Public Health Final Exam

What is the population growth formula?

Birth rate- death rate = Population growth -There is also in and out migration that is usually relatively small

What was rationing in Oregon?

Oregon realized that its medicaid budget wasn't large enough to provide comprehensive coverage for all its poor citizens so it tried to spread its resources over a larger number of people by limiting the services for which it would pay. -It stopped paying for organ transplants A new approach focused on life-saving treatments for serious conditions and tried to eliminate less effective therapies for less serious conditions. It developed a prioritized list of health services and drew a line below which treatments wouldn't be covered. They wanted to cover all citizens whose incomes were below the poverty level and use managed care plans to provide medical care. The plan struggled and collapsed

What does research on health care access tell us?

Over time, the percentage of people uninsured in the U.S. quarter has decreased. The affordable care act helped this decrease. In 2016 11% of adults aged 18 and older were uninsured

What are pathways?

Pathways are how hazard travels from source to human

What are preferred provider organizations? (PPOs)

Patients are required to seek care from participating providers who have agreed to provide services at lower rates. In some cases, patients need a referral from a primary care physician. This is a strategy for limiting access to expensive high-tech care as well as ensuring coordination of the care received by the patient from various providers

Why are more people in speciality care?

People go into debt from going to medical school and therefore go into a higher paying job (specialty care) that can pay this off. People in specialty care feel more on top of their game because there is less that they need to know.

Who makes up the clinical work force of the U.S health care system?

Physicians, surgeons, physician assistants, nurses, dentists, chiropractors, pharmacists, physical therapists, nutritionists, psychologists, social workers, etc

What are the types of services that the U.S Health Care System delivers?

Primary care, specialty care, subspecialty care (neurosurgery, gynecological cancer), diagnostic services, treatment (medical and surgical procedures), mental health/behavioral health care, pharmaceutical care, dental, vision, occupational health assessments/services, physical therapy, rehabilitation, long-term care, end of life care (palliative care and hospice)

What is radon gas?

Produced by the natural radioactive decay of uranium and is present in many homes. Prolonged exposure to radon is potentially a cause of lung cancer

How does public policy impact the health care system?

Public policy that wishes to effect the health care system must consider the triple aim. 1. Containing cost of care (reduce per capita cost of healthcare) 2. Care quality and experience (improve experience of care_ 3. Population health (think about disparities and inequalities in health) (improve population health)

What is response?

Response is biological response to agent

What is a hazard?

Something capable of harming human health

What is the exposure disease model?

Source of exposure (where is the potentially harmful agent originating from) -> Movement of pollutants (water) -> Human exposure (air pollution) -> Dose (how much do you breathe per day. what is getting into your body?) -> Adverse health effect (what we are trying to prevent)

What are the ethics on how to allocate medical resources?

The United Network of Organ Sharing (UNOS) maintains a computerized network of 58 organ recovery centers in 11 geographic regions of the nation. Patients are prioritized on how urgently they need the organ

What is a consumer-directed health plan?

The intent of these plans is to make consumers more cost-conscious when they seek medical care by providing them with information on cost and quality and requiring them to share more of the cost. They have high deductibles so that insurance payments do not kick in until after individuals themselves have paid for a significant amount of services, and they tend to be combined with health savings accounts, in which individuals set aside funds tax-free to be used in paying for medical expenses

What is a source?

The location or point from which hazard originates

Why is there a conflict between public health and the medical profession?

The medical profession has strongly resisted efforts to be included in the domain of public services. Public health has claimed the prevention and treatment of infectious disease as its responsibility, and doctors have resisted that claim. Private practitioners regard diagnosing and curing sick people as their domain. In the early 20th century they opposed the creation of public health clinics and centers which they perceived as an attack on their economic interests -Prevention and treatment vs. Diagnosing and curing

What are health maintenance organizations?

The organization has a financial incentive to maintain the health of its members. An HMO acts as both insurer and provider. In return for a fixed monthly or annual payment, the HMO agrees to provide all th medical care the individual needs. HMOs hire a staff of healthcare workers who earn a salary and thus have no incentive to provide expensive treatments when not necessary. HMOs have incentives to provide preventive care and health promotion programs, adopting some of the goals and objectives of public health

What are barriers to healthcare access?

The problems of access to medical care is closely related to the problem of its costs. It has become increasingly expensive for employers, especially small business, to provide health insurance for employees and their families. People who are uninsured tend to postpone seeking medical care when they need it and they may be denied care

Why doesn't increased spending on health care translate to better population health in the U.S?

The reasons are "deceptively simple"-Schroder -Many Americans don't receive health care when needed, receive it too late, or receive poor quality care -Pathways to better population health do not generally depend on better health care, yet 95% of health investments in the U.S. are spent on personal health services. This is because of the social determinants of health. The health care system isn't addressing problems with educational attainment, housing, employment, hunger, etc.

Why is it difficult and controversial to identify hazards and set standards for such hazards?

The risks posed by most synthetic chemicals that are discharged into the environment by industrial processes or that are disposed of by consumers are unknown. testing for potential harmful effects is expensive and time-consuming, and the choice of chemicals to test may be politically controversial. Local governments, industry, and even the average citizen may resist requirements to meet standards because of the expense and inconvenience of cleaning up the environment -expensive -inconvenient

What are patients in the U.S. Health Care System?

They are people receiving individual services. Patients live in different kinds of contexts (families, socioeconomic context, occupation, community, physical environment, cultural, and political)

What are concentrated animal feeding operations (CAFOs)?

They produce an estimated 1 mil tons of manure every day, 3 times the total waste produced by the U.S. human population. The farms deal with waste by creating "lagoons" in which the liquids are allowed to evaporate or from which they are sprayed on fields. These emit gases

What is associated with the greatest risk of death?

Traveling 4 hours by canoe. Statistically, 40/1 mil people will drown by accident

How does the U.S compare with other developed countries in terms of population health?

U.S spends more money on health care than any other nation yet ranks poorly on most population health measures: -life expectancy (ranked 53 worldwide. we are at 78.7 years and the country average is 80.1 years. If we wiped out cancer and heart disease it would add 3.6 years) -infant and child mortality rates (infant mortality is higher in the U.S. than in comparable countries) -premature mortality rate -incidence and prevalence rates of specific diseases -suicide, firearms injuries, homicides -foregoing needed health care because of costs

What is a physical hazard?

UV radiation, musculoskeletal, noise, vibration, and cell phone radiation. All around us all the time

What are the strategies to meeting clean air standards?

Use of less polluting alternative fuels, installation of vapor recovery systems on gasoline pumps, and inspection and maintenance programs that require annual measurement of tailpipe emissions on each car

How does the U.S. compare with other developed countries in terms of health care rankings?

We rank 7/7 in terms of quality of care. We spend more than other countries and don't do well! We are not getting value. We are 37/139 countries in terms of health care and France is ranked 1

What are occupational exposures?

Workers are regularly exposed to larger amounts of toxic substances on the job than most of the population is ever likely to encounter. Workers are exposed to larger quantities of chemicals so they may inadvertently serve as the guinea pigs that call attention to the dangers

What doe the ACA include?

-2,400 pages -1o titles 1. Quality, affordable health care for all americans (individual mandate) 2. Role of public programs (medicaid) 3. Improving quality and efficiency of health care (move from fee-for-service health care to value-based payments based on quality and efficiency 4. Prevention of chronic disease and improving health 5. Health care workforce 6. Transparency and program integrity 7. Improving access to innovative therapy 9. Revenue provisions 10. Strengthening quality affordable health care for all americans

What % of global disease burden is due to modifiable environmental factors? What % is in children?

-25% -33% in kids. Diarrheal disease, lower respiratory infections, and malaria

What are the 4 strategic directions and 7 priorities of the National Prevention Strategy?

-4 strategic directions: healthy and safe community environments, clinical and community preventive services, empowered people, elimination of health disparities -7 priorities: tobacco free living, drug/alcohol abuse, injury and violence, reproductive and sexual health, mental/emotional health, healthy eating, active living

What is 1,4 dioxane and its relationship with Ann Arbor?

-A grad student in 1984 was looking at properties in lakes in ann arbor. They were wondering what chemicals were in the lake. -They found 1,4 dioxane, a synthetic chemical in the lake water -There was a factory called Gelman industries very close by. They were using 60,000 lbs of it a year to measure pollution (ironic!) -They disposed of it via a lagoon, a giant hole in the ground and in sprinklers on their front yard - In 1982 they discharged it though an injection well (below ground) but it contaminated Ann Arbor aquifers -There were 3 square miles of water contaminated beneath Ann Arbor (85 pp.)

What are exposure routes?

-A route is how hazard gets into your body once it reaches you Ingestion, inhalation, skin contact, and skin absorption -The exposure assessment is the measurement or estimation of human exposure. Key components include: magnitude (how much agent is there?), frequency (how often does contact occur?), duration (how long does contact last?) -Exposure = magnitude x frequency x duration

Why do medical care costs keep rising?

-Aging populations are driving up medical expenditures -The continual development of new medical technology and high-tech procedures (CT and MRIS are expensive) -A large percentage of the American medical budget is spent on administration -Americans tend to sue for malpractice which adds to medical costs -One of the most significant factors driving up medical costs are financial incentives for medical providers. In the "fee-for-service" system of payment, doctors and hospitals are motivated to provide more services in order to increase their income

What is medicaid expansion under the ACA?

-Before ACA, few states offered medicaid coverage to people without extremely low incomes and categorical qualification -Now, medicaid will cover everyone under 133% of FPL (still really low income), including childless adults (12-20 million people) -Feds cover 100% of costs for newly eligible and over the years the cover less and less to 90% in 2020 -Reauthorized Children's Health Insurance Plan until 2019 -32 states took of the medicaid expansion. ACA said every state had to, but there were law suits that went to the supreme court and the supreme court agreed that it had to be optional. -Medicaid expansion increased employment, personal income, and economic activity

What is a chemical hazard?

-Cleaning products, cigarette smoke, lead in drinking water, carbon monoxide, bisphenol A (in plastics -There are 85,000 chemicals out there

What are the pros of managed care?

-Employees are able to incorporate cost control measures -Slowing of medical inflation in the 1990s -Advantage over fee-for-service in providing high-quality care -Emphasis on prevention and health education -Have the ability to monitor patients' health and to evaluate the quality of care they receive

What is the essential health benefits package part of the ACA?

-Every insurance plan must cover a minimum required set of services to be covered including: outpatient care, hospitalizations, emergency services, maternity and newborn care, pediatric care, mental health and addiction treatment, prescription drugs, rehab services and devices, laboratory services, clinical preventive services

What is the individual mandate part of the ACA?

-Everyone in the country has to be covered by health insurance (similar to auto insurance). -Government assistance in affording health insurance through expanded public programs and also a new marketplace for purchasing publicly subsidized private insurance. -The thought it would help with adverse selection problem because it makes the risk pool healthier. It brings down the premiums of health insurance for everyone. -Republicans first came up with this idea -Free-riders are those who do not purchase health insurance and cannot afford to pay out of pocket cost tax payers a lot of money -Mandating some level of health insurance for all should reduce some of the subsidizing middle/upper classes do for the poor/free riders -Downside is that individual mandate is on the same road as universal coverage- says some republicans -Everyone must have insurance or face a penalty if they don't purchase a plan. -Exemptions include financial hardship, those who don't have social security for religious reasons, indian tribes, unauthorized immigrants, uninsured for period of less than 3 months -In 2012 supreme court ruled this a tax and said it was constitutional

What is the insurance industry reform part of the ACA?

-Health insurance companies must spend 80-85% of premiums on health care (medical loss ratio). Limits the profit an insurance company can make

Who is dual eligible for medicaid and medicare?

-If over 65 and really poor -Low income people who are disabled and can't work

What are the exposure pathways of 1,4 dioxane and what is the primary route in Ann Arbor?

-Injestion of contaminated water/soil -Contact with contaminated groundwater/soil -Primary pathway: injection of contaminated water (adults drink 2 L/day) -124 private wells closed

What is Title 1 Health Insurance Industry Reforms all about in the ACA?

-Insurance plans must be guaranteed issue (cannot exclude people with pre-existing conditions -No rescission (cannot kick sick people off of their plans -No annual or lifetime caps -Can cover dependents up to 26 years old -Effective clinical preventive services must be offered at no charge to patients -These are trying to avoid adverse selection (not allow expensive people to get off of the insurance companies plan)

What is the ACA?

-Key component of the new law is the individual mandate, a requirement that all Americans have health insurance or pay a fine. This requires states to have affordable insurance exchanges -Expanded coverage for young adults on their parents' plan up to age 26 -Older adults have a yearly wellness visit and a range of no-cost screening -Contraception -Savings in the medicare prescription drug plan -Insurance companies can't can't cancel policies of patients with if their medical costs rise -Constitutionality of the law was challenged in the court by 26 states, with the individual mandate issue the most contested. The supreme court upheld the law in 2012. The ruling was that the fine for not having insurance amounted to a tax, which the government had the power to impose. But the decision did restrict the expansion of medicaid, allowing some states not to expand elgibility

What population does medicaid serve? SHARED PROGRAM BETWEEN FEDERAL AND STATES

-LOW INCOME * -People over 65 that are poor -Children under 19 that are poor -People who are blind * -Disabled people that are poor -People who need nursing home care and are poor -Medicaid covers nearly 50% of births. States vary by generosity. It covers pregnancy and 6 weeks post birth -Eligibility is determined by income and varies from one state to another. Medical bills are paid directly by the state or local government to the provider, usually at a low, fixed rate for each service

Is the ACA working?

-Lowest levels of Americans reporting an inability to pay medical bills or medical debt in decade -20 million fewer uninsured individuals since 2010 (yay better access) -Uninsured rate declined >50% for AA's, >25% for Latinos, ?50% for whites -Patient safety improvement has led to an estimated 50,000 saved lives and $12 billion

What are trends in mortality by cause in white non-hispanics and race?

-Lung cancer is going down -Poisoning is increasing (opioid epidemic) -Chronic liver disease is increasing -Diabetes is slowly increasing -Suicide is increasing -Blacks 45-54 are dying at less rates but still more than others -Whites non-hispanics are dying at increasing rates (opioid epidemic is disproportionately effecting poor white males) -Hispanics are dying at less rates

What are forms of medical care that are typically considered particularly important to the health of the public?

-Medical treatment of communicable diseases is particularly important because of the possibility that one sick individual could infect others. Public health has taken a major interest in all aspects of infectious disease control from quarantines, to immunization programs, to the provision of free medical treatment for those who don't have health insurance. -Emergency services -Veterans and prisoners communicable disease emergency service veterans and prisoners

How well regulated are HPV (high production volume) chemicals in the U.S?

-Most Americans assume basic toxicity testing is available ad that all chemicals in commerce today are safe. A recent EPA study has found that this is not a prudent assumption. -EPA reviewed publicly available data on these chemicals, and found most were never tested to determine how toxic they are to humans or the environment -6 basic tests necessary for minimum understanding of chemical's toxicity, known as the Screening Information Data Set: 1. acute toxicity (die immediately) 2. chronic toxicity (cause cancer over time) 3. developmental and reproductive toxicity (harm baby or impair reproductive abilities) 4. Mutagenicity (can cause blood cell organisms to mutate) 5. Ecotoxicity (bad for flora and fauna around us) 6. Environmental fate (will it degrade immediately or stay in environment for a while) -93% of 3,000 HPV chemicals missing one or more basic tests -43% of HPV chemicals are missing all tests -only 7% of HPV chemicals have all six basic screening tests

What are some challenges of the ACA?

-Ongoing political challenges -"Repeal and replace" platform of many Republicans -Patience: many ACA reforms are years away from maximum effect -Additional attention to prescriptive drug coverage and cost control is needed -Enhanced competition needed in Marketplace -20 states have yet to expand medicaid and there are regional differences in expansion of medicaid -Rising premiums?

What population does medicare serve? TOTALLY FEDERAL PROGRAM

-People 65 and older -People of any age who have kidney failure or long term kidney disease -People who are currently disabled and cannot work -A mandatory insurance program for people over the age of 65. It is part of the social security system. Workers pay into the system through deductions from their paychecks, employers pay a tax on their payroll, and workers are entitled to benefits when they reach retirement age. Part A covers hospital insurance and Part B pays doctor bills and other outpatient costs (this is voluntary and requires a monthly premium)

What are the cons of managed care?

-The financial incentives encouraged denial of treatment -Limits on choice of doctor -Patients were denied expensive procedures that would save their lives

How can we control the costs of medical care?

-The first cost control effort by the federal government was the imposition of price controls by President Nixon from 1971 to 1974. Although the policy moderated cost increases temporarily, providers adapted to the lower fees paid for each service by increasing the quantity of services -Another approach to cost control focused on limiting spending on new facilities and technology. Major strategy used by other OECD countries -In 1980s medicare devised a payment system designed to provide incentives for hospitals to limit the length of hospital stays. Medicare paid a flat fee for each hospital stay based on the illness of the patient and the average cost of treating similar patients. If a hospital could cure the patient in a shorter time it could keep the cash. Hospitals began charging private insurance companies more to make up for their losses so states forced the hospitals to accept the same rates for everyone. The DRG system was effective in reducing expenditures for hospital care, but overall costs continued to rise because there was no DRG system for outpatient care

Why does regulation tend to progress slowly?

-The sheer volume of potentially toxic chemicals being manufactured in the U.S. -Toxicity testing on any single chemical can be expensive and time-consuming -=Each chemical must be regulated separately, each with the potential for controversy, legal challenge, and extensive litigation over each proposed regulation

Has ACA been successful?

-Uninsurance dropped by 43%. -Rates of people being insured went up in states that expanded medicaid. -Improved access to care -Improved affordability of care -Slowed growth in health care costs -Improved quality of care

What are the 5 A's of access?

1. Affordability - can people afford the care? do people have the correct health insurance? 2. Accessibility - are the services you need located near where you are? (location of supply) 3. Availability - the volume of services available when people need them (size or volume of supply) 4. Accommodation - are people's needs accommodate? appointment systems and hours of operation 5. Acceptability - healthcare providers accept all clients regardless of their characteristics

With the ACA in place, what are the 4 main ways people experience health insurance? and what percentage of people fall into each category?

1. Employer 50% (from their job) 2. Government 33% (medicare and medicaid) 3. Buy their own 10% 4. No coverage 30 mil 10%

What are consumer reforms in the ACA?

1. Individual mandate. Every person purchase insurance or pay a fine 2. Subsidies. They help make insurance affordable. Individuals below 400% FPL are eligible to receive monetary assistance to purchase health insurance. Small business owners are offered tax credits for offering insurance 3. Medicaid expansion. Program for low-income individuals. Expands medicaid eligibility up to 138% of the federal poverty line, regardless of previous eligibility rules. Supreme court ruling in June 2012 gave states the freedom to expand medicaid or not

What are the 10 Essential Public Health Services? (don't really need to know)

1. MONITOR population health status to identify and solve community health problems 2. DIAGNOSE AND INVESTIGATE health problems 3. INFORM AND EDUCATED about health issues 4. MOBILIZE COMMUNITY PARTNERSHIPS to identify and solve problems 5. DEVELOP POLICIES AND PLANS 6. ENFORCE laws to protect health and ensure safety 7. lINK people to health services 8. ASSURE competent workforce 9. EVALUATE effectiveness, accessibility, personal, and services 10. CONDUCT RESEARCH

How is health insurance in the U.S. divided?

1. Private (employer-sponsered, individual market, health savings, account) 2. Public (medicaid, medicare, state children's health program, veterans health system, state/local plans) 3. Uninsured (out of pocket, health care safety net)

What are the three types of hospitals in the United States?

1. Prive for profit 2. Private non-profit 3. Public (fewer resources, more crowded, crappy facilities)

What are provider reforms in the ACA?

1. Reforms are focused on aligning incentives between different providers 2. There is an emphasis on population health 3. Payment to physicians and hospitals is based on expected costs for an episode of care 4. Primary care physicians are paid for coordinating care for patient amongst specialists

What are insurance market reforms in the ACA?

1. They are regulations limiting insurance company actions. Guaranteed issue: cannot exclude people from buying your insurance plan 2. Exchanges: marketplace for the purchasing of approved health plans. All exchanges are private insurance plans. Plans are easily comparable, with different "levels" of plan generosity 3. Insurance companies must offer standard minimum benefit packages, including mental health treatment, maternity, and prescription drugs

What are the six dimensions of quality of care?

1. Timely 2. Safe 3. Efficient 4. Effective 5. Equitable 6. Patient-centered

How much money do we spend on medicare and medicaid?

15% of the federal budget for medicare and 10% of the federal budget for medicaid (but medicaid has state support too. states vary in their generosity. it's usually 25-35% of the state budget)

What is a copayment?

A flat fee or fixed percentage of the remained of the bill

What is the Children's Health Insurance Program?

A joint federal-state program, similar to Medicaid, which expands coverage to children in families that earn too much to quality for medicaid

What is the joint commission?

A private organization that grants accreditation to healthcare institutions to confirm that they provide high-quality care. Medicare, medicaid, and many private health insurers usually require institutions to be accredited in order to pay them for patient services so maintaining accreditation is important

What is DDT?

A virtually ubiquitous pesticide DDT. The chemical could be found in lakes and streams, plants, and insects. When eaten or drunk by fish and birds, it accumulated in their flesh, to be eating in turn by their predators, which concentrated these chemicals further in their own bodies. A worldwide survey measuring chemicals in the body fat of people on 6 continents found DDT in all of them. The use of DDT was banned in the US in 1972

What are some controversial issues in medical care?

Abortion, physician-assisted suicide, system's insistence on providing expensive, intrusive, and unwanted treatment to patients whose conditions are medically hopeless, also the policy on distributing organs

What is the risk-benefit analysis?

Absolute safety is an impossible goal and attempting to avoid risk of one sort may increase risks of other kinds. Prevention of risk must be balanced against other societal goals, including economic well-being

What is the Stockholm Convention on Persistent Organic Pollutants?

Agreement amongst 91 nations to reduce and/or eliminate the production, use, and release of 12 of the POPs of greatest concern. Since then, 11 new POPs have ben added to the list

What are 2 key modifiable environmental factors contributing to such disease burden?

Air pollution and water pollution

What facilities are there to get Health Care?

Ambulatory care clinics (outpatient), ED's (urgent care), hospitals, nursing homes, community health centers, school-based clinics, family planning clinics, local health departments, mobile vans, retail clinics (in CVS and target. Relatively new. There are pros and cons), dialysis clinics

What are factory farms?

Animals are crowded into confined spaces where they can be fed and tended to by automated systems. The environmental problems caused by this approach to farming are the huge volumes of waste produced by these animals, which must be disposed of on a relatively limited amount of land

What is assurance and oversight in the health care system?

Assurance is stuff like making sure the people that deliver care are trained appropriately through accredited programs, have the right licenses, there are lab safety/quality standards, quality of care protocols, radiation safety standards, FDA (drug regulation), facility safety regulations

What is the association between population pyramid of the U.S and provider shortages?

Baby boomers are getting older. Females live longer. There are a lot of people in the age group from 20-30 these are the kids of the baby boomers (baby-boom let). We are going to have a lot of old people. We need enough people to take care of these aging people. Nurses and physicians are hitting retirement age. We need people to go into these jobs to get us through the baby boom years.

What is BPA?

Bisphenol A is a component of plastic commonly used in food and drink containers, capable of leaching into the containers' contents and being consumed. It is an endocrine disruptor. It can mimic estrogen, causing early puberty in females and abnormalities in male and female sex organs

Comparing adults and children what is the percent of people with a usual source of care other than the emergency room?

Children have a greater percent of usual source of care other than the emergency room. But, still people say that they don't have a usual source of care even after the ACA

What is dose?

Dose is amount of agent actually deposited within or imparted onto the body

What is overall governance in the health care system?

Executive and administration leadership. Includes the boards of directors and trustees

What is exposure?

Exposure is amount of contact with hazard

What is a biological hazard?

External organisms. TB, Zika, Influenza, Salmonella, and animals

Who are the administrators and other staff in the U.S Health Care System?

Health care executive leaders, administrators, board members/trustees, laboratory staff, diagnostic services staff, clerical and patient support staff, facilities staff, food service staff, and consultants

Health insurance vs. health care

Health insurance is financial access to health care

What is the Department of Veterans Affairs (VA)?

Hospitals and clinics were designed to treat war-related injuries, but they also serve as a safety net for low-income veterans who don't have other sources of medical care

What are trends in health care costs?

If we combine health expenditures as % of GDP and social service expenditures as % of GDP THEN we don't spend as much as other countries, but we spend so much more on health expenditures than social service expenditures where as other countries spend more on social service expenditures. We spend more on caring for sick than primary prevention

What is the limit on annual out-of-pocket spending in the ACA?

Individual: 6,600 Family: 13,200

What's an insurance exchange?

Individuals can shop for a plan that meets their needs. Individuals and small employee groups can purchase private insurance plans through insurance marketplaces (at the state level through the federal exchange) -All health insurance plans offered through marketplaces must be qualified health plans and meet actuarial value levels

What is the clear air act of 1970?

It established strict air quality standards, set limits on several major pollutants, and mandated reduction of automobile and factory emissions. It required monitoring 6 criteria air pollutants: particulates, sulfur dioxide, carbon monoxide, nitrogen oxides, ozone, and lead

What is the consumer product safety improvement act of 2008?

It imposed regulations and testing requirements for toys and children's furniture on manufacturers, importers, distributors, and retailers. The law limited the amount of lead allowed in paint or any similar surface coating on these products

What is the health care safety net?

It includes publicly-funded insurance, local public health clinics (immunizations and other preventive services, aging services, home health care), family planning clinics (specialty clinics), community health centers (federally qualified health centers (one in DC that caters to LGBTQ), community clinics), school-based health centers, prescription drug assistance programs, charity care/uncompensated care, long-term payment plans/bad debt

What is acid rain?

It is produced when two common air pollutants (sulfur dioxide and nitrogen dioxide) react with water to form sulfuric acid and nitric acid. It damages forests, reduces crop yields, and corrodes surfaces of buildings and statuary

What is the fee-for-service approach?

It permits doctors to make decisions about a patient's care with no consideration of cost

What did the ACA do for health care access?

It reduced the financial access to care problem. But, people still do put off seeking treatment of care even if its serious

What is the emergency planning and community right to know act?

It requires businesses to report the locations and quantities of chemicals stored at their sites

What is associated with the lowest risk?

Living 1 year 20 miles from a nuclear plant (.007 per 1 mil will die)

What's the relationship between ACA and public health?

Many ACA provisions explicitly address prevention, community health and "population health" 1. Coverage for clinical preventive services (immunizations, cancer screening, behavioral therapy for obesity, HIV counseling and testing, FDA approved contraceptives) 2. Prevention and public health fund (nation's first dedicated federal funding for prevention. money used for prevention research and health screenings, education and outreach, immunization programs) 3. Hospital community benefit regulations

What's the percentage difference between specialty physicians and primary care physicians?

Many more people are specialty physicians than primary care physicians. This is because there is a differential in pay, speciality seems to be more important. We have a shortage of primary care clinicians!

What is there to know about indoor air quality?

Most common indoor air pollutants are tobacco smoke, other products of combustion, radon gas, consumer products that release chemicals into the air, and biological pollutants, including bacteria, mold, dust mites, and animal dander

Why are food borne illnesses a public health problem?

-1 in 6 Americans develop food borne illness/year -128,000 are hospitalized/year -3,000 die/year -Foodborne illness costs about 15.6 billion/year

What was the dose of lead in the Flint water crisis?

-In the year before the Flint crisis, median BLL across the US was <1 ug/dL in most groups -There was a spike in 2014 in Flint -Elevated BLLs among children <5 years -2.4 to 4.9 in all of flint

TB?

-1/3 of world's population have latent TB, of which there is a 10% lifetime risk of developing active TB -In 2015, 10.4m new cases and 1.8m deaths -6 countries account for 60$% of total (large populations, low income) -TB is the leading killer of HIV-positive people -Treatable and curable

What are the origins of governmental regulation?

-1862: Lincoln forms USDA which had the bureau of chemistry which was the og FDA which led to the department of health and human services -1879: first USDA investigations into food adulteration practices -1906: Upton Sinclair's The Jungle outlined unhygienic conditions in meatpacking plants -People altered foods with cheaper ingredients and used toxic additives to improve appearance to cover up spoilage -1906: Passage of the Pure Food and Drug Act (prohibited interstate commerce in misbranded and adulterated foods, beverages, and drugs) and Meat Inspection Act (regulation of meat quality and safety) -1938: Food, Drug, and Cosmetic Act (gave the basis of modern food law, basic regulation of cosmetics (ingredients found to be harmful after the fact are banned from future use. there is no necessary pre-approval), gave the FDA authority over medical devices, feed and drugs for pets and farm animals, and put in drug requirements (it reviews the company tests and evidence)

What are polio eradication efforts?

-1988 world health assembly was a global effort to eradicate polio

Malaria?

-212M cases and 429,000 deaths in 2015 -Most cases/deaths (71%) in children under 5 years -92% of fatalities in Africa -Mortality rate decreased 62% 2000-2015 -Prevention/control methods include vector control, intermittent preventive therapy, and rapid diagnostic tests

What is the intersection of mental illness and other social issues?

-26% of homeless adults staying in shelters live with serious mental illness and an estimated 46% live with severe mental illness and/or substance use disorders -Approximately 20% of state prisoners and 21% of local jail prisoners have a recent history of a mental health condition -70% of youth in juvenile justice systems have at least one mental health condition and at least 20% live with a serious mental illness -Only 41% of adults in the U.S. with a mental health condition received mental health services in the past year -Among adults with a serious mental illness, 62.9% received mental health services in the past year

HIV/AIDS?

-36.7 million people live with it, -1.8 million newly infected in 1 year -1.0 million HIV related deaths in 1 year. -# of new infections is more than deaths. number of people infected is getting bigger. -Disproportionately in Africa. -Increase in infected population then begins to fall (screening, better access to antiretrovirals

Does being out to your health care provider influence whether or not sexual minority women receive sexual health services?

-4 times more likely to get HPV test if out, 2 times more likely to get pap test, but there is no change in STI testing -Public health efforts should focus on sexual health promotion -Clinicians should ensure practice meets clinical guidelines on sexual health service recommendations, increase efforts to solicit sexual orientation disclosure (coming out)

What are landfill alternatives?

-53% of municipal solid waste is disposed of in landfills -The only way to make landfills last longer is to reduce, reuse, and recycle -Composting allows the natural decay processes to convert yard and food wastes to mulch -Waste-to-energy incineration reduces solid waste and produces heat and energy

How do we decrease Detroit's lead exposure?

-7 years lifetime income loss due to rescued IQ -1.5x risk of an arrest for violent crime -7 times chances of dropping out of high school -Detroit suffers more from lead 56% live in Detroit -Case management through identification, home visits, referrals, abatement, and enforcement

What is the association between LGBT and HIV?

-81% of HIV diagnoses in youth were among gay or bisexual men. Of these, 55% were black, 24% were hispanic, and 16% were white -Youth living in the South are at greatest risk for HIV infection -51% of youth 13 to 24 are living with HIV and don't know it -GB youth are less likely to know their HIV status than hetero peers

What is the five tier pyramid?

-A conceptual framework for public health action -Efforts to address SES determinants are at the base, followed by public health interventions that change the context for health (clean water, safe roads), protective interventions with long-term benefits (immunizations), direct clinical care, and, at the top, counseling and education. The bottom requires less individual effort and has the greatest population impact. Interventions at the top tiers are designed to help individuals rather than entire populations

What is coal ash?

-A dam on the banks of a Tennessee River broke spilling a billion gallons of toxic sludge across 300 acres of East Tennessee. It was holding back wet coal ash, waste from a Tennessee Valley Authority power plant that burned coal and supplied electricity to homes. In addition to destroying and damaging homes in the area, the spill polluted the river water with thousands of pounds of arsenic, lead, and other toxic and carcinogenic metals

What is the FDA's role for regulating drugs?

-FDA does not test drugs itself -Companies seeking to market new drugs are required by law to conduct the tests and submit the evidence to the agency -FDA staff review the data and determine whether the evidence supports the new drugs' safety and efficacy

What are 3 strategies to prevent premature births?

-A premature birth is a baby born live before 37 weeks. This is the primary cause of infant death 1. Birth spacing (long acting reversible contraception or condoms) 2. Progesterone (natural occurring hormone, taking prenatal progesterone decreased preterm birth risk. it goes from .58 to .66. 3. Preconception health (keep women healthy before they get pregnant. access to care, managing health issues, screening and treatment for STIs, promoting optimal health-stress reduction, smoking cessation, exercise and diet

How do we decrease Detroit's unintended pregnancy

-A teenager living in Detroit is 2.5 times as likely to get pregnant than the typical Michigan teenager -Increased access to LARCS by building clinics in neighborhoods, education for providers, public awareness campaign

Why is it difficult to ensure safe drinking water?

-All community systems need to treat their water so that all contaminants are removed. The basic steps include sedimentation, coagulation, filtration, and disinfection -To ensure that the treatment process is working effectively, regular laboratory tests are generally done on the final product -Community sewage treatment plants discharge into watershed areas -There are substandard septic tanks -The very chemicals used to kill microbes in water may themselves be harmful to health

What are some AIDS facts?

-Antiretroviral treatment rising due to international aid -PEPFAR (U.S. President's Emergency Plan for AIDS relief) $72.7 billion, treatment, testing, counseling, training -No-governmental Gates foundation $2.5 billion to HIV research and organizations, $1.4 billion to Global Fund to fight AIDS, TB, & Malaria -In 2016 only 53% of people living with HIV received ART

What are human made causes of climate change?

-Atmospheric pollution due to industrial activity, urban/suburban sprawl and dependence cars, affluence, and waste disposal -Clear cutting and logging for agricultural and land use

What are patterns in human aging around the world?

-Because of the U.S. baby boomers born in 1946-64 14% of today's population is greater than 65 -European senior population is 18-22% -Japan's senior population is 26% -China and India have 1/3 of the worlds population that is greater than 65 -20 countries have negative population growth

What is behavioral health?

-Behavior health is the scientific study of the emotions, behaviors and biology relating to a person's well being, their ability to function in every day life and their concept of self -It includes not only ways of promoting well-being by preventing or intervening in mental illness such as depression or anxiety, but also has an aim preventing or intervening in substance abuse or other addictions -It encompasses all contributions to mental wellness include substances and their abuse, behavior, habits, and other external forces -It makes things seem like its in the person's control to change -It seems more holistic than mental health. People think mental health is more biologically based

What are childhood risk factors?

-Biological risk factors include intrauterine exposure to alcohol or cigs, environmental exposure to lead, malnutrition of pregnancy, birth trauma, and specific chromosomal syndromes

How do we decrease Detroit's infant mortality rate?

-Black babies in Detroit are twice as likely to die as babies in Michigan overall -Worked on program to decrease rates of preterm birth by supplying "sisters" to support and mentor the area and certain classes and supplies

What are the racial disparities for infant outcomes?

-Black children are more likely to die -They have lower birth weight, higher prematurity rates and higher infant mortality rates

What are the racial disparities for maternal mortality?

-Black women have 42.8 maternal deaths per 100,000 live births whereas whites have 12.5 -However, disparity reduction efforts can be effective. California has been successful in reducing maternal mortality rates by race/ethnicity. The rates in African-American women here has decreased. They targeted the biggest maternal mortality death causes

Income of the elderly?

-In the past, the elderly were expected to have the highest poverty rate but now they have the lowest and individuals under the age of 18 have the highest poverty rate -Social security and medicare began to help elderly

How do we diagnose mental health conditions?

-Classifying a specific psychiatric disorder is a more subjective endeavor -The defining symptoms for each mental illness are detailed in the diagnostic and statistical manual of mental disorders published by the American Psychiatric Association. this is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment -Diagnoses are usual determined through clinical interviews -A provider may rule out physical problems that could cause your symptoms by having a physician conduct an examination and potentially run lab tests

How has reductions in smoking impacted financial aspects of medicaid?

-Clear savings due to reduced smoking among medical care beneficiaries (healthier population under 65) -Nursing home support (reduction in smoking means more older seniors and therefore more nursing home care, net effect unknown) -Total net effect on Medicaid unknown but quite possible that aggregate impact on costs go down

What are the characteristics of human aging?

-Collective effects of physical, psychological, and social changes over the lifespan -Knowledge and wisdom improve -Reaction time declines -Vision and hearing decline -Social science reasoning peaks in mid life then declines -Muscle mass declines -Math reasoning declines -Sexual potency -Peak age is 20's -Reduction in some functions can be slowed. Exercise can retard deterioration of muscle mass; people in 90s can build muscle

What are vulnerable populations in risk assessment?

-Could be vulnerable due to differences in exposure, differences in susceptibility to disease, or both -Examples include children, pregnant women, elderly, people with preexisting disease, disabled people, low income communities, and people with genetic predisposition towards certain diseases

What are the fertility rate trends?

-Declining fertility (children per women)

What are the proposals for rationing medical care?

-Denying expensive life-prolonging technology to people over a set age

What is the contemporary issue of nutrition labeling?

-Dietary behavior has a bigger impact on health than food contamination -Nutrition labeling first established by the FDA in 1973 but it was voluntary and only included micronutrients -The nutrition labeling and education act of 1990 required labeling for almost all foods regulated by the FDA -The USDA developed a parallel regulations for meat and poultry -2006 nutrition labels were required to list trans fat for the first time -2020 new nutrition facts labels and serving size requirements. Things are bolded. Added sugars are included

What are surprises in public health?

-Emergence of new infectious diseases -Drug-resistant infections -Obesity epidemic -Emergence of terrorism as serious PH concern -Rapidity of spread of smoke-free laws -Genetics revolution (personalized medicine)

What is the food safety modernization act of 2011?

-Emphasizes prevention rather than responding to contamination -Requires increased plant inspections every 3 years for high-risk facilities -Food companies to establish written plans for safe manufacture -Mandatory recalls of contaminated foods (previously voluntary) -More frequent inspection of foreign food manufacturing facilities -BUT, congress may not grant budged needed

Prevention in the elderly?

-Exercise (elderly can build muscle) -Avoid tobacco, excessive alcohol -Control HBP -Proper diet -Weight control

How has reductions in smoking impacted financial aspects of social security?

-More beneficiaries, living longer -Financial impact unambiguously negative

What are disparities in birth outcomes?

-Factors like income and education don't explain racial disparities in birth outcomes -Racism in America leads to chronic stress, which affects birth outcomes -Birth outcomes are affected by the negative impact of racism over one's entire lifetime, not just during pregnancy -Black college grads infant mortality rate is 10.2 compared to white college grad infant morality rate of 3.7 -The infant mortality rate amongst white high school drop outs it about the same as black college grads

What foods are most commonly associated with outbreaks?

-Fish and shellfish cause about 26% of all outbreaks -They are difficult to regulate -Contamination

What are the regulatory challenges in the food regulation industry?

-Food and drug regulation for safety is a basic function of the government -Highly politicized because a lot of money at stake -Food industry wants to make health claims yet avoid new labeling requirements -Drug industry wants quick approval of new drugs yet consumer advocates claim the FDA too readily approves new drugs -Tobacco industry wants to minimize regulation -Coordination of government agencies -Resources needed to find sources of, or, better, to prevent problems

What is HACCP? (hazard analysis critical control point)

-Food safety protocol for food processors/manufacturers based upon the principles of hazard analysis and risk assessment -Requires an analysis of every step in the process of food production, processing, and preparation -Intended to prevent hazards, rather than rely on inspection of finished products -Purpose is to identify each possible hazard and for each, one or more "control points" which are practices and procedures that will eliminate, prevent, or minimize the hazard -Introduced by Clinton Administration for seafood and meat safety, given difficulty of inspections/regulation -96% of meat and poultry plants regulated by USDA use the system -HACCP principles: 1. Conduct a hazard analysis 2. Determine the critical control points 3. Establish critical limits 4. Establish monitoring procedures 5. Establish corrective actions 6. Establish verification procedures 7. Establish record-keeping and documentation procedures

What is the compression of mortality and morbidity?

-For mortality, curve has been moving to the right and is becoming more square shaped. Less mortality in early age groups are more mortality compressed in older aged groups -For morbidity, there's around 20 years of life at the end where people are dealing with morbidity. If we extend life, people are living longer with longer problems OR a compression of morbidity? onset of morbidity is later so it is now only 10 years of morbidity? it's mixed! Second one is true for high SES but do low SES have longer morbidity (failure of success)? not sure but evidence regarding high SES is promising. -Disability rates are lower for sure

Globally, how has population size changed over time?

-For most of human existence, the human population on the planet was flat and small. -1000 slow rise -Dip during black plague -Then takes off! Enormous acceleration in word population. This is because of industrialization (food), increase in productivity in every sector of the economy

What is the contemporary issue of genetically modified foods?

-GMOs are living organisms whose genetic material has been artificially manipulated in a lab through genetic engineering -Labeling is not required in the U.S. but its required in many other countries -Benefits include higher crop yields; potentially less expensive, improved quality; longer shelf life and higher nutrient content -Risks include modified with bacteria or viruses lead to new diseases, without resistance, allergic responses, take over of similar crops through cross-pollination (reduction in biodiversity), messing with nature in general, market domination by a few firms

What are the polio eradication efforts?

-Global effort to eradicate polio is the largest public-private partnership for public health (gates foundation, national gov, WHO, volunteers) -Top-down development -Approx $10 billion over 25+ years -Oral polio vaccine is 3 cents/dose -Expanded program on immunization/ national immunization day: large-scale vaccination rounds help rapidly boost immunity -8 million cases of life-long paralysis avoided -Top priority!!

What do we know about poverty and income inequality?

-Great variation in income inequality across countries -Income inequalities are greatest in poor countries -Income inequalities are greatest in Africa and throughout South and Central America -Income inequalities least in affluent countries with most homogenous population -U.S. and a few other developed countries have substantial inequality (usually lower than poorest countries)

Why do we care about aging?

-Health -Overall costs of health care and opportunity costs -Financial support for health care (medicare). it's unsustainable as it is! -Financial support for nursing home care (medicaid) -Financial support for income (social security). it's unsustainable as is -Adjustment over time in care providers/facilities/systems -Social support systems -Politics (old ppl voting)

Why does breastfeeding benefit both the mother and the child?

-If 90% of women breastfeed exclusively for first 6 months and continue until 1 year of age (american pediatrics recommendation) it would prevent 2619 maternal deaths and avoid many disease diagnoses such as breast cancer, type 2 diabetes, hypertension, heart attacks ALSO -Would prevent 721 baby deaths, >600,000 ear infections, 2.5 million GI infections, 20,900 severe lower respiratory infections, 45,298 cases of childhood obesity

Why 65 as the retirement age?

-In 1889 German man Bismark imposed social security and allowed people to retire at 70 and then lowered it to 65 -In 1935 we chose 65 too -More people now are surviving to 79 so they can get their benefits at 65

What is the contemporary issue of organic foods?

-In 2000 federal standards regulated what foods could be labeled organic -Organic meat, poultry, eggs, and dairy is raised without antibiotics/growth hormones -Organic produce is grown without pesticides, synthetics fertilizers, and sewage sludge -The advantages are fewer pesticide residues, may activate more natural pesticides, and may have more nutrients -The disadvantages are individual cost, feeding the world's poor, and organic and carbon footprint

What is international health?

-It focused primarily on health in developing countries, not on interconnectedness among countries -IH unidirectional: transfer of knowledge/technology from rich north to poor south

What is global health?

-It focuses on worldwide health issues, rather than country-specific -Interconnectedness of countries regarding health (how transportation, commerce, communications, economics, and politics influence health around the world - infectious disease communicability through air and other travel, chronic disease communicability through media and commerce, and climate change) -Addressing health disparities across and within countries -Bidirectional learning and training

What is the community health assessment: DHD goals?

-It is a community-driven strategic planning framework for improving community health. Ask the community what they think is wrong and focus on public health involving the community Goal 1: prioritize public health issues Goal 2: Identify resources to address public health issues Goal 3: Implement locally-relevant strategies

What is food safety regulation at the state level?

-It is highly variable -The responsibility is generally within the state health department

What is the contemporary issue of irradiation?

-It kills microbial food contaminants (widespread use could greatly increase the safety of the food supply) -It is currently in use in pests in herbs, insects in flour, and some treatment of meats, fruits, and veggies -There is no evidence of harm to humans

What do we know about Polio?

-It mainly affects kids under 5 -Occurs mostly in fecal-oral transmission but can also occur via oral-oral transmission -90% of infections are asymptomatic (headache, fever, sore throat, fatigue) -1/200 infections leads to irreversible paralysis -Polo cases have decreased by over 99% since 1988. Only a couple countries have it

What are the associations between LGBT youth and associated health threats?

-LGB youth are at increased risk of negative health behaviors, and decreased positive/promotive factors, especially HIV/STIs, violence and victimization, and access to health care

What is the association between LGBT youths and violence?

-LGBT youth are twice as likely as their peers to say they have been physically assaulted, kicked or shoved at -They get bullied more, forced into sex, experience dating violence more and experience sexual dating violence more

What are the breastfeeding recommendations?

-Length of nursing is as least 1 year as recommended by the American Academy of Pediatrics -Should be exclusively breast milk for the first 6 months -WHO recommends 2 years

We are making progress in some areas?

-Life expectancies rising dramatically -Birth rates declining -Infectious disease toll declining -International community responding

What progress in public health in the 20th century has their been?

-Life expectancy has increased 2/3rd -Infant mortality rate has decreased 94% -Maternal mortality rate has decreased 99% -Much of LE increase is due to decrease in IMR, but not all -Remarkable decreases in age-adjusted death rate from heart disease and stroke, especially in 2nd half of century (better MC and PH: less smoking, more exercise, screening and treatment acute care) -Vaccination (reduction in infectious diseases. eradication of smallpox, elimination of polio in Americas, control of others) -Sanitation, cleaner water, safer foods -Antibiotics as miracle drugs -Declining in smoking -Improvements in motor vehicle safety (safer cars, roads, and better law enforcement) -Large decrease in occupational injuries and deaths -Success of family planning -Better dental health -Air and water pollution decrease -Nutritional diseases decrease due to better diets and vitamin fortification -Safer workplaces have resulted in dramatic reduction in fatal occupational injuries

What is food safety regulation at the local level?

-Local health departments conduct inspections of restauraunts, food stores, food carts, institutions, etc -Food safety inspections in AA have been going poorly! There is a good safety report published monthly in the paper

What do we know about hazardous waste?

-Love Canal is a small community in NY. Canal built between Niagra falls and lake ontario -There was a neighborhood built on this hazardous waste town -It was cleaned up but there was an economic ramification -China has the most hazardous waste

Whats the relationship between health care spending and health?

-Low income mean per capita health care expenditures in US is $37 -High income mean per capita health care expenditures in US is $5,266 -Strong correlation for most countries reflects economic development and health, but among richest countries, marginal benefit is small if anything

What is urban migration?

-Majority of world's people live in cities for the first time -Adverse implications include overcrowding, sanitation, infectious disease has gone up, violence and crime, prostitution, HIV/AIDS, children without homes, death rates increasing

What are some maternal mortality rates in the last 100 years?

-Maternal mortality rates have decreased significantly in the last 100 years. -BUT in 2000 there was an increase? -Chronic disease is the primary cause of pregnancy related deaths

What is the net financial impact of further reductions in smoking on social supports?

-Medicare costs increase -Medicaid costs ?? -Social security costs increase -Aggregate social support costs increase

MSM MSWM WSW WSWM SOGI ?

-Men who have sex with men -Men who have sex with men and women -Women who have sex with women -Women who have sex with women and men -Sexual orientation gender identity

What can we do to promote mental health?

-Mental health is an integral part of health -Mental health promotion involves actions to create healthy living and environment conditions -An environment that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health promotion -National mental health policies should address broader issues which promote mental health, not just policies concerned with mental disorders -Early childhood interventions, support to children, socio-economic development, social support for elderly populations, mental health promotional activities in schools, mental health interventions at work, care for people with chronic illness, housing policies.....

Whats the relationship between mental illness, chronic disease, and co-morbidty?

-Mental illness is associated with increased occurrence of chronic diseases such as CVD, diabetes, obesity, asthma, epilepsy, and cancer -Mental illness is associated with lower use of medical care, reduced adherence to treatment therapies for chronic diseases and higher risks of adverse health outcomes -45% of those with any mental disorder meet the criteria for two or more disorders, with severity strongly related to comorbidity -Over 8.9 million persons have co-occurring disorders-- that is, they have both a mental and substance use disorder

What unintended consequences have resulted from aggressive polio immunization campaigns in Pakistan?

-Militant groups are threatening polio vaccinators and parents who immunize their children -The polio campaign is costing Pakistani lives, national pride and precious health resources

How does minority stress play a role in LGBT health?

-Minority stress is a cause of health disparities. It is a theory about the impact of prejudice and stigma

How has reductions in smoking impacted financial aspects of medicare?

-More beneficiaries increase the cost because smoking goes down. -The net effect of this success is going to increase medicare expenditures

What are barriers to treatment for mental illness?

-Negative connotations regarding psychiatric hospitalization -National comorbidity survey-replication showed that people diagnosed with psychiatric conditions said that they didn't seek treatment because of: 1. low perceived need for treatment 2. financial 3. availability 4. transportation 5. inconvenient 6. wanted to handle on own 7. perceived ineffectiveness 8. stigma 9. thought would get better 10. problem was not severe

What are the benefits of coming out to care providers?

-Open communication, partner inclusion, and patient-provider relationship?

What's the relationship between medicaid and aging?

-Out-of-pocket health care expenditures for medicare beneficiaries > 15% of income! This can bankrupt a significant number of elderly. These people then turn to medicaid -Nursing home care - covers almost 1/2 of nursing home costs -Medicaid = 21% of state budgets

What are the food and oceans resource implications for population growth?

-Over fishing -Pollution leads to declining fish populations -Fish farming increasing but creates problems/risks

Need for support for public health

-PH is 2.5% of national health expenditures -PH is grossly underfunded and infrastructure is in disarray

What are the barriers associated with coming out to care providers?

-Patient fears ill-treatment, discrimination and worse care -Provider deficits include embarrassment, discomfort, and lack of knowledge

What was the HMO backlash?

-Patients understood that the financial incentives encouraged denial of treatment and they were mad -Patients objected to limits on their choice of doctors to consult -HMO "gag rules" forbad physicians from recommending treatments for which the HMO would not approve payment (state legislatures passed laws against these) -Patients were denied expensive procedures that might have saved their lives -BUT, the use of PCP's as gatekeepers for controlling patient access to specialists may help to prevent unnecessary procedures that could put patients at risk

What is the stigma related to mental illness and mental health?

-People have disorders. They do not become the disorder. It's people WITH schizophrenia. -Don't say mentally ill -Avoid stuff like afflicted with, suffers from, or victim of

How might raising the age for social security exacerbate inequalities between socioeconomic groups?

-People in lower half of distribution are more reliant on social security -Raising retirement age would be difficult for those in the lower half of earnings distribution their life expectancy has not increased, their dependency on social security is more.

Why have birth rates declined?

-Policies: china's one child policy, policy support of birth control -Changing expectations and norms: we no longer live in agrarian societies so children are no longer economic aspects, cost of having children has gone up so people don't have as many kids

What are the barriers to population control?

-Politcal, economic value of children (as workers and caretakers), cultural/religious, personal, restrictions on individual liberty

Further progress faces challenges?

-Politics -Religion -Resources -Slow-moving bureaucracies

What are the cultural factors in diagnosing and treating psychiatric disorders?

-Presentation of psychiatric disorders are different around the world -The provider may have biases -Unlike biological diseases such as cancer because all cancer cells under a microscope are going to look the same -Different coping styles -Mistrust, stigma, immigration, and overall health status

What is the future of climate change?

-Preventing climate change is very unlikely -Developed nations contribute disproportionately to greenhouse emissions -People in poorer countries will suffer the most

What is the problem of public health's labor intensity?

-Price of labor is growing faster than price of technology -Cost of labor-intensive services is increasing faster than cost of technology-intensive services and products -Government is labor-intensive. -Real cost of providing a fixed set of PH services is going up over time -To get unchanging set of services the public must pay more per year

What foods are most commonly associated with illness?

-Raw foods of animal origin (raw/undercooked meat and poultry, raw or lightly cooked eggs, unpasteurized milk, raw shellfish) -Fruits and vegetables (field contamination, processing contamination, cross-contamination -(fish, dairy, chicken, beef....)

What are the water resource implications for population growth?

-Renewable resource, but rate of renewal is fixed. -The availability is variable depending on land and precipitation patterns. -Its a source of significant political issues and conflict. -Poorer countries suffer more pollution and therefore have to pay more. An american's 5 minute shower uses more water than an average person in a poor, developing country uses all day for all purposes. -Water scarcity can lead to unclean water for drinking/bathing/washing clothes -> water-borne disease -Water storage in homes increases risk of mosquito breeding

What should public health do to meet challenges?

-Sell PH to journalists, media, public, medical profession, and legislators -Work harder and smarter to use resources incredibly efficiently -Goal-setting "Healthy People": direct PH efforts -Select foci of work rationally: Frieden's health impact pyramid -Extend reach of PH agencies by enlisting non-PH resources -Work effectively with medical professional groups

What are the consequences of climate change?

-Significant overall increase and variability in global temperatures -Rising oceans -More intense storms -Heat waves -Threats to agriculture -More disease-carrying insects with temperature increase -These all lead to dislocation of major populations, threats to food supply, more and/or new infectious diseases, political upheavals, and others

What are the food and land resource implications for population growth?

-Since 2961 arable land per capita has declined 47% world wide -"Green revolution" dramatically increased food production but also damaged land -Improvements in agricultural yields at risk due to water shortages, soil depletion, and pesticide resistance -Declines in arable land due to urban sprawl and erosion from overgrazing -Deforestation modestly increases land available for crops but creates other problems

What are the effects of health promotion on aging and costs of social supports?

-Smoking among adults has decreased which contributes to a larger number of seniors that are healthier on average and live past 65

Why is it important to study maternal mortality and morbidity?

-Societal loss: motherless children, productive years -It measures the overall effectiveness of the health care systems -It identifies gaps in the health care system

What is negative population growth?

-Some countries face decreases in population (aids, war and famine, reduced fertility) which contributes to population aging

What is disorder?

-Some psychological disorders fit the definition of "disease" (bipolar disorder and schizophrenia)

Children's Health Insurance Program

-The Children's Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. -CHIP, which has enjoyed broad bipartisan support, helps lower- and middle-income families that otherwise earn too much to be eligible for Medicaid -The ACA further expanded this (additional financing through 2015)

What is maternal morbidity like in the US?

-The burden of maternal morbidity is much larger than maternal mortality -Severe morbidity 12.9 per 1000 deliveries. Complications during pregnancy, birth, or postpartum leads to women being disabled for some time -Overall mortality in postpartum period increased by 66% -Impacts >50,000 women each year -There has been an increase in maternal morbidity

Dilemma for medicare?

-The current system is unsustainable financially -Its been losing money for past 8 years. Expenditures> revenues beginning in 2009 -15% of the federal budget; $540 B -53 mil beneficiaries in 2014 expected to rise to 78 million in 2030. Active workers per beneficiary is going the other way! Revenue will not keep up -Now it only covers only about 1/2 of the beneficiaries health care costs -Solutions: increase age of eligibility from 65, increase premiums for high-income beneficiaries, increase co-pays, decrease benefits, Increase payroll taxes -Medical practice and end-of-life care changes

What is globalization?

-The development of an increasingly integrated global economy marked especially by free trade, free flow of capital, and the tapping of cheaper foreign labor markets -Good for economic development; essential to get poor people out of poverty -Transfers high-paying jobs to impoverished countries where wages lower -Good for innovation and modernization -BUT it spread infections and chronic diseases, transferred high-paying jobs out of affluent countries, and increased affluence in LMICs

What are the trends of the aging of the population?

-The population is getting older -Females increasingly outnumber males in older age groups

What is SIDS of sudden infant death syndrome?

-The third leading cause of infant death overall -The death is usually unexpected -SIDS is more common in infants of low birth weight and in infants of smokers or drug users, but it is not limited to infants with these risk factors -SIDS is listed as the cause of death if no other explanation is found

What are some unique aspects of Detroit compared to other cities?

-There are no public transportation systems so people are isolated (not many Detroit residents have access to cars) -There are no high rises -It has a large geographic footprint

How does USDA and FDA influence state and local governments?

-There are recommendations that state and local governments use to regulate food/retail establishments such as hand washing and temperature guidelines

How is the size of a food borne illness outbreak determined?

-There only needs to be 2 people -The size of an outbreak depends on 5 factors: 1. the pathogen that caused the illness 2. the contaminated food 3. where the contamination occurred 4. how the food was prepared 5. the number of people who ate it

What are food additives?

-There purpose is to prevent nutrient deficiencies, to act as a preservative (prohibit spoilage), and to act as an aesthetic (improve color, enhance flavor or texture) -The food additives amendment of 1958: required FDA approval for any proposed food additive. The manufacturer must show that the additive performs as its intended and doesn't cause harm. 2 major exceptions: additives already in use before 1958 were exempted and those generally recognized as safe substances were fine (don't need to be approved by FDA and are not tested by the FDA. food manufacturers don't need to tell the FDA which substances they certified as GRAS. controversy!!! high fructose corn syrup, artificial sweeteners, artificial colors, caffeine)

What is the contemporary issue of pesticides and herbicides?

-They are chemicals used to prevent, control, and eliminate insects/unwanted plants -They could pose some risks (cancers, birth defects, developments issues, etc) -1954 pesticide chemical act -1980s integrated pest management programs reduced the use of conventional pesticides by 50% -1996 pesticide law set maximum residue levels -Only a fraction of our food supply is tested -Dirty dozen vs. clean fifteen -Use of them dramatically increased crop yield in low income countries and dropped price. Helps with starvation!

What is the contemporary issue of growth hormones?

-They are used to increase feed efficiency, promote growth in farm animals, and increase milk production in cows -The main concerns include the ability of steroidal compounds to enhance the effects of estrogen; promote early puberty and some cancers

What is the contemporary issue of antibiotics?

-They are used to treat and/or eliminate bacterial infectious agents of significance to animal health, also given to healthy animals to encourage growth -80% of all antibiotics sold in the US are used on livestock -Believed to have led to increased antibiotic resistance in many bacteria

What happened in Flint?

-They didn't properly treat their municipal water system with anti-corrosion chemical to prevent lead particles and solubilized lead from being released from the interior of water pipes after a change in the source of water (from lake huron to the flint river) which resulted in elevated lead levels in the city's water and an increase in city children's blood lead levels. -Lead exposure in kids can lead to decrements in intelligence, development, behavior, attention, and other neurobiological functions. -Low-income and minority populations are at a particularly high risk for lead exposure and environmental injustice

Shared responsibility between FDA and USDA

-They share the primary responsibility for ensuring that foods are safe, wholesome, and properly labeled

What do we know about occupational health?

-US annual occupational deaths: 4-6k from injuries, 49-60 k from illness, $51 B -If we want to prevent most deaths we would work with transportation and warehousing -If we want to focus on most risk for dying we would work with lodging and fishing

What are some barriers to breastfeeding or factors that promote formula use?

-Undermining of women's confidence that they can breastfeed. Loss of knowledge between generations -Birthing practices -Medical and nursing education -Early hospital discharge (free diaper bags) -Limited support at home -Access to lactation support -Formula companies -Maternity leave and return to work

Why are there declining death rates?

-Vaccinations -Reduction in infectious disease -Sanitation -Clean water -Pest control (mosquitos) -Disease treatment -Reductions in warfare and genocide

We have tools to combat problems?

-Vaccines for some infectious diseases -Effective treatments -Some knowledge about how to avoid or reverse behavior-related problems -FCTC for tobacco -Large number of well-educated people committed to improving the condition of the less fortunate fellow human beings

What are the relationships between economic development and health?

-WHO has labeled poverty as the worlds biggest killer. People with lower income have worse health outcomes -10.7% of global population live on $1.9/day in 2013 -Under-nutrition contributes to 45% of all deaths per year among children under 5 years old -Increased GDP or per capita income is associated with higher life expectancy rate and impacts population health -For a given level of income, life expectancy has risen over time

What are the patterns and causes of death in the future?

-WHO thinks from 2005-2030 the total number of deaths of cancer, ischemic heart disease, road traffic incidents and cvd will increase -Acute respiratory infections, perinatal conditions, HIB, TB, and malaria deaths will decrease

What do we know about climate change?

-Warming for our climate system has been unequivocally confirmed and linked directly to human activity -We emit air pollution and the atmosphere lets in some uv energy that heats the planet. -Build up of greenhouse gases is trapping heat energy in atmosphere -Climate change leads to temperature rises and hydrologic extremes -This causes environmental changes of air pollution, vector-borne diseases, water-borne diseases, mental health, environmental refugees -This leads to health changes such as malaria, asthma, CVD, forced migration, anxiety, heat strokes, injuries -Few people are driving climate change for many -Poor and disadvantaged bear brunt of climate change -We have a moral obligation to future generations to reverse climate change -WHO estimates that the global burden of diseases from climate in 2000 already exceeded 150,000 excess deaths/year. This doesn't even include weather disasters that were likely associated with climate

Is the water supply running out?

-Water covers 71% of the earth's surface but only 1% is fresh water -Recent drought conditions have exacerbated the problem

Whats the difference in population growth across different countries from 2000-2005?

-We have a number of countries with negative growth rates

What challenges do we face?

-What will obesity and lack of exercise lead to? -Aging of population -Residual smoking -Dealing with racial/ethic & SES health disparities (infant mortality, maternal mortality, most causes of death, illness, and disability. gab likely to widen if income distribution continues to become more unequal) -Antibiotic resistance with known disease (TB) -Relationship between infectious and chronic disease -Food-borne pathogens -Climate change (droughts, hurricanes, floods, effects on agriculture) -Air pollution and lung disease -Aging infrastructure -Terrorism (emergency preparedness: prevention, disaster response, post-disaster management)

What demographic subgroups are less likely to breastfeed?

-Women from rural areas -Women under age 20 -Women with only a high school education -Women living below the poverty line -African American women -We must work for social change to challenge the intersections of poverty/race/gender

What is disease?

-a problem that impairs functioning and that mostly stems from biological causes -(bipolar disorder and schizophrenia)

How does the regulation of dietary supplements work?

-in 1973 the FDA tried to regulate them but the public and industry led Congress to ban FDA from regulating supplements -Dietary supplement health and education act of 1994: prohibited FDA from regulating herbs and supplements despite the risks of several supplements. Manufacturers are not required to alert the FDA to adverse side effects. The FDA must prove "significant and unreasonable risk to health" before removing supplements from stores

What are the three types of hazards associated with food borne illness?

1. Biological: bacteria, molds, viruses, parasites, toxins. We usually talk about these because they cause the majority of food borne illness in the U.S. 2. Chemical: substances added to foods (cleaners, sanitizes, lubricants, drug residues in foods of animal origins (these may be purposely added- antibiotics and growth hormones) 3. Physical: bone, metal, plastic, glass, and wood chips

What are the 3 main ways to improve maternal and child health?

1. Breastfeeding 2. Birth spacing and intended pregnancies 3. Pre-conception health and preventing premature birth

How do we decrease Detroit's overdose fatalities?

1. Clinician education 2. Public education campaign 3. Community empowerment

What are domain of mental health indicators?

1. Emotional well-being: perceived life satisfaction, happiness, cheerfulness, peacefulness 2. Psychological well-being: self-acceptance, personal growth, openness to new experiences, control of one's environment, spirituality, self-direction, positive relationships 3. Social well-being: social acceptance, beliefs in the potential of people and society as a whole, personal self-worth and usefulness to society, sense of community

What are the big three infectious diseases?

1. HIV/AIDS 2. TB 3. Malaria

What are some measures to improve population control?

1. Media campaigns to restrict family size 2. Family planning programs (subsidized bc) 3. Address basic conditions to improve infants' and children's changes of survival

What are the frameworks that exist for studying LGBT health?

1. Minority stress 2. Life course 3. Intersectionality 4. Social ecology -Research areas include demographic research, social influences, health care inequities, intervention research, and transgender-specific health needs. These lead to more compete understanding of LGBT health

What are the top five pathogens contributing to domestically acquired foodborne illnesses?

1. Norovirus 58% 2. Salmonella 11% 3. Clostridium perfringens 10% 4. Camplyobacter spp. 9% 5. Staphylococcus aureus 3%

Why is adolescent and young adult mental health so important?

1. Prevalence: 17.9% of individuals aged 18-25 have serious psychological distress 2. Disability (burden of disease): mental disorders account for the largest burden of disease among 15-29 year olds in the U.S. 3. Age of onset: 50% of mental illnesses have first onset by mid adolescence

What are the points of contamination in the food production chain?

1. Production: infected reproductive organs of hens (contaminated yolk or shell), feels sprayed with contaminated water, animal fecal matter contamination during growing season, human fecal matter contamination during harvest 2. Processing: contaminated water used to wash pack or chill fruits/veggies, slaughtering of animals, contaminated surfaces of equipment used for processing spread to foods 3. Distribution: refrigerated food left on a loading dock for a long time in warm weather, fresh produce loaded into a truck not properly cleaned after transporting animals/animal products 4. Preparation: most common form of contamination, sick food worker that doesn't wash hands, cross-contamination (contaminated surfaces of equipment are used for preparation. make 1 for meat and 1 for fruits/vegs. also, use plastic! it is easier to be disinfected), refrigerator (meat juices contaminate items that will be eaten raw. put meat on the bottom shelf), undercooking animal products 5. Mishandling at multiple points

What are the steps of outbreak containment?

1. Quickly detect the outbreak 2. Gather the evidence 3. Take action (health officials warn the public, companies recall contaminated products, restauraunts/food production facilities are temporarily closed -Sometimes outbreaks end before the source is identified

What are the top 5 pathogens contributing to domestically acquired food borne illnesses resulting in death?

1. Salmonella 28% 2. Toxoplasma gondii 24% 3. Listeria monocytogenes 19% 4. Norovirus 11% 5. Campylobacter spp. 6%

What are the top five pathogens contributing to domestically acquired foodborne illnesses resulting in hospitalization?

1. Salmonella 35% 2. Norovirus 26% 3. Campylobacter spp. 15% 4. Toxoplasma gondii 8% 5. E. coli (STEC) O157 4%

Who investigates a foodborne illness outbreak?

1. The local health department -Most foodborne outbreaks are local events. 2. The state health department -Typically investigates outbreaks that spread across several cities or countries -Often works with the state department of agriculture and with federal food safety agencies -Contaminated batch of something at a kroger 3. CDC -State may ask for help from the CDC for outbreaks that involve large numbers of people, or severe, unusual, or widespread illness -Contaminated food at one farm is shipped to grocery store worldwide

What is federal food safety regulation?

1. USDA: under food safety and inspection service -inspects meat, poultry, and processed eggs -daily inspection of processing plants -8,200 in-plant employees -20% of federally regulated foods -17% of food borne illnesses -1.03 billion budget more workers, more inspection 2. FDA: agency within US DHHS -all other foods -plant inspections every 10 years -800 employees -80% of federally regulated foods -67% of food borne illnesses -1.5 billion budget larger budget, responsible for more 3. CDC: responsible for epidemiological surveillance (collection, analysis, and reporting of food borne illness data) and prompt follow-up of any food borne outbreak -It has 2 surveillance systems (pulse net which is passive surveillance (ppl r already sick and they survey data after) and food net which is active surveillance (find people as they become sick during the food borne illness)) 4. It is a patchwork system between the FDA, USDA, and CDC -There have been repeated calls to establish a single, independent agency that would administer a unified, science-based food safety system -There has been resistance from the food industry that heavily influences congress

What is the lifetime prevalence, or total percentage of the population that has a mood disorder?

21.4%

What is the lifetime prevalence, or total percentage of the population that has a impulse-control disorder?

25%

What is the lifetime prevalence, or total percentage of the population that has an anxiety disorder?

31.2%

What is the lifetime prevalence, or total percentage of the population that has a substance disorder?

35.3%

What is the lifetime prevalence, or total percentage of the population that has a mental disorder

57.4%

What are the health issues of the aging?

58% hypertention, 47% high cholesterol, 31% arthritis, 29% ischemic heart disease, 27% diabetes, 18% chronic kidney disease, 14% heart failure, 14% depression, 11% alzheimer's disease, 11% pulmanary disease -High prevalence of heart disease 30% of deaths vs. 22% for cancer -Osteoporosis (serious bone loss) -Macular degeneration and cataracts -Falls -Drug interactions -Social isolation, loss of professional identity

What is the campus mental health treatment gap?

60% of students with an apparent mental health problem do not receive treatment -Most physical health problems are treated, most mental health problems are not -This is a missed opportunity for prevention and early intervention -Students prefer to deal with issues on their own and believe that stress is normal

What percent of the births in the next 25-50 years will be in the world's poorest countries?

95%

What is maternal morbidity?

Temporary or permanent disability that occurs during pregnancy or 42 days after

What are social determinants of mental health?

Adequate housing, safe neighborhoods, equitable jobs and wages, quality education, and equity in access to quality health care

How does trauma impact health?

Adverse childhood experiences lead to social emotional and cognitive impairment, lead to adoption of health-risk behaviors, lead to disease disability and social problems lead to early death

What is the Kinsey scale?

An attempt to classify people by sexual orientation that was in 1948. It ranges from exclusively heterosexual (0) to exclusively homosexual (6)

What is a food borne illness?

Any illness resulting from the ingestion of food

What is a health inequality?

Any quantifiable difference related to health

Social security and aging?

At the beginning, few people were receiving benefits and a lot of people were working so few qualified. The worker beneficiary ratio is decreasing. -The money is not being saved, its a pay as you go system -We need more employees because # of beneficiaries is increasing! -Reserves are supposed to be exhausted in 15 years -Increase age of eligibility (make it even higher)

What is the triadic understanding of human sexuality?

Attractionality, identity, behavior, and an emphasis on fluidity

What is the collaborative approach in Detroit initiatives?

Clinician engagement, public awareness, and improved access

What is mental illness?

Collectively all diagnosable mental disorders or health conditions that are characterized by alterations in thinking, mood, or behavior associated with distress and or impaired functioning

What is non point source pollution?

Contaminants from stormwater runoff from farmland, construction sites, and urban streets

What are the most common causes of food borne illness?

Contamination of foods with bacteria, viruses, or parasite due to breakdowns in sanitation and or/proper food handling practices. -Salmonella=bacteria -Some bacteria cause illness by ways of toxins they produce rather than by simple infection

What are determinants of birth?

Culture and religion, economics, social change, war, politics and policy, health care, and technology (birth control)

What is maternal death?

Death of a woman while pregnant or within 42 days of termination of a pregnancy from any cause related to or aggravated by pregnancy, not from accidental or incidental causes

What is pregnancy-related death?

Death of a woman while pregnant or within 42 days of termination of pregnancy (irrespective of cause) -Suicide

What are health care disparities?

Differences pertaining to access to and quality of care

What are health status disparities?

Differences pertaining to health outcomes

What are determinants of death?

Disease and famine, culture and religion, economics, social change, war, health care, and technology

What is a built environment?

Everything from buildings we work in, to transportation, roads, where we can go to gather. This has a strong influence on our help. There are exposures to hazards like air and water contaminants, noise, heat, crime, pests and traffic. At the city level, beneficial exposures include healthy food, health care service and recreation facilities. Built environment issues at the housing level include noise and light pollution, temperature humidity (mold), indoor air quality, pests and sanitation, building condition and safety, and toxins

What is J shaped growth?

Exponential or unrestricted growth. The growth rate of the population accelerates

What is red lining?

Federal government wanted to help people get housing by giving loans but didn't want to loose money so didn't want to loan to African Americans specifically. It encouraged a movement to suburbs. Also, it gave money to access to white wealthy (only gave economic prosperity to whites), prices of the homes went up giving whites more money, it left African American intercity in poverty

What was the source of lead in the Flint water crisis?

Gas, pipes, and paint

Why study population health?

Generate critical information to understand health implications and other consequences of population growth -Size of population -Population distribution -Births and deaths -Marriages and divorces -Planning for services and resources (schools, hospitals, services, roads, disaster preparedness, government spending -Environmental protection efforts -Planning to control population size, density

What are the adverse health effects of lead?

High blood pressure, abdominal pain, etc.

What is the state of mental health on college campuses?

High prevalence, high burden, age of onset, intensive period of investment in human capital -The campus mental health crisis: high prevalence of mental health issues at universities, most students with apparent mental health issues are not seeking help

What happens to the health of a population with strategic and intentional disinvestment?

Higher rates in: poverty, unemployment, lower college graduation rate, can't afford to see a doctor, adult obesity, diabetes, HIV incidence, cancer incidence, lower homocide, higher infant mortality

What happened to Detroit's population from 1840 to 2012?

In 1950 the population was 2 million and now it is 750,000. It's been declining. We can fit San Francisco, Boston, and Manhattan in Detroit

What is the equation for higher vulnerability for negative health outcomes?

Increased risky behavior + reduced care utilization = higher vulnerability for negative health outcomes

Is infant morality a health problem or social problem?

Infant mortality is a social problem with health consequences. The number one risk factor for infant mortality is poverty

What has happened to infant mortality in the last 70 years?

It has decreased!

What is a health inequity?

It involves a contextual judgement about a health inequality. It is unnecessary and avoidable and unfair and unjust

What is community based participatory research?

It involves community members and decision makers at both the upstream and downstream levels -It is a partnership approach to research that equitable involves community members, practitioners, and academic researchers in all aspects of the process, enabling all partners to contribute their expertise and share responsibility

What is infant morality a good measure of?

It is a sensitive measure of the overall health and wellbeing of women, communities, and nations

What is chronic obstructive pulmonary disease?

It is caused almost entirely by smoking

What is WIC or The special supplemental nutrition program for women, infants, and children?

It provides vouchers for milk, fruit juice, eggs, cereals, and other nutritious foods for pregnant women, lactating mothers, infants, and children up to five year old -Nutrition education is also provided -It saves medical costs

What is the safe drinking water act of 1974?

It required the EPA to set standards for local water systems and mandated that states enforce the standards

What is mental health in adulthood like?

Its characterized by the successful performance of mental function, enabling individuals to cope with adversity and to flourish in their education, vocation, and personal relationships -The most common psychological and social stressors in adult life include breakups of intimate romantic relationships, death of a family member, economic hardships, racism and discrimination, poor physical health, and accidental and intentional assaults on physical safety -Anxiety disorders are the most prevalent mental disorders in adults (panic disorders, agoraphobia, generalized anxiety disorder, specific phobia, social phobia, OCD, acute stress disorder and PTSD

What are terms to explain sexual orientation?

Lesbian, gay, bisexual, queer, and questioning

What is S shaped growth?

Logistic or restricted growth. The rate accelerates, there is a point of maximum growth and then the rate of acceleration slows down

What is Detroit's black bottom neighborhood?

Lots of African American businesses, prosperous but economic downturn affected them and the government thought that they could help them by building a highway through the town

What are the patterns and causes of death currently?

Low income have higher deaths: 1. lower respiratory disease 2. diarrhea 3. stroke 4. Ischaemic heart disease 5. HIV/AIDS 6. TB 7. Malaria 8. Preterm birth 9. Birth issue 10. Road injury -non-communicable 37% of deaths -40% of deaths occur in people under 15 20% in people over 70 years High income: 1. Ischaemic heart disease 2. Stroke 3. Alzheimer 4. Lung Cancer 5. Chronic obstructed pulmonary disease 6. Lower respiratory 7. Colon 8. Diabetes 9. Kidney disease 10. Breast cancer -non-communicable disease 88% of deaths -1% of deaths occur in people under 15 and 70% in people over 70 -Epidemiological transition!

What is the maternal mortality ratio?

Maternal death per 100,000 live births

What is mental health?

Mental health is defined as a state of well-being in which the individual realizes his or her born abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community -Prevention strategies may include coping and promoting positive living behaviors -Promoting mental health can be about any conditions (CVD, working condition, etc)

What are sources of water pollution?

Microbial pathogens, wide range of chemicals (mercury in Minamata bay or PCBs in the Hudson River), deposition from the air as acid ran or runoff from the land

What are the public and occupational health hierarchy of controls?

Most effective to Least effective 1. Elimination/substitution (eliminate chemical) 2. Engineering controls (changing physical environment to contain the hazard and prevent it from coming into contact with people. muffler on car 3. Warnings 4. Training and procedures 5. Personal protective equipment (respirators, ear plugs)

What type of population in Nigeria is considered a "polio reservoir"?

Nomads because they spread the disease around the country during their migrations

How do we tackle Detroit's challenging health issues using a social context?

Our public health system is diverse and interconnected. We need to work in partnerships to promote community health and make a robust system (public health agency, civic groups, non-profit organizations, labs, elected officials, hospitals, doctors, etc). Use 1,2,3 prevention and attack at levels in ecological model

What is a PPB?

Part per billion. Drop of ink in a pool

What is a PPM?

Part per million. Drop of ink in a bath tub

What are the major trends of population growth?

Population has gone up, life expectancy had gone up, fertility has dropped (children per women)

What are the issues in global health for the foreseeable future?

Poverty, population, urbanization, global warming, clean water, hunger, literacy, obesity, unsafe sex, violence, occupational hazards, etc.

What type of paradigm shift is suggested in the reading to effectively prevent mental, emotional, and behavioral disorders?

Prevention requires a paradigm shift. We need a national dialogue on mental health and substance abuse issues to embrace the healthy development of young people and at the same time to respond early and effectively to the needs of those with MEB disorders -Public sector should intervene when one person's action or behavior adversely impacts others. Government should intervene in areas in which shared interests require shared solutions

What is hazardous waste?

Radioactive wastes and infectious medical wastes are both hazardous wastes

What are the challenges to diagnosis?

Relying on self report

How does the U.S. compare to other countries in terms of infant mortality?

The U.S. ranking of infant mortality has been getting worse since 1960. As of 2013 we were ranked 50th -U.S. rate is 740.6 deaths per 100,000

Is legislation a solution to climate change?

The UN paris climate change conference in 2015 was a legally binding universal agreement amongst 195 countries, but the US has withdrawn

How does the US compare to other developed countries in terms of maternal mortality?

The US is the only developed country that has an increasing maternal mortality rate

What is infant mortality?

The death of a baby who was alive at birth but died before reaching his or her first birthday -Infant mortality rate is the number of deaths of infants under one year old per 1,000 live births

What is environmental justice?

The fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies -It is an academic area of inquiry and a social movement

What is carrying capacity?

The number of organisms that can be supported in an environment without degrading it -Determinants of carry capacity of human population include nature (weather, fertility of land, and water) and humans themselves (urbanization, agricultural practices, pollution, resource consumption/conservation practices, technology) -Malthus's predictions, 1798: world would experience overpopulation and outgrow the food supply, resulting in way, famine, and overall destruction. His predictions haven't come true due to improvements in technology and population expansion from Europe to Americas and Africa

What are the population growth trends within the U.S. from 1800-2016?

The percent growth began in 1850 drastically and although the percent growth is slowing, the population continues to rise -S shaped curve (fertility declining)

What is growth in the U.S. elderly like?

The percent of the population that is over 65 is growing

What is morbidity?

The rates of chronic disease and disability

What is social security?

The retirement system for the elderly

What are downstream intervention programs?

They are targeted at immediate health needs such as mortality and diseases and injury. In terms of income-related examples it is stuff like ensure that chronic disease prevention programs are accessible to low income people

What are midstream intervention programs?

They are targeted at intermediary determinants/ material circumstances such as risk behaviors (smoking, drinking, and violence). In terms of income, it can be linking clients with welfare, social assistance, or back-to-work programs

What are upstream intervention factors?

They are targeted at structural determinants such as targeting social inequalities (race, class, and gender), targeting institutional power (government, business, and schools), and neighborhood conditions. In regards to income, it is the process of advocating for living wage policies, wage capping, and progressive taxation

What are people's reasons for not seeking treatment?

They don't know that there are effective treatments, there is fear of the stigma of acknowledging the problem, there is a great cost of care, and insurance coverage of mental health care is inferior to that of physical health

What is gender identity?

Transgender, genderqueer and cisgender

What is the local legislation to protect breastfeeding in public?

Wasn't until 2014 that Michigan legislation to protect a woman's right to breastfeed in a public place -49 states now have this legislation -Federal: Patient protection and affordable care act said that employers must provide space that is not a bathroom for breastmilk expression for the first year after birth

What was the human exposure to lead in the Flint water crisis?

Water!