Exam 2 Flashcards
social determinants of health
conditions in places where people live, learn, work, play, and worship that affect a wide range of health risks and outcomes
5 domains of SDOH
o economic stability
o Education access and quality
o Health care access and quality
o Neighborhood and built environment
o Social and community context
example of how education is a strength
Good education –> better paying employment –> access to healthcare
example of how education is a weakness
lack of education – less employment opportunities –> struggle financially –> poor immunity –> poorer health, at risk for CV disease
root cause of problem example
if someone doesn’t have health care - our immediate intervention is providing health care but that doesn’t address root cause
Why don’t they have access to health care? Why do they lack insurance? They lack insurance because their job doesn’t provide adequate coverage
what level of the ecological model is this: knowledge, attitudes, behavior, self-concept, skill, developmental history
intrapersonal
what level of the ecological model is this: formal and informal social network and social support systems, including family, work group and friendship networks
interpersonal processes and primary groups
what level of the ecological model is this: social institutions and organizations characteristics, and formal and informal rules and regulations for operations
institutional
what level of the ecological model is this: relationships among organization, institutions, and informal networks with defined boundaries
Community factors
what level of the ecological model is this: local, state, and national laws and policies
public policy
racism
a system – structures, policies, practices and norms that assigns value and determines opportunity base on the way people look or the color of their skin
o Results in conditions that unfairly advantage or disadvantage others
o Can impact mental and physical health
equity
is about everyone getting what they need in order to thrive
health disparity
Must be comparing at least 2 groups
Can be age, poverty but often is race/ethnicity
PRAPARE tool
Protocol for responding to and assessing patient’s assets, risks, and experiences
Screening tool used to collect data so providers can act on patient’s SDOHs
layout for community diagnosis
o Risk of – identify the issue
o Among – population, community
o Related to – observations
o As evidenced by – data
how do we rank diagnoses
how important is it to solve
is it a positive change for the community if solved
will it improve quality of life if solved
midstream approach
individual impact: Addressing individual social needs
Include patient screening question s about social factors
Provide direct support/assistance to meet patients social needs
upstream
community impact
improve community conditions
laws, policies and regulations that create community conditions supporting health for all people
Discuss strategies to address social needs in public health through the utilization of technology.
- Now pow
- Aunt bertha
- Link NYC
health impact pyramid
The Health Impact Pyramid is a graphical representation of tiers of influence that may result from public health interventions. At the base of the pyramid, indicating interventions with the greatest potential impact, are efforts to address social determinants of health
In public health we want to make the greatest impact on the greatest number of people and that is by changing structure and infrastructure. What do we mean by this statement?
-Focus on changing policy or changing context to make it more likely to happen
CDC 5 year plan for public health
The Health Impact in 5 Years (HI-5) initiative highlights non-clinical, community-wide approaches that have evidence reporting 1) positive health impacts, 2) results within five years, and 3) cost effectiveness and/or cost savings over the lifetime of the population or earlier
how is the CDC changing the context
school based programming to increase physical activity
school based violence prevention
safe routes to school
motorcycle injury prevention
tobacco control interventions
clean syringes
Pricing strategies alcohol
Multi component worksite obesity prevention
how is the CDC impacting the SDOHs
early childhood education
clean deisel bus fleets
water flouridation
public tranportation system
home improvement loans and grants
earned income tax credits
three core functions of PH
Assessment – systemically collect, analyze and make available info on healthy communities
Policy development – promote use of scientific knowledge base in policy and decision making
Assurance – ensure provision of services to those in need
community
Any group sharing something in common
Often defined by race or ethnicity, professional or economic ties, religion, culture or shared background or interest
community health needs assessment
A process that uses quantitative and qualitative methods to systematically collect and analyze data to understand health within a specific community.
o Statistical data
o Perspectives from community members
o Collecting info about community resources
what does an ideal CHNA include (5)
o Demographics
o Health issues and outcomes
o Risk factors
o Assets and resources
o Supporting documentation
rationale/purpose of a CHNA
- Identify needs of target population
- Establish program, priorities, goals and objectives
- Identify organizations that may help meet needs or provide resources
- Create awareness of a community concern or problem
- Public health department accreditation requirement
- Identify additional resources and assets
- ACA requirement for hospitals
- Provide a systematic basis for which organizational decisions are made
- Provide baseline for an eval
- Serve as a PR tool
what 4 things do you learn from a CHNA
o Main health concerns in a community
o Main reasons for these health concerns
o Where we might want to intervene and create change
o Strengths/assets in the community
three phases of the CHNA
assessment planning
data collection and analysis
program action planning
CHNA assessment planning
o Determine purpose and objectives
o Define target population or community
o Identify major needs area and issues
o Identify existing info regarding needs areas of community
o Involve the stakeholders
o Develop project mgmt plan (PERT or Gantt chart)
chna: data collection and analysis
o Finalize context, scope and boundaries
o Gather data
o Analyze and synthesize data
o Set preliminary priorities or needs
CHNA program action planning
o Set priorities or needs
o Consider range of solutions
o Develop action plan to implement solutions
o Eval the CHNA
o Communicate results
different ways to collect primary data for CHNA
surveys
individual or group inquiry (focus groups, community forums, listening sessions, interviews)
observations (field notes, windshield survey, videos, photos)
federally funded nonprofit health centers
Federally funded nonprofit health centers or clinics that serve medically underserved areas and populations. Federally qualified health centers provide primary care services regardless of your ability to pay.
epidemiology
- Study of the distribution and determinants of health-related states among specified populations and the application of that study to the control of health problems
purpose of epidemiology
- Discover the agent, host, and environmental factors that affect health
- Determine the relative importance of causes of illness, disability, and death
- Identify those segments of the population that have the greatest risk from specific causes of ill health
- Evaluate the effectiveness of health programs and services in improving population health
endemic
refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.
epidemic
refers to an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.
pandemic
refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.
rates
are the number of cases occurring during a specific period; and is always dependent on the size of the population during that period
rate calculation
number of cases / population at risk
epidemiological investigation
identify problem, collect data, formulate and test hypotheses
passive surveillance
o Diseases reported by health care providers
o Simple and inexpensive
o Limited by incompleteness of reporting and variability of quality
active surveillance
o Health agencies contact health providers seeking reports
o Ensures more complete reporting of conditions
o Used in conjunction with specific epidemiologic investigation
descriptive epidemiology
describes the where and whom of the disease, allowing you to begin intervention and prevention measures.
analytic epidemiology
the epidemiologist relies on comparisons between different groups to determine the role of different causative conditions or risk factors.
looking for cause and effect
3 components of descriptive epidemiology
- Time: date of onset
- Place: geographic extent of problem and clues to place
- Person: age, sex, race, medical status
step 1 of outbreak investigation
establish existence of an outbreak
how to establish existence of outbreak (step 1)
Use data from data sources
Is it an outbreak or an epidemic?
step 2 of outbreak investigation
preparing for fieldwork
how do you prepare for fieldwork
Research the disease
Gather supplies and equipment
Arrange travel
step 3 of outbreak investigation: verifying the diagnoses
Speak with patients
Review lab findings and clinical test results
step 4 of outbreak investigation
defining and identifying cases
how to define and identify cases (step 4)
Establish a case definition by using a standard set of criteria
case definition
- is a standard set of criteria for deciding whether an individual should be classified as having the health condition of interest. A case definition includes clinical criteria and — particularly in the setting of an outbreak investigation — restrictions by time, place, and person
components of case definition
Clinical info about disease (signs and symptoms observed)
Characteristics about persons affected (what commonalities exist among people?)
Info about time and place of affected persons
Specification of time during which illness onset occurred and symptom duration
step 5 of outbreak investigation
using descriptive epidemiology
epidemic curve
tracks cases by time, shows the magnitude of the epidemic over time as a simple, easily understood visual. It permits the investigator to distinguish epidemic from endemic disease. As well as potentially correlated events can be noted on the graph.
Y axis = number of cases
X axis = units of time
step 6 of outbreak investgiation
- Developing hypotheses
step 7 of outbreak investigation
evaluating the hypotheses
step 8 of outbreak investigation
refining the hypotheses
If analytic epidemiology tests are inconclusive or do not reveal anything
step 9 of outbreak invesigation
- Implementing control and prevention measures
step 10 of outbreak investigation
communicate findings
how to evaluate hypothesis
using a combination of environmental evidence, laboratory science, and epidemiology
Two ways: either by comparing the hypotheses with the established facts or by using analytic epidemiology to quantify relationships and assess the role of chance.
example of implementing control and prevention measures
if appropriate control measures are known and available, they should be initiated even before an epidemiologic investigation is launched
Ex: COVID-19 - shutting schools
epidemiologic triangle
External agent
Susceptible host
Environment that brings agent and host together
*helpful to begin controlling it
communicating the findings - what does this include?
Determine who needs to know
(local health authorities, the medical community, the general public, and lawmakers and other leaders)
Determine how info will be communicated
I.e. written up in reports
Identify why the info needs to be communicated
Usually includes, what they did and how they did it,
what they learned, and
what should be done about the illness
line list
o Line lists (sometimes called line listing) are used to track and help define a ‘case’.
o Each line list is dependent on the condition it is tracking.
o Typically a line list will have column headings for the case #, date of report, data of onset, age, sex of person-the rest will depend on the condition and the case definition.
spot maps
o Simple spot maps show where a case occurs. However, they do not account for the size of the population.
horizontal transmission includes
contact or indirect
what are the two types of contact transmission
direct or droplet
types of indirect transmission
vector
airborne
fecal oral
foodborne
example of vertical tranmission
mother to baby
ex of droplet
Pertussis and meningococcal infection are examples of diseases transmitted from an infectious patient to a susceptible host by droplet spread.
example of direct contact
infectious mononucleosis (“kissing disease”) and gonorrhea are spread from person to person by direct contact. Hookworm is spread by direct contact with contaminated soil.
vector
mosquitoes, fleas, and ticks may carry an infectious agent through
agent
biologic (bacteria, viruses), chemical (alcohol, poison, smoke), physical (trauma, radiation, fire), nutritional (lack or excess)
an environmental factor is
temperature, humidity, crowding, housing, water, food, radiation, pollution
refers to extrinsic factors that affect the agent and the opportunity for exposure.
host examples
o For COVID-we know older adults and ones with co-morbidities are more susceptible. Studies are also showing that low levels of vitamin D impact susceptibility.
o For Legionnaires-it was older adults, who smoked
who is most affected by heath disparities
Racial and ethnic minorities
Immigrants
Children
Elderly
Poor
Less educated
No health insurance
Rural
People who live in developing countries
LGBTQ
what is a health disparity
preventable health differences between groups of people. These differences can affect how frequently a disease affects a group, how many people get sick, or how often a disease causes death.
medical desert
Areas without access to hospitals, primary care physicians, pharmacies and other healthcare providers
Requires more than 60 minutes of travel to reach an acute care facility
contributing factors to health disparities
o Income
o Educational inequalities
o Employment status
o Language barriers
o Unequal access to health care
o Limited access to transportation
o Limited access to healthy food
o Limited housing options
o Environmental conditions
how does education contribute to disparities
Dropping out of school leads to social and health problems
Health Risks: obesity, substance abuse, intentional and unintentional injury
Shorter life = those with education are linked to having better self advocate skills and understanding healthy living habits
Health literacy
environmental factors contributing to health disparities
chemical pollution
air pollution
climate change
disease-causing microbes
lack of access to health care
poor infrastructure
and poor water quality.
what leads to a medical desert
finances
hospital closures
lack of healthcare providers
environmental health
freedom from illness or injury related to exposure to toxic agents and other environmental conditions that are potentially detrimental to human health
environment
world that surrounds people wherever they go, whatever they do
environment and health relationship
→ The World Health Organization estimates that as much as 24% of global disease is caused by avoidable environmental exposures
→ The environment significantly affects more than 80% of major diseases
→ More than 33% of disease in children under the age of 5 is caused by environmental exposures (WHO, 2006)
environmental exposures linked to diseases example
Asthma - Environmental tobacco smoke, Outdoor air pollutants, Mold, Pesticides
nurses role in environmental health
Alliance of Nurses for Healthy Environments (ANHE) and American Nurses’ Association (ANA) partnership:
Development and inclusion of an Environmental Health standard in the ANA’s Scope and Standards of Practice for nurses (2010)
how can you be exposed to mercury
Fish (i.e. tuna)
how can you be exposed to lead
paint chips, pottery, air, water, soil
how can you be exposed to pesticides
grass
crops
what should lead level be below
5.0 mcg
how to prevent environmental exposure
- Home improvement practices that create hazards can be avoided to reduce lead exposure
- Pesticides can be avoided – Integrated Pest Management (IPM)
- Less toxic cleaning products can be chosen
- Diet can be altered to reduce mercury and pesticide exposure
- Water can be tested for solvents and treated or replaced
health effects of lead
Damage to brain and nervous system
Slowed growth and development
Learning and behavior problems
Hearing and speech problems
how to address lead issue
-Be aware of special risk groups that are prevalent locally - immigrants, foreign born adoptees, refugees, or children whose work with lead or lead dust in their occupation or hobby and those who live in, visit, or work in old houses
-Health assessment, inclusion of housing questions
-Lead screening
interventions for lead expsoure
water filtration
nutritional (adequate iron and Ca, avoid high fat)
personal behavior
housing
tertiary prevention for lead posioning
Individuals with Disabilities Education Act (IDEA)
health effects of mercury
Chronic, low dose prenatal exposure from maternal consumption of fish associated with:
Fine motor function
Language
Verbal memory
Mental retardation
CP
Deafness
Blindness
health effects of nitrates
Can cause blue baby syndrome
Can cause birth defects
Nitrate may increase risk for certain types of cancer
Can cause thyroid disease
where can you get exposure to nitrates
Concentrated Animal Feeding Operations (CAFOs)
how to avoid nitrates
-Protect wells from contamination by sealing them properly. Also keep wells away from: barnyard runoff, which can contain animal waste and fertilizers
septic tanks and sewer systems
-don’t boil well water
-Eliminate CAFOs
pesticides
any substance or mixture of substances intended for preventing, destroying, repelling or mitigating any pest
Harmful to pets
health effects of pesticides
depends on type
Some can affect nervous system
Skin or eye irritation
Carcinogens
Hormone or endocrine system effect
ways to reduce pesticide exposure
Integrated Pest Mgmt
Dry them out - reduce sources of water
Starve them out - reduce sources of food
Keep them out - reduce access and shelter
Least amount of least toxic pesticides, when needed
PFAS - why important
Widespread human exposure
Can bioaccumulate in people
May affected developing fetus and child, low birth weight
may increase cancer risk
Long half lives in humans
how do PFAS affect the body
PFAS bind to tissue proteins, accumulate in the blood, and at much lower levels, in the liver, kidneys, and brain
Most PFAS are not metabolized by the body
PFAS are primarily excreted through urine and feces
In women, PFAS are also excreted through breastmilk and during pregnancy and menstruation
PFAS uses
Non stick cookware
Carpet and clothing treatment
Paper and cardboard packaging
Fire fighting foam
PFAS sources
Waste from manufacturing facilities
Pfc containing sludge used as a soil amendment
Fire fighting foam run off
how to reduce PFAS exposure
Drinking water filters - granular activated carbon and reverse osmosis
Premixed baby formula
Dust control
Check local fish advisories
Avoid certain consumer products
Test garden soil
health impacts of climate change
Severe weather → injuries, fatalities, and mental health impacts
Air pollution → asthma, CV disease
Changes in vector ecology → malaria, dengue, encephalitis, lyme, west nile
Increasing allergent → resp allergies, asthma
Water quality impacts → cholera, harmful algal blooms
Water and food supply impacts → malnutrition and diarrheal disease
Environmental degradation → forced migration, civil conflict
Extreme heat → heat related illness and death, CV failure
how to reduce health risks from climate change
mitigation and adaptation
mitgation
Reducing emissions of and stabilizing the levels of heat-trapping greenhouse gasses in the atmosphere
adaptation
Adapting to the climate change already and in the future
preventing pfas exposure
The best health strategy is reduction or prevention of exposure
Filter contaminated drinking water or use another source
Avoid use of consumer products containing PFAS when possible
Check local fish and wildlife health advisories
Be aware of local water quality, EPA Health Advisories for PFAS
strategies to improve environment (global green and healthy hospitals)
-substitute harmful chemicals
-reduce, treat, and safely dispose of healthcare waste
-energy efficiency
-reduce hospital water consumption
-improve transportation for patients and staff
-purchase sustainably grown food
-safely mange and dispose of pharmaceuticals
-support green and healthy hospital design and construction
-buy safer and sustainable products
PERT vs Gantt chart
Gantt charts use a theoretical approach and show only the schedule, while PERT charts use the critical path method to calculate how long each task will take
4 core questions of PRAPARE
Personal characteristics
Family and home
Money and resources
Social and emotional health
Personal behavior changes for lead
Avoid use of imported ceramics, cosmetics
Avoid use of alternative medicines
Avoid consumption of international food products
Clean/remove shoes before entering the house
Housing w/ lead
Have families get homes tested
Pregnant woman should renovate homes if living him homes before 1978
Acceptable level of nitrates
Below 10mg/l
Health effects of PFAs
Increased cholesterol levels
Decrease vaccine response in children
Changes in liver enzymes
Increased risk of high BP
Small decreases in infant birth weights
Increased risk of kidney or testicular cancer
Chain of infection- 3 steps
Reservoir/agent
Mode of transmission
Susceptible host through portal of entry
Can step 5 of an investigation be repeated more than once
Can be done multiple times during an investigation as new cases are identified or new info is available
what should the case definition not include
exposure or the risk factor
