Download Key Concepts and History of Public Health: Definitions and Milestones and more Exams Public Health in PDF only on Docsity!
PUBH 302 Final – Galloway | 100% Correct
Answers | Verified | Latest Version
Define public health - ✔✔actions that society takes collectively to ensure that the conditions in which people can be healthy can occur Define the "Ps" of public health - ✔✔ Prevention Protection Promotion Prolonging Product safety Physical, social, economical environments (Big) Picture Populations define prevention - ✔✔practicing health and safety habits to remain free of disease and injury define protection - ✔✔protecting the population, making reccomendations to keep people healthy define promoting - ✔✔promoting healthy habits, promoting ways to think about healthy behavior define prolonging - ✔✔prolonging life and quality of life product safety - ✔✔ensuring safety of food product, vehicles define physical, social, economic environments - ✔✔healthy air in the environment, social influences, affording healthy habits
define populations - ✔✔what is truly effecting us at the population level, what are the leading causes of death? who is vulnerable or "at risk"? define (big) Picture - ✔✔looking at the complex world we live in and public health's role is to dig into the big picture and figure out how to protect populations define health issues - ✔✔identify shared health concerns within a society by looking at surveillance data define determinants of health - ✔✔the range of personal, social, economic, and environmental factors that influence health status define health - ✔✔a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity define quality of life - ✔✔involving social, emotional, mental, spiritual and biological fitness on the part of the individual, which results from adaptations to the environment define physical health - ✔✔absence of disease and disability; functioning adequately; physical condition of the body define emotional health - ✔✔ability to feel and express full range of human emotions; express/ control appropriately define social health - ✔✔ability to interact/communicate effectively; connect with others; demonstrate respect/tolerance; sense of belonging define mental (intellectual) health - ✔✔ability to make sound decisions and think critically; strive for continued personal growth/learn new information define spiritual health - ✔✔unifying force within individuals; meaning in life; common bond between individuals; individual perceptions of faith
b) the more you drive under the influence without getting caught, the more comfortable you get doing it c) people will DUI 80 times before getting caught d) the dash camera and officer not getting set up properly leading to not being able to convict the drunk driver e) males are more likely to drink and drive than women3. a) the role of the breathalyzer and how it can be refused b) distrust in law enforcement because of the copious amount of evidence required c) pulling someone over for possibility of DUI is subjective Define Health codes - ✔✔powerful codes and regulations that are based on the society's belief system and the society's understanding of health/disease Public Health in Ancient Greece - ✔✔-personal hygience
- physical fitness (olympics)
- naturalistic concepts (disease caused by imbalance between man and environment)
- The Greeks understood the importance of washing hands, bathing, exercising, and eating good food Hippocrates - ✔✔father of western med
- believed that illness had a physical and rational explanantion
- looked for and described casual relationships between disease and other factors (climate, soil, water, lifestyle) Public Health During the Roman Empire - ✔✔-adopted Greek health values
- built aqueducts to bring water into the city
- advanced plumbing technology
- collected taxes to support public services Public Health During the Middle Ages - ✔✔- shifted away from Greek and Roman values
- decline of hygiene and sanitation
- faith and prayer were accepted treatments for illness
- plague
- developed the concept of quarantine Public Health during the Age of Reason and Enlightenment - ✔✔- renewed interest in reason and enlightenment laid foundation for more specific explorations William Harvey - ✔✔-demonstrated the function of the heart and circulatory system
- first to suggest that humans and other mammals reproduce via fertilization of an egg by sperm
- birth of modern med
- used dissection Edward Jenner - ✔✔- proved that swinepox or cowpox provided immunity against smallpox
- coined the term vaccine
- laid foundation of modern immunology as a science Problems caused by Industrialization Urbanization - ✔✔- slums
- poverty
- disease Great Sanitary Awakening - ✔✔-the birth of modern public health
- Great strides in scientific knowledge to help understand the origin and treatment of disease.
- Interest in humanitarian ideals
- Acknowledgement of the connection between poverty and disease.
- Even today, poverty is the single best predictor of poor health.
- Returning to what the Romans had figured out, new infrastructure for clean water and sewage removal
- Birth of a system to monitor the health status of communities Bubonic Plague - ✔✔plague brought by fleas
Louis Pastuer - ✔✔proposed the germ theory of disease, which which was crucial to the development of modern scientific medical practices Robert Koch - ✔✔Developed the culture plate method to identify pathogens Sanitation Revolution - ✔✔Clean water; water treatment Food inspection Soaps, disinfectants, and pharmaceuticals Personal hygiene (bathing) Public works departments; garbage collection, landfills, and street cleaning Public health departments and regulation STD and 3 guiding questions:
- Define the public health issue. What makes this a public health issue?
- What are the factors/ determinants involved in this problem?
- What controversial/ethical concerns may be involved? - ✔✔1. rise in cases of gonorrhea, chlamydia, and syphilis
- a) unprotected sex b) moms pass it on to their children c) some people are symptomatic d) some are resistant to antibiotics e) contraceptives do not prevent STDs
- a) getting tested, knowing if you have something b) right to privacy v. right to be protected c) personal/ religious beliefs d) sex ed being taught Infant Mortality - ✔✔Death of an infant from time of birth - 1 year old
- overall infant mortality= neonatal deaths + postneonatal deaths Infant Mortality Relevance to PH - ✔✔- used to compare the health and well-being of populations across and within countries
- looks at health of the mother, population growth, conditions where babies thrive, and neighborhood impact
- indicates current health status of the population *Has decreased since 1990 What are risk factors for infant mortality? - ✔✔Low birth weight premature birth male infant maternal age <15 or > not married US born mother Poverty Primary Prevention - ✔✔action taken to avert occurrence of disease, preventing exposure to risk factors ex: smoking cessation programs, healthy diet, wearing sunscreen, not texting and driving - ✔✔examples of primary prevention Secondary Prevention - ✔✔action taken to identify diseases at their earliest stages and to apply appropriate treatments to limit their consequences, early detection and diagnosis having a yearly mammogram, going to the doctor, going to the dermatologist for skin exams, seatbelts - ✔✔examples of secondary prevention Tertiary Prevention - ✔✔specific interventions to assist diseases or disabled persons in limiting the effects of their diseases or disabilities
what ways is health measured? - ✔✔mortality, morbidity, injury/disability, productive life years lost, lost opportunity, quality of life, healthy days of life, psychological measures the PH "problem" P.e.r.i - ✔✔"what" person/place Formula for rate - ✔✔number of events, cases, or deaths / population in the same area
- for a specified time period death rate - ✔✔The number of deaths in a population in a certain amount of time adjusted rate - ✔✔a rate that is for a total population but is statistically adjusted for certain characteristics specific rate - ✔✔rate for a particular population subgroup such as for a specific disease (disease- specific) or for a particular age of people (age-specific) crude rates - ✔✔those in which the denominator includes the total population incident rate - ✔✔the number of and health-related events or cases of a disease in a population exposed to that risk in a given time period prevalence rate - ✔✔calculated by dividing all current (existing) cases of a disease (old and new) by the total population attack rate - ✔✔a special incidence rate calculated for a particular population for a single disease outbreak expressed as a percentage The Causes (Etiology) (P.E.R.I) of the PH Problem (the Why) E - ✔✔does the cause precede the effect?
what accounts for 54% of health influence? - ✔✔behavior multicausation disease model - ✔✔a model that explains the onset of disease caused by more than one factor socio-ecologic model (bull's eye) - ✔✔Diagram that demonstrates how individual and environmental causes affect a person's health § Inner circle - individual §Outer circle - environmental criteria for establishing contributory cause - ✔✔1. Cause is linked to effect (outcome)
- Cause comes before the effect (temporal sequence)
- Changing the causes, changes the effect (a relationship) list and describe the 4 health outcome considerations - ✔✔Strength o Relative risk: how strong is the relationship between developing lung cancer and cig smoking · Dose-response o Amount of exposure x time ex:The more cigs you smoke over more years increases your chance of lung cancer Consistency o Studies produce same results over time across different populations ex: Doesn't matter who you are or where you live · Biological plausibility o Known mechanisms (biological and otherwise) that explain relationships ex: Cig smoke enter lungs relative risk (relationship strength) - ✔✔The relative risk for persons with the factor/condition is greatly increased compared to those without
- (probability of Y if X exists)/(probability of Y if X does not exist)
State: state health agencies such as health departments and human service agencies Local: local public health agencies, often called local health departments How has PH extended life expectancy? - ✔✔Assessment- what is going on (what's killing us, making us sick) Policy Development- Inform, educate, and empower people about health issues- build knowledge, shape attitudes; inform decision-making choices Assurance- Enforce laws and regulations that protect health and ensure safety social determinants of health - ✔✔The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels How do social determinants impact health outcomes? - ✔✔- Diet, exercise, smoking habits, driving habits all impact health outcomes Describe the Tuskegee Study - ✔✔- Tuskegee study consisted of 600 black men 399 of which had syphilis who were told were being treated for "bad blood", men never received treatment and did not give informed consent.
- led to the National Research Act National Research Act - ✔✔- : required all researchers to get voluntary consent from all participants Required establishment of Institutional Review Boards (IRBs) that review and decide whether studies meet ethical standards Institutional Review Board (IRB) - ✔✔A committee at each institution where research is conducted to review every experiment for ethics and methodology. Explain what ACEs are - ✔✔- Experiences that children 0-18 yrs have (abuse, neglect, household dysfunction) CDC-Kaiser ACE study - ✔✔- landmark study over 17,000 people found that ACE's are common- 2/ people reported at least one ACE
- Impacts on health: toxic stress from ACE's has a direct effect on brain development, resulting in changes in:
- decision making
- learning and growth
- forming healthy relationships Dose response - ✔✔the longer/more exposed to something, the higher chance of having lasting impacts; more of the determinant=more likely to have negative outcome Stress response System - ✔✔prolonged release of stress hormones can have a negative impact on brain and other organs What are some prevention strategies for addressing ACEs and other social determinants of health? - ✔✔- early childhood home visitation
- safe dating and healthy relationship skills programs
- enhanced primary care SEEK MODEL SEEK Model - ✔✔- (Safe Environment for Every Kid): seek early problems to lessening the harm of ACE's and addressing them early on What did the Whitehall study reveal about the connection between health and wealth - ✔✔The lower grade of employment, the higher risk of heart disease and every other major cause of death. Death rates and illness correlated to status What is the wealth-health gradient? - ✔✔The corresponding health status to socioeconomic status. Ex: poorer people have worse health, richer people are healthier Describe the body's stress (fight-or-flight) response. - ✔✔When we feel threatened stress response kicks in. When the brain perceives a threat, it signals the adrenal glands to release stress hormones, cortisol, flood bloodstream with glucose. Increase heart rate and raise blood pressure and puts body on alert.
UNNATURAL CAUSES- Describe examples from the film that illustrate how racism imposes an additional health burden on people of color. - ✔✔African Americans no matter of SES have higher rates of chronic disease bc of the constant vigilance due to racism Give examples of both "everyday" racism (being treated unfairly) and "structural" racism (access to resources, power, status and wealth) and describe how these might affect health in different ways. - ✔✔Everyday- being followed in a store, getting stares on the street, avoidance Structural- differences in income due to race, being excluded from the GI bill
- Describe major issues that make the health system a public health concern - ✔✔- We spend the most money on healthcare per capita compared to all other countries but we do not have one of the highest lifespans
- Doctors are getting paid based of how many patients they see or how many procedures they do and not based off quality or outcome of their patient therefore they have more of an incentive to do unnecessary procedures and also primary care physicians do not have enough time in their day to sit and educate and inform their patients about healthier lifestyles to prevent disease, they just treat the disease after it has already happened.
- Healthcare is now geared greatly towards treatment and not prevention
- Health insurance is too expensive for a lot of the population to afford
- Complex; multiple systems
- Explain why the U.S. healthcare system costs so much compared to the rest of the world - ✔✔- Rise in chronic disease, uninsured/under-insured, misuse of the ER, reward for doing more rather than efficiency/outcomes, inappropriate tests/procedures, defensive medicine rather than preventative med., malpractice costs, greater use of higher technology and procedures, "middlemen", profit
- Describe characteristics of the non-elderly uninsured population - ✔✔- #1 reason for being uninsured is that it is too costly
- 1 or more full-time workers in household, family incomes vary not just low income are uninsured, more whites were uninsured Where does the National Health Dollar mostly come from? - ✔✔1. Health Insurance (75%) - large portion of the pie
- private health insurance (34%)
- Medicare (21%)
- Medicaid (16%)
- VA system (4%) Who paid largely for health services? - ✔✔1. Health Insurance (75%)
- Government insurance programs (41%) Medicaid, Medicare, VA, etc.
- private health insurance (34%)- more people are covered under private ins.
- Out of pocket (10%)
- Other (15%) Why was so little percentage of government health expenditures spent on PH activity? - ✔✔- Hard for the private sector to make money on things in the public health field
- Spending on public health has grown since the 1970s, and most of this growth is from state and local governments. Public health spending has been relatively flat in recent years, however, following the Great Recession.
- Describe where most of the national health dollar goes: - ✔✔- Hospital care (33%)- 1/3 of the money
- Physician and clinical services (20%) - 1/5 of the money
- Prescription drugs (9%) Medicaid - ✔✔- low income families, individuals with disabilities, elderly · Can be a secondary payer to Medicare for elderly with limited resources · "safety-net" care · Cost share between state and federal gov. (certain criteria for who can be on Medicaid by state) · Helps states tackle health coverage issues for low income individuals or the disabled · Its benefits reflect the needs of the population it serves Medicare - ✔✔- 58.4 million people (FY17) pay a premium Covers about 15% of the total federal budget
Prior to the ACA what was the largest age group without insurance - ✔✔ 19 - 25 y/
- Explain the South Carolina Health Outcomes Plan (HOP) - ✔✔- Expanded after the ACA
- Effort to increase access to care
- Incentivizes hospitals to partner with safety net providers and community organizations to build or expand service delivery models aimed at coordinating care for chronically ill, uninsured, high utilizers of emergency department (ED) services.
- 5 criteria for being eligible for HOP:
- without high school diploma
- unemployed
- Below poverty
- food stamps
- mobile homes
- Explain the Children's Health Insurance Program (CHIP) - ✔✔- A way that funding could become available through a partnership between federal and state level to provide health coverage for children and families who were just above the Medicaid criteria
- Shared responsibility between state and federal gov. all states were required to have a set scope of benefits and services, all states were required to provide immunizations and well-child checks
- Cost share so its funded differently in all states (SC is funded by tobacco taxes) Premium - ✔✔- monthly payment an insured person makes on an insurance policy Deductible - ✔✔- amount the insured pays before the policy (insurance co.) starts to pay Co-Pay - ✔✔- specific amount insured pays (out-of-pocket) for health care services (e.g., MD visits, hospital stays, prescription drugs) at the time the costs are incurred with the insurer paying the remaining costs; typically a fixed amount Co-Insurance - ✔✔same as co-pay except the amount is a % (80/20; 60/40)
In-Plan/Out-of-Plan (Network): - ✔✔Doctor offices and insurance companies that work together. People pay less for health care within their network Gatekeeper (Primary Care Provider): - ✔✔- some insurance companies require you to see a primary care doctor before seeing a specialist to cut back on expensive costs that come with specialists Health Savings Account (HSA): - ✔✔pre tax saving of money that goes towards your health insurance, usually only available with a high deductible Explain trends related to the utilization of the healthcare system - ✔✔· Aging population o Healthcare use increases with age but more so in women o US is not a young population but an older population thus requiring more healthcare/ more people on Medicaid rosters as "baby boomers" age o Half of all Medicare beneficiaries have incomes below $26,000 in 2016 · Diversity in the population o Healthcare needs to be confident in it's ability to treat all different kinds of ethnicity in a growing culturally diverse population · Income/insurance status o Higher income correlates with greater access to better insurance and healthier life habits (healthy food, safe neighborhoods, etc.) · Family structure More likely to have better insurance with a traditional family structure with dual incomes= dual insurance Growing population of children in single parent households · Specific chronic conditions (e.g., cancer, HIV/AIDS) A Dozen Facts - ✔✔1. U.S. per capita health-care spending nearly quadrupled from 1980 to 2018.
- U.S. health-care spending is almost twice as high as the OECD average.
- Most health-care spending is on hospitals and professional services.
- Five percent of Americans accounted for half of all U.S. health-care spending in 2017.
- Expenditures are high and variable for those with the poorest health.
