Public Health 270
risk/benefit ratio of deferring vaccines when vaccine-preventable diseases are still present in many communities
"disease risks are much, much greater than the risk of vaccination"
national health insurance
(Canada, Taiwan, South Korea) providers are private, payer is a government-run insurance program that every citizen pays into *can control costs through limiting medical services or making patients wait to be treated
Bismarck model
(Germany, Japan, Switzerland) Health insurance is private, financed by employers and employees, but it is not-for-profit and tightly regulated; providers are private.
Beveridge Model
(Great Britain, Italy, Spain) Health care is provided and paid for by the government as a public service, financed through taxes. Physicians may be public employees on salary, or stay in the private sector and collect fees.
out of pocket model
(the developing world) only the rich get medical care, most medical care is paid for by patient, no insurance or government plan
approach used in public health to identify a contributory cause of a disease and establish the efficacy of an intervention
- Ecologic (group) Association (population studies) - Individual association (case-control studies) - "cause" precedes "effect" (cohort studies) - altering the "cause" alters the "effect" (randomized controlled trials or natural experiments)(ex:those who quit smoking have reduced chances of developing cancer) - contributory cause or efficacy (supportive criterion: consistency, strength, dose response, biological plausibility)
Market Justice Philosophy
- Health care is your personal responsibility - you "get what you work for"
sources of excess costs in the US healthcare system and strategies for reducing the costs of health care
- administrative costs are astronomical (2-3 times more than in other countries - costs for drugs, procedures, and medical supplies is higher than in other countries - we get more treatments (not primary care) than people do in other countries *being done: consumer-directed health plans- more high deductible health plans
recognize some potential approaches to improve the performance of the US health system
- consolidate services for better quality and lower costs - eliminate the fee-for-service payment system - embrace technology
features of the ACA that represent key changes to the US health insurance system
- covering the uninsured (children to age 26, poor without children, pre-existing conditions) - strengthening primary care through the "medical home" model - encouraging integration across providers - stimulating growth in the "meaningful use" of information technology
approaches to promoting health
- health care: individual health services (ex: clinical services) - traditional public health: Group based interventions (ex: food safety) - social interventions: Interventions w/ a non-health related purpose, "secondary impact on health" (ex: tax laws)https://canvas.wisc.edu/courses/174483/quizzes/147643
background and rationale of county health rankings
- launched in 2003, the rankings is an annual publication - focuses on both health outcomes and health determinants - spark discussion of health issues - stress that there are multiple broad determinants of health
conditions that make eradication of a disease feasible
- limited to humans - limited persistence in the environment - absence of long-term carrier state - long-term immunity results from infection - vaccination confers long-term immunity - herd immunity prevents perpetuation of an epidemic - easily diagnosed disease - vaccination effective post-exposure
criteria for evaluating the quality of information presented in news stories about public health issues
- overall site quality - authors - information - relevance - timeliness - links - privacy
utility and disadvantages of group or "ecologic" associations
- rarely prove a causal association - best to generate hypotheses, that can later be studied in strong research designs
methods of transmission and factors that affect the transmissibility of a disease
- route of transmission - asymptomatic transmission (ability to transmit disease while animals/humans are free from symptoms) - reproduction rate
different options for preventing communicable diseases
- sanitation and hygiene - vaccination - antibiotics and other antimicrobial medicines
6 quantitative sources of public health data
- single case or small series - "vital statistics" and reportable diseases ("VS" ex: birth/death) - surveys and sampling - self-reporting - sentinel monitoring (ex: flu monitoring- used to identify outbreak & changes in virus type) - syndromic surveillance (use of symptom patterns to raise alert of possible new/increased disease)
current global health challenges and trends- familiarize yourself with general trends ex) "aging population"
-Growing population -Aging population manifesting in shifts in disease burden to NCDs -Urbanization -Changing patterns of consumption with economic development -Global spread of tobacco -Diets high in sugar, fat, salt -Physical inactivity
how new pathogens emerge and spread and their pandemic risk
-Growth in world population has led to increases in demand, production, and consumption of meat -Humans in all parts of the world interact with wildlife -Increases in life expectancy (aging) and survival following HIV infection, cancer, adn organ transplantation (immunocompromised people) -Inappropriate and overuse of antimicrobials selects for drug-resistant pathogens -Globalization and human movement -Changing ecologies and animal movement due to climate change
global health- how it has evolved over time and how it related to public health
-Includes HEALTH IN ALL POLICIES multi-sector efforts to improve well-being that use prevention as prime intervention strategy. -Includes government, bilateral and multi-lateral cooperation, NGOs, civil society and the private sector. -Global health is public health! *collaborative transnational research and action for promoting health for all
how different surveillance systems are used to track health status in college populations
-List of 70 nationally notifiable infectious conditions -Updated annually by council of state and territorial epidemiologists -Standard case definition -Reporting by states to CDC is voluntary; established by state law
global health success stories- just familiarize yourself with general successes
-Smallpox eradication 1979 -Vitamin A supplementation in Nepal prevents 200,000 child deaths -Polio eliminated from western hemisphere 1991 -Reduction of infant death due to diarrhea by 82% from 1982 to 1987 in Egypt -Dramatic reduction in Guinea Worm -reduced by 99% in 20 countries -Fertility reduction in Bangladesh from 7 to 3 children per woman -Overall improvements in IMR 126 to 49/1000 in 2013 -Under 5 child mortality decreased by 60% from 1990 thru 2010 -Between 1990 and 2010, life expectancy increased by 12-15 years for men and women -Burden due to HIV and Malaria is falling
basis of concerns for parents when considering vaccinations for their children
-correlation vs causation -wakefield produced writing stating that it was proven that vaccines cause autism
recognize individual and population-based approaches to increase the use of vaccines
-declination vs responsibility forms (increasing interest in forms indicator parental refusal to protect their child from potentially serious disease)
demographic transition- understand "double burden" and "triple burden" of disease
-double burden: the coexistence of undernutrition along with overweight/obesity or diet‐related non‐communicable diseases -triple burden:the backlog of common infections, undernutrition, and maternal mortality
effective strategies for improving immunization rates
-expiration on refusals for waivers -allowing teens to consent to vaccines without parental assent -requiring co-signatures for all school waivers (notarization) all around better education on vaccine importance
the role and ethics of school entry requirements as methods to improve immunization rates
-legal requirement increases vaccination rates (authority: state statute, implemented by schools, legally required versos recommended, and supported by Supreme Court rulings)
basic model of population health used in county health rankings (policies...)- proportion of health outcomes explained by health factors (behaviors..)
-policies and programs, health factors and health outcomes HEALTH FACTORS: health behaviors *30% (tobacco use, diet and exercise, alcohol and drug use, sexual activity), clinical care 20%(access to care and quality of care), social and economic factors 40% (education, employment, income, family and social support, community safety), physical environment 10% (air/water quality and housing/transit)
Epidemiology methods in defining a disease and measuring the burden
-problem: describes health and disease in human populations (when, who, where) -etiology: determines the causes of disease -recommendations: evaluates public health control efforts Measuring the burden: - Health Outcomes: Mortality & morbidity, Life expectancy, premature deaths (YPLL), Quality of life (QALYs, DALYs, HALEs) - Populations: Attack rate (incidence), Mortality
reasons why some parents are "hesitant" to immunize their children
-vaccine might cause harm -natural disease better than vaccine -child not at risk for disease -autism -thimerosal -vaccines overload the immune system -diseases not dangerous
3 levels of influence in which theories and models are categorized- provide examples of theories and models that correspond to these levels
1. intrapersonal- focusing on individual characteristics (knowledge, attitudes, beliefs, motivations, self-concept, past experiences and skills- five stages of change: precontemplation, comtemplation, preparation, action, maintenance) 2. interpersonal- focusing on relationships between people (other people influence behavior by sharing their thoughts, advice, feelings, and emotional support) 3. population and community- focusing on factors within social structures (norms, rules, regulations, policies, laws- diffusion of innovation theory which tells how a new practice or idea is adopted in a population)
population health
A broader concept of public health that includes all the ways that society as a whole or communities within society are affected by health issues and how they respond to these issues *uses an evidence-based approach to analyze the determinants of health and disease
role of theory in health behavior and why some behavior change is easier to accomplish than others
A set of interrelated concepts that presents a systematic view of relationships among variables in order to explain and predict events and situations - Combination of ideas and concepts taken from multiple theories and applied to specific problems in particular settings
Social Justice Philosophy
An individual's health is determined by their social & environmental conditions - all persons entitled to basics services - society has a shared responsibility
difference between "real" and "artifactual" changes
Artifactual changes - Differences between population or changes in a population over time due to changes in interest in identify the disease, change in ability to recognize the disease or changes in the definition of the disease Real Change-refers to efforts put in place to change people's personal habits and attitudes, to prevent disease
mechanisms of antimicrobial resistance
Bacteria: High replication rates Selection of strains with mutations that have an advantage for survival and/or transmission Horizontal gene transfer (sharing of antibiotic resistance genes) Viruses High replication rates Selection of strains with mutations that have an advantage for survival and/or transmission
interplay between genetics and environment on individual health factors and health outcomes
Contracting muscles are factories of beneficial anti-cancer and cardiovascular disease chemicals, and a boosted immune system generally *greener spaces allow people to outside more, and overall get more exercise and be healthier
reasons why outbreaks occur- how they end as well as common interventions to stop the spread of disease
Disease outbreaks are usually caused by an infection, transmitted through person-to-person contact, animal-to-person contact, or from the environment or other media. Outbreaks may also occur following exposure to chemicals or to radioactive materials *improved sanitation, more vaccines, and trapping the virus
Health Protection (antiquity-1830s)
Focus: Authority-based control of behaviors Action FW: Religious and Cultural practices Events: - Quarantine - sexual prohibitions (reduce STI)
Filling holes in the medical care system (1950s- 1980s)
Focus: Care of high-risk populations Action FW: Public system vs healthcare system Events: - antibiotics - randomized controlled trials - concept of rest factors - health maintenance orgs and community health centers
Population Health (2000s)
Focus: Coordination of public health and healthcare Action FW: evidence-based recommendations and info management Events: - information technology - antibiotic resistance - global collaboration
Contagion control (1880-1940s)
Focus: Germ theory (origins of disease) Action FW: Communicable disease control though environment control Events: - Linked epidemiology, bacteriology, and immunology to form TB sanatoriums
health promotion/disease prevention (1980s-2000)
Focus: Individual behavior and disease detection Action FW: Clinical and pop-oriented prevention with a focus on individual control of decision making Events: - AIDS epidemic
Hygiene Movement (1840-1870s)
Focus: Sanitary conditions Action FW: Environmental Events: - collection of Vitals stats - Snow on cholera
eras of public health
Health Protection (antiquity- 1830s), Hygiene Movement (1840- 1870s), Contagion Control (1880-1940s), Filling holes in medical care system (1950s-1980s), Health promotion/Disease prevention (mid 1980s-2000), Population health (2000s)
strategies to prevent CDI in healthcare settings
Many patients develop CDI in healthcare settings due to lack of healthcare professional sanitation and cleanliness, so improved hygiene and sanitation would be helpful
outbreak
More cases of a particular disease than expected in a given area or among a specialized group of people over a particular period of time. *can be one case, but just has to be more than what was expected in that area during that time
The public Health Approach
Surveillance (problem?), risk factor identification (cause?), intervention evaluation (solution?), implementation
discern data from an epidemic curve
The horizontal x-axis is the date or time of illness onset among cases -these are used to find when cases were most prevalent
impact immunizations have had on communicable disease in the US
The incidence, prevalence, morbidity, and mortality of many communicable diseases have significantly decreased in Western countries largely because of national immunization strategies aimed at infants and children
effects and health co-benefits of cross-sector responses to climate change
To be effective, climate change adaptation needs to be mainstreamed across multiple sectors and greater policy coherence is essential -when multiple groups work together it makes a greater positive impact
key global health organizations and actors
WHO, multilateral development partners Private sector Foundations Global fund Research and academia NGOs
epidemic curve
a graphic display of the cases of disease according to the time or date of onset of symptoms
flagship framework
a policy oriented tool Health system: Policy interventions *buttons: financing, payment, organization, regulation, persuasion Intermediate performance measures: *dial: efficiency, quality, and access Target population: Performance goals: *meter: health status, customer satisfaction, risk protection Examples of applications of flagship framework: International pharmaceutical reform (development of international guidelines for used FF
direct and indirect ways in which climate change threatens global public health
air pollution, ocean acidification, ozone depletion, biodiversity loss, vector and water borne diseases,
attack rate
an incidence rate calculated for a particular population for a single disease outbreak and expressed as a percentage
risk factors for hospital-acquired infections (HAIs)
antibiotic use, immune system, urinary catheter, hospital room partners
describe "action cycle" and the "what works" parts of the county health rankings
assess needs and resources, focus on what's important, choose effective policies and programs, act on what's important, and evaluate actions- to do this we all need to work together (public health, business, education, philanthropy and investors, nonprofits, community development, government, healthcare, and in the middle of all of these COMMUNITY MEMBERS)
determinants of disease (BIG GEMS)
behavior, infection, genetics, geography, environment, medical care, and socioeconomic- culture
utility and limitations of health adjusted life expectancy (HALE)
calculating whether a persons is over or under weight to determine their life expectancy ignores the other factors (ethnic background, socioeconomic status, etc.)
approaches to define and measure the quality of health care
care process, access, administrative efficiency, equity, and health care outcomes
criteria for evaluating health care systems performance across countries- how does the US compare to other countries in key areas?
care process- 5th (prevention, safety, and engagement) access- 11th *LAST (affordability subdomain) admin efficiency- 10th (problems related to coverage restrictions) equity- 11th *LAST (disparities between lower and higher-income adults) health outcomes- 11th *LAST (such as infant mortality and life expectancy)
how college population demographics impact public health in the US
college campuses are just one plane ride away and universities are a place where many international students come to study, so various diseases can easily be brought over and introduced through that contact
difference between droplet and airborne transmission
droplet transmission is when the virus travels on droplets from a human when they spit, sneeze, cough, etc. and airborne is when the virus particles travel on air particles
impact of decreased immunization rates for both individuals and populations- the role of school entry requirements
easier to spread the disease- herd immunity doesn't work and therefore the population is more susceptible and there's a greater chance for an outbreak *parents can sign a waiver choosing not to vaccinate their child
assets and barriers to better health for individuals living in diverse communities across the globe
energy sector (air pollution), food systems (unhealthy vs healthy food option and convenience, and transportation (lack of exercise)
major actors and initiatives in the current climate change policy landscape
energy sector (air pollution), food systems, and transportation
relationship between global health and SDGs- positive and negative health effects of SDGs- how are SDGs an example of "health in all policies"
goal #3: ensure healthy lives and promote well-being for all at all ages goal- all areas relate to a healthier lifestyle in general *improved sanitation will improve health, etc.
differences between incidence and prevalence
incidence - number of people who develop disease who did not have disease at the beginning of the measured time period (number of new cases divided by population times 100) prevalence - number of people who currently have the disease (number of existing cases divided by population times 100)
key messages to emphasize the importance of routine immunizations
infectious disease outbreaks require: -multiple exposures or close proximity for extended periods of time -poor or no hygiene -susceptible population *this is literally everyone, which is why disease spread so quickly
modern criteria for establishing that an organism is the contributory cause of a disease
koch's postulates: - isolate the pathogen from sick creature - grow pathogen in a lab and obtain a pure culture - inoculate a healthy creature with a sample of the pure culture - re-isolate the same pathogen from the second sick animal
relationship between income and socioeconomic status
lower income usually means they live in worse living conditions which leads to a more unhealthy lifestyle *think about seminar class last year*
morbidity and mortality
morbidity: #people/incidence/prevalence mortality: years of life lost from this problem *incidence of death
herd immunity threshold
number of immune individuals above which a disease may no longer circulate *infectious diseases: 90% (only a small number of the population can be left unvaccinated for herd immunity to be affected)
climate change- basic mechanisms and the impact of human behavior and lifestyles
population, water use, chemical fertilizer, paper, dams, automobiles - carbon dioxide - loss of forests and woodlands - biodiversity loss - nitrogen pollution of the sea *we are consuming or degrading natural resources at an unsustainable pace
Options for implementation of public health interventions
primary: prior to disease or condition - Who (how): individual (education) secondary: prior to symptoms - Who (how): high risk groups (Incentives) tertiary: prior to irreversible complications - Who (how): General pop (Requirement) *interventions can create disparities in health status, health behavior and not all interventions work with all audiences
evidence-based public health process (PERIE)
problem, etiology, recommendations, implementation, evaluation
social-ecological model
public policy, community (cultural values and norms), organizational (environment and ethos), interpersonal (social network), individual (knowledge, attitude and skills) ex) Child weight is determined by the child's behavior, parenting, feeding and parent characteristics, and community and demographic factors
relationship between global and local health and the value of a global perspective in public health
rather than local and global being an either/or we shall see it as a continuum with local perspectives growing into global ones *having a global view on health helps us see the disparities present
WHO building blocks
service delivery; health workforce; information; medical products, vaccines & technologies; financing, leadership/governance
role of asymptomatic carrier of C. difficile in the transmission of CDI in healthcare settings
spores form and shed, leading the spores to appear throughout healthcare settings waiting to be picked up by other patients, which makes it dangerous in large population settings at close proximity
how distribution of disease is used to generate hypotheses about the cause of a disease
the "triad" of descriptive epidemiology- calculate rates by time, person, and place (group/ecologic associations)
compare (generally) the current performance of the US health system to other national health systems
the US health system is getting more and more expensive and our performance is not increasing, which is widening the gap between the countries
planetary health
the achievement of the highest attainable standard of health, wellbeing, and equity worldwide through judicious attention to the human systems—political, economic and social, that shape the future of humanity and the earth's natural systems that define the safe environmental limits within which humanity can flourish
apply agent-host-environment triangle to understand how people develop HAIs
the agent is carried in by another host body when it exposes other hosts in healthcare settings, which is an environment that makes transmission of disease easier
how relative risks relate to attack rate and how to describe each using a sentence or 2
the attack rate is the biostatistical measure of frequency of morbidity, or speed of spread, in an at risk population *attack rate is used in hypothetical predictions and the relative risk is the actual amount of people affected compared to not in an area
Paternalism
the balance of society's general health protection with individual rights
one health
the collaborative effort of multiple disciplines working locally and nationally and globally to obtain optimal health for people, animals, and our environment
reproductive ratio
the expected number of cases directly generated by one case in a population where all individuals are susceptible to infection
onset
the first appearance of the signs or symptoms of an illness
relative risk
the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group
herd immunity
the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination
utility and limitations of disability adjusted life years (DALYs)
they focus solely on health and do not capture the broader societal impact of disability -disability is a wide range of things that gets jumbled into one number *MANY PEOPLE FEEL AS IF THIS NEEDS TO BE REPLACED AND IS NOT ACCURATE
important factors in the investigation and prevention of infectious disease outbreaks on college campus
travel is super important, where the student lives, where they have been, in which areas are students being most affected and then limiting those student interactions when an outbreak does occur
utility and limitations of Infant Mortality Rate (IMR)
underegistration of infant deaths is a common feature
public health
what we do to assure conditions so all people can live long and healthy lives
role of zoonotic diseases in emergent human infectious diseases
zoonotic diseases are transmitted from animals to humans and therefore harder to control
burden of communicable diseases
•Communicable disease may be caused by a wide variety of organisms, such as bacteria, viruses, or parasites •For many centuries, communicable diseases were the leading cause of death and disability among all ages, but especially among the young and the old -May cause great epidemics -Can also become endemic and become routine causes of death
how characteristics of a disease make eradication possible and contextual challenges globally
•No animal reservoir •Short persistence in environment •Absence of long-term carrier state •The disease produces long-term immunity •Vaccination produces long-term immunity •Herd immunity protects those who are susceptible •Easily identified disease •Effective postexposure vaccination