Intro to Public Health: Midterm 1, Chapter 1
When it comes to statistics, these numbers are __________, informing experts how healthy or sick a society is, and where its weaknesses are.
diagnostic tools
September 11, 2001: Public health was concerned not only with coordinating emergency medical care, but also with _______________________________________.
ensuring the safety of cleanup workers and area residents
Effective public health programs clearly save money on _______ in addition to saving lives.
medical costs
Public health contributes a great deal more to the health of a population than ________ does.
medicine
The organizational framework of public health encompasses
"both activities undertaken within the formal structure of government and the associated e orts of private and voluntary organizations and individuals."
The substance of public health is
"organized community e orts aimed at the prevention of disease and the promotion of health."
The "Future of Public Health" defines the mission of public health as
"the fulfillment of society's interest in assuring the conditions in which people can be healthy."
Epidemiology and statistics are the basis for the assessment functions of public health, including the collection and analysis of information. Both assessment and policy development need an understanding of the causes of health problems in the community, an understanding that depends on biomedical sciences, social and behavioral sciences, and environmental sciences .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 administra- tion, which also includes the administration and functioning of the public health system.
-Epidemiology -Statistics -Biomedical sciences -Social sciences -Behavioral sciences -Environmental sciences -Health policy/management; health administration
The three core functions of public health are these
1. Assessment 2. Policy development 3. Assurance
The Ten Essential Public Health Services
1. Assessment a. Monitor health status to identify community health problems b. Diagnose and investigate health problems and health hazards in the community 2. Policy Development a. Inform, educate, and empower people about health issues b. Mobilize community partnerships to identify and solve health problems c. Develop policies and plans that support individual and community health efforts 3. Assurance a. Enforce laws and regulations that protect health and ensure safety b. Link people to needed personal health services and assure the provision of health care when otherwise unavailable c. Assure a competent public health and personal healthcare workforce d. Evaluate effectiveness, accessibility, and quality of personal and population-based health services Serving All Functions a. Research for new insights and innovative solutions to health problems
Public health's approach to health problems in a community has been described as a ve-step process
1. Define the health problem. 2. Identify the 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 those interventions to assess their effectiveness.
In carrying out its core functions, public health
1. assesses the health of a population 2. diagnoses its problems 3. seeks the causes of those problems 4. devises strategies to cure them.
It is estimated that only about _______ of the nation's total health spending is spent on public health.
3%
According to one analysis,the life expectancy of Americans has increased from ___ to ___ years over the course of the 20th century. Only 5 of those 30 additional years can be attributed to the work of the _________. The majority of the gain has come from improvements in public health, broadly defined as including better ______, _______, _______, and _________.
45 75 medical care system nutrition, housing, sanitation, and occupational safety.
Importance of: social and behavioral science?
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. -Heart disease is related to nutrition and to exercise patterns; -many forms of cancer are caused by smoking; -abuse of drugs and alcohol is a notorious killer. -Violence is a significant cause of death in our society and attracts ongoing concern. Some subgroups of the population have poorer health overall than others, for reasons that, while not completely understood, relate to social and behavioral factors. -People with low incomes are less healthy than those with a higher socioeconomic status.
Importance of: biomedical science?
Biomedical research is still important to the understanding and control of new diseases such as AIDS, which has become the major epidemic of the late 20th and early 21st centuries worldwide. It has also contributed increasingly to an understanding of noninfectious diseases such as cancer and heart disease, which have become increasingly important as many infectious diseases have been controlled. Recent progress in understanding human genetics is providing new insights into people's inherent susceptibility to various diseases, raising new hopes of cures as well as concerns about discrimination.
Policy Development
Biomedical sciences Social and behavioral sciences Environmental health sciences The study of the medical care system
Importance of: environmental health science?
Environmental health science, a classic component of public health, is concerned with preventing the spread of disease through water, air, and food. In its concern with safe water and waste disposal, environmental health depends on engineering to design, build, and maintain these systems.
Assessment
Epidemiology Statistics (applied in assessing a population's health)
What is epidemiology?
Epidemiology has been called the basic science of public health.As its name suggests, epidemiology is the study of epidemics. It focuses on human populations, usually starting with an outbreak of disease in a community. Epidemiologists look for common exposures or other shared characteristics in the people who are sick, seeking the causative factor. Epidemiology is important not only for deciphering the causes of exotic new diseases, but for preventing the spread of old, well-understood diseases. Epidemiologic studies have also been important in identifying the causes of chronic diseases such as heart disease and cancer.
What role does the government play in public health?
Governments provide pure water and e cient sewage disposal. Governmental regulations ensure the safety of the food supply. ey also ensure the quality of medical services provided through hospitals, nursing homes, and other institutions. Laws regulating people's behavior prevent them from injuring each other. Laws requiring immu- nization of school-aged children prevent the spread of infectious diseases. Governments also sponsor research and education programs on causes and prevention of disease.
How would each of these methods of prevention relate to different stages of cancer, for example?
Interventions for primary prevention of cancer include efforts to discourage teenagers from smoking and efforts to encourage smokers to quit. In secondary prevention, screening programs are established to detect cancer early when it is still treatable. Tertiary prevention involves the medical treatment and rehabilitation of cancer patients.
Which of the three core functions of public health involves politics?
Politics enters the public health process as part of the policy development function and especially as part of the assurance function. 2. Policy development 3. Assurance Among the assurance functions of public health is the provision of basic medical services: How this should be done has been a matter of great political controversy.
Recap of the three preventive measures in public health:
Primary prevention aims to prevent a disease or injury from occurring at all; Secondary prevention aims to minimize the damage caused by the illness or injury-causing event when it occurs; And tertiary prevention seeks to minimize any ensuing disability by providing medical care and rehabilitation.
What is Charles-Edward A. Winslow's 1920 definition of public health?
The science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.
How would each of these methods of prevention relate to traffic safety measures, for example?
This way of thinking was very effective in developing traffic safety programs that, over the past five decades, have significantly reduced the rates of injury from motor vehicle crashes. -Primary prevention focused on preventing crashes from occurring, for example, by building divided highways and installing traffic lights. -Secondary prevention included the design of safer automobiles with stronger bumpers, padded dashboards, seat belts, and airbags. It also included laws requiring drivers and passengers to wear the seat belts. -And tertiary prevention required the development of emergency medical services including ambulances, 911 calling networks, and trauma centers.
___________ was the single largest cause of death in the mid-19th century.
Tuberculosis
Public Health vs. Medical Care
While medicine is concerned with individual patients, public health regards the community as its patient, trying to improve the health of the population. Medicine focuses on healing patients who are ill. Public health focuses on preventing illness.
Another approach to designing interventions is to think of an illness or injury as the result of a chain of causation involving an ________, a ________, and the ________.
agent host the environment
Prevention is accomplished by interrupting the chain of causation at _______ step.
any -Rendering a potential host unsusceptible through immunization, for example, can interrupt the chain. -Or the bacterium infecting a host can be killed through the use of antibiotics. -Or the environment can be sanitized through the puri cation of water and food.
The damage done by the anthrax mailings was relatively minor. However, the potential disaster that would result if a more infectious microorganism were used in a ___________ forced many sectors of society to pay attention to public health.
bioterror attack
Ironically, the threat of ____________ did more to teach the public about public health than any educational program.
bioterrorism
Over the past few decades, it has become apparent that our society's emphasis on ______ disease rather than ______ it has gone out of control.
curing preventing
Medical care has become so _________ that an increasing proportion of the population cannot afford it, and spending for medical care has eaten up resources that could more profitably be used for ________, _________, and the ________.
expensive education housing environment
Although many sectors of the community may be involved in promoting public health, people most o en look to _________—at the local, state, or national level—to take the primary responsibility.
government
Public health, like medical practice, is based on science. However, 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. When a doctor diagnoses a patient's illness and recommends a treatment, it is up to the patient to accept or reject the doctor's recommendation. When the "patient" is a community or a whole country, it is usually a ________—federal, state, or local—that must make the decision to accept or reject the recommendations of public health experts.
government
President Obama's ________, passed in 2010, did include provisions and funding for prevention, wellness, and public health.
health reform law
Concern about runaway costs, lack of access, and questionable quality of care has led to an increasing interest in studying the medical care system, its e ectiveness, e ciency, and equity, leading to a science called ________________.
health services research
Public health has developed systematic ways of thinking about such problems that facilitate the process of designing __________ that prevent undesirable ____________.
interventions health outcomes
The crashing of two planes into the World Trade Center triggered the activation of emergency response plans developed for New York City and New York State, plans designed as secondary prevention (_________________) and tertiary prevention (__________________).
minimizing the damage providing medical care to those injured in the disaster -role of public health = emergency planning
Public health depends on __________ for decision making.
politics
Problems with ____________________________ had to be dealt with in downtown Manhattan just as they must be dealt with a er a natural disaster.
polluted water contaminated air spoiled food infestation of vermin
Primary prevention
prevents an illness or injury from occurring at all, by preventing exposure to risk factors.
One approach is to think of prevention on three levels
primary prevention secondary prevention tertiary prevention.
There is a ______ attention paid to public health by politicians and the general public in comparison with medical care.
relative lack of
Tertiary prevention
seeks to minimize disability by providing medical care and rehabilitation services.
Secondary prevention
seeks to minimize the severity of the illness or the damage due to an injury-causing event once the event has occurred.
Because public health deals with the health of populations, it depends very heavily on _______. Governments collect data on
statistics; -births and deaths -causes of death -outbreaks of communicable diseases -cases of cancer, occupational injuries -many other health-related issues
Primary prevention of ___________ may be out of the domain of public health, but ________ and ________ prevention are very much a part of public health's mission.
terrorist acts secondary tertiary
Interventions can be directed toward eliminating or suppressing __________ that causes an illness or injury, strengthening the resistance of __________ to the agent, or changing _________ in such a way that the host is less likely to encounter the agent.
the agent the host the environment
Assessment constitutes
the diagnostic function, in which a public health agency collects, assembles, analyzes, and makes available information on the health of the population.
Public health is aimed at benefitting ____________ in contrast with medicine, which focuses on the individual.
the entire population
Assurance is equivalent to the doctor's actual treatment of the patient. Public health has the responsibility of assuring that
the services needed for the protection of public health in the community are available and accessible to everyone. These include environmental, educational, and basic medical services. If public health agencies do not provide these services themselves, they must encourage others to do so or require such actions through regulation.
Policy development, like a doctor's development of a treatment plan for a sick patient, involves
the use of scientific knowledge to develop a strategic approach to improving the community's health.
Social and behavioral sciences involve more ________ questions than biomedical and environmental sciences do.
unanswered (Very little is known about why racial and ethnic groups di er in their health-related behavior, why many people of all races behave in unhealthy ways, and how to prevent self-destructive behaviors.)
This approach is traditional when thinking of infectious diseases: the agent may be a disease-causing bacterium or ________; the host is a susceptible ________; and the environment includes the means of transmission by which the agent reaches the host, which may be contaminated _______, _______, or _______, or it may be another human being who is infected.
virus human being air water food