Foundations: Health Studies Midterm Review

Public health vs. medicine

*Public Health* -Populations (goal is to shift entire pop to healthier place) -Wellness -Prevention *Why do some populations have higher rates of illness and disease?* - may require addressing social, economic, and environmental policies not typically considered "health policy" - Public health focuses greatly on the prevention of disease. In other words, successful public health is invisible. - "Public health is about controlling that factors that you can't control, that control your health. You're only as healthy as the world around you." - Bob Fullilove, Professor of Sociomedical Sciences, Columbia University *Ex:* LECTURE This is Public Health (TIPH) campaign was created by the Association of Schools and Programs of Public Health (ASPPH) Public health sticker campaign - placed on hybrid buses, water fountains, bike racks, fresh fruit stand, no smoking sign *Ex:* LECTURE & HISTORY SLIDE 18, 20, 22 *Ex:* Fee & Brown "The Unfulfilled Promise of Public Health" - responses in times of crisis, immigrants, fear of socialism *Medicine* -Individuals -Illness -Diagnosis & Treatment *Why did this one individual get sick or injured?*

Relative risk

The IR of a disease in a population exposed to a particular factor ÷ the IR of those not exposed In epidemiology, relative risk (RR) can give us insights in how much more likely an exposed group is to develop a certain disease in comparison to a non-exposed group. ***used to determine whether a behavioral, demographic, or structural variable is associated with a higher risk of illness or mortality *Ex:* http://www.europeanpublichealth.com/research-methods/basics-of-epidemiology/relative-risk-and-odds-ratio/

Health-wealth gradient

every descending rung of the socioeconomic ladder corresponds to worse health *Ex:* Unnatural Causes: In Sickness & In Wealth Before the Whitehall study, it was thought that business executives had higher rates of heart disease. However, the studied revealed that the lower the grade of employment, the higher the risk of heart disease and the other major causes of death, creating the wealth-health gradient. Death rates and illness correlated to status even after they controlled for unhealthy behaviors. The combination of smoking, high blood pressure, cholesterol, being overweight, and a sedentary lifestyle explained no more than a quarter of the gradient. This means that if a poor person is smoking, he/she still has a higher rate of disease than a wealthy person who smokes. ***Social class is the biggest predictor of life expectancy. Societal forces such as housing, medical care, education, power, confidence, and a sense of security are all intertwined and all reinforce these stressors.

Health disparity

health inequity; differences in health and healthcare that occur between groups of people; a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage *Ex:* Unnatural Causes: In Sickness & In Wealth We have reduced health inequality in the past by improving living conditions/medical treatment and implementing social reforms, including universal education, better sanitation, the 8-hour workday, the controversial income tax, and social security. In the 1930s, these social reforms prevented an economic crisis from becoming an even worse health crisis. The GI bill for returning WWII veterans, which provided them with homes and education, also helped to narrow health inequality in the U.S. By the 1950s, the middle class was growing and income inequality decreased. Rather than medical advancements reducing this health inequality, the main contributing factors were the greater distribution of wealth, public health infrastructure, better education, and better housing. However, most African Americans were still excluded from many of these social reforms. In the 1960s, civil rights laws, anti-poverty programs, medicare and medicaid brought some prosperity to African Americans. The gap narrowed between black and whites on various health measures. In 1976, wealth inequality reached a record low. Since the 1980s, however, we've gone in the opposite direction. The government slashed social programs, deregulated industry, and reduced taxes for the wealthy, which all caused health inequality to rise again. Health policies that may help to reduce health inequalities include better education, housing support, increased access to childcare, and access to recreation subsidized through tax policy. *****"A type of difference in health that is closely linked with social or economic disadvantage. Health disparities negatively affect groups of people who have systematically experienced greater social or economic obstacles to health. These obstacles stem from characteristics historically linked to discrimination or exclusion such as race or ethnicity, religion, socioeconomic status, gender, mental health, sexual orientation, or geographic location." *Ex:* LECTURE ****** Rates of diagnosed diabetes 15.9% for "American Indians/Alaskan natives," while only 7.6% for "non-Hispanic whites" *Ex:* Unnatural Causes: Bad Sugar ******Gila River Indian Reserve - Today, half of the adults have been diagnosed with diabetes; Average age of diagnosis = 36; Diabetes was not common prior to 1950 but rose dramatically in the latter half of the 20th C - Disproportionate exposure to sugar-sweetened beverages in low-income communities and communities of color: Billion-dollar marketing campaigns target youth, low-income communities, communities of color

Sense of control (i.e. at work)

higher sense of control = tend to be healthier (less stress and uncertainty) *Ex:* Unnatural Causes: In Sickness & In Wealth An ability to influence events of your life (even if this means doing nothing) provides a sense of control/security that allows individuals to manage pressures and stress. When we feel threatened and don't have control, our stress signals kick in. A little stress is good, but too much is unhealthy. When our bodies produce too much cortisol, physical and mental processes are adversely affected. Chronically stressed individuals have higher rates of disease and accelerated aging. In an experiment, monkeys with less power and control were shown to be in a state of chronic stress. These subordinate monkeys developed more plaque than dominant monkeys under same conditions. This can also be applied to humans. In another experiment, researchers found that the greater the education/income a person has, the less cortisol he/she releases throughout the day. When participants immune systems were tested, those with less chronic stress caught fewer colds. This could provide a glimpse into more serious health concerns that result from stress. Furthermore, 21% of children in America in poverty. Childhood poverty can have lifelong health consequences. Children become stressed when they do not know if they will have food or a roof over their heads. This stress has been shown to affect children's brain development. The more years a parent owned a home, the less likely the participants were to get a cold. ***In order to reduce chronic stressors, it is important to narrow the income disparity and create policies that make it easier for people to move up the social ladder. It is also important to combat discrimination and provide better access to housing and education.

Prevalence vs. incidence

prevalence = percent of people affected in a population incidence = new incidents in a given time period/total population at risk point prevalence - the percent of people who have a particular condition at a particular point in time period prevalence - the percent of people who have or have had a particular condition over a particular period of time incidence - the number of new cases over the number of exposed people within a specific period of time *Ex:* Examples of incident cases or events include a person developing diabetes, becoming infected with HIV, starting to smoke, or being admitted to the hospital (incidence of type 2 diabetes could be a percentage of people who develop diabetes in a given year, while prevalence is the total percentage of people with type 2 diabetes out of the whole population) https://www.eupati.eu/pharmacoepidemiology/epidemiologic-concepts-incidence-and-prevalence/