Intro to PH Flashcards
Note Lecture Objectives:
1) recognize the differences between public health and clinical medicine
2) identify the effect that public health measures have made on life expectancy in the US
3) explain the effect public health has had on the types of disease affecting US citizens
4) identify the 3 core functions of public health
5) recognize the key elements of the US public health infrastructure
6) understand the relationship between federal, state, and local public health agencies
What is public health according the the first chair of department of public health at Yale?
science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals
What is the focus of PH vs clinical medicine?
communities vs individual
What is the emphasis of PH vs clinical medicine?
prevention of disease/promotion of healthy behavior vs diagnosis and tx of disease
What are the interventions of PH vs clinical medicine?
organizationally developed and delivered vs personally developed and delivered
Clinical medicine is…
obvious and discrete
Public health is…
invisible and ubiquitous
Clean air act 1970
regulated industrial air pollution
FDA and USDA regulate
food safety
Early efforts in public health:
Hippocrates 4th century BC thought of avoiding disease by moving away from where people are sick
Rome public health efforts:
sewers and running water 100 AD
Who is the father of epidemiology?
John Snow- conducted the 1st outbreak investigation in London 1854; cholera from water transmission at Broad Street pump
Define epidemiology:
the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health
How many of the top 10 causes of death were related to infectious disease in 1900?
4; top 3 are related to infectious disease
How many of the top 10 causes of death were related to infectious disease in 2010?
1; infectious disease accounted for 2.2% of deaths
What is the shift of public health focus?
from infectious disease to chronic noninfectious disease
What are examples of non-infectious airway diseases?
emphysema, asthma, chronic bronchitis; often attributed to smoking and pollution
What are the top 2 causes of 2010 deaths?
heart disease and cancer
What is the most common cancer?
lung
Where did COVID fall for cause of death in 2020?
3rd; will likely be 2nd in 2021
How has COVID infection changed over the past few months?
It occurs in a cyclical nature with peaks before vaccination and then with new variants
What is the average life expectancy for people born in 1997?
76 years
How has public health affected life expectancy?
25 years have been gained since 1900 from advances in public health (mostly improvements in infant mortality)
What is the #1 greatest public health achievement?
control of infectious diseases via clean water and better sanitation as well as antimicrobial therapy
T/F death rate due to infectious disease was declining before antibiotics or vaccines were even invented
true, due to public health initiatives
Introduction of vaccines
Salk vaccine for polio introduced around 1950; protect through herd-immunity; vaccines are very effective
What has lead to a recent uptick in vaccine-preventable illnesses in the US?
immigration and reduced vaccination rates
Prevention of heart disease and stroke
reduced death rates for coronary heart disease 51% since 1951, risk-factor modification
What are risk factor modifications for heart disease and stroke?
early detection and better treatment, smoking cessation, blood pressure control
Motor vehicle safety
car and roadway safety, seatbelts, education of car seats and distracted driving, traffic laws, federal funding
Safer workplaces
40% reduction in fatal injuries since 1980 (about when OSHA was developed); reduced work-related health problems and fewer severe injuries and deaths related to mining, manufacturing, construction, and transportation
Fluoridation of drinking water
40-70% fewer dental caries in kids and 40-60% fewer teeth lost in adults; safe and inexpensive wide reaching action
Safer and healthier foods
decrease in microbial contamination, increases in nutritional content, establishing food-fortification programs
1900s food safety developments
1905 The Jungle; 1906 Food and Drug Act
Food fortification
identifying essential micronutrients and establishing food-fortification programs have almost eliminated major nutritional deficiency diseases such as rickets, goiter, and pellagra in the US; iodized salt, niacin, vit D, folic acid
Recognition of tobacco use as a health hazard
1964 the US surgeon general released a landmark report that marked the Federal governments official recognition smoking as a health hazard and a likely cause of lung and throat cancer
Smoking prevalence 1965 vs today
‘65= 42% of adults, today 20%
Healthier mothers and babies
since 1900, infant mortality has decreased 90% and maternal mortality has decreased 99%
Decrease in mother/infant mortality attributed to:
better hygiene and nutrition, availability of antibiotics, greater access to health care and technologic advances in maternal and neonatal medicine
Where does the US rank worldwide with infant mortality?
45th
Family planning
smaller family size, longer interval between births; access to family planning and contraceptive services has altered social and economic roles of women
3 Core functions of public health
policy development, assurance, assessment and monitoring
Assessment and monitoring
tracking diseases, injuries, # of available health care providers to see where problems exist and which ones need to be addressed first; formulating public policies- developing a solution; working with the government and community to change the law, develop a program or provide support for existing agencies to address public health issues
Assurance
follow up, making sure the changes work; difficult and thankless but very important to proper functioning of PH systems
What is based off the three core functions?
the 10 essential public health services
Assess and monitor population health status, factors that influence health, and community needs and assets
disease surveillance: flu, diabetes, drug use, poverty and healthcare access
Investigate, diagnose, and address health problems and hazards affecting the population
household lead and air quality evaluation and difference in health outcomes between races
Communicated effectively to inform and educate people about health, factors that influence it, and how to improve it
anti-smoking campaigns, seatbelts, childhood vaccinations, obesity, safe sleep for babies
Strengthen, support and mobilize communities and partnerships to improve health
health care delivery- churches for diabetes education, salons for domestic abuse prevention
Create, champion and implement policies, plans and laws that impact health
federal regulations on cigarette advertising, allowing low-income seniors to use food aid at farmer’s market downtown
Utilize legal and regulatory actions designed to improve and protect the public’s health
local and state agencies fine and tax industries and businesses through air and water quality regulations
Assure an effective system that enables equitable assess to the individual services and care needed to be healthy
community health centers, community hospitals, NHSC
Build and support a diverse and skilled public health workforce
training through the schools of public health and CDC; voluntary licensing exam
Improve and innovate public health functions through ongoing evaluation, research and continuous quality improvement
research through agencies and the schools of public health and CDC
Build and maintain a strong organizational infrastructure for public health
at all levels but emphasized in schools and federal agencies
Kentucky scope expansion assessment and monitoring
high demand for eye care with low supply of providers for needed services
Kentucky scope expansion formulating public policies
expand the scope of ODs 2011
Kentucky scope expansion assurance
number of YAGs and SLTs performed by ODs, #RDs among treated patients, additional income of paitents due to more days at work, decrease in insurance payments due to improved quality of life
Kentucky scope expansion direct and indirect costs
direct: miles driven by treated patients; indirect: low revenue of patients’ employers due to absenteeism
Mandatory eye exams for children assessment and monitoring
untreated eye and vision disorders in US school children
Mandatory eye exams for children formulating public policies
mandatory eye exams for school children
Mandatory eye exams for children assurance
children receiving eye exams, reading scores for children before and after law enacted, cost of eye exams compared to lifetime impact of untreated vision disorders
Eye care needs in nursing homes assessment and monitoring
untreated eye and vision disorders in nursing home residents in the US
Eye care needs in nursing homes formulating public policies
change medicare regulations for nursing homes to require eye care
Eye care needs in nursing homes assurance
nursing home residents receiving eye exams, impact of eye care on medicare expenditures in nursing homes, # of ADLs performed by nursing home patients
Linchpin of the US public health system
public health agency, but the system has many entities
Centers for disease control and prevention mission
collaborating to create the expertise, info, and tools that people and communities need to protect their health through health promotion, prevention of disease, injury and disability, and preparedness for new health threats
What is the CDC under?
US Department of Health and Human Safety
How did the CDC begin?
1942 Office of National Defense Malaria Control Activities –> 1946 Communicable disease center
Primary functions of CDC
monitor health, detect and investigate health problems, conduct research to enhance prevention, develop and advocate sound public health policies, implement prevention strategies, promote healthy behaviors, foster safe and healthful environments, provide leadership and training
What is the national notifiable disease surveillance system?
annual disease recommendations from the Council of State and Territorial Epidemiologists, CDC and state health departments determine nationally notifiable disease
Who reports notifiable diseases?
voluntary from state to CDC; regulated on state level
All states generally report internationally quarantinable diseases like…
cholera, plague, yellow fever
Where is disease info typically de-identified
local or state level
What are reportable diseases in TN?
chlamydia, gonorrhea, HIV/AIDs, Nontuberculous mycobacteria infection, syphilis, TB latent or active
What do state departments of health do?
provide training, leadership and resources
What do city, county or regional departments of health do?
report to state and federal agencies, 10 essential public health services
Describe TN public health budget
Public health programs receive 1% of state budget in TN, and 50% of PH budget goes toward inmate health
What are some of the regional departments of health responsible for?
disease surveillance, epidemiology and prevention, provisions of primary health care services for the uninsured and indigent, overall planning, coordination, administration, and fiscal management of public health services
How are ODs involved in the public health workforce?
part of the 3000 county and city health department individuals or the 3000 local boards of health
What doe boards of health do?
advise department directors on public health policy, emergencies, and control of health hazards; review department rules and program proposals; recommend solutions to public health issues
What is the US Public Health Service Commissioned Corps
one of 8/9 uniformed services in the US; mission is to promote, protect, and advance the health and safety of the USA
How is the US Surgeon General chosen?
appointed by the President
Where does the US PH service commissioned corps work?
CDC, FDA, human resources and service administration, center for medicare service, indian health services, national institute of health
