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Flashcards in Exam 1 Deck (50):
1

Class description of "health"

Health is defined as an individuals personal perception and being capable of balancing their physical, emotional, spiritual, psychological and social-wellbeing.

However health can be changed based on internal & external factors.

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Public health definition:

Organized efforts to improve the health of populations

Dynamic, multidisciplinary approach that combines behavioral/social sciences

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Central goal for public health:

Reduction of disease & the improvement of health in a population

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Population health definition:

the physical, mental & social wellbeing of defined groups of people and the differences in health between population groups


evidence based approach to analyze determinants of health and disease

Intervention and prevention to preserve and improve health

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Healthcare (medicine) definition:

Maintenance or improvement of health via the diagnosis, treatment and prevention of disease, illness, injury & other physical or mental impairments

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Traditional tactics public health practitioners used in the practice of public health management

1) controlling epidemics

2) ensuring safe drinking water & food

3) reducing vaccine preventable diseases

4) Improving maternal/child health

5) Surveillance of health problems

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Modern focus on public health:

1) Obesity

2) injury

3) violence

4) bioterrorism

5) substance abuse

6) STI'S, HIV/AIDS

7) natural disasters

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Role of public health administrator/manager (7-POSDCRB)

Planning- specifying goals, establishing priorities

Organizing- structure or plans to be implemented & goals accomplished

Staffing- assignment of personnel to roles

Directing- making decisions and communicating them

Coordinating- task of assuring effective interrelationships

Budgeting- fiscal planning, accounting and control

Reporting- transfer of information and assurance of accountability

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3 core public health functions (AAP)

Assessment-Assurance-Policy Development

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Discuss assessment:

collect, assemble, analyze & make available info on the health needed of the community

stats on health status
community health needs
epidemiological studies

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Discuss assurance:

Oversight responsibility for ensuring that essential components of an effective health system are in place


agreed upon goals by encouraging actions by other entities (private/public sector) by requiring action through regulation or providing services directly

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Discuss policy development:

Promote the use of scientific knowledge base in decision making about public health and by developing public health policy

STRATEGIC APPROACH

Developing evidence-based recommendations and analysis to guide public policy

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10 Essential Services

MONITOR health status to identify community health problems

DIAGNOSE health problems/hazards in community

INFORM people about health issues

MOBILIZE community partnerships to identify and solve health problems

DEVELOP policies and plans that support individual and community health efforts

ENFORCE laws and regulations that protect health and ensure safety

LINK people to needed personal health services and assure the provision of healthcare

ASSURE a competent public health and personal healthcare workforce

EVALUATE effectiveness, accessibility & quality of personal and population based health services

RESEARCH new insights and innovative solutions to health problems

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Major Historical Developments in order

Hellenistic Health

Latin Engineering & Administration

Middle Ages

Industrialization & Great Britain Influence

Emergence/Impact Bacteriology

American Colonies and Early U.S.

Public health 19th century

Public health 20th century

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Key points of hellenistic health

Hippocratic oath- medicine as an empirical practice, still used by physicians today

4 humours- blood, black/yellow bile, phlegm

Humours reflected essential events of physical universe- fire, earth, air & water

ENVIRONMENTAL FACTORS ARE DETERMINANTS OF HEALTH

divided diseases into endemic (always present) & epidemic (occurring occasionally)

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Body composed of which 4 humours

Blood

black bile

yellow bile

phlegm

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Key points of Latin engineering & administration

Built on Greek beliefs- complex sewage and bathing facilities and systems


FOCUSED ON WATER DELIVERY SYSTEMS

Roman empire recognized relationship between SWAPS, MARSHES & DISEASE

Public Health was role of state, regulations extended to bathing, water supplies street cleaning & spoiled food

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Key points in Middle Ages

2 MAJOR EPIDEMICS: BUBONIC PLAGUE (PLAGUE OF JUSTINIAN) AND THE BLACK DEATH

Plagues spurred action in communities to promote public health

After roman empire declined, CHRISTIAN CHURCH became presiding authority & took role of public health!


CHURCH focused on health of poor and underprivileged


BLACK DEATH KILLED 75-200 MILLION


QUARANTINE- 40 DAYS -separate acute from chronic disease

recognized need for collective action to promote public health

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Key points for Industrialization & Great Britain Influence

London tripled in size

MALNUTRITION, OVERCROWDING, FILTH, POOR WORKING CONDITIONS contributed to severe disease outbreaks

Rise of typhus in NY-significant cause of death was due to increased immigration

EDWIN CHADWICK- sanitary reform

Epidemics attributed to fifth, stagnant pools of water, rotting animals/veggies & garbage!

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Edwin Chadwick did what

Championed sanitary reform

poor suffered more diseases and disabilities compared to affluent populations

Report concluded that gross environments caused the poor health!! Disease attributed to miasma and foul odors

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1848 Public Health Act

Repealed but set the stage for current population based preventative efforts in public health


Identified major public health issues at the time and assigned responsibility to national and local board

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Key points for Emergence/Impact of Bacteriology

NEW PUBLIC HEALTH

PASTEUR & KOCH

Pasteur- aerobic/anaerobic organisms and considered the causal relationship between germs and disease

Koch discovered bacillus for anthrax and demonstrated transmission in mice

-Found TB & CHOLERA


DEVELOPMENT OF ANTITOXINS/IMMUNIZATIONS

understanding of carrier states & vectors

Recognized that diseases caused by germs could not be separated from living and working conditions

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Key points for American Colonies & Early U.S.

HUNGER/MALNUTRITION

Smallpox, cholera, measles, diphtheria, typhoid fever

Malaria endemic and smallpox epidemic 1600's

yellow fever- 1700's

cholera- 1800's


SMALLPOX INOCULATION

Main public health measures were QUARANTINE AND SANITATION

YELLOW FEVER EPIDEMICS-INOCULATION, INCREASED POPULATION

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Key points public health 19th century

Leading cause of death -TUBERCULOSIS

Sewage disposal considered most important

Promoted sewage, refuse, waste disposal and drainage as public health priorities

EMPHASIZED GOV'S ROLE IN PUBLIC HEALTH


The increased epidemics spurred federal government to establish local health departments throughout U.S.

1st successful board of health established in MASSACHUSETTS 1869

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Public health in the 20th century

Improved sanitation

-water purity, nutrition, control of infectious disease, immunizations

LIFE EXPECTANCY INCREASED MORE THAN 30 YEARS

FOCUSED ON

OBESITY, HIV/AIDS, VIOLENCE, SUBSTANCE ABUSE, SAFETY, TOBACCO USE, NON COMMUNICABLE DISEASE, WORKPLACE SAFETY

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Public health system definition:

The constellation of organizations, both governmental & private that contribute to the delivery of core public health services for a defined population

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4 Policy and Administrative Instruments

1) Regulatory development & enforcement

2) Health resource allocation

3) Information production and dissemination

4) Policy advocacy & agenda setting

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Regulatory development and enforcement key points:

Federal agencies receive power through congress or presidential executive order

Food protection

Drug/device development

Occupational health and safety

Environmental health

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Health resource allocation

Categorical & block grants

Entitlement programs-benefits certain people meeting requirements are legally entitled to

Discretionary programs- operate on a fixed appropriation of federal funds such as preventative health & health services

Matching requirements- grantees contribute non fed funds to secure funding

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Information production & dissemination

Data collection, research, education, surveillance systems, policy studies

National Institutes of Health (NIH)

AHRQ- Agency for healthcare research & quality &CDC

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Policy Advocacy & agenda setting

Advocacy in the legislative process-placing important issues on congress. Legislative agenda

INFORM CONGRESS

-Briefings, testify, conferences, participate in policy making process

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CDC 3 organizing offices that oversee individual centers organized around specific disease processes & intervention opportunities

Office of surveillance

epidemiology

laboratory services

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Federal agencies consist of

HHS: all programs fall under jurisdiction of the OFFICER OF THE INSPECTOR GENERAL for investigations of fraud/abuse cases

OFFICE FOR CIVIL RIGHTS-ensures equal access to programs

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Agencies in executive branch (federal)

OFFICE OF MANAGEMENT/BUDGET-evaluates effectiveness of agency programs, policies and administrative procedures

LEAD AGENCY FOR MAKING FUNDING-ALLOCATION DECISIONS

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External advisory committees (FEDERAL)

US Preventative services task force

IOM (NATIONAL ACADEMY OF MEDICINE)

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STATE HEALTH AGENCIES key points

2 basic models

Free standing-admin reports directly to governor (cabinet level appointee)

-organizational unit within a larger supremacy

States change structure a lot due to changes at governor/cabinet levels

State agencies rely HEAVILY on local public health agencies to implement health admin authority

State agencies can make staffing, financing and organization rules for local agencies

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Local government agencies key points

MOST DIRECT/IMMEDIATE RESPONSIBILITY FOR PERFORMING PUBLIC HEALTH OPPORTUNITIES AT COMMUNITY LEVEL

3,000 agencies across U.S.


NACCHO-"opperational definition of local health department"

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Local health department definition

public health government entity at local level includes locally governed health department; state created a district department serving a multi county area or other level

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Consequentialism/Utilitarianism key points

right or wrong depends on consequences
Creates more good than bad

GREATEST GOOD FOR THE GREATEST NUMBER

CRITICISMS: ignores how a benefit is distributed among a population

Ignores impact to individuals-focuses on quantity

Does not respect individual

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FRAMEWORK FOR ETHICAL ANALYSIS ALL POINTS

1) ANALYZE ETHICAL ISSUES

risks? harms? stakeholders? do professional codes of ethics provide guidance?


2) IDENTIFY OPTIONS AND DIMENSIONS

Utility- balance of benefits over harms

Justice- if benefits and burdens are distributed fairly

Respect for individual interests (autonomy, liberty, privacy)

Respect for legitimate public institutions (transparency, honesty, trustworthiness)

3) PROVIDE JUSTIFICATION

Effectiveness

Proportionality

Necessity

Least infringement

Public justification

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1st ethical analysis step

Analyze the ethical issues in the situation

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2nd ethical analysis step

Identify the options

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3rd ethical analysis step

provide justification

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Definition of public health finance

examines the acquisition, utilization and management of resources for the delivery of public health functions and the impact of these resources on population health and the public health system

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Fiscal federalism

theory that sets the responsibility to each national, state, and local levels of government and make sure everything runs smoothly!

Use federal grants

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How are public health services funded at the state and local level

by HRSA (health resources and services admin) CDC

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CDC has more

variability when distributing funds

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Describe the variability of public health funding at the state and local level

communities that have a high level of ethnic/racial minorities tend to have lower health expenditures

variation lies in using dedicated property taxation for public health services


BOTH STATE/LOCAL level: geographic variation is a huge factor in determining how fundin for medical care should be distributed


CDC has more variability to distribute funds and also more competitive grants

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Some of the common activities of local public health agencies

Immunization programs

Communicable/infectious disease surveillance

laboratory services, communicable/infectious disease screening and treatment

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Some critical steps in the grant management project (6)

Study terms and conditions

hold a briefing

develop a checklist of all compliance actions required

Establish a sound financial control system

Conduct regular audits

Monitor program performance