Week 3 Flashcards
WHO Definition of Health
Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity
The Natural Environment
1) Land
2) Air
3) Water
Components of the Epidemiological Triangle
1) Host
2) Environment
3) Agent
Causes of great epidemics
1) Urbanization
2) Increased human biomass
3) Concentration of poverty
4) Global Trade
5) Failure to safely dispose human waste
The Great Endemics (3)
1) Tuberculosis
2) Respiratory viruses and bacteria
3) Diarrheal viruses and bacteria
3 parts of IOM Public Health Definition
1) Mission
2) Substance
3) Organizational Framework
Mission of Public Health (IOM Definition)
The fulfillment of society’s interest in assuring the conditions in which people can be healthy
Substance of Public Health (IOM Definition)
Organized Community Efforts Aimed at the Prevention of Disease and Promotion of Health. It links many disciplines and rests upon the science of epidemiology
Organizational Framework (IOM Definition)
Both activities undertaken within the formal structure of government and the associated efforts of private and voluntary organizations and individuals
Ways public health improves medicine
1) Community Specific prevalence
2) Addresses access issues
3) Avoidance of numerator/denominator confusion
4) Hidden problems identified
5) Rewards of prevention reinforced
5) Addresses community-specific issues
6) Adds opportunity to use robust ecological model
Ways medicine improves public health
1) Identification of issues
2) Identification of system failures
3) Reminder of real world complexity
4) System entry point – local and personal
5) Use of clinical tools to address public health
problems
3 Essential public health services
1) Assessment
2) Policy Development
3) Assurance
Public Health Infrastructure
1) Government
2) Community
3) Organizations
4) Philanthropy
5) Workplaces
6) Medical Care System
7) Academia
Environment is where we:
Work, sleep and play
Current environmental threats
1) Air contamination
2) Water contamination
3) Land use
4) Persticides and Industrial Chemicals
Prevention paradox
Most individuals derive little or no benefit from prevention strategy
Timeline of a chronic, life threatening disease
Health-> disease onset->Illness onset->Complications-> Death
Primary prevention
Take action to eliminate precipitating causes of disease and injury before they happen. Outcome is no health event. (Between Health->disease onset)
Secondary Prevention
Screening Test. Detect and treat asymptomatic disease, or its predisposition, before it becomes symptomatic or does irreversible harm. Outcome is no symptomatic disease. (Between Disease onset->Illness onset).
Tertiary Prevention
Minimize risk of recurrence or clinical deterioration once a disease is diagnosed. (Between Illness onset->Complications)
5 Guiding principles of Clinical Prevention
1) Asymptomatic individuals are legitimate patients who deserve the
attention of busy clinicians
2) People who tend to seek out clinical preventive services are less
likely to benefit from them than people who do not
3) Far more people undergo preventive interventions than would ever
have developed the targeted health outcome without the
intervention
4) Preventive interventions are neither free nor harmless
5) For most people the benefits of prevention are never appreciated
because success is a non-event off in the distant future
5 Predictors of Succesful Clinical Prevention Programs
1) Target condition is associated with high morbidity and/or
mortality
2) Risk is unacceptable to the individual
3) Risk of future harm to an individual is predictable
4) Risk of future harm to an individual is modifiable in the
present
5) Preventive intervention is cost-effective
4 Clinical Preventive Services
1) Immunizations
2) Screening
3) Chemopreventive Agents
4) Lifestyle Counseling
6 Influences on Health Behavior
1) Free Choice
2) Biology
3) Culture
4) Social Position
5) Government
6) Healthcare
Screening cascade
Results after a screening test
PSA Testing
Prostate Cancer Screening is useless
USPSTF
U.S. Preventive Services Task Force
Distributive justice
How to ethically distribute resources among a population
Rationing
Distributing resources under conditions of extreme scarcity
The value problem
to provide higher quality care, with better outcomes, at a lower cost.
Value (formula)
Value = Quality/Cost
The fairness problem
to distribute health care goods and services fairly; to provide access to health care that does not unfairly disadvantage anyone
What does fee for service eat to?
More procedures
What does capitation lead to?
Fewer procedures
What does Capitation + Outcomes lead to?
Better clinical decisions
Unwarranted Variation
Variations that cannot be explained on the basis of illness, scientific evidence or well-informed patient preferences
Effective Care
Care that we know works and improves outcomes
Preference Sensitive Care
Care in which there is equal evidence on both sides of the intervention
Supply Sensitive Care
Care that is sensitive to the supply of medical care in an area
Bedside Rationing
Choosing a suboptimal treatment for a particular
patient based on cost (and not according to
standard guidelines)
Formal Principle
Equals must be treated equally
Material Principles (7)
Give content to formal principle and are:
1) To each an equal share
2) To each according to need
3) To each according to merit
4) To each according to effort
5) To each according to likely contribution to society
6) To each according to fair market exchange
7) To each in redress for past harms
Englehardt’s view (Libertarianism)
Fair processes of
exchange matter, rather than aiming at any desired
end state. —-Regarding the natural and social lottery, no obligations are created. It is unfortunate, but not unfair, that some lose the lottery.
Night watchman state
Idea by Englehardt. Libertarianism. Government should be minimal and only used to implement rules of acquisition and exchange (police, etc.) and to set up a military to protect against foreign invaders.
John Rawls idea of the Social Lottery (Qualified Egalitarianism)
Equal access to the
goods valued by rational actors, with inequality
tolerated only if it benefits least well off. —–The Original Position thought experiment shows that society should compensate for the outcome of the natural and social lottery.
Rawls’s First Principle of Justice
Each person is to have an equal right to the most extensive basic liberty compatible with a similar liberty for others (Vote, Political Office, Speech, No Arbitrary Arrest)
Rawls’s Second Principle of Justice (two parts)
1) Difference Principle: inequalities are to be of the greatest benefit to the least advantaged members of society
2) Opportunity Principle: offices and positions must be open to everyone under conditions of fair equality of
opportunity
Libertarian view of healthcare
Would largely view health disparities as “unfortunate but not unfair,” and would seek to address the issue through voluntary philanthropic activities.
Rawlsian view of healthcare
A well-ordered society would adopt policies that
“even out” the results of the natural and social lottery (even if they are no one’s
fault) in order to allow for an equality of opportunity and to benefit the least well-
off.
