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76 Cards in this Set
- Front
- Back
Public Health Subdisciplines
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Biostatistics
Environmental Health Epidemiology Health Administration Health Promotion & Education Nutrition |
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Themes in Modern Public Health
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Knowledge doesn't equal behavior
Prevention vs. Treatment Education vs. Regulation Quality vs. Quantity of Life An art and science |
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Settings for HRPE
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community
worksite medical/clinical schools places of worship colleges/Universities retirement/nursing |
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Primary prevention
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Pre-disease state
i.e. keep non smokers from smoking |
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Secondary prevention
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Clinical detection at early stages of the disease
i.e. bp screenings |
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Tertiary prevention
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Disease is present and there is a need for rehabilitation
i.e. cardic rehab-for survivors of heart attack, prevents worsening condition |
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Public health in ancient China
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-Confucionism relates to modern stress management with calming and quieting
-Tea and Chi (very few water born illnesses) -Accupuncture |
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Public health in ancient India
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-Yoga: Calming, quieting, stress management
-Surgery: means to deal with health concerns |
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Public health in ancient babylonia
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-Code of Hammurabi contained laws for dealing with illness or disease
-cities-could not survive unless disease was under control -bathing was a common practice -preparation for war-men were physically fit |
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Public health in ancient Israel
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Mosaic law-Leviticus: Gave detailed description what to eat, do in the event of an illness or death
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Public health in ancient Egypt
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-bathed regularly
-one of the 1st civilization to create written documentation to enforce alcohol regulation |
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Public health in ancient Greece
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-Men were physically active-origin of olympics
-emphasis on keeping body, mind, and spirit healthy -Galen-developed extensive sports medicine code -Hippocrates-father of modern medicine |
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Public health in ancient Rome
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-Sanitation
-City of Rome could support up to 800K people -Sewage pipes, garbage systems, venhilation systems -bathers -aqueducts- capture melting snow to provide water for large population- some theories suggest it caused lead poisoning |
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Public health in Medieval Europe
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-Scholasticism: philosophical mvt. saying education mind is more important that education one's body
-knights only physically active people -Asceticism-power of Catholic Church-believe body is sinful and should not be naked-caused lack of bathing -Bubonic plague- bacterial disease-passed easily -Medieval indulgences-blamed sin for illness-sale of charms and potions to benefit health |
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Public health during the Renaissance Reformation
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-Study of anatomy began
-Medical texts show study of body, and observations of disease |
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Public health in 1700s England
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-Microscope invented-diseases has origins in bacteria-linked disease to living conditions
-blood pathways described -vital statistics gathered-couting causes of death, disease rates -Smallpos vaccine invented by Edward Jenner |
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Public Health in 1700s US Colonies
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-Europeans brought disease and killed themselves and Native Americans
-disease was born or spread on ships -US avg. age of death is 29 yrs. -Wigs-people didn't clean hair (wooden teath) -Smallpox vaccinations |
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Early 1800s Industry
-England |
England:
Edwin Chadwick -Wars-started triage system -Early deaths of writers & musicians-imagine work if longer life span |
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Early 1800s Industry
-United States |
-Lemuel Shattuck-mant suggest as cornerstone of public health
-slight decrease in epidemics and increase in age span -poor and dangerous factory conditions |
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Miasma phase
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-Characterized by belief that disease came from bad odors-led to sanitation efforts
-APHA-1872 American Public Health Association -Temperance Movements -Nursing-Florence Nightengale -John Snow discovered Cholera in water pump -Muscular Christianity-emphasis on work ethic in colonies-body is a temple of God-beginning of sports-led to founding of YMCA and YWCA |
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Bacteriology Phase
(1880-1910) |
-discovery of specific organisms causing a disease
-quarantine practiced -better water treatment techniques discovered -"The Jungle"-upton sinclair led to Pure Food and drug act-only modified 2x since creation -Lister- antiseptics -prohibition movement culminates |
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Health resources phase
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-WWI and II caused need for surgery and rehab
-county health depts. developed (every 1-2 counties has a health dept.) -health dept-provides food inspection, std treatment, food stamps -Hill-Buurton Act-Poured tax dollars into developing hospitals -WHO-1948 World Health Organization -Children's health-reduction in mortality because of vaccinations and antibiotics -health and disease foundations -many medications and rehabilitation develop |
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Social engineering
1960-1975 |
-Kennedy/Johnson presidencies-many laws passed promoting health
-Medicare/Medicaid-Gov't insurance -Private insurance -Pres. council on physical fitness -cold war- study showed ssoviet children more fit than American children -Peace Corps- provides health needs |
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Health Promotion
1975-Present |
-LaLonde Report-Canada-scientific report suggest relation between lifestyle and disease
-Prevention & health, everybody's busines -Healthy People- US report-research to evaluate progress Alma-Ata & Ottawa Summits- WHO- HOw to plan for health & healthcare |
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Health Promotion
continued |
Fittness mvt.- 1950s-60s-not socially acceptably to jog
-Kenneth Cooper-researched fitness reports and started aerobic institute in Dallas, TX -Wellness Movement-looking at all aspects of well being -AIDS-newest infectious disease -antibiotics-not as powerful & effective |
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Health Promotion
continued again |
-3 layers of the public health service:
CDC- vital stats, ed & outreach Food & Drug Admin.-responsible for reviewing new drugs & food in grocery stores NIH-funds health research -State & community Agencies SC: DHEC(dept. of health and environmental control) is the state agency -county health departmens -CHES(certified health education specialist)-public health professional |
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US infant mortality ranking
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8th in world
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US cancer mortality ranking
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3rd in world
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percentage of bankruptcies caused by health care costs
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40-50
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Health Care Costs
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-Hostpital costs
-Paper work-$79 billion industry -MD salaries & malpractice insurance -unnecessary surgery -insurance fraud-paying for tests & serviced that did not occur -Medical equiptment & personnel -Pharmaceuticals -largely unregulated industry -lack of prevention of diseases & illness |
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Current US Health care System
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-85% of US population covered with 70% being private and 15% is government
-15% uninsured is 44 million people who are unemployedm working people who can't afford it, part-time, or young adults |
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Current US System Continues
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-Private insurance is tied to workplace
-Alternative Medicines are popular-most insurance plans do not cover -1/3 Americans have tried alternatices -Self-care and self-testing are popular--amnt of over the counter drugs have grown--pregnancy tests -concerns with fraud and quackery in self care-informercials-how to regulate w/o eliminating capitalism? |
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Premium
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what people pay
Dr. P-$200 FU-$300 |
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Deductible
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Yearly amount of money that must be spent before insurance plan kicks in
-Usually Jan-Dec |
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Coverages & Exclusions
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what the insurance provider will and will not pay for
i.e eyecare, dental, psychiatric |
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Pre-existing conditions
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insurance company not accepting someone with cancer-company switching providers does not apply
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Maximum out of pocket
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-In major crisism, patient will not necessarily have to spend 20% if costs are over a certain amount
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Maximum lifetime limit
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-Usually one million dollars
-pre mature babies -if over 1 million, must devest everything before receiving gov't aid |
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co-payment
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-higher premium but no deductibles
-still pay 20% |
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Traditional Plan or 80/20 plan
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uses all terms but co-payment and DRG-allows for more dreedom of choice with physicians
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HMO
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Health Maitenance Organization-uses higher premium and co-payments-often a narrow choice of physicians
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PPO
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Preferred provider Organization-combination of HMO & Traditional Plan
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Medicare
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for retired citizens (65 plus yrs. or disables) and those with kidney disease
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Medicaid
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-For medically indigent & single parent families, closely tied to states
indigent-chronic diseases, i.e. cancer |
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Personnel
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-Thension between primary & specialty care-more specialists in US than primary care
-Sweeden- Gov't pays for Med School-no differention of pay between primary & specialty care -Primary care MD are 1/3 of force with most opting for urban specialties -Nurses outnumber MDs 3 to 1 & okay a large role in patient education -PAs & Nurse Practicioners- can diagnose, dispense, & refer to other physicians |
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Hospitals
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-4 beds for every 1000 US citizens
-most have 2/3 occupance rate -lots of pressure to discharge early -emergency rooms are used for primary care more than emergencies - hospital has to absorb unpaid bills & charge insured people more later -Nursing homes & rehabilitation centers -home health care |
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Health Care Reform
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-Methods to approach health care:
Business: pay or don't get it Assist those who can't pay- raise taxesor redistribute current tax base single power for health care (i.e. the gov't like in other countries -Methods to alleviate current situation: education & prevention Get MDs to practice health promotion More regulation by gov't consumer power-pressure the system-know exact charge for each MD or hospital visit eliminate waste in paper & procedures technology-computers/robots/etc. |
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Other HC models
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Sweeden: Federal program paid by taces serves all SES groups
-physicians paid by gov't -high citizen confidence level Canada: -gov't & provinces w/taxes -primary care MD with referrals to specialist -high citizen confidence level -Model HPRE programs |
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Community Health
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-Health promotion focuses on city, town, or country level
-physical factors-environment, geography, neighborhoods, etc. -social/cultural factors-SES, religion, politics, etc. -technology & agriculture-internet access, goods available & valued -health field concepts & diagrams- not responsible for details of naturalm socialm & personal health histories |
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Promoting community health
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-Quality of Health- balance of protection & promotion (i.e. safety of walking)
-coalitions-need for input from multiple layers(i.e. teen pregnancies in community) -empowerment-inspire people to help |
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Diffusion of an idea
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Figure 2-11-p. 54
-Innovators & early adopters -Early & late majority -Late adopters & hard to reach |
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Demography & Health
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Seasonal-Fig. 3-1
-pregnancy rates higher after snow & ice storms -certain diseases higher in summer -population growth-Figs 3-2,3-3,3-4 |
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biotic potential
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chance for more children in community
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fecundity
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actual rate at which biotic potential lives out
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ZPG
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Zero Population Growth-some areas advocate small families because health care can't support more people-tax incentives-mor money for 2nd child
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reductionist approach to epidemiology
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reduce disease to smallest level. i.e. cause of AIDS, reduce to smallest level of source.
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expansionist approach to epidemiology
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Heart Attack-big clues for reason behind clogged artery
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epidemiological triangle
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ex. malaria
host-person agent-mosquito encironment-warm,moist,humid |
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cross sectional studies
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# cases per population at a given time. compare to other times and populations
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case control studies
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compare who has disease to who does not have disease
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retrospective studies
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drug to prevent miscarraige, later caused high risk for breast cancer
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prospective studies
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follow group over time and observe health and behavior-do not typically have disease-most studies have findings along the way
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morbidity
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disease/illness rates. i.e. cancer, flu
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mortality
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death rates
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incidence
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# of cases of disease or deaths in a given time period
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prevalence
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# cases at any one point in time
-primarily used w/infectious diseases |
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rate
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# of events per population at risk
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examples of rates
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crude death rate
age-specific race-specific disease-specific birth rate infant mortality |
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relative risk ratios
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10x greater risk of getting lung cancer if a smoker
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survival rates
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people who live vs. people who die from certain cancers
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lifespan
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humans have a potential to live 120 yrs
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life expectance
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avg. age of death=80
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disability free longevity
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new measure-most elderly people depend on assistance for basic needs for avg. 2 yrs.
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yrs of potential life lost
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looks at results of early age deaths
i.e SanFransisco- AIDS caused 5000 deaths of age 30-35 |
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geographic differences
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midwest-highest life expectance
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Factors affecting life expecancy
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-Gender-women
-Genetics-predisposition to diseases -Race- lower socioeconomic-lower life expectancy -occupation-preachers -income-higher -marital status-married -body composition -lifestyle habits |