Community Health Flashcards
A federal health insurance program for individuals 65 years and older
Medicare
A government health plan that outlines a health agenda for the United States
Healthy People 2030
A study of disease distribution in any given community/population
Epidemiology
The capability of a communicable disease agent to cause disease in a susceptible host
Pathogenicity
The 3 elements of the communicable disease model include the pathological agent, the host, and the ______
Environment
The numerical rate of new cases of a disease in any given population
Incidence
Total elimination of disease from a human population
Eradication
Referring individuals in a community to a drug and alcohol rehabilitation center for treatment is an example of what level of prevention?
Tertiary
The first step in risk management that looks at reducing the risk of an event occurring in the workplace
Mitigation
Incubation
The time period between exposure to an infectious disease to the onset of symptoms
Medical Preparedness
The ability of a healthcare system to prevent, protect against, quickly respond to, and recover from health emergencies
Health Disparities
Preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations
Diabetes is an example of what type/category of disease?
Non-Communicable
When healthcare is effective, safe, timely, patient centered, equitable, and efficient, it is referred to as ______ care
Quality
Three major factors that affect the structure of the U.S. healthcare system are access, quality, and ____
Cost Containment
The type of disease transmission that occurs from droplet infection during a person who sneezes without covering their mouth
Airborne
Four fundamental tasks of prevention and control of unintentional injuries in the workplace include recognition, evaluation, control, and _____
Anticipation
Falls, car accidents, drownings, sports injuries, and poisonings are examples of what type of injuries?
Unintentional
A federal and state health insurance program that is designed to pay for services to low-income patients
Medicaid
Musculoskeltal, skin diseases, noise-induced hearing loss, and respiratory disorders are examples
Occupational Illnesses
Computer based health records that allow easy access to health care providers
Electronic Health Information
An outbreak of a disease over a wide geographical region is referred to as a(an) ______
Pandemic
Working with the public, working around money or valuables, working alone, and working late at night are ________ _______ that may encourage workplace violence
Risk Factors
A renewable state legal document that is given to a health care provider who graduates from an accredited school, passes a board examination, and meets residency or continuing education requirements
Licensure
An organization that ensures employers in private sector furnish each employee a workplace free from recognized hazards causing or likely to cause death or serious physical harm
OSAH (Occupational Safety and Health Administration)
The type of occupation that has the highest work-related fatality rate
Transportation
A leading cause of a work-related illness that is the result of performing the same motion over and over and may cause carpal tunnel syndrome, bursitis, and tendinitis
Repeated Trauma
A lack of health insurance, inadequate health insurance, and poverty are factors that limit _______ to healthcare
Access
Type of pollutants formed when primary pollutants chemicals react with one another
secondary
A federal agency of the United States created to protect the health of all Americans and providing essential human services
Department of Health and Human Services
Society’s Vulnerable Groups
- Mothers and children
- Individuals in high risk occupations
- The disabled
- The frail elderly
- Individuals without health insurance
- HIV/AIDS patients
- Those with genetic vulnerability
- Low socio-economic groups
Social Determinants of Disease (Related to Socioeconomic Status))
-Behavior
- Infection
- Genetics
- Geography
- Environment
- Medical Care
Herd Immunity
The resistance of a population to the spread of an infectious agent based on the immunity of a high proportion of individuals
- measles were eradicated in the year 2000
- “Anti-vaxxers”
- MMR Immunization (Measles Mumps Rubella)
What is the U.S. doing to improve health?
United States Planning
- focused on 10 year blocks of time
- current plan outlines health agenda: Healthy People 2030
Healthy People 2030’s four achieving goals:
- attain high-quality, longer lives free of preventable disease, disability, injury, and premature death
- achieve health equity, eliminate disparities, and improve the health of all groups
- create social and physical environments that promote good health for all
- promote the quality of life, health development, and healthy behaviors across all life stages
Evidence based public health: The P.E.R.I.E approach
P: what is the Problem? (Problem)
E: what is the cause of the disease? (Etiology)
R: what may work to reduce the health impact? (Recommendations)
I: what is done to reduce the problem? (Implementation)
E: how well did the intervention work? (Evaluation)
How should we describe a health problem?
Burden of disease: the occurrence of disability (morbidity) and death (mortality) due to a disease
Course of disease: how often the disease occurs, how likely it is to be present currently, and what happens once it occurs
Distribution of disease: Who? When? Where?
Specific Rates
- measure morbidity and mortality for particular populations or diseases
Mortality Rate
measures the death rate for a specific disease
Morbidity Rate
measures illness rate for a particular disease
Epidemiologist
- are concerned with course of disease in a population
- collect information about disease status of a community
- how many people are sick? who is sick? when did they become sick? where do they live?
Incidence Rate
of new cases of a disease population at risk
Prevalence Rate
of existing cases of disease overall population
Attack rate
incidence rate calculated for a particular population for a single disease outbreak; expressed as a percentage
Etiology
the cause of a disease
Endemic
a disease spreading in a community at the normal or expected level
Epidemic
an unexpected increase in the number of disease cases in a specific geographical area
Pandemic
Disease that occurs over a wide geographic area and affects a very high proportion of the population.
Potential Interventions in Reducing Disease in Populations
- Education (information)
- Motivation (incentives)
- Obligation (requirements)
- Innovation (technology change)
Chain of Infection
- Step by step model to conceptualize the transmission of a communicable disease from its source to a susceptible host
Pathogen -> Reservoir -> Portal of Exit -> Transmission -> Portal of entry -> Establishment of infection in new host
Chain of infection: pathogen
disease causing agent (virus, bacterium, etc.)
Chain of infection: reservoir
favorable environment for infectious agent to live and grow (human, animal, etc.)
Chain of infection: portal of exit
path by which agent leaves host
Chain of infection: transmission
how pathogens are passes from reservoir to next host
Chain of infection: portal of entry
where agent enters susceptible new host: susceptible to new infection being established
Modes of transmissions
- direct transmissions
- indirect transmissions
Direct transmission
immediate transfer of disease agent between infected and susceptible individuals
- touching, kissing, biting, sexual intercourse
Indirect transmission
transmission involving intermediate step
- airborne, vehicleborne, vectorborne, biological
- vehicles: nonliving objects by which agents are transferred to susceptible host
Fomites
objects such as clothing, towels, and utensils that may harbor a disease agent and are capable of transmitting it; usually used in the plural
How many times does a person touch their face?
approximately 3000 times per day
Vector
- an invertebrate animal (e.g. tick, mite, mosquito, bloodsucking fly) capable of transmitting an infectious agent
- can spread an infectious agent from an infected animal or human to other susceptible animals or humans through its waste products, bite, body fluids, or indirectly through food contamination
Prevention, Intervention, Control, and Eradication of Diseases: Intervention
effort to control disease in progress; taking action during an event
Prevention, Intervention, Control, and Eradication of Diseases: Control
containment of a disease; prevention and intervention measures
Prevention, Intervention, Control, and Eradication of Diseases: Eradication
total elimination of disease from human population
Levels of prevention
primary, secondary, tertiary
Primary prevention
forestall onset of illness or injury during prepathogenesis period
Secondary prevention
early diagnosis and prompt treatment before disease becomes advanced and disability severe
Tertiary prevention
aimed at rehabilitation following significant pathogenesis; retrain, reeducate, rehabilitate
Infectivity
ability of biological agent to enter and grow in the host
Agent
cause of disease or health problem
Host
susceptible person or organism invaded by an infectious agent
Environment definition
factors that inhibit or promote disease
Pathogenicity
capability of a communicable agent to cause disease in a susceptible host
Communicable disease model
triangle:
Host
Agent. Environment
Host Factors
- age
- sex
- race
- genetic profile
- previous diseases
- immune status
- religion
- customs
- occupation
- marital status
- family background
Environment Factors
- temperature, humidity, altitude
- crowding, housing, neighborhood
- water, milk, food
- radiation, pollution, noise
Agent Factors
- biologic (bacteria, viruses)
- chemical (poison, alcohol, smoke)
- physical (trauma, radiation, fire)
- nutritional (lack, excess)
Anthroponoses
is an infectious disease in which a disease causing agent carried by humans is transferred to humans
Zoonoses
a disease transmitted from animals to humans
Non-communicable diseases
Nation’s leading causes of death
- heart disease, stroke, cancer
Complex etiologies (causes)
Multicausation disease model
- Host: inalterable, unique genetic endowment
- Personality, beliefs, behavioral choices: impact host
- Complex environment: exposes host to risk factors
Diabetes has increased in incidence and prevalence
Prioritizing Prevention and Control Efforts
*Criteria used to judge importance of disease to a community
- Number of people who will die from a disease
- Leading causes of death
*Number of years of potential life lost
- Captures issues affiliated with various groups
*Economic costs associated with disease
- money spent at various levels of government; ex: alcohol and other drugs
What is health communication?
*methods for collecting, compiling, and presenting health information
- addresses how we perceive, combine, and use information to make decisions
*Is about information-from its collection to its use
Where does community health data come from?
- data is collected, published, and distributed without identifying specific individuals
- data from different sources are increasingly being combined to create integrated health data systems or data bases
How do socioeconomic status, culture, and religion affect health?
*These three key components of the social system have a strong relationship with health
- socioeconomic status
- culture
- religion
*Broad social influences can affect an individual’s response to disease
What are social determinants of health?
*Conditions in which people are born, grow up, live, learn, work, play, worship, and age, as well as the systems put in place to deal with illnesses that affect health and quality of life
- they are shaped by a wider set of forces, including economics, social policies, and politics
10 key categories of social determinants of health
- social status
- social support or alienation
- food
- housing
- education
- work
- stress
- transportation
- place
- access to health services
How do social determinants affect health?
- they contribute to a wide variety of diseases rooted in lifestyle, environmental, and social factors
- connected with health disparities, a type of difference in health closely linked with social or economic disadvantages
What are some individual health behaviors easier to change?
*The most difficult behaviors to change are those that have a physiologic component or addictive element
- obesity
- cigarette smoking
*Physical, social, and economic barriers can stand in the way of behavior change
- even if the individuals are motivated
Levels of Influence
intrapersonal, interpersonal, population and community
Intrapersonal
focusing on individual characteristics
- knowledge, attitudes, beliefs, motivations, self-concept, past experiences, skills
Interpersonal
focusing on relationships between people
- other people influence behavior by sharing their thoughts, advice, feelings, and emotional support
People and community
focusing on factors within social structures
- norms, rules, regulations, policies, laws
Laws
- are set standards, principles, and procedures that must be followed in society and are administered through the courts
- are enforceable
- more formal as it is a system of rules and guidelines that derived for the welfare and equity in society
Policy
- are a set of rules that guide any government or any organization
- comply
- informal as it is just a statement or a document of what is intended to be done
What legal principles underlie public health and health care?
*The U.S. Constitution is a fundamental document that governs the issues of public health and healthcare law
- however, it does not mention health
*The U.S. Constitution allows, but does not require, governments to act to protect public health or to provide healthcare services. Therefore, authority is left up to the states, unless delegated by the state to local jurisdictions, such as cities or counties.
Prevention, Intervention, Control, and Eradication of Diseases: Prevention
planning for and taking action to prevent or forestall onset of disease or health problem
Four fundamental tasks of prevention and control of unintentional injuries in the workplace include recognition, evaluation, control, and _____
Litigation
Police power
authority to the states to pass legislation and take actions to protect the common good
- regulation of healthcare professionals and facilities
- establishment of health and safety standards in retail and occupational settings
- control of hazards ranging from requiring the use of car restraints systems, to vaccinations, to restricting the sale of tobacco products
How does public health balance the rights of individuals with the needs of society?
*Focus of responsibility differs by the type of risk
Self Imposed risk
risk and individual knowingly and willingly takes on through his or her own actions
- wearing a helmet on a motorcycle
Imposed risk
risk to individuals and populations that is out of their direct control
- exposure to environmental toxins from a factory
Preventative, Curative, and Rehabilitative approaches to non-communicable diseases?
- screening for early detection and treatment
- multiple risk factor interventions
- identification of cost-effective treatments
- genetics counseling and intervention
- research
Primary Prevention of Non-communicable Diseases in Individuals?
education and knowledge about health and disease prevention, eating properly, adequate exercise, driving safely
Primary Prevention of Non-communicable Diseases in Communities?
adequate food and energy supplies, efficient community services, opportunities for education, employment and housing
Secondary Prevention of Non-communicable diseases in Individuals?
personal screenings (blood pressure, mammogram, pap test, prostate test), regular medical and dental checkups, pursuit of diagnosis and prompt treatment
Secondary Prevention of Non-communicable diseases in Communities?
provision of mass screenings for chronic diseases, case-finding measures, provision of adequate health personnel, equipment, an facilities
Tertiary Prevention of Non-communicable diseases in Individuals?
significant behavioral or lifestyle changes, adherence to prescribed medications, following rehabilitation requirements after surgery
Tertiary Prevention of Non-communicable diseases in Communities?
adequate emergency medical personnel and services; hospitals, surgeons, nurses, ambulance services
Environmental health
*Health is affected by the quality of the environment
- includes air we breathe, water we drink, food we eat, communities in which we live
- FDA: Food and Drug Administration - addresses food safety
*Environmental hazards - increases the risk of human injury, disease, or death
What is meant by “Environment”?
- The physical environment can be thought of in three categories:
- Unaltered environment: “Natural”
- Altered environment: The result of added chemicals, radiation, and biological products
- Built environment: result of human construction
*Injuries and exposures in the home, the transportation system, and where we work and play
How do we interact with our physical environment?
*We are exposed to the physical environment every minute of our lives through multiple routes:
- Skin (contact exposure)
- Respiratory tract (what we breathe)
- Alimentary or digestive tract (what we ingest)
- Genital-urinary tract (an acidic environment based on bodily input)
Outdoor Air pollution
contamination of air by substances in great enough amounts to harm living organisms
- Major sources in U.S. - transportation, electrical power plants fueled by oil and coal, industry
Outdoor Primary pollutants
from sources such as cars, factories, and power plants
Outdoor Secondary pollutants
formed when primary pollutants react with one another
- photochemical smog vs. industrial smog
Ozone
single most dangerous air pollutant
- thermal invasion
Indoor air pollutants
- Come from a variety of sources
- Asbestos (used in older buildings for insulation)
- Biogenic pollutants (fungus, mold, bacteria, pollen)
- Combustion by products (gases from burning)
- Volatile organic compounds (VOCs) (vapors ie paint)
- Formaldehyde (widely used in chemicals)
- Radon (#1 cause of lung cancer - from soil, rocks, H2O)
- Environmental tobacco smoke
Protecting Indoor Air
- people spend 50-90% of time indoors
- indoor air is more pollutant than outdoor air
- no federal indoor clean air act
- smoking ordinances in public indoor spaces are in effect
Sources of water pollution
- water pollution - includes any physical or chemical change in water that can harm living organisms or make water unfit for other uses
- point source pollution - pollution that can be traced to a single source
- nonpoint source pollution - all pollution that occurs through runoff, seepage, or falling of pollutants into water
Foodborne Disease Outbreaks
Causes
- inadequate cooking temperatures; improper holding temperatures
- unsanitary practices (hand washing)
- contaminated equipment
- FDA food and drug administration
Risk management
mitigation, preparedness, response, recovery
mitigation
reduce risk of event
preparedness
how to prepare for the event
Response
responding to the event
how to recover post event
Recovery
Community organizing methods (to reduce disease and improve health)
- start where the people are
- participation
- create environments in which people and communities can become empowered as they increase problem solving abilities
Recognizing the issue
*initial organizer
- recognizes that a problem exists and decides to do something about it
- gets things started
- can be from within or outside of the community
- grass roots, citizen initiated, bottom up
- top down, outside in
gaining entry into the community:
organizers need:
- cultural sensitivity, cultural competence, cultural humility
organizers need to know:
- who is causing problem and why; how problem has been addressed in past; who supports and opposes idea of addressing problem; who could provide more insight
* Gatekeepers - people who have access and influence in a community and strongly influence the value systems of the community
organizing the people
- executive participants
- leadership identification
- recruitment
expanding constituencies - task force - a temporary group brought together to deal with a specific problem
- coalition - an alliance for a combined action for a particular cause
Goals
- more encompassing than objectives
- written to cover all aspects of the program
- provide overall program direction
- are more general in nature
- usually take longer to complete
- often not measured in exact terms
Health promotion programming
Important tool for community health professionals
Health education - part of health promotion
Health promotion - more encompassing than health education
Program planning:
-May or may not be associated with community organizing/building
-Process by which an intervention is planned
implementation
putting a planned program into action
pilot test
- trail run implementation to a small group
- determine problems and fix before full implementation
phasing in
Step-by-step implementation; implementation with small groups
injury
physical damage to body
unintentional injuries
motor vehicles, falls
intentional injuries
suicide, homicide
unsafe act
any behavior that increases the probability of an injury occurring
unsafe condition
icy roads, poisonous gas, hazards
Leading unintentional injuries…
Cause of nearly 2/3 of all injury related deaths in the US
- motor vehicle crashes
- poisoning
- falls (head and spinal cord injuries)
- drowning
- suffocation
- fires and burns
- unintentional discharge of firearms
prevention accumulation of energy producing agent
reducing speed limits, lowering settings on hot water heaters (all reduce the number and seriousness of energy)
prevent inappropriate release of excess energy
flame retardant fabric (will not ignite), nonslip surfaces (movement of the human body)
place barrier between host and agent
sunscreen, non-heat handles on cookware (all provide a barrier to modify release of energy)
completely separate host from energy sources
locked gates around swimming pools (completely separate the host)
Education
process of changing people’s health-directed behavior
regulation
enacting and enforcing laws to control conduct
automatic protection
modifying products or environments to reduce risk
Litigation
seeking justice for injury through courts
intentional injuries
- outcome of self-directed or interpersonal violence
- assaults, rapes, suicides, homicides
- can be perpetrated against family members, community members, or complete strangers
- interpersonal violence a costly community health problem
environmental designs
safer cash handling procedures, improving lighting
administrative controls
staffing policies, procedures for opening and closing workplace
behavior strategies
training employees in nonviolent response and conflict resolution
Credentialing
- an individual, not the institution is evaluated
- process of verifying that an individual has the desired or required qualifications to practice a profession
How do education and training serve to define health professions?
Licensure
- state governmental function
- usually required for practice of a health profession
- may include residency requirements, a legal background check, continuing education requirements, etc..
Primary health care
first contact providers who handle the majority of common problems for which patients seek care (common colds, influenza, allergies, strep throat)
Secondary health care
specialty care provided by clinicians who focus on a small number of organ systems or type of service (diabetes, heart disease, dermatology, respiratory)
Tertiary care
subspecialty care defined by type of institution is it delivered at and the type of problem addressed (Mayo Clinic - cancer management, DaVita - kidney dialysis, neurosurgery, cardiac surgery, rehabilitation care)
Quality of health care should be
- effective
- safe
- timely
- patient centered
- equitable
- efficient
Lack of access to primary care
factors that limit access are lack of health insurance, inadequate insurance, and poverty
accreditation of health care facilities
- assists in determining quality of health care facilities
- process by which an agency or organization evaluates and recognizes an institution as meeting certain predetermined standards
- joint commission
- predominant accrediting organization
Current issues of the USA health care system
major issues are cost containment, access, quality
- all are equally important; expansion of one compromises other two
assessment
obtaining data that defines the health of the population overall and specific groups within
policy development
developing evidence based recommendations and other analyses of options to guide implementation
assurance
oversight responsibility for ensuring key components of an effective health system
