Chapter 1 Flashcards
Health Protection (Antiquity - 1830s): Focus of Attention
Authority-based control of individual and community behaviors
Health Protection (Antiquity - 1830s): Action Framework
Religious and cultural practices and prohibited behaviors
Health Protection (Antiquity - 1830s): Notable Events
Quarantine for epidemics; sexual prohibitions to reduce disease transmission; dietary restrictions to reduce food- borne disease
Hygiene Movement (1840–1870s): Focus of Attention
Sanitary conditions as basis for improved health
Hygiene Movement (1840–1870s): Action Framework
Environmental action on a community-wide basis distinct from health care
Hygiene Movement (1840–1870s): Notable Events
Snow on cholera; Semmelweis and puerperal fever; collection of vital statistics as empirical foundation for public health and epidemiology
Contagion Control (1880–1940s): Focus of Attention
Germ theory: demonstration of infectious origins of disease
Contagion Control (1880–1940s): Action Framework
Communicable disease control through environmental control, vaccination, sanatoriums, and outbreak investigation in general population
Contagion Control (1880–1940s): Notable Events
Linkage of epidemiology, bacteriology, and immunology to form tuberculosis (TB) sanatoriums; outbreak investigation, e.g., Goldberger and pellagra
Filling Holes in the Medical Care System (1950s–mid-1980s): Focus of Attention
Integration of control of communicable diseases, modification of risk factors, and care of high- risk populations as part of medical care
Filling Holes in the Medical Care System (1950s–mid-1980s): Action Framework
Public system for control of specific communicable diseases and care for vulnerable populations distinct from general healthcare system, beginning of integrated healthcare systems with integration of preventive services into general healthcare system
Filling Holes in the Medical Care System (1950s–mid-1980s): Notable Events
Antibiotics; randomized controlled trials; concept of risk factors; surgeon general reports on cigarette smoking; Framingham study on cardiovascular risks; health maintenance organizations and community health centers with integration
of preventive services into general healthcare system
Health Promotion/ Disease Prevention (Mid-1980s–2000): Focus of Attention
Focus on individual behavior and disease detection in vulnerable and general populations
Health Promotion/ Disease Prevention (Mid-1980s–2000): Action Framework
Clinical and population- oriented prevention with focus on individual control of decision-making and multiple interventions
Health Promotion/ Disease Prevention (Mid-1980s–2000): Notable Events
AIDS epidemic and need for multiple interventions to reduce risk; reductions in coronary heart disease through multiple interventions
Population Health (2000s): Focus of Attention
Coordination of public health and healthcare delivery based upon shared evidence-based systems thinking
Population Health (2000s): Action Framework
Evidence-based recommendations and information management, focus on harms and costs as well as benefits of interventions, globalization
Population Health (2000s):Notable Events
Evidence-based medicine and public health; information technology; antibiotic resistance; global collaboration, e.g., one health; tobacco control; climate change, and a full life cycle approach to improving community health
Historical: Health
Physical
Historical: Population
Geographically limitted
Historical: Example of Society-wide Concerns
Communicable disease
Historical: Examples of Vulnerable Groups
High-risk maternal and child, high-risk occupations
Current: Health
Physical and mental
Current: Population
Local, state, national, global, governmentally defined
Current: Examples of Society-wide Concerns
Toxic substances, product and transportation safety, communicable diseases, costs of health care
Current: Examples of Vulnerable Groups
Disabled, frail elderly, individuals with pain, uninsured
Emerging: Health
Cosmetic, genetic, social functioning
Emerging: Population
Defined by local, national, and global communications
Emerging: Examples of Society-wide Concerns
Disasters, climate change, technology hazards, emerging infectious diseases
Emerging: Examples of Vulnerable Groups
Immunosuppressed, genetic vulnerability
High-Risk Approach
assumes that those with a high probability of developing disease are heavily concentrated among those with exposure to what we call risk factors
Improving-the-Average Approach
Focuses on the entire population and aims to reduce the risk for everyone. Assumes that everyone is at some degree of risk and the risk increases with the extent of exposure.
Neonatal (Birth to 28 days)
Highest death rate of any age group until over 50. Approximately 4/1,000. Nearly two-thirds of deaths during first year of life occur in this period
Neonatal (Birth to 28 days): Major Causes of Death/Disability in the U.S.
Most deaths due to conditions present at birth including premature birth, low birthweight, and birth defects.
Infancy (1–5 years)
Infant mortality rates approximately 6/1,000 live births with approximately 2/1,000 after 1 month
Infancy (1–5 years): Major Causes of Death/Disability in the U.S.
Sudden infant death syndrome and infectious diseases are important causes of death after 1 month.
Early Childhood (1–5 years)
Death rates fall dramatically in the U.S. and developed countries where infectious disease and malnutrition deaths are low. Rates approximately
0.2–0.4/1,000 per year
Early Childhood (1–5 years): Major Causes of Death/Disability in the U.S.
Unintentional injuries are the leading cause of death and disability.
Childhood (5–14 years)
Lowest death rates of any period with most years approximately 0.1/10,000
Childhood (5–14 years): Major Causes of Death/Disability in the U.S.
Unintentional injury remains the leading cause of death and disability, with cancer being the second leading cause of death. Suicide is the third leading cause of death among those 10–14.
Adolescents & Youth (15–24 years)
Increasing death rates with nearly 1/1,000 deaths per year by age 24
Adolescents & Youth (15–24 years): Major Causes of Death/Disability in the U.S.
Dramatic increase in unintentional injuries and intentional injuries with homicide and suicide as the second and third leading causes of death. Behavior and mental disorders are the single largest cause of disability, and remain so until after age 65.
Working Age (25–65 years)
Rates gradually increase from approximately 1/1,000 at age 30 to 1.5/1,000 at age 40 to 3/1,000 at age 50 to 8/1,000 at age 60 to 12/10,000 at age 65
Working Age (25–65 years): Major Causes of Death/Disability in the U.S.
Causes of death change with increases in cancer and heart disease as the first and second leading causes of death by age 45 and remaining so through age 65. Chronic obstructive pulmonary disease is the third leading cause of death by age 55 and remains so until age 85.
Muscular-skeletal diseases are the greatest cause of disability during this period.
Senior citizens (66–85 years)
Rates gradually increase from approximately 20/10,000 at age 70 to 30/1,000 at age 75 to 50/1,000 at age 80
Senior citizens (66–85 years): Major Causes of Death/Disability in the U.S.
Cancer remains the leading cause of death until age 80 when it is exceeded by heart disease. Strokes and Alzheimer’s increase as cause of death and disability after age 75.
Old Elderly/ Frail elderly (85+years)
Rates rapidly increase from approximately 80/1,000 at age 85 to 140/1,000 at age 90 to 225/1,000 at age 95 to 300 per 1,000 at age 100
Old Elderly/ Frail elderly (85+years): Major Causes of Death/Disability in the U.S.
Heart disease and cancer remain the first and second leading causes of death followed by Alzheimer’s and strokes until age 95 when Alzheimer’s becomes the second leading cause of death. Alzheimer’s becomes the leading cause of disability in this age group.
Health Care: Characteristics
Systems for delivering one-on-one individual health services, including those aimed at prevention, cure, palliation, and rehabilitation
Health Care: Examples
Clinical preventive services, including vaccinations, behavioral counseling, screening for disease, and preventive medications
Traditional Public Health: Characteristics
Group- and community-based interventions directed at health promotion and disease prevention
Traditional Public Health: Examples
Communicable disease control, control of environmental hazards, food and drug safety, reduction in risk factors for disease
Social Interventions: Characteristics
Interventions with another non-health-related purpose, which have secondary impacts on health
Social Interventions: Examples
Interventions that improve the built environment, increase education, alter nutrition, or address socioeconomic disparities through changes in tax laws; globalization and mobility of goods and populations
Contributory Causes
immediate causes of disease
Determinants
underlying factors, or “causes of causes” that ultimately bring about disease.
BIG GEMS
Behavior Infection Genetics Geography Environment Medical care Socioeconomic-cultural
Behavior
implies actions that increase exposure to the factors that produce disease or protect individuals from disease.
Infection
the direct cause of disease
Genetics
roles that genetic factors play in the development and outcome of disease
Geography
Geographic location influences the frequency and even the presence of disease.
Environment
Environmental factors determine disease and the course of disease in a number of ways.The unaltered or “natural” physical world around us may produce disability and death from sudden natural disasters. The altered physical environment produced by human intervention includes exposures to toxic substances in occupational or nonoccupational settings.
Medical Care
Access to and the quality of medical care can be a determinant of disease
Socioeconomic-cultural
In the United States, socioeconomic factors have been defined as education, income, and occupational status
