US Health pop. health, PH Law, gov't in PH Flashcards
Public Health
Measure of the general, overall state of health of a population or society
Measures that people take to bring about and maintain the health of a population or society
The science and the art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the
- Sanitation of the environment
- Control of community infections
Education of individuals in principles of personal hygiene
Organization of medical and nursing services for early diagnosis and prevention of disease
Development of social machinery which will ensure to every individual a standard of living adequate for the maintenance of health
Public health is the science of protecting and improving the health of families and communities through promotion of healthy lifestyles, research for disease and injury prevention and detection and control of infectious diseases.
CDC works with its partners around the world to
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 Public Health
1988 definition, The Future of Public Health by the Institute of Medicine (4 part definition)
Mission: The fulfillment of society’s interest in assuring the conditions in which people can be healthy
Substance: Organized community efforts aimed at the prevention of disease and the promotion of health
Organizational framework: encompasses both activities undertaken within the formal structure of government and the associated efforts of private and voluntary organizations of individuals
3 Core functions of PH
Assessment
Policy Development
Assurance
Assessment
The diagnostic function
Determines what should be done
Examines the health status and threats to health that exist in a community
Requires surveillance of disease, identifies needs, monitors trends and analyzes causes
Diagnoses and investigates health problems and health hazards in the community
Policy Development
Development of the treatment plan
Determines what will be done
Informs, educates and empowers people about health issues
Mobilizes community partnerships to identify and solve health problems
Develops policies and plans that support individual and community health efforts
Uses scientific knowledge to devise strategic approaches to improve community health
Assurance
Equivalent to the actual treatment plan
Determines what is being done
Enforcement of laws and regulations that protect health and ensure safety (interventions)
Link the public to health services and ensure the provision of health care
Assure a competent public health and personal healthcare workforce
Evaluate effectiveness, accessibility, and quality of personal and population-based health services
Public Health
Prevents epidemics and the spread of disease
Protects against environmental hazards
Prevents injuries
Promotes and encourages healthy behaviors
Responds to disasters and assists communities in recovery
Assures the quality and accessibility of health services
From http://www.health.gov/phfunc
Public Health vs Medical Care
Public Health
The “Patient is the Community”
Goal or focus is on prevention (abstract, difficult to quantify and recognize)
Accounts for approximately 3% of health spending
Decision makers are public health experts, involves scientific recommendation, government intervention
more related to social justice where health is a right and community responsibility
Medical Care
The Patient is an individual
Goal or focus is to treat and cure those that are ill (benefits are easier to quantify and recognize)
Accounts for approximately 97% of health spending
Decision makers are physicians, mid-level providers and the individual patient
more related to market justice where health is a right and personal responsibility
Public Health vs Medical Care
Public Health core functions: Assessment, Policy Development, Assurance
Medical Care core functions: Diagnosis, Providing Treatment Options, Actual Treatment
PH: Science plus politics
Science: the understanding of threats to health, determine necessary interventions, evaluate efficacy of interventions
Politics: determine policies for development, implementation and assurance
Six sciences/disciplines of Public Health
Epidemiology
Statistics
Biomedical Sciences
Environmental Health Sciences
Social and Behavioral Sciences
Health policy, management and administration
Epidemiology
The basic science of public health
The study of epidemics (or common exposures, shared characteristics)
Epidemic (or outbreak) is an illness or disease that happens more often than what we desire in a population
Seeks causative factors
Aims to control the spread of disease
Seeks cause of acute and chronic diseases and strategies to limit exposure
Statistics
Data/numbers are diagnostic tools that aid in determination of risk
Government collects data on populations
Statistics also assess benefits of interventions
Biomedical Sciences
A major proportion of disease is caused by microorganisms
Prevention and control of diseases requires understanding of infectious agents
Lead to understanding of risk factors for non-infectious chronic diseases
Includes study of genetic predisposition and effects on disease risk, prevention and treatment
Environmental Health Science
A component of public health
Concerned with preventing the spread of disease through water, air and food
Shares concerns about the spread of infectious organisms
Depends on epidemiology to track environmental causes of disease
Social and Behavioral Sciences
People are negatively impacted by diseases caused by their behavior and their social environment
There are many disparities in heath between subgroups of the population, causes of the disparities are often unknown
Some subgroups of the population have poorer health overall than others related to social and behavioral sciences
Health policy, management and administration
Attempts to address
- Rising cost of healthcare
- Access to healthcare
- Quality of healthcare
- Role of public health in medical care
3 Core Functions and 6 Disciplines
How are the 6 disciplines used to accomplish the 3 core functions?
Assessment
Policy Development
Assurance
Prevention and Intervention
5 step process
1 - Define the health problem
2- Identify the risk factors associated with the problem
3- Develop and test community-level interventions to control or prevent the cause of the problem
4- Implement interventions to improve the health of the population
5- Monitor those interventions to assess their effectiveness
Prevention and Intervention
PH = prevention of disease
PH = keeping a population healthy
Prevention
Requires development of interventions aimed at specific health problems or behaviors
What are some interventions we see every day?
2 Approaches to designing interventions
Prevention at 3 levels/stages
- Primary prevention: aims to prevent an illness or injury from happening at all by preventing exposure to the risk (true prevention)
- Secondary prevention: aims to minimize the severity of the illness or injury when it occurs (early detection and treatment)
- Tertiary prevention: aims to minimize disability by providing medical care and rehabilitation
Chain of causation
Agent : could be a disease causing bacteria or virus. Goal is to eliminate or minimize
Host: a human being. Goal is to make less susceptible/strengthen resistance to agent
Environment: the means of transmission by which the agent reaches the host. Goal is to make the host less likely to encounter the environment and decrease or eliminate the means of transmission
Examples of Prevention at 3 levels/stages
Primary: discouraging teenagers from smoking and efforts to encourage smokers to quit (prevents lung cancer and COPD)
Secondary: screening programs for early cancer detection; may be showing symptoms so we want to screen and make sure and if needed enroll into a tertairy interventiion program
Tertiary: medical treatment and rehabilitation for cancer patients
Example
PH goal: prevent suicides in age group 15 to 24
what is the
host
agent
environment
Host: susceptible young people
Agent: guns, overdose
Environment: the young person’s social environment (family, school, media)
PH intervention: change messages in the media, reduce access to guns and drugs for overdose
Chain of Causation
Goal is to interrupt the chain
- Think of an illness or injury
- Identify the agent, host and environment
- Describe how you would interrupt the chain of causation related to the agent, host and environment
Public Health and Terrorism
Public health response to disasters and terrorism help control damage and prevent further harm to survivors and rescuers.
What level of prevention is this?
- Primary?
- Secondary?
- Tertiary?
Why is PH Controversial?
19th century public health closely tied to social reform movements: campaigns for improved housing, trade unions, abolition of child labor, child and maternal health
Public Health viewed as a broad social movement
Winslow’s 80 yr old definition: the role of PH is the development of the social machinery to ensure every individual in the community a standard of living adequate for maintenance of health.
Contrasting views that direct the production and equitable distribution of scarce health care resources
Distribution of benefits/burdens and responsibilities within a society
Free market vs government responsible for allocation and delivery of resources
Health care access a right vs ability to pay
Health care an individual vs collective responsibility
Role of PH in society, broad and expansive vs restrictive
Social Justice
Health is a collective responsibility
Emphasizes community well-being
Views health care as a social resource
Allocation and delivery of health care resources governed by need
Minimum levels of income, housing, employment, education and health care are fundamental rights
PH closely tied to social reform movements (public hygiene, improved housing, abolition of child labor, maternal and child health, trade unions
Emphasizes collective responsibility for health
Emphasized community well-being
Strong obligation to the collective good
Access to health care universal
Proposes public solutions to social problems (drug abuse, homelessness, violence)
Market Justice
Health is an individual responsibility
Emphasis on individual well-being
Views health care as an economic good
Allocation and delivery of health care resources governed by demand
Powerful forces of environment, heredity, social structure prevent equitable distribution of the burdens and benefits of PH
PH is an enterprise focused on controlling communicable disease or as a safety net that provides medical care to the indigent
Encouraged by MD’s
Limits federal health funding to programs run by local health departments
Medical care distribution based on the ability to pay
Access to medical care is viewed as an economic reward for personal effort and achievement
Role of government and public health
- Restricted, narrow
- Limited to a technical enterprise
Sources of Controversy
Economic impact
Individual liberty
Moral and religious concerns/values
Political interference with science
Economic Impact
PH measures may have negative impact on segment of population or industry
Those paying for PH measures may not benefit from those measures
Costs are measurable/benefits are often not
Costs may be short-term while benefits may not be immediately seen
Example of a PH initiative with significant economic impact? Discuss in groups of 3 to 4.
Tobacco industry: product labeling, bans on smoking in public places, restaurants
Lumber industry: regulations cost jobs to preserve a long term stable climate
Standing orders for Narcan in community pharmacies: high cost to insurance companies
Mandatory immunizations
Individual Liberty
To what extent can and should the government restrict individual freedom for the purpose of improving the community’s health
Restrictions on behaviors that may cause direct or indirect harm to others
Restrictions may benefit the individual or the community
Example of PH initiative affecting individual liberty?
Seat belts
Bike helmets
Extra large soft drinks
Removal of vending machines in public areas
Additional driving tests for elderly
Mandatory health screenings
Mandatory immunizations
Moral and Religious Concerns
Some PH initiatives provoke moral or religious objection
Discussion of some PH issues are offensive or embarrassing to discuss (sex and reproduction, alcohol and drug addiction, suicide and end of life decisions)
Can the government determine and enforce moral behavior?
Some religions may prohibit some common PH initiatives (birth control, immunizations)
Politics vs. Science
Presidential administrations criticized for misrepresenting and/or distorting scientific information and evidence to support its policies and political agenda
Examples:
Bush admin pressured CDC to promote abstinence only programs for preventing teen pregnancy
Promoted condom failure rates rather than place in prevention of spread of AIDS and other STD’s
Prevented publication of research on agriculture affect on antibiotic drug resistance
Handling of the AIDS crisis
Handling of drug/alcohol addiction crisis
Health Statistics
Public health workers monitor the health of a community by collecting and analyzing health data
Health statistics
Identify special risk groups
Detect new health threats
Determine success of disease state management
Help plan and evaluate success of public health programs
Are considered when preparing government budgets
NCHS
National Center for Health Statistics
Primary agency that collects, analyzes and reports data on the health of Americans
Part of the CDC
Collects data in two ways
States and local agencies periodically transmit data they have compiled from local records: vital stats, births and deaths
Conducts periodic surveys of representative samples of the population on health status, lifestyle, health-related behaviors, onset and diagnosis of illness and disability, use of health care resources
Vital Statistics
Birth Certificates
Births and deaths are the most basic and reliable and complete data set
Causes of death subject to uncertainties
Utilize birth and death certificates
Vital Statistics also include information on marriage, divorce, spontaneous fetal deaths and abortions
The state health department is generally responsible for collecting these reports and transmitting them periodically to the NCHS
Mother supplies information about the baby’s family (names, address, ages, race, ethnicity, education level)
Medical and health information supplied by hospital, doctor, birth attendant (prenatal care, birth weight, medical risk factors, complications during delivery, OB procedures, abnormalities in the newborn)
S Ch 8 - The Role of Data in Public Health
Objectives – Understand and define
Health statistics
Collecting Data
Vital Statistics
The Census
Why is this data important to public health?
NCHS surveys and other sources of health data
NHIS, NHANES, BRFSS
What data is necessary, accurate and available?
Confidentiality of data
The Census
The number of people in the population is necessary in order to convert the data collected through vital statistic systems into rates per number of people
The number of people in the population serves as the denominator when a vital statistic is used as the numerator.
To calculate age-adjusted or age-specific rates it is necessary to know how many people are in each age group
To determine sex-specific or race-specific rates, we need to know how many males and females there are in a population as well as the breakdown of races within the population
The Constitution requires that the population of the United States be counted every 10 years to determine each state’s representation in the House of Representatives
2 controversial issues
How race is determined
Ability to accurately count every individual household
A major change in the way the 2010 census was conducted was that only the most basic data was collected using a short form (included name, sex, race and ethnicity, and relationship of everyone living in the household)
American Community Survey (ACS) launched in 2005 by the Census Bureau
Same information as long form
Sent to 3 million households selected to be representative of the populations of local jurisdictions
Designed to help communities plan for transportation systems, zoning, schools, healthcare facilities, housing and social services
National Center for Health Statistics Surveys
In addition to collecting data from the states, NCHS actively conducts a number of surveys to gather additional information on the health of the American public
Two ongoing NCHS surveys
The National Heath and Nutrition Examination Survey (NHANES)
Designed to obtain detailed and accurate information
Doctors and nurses conduct physical and dental exams and lab tests on a carefully selected sample of the population
Data collected determines prevalence of chronic conditions and risk factors as well as nutritional status and its association with chronic disease
NCHS Surveys
Two ongoing NCHS surveys
The Behavioral Risk Factor Surveillance Survey (BRFSS)
Largest telephone survey in the world
Self reported data (may be less reliable)
The only available source of timely, accurate data on health-related behaviors
Conducted by the states which report their findings to the CDC
Asks questions about health status, high risk behaviors, physical activity, preventive medical care
National Youth Fitness Survey
National Survey on Family Growth
National Immunization Survey
National Asthma Survey in collaboration with the CDC National Center for Environmental Health
National Infant Feeding Practices Study
Other Governmental Surveys
EPA surveillance for health hazards in the environment
National Cancer Institute monitors long-term trends of cancer incidence and mortality through a program called Surveillance, Epidemiology, and End-Results (SEER)
The Centers for Medicare and Medicaid Services utilize billing records for research on utilization and outcomes of medical care
Is so much data necessary?
Data is critically important in making up the surveillance systems that form the basis of effective public health practice as well as the planning and evaluation efforts that are increasingly being used in public health programming
The success of intervention programs to confront a problem is evaluated based on whether they improve the statistics
Accuracy and Availability of Data
The process of data collection is always imperfect
Health information relying on surveys or voluntary reports are often incomplete or subject to bias
Census information contains errors and there are political difficulties in attempting to correct these errors
Errors exist in reporting cause of death on death certificates
Maternal deaths are suspected of being underreported because doctors fail to indicate the woman was pregnant on the death certificate
The data collection and reporting processes contain sources of inaccuracy and bias
New information technology (public health informatics) has vastly improved accessibility of information to public health workers and the general public
Confidentiality of Data
All information collected from individuals by governments for whatever purpose is considered confidential and cannot be divulged without the consent of the individual
Information is generally entered into a database without any names, addresses or personal identifiers
Exception: when someone has been exposed to a communicable disease they must be notified
Data and PH Interventions
PH problems are identified in terms of statistics
Data is the basis of the statistics utilized in PH initiatives
Success of PH initiatives is evaluated based on improvement in statistics
Government’s role in public health
Determined by law
Government’s public health activities must be authorized by legislation at the federal, state, or local levels
The body of public health law is huge, consisting of all written statements relating to health by any of the three branches of government
The U. S. Constitution
Does not mention health
Tenth Amendment states that “the powers not delegated to the United States by the Constitution…are reserved to the States respectively.
Preamble includes “to promote the general welfare”
Gives federal government authority to regulate interstate commerce and “to collect taxes…to pay the debts and provide for the common defense and the general welfare:
Federal influence over public health
Interstate commerce provision: justifies the activities of the Food and Drug Administration (FDA)
Power to tax and spend: (1967) lead to federally mandated motorcycle helmet laws as a condition of federal funding for highways
Federal government provides 50 to 80% of Medicaid funding though states and counties administer the programs
From WW II to the 1980s the federal government used its powers to widen its role in public health
Trend reversed in 1980 due to politically hostile climate in government
Movement in Congress and the Supreme Court to cut government regulations and return power to the individual states
New federalism in the 1990s
Limited Congress’s powers and returned authority to the states
Supreme Court struck down a law making gun possession within a school zone a federal offence, rejecting that gun possession was a matter of interstate commerce
New federalism lost much of its momentum after 9/11 when the role of the federal government in public health looked useful and necessary
In 2003 this movement seemed to reverse, giving federal law more power over state law
How the law works
Governments have police power (broad power) to act in ways that curtail the rights of individuals. Police powers are invoked for 3 reasons
To prevent a person from harming others (direct or indirect)
To defend the interests of incompetent persons such as children or the mentally handicapped
To protect a person from harming him or herself
Examples of police powers
Mandatory vaccinations
Occupational Safety and Health Act (OSHA)
Some may argue that prior to government implementing PH initiatives a cost benefit and feasibility analysis should be considered.
How public health is organized and paid for
Local Agencies
Have day to day responsibility for public health activities and provide the bulk of services (include collecting statistics, conducting communicable disease control programs, health screenings, immunization clinics, provision of medical care to the indigent)
Organization varies from state to state (most common is county health departments, large cities have municipal health departments, towns have boards of health, rural areas have multicounty health departments )
Funding varies from state to state, including state, federal and local taxes, fees for services
How public health is organized and paid for
State Agencies
Has primary responsibility and authority for the protection of health, safety and general welfare of the population
Most states have a state health department (Mass Dept of Public Health)
Funding depends heavily on federal money
Define to varying degrees the activities of local health departments
Charged with licensing and certification of medical personnel, facilities and services
Administer Medicaid programs
Federal Agencies
Fall under jurisdiction of the Department of Health and Human Services (HHS)
The Surgeon General is the nation’s leading spokesperson on matters of public health
Agencies include
CDC – the main assessment and epidemiologic agency (figure 3-4)
NIH – the greatest biomedical research complex in the world (Box 3-1)
FDA
The CDC
Mission is to control and prevent human diseases
Traditionally focus has been on infectious diseases (crisis oriented)
Change in focus and expanded mission includes chronic diseases, genetics, injury, violence and environmental health
NIH
The greatest biomedical research complex in the world
Supports research ranging from basic cellular processes to physiological errors that underlie human diseases
Includes the National Library of Medicine, the largest reference library for medical centers around the world
Other federal agencies with public health responsibilities
Environmental Protection Agency (EPA)
Department of Agriculture
Department of Education
Department of Transportation
Department of Labor
Department of Veterans Affairs
Department of Homeland Security
Worcester Department of Public Health (DPH)
Your Public Health Division works to protect and improve community well-being by preventing disease and injury while promoting social, economic and environmental factors fundamental to health. This Division is the foundation of the local public health system that comprises public- and private-sector health care providers, academia, community based organizations, business, the media and other local and state governmental entities.
Track and investigate health problems and hazards in the community
Prepare for and respond to public health emergencies
Develop, apply and enforce policies, laws and regulations that improve health and ensure safety
Lead efforts to mobilize communities around important health issues
Worcester DPH
Link people to health services.
MA Health Insurance Connector
Free Clinics in Worcester
Central MA Independent Physicians
Reliant Medical Group Physicians
St. Vincent Private Physicians
UMass Memorial Private Physicians
Nongovernmental role in public health
Many nongovernmental organizations play important roles in public health, especially in education, lobbying and research
American Cancer Society
American Heart Association
Alzheimer’s Disease and Related Disorders Association
American Diabetes Association
Conduct campaigns to educate the public
Sponsor research on a particular disease
Include professional membership organizations
Include several major philanthropic foundations providing funding for supporting research or special projects, health care to certain populations and support for health and public policy development
Epidemiology-Defined
Study of:
the patterns of disease occurrence in human populations,
the factors that influence these patterns and
the application of this study to prevention and control of health problems
It looks to find the answers of person (who), place (where) and time (when) of a disease or other health related event -Descriptive Epidemiology
Why and how questions are answered by Analytic Epidemiology
Epidemiology is not only concerned with only death, illness and disability; but also positive health states and the means to improve health
Obj. 2: Elements of Descriptive Epidemiology
Time:
Do disease patterns differ by time of year? Are they seasonal?
Person:
Do disease patterns differ by age or gender?
Are certain groups of people at a higher risk of developing a disease or complications from an illness?
Place:
Do disease patterns differ on geographical areas?
Combination of time, person, & place
Age groups stratified by location
Purpose of Epidemiology in Public Health Practice
Discover the agent, host, and environmental factors that affect health
Determine the relative importance of causes of illness, disability, and death
Identify those in the population that have the greatest risk from specific causes of illness
Evaluate the effectiveness of health programs and services in improving population health
host
agent
environment
host
- age
- sex
- race
- genetic profile
- past diseases
- immune status
- religion
- customs
- occupation
- marital status
- family background
agent
- biologic: bacteria, virus
- chemical: poison, alcohol, smoke
- physical: trauma, radiation, fire
environment
- temp. humidity, altitude
- crowding, housing, neighborhood
- water, milk, food
- radiation, pollution, noise
Epidemic or outbreak
disease occurrence among a population that is in excess of what is expected in a given time
Endemic
disease or condition present among a population at all times
Pandemic
: a disease or condition that spreads over a wide geographic area and affects an exceptionally large population across regions, may be worldwide.
Surveillance
Ongoing systematic collection, analysis, and interpretation of health data needed for planning, implementation, and evaluation of public health practice
Cluster
group of cases in a specific time and place that might be more than expected.
A public health approach-Public health problems are diverse
surveillance: what is the problem - probelm
idenify risk factors: what is the cause
Intervention Evaluations: what works
Implementation: how do you do it - response
Surveillance
Epidemiologic surveillance is a major line of defense in protecting the public against disease
It is a warning system that alerts communities that something is wrong
Once an outbreak is discovered, public health officials can begin to take action to prevent the spread of disease
Immunizations
Isolation of an infected person
Recall of medication or contaminated food
The Federal government has a list of notifiable diseases that a healthcare provider must report to the public health department
Hepatitis B
HIV
STDs
Tuberculosis
COVID-19
Surveillance is ongoing and systematic
Obj. 4: Outbreak Investigations
There are many steps involved in an investigation once it has been established that an outbreak exists:
Construct a working case definition
Perform descriptive epidemiology (Who, Where, When)
Implementing control and prevention measures
Initiate or maintain surveillance
Communicating findings to stakeholders, community etc
Outbreak Investigation
Once a decision is made to investigate an acute outbreak- work needs to be done quickly but also be done accurately to get the right answer
Before we can make working case definition we must:
- Review laboratory findings and clinical test results
- Speak to patients with the disease
- Summarize clinical features of the disease
Outbreak Investigation
Step 1- Construct a working case definition
Establish a case definition by using a standard set of criteria
Probable Case: Have signs and symptoms but no confirmed laboratory work
Confirmed Case: Have signs and symptoms with laboratory confirmation
Example: Meningococcal disease
Clinical case definition: An illness with sudden onset of fever (>380C and one or more of the following: neck stiffness, altered consciousness, other meningeal signs or petechial or puerperal rash
Lab diagnosis: Positive cerebrospinal (CSF) fluid antigen detection or positive culture
Case classifications:
Suspected: Meets clinical case definition
Probable: As suspected case and turbid CSF (with or without positive Gram stain) or ongoing epidemic and epidemiological link to a confirmed case
Confirmed: A suspected or probable case with laboratory confirmation
Outbreak Investigation
Step 2- Perform descriptive epidemiology- This step is very important because it will:
Summarize data by key demographic variables
Provide trends over time, geographic areas and the population affected
From this information you can infer the population at risk for the disease
Can provide clues about the source, modes of transmission
Can begin interventions and preventative measures to control disease
Establish epidemic curve-shows magnitude of disease over time
Q
Outbreak Investigation
step 3 & 4
what does step 3 do
- what does it control and preventand what is the primary goal
- what kinds of things can be done
step 4
- once control measures are in place, what must be done
Step 3- Implement control and prevention measures
- Control and prevent additional cases is the primary goal. If appropriate measures are known they should be put in place as early as possible.
- Masks for respiratory transmission, spraying or bed nets for mosquito transmission
Step 4- Initiate or maintain surveillance
Once control measures are in place must monitor to see if working or not
Outbreak investigation
Step 5- Communicate findings
Determine who needs to know
Local health authorities. Medical community, general public, lawmakers
Determine how information will be communicated
Oral briefings via news of implementation of control and prevention measures
Identify why information needs to be communicated
Control spread of illness
Outbreak Investigation
New regulations may result from the findings
Legionnaire’s disease led to the development of new regulations worldwide for climate control systems (A/C systems and cleaning requirements)
More recent outbreak that led to changes in regulations:
Meningitis outbreak of 2012 from New England Compounding Center (NECC)
Changed continuing education requirements for pharmacists conducting sterile and non-sterile compounding
Owner of pharmacy found guilty on 57 of 96 charges- serving 9 years in prison
Chief pharmacist- charged with 25 counts of second degree murder (found not guilty) found guilty on racketeering charges- Serving 8 years in prison
Chronic Diseases
what is epidemiology also useful for
what epidemiology show links between
how long do chronic diseases develop and is there a single cause
what is the risk factor concept
Epidemiology is also useful in identifying the causes of some chronic diseases
Can show links between the occurrence of disease with exposure to risk factors
Chronic diseases develop over time and do not have a single cause
Risk factor concept: a particular biologic, lifestyle & social conditions are associated with increased risk for specific chronic diseases
Heart Disease
Framingham Heart Study
Began collecting data in 1948- still collecting today
Was the first epidemiologic study of a chronic disease
> 5000 healthy, middle-aged subjects in Framingham, MA- examined every 2 years
Findings from this study:
Three major risk factors for heart disease are:
High cholesterol
Hypertension
Smoking
Heart Disease
In 1971- the study continued to the off-spring of the original study subjects
In 2001-2002- the grandchildren of the original study subjects became part of the study
This type of study is called prospective cohort study because it follows the subjects through time
Guidelines to treat cardiac conditions such as hypertension and dyslipidemia have been developed based upon the knowledge gained in this study
heart disease
Data from these trials helps us today in medicine for evidence-based recommendations
The Framingham Heart Study found:
Weight gain and lack of exercise are associated with high blood pressure and high cholesterol levels therefore increasing risk of heart disease
Expanded studies found;
Effects of quitting smoking
“Good” cholesterol versus “bad” cholesterol”
Alcohol in moderation has beneficial effects
Lung Cancer
What link has been associated with lung cancer?
Two landmark studies:
Doll and Hill (UK)
- Death rate from lung cancer was 20 times more in smokers than non-smokers
- Death from heart attacks was significantly higher in heavy smokers age 35-54 than non-smokers
Hammond and Horn (US)
- Smokers are 10 times more likely to die of lung cancer than non-smokers
- Heavy smokers are 2.4 times more likely to die of heart disease than non-smokers
Evidence-Based medicine
Based upon the results we looked at the American College of Cardiology/ American Heart Association Guidelines for Primary Prevention of Cardiovascular Disease.
Overall, “in adults at increased cardiovascular disease risk but without prior cardiovascular disease events, statin therapy for primary prevention of cardiovascular disease was associated with reduced risk of all-cause mortality and cardiovascular disease events,” accordingRoger Chou, MD, et al., authors of theevidence report and systematic review. They write that the “benefits of statin therapy appear to be present across diverse demographic and clinical populations, with consistent relative benefits in groups defined by demographic and clinical characteristics.”
Summary of epidemiology
Epidemiology is an important component of the assessment function of public health
Epidemiologists investigate epidemics by counting the number of cases and how they are distributed by person, place and time
Epidemiology also provides information on the cause of chronic diseases
Epidemiology’s role in identifying causes of disease leads directly and indirectly to prevention and control
To achieve improvements in public health:
Agencies build on the information from information gathered from epidemiological studies to develop policies
They help plan programs aimed at reducing risk and promoting health in the population
primary secondary and tertiary prevention
primary: avoiding disease entirely
secondary:
- comes after
- screening or testing that is done to identify diseases or negative health conditions
- Ideally, secondary prevention occurs before the patient exhibits any signs or symptoms. This is done with tests such as mammograms, measuring blood pressure, and testing for different transmittable diseases.
tertiary:
- measures that are taken to manage disease or negative health conditions after there has been a diagnosis.
- stop the disease or adverse health conditions from progressing or getting worse
- example: chemotherapy or rehabilitation.
primary: prevent exposure entirely
secondayr: just in case you are exposed
tertiary: you are exposed and so help you recover from exposure/prevent any disabilites or progressive daamge that can be done to you
primary prevention examples
legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets)
education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking)
immunization against infectious diseases.
secondary prevention examples
regular exams and screening tests to detect disease in its earliest stages (e.g. mammograms to detect breast cancer)
daily, low-dose aspirins and/or diet and exercise programs to prevent further heart attacks or strokes
suitably modified work so injured or ill workers can return safely to their jobs.
tertiary prevention examples
cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.)
vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.
