What is Public Health

Study Guide, Exam 1 To best prepare for this exam: Review your slides and notes – exam material will primarily be based on what was covered during lectures, however it will also integrate the following on a broad level. Re-read textbook chapters 1,2, 4, 7, 11 and Friedan’s Health Impact Pyramid. Make sure you’ve watched Unnatural Causes and Sick Around America. Format of this test This test will be a mix of multiple choice, identification, matching, True/False questions, listing, and a few short answer questions. What is Public Health? What is public health? How would you define this term? o “the fulfillment of society’s interest in assuring conditions in which people can be healthy” o “organized community efforts aimed at prevention of disease and the promotion of health.” o All organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population. Social determinants of health - BIG GEMS o B -behavior o I – infections – who has it/predominantly located o G -genetics o G - geography o E - environment o M – medical care o S – socio-economic- cultural Famous people in the history of public health o John Snow – traced contamination to broad Street pump. Removed the pump handle as an experiment. “father of epidemiology” o James Lind – citrus and scurvy in sailors – vitamin C o Edward Jenner – smallpox vaccine from cowpox Eras of public health o Health protection - quaratine, o hygiene movement – first state health department formed, garbage control, street cleaning, washing hands, John Snow mentioned in this phase, o contagion control – controlling of diseases, o social engineering – health resources weren’t as equally avaibliable and so instead of putting investment into public health but rather hospitals, rich and poor gap closing o health promotion – promoting health o population health – evaluating health over lifespan of individuals Major areas of public health o Epidemiology: Branch of science that deals with the incidence, distribution, and control of disease in a population o Biostatistics: Statistics applied to the analysis of biological data o Environmental health sciences: Art and science of protecting against environmental factors that may adversely impact human health or the ecological balances essential to long-term human health and environmental quality o Health policy and management: Multidisciplinary field of inquiry and practice concerned with the delivery, quality and costs of health care for individuals and populations. o Social and behavioral sciences: Address the behavioral, social and cultural factors related to individual and population health and health disparities over the life course.  Research and practice in this area contributes to the development, administration and evaluation of programs and policies in public health and health services to promote and sustain healthy environments and healthy lives for individuals and populations. * Evidence-based public health The P.E.R.I.E. approach (Chapter 2) KNOW THIS WELL o Understand what each letter stands for and the details associated with this health problem-solving acronym. Know the types of studies/ study designs used to determine associations and causality (etiology).  Problem – what is the problem  Etiology – what are the causes  Recommendations – what works can reduce health impact  Implementation – implementing it  Evaluation – evaluating, how well did it work Identify o Prevalence: the presence of a disease or condition in population, which includes new cases as well as previously-existing cases; # living with a particular disease/# in the at-risk population (new+old cases/total people) o Incidence: the development of the new cases of disease in previously disease-free individuals; # of new cases of a disease in a year/# of people in the at-risk population (new cases/total people) o Morbidity: sickness due to burden o Mortality: death due to burden o Infant mortality rate Health disparities and the Social Determinants of Health Health Impact Pyramid (Frieden article) Understand the relationship between wealth, power, work, and health o Upward trend with increasing wealth, power, & work with health Health Equity vs Health Equality o Health Inequity  Unfair, avoidable differences arising from poor governance, corruption or cultural exclusion (for example, babies born to black women are more likely to die than to black women)  Tied to social justice  Health equity - Everyone has a fair opportunity to live a healthy life o Health Inequality  Uneven distribution of health or health resources because of genetic factors, other factors, or lack of resources  Difference in health that is linked with the social determinants of health. Differences in presence of disease, health outcomes, or access to health care between groups ex – male babies at heavier weights than female Affordable Care Act Key components: o Free preventative care o Young adults can stay on a parent’s plan until the age of 26 o Ends lifetime limits on coverage o Ends pre-existing condition exclusions o Removes barrier to emergency care outside of network o Reviews premium increases o 10 essential health benefits o Health insurance marketplace 10 essential health benefits – must have these of its not health insurance  Outpatient care  trips to ER room  treatment in the hospital for inpatient care  care before and after your baby is born  mental health and substance use disorder services  your prescription drugs  services and devices  your lab tests  preventative services  pediatric services Understand the basics of enrollment, penalties and exemptions o Penalty – not having coverage for 3 or more consecutive months, you must pay some penalty during tax time o Special enrollment periods – something happens that changes household size, you have 60 days to enroll. Same thing if you lose job that had health insurance o Exemptions - if you are under 100% you can get exemption to not get penalized i. Hardship, domestic violence, death of family member, etc. Understand the consequences of repealing and replacing (if replacement occurs immediately, in several years, or not at all) o Consequence – premiums would soar, reliance on private insurance, less people will have health insurance Social/ Behavioral Influences on Public Health Be able describe and apply major constructs of the Health Belief Model Be able describe and apply the stages of the Trans theoretical Model Understand major components of PRECEDE/PROCEED model, particularly predisposing, reinforcing, and enabling factors o PRECEDE  PHASE 1 - SOCIAL DIAGNOSIS: Main part here is looking at the current quality of life that the community is experiencing and what are the factors influencing this good or poor? who needs to be involved to affect the quality of life. Who are the community members? accomplished by asset mapping  Who are the assets in the community and what are the resources? o PHASE 2 - EPIDEMIOLOGICAL DIAGNOSIS  5 D’S DEATH (MORTALITY) DISEASE (MORBIDITY) DISABILITY DISCOMFORT DISSATISFACTION o PHASE 3 - BEHAVIORAL & ENVIRONMENTAL DIAGNOSIS  PREDISPOSING FACTORS “ANTECEDENTS OF BEHAVIOR CHANGE THAT PROVIDE RATIONALE OR MOTIVATION FOR THE BEHAVIOR” WHAT INHERENT MOTIVATIONAL FORCES PROVIDE REASONS FOR TAKING A GIVEN ACTION? CHANGEABLE FACTORS o AWARENESS, KNOWLEDGE, BELIEFS, VALUES, ATTITUDES, EXISTING SKILLS, BEHAVIORAL INTENTION  REINFORCING FACTORS “FACTORS FOLLOWING A BEHAVIOR THAT PROVIDE THE CONTINUING REWARD OR INCENTIVE FOR THE PERSISTENCE OR REPETITION OF THE BEHAVIOR” WHAT WOULD REINFORCE OR SUPPORT NEW/OLD BEHAVIORS? o CHANGEABLE FACTORS:  SUPPORT FROM FAMILY OR FRIENDS  EMPLOYER ACTIONS AND POLICIES HEALTH PROVIDER COSTS o COMMUNITY RESOURCES  ENABLING FACTORS “ANTECEDENTS TO BEHAVIORAL OR ENVIRONMENTAL CHANGE THAT ALLOW A MOTIVATION OR ENVIRONMENTAL POLICY TO BE REALIZED”  WHAT FACTORS OR RESOURCES FACILITATE OR IMPEDE (BASED ON THEIR DEGREE OF AVAILABILITY) BEHAVIOR? CHANGEABLE FACTORS o SKILLS, HEALTH CARE RESOURCES, EFFECTIVE USE OF INFORMATION What’s going on externally o PHASE 4 - EDUCATION & ORGANIZATIONAL DIAGNOSIS o PHASE 5 - ADMINISTRATIVE & POLICY DIAGNOSIS  Should be S.M.A.R.T Specific, measureable, action verb, realistic, timely o PROCEED  PHASE 6 – IMPLEMENTATION  PHASE 7 - PROCESS EVALUATION  PHASE 8 - IMPACT EVALUATION Prevention Science What is prevention science? (key components, goal) o Goal - to improve public health by identifying malleable risk and protective factors, assessing the efficacy and effectiveness of prevention interventions, and identifying optimal means for dissemination and diffusion o Integrates epidemiology methods, intervention trials technology, and Life course perspective for understanding a monitoring social and behavioral processes Reasons why it is important to invest in prevention – it’s easier to prevent something than to treat it Guiding framework for prevention science to assist with implementation – flow chart Basic understanding of life course perspective & importance of understanding development phases when implementing interventions o Literally over the life course, take into account developmental stage one is in Risk & protective factors (i.e. example of Familias Unidas intervention) o Risk factors – more likely to engage to risky sex and substance abuse o Protective factors – encouraging family togetherness, education, Communicable Diseases and Vaccines Why are vaccines important? – protect and prevent diseases What is herd immunity? – if enough people in one area are vaccinated and say there is one person is not vaccinated, since the rest of the population is vaccinated, the one person is protected in a way by the “herd” Why have people opted NOT to vaccinate their children? – they think that vaccines are linked to mental-deficits i.e. autism How are vaccine exemptions decided? How did vaccines get a bad reputation? How do communicable diseases differ from non-communicable diseases? Understand the differences between pandemics, epidemics, endemic  Pandemic – epidemic that spreads throughout the world  Endemic – within a one region  Epidemic – through several communities Which social and environmental contributing factors lead to faster spread of infectious disease? – urban areas, high population density, poor sanitation, lack of access to clean water, natural resources, movement, over time, bacterial resistance, lack of education What are some of the social implications or unintended outcomes of infectious diseases?