafe sex loss of employment and productivity disruption of families

surveillance analysis

change in frequency of risk activities (number of different partners, use of condoms, and specific risk behaviors) change in prevalence/incidence consistency of trends interpretation and implications

bipolar disorder

characterized by repeated episodes in which the patient's mood and activity levels are significantly disturbed

highest risk factors for NCDs in LOW-INCOME COUNTRIES

childhood underweight high blood pressure unsafe sex unsafe water, sanitation, and hygiene

which 3 countries have the highest number of new cancer cases?

china U.S. india

which 3 countries have the highest number of cancer deaths?

china india U.S.

largest religious groups in 2015

christians = 31.2 muslims = 24.1% unaffiliated = 16% hindus = 15.1% buddhists = 6.9% folk religions = 5.7%

reasons for lack of clean water

climate and dropping water tables worldwide poverty rural dwellers pollution and poor control of waste

surveillance study designs

cohort studies cross-sectional studies and surveys serial cross-sectional studies mortality surveillance sentinel surveillance syndromic (early outbreak detection)

surveillance

collection of health data expressly for use in health planning, disease control and prevention, and/or health promotion ongoing collection of data timely analysis easily understood dissemination of results action based on results periodic evaluation of the system

4th stage: 12th day

coma, organ failure, shock, massive internal bleeding, death

global health

common health problems across borders health disparities: between countries, within countries, and global responsibility

ebola prevention

community engagement: case finding, case management, surveillance, and contact tracing isolation of patients in maximum containment facilities maximum protective apparel for caregivers quarantine of contacts vaccines (containment strategy and preventive)

modern balanced mental health system

community services for children and adolescents crisis resolution teams home treatment assertive outreach early intervention teams day treatment facilities supported work programs decrease emphasis on mental hospitals

testing strategies to reduce selection bias

compulsory mandatory unlinked anonymous voluntary anonymous voluntary confidential routine confidential

standard drink

contains 0.6 ounces of pure alcohol 12oz of beer = 5% alcohol content 8.5oz of malt liquor = 7% alcohol content 5oz of wine = 12% ALC 1.5oz of 80 proof = 40% ALC

sociopolitical considerations of vaccines

cost of development responsibility for liability priorities for funding and distribution of vaccine appropriateness and acceptability of vaccine for target populations

U.S. lacks national health insurance:

coverage is based on a mix of private and public programs 1. workers and dependents = employer-sponsored insurance (ESI) 2. age 65+ = medicare 3. poor plus another "appropriate" qualification = medicaid 4. not eligible for above, or not offered or cannot afford ESI = private insurance in the individual (non-group) market or uninsured and reliant on free (charity) care

1970 occupation safety and health act

creates and enforces occupation health and safety standards