Final exam Flashcards
6 P’s of Public Health
Prevent, Promote, Protect, Provide Access, Primary Care, Preparedness
Prevent
Disease Surveillance, monitoring, immunication programs and injury prevention programs
Promote
Work with community partners to deliver effective health promotion and prevention services. ie: asthma control, cancer control, heart disease and stroke prevention, diabetes prevention and control, UT partnership for healthy weight, tobacco control and prevention
Protect
“real-time” bio surveillance to detect man-made and natural threats ie: bioterrorism, pandemic flu, infectious disease
Provide Access
responsible for administering Medicaid and CHIP
- Approximately 230,000 enrolled in Medicaid - Approximately 42,000 enrolled in CHIP - $2.0 billion annual budget - Still, more than 300,000 Utahans have no coverage (rely on “safety net” providers)
Primary Care access
26 agencies providing care at 47 locations, including: Federally qualified health centers, UDOH clinics, free/volunteer clinics, Intermountain neighborhood clinics, low cost/cash only clinics, family planning agencies, homeless health care, migrant health care, UT partners for health
Preparedness
a noun since 9-11
- developing and acquiring medical countermeasures against chemical, biological, radiological and nuclear agents
- preparing for response- personnel trained in emergency response
- establishing infrastructure capable of providing regionalized emergency response and care
What are MDG and why are they important?
Millennium Development Goals are eight international development goals established by the United Nations in 2000, with the objective to encourage development by improving social and economic conditions in the world’s poorest nations. The eight goals are:
1) Eradicating extreme poverty and hunger
2) Achieving universal primary education
3) Promoting gender equality and empowering women
4) Reducing child mortality rates
5) Improving maternal health
6) Combating HIV/AIDS, malaria, and other diseases
7) Ensuring environmental sustainability
8) Developing global partnerships
Cultural humility
o A lifelong commitment to self-evaluation and critique, to redressing the power imbalances in the physician-patient dynamic, and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations. An institution committed to cultural humility would be characterized by training, established recruitment and retention processes, identifiable and funded personnel to facilitate the meeting of program goals, and dynamic feedback loops between the institution and its employees and between the institution and patients and/or other members from the surrounding community (Tervalon).
Social Autopsy
Social autopsy is based on individual-level factors that affect death rates within a broader context of neighborhoods, social-service systems and government programs in order to provide a multilayered analysis of what happened,(talking about the heat wave in Chicago in 1995 that killed 700 people and examining the social, political, and institutional organs of the city that made this urban disaster so much worse than it ought to have been)
Social Vs. Cultural
the term social refers to the interaction that exists within a society. This includes the co-existence of individuals with one another. Additionally, at times the actions and interactions that take place between one another can either be voluntary or involuntary based on the circumstances. On the contrary, culture is more clearly defined as the act of developing intellectual and moral faculties based on social norms, customary beliefs, human knowledge, and racial and religious traits. Culture is not necessarily the interaction but the development that takes place from being a part of that society.
milestones in medical ethics
o Hippocratic Oath 400-500 BCE—→confidentiality, no abortion, no euthanasia
o AMA Code 1847 —-→Withhold bad news & Protect, respect colleagues
o Nuremburg Doctor Trials 1945—-→Research Consent
o Beecher article NEJM 1960—-→Research Informed Consent
o Rights Movements 1960’s —-→ Clinical Informed Consent
o Tuskeegee USPHS Syphilis Study 1927-70 —–→ Institutional Review Boards
o Dialysis allocation 1970’s —–→Distributive justice, Decision making & End Stage Renal Disease (ESRD) entitled
o Medicare/Medicaid (1975) and Health Care Reform(2010)—→ non-discrimination, age (not means) and poverty are entitled, access expanded with individual and employer “mandates”
o EMTALA (1986) Acuity, severity, delivery are entitled, unfunded
o Karen Quinlan Case 1976—-→Right to Die, Ethics Committees
o Patient Self Determination Act 1990—-→Advance Directives
o AIDS (1980’s) and SARS epidemics —-→Quarantine, Duty to Warn and to Treat
o AIDS (1980’s), SARS (2003), Influenza (2009) epidemics. —-→Quarantine, Duty to Warn and to Treat, Triage
. (From Jay Jacobson power point in module 4)
Gender differences in illness/sick roles
Men get sicker, but women die quicker slides
o Men in industrialized countries get killer diseases earlier
o Women have more non-life threatening illnesses due to stresses
Women are more likely to attempt suicide
o Men
• More prone to chronic and life-threatening diseases (ie heart attacks) because:
• Lifestyle
• Occupations
More likely to succeed at suicide because of deadlier methods
• Healthier when married, but suffer mentally and physically after divorce, separation, or death of spouse
What is the burden of informal caregiving? How many are there and how much do they cost?
Care givers have 20% more likelihood of mental problems.
estimated value of unpaid caregivers is $450 billion dollars.
42 million care givers in the US.
13% of Americans are care givers (42Mil / 313Mil).
What are the five sexes?
Male
Female
“Herms”- true hermaphrodites with testes and ovaries
“Merms”- male pseudo-hermaphrodites who have testes with combined with some aspect of female genetalia
“Ferms”- females pseudo-hermaphrodites who have ovaries combined with some aspect of male genetalia
What is the greatest indicator of an infant’s health?
pgs 168-169 in The Social Medicine Reader. Socioeconomic status of the mother. “In industrialized countries, the condition that enables us to predict with the greatest accuracy whether or not a baby will be stillborn, sick, malformed, premature, or will die in the first year, is the mother’s socioeconomic status. If she belongs to a disadvantages social class this means, among other things, low income, poor health, hard domestic and extra-domestic work, low educational level, and bad housing”.
Significance of the eugenics movement.
g 30 of The Social Medicine Reader.”Rather., I believe the history of eugenics is valuable because it makes so dramatically visible the cultural value judgements that are inevitably part of defining any human difference as a disease or a disability and identifying any specific factors as “the” cause.
Remember, the eugenics movement was based on the idea that beautiful people were morally better, and healthier as well, and that uglier people were the opposite. The idea was to create a more beautiful society, and therefore healthy society, and basically allow doctors to let those who were “unfit” die rather than try to save them. Recall the story about the baby who was born with a defect, and the doctor was advising the parents to just let the baby die. The significance of the movement would be that illness was associated with physical ugliness, and that these people are somehow inferior to beautiful people, thus allowing them fewer options in life and medical care.
What can healthcare providers do to reduce health disparities?
Cross-cultural education including: Attitudes Knowledge Skills Standardized data collection: Would allow researchers to: Better disentangle factors that are associated with healthcare disparities Help health plans to monitor performance Ensure accountability Improve patient choice Allow for evaluation of intervention Help identify discriminatory practices The limitations are ethical, fiscal, and logistical concerns
Medicalization of aging, particularly in men and symptoms of declining testosterone
Typical signs of aging in men—now called “Andropause”
PADAM-Partial androgen deficiency in aging men
With the medicalization of aging in men comes treatment for the symptoms of declining testosterone with a new drug called Androgel
Low quantities of testosterone can cause decreased:
Muscular strength
Libidos
Bone density
⇨ Pretty much just signs of old age…
Medicalization of aging:
• Opportunity for pharmaceutical companies
• 45 million men > 50
• Billions dollars
• #36 out of 100
