PU500: Foundations in Public Health Flashcards
What is public health to Charles-Edward Armory Winslow?
Public health is a science and art of preventing disease, prolonging life, and promoting health through organized efforts and informed choices of society, organizations, public and private communities, and individuals.
Without people living near public health resources, how much earlier can people die?
Up to 20 years earlier than people living just a short distance away.
What type of approach does public health use? What does it focus on?
A population-based approach.
It focuses on societies rather than individuals within. It aims to inform educators, policymakers, community leaders, and all of whom play different roles in the health of the community.
What type of focus does public health utilize to fix downstream issues? What would you call these initiatives in public health?
Public health uses an upstream focus that fixes downstream issues. The initiatives are holistic.
This aims to keep people from getting sick or injured in the first place.
Bonus - No backside to card.
The Institute of Medicine states that the mission of public health is fulfilling society’s interest in assuring conditions in which people can be healthy.
The World Health Organization stresses that public health aims to provide maximum benefit for the largest number of people.
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What is the definition of health?
A state of complete physical, mental, and social wellbeing rather than the mere absence of disease of infirmity
What is the definition of public health?
The science and art of preventing disease, prolonging life and promoting health, through the organized efforts of society.
What is the difference between medicine and public health?
A clinician focuses on immediate and emergent issues, while public health focuses on many things that would prevent this issue in the future.
Public health focuses on populations, while medical care focuses on the individual patient. Health care and the public should be considered complimentary. When they work collaboratively, all people benefit.
What are the three core areas of public health and their enablers?
Hint: 3 Ps
- Protection (of the health of the population) – control of infectious disease, managing environmental hazards, ensuring healthy workplace, and managing health emergencies.
- Promotion (improving the health of the population) – covers a broad range of activities that not only focus on the individual and promoting health behaviors but also improving the social determinants of health.
- Prevention (preventing health issues before they occur) – it includes activities such as vaccination and screening.
What are the enablers of public health?
Enablers of public health are good governance, advocacy (to influence and to obtain support and commitment to support actions for a health goal), capacity (having an adequate and well-training public health workforce), having accurate and timely information and research.
Bonus: Top Historical Events in Four Areas (See other side as well)
Sanitation and Environmental Health
- 500 BCE – The ancient Greeks and Romans actively practiced community sanitation measures (concrete toilets for waste collection)
- 1848 – The public health act of 1848 was established in the UK which provided a central board of health and placed responsibilities for sanitation in the hands of boroughs
- 1970 – Nixon administration established the EPA, which protects human health by safeguarding air, water, and land.
Pandemics
Epidemics or outbreaks of disease that spread far and wide, affecting the populations of multiple continents. Influenza, or the flu, has caused pandemics many times. The Spanish flu infected 500 million people across the world. Preparing for and controlling the effects of influenza will likely remain top priorities for public health.
Polio was a feared disease and killed thousands of people each year. Thousands lined up for the polio vaccine and it was introduced in 1955. An initiative to eradicate polio was launched in 1988 because of outbreaks in more than 125 countries. Today, it exists in a few countries.
In the 1980s, human immunodeficiency virus, or HIV, emerged and spread rapidly across the globe. Public health developed ways to diagnose and treat those who are infected. Worldwide, 34 million people are living with HIV. New infections are down 20% over the past 10 years, which is a sign that public health interventions are successful.
Preparedness and Disaster Response
The use of biological warfare to infect people and animals goes back centuries. During the siege of Kaffa in the 14th century AD, the attacking Tartar forces used plague as weapon of war by hurling plague-infected corpses into the enemy’s city. Their actions started the first stage of the Black Death (or plague) among Europeans.
In the wake of September 11th, public health workers were on the ground conducting surveillance to identify outbreaks of disease or other possible health conditions resulting from the attacks. They monitored the health of first responders, city residents, and environmental conditions to detect health threats during the cleanup after the attack.
After Hurricane Katrina in 2005, public health workers and other disaster-relief agencies tirelessly provided emergency services. Surveillance of injury and illness among people who evacuated to shelters and other places of refuge.
Prevention Through Policy
Public health works to protect and improve health, not just by responding to disease outbreaks or preparing for natural or human-made disasters, but also by implementing policies that support these efforts on a societal level.
As far back as 1500 BCE, Leviticus, the third book of the Hebrew Bible, is believed to be the first written health code in the world. The book deals with personal and community responsibilities and includes guidance regarding bodily cleanliness, sexual health behaviors, protection against contagious diseases, and isolation of lepers.
During 2000 to 20004, cigarette smoking was reported to be responsible for $193 billion dollars in annual health-related economic losses in the United States. Laws banning smoking in the workplace and other publics have been developed to encourage smokers to quit while protecting nonsmokers from the effects of second-hand smoke.
- 1/3 of U.S. adults and 17% of children and adolescents aged 2 to 19 years are obese.
- Highlighting fat, sugar, and salt content in food labeling regulations have been developed along with the promotion of physical activity in schools, workplaces, and neighborhoods.
What are the 5 Core Sciences of Public Health?
These five core sciences can help us protect and promote the public’s health by giving public health practitioners the answers they need. Public health is better able to respond to the situation by using contributions from each of these sciences. One science alone cannot answer the questions and provide a solution; it is the application of these core sciences together.
Public Health Surveillance – used to monitor a public health situation.
Epidemiology – enables us to determine where diseases originate, how or why they move through populations, and how we can prevent them.
Public Health Laboratories – support public health by performing tests to confirm disease diagnoses. Laboratories also support public health by conducting research and training.
Public Health Informatics – With EHRs, this increases in importance. Informatics deals with the methods for collecting, compiling, and presenting health information. It enables us to use electronic data effectively when addressing a public health situation.
Prevention Effectiveness – is closely linked to public health policy. Prevention effectiveness studies provide important economic information for decision makes to help them choose the best option available.
Use the 5 Public Health Core Sciences in the context of influenza.
Public Health Surveillance can monitor when and where cases of influenza occur each year.
Professionals can use the science of epidemiology to understand why different population choose to get vaccinated against influenza.
Public Health practitioners can use laboratory science to determine whether persons with fever and cough have influenza or a different infection.
They can use the science of informatics to receive and analyze electronic information from health care institutions (e.g., doctor’s offices and hospitals) to determine whether persons who get influenza go to see a doctor and whether they get well or die.
They can use prevention effectiveness to show that influenza vaccination campaigns that might cost $200,000 can prevent $1 million in medical costs, lost wages, and other costs.
Briefly go over the Public Health Approach in regards to what questions are asked.
What is the problem? Surveillance
What is the cause? Risk Factor Identification
What works? Implementation
How do you do it? Intervention Evaluation
What makes up the framework or concept of public health that protects and promotes the health of all people in all communities?
The 3 Core Functions and 10 Essential Services
What are the 3 Core Functions?
Assessment (knowing what needs to be done), Policy Development (being part of the solution to get it done), and Assurance (making sure it gets done)
These must be carried out by all levels of government – federal, state, and local – for the overall public health system to function effectively.
What are the 2 essential health services that involves the core function of assessment?
- Assessing and monitoring population health
- Investigate, diagnose, and address health hazards and root causes
What are the 4 essential health services that involves the core function of policy development?
- Communicate effectively to inform and educate
- Strengthen and mobilize communities and partnerships
- Create, champion, and implement policies, plans, and laws
- Utilize legal and regulatory actions
What are the 4 essential health services that involves the core function of assurance?
- Enable equitable access
- Build a diverse and skilled workforce
- Improve and innovate through evaluation, research, and quality improvement
- Build and maintain a strong organizational infrastructure for public health
Bonus: Essential Services at play with Tobacco Use Prevention
Assessment
- Monitor health status: Monitor smoking use among segments of the population, such as the youth.
- Diagnose and investigate health problems: Investigate risk factors associated with tobacco use.
Policy Development
- Inform, educate, and empower people about health concerns: Place public service announcements on television regarding the dangers of smoking.
- Mobilize community partnerships: Work with advocacy groups to develop antismoking interventions that will work in a specific community.
- Develop policies and plans: Passage of Proposition 99 (the cigarette tax to fund antismoking campaigns); smoke-free workplaces, apartment complexes, and other shared spaces.
Assurance
- Enforce laws and regulations: Enforcement of policies and laws, such as placement of cigarette vending machines.
- Link people to needed personal health services: Address potential barriers related to culture and the language of materials, or staff serving special population groups. In California, ads in the tobacco control media campaign were broadcast in Spanish and Mandarin as well as English.
- Assure a competent public health and personal health care workforce: Ensure a knowledgeable workforce is in place to develop and implement the antismoking campaign.
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How do nongovernmental organizations (NGOs) play a key role in public health?
NGOs serve many different purposes from advocacy or education to emergency relief and economic development. General types include:
- Professional membership organization, such as the American Public Health Organization
- Organization with specific focus like the American Cancer Society
- Citizen groups like Americans for Nonsmokers’ Rights
- Foundations that support health projects and work at the policy level, like CARE, which fights global poverty, and the Bill and Melinda Gates Foundation, which funds public health projects around the world.
When did the greatest improvement to life expectancy occur? And by how many years?
Also. due to mainly what?
In the first half of the 20th century where the U.S. and Europe increased by an average of 20 years.
Universal availability of clean water and rapid declines in infectious diseases, to include broad economic growth, rising living standards, and improved nutritional status.
Explain how the 5-tier health impact pyramid dynamics work (2)?
Bottom to Top of Pyramid: Socioeconomic factors, changing the context to make individual’s default decisions healthy, long-lasting protective interventions, clinical interventions, and counseling and education.
From bottom to top, the efforts at the bottom have the most impact on populations but may be more controversial, particularly if the public does not see such intervention as falling within the government’s appropriate sphere of action.
From top to bottom, these efforts require more individual effort. The top portion of the pyramid will reach less people but is more adaptable by single individuals.
What is socioeconomic factors referred as and forms the basic foundation of society?
The social determinants of health (SDOH)
What tier of the health impact pyramid deals with representing interventions that change the environmental context to make healthy options the default choice, regardless of education, income, service provision, or other societal factors?
The second tier of the pyramid - Changing the Context to Encourage Healthy Decisions
The defining characteristic of this tier of intervention is that individuals would have to expend significant effort not to benefit from them.
What are some examples of second tier?
Other contextual changes that create healthier defaults include clean water, air, and food; improvements in road and vehicle design; elimination of lead and asbestos exposures; and iodization of salt.
Strategies to create healthier environmental contexts also include designing communities to promote increased physical activity; enacting policies that encourage public transit, bicycling, and walking instead of driving; designing buildings to promote stair use; passing smoke-free laws; and taxing tobacco, alcohol, and unhealthy foods such as soda and other sugar-sweetened beverages.
For the third level of the pyramid, what does it represent?
The third level of the pyramid represents 1-time or infrequent protective interventions that do not require ongoing clinical care; these generally have less impact than interventions represented by the bottom 2 tiers because they necessitate reaching people as individuals rather than collectively.
What are some examples of the third tier of the health impact pyramid?
Historic examples include immunization, which prevents 2.5 million deaths per year among children globally. Another example is colonoscopy, which can significantly reduce colon cancer and is only needed every 5 to 10 years for most people. Smoking cessation programs increase quit rates; life expectancy among men who quit at age 35 is almost 7 years longer than for those who continue to smoke.
Male circumcision, a minor outpatient surgical procedure, can decrease female-to-male HIV transmission by as much as 60%. Scale-up could potentially prevent millions of HIV infections in sub-Saharan Africa. A single dose of azithromycin or ivermectin can reduce the prevalence of onchocerciasis, a major cause of blindness.
What does the fourth tier of the health impact pyramid represent?
The fourth level of the pyramid represents ongoing clinical interventions, of which interventions to prevent cardiovascular disease have the greatest potential health impact.
What is the issues surrounding the fourth tier?
Lack of access, unpredictable adherence, and imperfect effectiveness. At least a third of patients do not take medications as advised, and nonadherence cannot be predicted from socioeconomic or demographic characteristics.
This goal is more likely to be attained if electronic record keeping is implemented along with changes in both financial incentives and physician practices to proactively support preventive care and control of chronic diseases.
Why is tier 5, counseling and educational interventions, perceived as the essence of public health action but is generally the least effective type of intervention?
The need to urge behavioral change is symptomatic of failure to establish contexts in which healthy choices are default actions (Tier 2).
For example, counterbalances to our obesogenic environment include exhortations to increase physical activity and improve diet, which have little or no effect.
More than one third of US adults, or 72 million people, were obese in 2006, a dramatic increase over 1980. Two thirds of these individuals were counseled by a health care provider to lose weight, yet daily calorie and fat intake continues to rise.
Counseling, either within or outside the clinical context, is generally less effective than other interventions; successfully inducing individual behavioral change is the exception rather than the rule.
Nevertheless, educational interventions are often the only ones available, and when applied consistently and repeatedly may have considerable impact. An example of a successful evidence-based educational intervention is trained peer counselors advising men who have sex with men about reducing HIV risk.
Public health promotes and protects the health of people in the communities where they _, _, _, and _.
Live, learn, work, and play.
How many additional years in life expectancy did public health add opposed to medicine?
25 years for public health, and 5 years for clinical medicine.
What are some of the differences of Public health and Clinical Medicine?
- Public health focuses on the entire population while Medicine emphasizes diagnosis and treatment of the individual.
- Public health focuses on UPSTREAM healthcare while not ignoring downstream healthcare. Medicine focuses on DOWNSTREAM healthcare.
- Public health intervenes through public policy, the environment, community, and individual. Medicine intervenes through medical care, medications, and surgical procedures.
What are the four levels of prevention within Public Health?
- Primordial – prevention of risk factors occurring (must go UPSTREAM far enough)
- Primary – prevention of disease/illness occurring.
- Secondary – reduce the impact of disease.
- Tertiary – soften the impact of chronic illness.
What are the five categories of the determinates of health?
They influence the health of individuals and communities.
Behavioral Choices – directly impact health by affecting risk of injury, illness, or disease. Examples include diet, physical activity, hand washing, seatbelt use, alcohol use, and preventative behaviors such as vaccination, screenings, etc.
Biology and Genetics – affect the likelihood of developing certain diseases like age, sex (different risk factors), inherited conditions, BRCA1 and BRCA2 gene, family history of heart disease.
Social and Physical Environment (sometimes believed these are the only determinates)
– Social determinates: availability of resources to meet daily needs; social norms and attitudes; exposure to crime, violence, and social disorder; social support and social interactions; socioeconomic conditions; quality schools; availability of transportation; residential segregation.
– Physical determinates: natural environment; availability of clean water and air; exposure to toxic substances; built environment; worksites, schools, and recreation settings; housing, homes, and neighborhoods; physical barriers, aesthetic elements.
Health Services – access to service and the quality of services. It is not just about having a facility close, but can you get there, can you take time off work to go to the hospital (will you lose wages), is the doctor too booked.
Policy - laws and regulations influence individual behavior choices, social norms, and the environment. Examples: taxes on tobacco sales, motor vehicle safety standards, seatbelt laws and speed limits, laws preventing toxic waste dumping.
