Public Health Midterm
endemic
(adj.) native or confined to a particular region or people; characteristic of or prevalent in a field refers to the constant presence and/or usual prevalence of a disease or infection within a particular geographic area or population.
Downstream prevention
disability and illness treatment of disease go back and watch video on slides
State Health Departments
-Coordinate activities of local health agencies and provide funding -Collect and analyze data - Provide Laboratory services -Manage Medicaid -License and certify medical personnel, facilities, and services - handle Environment, mental health, social services, and aging may be handled by separate agencies - Provide funding to hospitals to reimburse them for treating uninsured patients
Local Public Health Agencies
-County and city health departments -Day-to-day responsibility -Core public health functions -Often also have responsibility for providing medical care for the poor -Funding sources are variable; city or county legislatures may not understand importance of core functions. Mandates may be funded from state or federal governments.
Characteristics of a Public Health Approach
-grounded in science -focused on prevention as a primary strategy -founded on social justice and health equity philosophies -dedicated to ethical principles -linked with Government -based on an inherently political nature -reliant on the broader public health system/ health in all policies approaches -engaged as a multidisciplinary culture with common bonds -dynamic, with an ever-expanding agenda
Overarching goals of Healthy People 2020
1. Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. 2. Achieve health equity, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages.
Public Health Approach
1. Define the health problem 2. Identify risk factors associated with the problem 3. Develop and test community-level interventions to control or prevent the cause of the problem 4. Implement interventions to improve the health of the population 5. Monitor interventions to assess their effectiveness
What are the 17 sustainable development goals?
1. No poverty 2. Zero hunger 3. Good health and well-being 4. Quality education 5. Gender equality 6. Clean water and sanitation 7. Affordable and clean energy 8. Decent work and economic growth 9. Industry, innovation and infrastructure 10. Reduced inequalities 11. Sustainable cities and communities 12. Responsible consumption and production 13. Climate Action 14. Life below water 15. Life on land 16. Peace, just and strong institutions 17. Partnerships for the goals There are 169 targets within these.
What are the public health disciplines?
Epidemiology Statistics Biomedical Sciences Environmental Health Science Social and Behavioral Sciences Health Policy and Management
What are the sustainable development goals?
17 goals adopted by the UN in 2015 to reduce disparities between developed and developing countries by 2030 They are intended to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity. The SDGs include targets and indicators for a wide range of economic, social, and environmental issues, such as ending poverty and hunger, improving health and education, making cities more sustainable, combating climate change, and protecting oceans and forests.
Tuskegee Syphilis Experiment
1932-1972 Clinical trial: Follow natural progression of Syphilis 600 poor African American men in Alabama 399 of these men tested positive for syphilis Not told they had syphilis Not prescribed penicillin when it was demonstrated penicillin treated syphilis.
Where did public health come from?
19th century, when the rapid industrialization and urbanization of many countries led to a significant increase in the spread of infectious diseases, such as cholera and tuberculosis. This led to the development of public health movements and the formation of public health agencies, such as the Public Health Department in the UK (1848) and the US Sanitary Commission (1864). John Snow, a physician, is considered one of the founders of modern epidemiology and public health, is famous for his investigation of a cholera outbreak in London in 1854. He demonstrated that the disease was spread through contaminated water, rather than through the air, which was the prevailing theory at the time. This work led to the development of the field of epidemiology and the rec
What is equality? What is equity?
Equality = sameness (i.e., equal opportunity, equal access, equal treatment, equal sharing and division) Equity = fairness and justice
What is Healthy People 2020?
A NATIONAL agenda that communicates a vision for improving health and achieving health equity. AND A set of specific measurable objectives with targets to be achieved over the decade. The Healthy People initiative began in 1979 when Surgeon General Julius Richmond issued a landmark report titled "Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention." • Healthy People 2030 is the fifth iteration of the initiative. It builds on knowledge gained and lessons learned to address the latest public health priorities. Vision • A society in which all people can achieve their full potential for health and well-being across the lifespan. Mission • To promote, strengthen, and evaluate the nation's efforts to improve the health and well- being of all people.
randomized clinical trial
A controlled medical experiment in which subjects are randomly chosen to receive either an experimental treatment or a standard treatment (or placebo).
Market Justice
A distributional principle according to which health care is most equitably distributed through the market forces of supply and demand, rather than government interventions.
Socioecological Model of Health and Wellness
A framework that recognizes the interrelationship between individuals and their environment; emphasizes that where we live, work, and play strongly influences our health.
What is the epidemiologic triangle? The agent is the infectious agent or pathogen that causes the disease. The environment includes all external factors that affect the host and agent, such as physical, biological, and social factors The host is the organism that is affected by the disease. A model understand the factors that contribute to the occurrence of infectious diseases.
A model understand the factors that contribute to the occurrence of infectious diseases.
outbreak
A sudden rise in the incidence of a disease sudden increase in the number of cases of a disease above what is normally expected in a particular area or among a specific group of people.
cohort study
A type of epidemiologic study where a group of exposed individuals (individuals who have been exposed to the potential risk factor) and a group of non-exposed individuals are followed over time to determine the incidence of disease
Case-control study
A type of epidemiologic study where a group of individuals with the diseases, referred to as cases, are compared to individuals without the disease, referred to as controls
Measures of disease frequency in epidemiology include: Incidence All of these Mortality rate Prevalence
All of these
The discovery of which of the following allowed medicine to gain the power to work miracles of healing, leading to a period of rapidly growing influence? Monoclonal Antibodies Immunizations Stem Cells Antibiotics
Antibiotics
Epidemiology is used to perform what function of public health? Assessment Assurance Policy development Analysis
Assessment
Which of the following was used as a treatment for almost any illness by 18th century physicians? Opiates Antibiotics Alcohol Bleeding
Bleeding
social justice
Community responsibility. Individuals are interconnected. Fundamental rights are minimal levels of: Income, education, housing, employment, healthcare and environmental safety
Politics vs. Science as a source of controversy and debate in response to a public health action
Competing interests and competing evidence -Climate change Political parties can influence the Federal Government priorities -Abstinence -only health education Scientific integrity, development and global competitiveness in the US: Under Bush administration, EPA changed a section of a major report. Obama administration made efforts to inform policy decisions based on honest science. Under Trump administration, EPA director proposal would bring politics into initial review and synthesis of research step.
HHS stands for CDC stands for FDA stands for
Department of Health and Human Services Centers for Disease Control and Prevention Food and Drug Administration (FDA)
Pandemic
Disease that occurs over a wide geographic area and affects a very high proportion of the population. is an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population.
Which of the following is comprised of the answers to the who, when, and where questions? Frequency Incidence Prevalence Distribution
Distribution
what are the foundations of public health?
Social justice and health equity
How is biomedical science used to accomplish the core functions?
Examine Viral, Bacterial and Parasitic Disease Etiology A major portion of human disease is caused by microorganisms. • Control of infectious diseases was a major public health focus in the 19th and early 20th centuries. • Biomedical research remains important to understanding and control of new diseases and noninfectious diseases. -Chronic diseases -Genetics
Which of the following is not a source of systematic error in epidemiology? Confounding bias Selection bias Information bias Random error
Random error
The UCS had significant issues with the actions by the Bush administration regarding which of the following issues? Embryonic stem cells Bioterrorism AIDS epidemic Global warming
Global warming
examples of primary prevention
Health education, Good nurtrition, Marriage counseling and sex education, genetic screening, immunizations, personal hygeine, protection from accidents, avoidance of allergens
The foundations of public health does not include the following: Heath equity Health equality Social justice Social and ecological determinants
Health equality
How is health policy and management use to accomplish the core functions?
Health services research: effectiveness, efficiency and equity Cost effectiveness Access Organizational aspects of healthcare Quality of care Human resources for health Training • This area of study examines the role of medical care in public health. • Cost of medical care in the U.S. is out of control. • U.S. has a high percentage of population without health insurance. -These people often lack access to medical care. • Quality of medical care can be measured and is often questionable. • Medical care has eaten up profits that could be used more beneficially for education, housing, and the environment.
Which of the following about Healthy People is false? Healthy People was developed by C.E.A. Winslow. Four other Healthy People Initiatives existed prior to Healthy People 2030. The Healthy People initiative began in 1979 when Surgeon General Julius Richmond issued a landmark report titled, Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention. Healthy People 2030 is the 5th iterative.
Healthy People was developed by C.E.A. Winslow.
Research Ethics in Public Health as a source of controversy and debate in response to a public health action
Historical ethical violations in health research have compromised community trust in public health.
How is epidemiology used to accomplish the core functions? what is it?
Identifies and examines common exposures and shared characteristics of people -Illness -Low mortality rates Seeks causes of chronic disease and infections to limit harmful exposures. define: the basic science of public health. the study of epidemics: - Focuses on human populations, usually starting with an outbreak of disease in a community - Looks for common exposures, seeking the causative factor Deciphers causes of new disease and prevents spread of old, well-understood diseases Epidemiologists are mainstays of local public health departments. "Shoe-leather epidemiology" = field epidemiology or intervention epidemiology
What factors were traditionally considered determinants of health? Structural conditions and determinants of every day life Economics and social policies Systems that are put in place Individual behaviours
Individual behaviours
The socio-ecological model considers the complex interplay between multiple factors. The correct interplay between these factors is: Individual, relationship, community, and societal factors. Individual, community, relationship, and societal factors. Community, intrapersonal, interpersonal, and societal factors. Interpersonal, community, intrapersonal, and societal factors.
Individual, relationship, community, and societal factors.
How is global health used to accomplish the core functions?
Investigates and responds to health needs in low-resource settings Develops plans and processes to bridge diverse national strategies for health
Non-communicable diseases are: Chronic diseases that are passed from person to person. Leading cause of death and disability worldwide. Infectious agents that crosses species. Influenza viruses that are linked to higher pneumonia deaths in older adults.
Leading cause of death and disability worldwide.
Branches of Government: Federal, State, and Local
Legislative - passes statutes Executive - public health agencies carry out the law; may issue regulations consistent with statutes Judicial - laws and regulations can be challenged in court
Market Justice vs. Social Justice
Market Justice View - Healthcare is a commodity Goal: To deliver services that are cost-effective and meet acceptable standards of quality Social Justice View - Healthcare is a right Goal: To enable all citizens to receive health care services whenever needed - universal access
How do these functions compare with the functions of medical care?
Medicine--- Patient is the individual Goal of medicine is diagnosis, treatment, therapy and patient care- to cure Biomedicine develops medical treatments Public health--- Patient is the community Diagnoses the health of the community using public health sciences Treatment of the community involves new policies and interventions Goal of public health is prevention of disease and disability
Tertiary prevention
Minimizes disability after illness or injury with medical care and rehabilitation services. Ex. Medical treatment of cancer
Secondary prevention
Minimizes the severity of the illness after the injury or infection has occurred. Ex. Cancer screening for early detection
Moral and Religious Concerns as a source of controversy and debate in response to a public health action
Moral arguments against public health action may state that interventions will promote undesired or unacceptable behavior. Morality arguments against public health action can perpetuate epidemics by silencing -those providing care and -those who need the care. Religious and traditional and cultural belief systems may not align with public health interventions • Sex and reproduction • AIDS, STDs, teenage pregnancy, and low birth-weight babies are major U.S. public health concerns. • Public health solutions are often viewed as promoting immoral behavior. Such opposition may discourage • Alcohol and drugs scientists and funding agencies from conducting research on many important health problems. Physician assisted dying/ birth control/abortion
Which of the following is false? Even when public health scientists are certain they know all about the causes of a problem and what should be done about it, a political decision is generally necessary before action can be taken to solve it. Most Americans understand the role of public health. As biomedical and environmental sciences have conquered many of the diseases that killed people of previous generations, people in modern societies are dying of diseases caused by their behavior and the social environment. As part of the assurance function, public health seeks to understand the medical care system in an area of study generally referred to as health policy and management or health administration, which also includes the administration and functioning of the public health system. *A) True
Most Americans understand the role of public health.
Economic Impact as a source of controversy and debate in response to public health action
Most public health measures have a negative economic impact on some segment. Businesses often resist public health measures because they affect profits. Those who must pay may not be the ones who benefit. Costs may be short-term, while benefits may be long-term. Costs are easier to calculate than benefits. Businesses and Community Resistance Profit loss Increased job insecurity especially if the community has less economic diversity Tobacco Industry Perception that those who pay do not benefit DIRECTLY Government funding of social services Short-term costs with unseen long-term benefits Pollution control laws Incentives for electric and hybrid vehicles Costs easier to calculate than benefits Food availability and cost to public with and without pesticides.
Primary prevention
Reduces exposure to risk factors that contribute to any injury or illness. Prevents an illness or injury from occurring at all Ex. Smoking prevention activities
National Institutes of Health (NIH)
NIH is the largest biomedical research complex in the world. • Institutes exist for cancer; heart, lung, and blood; diabetes; aging; child health and human development; and other topics. • National Library of Medicine is an NIH institute. • NIH has laboratories in Bethesda, MD and provides grant funding to researchers at universities and research centers. • NIH has a clinical center where medical researchers test experimental therapies. • NIH enjoys strong Congressional support.
Which of the following does not explain the social determinants of health approach? None of these. Nonmedical factors influencing health. The circumstances in which people are born, grow up, live and age. Heath knowledge, attitudes, beliefs and behaviours.
None of these.
nongovernmental public health organizations
Organizations that focus on specific diseases include: - American Cancer Society- American Heart Association- American Diabetes Association- Alzheimer's Association • Professional membership organizations include:- American Medical Association- American Nurses Association- American Public Health Association • Organizations that play an important role in defining the future of public health include:- National Association of City and County Health Officers- Association of State and Territorial Health Officers- Association of Schools and Programs of Public Health
How is disease distributed throughout the population?
Person: age, sex, SES Place: urban, US states, near incinerator Time: June, annual, decade
When calculating the rate of a disease, which of the following is generally the denominator of the calculation? Population infected Population at risk Total world population Total state population
Population at risk
Public Health
Preventing disease Prolonging life Promoting health in communities through education and organization Engaging medical and nursing services in detection and treatment of disease Ensuring a standard of living for all through health and human services
How is environmental health science used to accomplish the core functions?
Preventing spread of disease through water, air and food • A classic component of public health: - Much of the public health improvement in the U.S. in the 20th century was due to improved environmental health. • Health is affected by exposure to environmental factors: - Air quality - Water quality - Solid and hazardous wastes - Safe food and drugs - Global environmental change • Thousands of new chemicals enter the environment every year, and little is known about their effect on human health.
Assurance (core function)
Public health professionals use the information gathered during assessment to develop policies, plans, and programs that address the identified health needs. They also work to ensure that these policies and programs are implemented effectively and that they meet the needs of the community.
Policy development (core function)
Public health professionals use the information gathered during assessment to develop policies, plans, and programs that address the identified health needs. They also work to ensure that these policies and programs are implemented effectively and that they meet the needs of the community.
Philanthropic Foundations
Rockefeller Foundation Robert Wood Johnson Foundation Pew Charitable Trusts Kaiser Family Foundation Commonwealth Fund Bill and Melinda Gates Foundation
What type of prevention seeks to minimize the severity of the illness or the damage due to an injury-causing event once the event has occurred? Primary Prevention Tertiary Prevention Secondary Prevention Quaternary Prevention
Secondary Prevention
Public health often arouses controversy on moral grounds, most often when it confronts what type of issues? Sexual and reproductive issues Legislative issues Economic issues Drug and alcohol issues
Sexual and reproductive issues
commercial determinants of health
Strategies and approaches used by the private sector to promote products and choices that are detrimental to health Factors that influence health which stem from the profit motive 1. Relate to unhealthy commodities/products that are contributing to ill-health 2. Include business, marketing, and corporate political activities that are harmful to health 3. Include the global drivers of ill-health, such as transnational companies and globalization, that facilitate the use of such harmful practices in #2 4. Health risks
Which of the following is a definition for commercial determinants of health? Strategies and approaches used by the private sector to promote products and choices that are detrimental to health. Companies that have business operations in its as well as in other countries around the world. The non-medical factors that influence health outcomes. Products that are detrimental to health, such as: ultra-processed, energy-dense nutrient-poor (EDNP) food and beverages, tobacco and alcohol.
Strategies and approaches used by the private sector to promote products and choices that are detrimental to health.
Corporate Political practices (CPA)
Strategies used by businesses to protect or increase their market shares by influencing public policy, research, and practices Tobacco and unhealthy foods
Which of the following is the nation's leading spokesperson on matters of public health? Director of the Centers for Disease Control and Prevention A table of answers and brief statistics regarding student answer choices. Answer Text Number of Respondents Percent of respondents selecting this answer Answer Distribution Secretary of Health and Human Services, Secretary of Health and Human Services Surgeon General of the United States Chief Justice of the United States
Surgeon General of the United States
Which of the following is not true? According to Beauchamp, market justice emphasizes individual responsibility, minimal obligation to the common good, and the fundamental freedom to all individuals to be left alone. A recently proposed rule would allow the EPA to only consider research studies where the underlying data could be provided. The UCS report from 2004 was signed by 10 Nobel Prize winners. Politicians would usually not like to implement public health initiatives with significant, negative economic impacts.
The UCS report from 2004 was signed by 10 Nobel Prize winners.
Exposome Concept
The exposome can be defined as the measure of all the exposures of an individual in a lifetime and how those exposures relate to health. An individual's exposure begins before birth and includes insults from environmental and occupational sources. Understanding how exposures from our environment, diet, lifestyle, etc.
Corporate social responsibility is: The idea that a business can have a positive impact on the world. Partnerships among public or nonprofit entities such as health depts, universities, or civil society groups and for profit entities designed to achieve research, practice, or other public health goals. Some of the strategies employed by businesses to protect or increase their market shares, by influencing public policy, research and practice. A process that involves product promotion, distribution, selling, advertising, product public relations, research, and information services with the target audience.
The idea that a business can have a positive impact on the world.
How is social and behavioral science used to accomplish the core functions?
Theory of health behavior: Social environment affects people's behavior • Behavior is now the leading concern of factors that affect people's health. • A theory of health behavior is that social environment affects people's behavior. -Major health threats are tobacco, poor diet, and physical inactivity and injuries. -Blacks have a lower overall life expectancy than whites even when incomes are similar. -Other ethnic minority groups are also at increased risk for a variety of health problems.
intervention
a program or policy designed to impact health.
Individual Freedom as a source of controversy and debate in response to public health action
To protect the 'commons':Air, Water and Shared Elements in Environment. Restricting the freedom to pollute. Paternalism: Restricting certain freedoms to protect health and individuals from their own actions Seat belts, helmets, drugs and alcohol Mandatory health insurance Collective problems require collective action.
In the mid-19th century, what was the single largest cause of death? Cholera Smallpox Typhoid Tuberculosis
Tuberculosis
Examples of ethical violations in epidemiologic research include: British study of physicians Generation Three Cohort Framingham Study Tuskegee syphilis study
Tuskegee syphilis study
Federal government vs state government in public health
U.S. Constitution states that a fundamental purpose of the government is "to promote the general welfare." • Reserve clause is interpreted to mean that, since health is not mentioned in the Constitution, responsibility for public health primarily belongs to the states. • Interstate commerce provision justifies the activities of the Food and Drug Administration (FDA). • Power to tax and spend is widely used by federal government to control public health policy. - The federal government provides 65% of the funding for Medicaid.
Which of the following is true? When the Institute of Medicine reexamined the definition of public health, it concentrated mostly on disease prevention. Unless something unusual happens, like the outbreak of Cryptosporidium in the Milwaukee water supply, people assume that they are basically safe. Public health is generally easy to define. When the Institute of Medicine reexamined the definition of public health, it concentrated on mental and physical disease prevention.
Unless something unusual happens, like the outbreak of Cryptosporidium in the Milwaukee water supply, people assume that they are basically safe.
Which of the following statement is false? Upstream prevention activities focuses on primary prevention. Upstream prevention activities focuses on tertiary prevention. Policy development is an example of an upstream prevention activity. Downstream prevention activities focuses on tertiary prevention.
Upstream prevention activities focuses on tertiary prevention.
Which of the following is true? Most industries welcome public health-driven alterations in how they produce their products because it helps their customers. Public health measures such as sex education in schools and the provision of contraceptive services are widely accepted by members of certain religious groups who believe they discourage immoral behavior. While the government cannot guarantee health and safety for each individual, its role is to provide for maximum health and safety for the community as a whole. In times of economic difficulty, people are often willing to pay short-term costs in order to obtain a benefit in the long term.
While the government cannot guarantee health and safety for each individual, its role is to provide for maximum health and safety for the community as a whole.
noncommunicable disease
a disease that is not transmitted from one host to another NCDs also known as chronic diseases, tend to be of long duration and are the result of a combination of genetic, physiological, environmental, [commercial], and modifiable behavioral factors
epidemic
a widespread occurrence of an infectious disease in a community at a particular time. is a sudden increase in the number of cases of a disease above what is normally expected in that population in that area.
Core Functions of Public Health
assessment, policy development, assurance
Paternalism describes what function in public health?
behavior, by a person, organization or state, which limits some person or group's liberty or autonomy for their own good.
socioecological model individual level
biology and other personal characteristics (age, education, income, and health history)
socioecological model societal level
broad societal factors that affect health (cultural and social norms and the health, economic, educational, and social policies) that help to create, maintain, or lessen socioeconomic inequalities between groups
socioecological model relationship level
close social circle (friends, partners, and family members) that influence a person's behavior and contribute to their health
What are the social determinants of health?
conditions in which people are born, grow, live, work and age that affect a wide range of health, functioning, and quality of life outcomes and risks The non-medical factors that influence health outcomes; or conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes 1. economic stability 2. Education Access and Quality 3. Health Care Access and Quality 4. Neighborhood and Built Environment 5. Social and Community Context examples: • Income and social protection• Education• Unemployment and job insecurity• Working life conditions, Housing, basic amenities and the environment• Access to affordable health services of decent quality• Social inclusion and non-discrimination• Structural conflict
Why is Public health important in the United States?
disease prevention and control health promotion and education emergency preparedness health equity cost-effective care Overall, public health is important in the United States today because it helps to protect the health and well-being of individuals and communities, and to ensure that all people have the opportunity to live healthy and productive lives.
notifiable diseases
diseases for which health officials request or require reporting for public health reasons are certain diseases that are required by law to be reported to public health authorities as soon as they are diagnosed, in order to track and control their spread.
Which of the following is not an analytical epidemiological study? Ecologic study Case-control study Cross-sectional study Prospective cohort study
ecologic study
life course model
emphasizes the decisions one makes across the lifespan, the timing of those decisions, and how those decisions are influenced by history, society, and culture
Equity is not: equal opportunity. a needs-based approach. focuses on social justice. respects diversity among people.
equal opportunity.
examples of secondary prevention
health screenings (diabetes, high blood pressure, self examinations) • Regular exams and screening tests• Low-dose aspirins therapy• Diet and exercise programs• Modified work for injured or ill workers
What are the leading causes of death in the US?
heart disease, cancer, stroke
The life course perspective is primarily interested in: social, cultural, environmental, economic and political factors that influence health inequities or differences in disease risk. conceptualizes health broadly and focuses on multiple factors that might affect health. how life experiences and events affect a person's functional capacity as they age. about preventing the problem saves resources, energy, and lives.
how life experiences and events affect a person's functional capacity as they age.
liberation
including everyone and removing all barriers; combines equality and equity
incubation period
interval between initial infection and first signs and symptoms the time between infection with a pathogen and the onset of symptoms of the disease it causes.
Assessment (core function)
involves systematically collecting data on the population, monitoring the population's health status, and making information available about the health of the community Public health professionals assess the health needs and concerns of the community by collecting and analyzing data on health status, behaviors, and the social and environmental factors that affect health.
midstream prevention
lifestyle (healthy/unhealthy) individual behavior change
Which prevention do we focus on for public health?
primary
examples of tertiary prevention
rehabilitation after brain injury, surgery to correct chronic or recurring illness, medication to prevent chronic symptoms • Cardiac or stroke rehabilitation programs• Chronic disease management programs• Support groups• Vocational rehabilitation programs to retrain workers
cross-sectional design
research design that examines people of different ages at a single point in time a type of research design in which you collect data from many different individuals at a single point in time.
socioecological model community level
settings of their social relationships (schools, workplaces, and neighborhoods) that affect health
what is upstream prevention?
socioeconomic factors context - social/environmental policy (e.g. minimum wage) environmental change built environment
epidemiology
the science or the study of epidemic− It is the scientific method of disease investigation− Typically, it involves the disciplines of biostatistics and medicine The study of the distribution and determinants of disease frequency in human populations and the application of this study to control health problems
surveillance
the systematic collection, analysis, interpretation and dissemination of data for the planning, implementation, and evaluation of public health practice.
Centers for Disease Control and Prevention (CDC)
• CDC is the main epidemiologic and assessment agency for the nation. • CDC publishes Morbidity and Mortality Weekly Report (MMWR). • CDC's National Center for Health Statistics collects data on the U.S. population concerning all aspects of health. • CDC also has centers to address infectious diseases, chronic disease, injury prevention, and other issues.
Measurements in Epidemiology
• Count the number of people with a disease and relate that to the population at risk (PAR) • PAR (denominator) may be the total population or exposed population, or one gender or age group • Two ways to measure frequency are - Incidence, the number of new cases - Prevalence, the number of existing cases (new and old) • Incidence is used for studying causes of disease • Prevalence rates are used to assess the societal impact of a disease and planning for healthcare services • Mortality rates are used to measure frequency for diseases that are often fatal
How is statistics used to accomplish the core functions?
• Governments collect health data on the population. • These numbers are diagnostic tools for the health of the community. • The science of statistics is used to calculate risks and benefits. • Statistical analysis is an integral part of any epidemiological study seeking the cause of a disease. • Statistical analysis is an integral part of any clinical study testing the effectiveness of a new drug.
traditional/Biomedical/epidemiology approach to health
• Health is determined by: • Genetic and biological factors • Sex, age, genetic make up, physiological interactions • Individual behaviours • Alcohol use, smoking, unprotected sex, drug use, non-adherence to treatment and medical care
Cholera and John Snow
• London physician to the poor • Studied cholera outbreaks • Symptoms were gastrointestinal (not pulmonary), so he reasoned it might be transmitted by water or food. Snow conducted a landmark series of studies which: 1. Tested his hypothesis about mode of transmission 2. Led to an intervention
traditional/Biomedical/epidemiology limitations to approach
• Reductionist Focus on specific objective factors neglects the influence of wider social factors (social constructs) • Focus on objectivity (male/female; black/white) neglects their inherent social subjectivity (gender; race) • Judgmental - what 'should be' vs. 'what is' • Health is considered an individual issue, not connected to larger societal factors
Historical Development of Epidemiology
• Spans about 400 years • Progress slow and unsteady • Key figures: -John Graunt, who summarized the pattern of mortality in 17th century London -James Lind, who used an experimental study to discover the cause of scurvy in the 18th century -John Snow, who showed that cholera was transmitted by fecal contamination of drinking water in the 19th century
Global Burden of Disease (GBD)
• The Global Burden of Disease (GBD) study is a comprehensive and ongoing research effort led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington to quantify the magnitude of health loss from all major diseases, injuries, and risk factors by age, sex, and population. It provides a common metric to compare and track the health status of populations across countries and over time. • The GBD study uses a combination of data sources and methods to estimate the incidence, prevalence, and mortality of more than 300 diseases and injuries, and the impact of more than 84 risk factors on health. The study also estimates the years of healthy life lost due to premature death or disability, known as Disability-adjusted life years (DALYs). • The GBD study provides a common framework and data to inform health policies and programs, and to measure progress towards global health goals, such as the Sustainable Development Goals. The study has been conducted every few years since 1990, and the latest version of the GBD study (GBD 2019) was published in 2020. • The GBD study is widely used by governments, international organizations, and researchers to understand the distribution and determinants of health, and to identify opportunities for health improvement. The data and analyses from the GBD study are freely available to the public through the IHME website.
Patterns of diease occurance
•From the following information, epidemiologists can infer why a disease is occurring: •Who is getting the disease? •When did they get the disease? •Where is the disease occurring? •The ultimate goal is to use this knowledge to control and prevent the spread of disease.