Public Health 380 Final
Between 1980 and 2010, rates of obesity among children 12-19 years old have
tripled!
Summarize the basic physiology of immunizations. Describe primary and booster vaccination.
- Weakened or harmless version of pathogen is introduced into your body - Although the weakened pathogen is harmless, your body recognizes it and create antibodies against it. - If your body is invaded by the pathogen causing disease, your body responds immediately with huge numbers of antibodies to destroy the pathogen. • Primary vaccination - One dose vaccines (measles, mumps, rubella) - Multiple dose vaccines (polio, DPT, hepatitis B) • Booster vaccination To maintain immunity level after it declines after some time has elapsed (DT, MMR).
Explain how human pathogens evolve from animal pathogens
- Zoonotic diseases, they can pass over
Discuss determinants of health and how they impact interactions with communities
-Determinants of health create inequity and disproportionate levels of who has good health and who doesn't based on determinants of health
Summarize the impact of the 1993 Jack in the Box E. coli outbreak on food safety
-E. coli outbreak in Jack in the Box. Four kids died. One from being exposed to a kid that had eaten at Jack in the Box. E. coli is bacteria in a cows gut. Dad became food safety advocate. Jack in the Box didn't heat up the beef enough, but original source of contamination was in the slaughterhouses. food safety checkers use old methods of checking meat quality which doesn't work for E. coli. USDA made it so any meat with E. coli is not allowed to go on the market. Meat industry has to check this. Jack in the Box created a new way of checking food. Basically lead to better inspection practices for meat.
Define health equity
Definition of Health Equity: (The) attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.
Define environmental health
Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments.
Discuss characteristics of well-functioning health systems
Definition of a health system: - "all actors, institutions and resources that undertake health actions - where a health action is one where the primary intent is to improve health." Reaches the goals of health systems: - Good health - Responsiveness to the expectation of the population - Fairness of financial contribution Functions of HS - Provide health services - Provide access to health services - Resource Generation - Raise money that can be spent on health - Financing - Pay for health services - Protect the sick and their families against financial costs of ill health and disability - Stewardship - Govern and regulate the HS - Improve health of population through governances of the HS, regulation, promotion, key PH functions
Define the concepts of "Complete Streets" and "Safe Routes to Schools" and explain how they relate to health
Definition: a safe, comfortable and convenient route designed for travel via automobile, foot, bicycle, and transit. • Oregon state law: "Footpaths and bicycle trails... shall be provided wherever a highway, road or street is being constructed, reconstructed, or relocated."
Define health disparity
Definitions of Health Disparity: - A type of difference in health that is closely linked with social or economic disadvantage (CDC) - A health outcome...seen in a greater or lesser extent between populations (HealthyPeople2020)
Summarize how foodborne outbreaks are investigated
1. Detect a possible outbreak 2. Find cases in an outbreak 3. Generate hypotheses through interviews 4. Test hypotheses through analytic studies and laboratory testing 5. Solve point of contamination and original source of outbreak vehicle 6. Control outbreak through recalls, facility improvements, and industry collaboration 7. Decide an outbreak is over
Describe factors in the social and physical environments that influence health behaviors and health status
Determinants of health: - Income and Social Status - Social Support Networks - Education and Literacy - Employment/Working Conditions - Social Environments - Physical Environments - Personal Health Practices and Coping Skills - Healthy Child Development - Biology and Genetic Endowment - Health Services - Gender - Culture Another example of determinants: 1. Socio-economic 2. Food 3. Water 4. Sanitation 5. Other environmental determinants 6. Behaviour 7. Health services
Define occupational health
Occupational Health is the promotion and maintenance of the highest degree of physical, mental and social wellbeing of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs.
State the case for why clinicians need to treat climate change as a critical public health issue
Because health and climate change are closely related and linked. Climate change negatively effects health of people
Describe key approaches to improve health by addressing the social determinants
- health equity, decreasing the gap between socio-economic statuses - Focus on early life where a lot of your health is programmed in. Lower inequalities so early on in life can be equal where it counts the most - The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart. Take action politically and implement policy.
Describe the role of government in protecting occupational health
- Enforcing and putting into place, policies that keep workers safe like OSHA: - "The Occupational Safety and Health Act of 1970 (OSH Act) was passed to prevent workers from being killed or seriously harmed at work. This law created the Occupational Safety and Health Administration (OSHA), which sets and enforces protective workplace safety and health standards. OSHA also provides information, training, and assistance to employers and workers. Under the OSH Act, employers have the responsibility to provide a safe workplace"
Give an overview of the organization of the public health system
- Federal, State, Local, and Tribal levels. Federal has the money, state has the authority, and local has the responsibility. - Public health relies on collaboration so public health work ties in hospitals, law enforcement, community centers, nursing homes, NGO's, transit, etc.
Identify specific disease processes that are likely to become more common or be exacerbated by changes in weather patterns, rising temperatures, and increasing extreme weather events
- malaria because increase heat and precipitation is perfect for mosquito breeding - deaths in over heating or over heating problems - Food insecurity, malnutrition, etc. - Less nutrients in plants as they grow faster with CO2 so nutrient deficiencies - pollution leads to worse respiratory illnesses and diseases
Describe the impact of malnutrition on disease and death rates
- malnutrition puts you at a higher risk of disease and death rates
Explain how Health Impact Assessments can be used to convey information about health impacts of projects and policies to decision makers who may know little about public health
- "A tool to increase partnerships and communication between public health professionals and planners and other decision-makers" - It requires collaboration of a lot of different people so different backgrounds can gain understanding of one another's disciplines and come together to benefit all fields -"HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects." - People are also directly involved from the community so they can learn about public health through the process and also help explain to others like the decision makers who didn't originally know exactly about public health either - "Planners and others will request information on potential health consequences of projects and policies as part of their decision-making process • Health officials will have a tool to facilitate their involvement in planning and land use decisions • HIAs will lead to a better informed decisions" "Steps in Conducting an HIA • Screening - Identify projects/policies for which HIA useful • Scoping - Identify which health impacts to include • Assessment - Identify how many and which people may be affected - Assess how they may be affected • Recommendations - Identify changes to promote health or mitigate harm • Reporting of results to decision-makers • Evaluation of impact of HIA on decision process"
Give an overview of the history of vaccine development in the US, from the Salk polio vaccine to pandemic influenza A 2009 H1N1 vaccine
- 1796: Edward Jenner created smallpox vaccine through variolation (taking piece of material from infected person and putting it into different person so they won't get infected), smallpox not eradicated though because eradication efforts were weak - The two polio vaccines used worldwide: • inactivated vaccine developed by Jonas Salk in 1955 • oral vaccine developed by Albert Sabin in 1962 1957: new polio cases reduced to < 6000 / year just one year after made widely available - Maurice Hillman • Developed over 40 vaccines - Mumps, - Hepatitis B - Hepatitis A - Varicella (Chickenpox) - Haemophilus influenzae A • 1963 Measles vaccine - 1958-62: • 500,000 cases and 432 deaths/year - 1998: • reduced to 89 cases and zero deaths
Summarize the history of American society's response to HIV/AIDS
- A little before 1980: Morbidity and Mortality Weekly Report reported 5 cases of PCP (type of pneumonia) in healthy young men - Increase in similar cases by end of year 270 cases reported and 121 dead - HIV first noticed in gay men, but then started noticing in drug users - After being called Gay-Related Immune Deficiency (GRID), the disease is renamed Acquired Immune Deficiency Syndrome - Ryan White, an Indiana teenager with AIDS is barred from school, then speaks out publicly about HIV/AIDS stigma and discrimination - Rock Hudson dies of AIDS - First panel of HIV/AIDS quilt created - President Reagan made 1st speech about AIDS, but did not calm the fear and misinformation related to the disease - AZT becomes first anti-HIV drug approved by FDA - US shuts its doors to HIV infected immigrants and travelers - ACT Up is founded in New York working to end HIV/AIDS - Ryan White dies at age 18. Ryan White Care Act enacted to provide services for HIV positive people - Magic Johnson announces he is HIV positive and retires from NBA - FDA licenses first rapid HIV test - Red ribbon introduced as international symbol of AIDS awareness at Tony Awards - FDA approves first oral test for HIV (OraSure) - Rapper Eric Wright, aka Easy-E, dies of AIDS - 1995: Joint UN programme on HIV/AIDS (UNAIDS) begins operations - FDA approves viral load test, which detects level of HIV in the body - HAART, consisting of 3 antiretrovirals becomes the standard of HIV care - Global AIDS and TB Relief Act authorizes up to 600 million for US global efforts - Global Fund to Fight AIDS, TB, and Malaria created - President Bush announces the President's Emergency Plan for AIDS Relief (PEPFAR), committing 15 billion to combat HIV/AIDS. Provision gives a third of USAID's prevention funding to abstinence programs - US releases federal ban on needle exchange - US releases travel ban on HIV positive individuals - President Obama's 2010 federal budget eliminates funding for abstinence only - White House issues first National HIV/AIDS Strategy for US - US, June 2011 marks 30 years since the first AIDS case reported
Describe the role of mass communication in promoting behavior change. Describe the key elements of effective public health communication
- Can promote change if it is truthful - If it is fear based it can make people feel helpless - You need to show a desired outcome Health belief model (preventative behaviors are influenced by): - Perceived barriers to changing behaviors - perceived benefits of new behavior - perceived susceptibility to risk or injury - perceived severity of the outcome of that risk - Good to do, but usually multicomponent campaigns and strategies work best. Smaller safety changes work the best - Using opinion leaders to take on the desired behaviors is really good too to get the conservative and unwilling people to do the same - Also good to have a behavior fit compatibility with sociocultural values, economy, and current technology in the community
Compare and contrast different modes of public health communication (e.g. print, television, social media) and describe their strengths and limitations
- Certain ones get only certain demographics so you need all of them
Discuss future challenges of public health
- Challenge: core funding for public health services - Challenge: How to collaborate and make change - Challenge: climate change - Challenge: health disparities and relation to chronic diseases - Challenge: Chronic disease in general because complex issue
Discuss the social and historical factors underlying Haiti's cholera outbreak
- Cholera, it is often said, is a symptom of poverty. Cholera loves chaos. Haiti, home to both chaos and poverty, is a place where cholera thrives. - French colonial power in control, slave rebellion, slaves win and Haiti is independent, then various controls in different ways by the U.S., various coups, all together a weak stability in the country so health systems are not in place so Cholera outbreak occurs after hurricane and cannot be eradicated quickly or at all.
!!! Discuss factors that led to increasing human life expectancy throughout history
- Chronic disease increased and less death from common illnesses and prevention of certain diseases - increased sanitation and housing - vaccines - cleaner water - The growth of agriculture, collective learning, globalization, and energy use have enabled us to transform our social and physical environments -Most of the improvements in life expectancy in the US last century came from the provision of clinical and preventive health care services.
Describe the role of government in protecting environmental health
- Help fund research into environmental health, advocate, enact and enforce environmental health policies, create interventions for environmental health problems and assess and evaluate those interventions Shortcomings of the Toxic Substances Control Act: - 62,000 grandfathered into TSCA and only 200 tested for human health safety - No mandatory safety requirement before a chemical can gain access to market - Before requiring additional testing of existing chemicals, the agency must prove that a chemical presents an unreasonable risk to human health or the environment - New chemicals can enter the market without basic toxicity data if the EPA does not response to a pre-manufacture notice within 90 days
Summarize the history of Andrew Wakefield's 1998 Lancet paper and society's response
- In 1998, Andrew Wakefield and colleagues published an article in The Lancet claiming that the measles vaccine virus in MMR caused inflammatory bowel disease, allowing harmful proteins to enter the bloodstream and damage the brain. - the findings were further discredited when an investigation found that Wakefield did not disclose he was being funded for his research by lawyers seeking evidence to use against vaccine manufacturers. Wakefield was permanently barred from practicing medicine in the United Kingdom Key points regarding the Wakefield "study" and investigative findings: •None of Wakefield's claims regarding MMR and autism has been accurate. • Wakefield altered information from all the patient's medical records in his publication to support his argument that MMR vaccine caused autism. • The Wakefield study claimed that all 12 children were "normal" prior to being vaccinated with MMR, however five had shown developmental problems before receiving MMR vaccine and three never had autism. No studies have been able to replicate the results reported by Wakefield and Wakefield himself was unable to reproduce his results in subsequent studies. Wakefield failed to disclose serious financial conflicts of interest. - He received nearly $674,000 from lawyers trying to build a case against vaccine manufacturers Wakefield's medical license was revoked after the British General Medical Council concluded that he committed 30 ethics violations - Groups still support Andrew Wakefield's 'study' - Despite the Lancet's actions and the broadly publicized BMJ series, some vaccine‐ hesitant parents may still be concerned that MMR or other vaccines are linked to autism - Decrease vaccines coverage increases risk of disease outbreak. Now measles cases, which was thought to have been eradicated are reappearing
Give an overview of how the epidemiology of chronic diseases in the US has changed over the past 50 years
- Increase in chronic diseases, mainly in the midwest and south there it is the highest - Located in low-income areas (the black belt)
Describe different scenarios for the future of public health and global health
- Increased collaboration - Get more into the political arena - Start looking into innovative ideas - Increased community engagement and listening and gaining knowledge from the community
Give an overview of potential interactions between the key determinants of human health
- Just as social and environmental conditions influence the epidemiologic transition, social inequities and environmental inequities are linked to health inequities - For example, low socio-economic status can put a person in a poor neighborhood that is next to a factory that is producing pollutants which can her the person's health
Discuss the link between water and development
- List ways that lack of clean water can impact a country's development • Direct - High child mortality rates due to diarrhea - Decreased quality of life due to non-fatal waterborne diseases - High rates of hospitalization due to waterborne diseases • Indirect - Women burdened by the chore of manually retrieving water - Decreased educational attainment by children - Poor sanitation leads to flooded latrines that become mosquito breeding grounds
Explain underlying logistical and social challenges in mounting public health responses to HIV and other historical outbreaks
- Main things: Stigma, Politics, and Discrimination, and Activism - Political opposition - Disagreement on how to use funding - Marginalized groups unsupported - Conducting research fast enough- creating treatments as people are dying from HIV/AIDS
Summarize the science investigating the relationship between vaccines and autism
- More than 20 articles refute that MMR vaccines is connected to autism
Discuss the links between race and health
- Most human genetic variation occurs within human populations, not between populations - Why does sickle cell seem to afflict blacks the most? Sickle cell is found more frequently in persons of Middle Eastern, Indian, Mediterranean and African heritage because those geographic regions are most prone to malaria. The gene variant for sickle cell disease is related to malaria, not skin color. Main Point: How does race impact health? Health care Housing Education Employment Poverty Justice system Environmental toxins Access to healthy foods Racism
Summarize the UN's Sustainable Development Goals
- No poverty - Zero hunger - Good health and well-being: end AIDS, TB, and Malaria, communicable diseases, access to care and medicines, and develop vaccines - Quality education - Gender equality: leadership, women and reproductive health, and a part of the economy - Clean water and sanitation - Affordable and clean energy - Decent work and economic growth - Industry, Innovation, and Infrastructure: Investment in transporation, renewable energy, information, communication, and technology industries - Reduced inequalities: Income inequalities - Sustainable cities and communities - Responsible consumption and production - Climate action - Life below water: sustainability of ocean resources, ocean acidification, protect ocean and coastal ecosystems - Life on land: restore and conserve terrestrial ecosystems - Peace, justice, and strong institutions: strengthening the rule of law and promoting human rights is key to this process, as is reducing the flow of illicit arms and strengthening the participation of developing countries in the institutions of global governance. - Partnerships for the goals: global solidarity
Explain the relationship between obesity, diabetes, and heart disease
- Obesity leads to diabetes, which leads to heart disease - high blood pressure from diabetes leads to heart disease - All are/create chronic diseases and health problems
Disease in the body, onset date and what it can tell us
- Onset date is when you start to show symptoms - Incubation period is before the onset date and can be long or short - our exposure period (when you could have gotten exposed to the disease) is during the beginning of the incubation period - The communicable period starts when the symptoms start showing
Understand the basic science about climate change and the connection between human activities and global warming
- climate change data doesn't add up without human contributions factored in - Solar radiation bouncing off of human created greenhouse gases and trapping heat in the atmosphere
Compare the status of US health to other countries and outline historical reasons for the differences
- U.S. decreased from 1955 to 2007 in health compared to other countries: US life expectancy not better than other developed countries anymore - "Americans with healthy behaviors or those who are white, insured, college-educated, or in upper-income groups appear to be in worse health than similar groups in comparison countries" - In comparison to developed countries, we are one of the worst in terms of health even though we spend them most on healthcare - Reasons for difference is very limited amount of social services and social welfare and increased inequality overtime - lack of social services and increased inequality is increase in neoliberalism and a market based economy and healthcare system that benefits the wealthy and builds the gap between the rich and the poor
Understand the ways in which changes to the climate impact human health and increase the risk of adverse health events
- Uneven distribution of climate change effects - More natural disasters and increase in heat - Depleting food supplies - Increase in infectious diseases, more mosquitoes, etc. - These things can all lead to war, etc.
Describe different approaches to responding to vaccine hesitancy in the healthcare setting and the community setting
- Vaccine promotion and increase availability - smaller changes at a community level that looks at race, class, etc. - Have doctors speak out about the importance of vaccines and other people trusted in the medical field should do the same
Describe how prenatal and early childhood factors influence chronic disease in adulthood
- adverse childhood experiences starting at a young age can put stress on your body and actually impact your health, leading to a hire chance of chronic diseases and acting out causes of chronic disease such as smoking tabacco - Adverse Childhood Experience study showed a dose response relationship (in which there is typically little or no effect at very low dosages and a toxic or unchanging effect at high dosages with the maximum increase in effect somewhere between the extremes) between adverse childhood experiences and negative health
Describe the key elements of effective public health communication
- multicomponent, multichannel campaigns - mix of voices to spread campaign messages: info sharing by leaders in a community, peers, etc. - simple steps to desired behavior - encouraging the confidence to make change - spread self efficacy, you can do it! - Benefits emphasized over risks - Addressing and reducing constraints/barriers to action - Opinion leaders as gatekeepers to attitude and behavior change - consideration of mediating factors in message design - look at sex, ethnicity, etc.
Endocrine Disruptors
- multiple chemicals could contain endocrine disruptors - Endocrine disruptors, when absorbed in the body, can decrease or increase normal hormone levels, mimic the body's natural hormones, or alter the natural production of hormones
Describe the health impacts of inadequate access to clean drinking water
- non-fatal illnesses can be fixed - childhood illnesses like diarrhea can be fixed - girls could go to school if they didn't have to fetch water - women can be attacked or sexually assaulted when going far to get water
Define indicators of malnutrition, including under- and over-nutrition
- poverty, dysfunctional food system,etc.
Give examples of food policy interventions to improve population health
- tax sodas, limit calories and sugar in certain foods, better labeling, better deals on healthier food, etc.
Describe how antiviral and antibiotic resistance develops, and describe different strategies to prevent or slow the development of resistant organisms
- when a mutated version of a virus does not get affected by the antibiotic and then grow in numbers and is resistant to the antibiotic - you can continue with your full antibiotic prescription so that you don't leave any of the virus behind - Don't unnecessarily use antibiotic and expose to viruses that do not need the antibiotics so they don't grow resistant
Define: epidemic, outbreak, cluster, and pandemic
Epidemic refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area. • Outbreak carries the same definition of epidemic, but is often used for a more limited geographic area. • Cluster refers to an aggregation of cases grouped in place and time that are suspected to be greater than the number expected, even though the expected number may not be known. • Pandemic refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.
Describe the food safety system at the local, state, and federal level
Federal food safety responsibilities: • Centers for Disease Control and Prevention - Surveillance at national level - Multi-state outbreak investigation - Collect PFGE data • Food and Drug Administration - Ensuring that domestic and imported food products are "safe, sanitary, nutritious, wholesome and properly labeled" - Sets food safety standards • US Department of Agriculture - Ensuring that the nation's commercial supply of meat, poultry, and egg products is "safe, wholesome, and correctly labeled and packaged." State health department food safety: responsibilities • Establish food safety regulations • Coordinate surveillance and outbreak investigation when multiple local health jurisdictions are involved • Provide laboratory testing facilities • Traceback of some foods such as shellfish • Report foodborne illness surveillance data to CDC Local public health food safety responsibilities • Inspecting restaurants, grocery stores, day care facilities, hospitals, schools • Responding to consumer complaints • Training food workers in food safety • Alerting community to food recalls • Investigating outbreaks
● Describe the relationship between sustainability and healthy community design
Green and sustainable: Unplug unused electronics Recycle newspapers Install solar panels Healthy: Get regular exercise Get adequate sleep Eat a low-salt diet Both! Build and use walking and biking infrastructure Use non-toxic cleaners Take the stairs Plant trees Buy locally grown organic food
Describe examples of low-resource developing countries that have strengthened their health systems
Health success stories (1950-80) Kerala (India), China, Sri Lanka - Taiwan, S.Korea Common Policies Primary education - Universal and compulsory (all) Housing, Water, Sanitation for poor (all) Food/agriculture subsidies (all) Land Reform (all) Protection of nascent industries (Taiwan, S. Korea) Simple health services (all) Common Denominator - all require government intervention, taxation
Demonstrate the contrasts between health and healthcare
Health: - Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Healthcare: - the maintenance and improvement of physical and mental health, especially through the provision of medical services. - Healthcare can come in different forms depending on a persons culture, society, etc. In the US we have a healthcare system of doctors, etc. - Healthcare really only comes at the end of a health issue when treatment is necessary and has limited work with prevention compared to public health Genetics has 30% affect on health, environment and behavior have a 60% affect on health, and healthcare has a 10% affect on health Environment and behavior encompass all stages of prevention from healthy to sick to treatment to outcome. Environment and behavior affects ALL STAGES
Give an overview of the history of health care reform in the US
How did we get here? Write down a list of health system factors that contributed to the US having the most expensive and least effective health care among industrialized nations. • Fee for service - health care providers paid for services, not for individual or population outcomes • Increasing technology - new medications, tests, and devices that are expensive • Inadequate evidence based practice - some technology and medications are used despite evidence that less expensive interventions are cheaper and more effective • Lack of behavioral and physical health integration - difficult for individuals to obtain mental health and substance abuse services • Lack of clinical-community linkages - public health and health care have been working separately, inadequately addressing social determinants of health - Most health care received at home before 1900s - Forces shaping the creation of US hospitals: Industrialization and urbanization, professionalization of medicine (nursing), advancing medical science, poverty (people needed medical care), infectious disease control (germ theory knowledge, etc.), medical education (hospitals for hands on experience) - 1912 Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House - 1935 President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first. - 1942 Roosevelt establishes wage and price controls during World War II. Businesses can't attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk - 1945 President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as "socialized medicine" and it goes nowhere. - 1960 John F. Kennedy makes health care a major campaign issue but as president can't get a plan for the elderly through Congress. - 1965 President Lyndon B. Johnson's legendary armtwisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor. - Medicare desegregated hospitals in the South - 1974 President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance. The Watergate scandal intervenes. - 1976 President Jimmy Carter pushes a mandatory national health plan, but economic recession helps push it aside - 1986 President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost. - 1993 President Bill Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have health insurance. The plan meets Republican opposition, divides Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It dies in the Senate. - 1993 Clinton signs bipartisan legislation creating a state-federal program to provide coverage for millions of children in families of modest means whose incomes are too high to qualify for Medicaid. - 2003 President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program for older people. - 2009 President Barack Obama and the Democratic-controlled Congress spend an intense year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can't afford insurance. - 2010 With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people. Republican opponents scorned the law as "Obamacare."
Describe the impact of HIV/AIDS on public health globally and in the US
In the U.S.: - Public health had to try and educate the people about HIV/AIDS because political leaders were not helping and there was a lot of stigma - Had to step up the speed in quickly finding treatment - Activists had lots of opposition (needle exchanges made illegal, etc.) Globally: - Some countries quickly took action and formed interventions - For example in Uganda they preached tolerance and education through slogans and theater - Thailand promoted condom and AIDS education - Britain noticed AIDS spreading through drugs so they formed needle exchanges
According to Abrams, in addition to labor unrest what were the other "vital catalysts" that have advanced occupational health?
It is important to recognize that throughout the often tragic history of worker health and disease, the worker played a primary role as the basis of every significant improvement in legislation, factory inspection, compensation, correction, and prevention. Labor unrest, protests, strikes, lawsuits, and catastrophes were vital catalysts in obtaining action.
Describe the historical significance of Rachel Carson's Silent Spring
Lead to environmental health legislation: Sample of Environmental Health Legislation After Silent Spring: 1963 - Clean Air Act gives federal government authority to reduce interstate air pollution 1965 - Water Quality Act enhances Federal control over water quality set by the Federal Water Pollution Control Act of 1948. 1965 - Motor Vehicle Air Pollution Control Act sets automobile emission standards. 1970 - National Environmental Policy Act (NEPA) requires every federal agency to prepare an Environmental Impact Statement (EIS) for any legislation. 1970 - Environmental Protection Agency (EPA) created to be responsible for United States environmental policy. 1972 - Clean Water Act (CWA) becomes the primary legislation governing water pollution in the country. 1973 - Endangered Species Act aims to prevent extinction of animals in U.S. 1976 - Toxic Substances Control Act mandates the EPA to control all new and existing chemical substances being used in the United States. - Spurred the creation of the Environmental Protection Agency (EPA) - Carson was more successful in forming a movement than Sinclair because she was more inspiring, used big picture ideas, politically the government was more supportive during that time, and she used qualitative data of DDT to prove her point. Also, DDT affected everyone, not just workers. Also easier to removed one item (DDT) than it is to gain workers rights. Carson was also already a well known writer
Describe the components of the Patient Protection and Affordable Care Act (ACA)
Moving toward the triple aim... - improving the individual experience of care; - improving the health of populations; and - reducing the per capita costs of care for March 23, populations No-Cost Clinical Preventive Services: No deductibles, co-payments, etc ◻ Coverage effective 2010 (examples): ⬜ Cancer screenings such as mammograms and colonoscopies ⬜ Vaccinations such as flu, mumps, and measles ⬜ Blood pressure and cholesterol screenings ⬜ Tobacco cessation counseling and interventions ◻ Coverage effective 2012-13: Add'l women's preventive health services such as pap smears and birth control Closing the coverage gap- Four interrelated ACA approaches: - Medicaid expansion - Health insurance marketplaces and subsidies - Insurance reforms: more people covered (have to give people insurance even with pre-existing health problems), more benefits and protections, lower costs - Individual and employer "mandates"
Explain how physical activity and obesity are influenced by the physical design of a community
Physical Activity A sedentary lifestyle increases the risk of • overall mortality (2 to 3-fold) • cardiovascular disease (3 to 5-fold) • some types of cancer, including colon and breast cancer The effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, and even smoking. Determinants of Physical Activity More likely to exercise if: • Walking trails, parks and gyms accessible • Sidewalks present and scenery enjoyable • Many people exercising • Friends available with whom to exercise Less likely to exercise if: • Too little time • Too tired • Unmotivated • Perceived traffic, crime or danger • Long distance to exercise location
Summarize basic concepts in population dynamics and demographic change
Population dynamics: - Birth rate adds people to the population - Population size is the already present population - Death rate detracts people from the population - Migration scoops out groups of people from the population Factors influencing birth rate: • Infectious diseases • Health care • Birth control • Education • Income • Culture • Policies Factors influencing death rate: • Nutrition • Infectious diseases • Chronic diseases • Occupational diseases • Environmental diseases • War • Health care • Education • Income Demographic change: - Larger population with lower birth rate but even lower death rate - population became more dense - Changes occurring from hunter-gatherer to agricultural to industrial to post-industrial - energy consumption grew - material wealth grew - employment grew - types of work changed - income inequality recently increased - lifestyles became more sedentary - obesity became more prevalent - increase in chronic diseases - increase in healthcare spending - health disparities based on race
Demonstrate the contrasts between individual and population health
Population health: - "...we propose that population health as a concept of health be defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group." These populations are often geographic regions, such as nations or communities, but they can also be other groups, such as employees, ethnic groups, disabled persons, or prisoners." Individual health: - is focused on one body and one person and the health related to a single individual and how their health specifically affects them. It does not relate the individual to other individuals.
Demonstrate the contrasts between prevention and treatment
Prevention: - Prevention is taking steps to address a potential health problem and start counteracting it before it actually comes into full affect. However, prevention can occur at different stages of a current issue on hand. - There are different types of prevention at different levels: - Primary prevention is designed to prevent a disease or condition from occurring in the first place (example: vaccination reduces the risk of certain infectious diseases) - Secondary prevention attempts to identify a disease at its earliest stage so that prompt and appropriate management can be initiated. (example:mammograms to detect breast cancer) - Tertiary prevention focuses on reducing or minimizing the consequences of a disease once it has developed. (example: screening diabetics for foot ulcers) Treatment: - Treatment can be a form of prevention for example for an already sick person or person's to minimize the consequences of a health problem and reduce spread. This would be more of a tertiary prevention. - Unlike prevention, treatment is dealing with a problem when it is already present
Define public health and the relationship between domestic and global health
Public health is: - "Activities that society does collectively to assure the conditions in which people can be healthy. This includes organized community efforts to prevent, identify, preempt, and counter threats to the public's health." - (1) preventing disease, (2) prolonging life, and (3) organized community efforts - Public health is prevention at the individual level, and at the community and organization levels The relationship between domestic and global health is: - Global public health is "The application of the principles of public health to health problems and challenges that transcend national boundaries and to the complex array of global and local forces that affect them" - In my own words... the relationship between domestic and global health is that both rely on the same principles of public health, but global health transcends national boundaries and community efforts is seen as a collective of countries so the scale is greater than at a domestic level. Domestic public health definitely plays a part of global health work because it relies on country partnerships, etc.
Describe at least four major impacts on public health of the design of the built environment
Related to land use: •Obesity, physical activity, CVD • Water quantity and quality • Access to healthy food Related to automobile dependency: •Air pollution and asthma • Climate change contribution • Car crashes • Pedestrian injuries Related to social processes: •Mental health impact • Social capital • Environmental justice - Trails and walking paths: people will exercise - More bike lanes and and bus systems: less polluation and more exercise - Connected neighborhoods: more communication between neighbors and a sense of community for mental health and less stress about crime, etc. - Good water quality: less illness and also swimming, etc.
Discuss the public health provisions of the ACA
The Prevention and Public Health Fund- Four major funding goals: Clinical prevention • Enhance awareness of ACA prevention services and benefits • Immunization programs • Integrating primary and behavioral health Community prevention • Community Transformation Grants • Comprehensive Chronic Disease Prevention Grants • Other efforts (e.g. CDC's "Tips from Former Smokers" Workforce and infrastructure • National Public Health Improvement Initiative • Lab capacity grants • Workforce training grants Research and tracking • National Prevention Council & Strategy • Environmental Public Health Tracking System • Prevention research centers -------- Community health needs assessments (CHNAs): Tax-exempt hospitals must conduct CHNAs and implement strategies to address community needs ⬜ A revision to existing community benefit requirements ⬜ First assessments due 2012-13, then at least every 3 years ◻ CHNAs must take into account input from "persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health." Workforce and systems funding: PH workforce training centers and programs: avg $30M/yr FY10-12 ◻ Community health centers: $11B over 5 years ◻ School-based health centers: $50M/yr, FY10- 12 ◻ PH services and systems research: $20M in FY11 ◻ But many unfunded provisions, including: ⬜ PH workforce loan repayment program ⬜ Community health workforce grants ------- Public Health Provisions of the Affordable Care Act: - States are given flexibility to create innovative health care payment systems that incentivize disease prevention and community-based interventions. - Through the Prevention and Public Health Fund, federal agencies award grants to states to develop transformative strategies for public health. - Community Transformation Grants awarded by the Centers for Disease Control and Prevention support disease prevention efforts by community-based and nonprofit organizations. - Nonprofit hospitals are required to conduct community health needs assessments every three years to maintain their tax exempt status. - Federally Qualified Health Centers will receive $11 billion in new funding to enhance and expand care for underserved populations. - Private insurance, Medicare, and Medicaid are required to cover preventive services such as annual checkups and personalized prevention plans. - States are given funding for community-based interventions such as community health workers, home visiting programs, and school-based health centers.
Describe the demographic transition
The epidemiological transition or demographic transition is that process by which the pattern of mortality and disease is transformed overtime, for example, from one of high mortality among infants and children and episodic famine and epidemic affecting all age groups to one of degenerative and man-made diseases (such as those attributed to smoking). - The first epidemiological transition was stimulated by agriculture then by industrialization and then by post industrialization - Over the demographic transition shows birth rate declining and death rate declining even more with total population increasing and then leveling out in post industrial age
Describe the social ecological model of health
The social ecological model of health considers the complex interplay between individual, relationship, community, and societal factors. It allows us to understand the range of factors that put people at risk for public health issues. The overlapping rings in the model illustrate how factors at one level influence factors at another level. This model can be used to think of prevention at multiple levels for various health issues like obesity, etc. - Individual: The first level identifies biological and personal history factors - Relationship: The second level examines close relationships (friends, partners, family members, etc.) - Community: The third level explores the settings, such as schools, workplaces, and neighborhoods, in which social relationships occur and seeks to identify the characteristics of these settings that are associated with whatever public health issue at hand - Societal: The fourth level looks at the broad societal factors. These factors include social and cultural norms, health, economic, educational and social policies that help to maintain economic or social inequalities between groups in society.
Summarize the 10 essential services of public health and the three core functions of public health
Three core functions: - Assurance - Assessment - Policy Development Within each core function are essential services: Assurance: - Enforce laws - Link to/provide care - Assure competent workforce - Evaluate Assessment: - Monitor health - Diagnose and investigate Policy Development: - Inform, educate, empower - Mobilize community partnerships - Develop policies Last essential service is research which is a component of all essential services and under the function "system management"
Describe the top three causes of preventable death in the US today
Top five causes of death that are potentially preventable: Heart disease, cancer, chronic lower respiratory conditions, accidents, stroke Top preventable causes of death in order are: - Tobacco use - poor nutrition - physical inactivity - Cigarette smoking is responsible for more than 480,000 deaths per year in the U.S., including nearly 42,000 deaths from secondhand smoke exposure
Describe the historical importance of Upton Sinclair's The Jungle
Upton Sinclair • 1902 - "Discovered" socialism • 1904 - For seven weeks, lived and worked among meat workers • 1905 - Self-published The Jungle after refusing a publisher's request to remove gory descriptions • 1906 - The Jungle published by Doubleday - President Roosevelt ordered an investigation that confirmed the conditions described, but then withheld the report - Sinclair exposed investigation in a letter to the NY Times - The Jungle becomes a best seller - Pure Food and Drug Act passed by Congress and signed by President Roosevelt Upton Sinclair worked to improve public health by stimulating changes in policy and practice. Yet the nation did not respond to his efforts the way he intended. The policy changes stimulated by The Jungle focused more on the food than the worker. In his words, "I aimed at the public's heart and by accident hit its stomach."
Describe how class, labor, and politics shape society's response to health issues
What are possible explanations for why policymakers acted first to protect food safety instead of worker safety? - Food affects the wealthy and privileged people - People working in the meatpacking industry are not wealthy, not privileged and have little power or influence in politics so they are not a priority to the people making big decisions in government - They do not want to spend money and energy on people who have a lower socio-economic status, they are probably not even noticed.
Explain the historical importance of John Snow's investigation and control of the London cholera outbreak of 1854
• He used epidemiologic methods to identify the source of an epidemic (he looked at incidence of cholera, the distribution and possible control ideas of the disease and other factors relating to health, more explained in the below bullet points) • He identified cholera as a disease agent transmitted through water • He recommended a public health intervention (removing the Broad street pump handle) based on a scientific understanding of disease • His insight helped make big cities safer at an important juncture in human history: the industrial revolution
Define public health surveillance
• Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of health data to help guide public health decision making and action. • Surveillance is equivalent to monitoring the pulse of the community. The purpose of public health surveillance, which is sometimes called "information for action," is to portray the ongoing patterns of disease occurrence and disease potential so that investigation, control, and prevention measures can be applied efficiently and effectively. • This is accomplished through the systematic collection and evaluation of morbidity and mortality reports and other relevant health information, and the dissemination of these data and their interpretation to those involved in disease control and public health decision making.
In what ways could the public health response to events of 2001 been stronger?
•More investment in the public health workforce - the US has 50,000 fewer public health workers than it did 20 years ago • Stronger health care system surge capacity - hospitals and clinics have little ability to go beyond normal capabilities • More modern and integrated surveillance systems - need integration with electronic medical records • Better support for vulnerable populations - children, elderly, low-income, disabled, immigrant groups • More research and development of medical countermeasures such as antiviral medications, antibiotics, and vaccines WHY DIDN'T THESE HAPPEN?
Summarize critical public health functions in disaster management
•Planning and coordination • Public health laboratory testing • Distributing biologics such as vaccines, antibiotics, and antiviral medications • Distributing pharmaceutical and medical equipment • Surveillance • Communication • Community resiliency • Legal protections • Health responders, both workforce and volunteer • Surge capacity • Vulnerable populations
Describe how the events of 2001 impacted the US public health system (events = 9/11 and anthrax attacks)
•Stronger public health laboratory systems • Stronger disease surveillance systems • Stronger emergency planning and response • More cross-agency collaboration
