US Health pop. health, PH Law, gov't in PH Flashcards

Question

Chain of Causation

Answer 1

Goal is to interrupt the chain - Think of an illness or injury - Identify the agent, host and environment - Describe how you would interrupt the chain of causation related to the agent, host and environment

Answer 2

- Primary? - Secondary? - Tertiary?

Answer 3

19th century public health closely tied to social reform movements: campaigns for improved housing, trade unions, abolition of child labor, child and maternal health Public Health viewed as a broad social movement Winslow’s 80 yr old definition: the role of PH is the development of the social machinery to ensure every individual in the community a standard of living adequate for maintenance of health. Contrasting views that direct the production and equitable distribution of scarce health care resources Distribution of benefits/burdens and responsibilities within a society Free market vs government responsible for allocation and delivery of resources Health care access a right vs ability to pay Health care an individual vs collective responsibility Role of PH in society, broad and expansive vs restrictive

Answer 4

Health is a collective responsibility Emphasizes community well-being Views health care as a social resource Allocation and delivery of health care resources governed by need Minimum levels of income, housing, employment, education and health care are fundamental rights PH closely tied to social reform movements (public hygiene, improved housing, abolition of child labor, maternal and child health, trade unions Emphasizes collective responsibility for health Emphasized community well-being Strong obligation to the collective good Access to health care universal Proposes public solutions to social problems (drug abuse, homelessness, violence)

Answer 5

Health is an individual responsibility Emphasis on individual well-being Views health care as an economic good Allocation and delivery of health care resources governed by demand Powerful forces of environment, heredity, social structure prevent equitable distribution of the burdens and benefits of PH PH is an enterprise focused on controlling communicable disease or as a safety net that provides medical care to the indigent Encouraged by MD’s Limits federal health funding to programs run by local health departments Medical care distribution based on the ability to pay Access to medical care is viewed as an economic reward for personal effort and achievement Role of government and public health - Restricted, narrow - Limited to a technical enterprise

Answer 6

Economic impact Individual liberty Moral and religious concerns/values Political interference with science

Answer 7

PH measures may have negative impact on segment of population or industry Those paying for PH measures may not benefit from those measures Costs are measurable/benefits are often not Costs may be short-term while benefits may not be immediately seen Example of a PH initiative with significant economic impact? Discuss in groups of 3 to 4. Tobacco industry: product labeling, bans on smoking in public places, restaurants Lumber industry: regulations cost jobs to preserve a long term stable climate Standing orders for Narcan in community pharmacies: high cost to insurance companies Mandatory immunizations

Answer 8

To what extent can and should the government restrict individual freedom for the purpose of improving the community’s health Restrictions on behaviors that may cause direct or indirect harm to others Restrictions may benefit the individual or the community Example of PH initiative affecting individual liberty? Seat belts Bike helmets Extra large soft drinks Removal of vending machines in public areas Additional driving tests for elderly Mandatory health screenings Mandatory immunizations

Answer 9

Some PH initiatives provoke moral or religious objection Discussion of some PH issues are offensive or embarrassing to discuss (sex and reproduction, alcohol and drug addiction, suicide and end of life decisions) Can the government determine and enforce moral behavior? Some religions may prohibit some common PH initiatives (birth control, immunizations)

Answer 10

Presidential administrations criticized for misrepresenting and/or distorting scientific information and evidence to support its policies and political agenda Examples: Bush admin pressured CDC to promote abstinence only programs for preventing teen pregnancy Promoted condom failure rates rather than place in prevention of spread of AIDS and other STD’s Prevented publication of research on agriculture affect on antibiotic drug resistance Handling of the AIDS crisis Handling of drug/alcohol addiction crisis

Answer 11

Public health workers monitor the health of a community by collecting and analyzing health data Health statistics Identify special risk groups Detect new health threats Determine success of disease state management Help plan and evaluate success of public health programs Are considered when preparing government budgets

Answer 12

National Center for Health Statistics Primary agency that collects, analyzes and reports data on the health of Americans Part of the CDC Collects data in two ways States and local agencies periodically transmit data they have compiled from local records: vital stats, births and deaths Conducts periodic surveys of representative samples of the population on health status, lifestyle, health-related behaviors, onset and diagnosis of illness and disability, use of health care resources

Answer 13

Births and deaths are the most basic and reliable and complete data set Causes of death subject to uncertainties Utilize birth and death certificates Vital Statistics also include information on marriage, divorce, spontaneous fetal deaths and abortions The state health department is generally responsible for collecting these reports and transmitting them periodically to the NCHS Mother supplies information about the baby’s family (names, address, ages, race, ethnicity, education level) Medical and health information supplied by hospital, doctor, birth attendant (prenatal care, birth weight, medical risk factors, complications during delivery, OB procedures, abnormalities in the newborn)

Answer 14

Objectives – Understand and define Health statistics Collecting Data Vital Statistics The Census Why is this data important to public health? NCHS surveys and other sources of health data NHIS, NHANES, BRFSS What data is necessary, accurate and available? Confidentiality of data

Answer 15

The number of people in the population is necessary in order to convert the data collected through vital statistic systems into rates per number of people The number of people in the population serves as the denominator when a vital statistic is used as the numerator. To calculate age-adjusted or age-specific rates it is necessary to know how many people are in each age group To determine sex-specific or race-specific rates, we need to know how many males and females there are in a population as well as the breakdown of races within the population The Constitution requires that the population of the United States be counted every 10 years to determine each state’s representation in the House of Representatives 2 controversial issues How race is determined Ability to accurately count every individual household A major change in the way the 2010 census was conducted was that only the most basic data was collected using a short form (included name, sex, race and ethnicity, and relationship of everyone living in the household) American Community Survey (ACS) launched in 2005 by the Census Bureau Same information as long form Sent to 3 million households selected to be representative of the populations of local jurisdictions Designed to help communities plan for transportation systems, zoning, schools, healthcare facilities, housing and social services

Answer 16

In addition to collecting data from the states, NCHS actively conducts a number of surveys to gather additional information on the health of the American public Two ongoing NCHS surveys The National Heath and Nutrition Examination Survey (NHANES) Designed to obtain detailed and accurate information Doctors and nurses conduct physical and dental exams and lab tests on a carefully selected sample of the population Data collected determines prevalence of chronic conditions and risk factors as well as nutritional status and its association with chronic disease

Answer 17

Two ongoing NCHS surveys The Behavioral Risk Factor Surveillance Survey (BRFSS) Largest telephone survey in the world Self reported data (may be less reliable) The only available source of timely, accurate data on health-related behaviors Conducted by the states which report their findings to the CDC Asks questions about health status, high risk behaviors, physical activity, preventive medical care National Youth Fitness Survey National Survey on Family Growth National Immunization Survey National Asthma Survey in collaboration with the CDC National Center for Environmental Health National Infant Feeding Practices Study

Answer 18

EPA surveillance for health hazards in the environment National Cancer Institute monitors long-term trends of cancer incidence and mortality through a program called Surveillance, Epidemiology, and End-Results (SEER) The Centers for Medicare and Medicaid Services utilize billing records for research on utilization and outcomes of medical care

Answer 19

Data is critically important in making up the surveillance systems that form the basis of effective public health practice as well as the planning and evaluation efforts that are increasingly being used in public health programming The success of intervention programs to confront a problem is evaluated based on whether they improve the statistics

Answer 20

The process of data collection is always imperfect Health information relying on surveys or voluntary reports are often incomplete or subject to bias Census information contains errors and there are political difficulties in attempting to correct these errors Errors exist in reporting cause of death on death certificates Maternal deaths are suspected of being underreported because doctors fail to indicate the woman was pregnant on the death certificate The data collection and reporting processes contain sources of inaccuracy and bias New information technology (public health informatics) has vastly improved accessibility of information to public health workers and the general public

Answer 21

All information collected from individuals by governments for whatever purpose is considered confidential and cannot be divulged without the consent of the individual Information is generally entered into a database without any names, addresses or personal identifiers Exception: when someone has been exposed to a communicable disease they must be notified

Answer 22

PH problems are identified in terms of statistics Data is the basis of the statistics utilized in PH initiatives Success of PH initiatives is evaluated based on improvement in statistics

Answer 23

Determined by law Government’s public health activities must be authorized by legislation at the federal, state, or local levels The body of public health law is huge, consisting of all written statements relating to health by any of the three branches of government

Answer 24

Does not mention health Tenth Amendment states that “the powers not delegated to the United States by the Constitution…are reserved to the States respectively. Preamble includes “to promote the general welfare” Gives federal government authority to regulate interstate commerce and “to collect taxes…to pay the debts and provide for the common defense and the general welfare:

Answer 25

Interstate commerce provision: justifies the activities of the Food and Drug Administration (FDA) Power to tax and spend: (1967) lead to federally mandated motorcycle helmet laws as a condition of federal funding for highways Federal government provides 50 to 80% of Medicaid funding though states and counties administer the programs From WW II to the 1980s the federal government used its powers to widen its role in public health Trend reversed in 1980 due to politically hostile climate in government Movement in Congress and the Supreme Court to cut government regulations and return power to the individual states

Answer 26

Limited Congress’s powers and returned authority to the states Supreme Court struck down a law making gun possession within a school zone a federal offence, rejecting that gun possession was a matter of interstate commerce New federalism lost much of its momentum after 9/11 when the role of the federal government in public health looked useful and necessary In 2003 this movement seemed to reverse, giving federal law more power over state law

Answer 27

Governments have police power (broad power) to act in ways that curtail the rights of individuals. Police powers are invoked for 3 reasons To prevent a person from harming others (direct or indirect) To defend the interests of incompetent persons such as children or the mentally handicapped To protect a person from harming him or herself Examples of police powers Mandatory vaccinations Occupational Safety and Health Act (OSHA) Some may argue that prior to government implementing PH initiatives a cost benefit and feasibility analysis should be considered.

Answer 28

Local Agencies Have day to day responsibility for public health activities and provide the bulk of services (include collecting statistics, conducting communicable disease control programs, health screenings, immunization clinics, provision of medical care to the indigent) Organization varies from state to state (most common is county health departments, large cities have municipal health departments, towns have boards of health, rural areas have multicounty health departments ) Funding varies from state to state, including state, federal and local taxes, fees for services

Answer 29

State Agencies Has primary responsibility and authority for the protection of health, safety and general welfare of the population Most states have a state health department (Mass Dept of Public Health) Funding depends heavily on federal money Define to varying degrees the activities of local health departments Charged with licensing and certification of medical personnel, facilities and services Administer Medicaid programs Federal Agencies Fall under jurisdiction of the Department of Health and Human Services (HHS) The Surgeon General is the nation’s leading spokesperson on matters of public health Agencies include CDC – the main assessment and epidemiologic agency (figure 3-4) NIH – the greatest biomedical research complex in the world (Box 3-1) FDA

Answer 30

Mission is to control and prevent human diseases Traditionally focus has been on infectious diseases (crisis oriented) Change in focus and expanded mission includes chronic diseases, genetics, injury, violence and environmental health

Answer 31

The greatest biomedical research complex in the world Supports research ranging from basic cellular processes to physiological errors that underlie human diseases Includes the National Library of Medicine, the largest reference library for medical centers around the world

Answer 32

Environmental Protection Agency (EPA) Department of Agriculture Department of Education Department of Transportation Department of Labor Department of Veterans Affairs Department of Homeland Security

Answer 33

Your Public Health Division works to protect and improve community well-being by preventing disease and injury while promoting social, economic and environmental factors fundamental to health. This Division is the foundation of the local public health system that comprises public- and private-sector health care providers, academia, community based organizations, business, the media and other local and state governmental entities. Track and investigate health problems and hazards in the community Prepare for and respond to public health emergencies Develop, apply and enforce policies, laws and regulations that improve health and ensure safety Lead efforts to mobilize communities around important health issues

Answer 34

Link people to health services. MA Health Insurance Connector Free Clinics in Worcester Central MA Independent Physicians Reliant Medical Group Physicians St. Vincent Private Physicians UMass Memorial Private Physicians

Answer 35

Many nongovernmental organizations play important roles in public health, especially in education, lobbying and research American Cancer Society American Heart Association Alzheimer’s Disease and Related Disorders Association American Diabetes Association Conduct campaigns to educate the public Sponsor research on a particular disease Include professional membership organizations Include several major philanthropic foundations providing funding for supporting research or special projects, health care to certain populations and support for health and public policy development

Answer 36

Study of: the patterns of disease occurrence in human populations, the factors that influence these patterns and the application of this study to prevention and control of health problems It looks to find the answers of person (who), place (where) and time (when) of a disease or other health related event -Descriptive Epidemiology Why and how questions are answered by Analytic Epidemiology Epidemiology is not only concerned with only death, illness and disability; but also positive health states and the means to improve health

Answer 37

Time: Do disease patterns differ by time of year? Are they seasonal? Person: Do disease patterns differ by age or gender? Are certain groups of people at a higher risk of developing a disease or complications from an illness? Place: Do disease patterns differ on geographical areas? Combination of time, person, & place Age groups stratified by location

Answer 38

Discover the agent, host, and environmental factors that affect health Determine the relative importance of causes of illness, disability, and death Identify those in the population that have the greatest risk from specific causes of illness Evaluate the effectiveness of health programs and services in improving population health

Answer 39

host - age - sex - race - genetic profile - past diseases - immune status - religion - customs - occupation - marital status - family background agent - biologic: bacteria, virus - chemical: poison, alcohol, smoke - physical: trauma, radiation, fire environment - temp. humidity, altitude - crowding, housing, neighborhood - water, milk, food - radiation, pollution, noise

Answer 40

disease occurrence among a population that is in excess of what is expected in a given time

Answer 41

disease or condition present among a population at all times

Answer 42

: a disease or condition that spreads over a wide geographic area and affects an exceptionally large population across regions, may be worldwide.

Answer 43

Ongoing systematic collection, analysis, and interpretation of health data needed for planning, implementation, and evaluation of public health practice

Answer 44

group of cases in a specific time and place that might be more than expected.

Answer 45

surveillance: what is the problem - probelm idenify risk factors: what is the cause Intervention Evaluations: what works Implementation: how do you do it - response

Answer 46

Epidemiologic surveillance is a major line of defense in protecting the public against disease It is a warning system that alerts communities that something is wrong Once an outbreak is discovered, public health officials can begin to take action to prevent the spread of disease Immunizations Isolation of an infected person Recall of medication or contaminated food The Federal government has a list of notifiable diseases that a healthcare provider must report to the public health department Hepatitis B HIV STDs Tuberculosis COVID-19 Surveillance is ongoing and systematic

Answer 47

There are many steps involved in an investigation once it has been established that an outbreak exists: Construct a working case definition Perform descriptive epidemiology (Who, Where, When) Implementing control and prevention measures Initiate or maintain surveillance Communicating findings to stakeholders, community etc

Answer 48

Once a decision is made to investigate an acute outbreak- work needs to be done quickly but also be done accurately to get the right answer Before we can make working case definition we must: - Review laboratory findings and clinical test results - Speak to patients with the disease - Summarize clinical features of the disease

Answer 49

Establish a case definition by using a standard set of criteria Probable Case: Have signs and symptoms but no confirmed laboratory work Confirmed Case: Have signs and symptoms with laboratory confirmation

Answer 50

Clinical case definition: An illness with sudden onset of fever (>380C and one or more of the following: neck stiffness, altered consciousness, other meningeal signs or petechial or puerperal rash Lab diagnosis: Positive cerebrospinal (CSF) fluid antigen detection or positive culture Case classifications: Suspected: Meets clinical case definition Probable: As suspected case and turbid CSF (with or without positive Gram stain) or ongoing epidemic and epidemiological link to a confirmed case Confirmed: A suspected or probable case with laboratory confirmation

Answer 51

Summarize data by key demographic variables Provide trends over time, geographic areas and the population affected From this information you can infer the population at risk for the disease Can provide clues about the source, modes of transmission Can begin interventions and preventative measures to control disease Establish epidemic curve-shows magnitude of disease over time

Answer 52

Step 3- Implement control and prevention measures - Control and prevent additional cases is the primary goal. If appropriate measures are known they should be put in place as early as possible. - Masks for respiratory transmission, spraying or bed nets for mosquito transmission Step 4- Initiate or maintain surveillance Once control measures are in place must monitor to see if working or not

Answer 53

Determine who needs to know Local health authorities. Medical community, general public, lawmakers Determine how information will be communicated Oral briefings via news of implementation of control and prevention measures Identify why information needs to be communicated Control spread of illness

Answer 54

New regulations may result from the findings Legionnaire's disease led to the development of new regulations worldwide for climate control systems (A/C systems and cleaning requirements) More recent outbreak that led to changes in regulations: Meningitis outbreak of 2012 from New England Compounding Center (NECC) Changed continuing education requirements for pharmacists conducting sterile and non-sterile compounding Owner of pharmacy found guilty on 57 of 96 charges- serving 9 years in prison Chief pharmacist- charged with 25 counts of second degree murder (found not guilty) found guilty on racketeering charges- Serving 8 years in prison

Answer 55

Epidemiology is also useful in identifying the causes of some chronic diseases Can show links between the occurrence of disease with exposure to risk factors Chronic diseases develop over time and do not have a single cause Risk factor concept: a particular biologic, lifestyle & social conditions are associated with increased risk for specific chronic diseases

Answer 56

Framingham Heart Study Began collecting data in 1948- still collecting today Was the first epidemiologic study of a chronic disease > 5000 healthy, middle-aged subjects in Framingham, MA- examined every 2 years Findings from this study: Three major risk factors for heart disease are: High cholesterol Hypertension Smoking

Answer 57

In 1971- the study continued to the off-spring of the original study subjects In 2001-2002- the grandchildren of the original study subjects became part of the study This type of study is called prospective cohort study because it follows the subjects through time Guidelines to treat cardiac conditions such as hypertension and dyslipidemia have been developed based upon the knowledge gained in this study

Answer 58

Data from these trials helps us today in medicine for evidence-based recommendations The Framingham Heart Study found: Weight gain and lack of exercise are associated with high blood pressure and high cholesterol levels therefore increasing risk of heart disease Expanded studies found; Effects of quitting smoking “Good” cholesterol versus “bad” cholesterol” Alcohol in moderation has beneficial effects

Answer 59

What link has been associated with lung cancer? Two landmark studies: Doll and Hill (UK) - Death rate from lung cancer was 20 times more in smokers than non-smokers - Death from heart attacks was significantly higher in heavy smokers age 35-54 than non-smokers Hammond and Horn (US) - Smokers are 10 times more likely to die of lung cancer than non-smokers - Heavy smokers are 2.4 times more likely to die of heart disease than non-smokers

Answer 60

Based upon the results we looked at the American College of Cardiology/ American Heart Association Guidelines for Primary Prevention of Cardiovascular Disease. Overall, “in adults at increased cardiovascular disease risk but without prior cardiovascular disease events, statin therapy for primary prevention of cardiovascular disease was associated with reduced risk of all-cause mortality and cardiovascular disease events,” according Roger Chou, MD, et al., authors of the evidence report and systematic review. They write that the “benefits of statin therapy appear to be present across diverse demographic and clinical populations, with consistent relative benefits in groups defined by demographic and clinical characteristics.”

Answer 61

Epidemiology is an important component of the assessment function of public health Epidemiologists investigate epidemics by counting the number of cases and how they are distributed by person, place and time Epidemiology also provides information on the cause of chronic diseases Epidemiology’s role in identifying causes of disease leads directly and indirectly to prevention and control To achieve improvements in public health: Agencies build on the information from information gathered from epidemiological studies to develop policies They help plan programs aimed at reducing risk and promoting health in the population

Answer 62

primary: avoiding disease entirely secondary: - comes after - screening or testing that is done to identify diseases or negative health conditions - Ideally, secondary prevention occurs before the patient exhibits any signs or symptoms. This is done with tests such as mammograms, measuring blood pressure, and testing for different transmittable diseases. tertiary: - measures that are taken to manage disease or negative health conditions after there has been a diagnosis. - stop the disease or adverse health conditions from progressing or getting worse - example: chemotherapy or rehabilitation. primary: prevent exposure entirely secondayr: just in case you are exposed tertiary: you are exposed and so help you recover from exposure/prevent any disabilites or progressive daamge that can be done to you

Answer 63

legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking) immunization against infectious diseases.

Answer 64

regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer) daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes suitably modified work so injured or ill workers can return safely to their jobs.

Answer 65

cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.

US Health pop. health, PH Law, gov't in PH Flashcards

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