PB 1 MID, ch 1, ch 2, ch 12, ch 3 Flashcards
Public Health- 2 definitions
The science and the art of preventing disease, prolonging life, and promoting health through organized community efforts (WINSLOW)
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 (KIRKWOOD)
Six historical eras
Health Protection
Hygiene Movement
Contagion Control
Filling Holes in the Medical System
Health promotion and disease prevention
Population Health (2000s)-
Health Protection
1
Antiquity - 1830s) - control based on individual and 1
community behaviors
Hygiene Movement
2
(1840-1870s) - sanitary condition as a foundation for improved health
Contagion Control
3
(1880-1940s) - germ theory of disease; demonstration of infectious origins of disease
Filling Holes in the Medical System
4
(1950s - mid1980s) - integration of control of communicable diseases, risk factor modification, and care of high risk populations as part of medical care
Health promotion and disease prevention
5
mid1980s-2000s)- focus on individual behavior and disease detection in vulnerable populations
Population Health
6
(2000s)- coordination of public health and healthcare delivery based on evidence based, systems thinking, holistic interdisciplinary thinking of multiple contributing factors to health
Levels of prevention- base to top
Primordial Prevention
Primary Prevention
Secondary Prevention
Tertiary Prevention
Primordial Prevention
targets social and economic policies affecting health, what is creating this
Primary Prevention
targets risk factors leading to injury/disease
Secondary Prevention
prevents injury/disease once exposure to risk factors occurs but still in early preclinical stage
Tertiary Prevention
rehabilitating persons with disease/injury to reduce complication
Population Health approach
- Health issues - physical and mental, health behaviors
- Populations - expands beyond geographic confines and forces us to consider ideas of global community
- Society’s shared health concerns- toxic exposures from physical environment or risk factors like climate change, cost of healthcare, transportation safety
- Vulnerable groups- mothers and children, people with high risk occupations, disabled, elderly, poor or uninsured, people with genetic vulnerabilities, marginalized groups
BIG GEMS
what caused the cause that affects health
behavior
infection, genetics, geography, environment, medical care, socioeconomic-cultural
Contributory causes how established
- Potential cause is associated with the potential effect, a correlation
- Potential cause precedes the potential effect, does time ordering exist
- Altering the potential cause, alters the potential effect
Risk factors
an exposure that increases the probability of developing disease
High risk approach
people with the highest probability of getting a disease and aims to bring their risk close to the levels that are experienced by the rest of population
Improve the average approach
aim to reduce risk for everybody assuming that everyone is at some degree if risk
Demographic Transition
impact of falling childhood rates and extended life spans on the size and age distribution
Epidemiologic Transition
social and economic development occurs, so different types of disease become prominent
Nutritional Transition
implies that countries frequently move from poorly balanced diets to a diet of highly processed food
The 3 core functions that governmental public health agencies need to perform
- Assessment - obtains data that defines the overall population and specific groups within the population
- Policy development - develop evidence based recommendation and other analyses of options to guide implementation
- Assurance - governments public health’s responsibility ensuring that key components of an effective health system are in place even they won’t perform the implementation
Framework for viewing governmental public health agencies & their complex connections
look at diagram in study guide for answer
PERIE
steps of an evidence based public health approach
1. Problem
2. Etiology - the contributory causes
3. Recommendations
4. Implementation
5. evaluation
Epidemiology
the study of the distribution and determinants of disease frequency in human populations
Epidemic
an increase in the frequency of a disease above the usual and expected rate(endemic rate)
Endemic
present at all times but at a low rate
Morbidity
disability, sickness, injury, any departure from a state of physiological or psychological well-being
Mortality
death
Prevalence
people who have disease at certain time / the number of people in the population
What are prevalence and incidecne rates measure
measures of morbidity and mortality
Incidence
number of new cases during a specific time / people at risk at that specific time
Confounder/confounding variable
no evidence of an association at the individual level (ice cream and drawing example)
Ecological analysis
analyze surrounding area and the confounding factors that may cause disease OR an assessment of the impact of an alteration of the physical environment
Artifactual
differences between populations or changes in a population over time due to
1. Difference or changes in the interest in identifying the disease
2. Differences or changes in the ability to identify the disease
3. Difference or changes in the definition of the disease
Case-Fatality Rate
the chances of dying from the disease once its diagnosed
Mortality / incidence rate times 100 percent
Case-Control Study
for requirement #1
Compares individuals with a disease with individuals who do not to identify possible exposure
Cohort Study
for requirement #2
Compares individual exposed and individuals not exposed and follow both over some time to compare the incidence of disease/ who develops it
Randomized Controlled Trial (RCT)
for requirement #3
Randomly assign exposure or control studies and follow over time to compare results
Randomization
part of randomized controlled trial, using chance process to assign people to a specific group of the trial
Efficacy
an intervention increased positive outcomes pr benefits in the population that it was investigated for
Effectiveness
an intervention has been shown to increase in positive outcomes in the population in which it will be used
Strength of a relationship
supportive or ancillary criteria (extra info for establishing a contributory cause) that the magnitude of an association is large
—What is the magnitude of the observed association between an exposure and the likelihood of an outcome
Relative risk
probability of developing the disease if the risk factor is present vs no risk factor present
Probability of getting disease with risk factor / probability of disease without the disease
—More than 1.0 - risk- increased risk in exposed group vs non exposed group
—=1.0- no creased risk of disease
—-Less than 1.0 - protective effect- decreased risk in the exposed groups
Dose-response relationship
relationship that is present if changes in levels of exposure are associated with changes in the frequency of the outcome
Consistency of the relationship
ancillary data implying that the relationship has been observed in a wide range of populations
Do you see similar results
Biological plausibility
ancillary criteria for contributory causes in which the disease can be explained by what is known about the biology of the risk factor
To affect health, theres has to be a biological mechanism
Necessary cause
cause must be present for disease to occur
Sufficient cause
if cause is present, disease will occur
Recommendations
statements based on evidence indicating actions will improve an outcome
Dissemination
the widespread circulation of information aimed at integrating into public health or clinical practice
Public health surveillance
collection of health data as the basis to monitor and understand health problems
Vital statistics
data on births, deaths, and other events/ a source of public health data
Life expectancy
probability of dying at each age of life in a particular year
Health-adjusted life expectancy (HALE)
quality of health
—Quality health measurement times life expectancy
Ed Yong Atlantic article about public health getting back to its roots
Evolution from advocacy and societal issues towards more personalized conception of health
Will it return to original of just promoting health
Without society issues
