Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
88 Cards in this Set
- Front
- Back
|
health
|
who definition:
• “…A state of complete well-being, physical, social, and mental and not merely the absence of disease or infirmity.” |
|
|
public health
|
formal definition:
• “…What we, as a society, do collectively to assure the conditions in which people can be healthy.” • Concerned with the health of populations • Works to PREVENT injury, illness, and death at the population level • Seeks to promote healthy practices and creating healthy environments |
|
|
Public health vs medicine
|
• Public health:
o Focus on population o Emphasis on prevention o Multiple professional identities with diffuse public image • Very broad field • Many, many ways to promote the health of a population Many of these things are non-medical in nature • Medicine: o Focus on individual o Emphasis on diagnosis and treatment o Well-established profession with sharp public image |
|
|
Levels of prevention commonly used in public health
|
• Primary
o Preventing populations from getting a disease or becoming injured in the first place o Keeping something from occurring o Ex: vaccines, promoting condom use • Secondary o Trying to detect disease or intervene early to prevent progression of disease o Reduce negative consequences o Ex: cancer screenings • Tertiary o Treatment or intervention that tries to restore functionality and reduce disability o Maximize capacity and functionality o Ex: occupational therapy, rehab |
|
|
Active prevention
|
o Individual has to do something on a regular basis
o Ex: brushing teeth with fluorinated toothpaste |
|
|
Passive prevention
|
o Individual gets the benefit without actually having to actively do something themselves
o They may not even be aware of intervention o Ex: fluorinating the water supply |
|
|
International public health
|
o Response to health issues
o What we can do as a collective society to promote health and prevent disease o Talks about the borders o Our responses to global health issues are constrained by national sovereignties → countries need to collaborate to make public health interventions |
|
|
Global health
|
o Refers to the fact that our diseases know no boundaries
o Disease is omnipotent; DGAF about boundaries o Disease knows no boundaries |
|
|
Surveillance
|
o Tracking and understanding what patterns of disease are in a population;
o basic epidemiological data about patterns and risk factors for disease |
|
|
Life expectancy
|
• How long can a baby expect to live on average born in a given year in a given location
|
|
|
General Trends for Health Indicators in a Population
|
• Urban populations tend to have better health outcomes than rural
• More educated higher indicators • Wealthier populations have higher indicators • Indigenous populations tend to have poorer health outcomes than non indigenous • Disadvantaged ethnic minorities have poorer health outcomes |
|
|
Mortality rates
|
number of deaths per a standardized population amount
|
|
|
Neonatal mortality
|
<28 days
major causes: preterm birth, low birth weight, infections, asphyxia, congenital abnormalities |
|
|
Infant mortality
|
<1 year
major causes: malnutrition, infections, SIDS |
|
|
under-5 child mortality
|
<5 yrs
major causes: diarrhea, malaria, malnutrition, pneumonia |
|
|
maternal mortality
|
while pregnant or within 28 days of giving birth
major causes: hemorrhaging, infection, hypertensive disorders, obstructed labor |
|
|
Health Adjusted Life Expectancy (HALE)
|
o Estimates life expectancy adjusted for time spend in ill health
o Combines all diseases o Compiled through country death registries and multi-country surveys implemented by WHO • “ill health years” can be spread out across entire life • gives an idea of how much morbidity is in a population full health = cannot perform normal routine |
|
|
Disability Adjusted Life Years (DALY)
|
o DALY = YLL (years of life lost) + YLD (years of life in disability)
• YLL measured with respect to life expectancy for a population • intervention costs less than $100 per DALY saved = good intervention |
|
|
Prevalence
|
o The total amount of disease in the population at a specified time point
|
|
|
Incidence
|
o The amount of new disease within a population over a specified time period
• Typically within 1 year |
|
|
Population pyramid
|
• tells age distribution of the population and gender distribution of the population at each age group
can be used to draw conclusions about a population --> fertility rates, mortality rates for certain groups, risk groups for diseases etc. |
|
|
Stages of change (aka Transtheoretical Model)
|
o Precontemplation → contemplation → preparation → action → maintenance
• Precontemplation = haven’t thought about issue • Contemplation = see issue as something that is important to you and affects you • Preparation = start making steps; plan for change • Action = do that behavior; follow through plans • Maintenance = maintaining healthy behavior |
|
|
Ecological model
|
o People are part of a larger environment and there are factors at different levels that effect health behavior
• Personal characteristic of individual Genetics, sex, age, health practices and behavior • Social and cultural: Social networks and norms, cultural expectations, socioeconomic status (SES), education • Environmental: Air, water, sanitation, access to health services, laws and policies |
|
|
Gini Coefficient
|
• Economic indicator
• Refers to the wealth distribution within a country • 0-1 • 0 = perfectly distributed • 1 = perfectly unequal (one entity has all) • as you get a higher coefficient, it indicates that within the population there is greater inequality with health distribution |
|
|
Private Insurance Model
|
• US = only health system in the world to rely on insurance/private insurance
• System is good for people who are insured, but because of the low amount of regulation especially around the private insurance, there are an increasing number of people who are uninsured or underinsured • Insurance o Private (funding: employee contributions and employer contributions) • For profit • company directors manage • establish eligibility criteria • coverage varies widely o safety nets (funding: taxes→government) • Medicare • Medicaid o Direct services (funding: taxes → government) • American Indians • Veterans • Services o Private and safety net insurance • Privately owned facilities and staff privately employed • Physicians contract with private and/or safety net insurance o Direct service insurance • Government owned facilities and employed staff (including physicians) |
|
|
Social Insurance Model
|
Germany = example country
• Insurance o Social (sickness funds) [funded by employee contributions/employer contributions and taxes→government] • Non profit • Managed by a set of boards • No eligibility criteria • Required participation • Over 90% of population o Private insurance [funding = out of pocket] • Must be of certain income level to opt out (wealthy opt out) • Very small slice of population • Services o Social and private • Primary care facilities privately owned and staff privately employed • Physicians contract with funds or insurance • Secondary and tertiary facilities and of public and private • This is NOT universal health care or a single payer system • Covers a larger percentage of the population • Relatively highly regulated • Good because it covers a wider percentage of the population and emphasizes primary health care and primary services • Cons = economic strain |
|
|
Universal Insurance Model
|
U.K. = example country
• Insurance (funded by taxes → government) o Universal • Everyone eligible regardless of employment status o Supplementary (funding = out of pocket) • NOT an opt out → supplementary to universal • Provides to extra services • Services o Universal • Government owned facilities and employed staff • Primary care physicians contracted by NHS by capitation, not by services Capitation = they get a flat rate for every individual who is on their role. Idea is that most people, most months will not use any services, but a few will use a lot and over time it will average out. Rates are adjusted based on demographic of list (i.e. children go to doctor more, so pediatricians get higher capitation) o Supplementary • Physicians can have both public and private practices • 10-15% of population can afford • Good because it provides primary and preventive services to everybody • Con = burden on tax payers → not everyone pays into taxes at the same rate, but everyone gets the same coverage • Concern about wait time and elective procedures o Ex: seeing a specialist can make longer wait times |
|
|
Network System Model
|
Bolivia = example country
• Idea of how these systems are set up= for every so many people there should be a health post o Health posts feed into primary center, which feeds into secondary, which feeds into tertiary • Primary level: health center (normal deliveries, ER, and traditional medicine) • Secondary level: direct hospital (basic hospitalizations and specialized consultations) • Tertiary level: general and specialty hospitals Almost always in urban settings, clustered together |
|
|
Health Extension Program: Ethiopia
|
• Enhance preventive health interventions at village and household levels
• Shift health resources from urban to rural areas • Train and deploy >33,000 health extension workers to over 15,000 health posts • Focus on hygiene and environment sanitation, disease control and prevention, and family health issues |
|
|
Pregnancy-related death
|
o death of a woman while pregnant or within 42 days of pregnancy of termination, irrespective of cause
|
|
|
Late maternal death
|
o Death of a woman from obstetric causes between 42 days and 1 year of pregnancy termination
|
|
|
Maternal mortality ratio (MMR)
|
o The number of maternal deaths per 100,000 live births
|
|
|
Maternal mortality rate (MMRate)
|
o The number of maternal deaths per 100,000 women of reproductive age (usually 15-44 years)
|
|
|
Lifetime risk of maternal death
|
o Probability of a woman dying from a maternal cause during her reproductive years
o Takes into account that each pregnancy is a risk in itself o Each pregnancy is a cumulative risk |
|
|
3 core functions and 10 essential services of public health
|
• assessment
o epidemiology; surveillance; what are the patterns of disease?; what are risk factors? o Monitor health o Diagnose and investigate • Policy development o Inform, educate, empower o Mobilize community partnerships o Develop policies • Assurance o Enforce laws o Link to/provide care o Assure competent workforce o Evaluate |
|
|
Bilateral Agencies
|
• Agencies of a country’s federal government that is responsible for providing direct assistance to another country’s government
• Provide direct funding and technical expertise from one government to another • Examples o USAID (united states) o DfID (UK) o AusAID (Australian) |
|
|
Multilateral agencies
|
• Pool money from member nations
• Provide technical expertise plus some funding, equipment and advocacy • Are limited in their authority unless countries request assistance • Examples: o WHO o UNICEF o UNAIDS o World Bank |
|
|
Non-governmental Organizations (NGOs)
|
• Receive at least some funding from private donations
• May be either international or local • Many pick a particular area of focus • Examples: o CARE o Save the Children o Partners in Health |
|
|
Foundations
|
• Provide an alternative funding source for public health initiatives and research
• Focus on a particular issue or set of issues • Have become more major players in global health over the past decade • Do not carry out initiatives, only provides funding. • Examples: o Bill and Melina Gates Foundation o Kellogg Foundation o Carter Center |
|
|
Partnerships
|
• Involve some combination of governments, multilateral agencies, foundations, private sector companies and academia
• Strive to pool resources, skills, and finances |
|
|
Case Study: Maternal Mortality in Sri Lanka
|
4 key elements of success
• broad emphasis on primary and preventive initiatives • “trained” midwives → 18 months of training • acquisition and use of data • tiered health care system with a broad base Other factors in Sri Lanka that contributed to success: • Emphasis on education • Civil registration system |
|
|
Fertility rate
|
total number of a children a woman can expect to have over her reproductive years
|
|
|
Mexico city policy
|
o expanded US policy--that said countries/organizations cannot use direct foreign from the US to provide or promote abortions--and said if you receive money from US government, you may not use ANY money for providing abortions, advocating abortions, etc.
- 1984 instated, 1993 revoked, 2001 reinstated, 2009 revoked |
|
|
International development conference on population and development (ICDP), Cairo
|
o First conference to push towards a larger, more holistic perspective about reproductive health
• Move away from singular focus of women’s fertility → trying to provide access to primary and preventative for all reproductive services • Looking at women as holistic → not just reproductive vessels |
|
|
PEPFAR
|
o Presidents emergency plan for AIDS relief
• Initial funding for PEPFAR included language that explicitly prevented PEPFAR money from going to family planning services • in 2008 language changed --> family planning services allowed, but must go through another level of bureaucracy → countries have not been doing it because it is complicated |
|
|
Case Study: Family Planning in Bangladesh
|
Key factors:
• Media use (sociocultural levels) • Focused on individual women • Contraceptive mix → wide scale • Large portion of funding came from foreign aid/NGOs • Use of research • Supply side vs. demand side |
|
|
Prevention of Neonatal complications
|
• Ensuring maternal health
• Providing a clean birthing setting • Promoting “kangaroo care” • Encouraging breastfeeding |
|
|
Primary Prevention of Diarrhea
|
• Vaccinating against measles and rotavirus
• Breastfeeding • Providing access to safe water and improved sanitation • Hand-washing |
|
|
Oral rehydration therapy
|
• Secondary prevention
o Used when someone already has diarrheal disease to prevent further development of disease o MAKE YOUR OWN: 1 teaspoon of salt salt, 8 teaspoons of sugar, 1 liter water (maybe a little lemon) |
|
|
herd immunity
|
• If you get to a large enough portion of people in the population who are immune to a disease then the pathogen can’t get established within the community
o Means that even those people who are not immunized get some protection |
|
|
immunization
|
o the process by which an individual's immune system becomes fortified against an agent
o immunization results because of vaccination |
|
|
vaccination
|
o the administration of antigenic material (a vaccine) to stimulate the immune system of an individual to develop adaptive immunity to a disease.
|
|
|
eradication
|
o “permanently reducing the number of new infections worldwide to zero, with interventions no longer needed”
|
|
|
elimination
|
o “reducing the number of infections to zero in a defined geographical area, with continued interventions required”
|
|
|
Case Study: Smallpox Eradication
|
summary points:
o technological innovations o political commitment o flexible approach o bolstered existing health services |
|
|
polio
|
• Caused by a virus
• Spread easily via oral/fecal transmission • Affects the nervous system • Can result in non-symptomatic carriers, paralysis, or death o This is a large number of people o Carry virus in their gut o Makes polio eradication very difficult o For each case you have, there are 2000-3000 carriers able to transmit the disease → a single case is considered an outbreak • Non-symptomatic carriers can still spread the disease • One case of polio is considered an outbreak! • Paralysis can be life long |
|
|
polio vaccines
|
two types:
• Oral polio vaccines (OPV) o Uses attenuated (weakened, but still live) virus o Carries a slight risk of actually acquiring polio Better at reducing transmission among non-symptomatic carriers • Inactivated polio vaccines (IPV) o Uses a inactivated (killed) virus o No risk of acquiring polio |
|
|
Case Study: Polio Elimination in the Western Hemisphere
|
Summary Points:
• Technological innovations • strong surveillance system • national campaign days • risk of complacency and importation |
|
|
Measles
|
• measles is highly infectious and kills more infants/children than any other disease
• no real treatment or cure → can only treat symptoms • it requires very high rates of immunization coverage in order to reach the threshold of “herd immunity” |
|
|
Case Study: Measles in Southern Africa
|
• coordinated regional effort but adapted to specific country and local circumstances
• mostly internal funding with some external (multilateral and bilateral) funding • catch up, keep up, follow up • importance and challenge of sustained efforts |
|
|
Case Study: HiB in Chile and the Gambia
|
Summary points:
Chile: -use of research -pharmaceutical company supported research -ability to captalize on timly public event -vaccinations viewed as a "public good" The Gambia: -use of research -role of external support, including GAVI and Aventis Pasteur -integration with other vaccines --> DTP |
|
|
Unimproved sources of drinking water
|
• Surface water collection
• Unprotected Hand dug wells • Water tanker trucks o Unprotected spring |
|
|
improved sources of drinking water
|
• Community borehole
• Standpipe in the yard |
|
|
Arsenic Poisoning: Bangladesh
|
failied public health intervention:
- thousands of wells dug and put in, but wells were not dug deep enough and water was not tested/monitored so people were suffering from arsenic poisoning from the "improved" water sources -now there is an effort to make new wells --> much more complex and expensive |
|
|
improved sanitation
|
• Hygienically separating human excreta from human contact
|
|
|
improved sanitation sources
|
separates feces and keeps it out of water source
o flush or pour into • piped sewer system • septic tank • pit latrine o pit latrine with slab o ventilated pit latrine o composing toilet |
|
|
unimproved sanitation sources
|
contaminates water source
o open sewer o hanging latrines |
|
|
ladder of access to sanitation
|
open defecation -->
unimproved sources--> shared sources --> improved sources |
|
|
Case Study: Controlling Trachoma in Morocco
|
• Initial research funding from private foundation
• Financial and political commitment from national government • Donation of antibiotics from Pfizer • Epidemiology and medicine are interdependent • intertwined nature of health and education • importance of maintenance and continued surveillance |
|
|
Trachoma
|
• The leading cause of preventable blindness in the world
• Children most susceptible to infection, but blindness manifests in adulthood • Disproportionately affects women (3:1) • Does not cause mortality, causes tremendous morbidity (blindness) • Transmitted by flies from human feces o Chronic infections inflame eyelid and starts to turn eyelid in → eyelashes scratch eyelid every time you blink • Causes blindness in the eye |
|
|
SAFE
|
intervention designed for combating trachoma in morocco
S = surgery A = antibiotic treatment F = facial cleanliness E = environmental changes spectrum S-->E = clinical --> public health |
|
|
health effects of pesticide exposure
|
• Neurological
o Headaches, dizziness, and nausea o Tremors o Mental impairment • Reproductive o Congenital defects o Reduced fertility, miscarriages and stillbirths • Respiratory o Asthma o Irritation • Skin and eyes o Rashes o Blurred or impaired vision |
|
|
Pterygium
|
• Long term exposure to sunlight, dust, wind, and chemicals
|
|
|
Cataracts
|
• The leading cause of blindness globally
• Mainly age-related, but some modifiable risk-factors • Treatment requires surgery |
|
|
Case Study: Cataracts in India
|
Summary Points:
• NGOs step-in to help meet demand • Technological innovation allows large-scale implementation • Coordination led to collaboration, not duplication • Train-the-trainer program to educate surgeons, health workers, and teachers • Future challenges include sustainability and primary prevention |
|
|
Ecuador Flower Exportation
|
-flower exportation big business in ecuador
-pesticide regualtion low -big companies use large quantities of pesticides, and the neighboring communities have started to show health effects, specifically in maternal health Main point: • Our consumer demand in the US can drive health issues in other countries o Our demand for perfect flowers leads to maternal health issues in Ecuador |
|
|
Sources of Indoor air pollution
|
•Biomass fuel
-Animal dung o Crop waste o Wood • Coal • Tobacco smoke |
|
|
Particulate Matter (PM)
|
• Any particles suspended in the air
o The smaller the particulate the more harming it is |
|
|
Preventative methods of indoor air pollution
|
• Cleaner fuels
• Improved stoves • Improved ventilation • Reduced exposure |
|
|
Case Study: Indoor Air Pollution in Mexico
|
summary points:
• challenge of encouraging and supporting the maintenance of a changed behavior • importance of non-health related barriers and facilitators to behavior change • length of time required to change ingrained behaviors |
|
|
3 top issues of environmental public health
|
o Water and sanitation
o Indoor air pollution o Outdoor air pollution |
|
|
main outdoor air pollutants
|
• Sulfur dioxide (SO2)
• Nitrogen dioxide (NO2) • Particulate matter (PM10) • Ozone • Lead |
|
|
health effects of outdoor air pollution
|
• Respiratory ailments
• Eye problems • Skin Problems • Neurological damage |
|
|
Case Study: SunSmart in Australia
|
Summary points:
• Major players and funding sources • Cultural values around tanning • Contextual opportunities • Transferability of lessons |
|
|
SunSmart
|
• Well known Australian successful program in public health in terms of addressing behavior changes surrounding sun exposure and skin cancer
|
|
|
Consequences of poor oral health
|
o Health/developmental
• Pain discomfort, sleeplessness, language and speech problem (cancer) • Individual level o Social consequences • Self confidence • Stigma o Economic consequences • Some of the most expensive traumas to treat • Almost all are preventable |
|
|
oral health and maternal heatlh
|
• The hormonal changes in pregnancy make women more susceptible to gum diseases and other oral health problems
• Women with severe gum disease are more likely to deliver a preterm or low birth weight infant • Women often have more missing teeth because they often have more interaction with the health system |
|
|
Case Study: Salt Fluorination in Jamaica
|
Summary points:
• Key advocate • Government commitment • Policy enactment, monitoring and enforcement • Use of mass media to prepare population for the intervention |
