Midterm Flashcards
What is the definition of public health?
There are many different definitions, but the one shown in class is: "The art and science of preventing disease, prolonging life and promoting health through the organized efforts of society"
Name 5 disciplines from which public health draws.
Epidemiology
Sociology
Behavioral science
Immunization
What is the main goal of activities to maintain public health capacities and service?
To provide conditions under which people can maintain to be healthy, improve their health and well-being, or prevent the deterioration of their health.
Where does public health focus on the spectrum of well-being?
Public health focuses on the whole spectrum of health and well-being. Not only on the eradication of particular diseases.
Name examples of public health activities/services that target individual persons.
Vaccination, behavioural counselling, health advice…
What are the 5 main goals of public health?
- Create conditions that create opportunities to be healthy (behaviours), by policies, programs, law.
- Create conditions that prevent disease
- Create science and new knowledge to inform public health actions
- Evaluate impacts of policies and programs
- Engage communities
What are the functions of the Public Health Agency of Canada?
- Empower canadians to improve their health
- Focuses on preventing diseases and injuries, promoting good physical and mental health
- Provide information to support informed decision making
- Values scientific excellence and provides national leadership in response to PH threats
What is the “Programme National de Santé Public” (PNSP)?
It defines public health services offered by the department of health and social services and its network for the 2015-2025 period
It structures the PH actions to maintain and improve the health of the population through quality services, which are adapted to the specific needs and realities of all territories of quebec.
The offer of services targets people and their living environment, paying particular attention to the most vulnerable groups, thereby helping to reduce social inequalities in health
Name the 5 core functions of public health.
- Health Assessment
- Health surveillance
- Health promotion
- Injury and disease prevention
- Health protection
Explain the health assessment function of public health
Serves to identify what influences health on a population (e.g. risks and contributing factors) and develop priorities for policies programs and services for the public.
Explain the health surveillance function of public health
Using multiple sources and data systems at a local, provincial and national levels. It gathers, analyses and interprets information on the health of the population.
Explain the health promotion function of public health
Empowering communities to take control over the determinants of their health.
Explain the injury and disease prevention function of public health
Applying well-known knowledge that is readily available about preventing disease – e.g. seatbelts, immunizations, PA
Explain the health protection function of public health
Ensures that people are supplied with clean drinking water, communities are protected from environmental threats and infectious diseases. e.g. restaurant inspections, child care facility inspections, water quality…
What are the 5 PH actions for health promotion?
- Strengthening community action
- Creating supportive environments
- Developing personal skills
- Building healthy public policy
- Reorienting health services
Name the 7 core competencies for PH in Canada.
- Public health science
- Assessment and analysis
- Policy and program planning, implementation and evaluation
- Partnerships, collaboration, advocacy
- Diversity
- Communication
- Leadership
Explain the public health science competency of PH.
Includes key knowledge and critical thinking skills related to the public health sciences: behavioural and social sciences, biostatistics, epidemiology, environmental public health, demography, workplace health, and the prevention of chronic diseases, infectious diseases, psychosocial problems and injuries. Competency in this category requires the ability to apply knowledge in practice
Explain the assessment and analysis competency of PH.
Collect, assess, analyze and apply information (including data, facts, concepts and theories). These competencies are required to make evidence-based decisions, prepare budgets and reports, conduct investigations and make recommendations for policy and program development.
Explain the “policy and program planning, implementation and evaluation” competency of PH.
Competencies needed to effectively choose options, and to plan, implement and evaluate policies and/or programs in public health. This includes the management of incidents such as outbreaks and emergencies.
Explain the “partnerships, collaboration, advocacy” competency of PH.
Competencies required to influence and work with others to improve the health and well-being of the public through the pursuit of a common goal. Partnership and collaboration optimize performance through shared resources and responsibilities. Advocacy–speaking, writing or acting in favor of a particular cause, policy or group of people–often aims to reduce inequities in health status or access to health services.
Explain the diversity competency of PH.
Identifies the socio-cultural competencies required to interact effectively with diverse individuals, groups and communities. It is the embodiment of attitudes and practices that result in inclusive behaviors, practices, programs and policies.
Explain the communication competency of PH.
Involves an interchange of ideas, opinions and information. This category addresses numerous dimensions of communication including internal and external exchanges; written, verbal, non-verbal and listening skills; computer literacy; providing appropriate information to different audiences; working with the media and social marketing techniques.
Explain the leadership competency of PH.
Competencies that build capacity, improve performance and enhance the quality of the working environment. They also enable organizations and communities to create, communicate, and apply shared visions, missions and values.
Who is the father of epidemiology?
John Snow
What did John Snow do which was the basis of public health?
He mapped the cholera cases in East London and connected them to a single well on Broad Street that was contaminated by sewage.
What did Robert Koch do?
He identified the bacteria as the cause of infection which led to the development of vaccination
Name the 6 eras in the evolution of public health and the years they were in.
- Health Protection (antiquity - 1830s)
- Miasma control (1840s - 1870s)
- Contagion control (1880s - 1930s)
- Preventive Medicine (1940s - 1960s)
- Primary health care (1970s-1980s)
- Health Promotion (1990s - now)
Explain the health protection era.
Went from antiquity to 1830s
Thought diseases might be prevented by enforced regulation of human behaviours through societies’ social structures
There were religious and cultural rules that were thought to protect the health of individuals (e.g. quarantine for epidemics, sexual relations and alcohol drinking)
What was the legacy of the health protection era to contemporary public health?
Quarantine of illegal migrants; enforcement of some environmental protection laws; aspects of spirituality in prevention and coping with disease; some occupational and transport safety laws.
Explain the miasma control era.
From the 1840s to the 1870s.
Wanted to address unsanitary environmental conditions to prevent diseases (they demonstrated that poor health and epidemics resulted from unsanitary physical and social environments) –> started minimum standards of drainage, sewage and refuse disposal
What was the legacy of the miasma control era to contemporary public health?
Healthy cities initiatives such as potable water and sanitation programs, foundations of modern epidemiology and surveillance. Public health included in legal framework.
Explain the contagion control era.
Lasted from the 1880s to the 1930s.
Germ theory: Positivist approach to demonstration of infectious origins of disease. Demonstrated presence of micro-organisms that cause disease in infected media. Led to improved water filtration processes, vaccination, and standardized disease outbreak control measures.
What was the legacy of the contagion control era to contemporary public health?
Evidence-based PH practice, ethical vaccination practice, foundations of international cooperation in health, foundations of modern chemotherapy.
Explain the preventive medicine era
From the 1940s to the 1960s. Improvements in PH through focus on the prevention and cure of diseases in high-risk groups
Based on analysis of definition and interventions for disease transmission. Also treatment of communicable diseases and primary care of special populations (pregnant women, factory workers…)
Did environmental interventions to target disease vectors (e.g. mosquitoes), identification and use of useful microbes, enhanced medical care for high-risk groups, foundations of modern clinical pathology
What was the legacy of the preventive medicine era to contemporary public health?
Focus on “high-risk” groups in the planning and implementation of PH programs
Improved understanding of pathogenesis of communicable and non-communicable diseases
Explain the primary health care era
From the 1970s to the 1980s
Focuses on health for all: HC geared toward the community, for the community and by the community. Preventative approach which emphasizes on equity, community participation, accessibility of services and social determinants of health.
Emphasizes on global cooperation, adapting health services to countries and communities, link between HC and socioeconomic development, intersectoral cooperation in health promotion and disease prevention and equity in health care
What was the legacy of the primary health care era to contemporary public health?
Concepts underpinning multicultural health and Healthy Cities initiatives, health inequalities, and community participation in health promotion activities.
Explain the health promotion era
From the 1990s to now.
Advocacy for health: Enabling individuals and communities to attain optimal health.
Individuals and communities may be assisted by educational, economic, and political actions to increase control over, and improve, their health through attitudinal, behavioral, social, and environmental changes.
Encapsulated by the key action areas of the Ottawa Charter: build healthy public policy; create supportive environments; strengthen community action; develop personal skills; and reorient health services.
Differentiate the traditional view of the health field from Lalonde’s health field concept. What did the Lalonde report bring up to the table?
The traditional view saw the art or science of medicine as the fount from which all improvements in health have flowed, and popular belief equates the level of health with the quality of medicine. The consequence of the traditional view is that most direct expenditures on health are physician-centered, including medical care, hospital care, laboratory tests and prescription drugs. A view mainly oriented to treating existing illness.
Marc Lalonde brought the term “health promotion” in 1974 and attempted to tackle wider determinants of health, and suggested that health care services were not the most important determinants of health.
Health field concept: The 4 health fields are: Lifestyle, environment, health care organization and human biology. He said that major improvements in health would result primarily from improvements in lifestyle, environment and our knowledge of human biology (not only by health care)
–> the promotion of health in future depends more on the pattern of living adopted by the individual than on technical or allied procedures…
What are the 5 action areas of the Ottawa charter?
- Build healthy public policy
- Strengthen community action
- Develop personal skills
- Create supportive environment
- Reorient health services
What is the Ottawa Charter for Health Promotion and what was it caused by?
An international agreement signed at the first international conference of health promotion, organized by the WHO in 1986
Preceded by the Lalonde’s report.
What are the 3 basic strategies for health promotion from the Ottawa Charter?
Advocate: Health is a resource for social and developmental means, thus the dimensions that affect these factors must be changed to encourage health.
Enable: Individuals must become empowered to control the determinants that affect their health.
Mediate: Health promotion’s success will depend on the collaboration of all sectors of government (social, economic, etc.) as well as independent organizations (media, industry, etc.).
What does the “build healthy public policy” action area of the Ottawa Charter include?
o Put health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health.
o Combine diverse but complementary approaches including legislation, fiscal measures, taxation and organizational change. It is coordinated action that leads to health, income and social policies that foster greater equity.
o Joint action contributes to ensuring safer and healthier goods and services, healthier public services, and cleaner, more enjoyable environments. Health promotion policy requires the identification of obstacles to the adoption of healthy public policies in non-health sectors, and ways of removing them. The aim must be to make the healthier choice the easier choice for policy makers as well.
What does the “Strengthen community action” action area of the Ottawa Charter include?
o Concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities, their ownership and control of their own endeavours and destinies.
o Community development draws on existing human and material resources in the community to enhance self-help and social support, and to develop flexible systems for strengthening public participation and direction of health matters. This requires full and continuous access to information, learning opportunities for health, as well as funding support.
What does the “Develop personal skills” action area of the Ottawa Charter include?
Personal and social development through providing information, education for health and enhancing life skills –> increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health. Enabling people to learn throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential. This has to be facilitated in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies, and within the institutions themselves.
What does the “Create supportive environment” action area of the Ottawa Charter include?
o The inextricable links between people and their environment constitutes the basis for a socioecological approach to health. Need to encourage reciprocal maintenance – to take care of each other, our communities and our natural environment. The conservation of natural resources throughout the world should be emphasized as a global responsibility.
o Work and leisure should be a source of health for people. The way society organizes work should help create a healthy society. Generate living and working conditions that are safe, stimulating, satisfying and enjoyable.
o Systematic assessment of the health impact of a rapidly changing environment – particularly in areas of technology, work, energy production and urbanization – is essential and must be followed by action to ensure positive benefit to the health of the public. The protection of the natural and built environments and the conservation of natural resources must be addressed in any health promotion strategy.
What does the “Reorient health services” action area of the Ottawa Charter include?
The responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health service institutions and governments. The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services. Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization of health services, which refocuses on the total needs of the individual as a whole person
What is health promotion?
Health promotion is the process of enabling people to increase control over, and to improve, their health.
To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs and to change or cope with the environment. Health is therefore seen as a resource for everyday life, not the objective of living.
Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being.
What is a blue zone?
A part of the world where people live much longer than average.
What is the main problem with using blue zones in regards to health promotion?
It promotes a desocialized discourse about creating healthy communities. The BZP avoids contemplation of structural determinants of health, such as income and wealth, educational attainment, employment status, or race and ethnicity. These social factors may play a large role in the US health outcomes disadvantage vis-a-vis other high-income countries.
While it has been shown possible to organize place-based, community health improvement efforts using a framework that foregrounds such social determinants, the BZP discourse almost completely ignores them, and its praxis has no remedy for these structural and persistent causes of health inequality.
Also problematic:
Due to Buettner’s (Author and founder of BZ,) holistic, place-based, and community-centered assessment of what accounts for long and healthy lives, in practice the BZP relies on modifying the built and social environment to facilitate personal practices of healthy living. In that sense, the BZP reflects the ethos of libertarian paternalism, where targeted but subtle “nudges” provoke people to adopt healthy habits and, in the process, engage in creating “healthy places”. Whatever its other effects, one consequence of the BZP is to sidestep systematic analysis of socio-structural causes of health disparities.
Name the 9 components of blue zones and briefly explain them.
- Move naturally (their environments constantly nudges them into moving w/o thinking about it)
- Purpose (knowing your sense of purpose)
- Down shift (even if they do experience stress, they have routines to shed stress, e.g. pray, nap, happy hour)
- 80% rule (Stop eating when stomach is 80% full)
- Plant slant (Meat (mainly pork) = 5x/mo. Beans and pulses are the cornerstone of most centenarian diets. Portion sizes are 3-4 oz)
- Wine at 5 (moderate and regular alcohol intake - 1 to 2 glasses per day)
- Belong (must feel like a part of something - faith based services 4x/mo increases life expectancy)
- Loved ones first (Families first, keep aging parents or grandparents nearby or in the home, commit to a partner and invest in their children with time and love)
- Right tribe (social circles that promote healthy behaviours - smoking, obesity, happiness and loneliness are contagious)
What are the differences between primary health care and health promotion?
- Looking at how the community can enable the individual
- We want communities and individuals to promote health by economic and political actions
- Focus on educational, economic and political actions
- Federal, provincial, regional policies
Explain the whitehall study and its main findings.
- Graphed all-cause and CHD mortality by grades of employment
- Examined mortality rates over 10 years among male british servants aged 20-64
- Found an inverse association between grade of employment and mortality from CHD and all-cause. Men in the lowest grade has 3x higher mortality rate than in the highest grade
- Low status was associated with other specific causes of death, (such as obesity, smoking, less PA, higher BP, shorter height…) but even controlling for those accounted for only 40% of the grade difference in CHD mortality (the risk of CHD mortality was still 2.1x higher)
What are possible explanations of the grade differences in CHD mortality?
May be d/t grade differences in job control and job support.
BP at work was associated with job stress, lack of skill utilization, tension and lack of clarity in tasks
The rise in blood pressure from the lowest to the highest job stress score was much larger among low grade men than among upper grade men (although home BP was not related to job stress levels.
–> The structure of society may get into our skin… Still looking for mechanisms that explain it.
