Final Flashcards
What are 5 reasons why routines for older adults have changed since onset of COVID pandemic
Broader life circumstances, altered access, COVID-19 exposure concerns, inertia, and mental health
What are 4 examples of broader life circumstances that have altered adults routines since the onset of the COVID pandemic
Caregiving, death, moving, and retirement
What are 4 examples of altered access that’s altered adults routines since the onset of the COVID pandemic
Business closures, online-only activities, staffing issues, and convenience
What is inertia in global health terms
The tendency to stay active or not
How has inertia impacted people’s habits since the onset of the COVID pandemic
People are now more socially fatigued and in the habit of staying home, they have diminished relationships, and some new positive habits
What changes to mental health have occured since the onset of the COVID pandemic
Experiences of grief, loss, and depression as well as a desire to return to “normal”
How are depression, anxiety, and loneliness linked to the pandemic and lifestyle routine changes
Symptoms of all 3 have increased in reporting
What mass containment measures were implemented in China in response to COVID
Mass vaccination nationwide, digital surveillance, lockdowns in high-risk cities/communities, mass testing, and central quarentine centers and treatment
What are 3 unintended consequences and effects of mass containment measures in China during COVID pandemic
Monetary costs, social costs, and health costs
What were the monetary costs of mass containment measures in China during COVID pandemic
Huge financial burden on local governments and hospitals (and much infrastructure not even used) and increased unemployment rates among young people
What were the social costs of mass containment measures in China during COVID pandemic
Individual autonomy over one’s own body and healthcare decisions was stripped away
What were the health costs of mass containment measures in China during COVID pandemic
Many Chinese citizens suffered and died (e.g. bus accident in the middle of the night killed 27 people, citizens may have been locked in during a fire and fire trucks were delayed by road barricades, and people died from delayed treatment in quarantine centers)
What are the top 5 chronic diseases
Heart disease and stroke, chronic respiratory disease, diabetes, cancer, and mental health
What do chronic diseases have in common
Often have shared risk factors, often long-lasting and take a long time to fully develop, and can co-exist
What are the 6 shared risk factors for NCDs
Tobacco use and exposure to secondhand smoke, high blood pressure, obesity, physical inactivity, excessive alcohol use, and poor diets (low in fruits and veggies, high in sodium and saturated fats)
What are 5 impacts of short-term alcohol use
Injuries, violence, miscarriage, risky sex, and alcohol poisoning
What are 6 impacts of long-term alcohol use
1) High BP, heart disease, stroke, liver, disease, and digestive problems
2) Cancers of breast, throat, mouth, esophagus, liver, and colon,
3) Learning and memory problems
4) Mental health problems
5) Social problems
6) Alcohol dependence or alcoholism
What is primary prevention
Intervening before a health effect occurs (e.g. educational campaigns, vaccines, altering risky behaviors, etc.)
What is seconday prevention
Catching diseases in the earliest stages, before the onset of signs and symptoms (e.g. screenings)
What is tertiary prevention
Managing disease post diagnosis to slow or stop disease progression (e.g. chemotherapy, etc.)
What are the 3 “best buys” to prevent alcohol use
Increase excise taxes on alcoholic beverages, bans/restrictions on advertising of alcohol, and ban/restrict physical availability of retailed alcohol (e.g. reduced hours/days of sale)
What are the “best buys” to prevent physical inactivity
Implement community wide public education and awareness campaign for physical activity (include mass media as well as other community-based education, motivational, and environmental programmes) for behavioral changes
What are the 5 “best buys” to prevent tobacco use
1) Increase excise taxes and prices on tobacco products
2) Implement plain/standardized packaging and/or alrge graphic health warnings on tobacco packages
3) Ban/restrict tobacco advertising, promotion, and sponsorship
4) Eliminate exposure to second-hand smoke in all indoor and public spaces
5) Implement mass media campaigns to educate public about harms of smoking and second-hand smoke
What are WHO’s 4 NCD targets
Cardiovascular disease, cancer, diabetes, and chronic respiratory disease (want to reduce premature death in all by 25% by 2025)
Why can cervical cancer and liver cancer blur the line between infectious disease and chronic disease
Because they can be caused by a viral infection but lead to chronic conditions
What are structural reasons why COVID-19 is affecting the health of POC in the US more than white individuals
Redlining and decreased generational wealth leading to poverty, limited physical and financial access to quality hospitals, and discriminaiton in health tools (e.g. race adjustment on spirometers)
What are 3 secondary preventions specific to chronic illness
Early diagnosis and treatment of high blood pressure, obesity, and high blood sugar
What are the 6 most common cancers
Lung, breast, colorectal, prostate, skin, and stomach
What are the 4 ways the CDC tries to prevent hcronic disease and associated risk factors
Epidemiology and surveillance, environmental approaches (e.g. changes in policies and physical surroundings), health care system interventions, and community programs linked to clinical services
How are community health volunteers increasing awareness of dementia in Kenya
10 locals go house-to-house with screening tools for family members and educate individuals
Why is it crucial to know how many people in Kenya have dementia
Because 9% of adults have some sort and knowing will give them access to early care (part of DAVOS World Health Initiative)
After being flagged by the screening tool, how does seeing a doctor help address both early dementia and other health conditions an individual in Kenya may have
Other conditions (diabetes, AIDS, etc.) can be treated to ease symptoms of dementia, meedication can be accessed, and there is a sense of ease with someone to talk to
What are 4 common themes that make some communities so much healthier like in “Blue Zones”
1) Diet (whole grains, beans, tubers, nuts, etc.)
2) Daily activities/movement every day (walking to work, gardens in backyard, etc.),
3) Community norms (tightknit, cohesive, frequence social interactions)
4) Manufactured environments (healthy food subsidized, junk food taxes, tax breaks for living near elderly relatives, driving taxed, walking subsidized, etc.)
How is the world’s population changing
People are having less children and living lognger (populations becoming dominated by older individuals) but proportion of life in good health hasn’t changed (lving longer but not healthier)
Which countries are experiencing the fastest aging demographic shift
Low and middle income countries
What is the current global life expectancy
~73 years
How much variation in human lifespan is determined by genetics
~25%
What is most of the variation in people’s lifespan due to
Physical and social environemnts (e.g. homes, neighborhoods, communities) and personal characteristics (e.g. sex, ethnicity, SES)
What is dementia
An umbrella term for loss of memory and other thinking abilities severe enough to interfere with daily life
How many people have dementia worldwide
More than 55 million (over 60% live in low-and middle-income countriest)
Is there a cure for dementia
None that can effectively prevent or meaningfully slow down the progression of dementia (plus Alzheimer’s trials lack racial diversity and the drugs are super expensive) but some meds can manage symptoms
What are the 4 pathways thorugh which “Cognability” links neighborhoods and cognitive health later in life
Physical activity (walkable destinations, parks, and rec centers), social connection (e.g. senior centers, food and drinking places, and civic/social organizations), cognitive stimulation (arts and cultural sites), and hazards (polluting sites and highways)
How does the ‘Cafe of Forgotten Orders’ exemplify an age-friendly environment
It provides servers with a safe, stimulating environment with chair sto rest, younger volunteers to help, and colored or symboled tables vs. numbered
What is cognability
A measure of how supportive an area is to cognitive health
What 5 features make an environment age-friendly
Allow speople to age well in a place that is right for them, continue to develop personally, be included, contribute to their communities, and enjoy independence and good health
What 4 ways are multinational food companies (e.g. Nestle, PepsiCo, and General Mills) expanding into developing nations
Door-to-door sales, marketing (especially to children), transforming local agriculture, and political influence (e.g. political donations and blocking legislation/taxation)
What are some ways multinational food companies expand in developing nations through local agriculture
Farmers abandon substinence crops in favor of cash crops for industrial food
What are some ways multinational food companies expand in developing nations through political influence
Stymieing public helaht officials seeking soda taxes or legistlation aimed at curbing helath impacts of processed food
What are some ways multinational food companies expand in developing nations through marketing
Door to door marketing, customers can get almost loans where they have 1 month to pay, and the salesmen are local
What new type of malnutrition is occuring giving the growing availability of high-calorie, nutritent-poor foods
Overweight and undernourished
What multiple factors are contributing to the rise of obesity among children
Diets heavy in salt, fat, and sugar but lacking nourishment, improved economics, busy parents, street violence keeping people indoors, etc.
What is malnutrition
Deficiences, excesses, or imbalances in a person’s intake of energy and/or nutrients
What are the 3 broad types of conditions relating to malnutrition
Undernutrition (includes wasting, stunting, and underweight), micronutrient-related malnutrition (both difficiencies and excess), and overweight/obesity (most of global population)
What is the global double burden relating to nutrition
LMICs are dealing with problems of infectious disease and undernutrition but they are simultaneously experiencing a large increase in obesity and overweight
What is wasitng
Acute malnutrition resulting in low weight-for-height
What is stunting
Chronic malnutrition resulting in low height-for-age
What is underweight
Combination of wasting and stunding resulting in low weight-for-age
What type of malnutrition do most children under 5 globally experience
Undernutrition
How are different forms of malnutrition biologically connected
Someone who was undernourished in the womb/as a baby is more likely to become overweight/obese and have NCDs later in life
What are the 4 steps of Positive Deviance Inquiry Process
1) Define norms (feeding, caring, and practices in community)
2) Identify ‘positive deviant’ children
3) Look fo what’s demonstrably successful/working for these ‘positive deviants’
4) Share findings with community and design and activity
What are 7 risk factos for undernutrition
Sociocultural, poverty, behavioral, infection, intrauterine growth restriction, diarrhea, and zinc, vitamin A, iron, and iodine deficiencies
What are 4 behavioral risk factors influencing undernutrition
Lack of exclusive breastfeeding for 6 months (increases infection risk in resource poor environments), adverse weaning practices (e.g. sudden weaning) no re-feading after infection, and inappropriate food supplementation (e.g. no mashing beans to make them more digestible or no frequent snacks)
What is intrauterine growth restriction
Kids not getting enough nutrition in utero causing the baby to grow at unexpected rates (could be due to placental abnormalities, high BP in mom, anemia, underweight, etc.)
What 3 practices can help prevent undernutrition
Exclusive breastfeeding for 6 months in resource-poor contexts, supplementaiton (of iron, vitamin A, zinc, etc.), and prenatal and under-threes care
What is the positive deviance appraoch
A horizontal apprach to identify what allows some memebrs of a community to have well-nourished children when neighbors don’t and SES is similar
What are the key causes behind the global rise in obesity
Increased intake of energy-dense foods that are high in fats and sugars and an increase in physcial inactivity (due to increasingly sedentary of many forms of work, changing modes of transportation, and increasing urbanization)
How does the global food industry aggressively market ultra-processed foods (especially to children)
Advertising is more prevalent where kids gather (e.g. schools and sports clus), more frequent during kid’s viewing times (school holidays) and on children’s programming
What are the commercial determinants of health
Private sector activities that affect people’s health, directly or indirectly, positively or negatively
What are 3 reasons why fresh foods are so expensive
Farming (machine farming is cheapers because it can use preservatives and bumps/bruises don’t matter), human labor is more expensive than machines and not as long-lasting or efficient, and governments don’t subsidize wheat, fruit, or corn
What are 4 reasons why more people eat unhealthily
Environmental and livelihood changes (e.g. no longer farming in rural/costal areas), ease and convenience, affordable, and indistries pushing food behaviors and norms
What are 4 policy actions to combat industries aggressive marketing of processed foods
Taxes on ultra-processed food and beverages, front-of-pack or shelf-labeling systems, reformation on food supply (e.g. NYC’s trans fat ban and UK’s salt reduction program), and multi-pronged approaches (e.g. in Mexico)
What 2 events led to an uptake in tobacco consumption in the US
The Depression and WWII
When did the first health studies show that tobacco consumption was linked to lung cancer
Around 1950
When was the Surgeon General’s Report that reiterated that tobacco consumption was linked to lung cancer
1964
What 7 factors have lead to the declien in cigarette consumption in the US since the 1970s
1) Public health messages on TV and ban of cigarette ads on TV
2) Non-smoker’s rights movement
3) Surgeon General’s Report on second-hand smoke in 1986
4) Increasing taxes on cigarettes
5) Bans on smoking in public places
6) Public health messaging
7) Improved methods to help people quit smoking
Where in the world has the highest rates of tobacco use
Asia
What is the ‘next frontier’ in tobacco tactics
To push tobacco products elsewhere in the world since US rates are declining and starting those populations early
What are 6 ways the tobacco industry interferes in public health efforts to control tobacco use
1) Hijacking political and legislative processes (e.g. lobbying groups and involving themselves in legislation)
2) Exaggerating the economic importance of tobacco
3) Manipulating public opinion
4) Using front groups to create illusion of support
5) Discrediting proven science
6) Intimidating governments with litigation
What are 4 strategies involved with the tobacco industry’s ‘next fronteir’ of tactics
Developing online games to advertise tobacco brands, promoting partying and smoking in the metaverse and even sponsering metaverse events, selling products via e-commerce and through messaging apps like WhatsApp, and creating commemorative NFTs
What is the power imbalance at the heart of the commercial determinants of health
Governments and corporations/commercial entities are fighting for power
Why is vaping on the rise among children and teens
Because public messaging intended to help people quit cigarretes was not clear enough (95% safer figure still used), and similar marketing strategies towards kids
What is the WHO Framework Convention on Tobacco Control (FCTC)
A treaty signed by most countriest that went into affect in 2005 intended to strenghten coordination to decrease tobacco use using 8 goals
What 7 agreements were a part of the FCTC
Restricting advertising, sponsoring, and promotion of tobacco products, implementing labelign requirements, establishing clean indoor air controls, strenghtening legislation to combat tobacco smuggling, tax and price policies, testing/regulating tobacco product contents, requiring manufacturers and importers to disclose contents, and goverments must disclose toxic ingredints to public
What does MPOWER stand for
Monitor tobacco use and prevention policies, Protect people from tobacco smoke, offer to help quit tobacco use, Warn about dangers of tobacco, Enforce bans on advertising, promotion, and sponsorship, and Raise taxes
What is anxiety
Intense and uncontrollable feelings of anxiety, fear, worry, and/or panic that can interfere with daily activities and may last for a long time
What is bipolar disorder
A brain disorder that causes changes to a person’s mood (manic/hypomanic vs depressive), energy, and ability to function
What is schizophrenia/psychoses
A chonic brain disorder affecting <1% of the population that can induce delusions, hallucinatins, disorganized speech, lack of motivation, and/or distortions in thinking, perceptions, emotions, language, sense of self, and behavior
What are 9 symptoms of major depressive disorder
Feeling sad or having a depressed mood, loss of interest/pleasure in activities once enjoyed, changes in appetite w/weight loss or gain, trouble sleeping or sleeping too much, loss of energy or increased fatigue, increase in purposeless physical activity or slowed movements or speech, feeling worthless or guilty, difficulty thinking, concentrating, or making decisions, and thoughts of death or suicide
Must have at least 5 symptoms for at least 2 weeks and represent change in previous level of functioning
What is the “treatment gap”
In LMICs, people with mental disorders receive no westernized mental health treatment (e.g. medicine, therapy, etc.) for their disorder and in HICs, 35-50% recieve “no treatment”
Which countries are less likely to diagnose and treat mental health disorders and why
Lower income countries because of stigma and lack of resources like mental health practitioners
What are 8 kinds of mental health disorders
Depression, bipolar affective disorder, schizophrenia and other psychoses, drug and alcohol abuse, dementia, anxiety, eating disorders, and intelectual disabilities and developmental disorders (e.g. autism)
What are 3 kinds of anxiety disorders
Obsessive compulsive disorders (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorders
What 3 diagnoses are included within bipolar disorder
Bipolar I, bipolar II, and cyclothymic disorder
What is a manic episode
A period of at least one week wherein a person is extremely high-spirited or irritable most of the day for most days, possesses more energy than usual, and exxperiences at least 3 manic symptoms that interfere with ADLs
What are 6 possible symptoms of mania
Decreased need for sleep, increased or faster speech, uncontrollable racing thoughts or quickly chaning ideas or topics when speaking, distractibiity, increased activity, and increased risky behavior
What are the 2 kinds of eating disorders
Anorexia nervosa and bullimia nervosa
What is anorexia nervosa
Deliberate, self-induced weight loss, body image distortion, and body weight at least 15% under what is expected associated with undernutrition
What is bullimia nervosa
Repeated behaviors of overeating, preoccupation with controlling body weight and using extreme measures to reverse the effects of overeating
What is severe mental health
Longstanding mental illnesses, typically psychosis, that cause moderate-to-severe disability of prolonged duration
What are 7 human rights issues associated with mental health
Dignity of many is not respected, sometimes people are locked up in institutions, many are subjected to physcial, sexual, and emotional abuse and neglect, they are very often deprived of the right to make decisions for themselves (e.g. conservatorship), they are denied access to general and mental health care, deprived of access to education and employment opportunities, and prevented from participating fully in society
What are 4 critiques of global mental health initiatives
The medicalization of social suffering, they ignore local knowledge and practice, they’re not a true collaborative partnership between north and south, and they’re antropologically and socially naive
According to Oxfam, how do ultra-rich individuals contribute to the climate story
Through the carbon they emit in daily lives and consumption, investments and shareholders in heavily polluting industries with vested financial interest in economic status quo, and through undue influence they have over the media, economy, and politics/policy making
Which groups tend to face the greatest threat from environmental health impacts, and why
People living in poverty, marginalized groups, and LICs because they tend to live in more vulnerable housing that’s overwhelmed, more prone to flooding, and without access to air conditioning in addition to fewer economic resources and relief assistance
What does Oxfam recommend that governments do to address climate change and inequality
Mainly hold goverment leaders and big polluters accountable, but also radical increase in equality, fast transition away from fossil fuels, and new economic system that focuses on the twin goals of human and planetary flourishing
What health outcomes are due to lack of access to safe water, sanitation, and hygiene
Mainly enteric infections but also respiratory infections
What is WASH/HSW
Water, sanitation, and hygiene
What was WHO’s statement on WASH/HSW
Essentially said that access to safe drinking water and improved sanitation are fundamental needs and human rights vital for the dignity and health of everyone
What are the 3 kinds of improved water sources or sanitation facilities
Limited, basic, and safely managed
What is surface water
Water directly from a river, dam, lake, pond, stream, or canal
What is an unimproved water source
Water from an unprotected dug well or spring (not contaminated but fecal matter can get in because there is no cap/cover)
What is a safely managed water source
An improved source that is located on the premises, available when needed, and free from contamination
What is a basic water source
An improved source that misses a ‘Safely managed’ criteria and takes <30 mins to collect roundtrip
What is a limited water source
An improved source that misses a ‘Safely managed’ criteria and takes >over 30 mins to collect roundtrip
What is open defecation
Disposal of human faeces in fields, forests, bushes, open bodies of water, beaches, and other open spaces
What are sanitation facilities
Ways to keep fecal matter from getting into water sources
What are unimproved sanitation facilities
Use of pit latrines without a slab or platform, hanging latrines, or bucket latrines
What are limited sanitation facilities
Use of improved facilities that miss a ‘Safely managed’ criteria but are shared with other households
What are basic sanitation facilities
Use of improved facilities that miss a ‘Safely managed’ criteria and is not shared with other households
What are safely managed sanitation facilities
Use of improved facilities that are not shared with other households and excreta are safely disposed in-situ or transported for treatment off-site
What are improved water sources
Water sources that have the potential to deliver safe water by nature of their design
What are improved sanitation facilities
Sanitation facilities designed to hygienically separate excreta from human contact
What are 3 examples of improved sanitation facilities
Flush to piped sewer system, septic tanks or pit latrines, composting toilets or pit latrines with slabs
What are 5 examples of improved water sources
Piped water, boreholes or tubewells, protected dug wells or springs, rainwater, and packaged water
What are 5 criteria air pollutants
Carbon monoxide (CO), sufur dioxide (SO2), ground level ozone (O3), particulate matter (PM10, PM2.5), and lead (Pb)
What health endpoints are associated with outdoor air pollution
Respiratory infections, maternal and neonatal impacts, neoplasms (mainly lung cancer), cardiovascular disease, chronic respiratory disease, and diabetes and chronic kidney disease
What is fine particulate matter
Particles contributing to air pollution because they are so small that they do not fall due to gravity and stay in the air (the smaller the particle, the deeper they get in the body, and the more damage they can do)
What are 3 causes of indoor air pollution in developed countries
Tightly sealed houses trap air pollution from indoor sources, many modern products emit hazardous air pollutants (e.g. formaldehyde), and radon
What are 2 causes of indoor air pollution in developing countries
~3 billion people cook and heat their homes using open fires and simple stoves burning biomass (wood, animal dung, and crop waste) and coal, and >4 million people die prematurely from illness attributable to household air pollution
What does WHO call the “world’s largest single environmental health risk”
Household air pollution
What are 5 health impacts of household air pollution
Pnemonia (especially in children), ischaemic heart disease, chronic obstructive pulmonary disease (COPD), stroke, and lung cancer
Who does household air pollution disproportionately affect
Very poor women and children
What is the energy ladder
A diagram that shows that people will typically choose cleaner fuels as they move up in SES
What is clean energy
Energy sources that don’t cause harmful air pollution within the household
What are solid fuels/traditional biomass fuels
Energy sources that cause indoor air pollution such as crop waste, dung, wood, and charcoal
What are fossil fuels
Natural gas, gas, liquefied petroleum gas, ethanol and methanol, kerosene, and coal
What are some solutions to household air pollution from solid fuels
Improved cookstoves (less smoke per unit fuel and chimneys that vent the air pollution outdoors) and improved access to cleaner fuels through electrification and funding
Which city has the highest concentration of fine particulate matter
No one knows (seasonal shifts, incomplete data, etc.)
Why is violence like an infectious disease
Because maps of violence showed clustering similar to infectious diseases, the greatest predictor of violence is violence (similar to exposure to an illness), and similar strategies also work
What are the 3 main prongs of stopping infectious disease transmission according to the WHO
Interrupt transmission, prevent future spread, and change group norms
What are some of the structural factors that are associated with neighborhoods that have high rates of violence
Poverty, lack of jobs, exclusion, racism, segregation, and language (e.g. gang, thug, criminal, etc.)
What are the 4 steps of the public health approach
Surveillance (what is the scope of the problem, distribution, etc.), identifying risk and protective factors, developing and evaluating interventions, and implementation
What 2 steps of the public health approach present a problem when tackling gun control
Surveillance and identifying risk and protective factors
What is the timeline of policies on studying firearms
1993: Study found people were much more likely to die of gun violence if there was a gun in the home
1996: NRA effectively ended research on gun violence as a public health issue because Dickey Amendment said CDC can’t do research on anything that promotes gun control
2018: Congress clarified that Dickey Amendment didn’t ban research on gun violence but said funds can’t be used for gun control
2019: Congress passed funding for CDC and NIH to study gun violence
What is the result of the 20 year gap in research on gun violence
Outside of media reports, we don’t know who’s most likely to use a gun in a crim eor where it comes from, how often guns are used in DV cases, how often people arrested for gun crimes actually bought the weapons, or what policy changes or prevention efforts are efective at stopping gun violence
What is an interrupter
A worker whose goal is to stop the spread of violence through education, calming, etc.
How does the successful treatment of vilence as an epidemic shift the paradigm of how we think about violence
Challenges the belief that there are just “bad people” and highlights that there are ways to intervene to prevent violence
To treat violence do we have to treat everythign (schools, poverty, etc.)
No
Where do the vast majority of deaths from gun violence occur
In North and South America
What are 5 risk factors for death from gun violence
Impulsivity, anger issues, mental health issues, substance abuse (specifically alcohol), number of firearms, etc.
What are reasons why countries might have high gun homicide
Drug producing and transporting because people are more heavily armed than law enforcement (e.g. Latin America)
What are reasons why countries might have high gun suicide
Firearm access and culture (e.g. Europe, U.S., Australia, etc.)
According to WHO, what are 7 steps to prevent interpersonal and self-direced violence
1) Developing safe, stable, and nurturing relationships between children and their parents and caregivers
2) Developing life skills in children and adolescents
3) Reducing availability and harmful use of alcohol
4) Reducing access to guns, knives, and pesticides
5) Promoting gender equality to prevent violence against women
6) Changing social and cultural norms supporting violence
7) Victim identification, care, and support programs
What are 2 programs that develop safe, stable, and nurturing relationships between children and their parents and caregivers
Nurse Family Partnership and Positive Parenting Program (Triple P)
What are 4 outcomes from the NFP (Nurse Family Partnership) program
Reduction in child arrests at age 15, fewer injuries among children, reduction in emergency room visits for accidents and poisonings, and reduction in child abuse and neglect
