Mod 1-2 Quiz Flashcards
Explain the Steps in evidence-based public health process (P.E.R.I.E)
- Problem: what is the health problem (what)
Person, place, time -> describe using rates (ex. Case fatality) - Etiology: What is/are the contributory causes?
What contributes to disease -> use math tools and biostatistics
Population compares -> generate hypotheses
Ex. Cause and effect w/ smoking cigs and lung cancer
3 studies
Case-control or retrospective -> establish individual association
Cohort/ prospective -> establish the cause and effect
Randomized trials or studies -> how does changing the cause affect the effect - Recommendations: what works to reduce the effects
Evidence from above steps summarized and interventions are suggested - Implementation: the how can we change this?
Use “when-who-how” approach
When -> ask about timing of disease when intervention occurs
Who -> who to direct intervention too
How -> how to implement interventions - Evaluation: how well does the intervention work?
Look at how well implementations have lowered health impact on disease
Public health terms of morbidity and mortality
Burden of disease -> how much morbidity and morality occur due to a disease
Describe the course of a disease in terms of incidence, prevalence, and case-fatality
How often, how likely to be present, and what happens when it occurs?
Case Fatality: the chances of dying from a condition once it is diagnosed
Incidence Rate = # of new cases in a year/# of people in the at-risk population (measure chances of developing the disease)
Prevalence Rate = # of people living with the disease / # in at-risk population (point in time, those with it at the time)
Prevalence = Incidence x duration
How does distribution of disease may be used to generate hypotheses about the cause of a disease
Allows epidemiologists to find group associations or patterns in the frequency of a disease
Examine to understand
Person -> demographic like behaviors, characteristics
Place -> geographic location, people connections
Time
Describe the approach used in public health to identify a contributory cause of a disease
Cause is associated with effect at the individual level
- Case-Control Studies
Cause precedes effect in time
-Cohort Studies
Altering the cause alters the effect
- Randomized Controlled Trials or Natural Experiments
Explain the upstream/downstream metaphor for public health approaches
- Pulling bodies out of the river downstream and public health people go upstream to see why people are falling in the river in the first place
- Addressing problems early on, focus on preventive measures (upstream)
- addressing treatment when disease is already present (downstream)
-Ex. addressing malnutrition in a low-income community by making access to healthy foods more affordable
Epidemiology Video definition
- the science that considers the demographic, the geographic and the temporal distribution of exposures and outcomes and the causative relationship between them
Epidemiology Video Distribution and Causation
- Distribution: how various diseases or states of health are distributed in society (outcomes and exposures)
- Causation: extent to which these exposures really do or don’t translate into changes in outcomes or the health status of people and populations
Core Disciplines
- biostatistics
- epidemiology
- environmental health science
- health policy management
- social/ behavioral sciences
Burden of Disease
the occurrence of disability and death due to a disease
Morbidity
disability
Mortality
death
Course of Disease
asks how often the disease occurs, how likely it is to occur again, and what happens once it does occur
Rate
any type of measurement that has a numerator and a denominator where the numerator is a subset of the denominator
- Numerator measures number of times event occurs (individuals)
- Denominator measures the number of times the event could occur
Case Definition
define the criteria they are using to measure the occurrence of the disease
Incidence Rates
measure the chances of developing a disease over a period of time (# of new cases of disease during the year / # of people in the at-risk population)
- Helps establish the cause of the problem (etiology)
- Morality rates -> measure burden of disease
Case-Fatality
the chances of dying from a condition once it is diagnosed
RE-AIM
Reach, effectiveness, adoption, implementation, maintenance
- RE -> evaluating the potential of the intervention for those it is designed to include or reach (often applied beyond groups that were investigated)
- AIM -> examine the acceptance of the intervention in clinical and public practice in short and long term
Population Health
the totality of all evidence-based public and private efforts throughout the life cycle that preserve and promote health and prevent disease, disability, and death
Focuses on the big picture issues and determinants of disease
Public Health
all we do together to promote and preserve health and prevent disease, disability, and death
Focus more on health promotions and disease prevention for populations
Addresses health at a population level
Health
physical, mental, and social well-being
Individual or population level
Give 3 examples of how public health affects everyday life
Vaccinations
Tabacco Control
car safety, like wearing a seatbelt
Health Protection Era
up to 1830
Authority-based control of individual and community behaviors
Hygiene Movement
1840s-1870
Sanitary conditions as basis for improved health
Contagion Control
1880-1920s
Germ theory: demonstration of infectious origins of disease
Filling Holes in the Medical Care system
1950s-mid 1980s
Integration of control of communicable disease, modification of risk factors, and care of high-risk populations as part of medical care
Health Promotion/ Disease Prevention
Focus on individual behavior and disease detection in vulnerable and general populations
Present Times
Population health era:
- Considers all of the ways society is affected by and responds to health issues
- Evidence-based approaches
- Addressing shared health concerns of society
Determinants of Disease
underlying causes, the causes of causes
ex. smoking causes lung cancer but why does one smoke in the first place and how are they exposed to it
BIGGEMS
Behavior: actions that increase exposure to factors that produce or protect one from disease (wearing or not wearing a seatbelt)
Infections: Direct cause of disease
Genetics: Roles genetic factors play in development of disease
Geography: influences the frequency and presence of disease, special locations required to produce disease
Environmental: Built environment, kind of connect with geographical
Medical Care: access to and quality of medical care (high amount of people vaccinated that could protect unvaccinated as well)
Socioeconomic-cultural: Education, income, and occupational status
Religion and cultural beliefs becoming a factor
Differences between public health and medicine
Public Health:
- population
- public serve ethic
- prevention
- stimulated by threats to population health
Medicine:
- individual
- personal service ethic
- diagnosis and treat individual
- stimulated by needs of patients
health care
Includes the delivery of services to individuals on a one-to-one basis
Ex. Services for those who are sick with diseases as well as asymptomatic
Traditional public health
population based preventive idea by using interventions targeting communities/ populations along with vulnerable groups
- Communicable disease control
- Reduction of environmental hazards
- Food and drug safety
- Nutritional and behavior risk factors
Shared goal of health care and traditional public health
directly affect the health of those they reach
Public Policy Interventions
aims at achieving other non-health goals, interventions with another non-health-related purpose, which have SECONDARY impacts on health
ex. increase education, alter nutrition, address socioeconomic disparities through change in taxes, globalization
Demographic Transition
impact of falling childhood death rates and extended life spans on the size and age distribution of populations
Population Pyramids
useful for displaying the changes in the age distribution over time
Epidemiological Transition (or public health transition)
As social and economic development occurs, different types of diseases become prominent
Nutritional Transition
countries frequently move from poorly balanced diets to that of highly processed food -> cause over and under nutrition
High-risk approach
focuses on populations at highest risk or greatest likelihood of developing disease
Improving-the-average-approach
everyone is at risk (like getting the flu)
Reducing Health disparities
linked to differences in access to healthcare, income, built environment, and other social determinants of health
4 components of population health
Health issues
Historical: physical
Current: Physical and mental
Emerging: cosmetic, genetic, social functioning
Populations
Historical: geographically limited
Current: local, state, national, global, governmentally
Emerging: local, national, global communications
Society’s shared health concerns
Historical: communicable disease
Current: toxic substances, product and transportation safety, communicable diseases, costs of health care
Emerging: disasters, climate change, technology hazards, emerging infectious diseases
Society’s vulnerable groups
Historical: high-risk maternal and child, high-risk occupations
Current: disabled, frail elderly, uninsured
Emerging: immunosuppressed, genetic vulnerability
Contributory Causes
the immediate causes of disease (HIV and smoking)
Social Determinants of Health
Education access and quality
Economic stability
Healthcare access and quality
Neighborhood and built environment
Social and community context
Video: Public Health
Population Based Approach
Upstream focus
Maintain health behaviors
Holistic treatment
Includes all of the organized and holistic efforts to improve policy, education, and access to make the healthiest choice the easiest choice
Video Public Health: what do professionals do
- Works to understand: gather information how we intervene and act (surveillance and research)
- Understand their magnitude and distribution to allow interventions plans to be made
- Act: prevention, care and treatment -> ensure health systems are in place to provide care
How do Epidemiologists Investigate Explanations for changes in the distribution of disease?
May be artifactual rather than real for 3 different reasons
- differences or changes in interest in identifying the disease
- differences or changes in ability to identify disease
- differences of changes in the definition of the disease
What is the Implication of a Group Association?
group association: a hypothesis that requires investigation at individual level
can be mislead by suggesting relationships that don’t exist at individual level and can indicate the presence of a confounding variable (a third variable in cause and effect)
What does contributory cause imply?
implies the “cause” increases the chances of the “effect” happening
Note: does not guarantee a disease will develop or not develop (sufficient or necessary cause)
Sufficient Cause
If cause present then disease will occur (A is sufficient to cause B)
Necessary Cause
If cause is present, disease doesn’t always occur but can’t occur unless the cause is present
Approaches to Population Health
Health Care: systems for delivering one-on-one individual health services, including those aimed at prevention
Traditional Public Health: group and community based interventions directed at health promotion and disease prevention
Social Interventions: non-health-related intervention that have 2nd impacts on health (increase education, alter nutrition)
