Intro To Health Promotion

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What is the WHO definition of "health" ?

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A state of complete physical, mental, and social well-being, not merely the absence of disease.

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What is the WHO definition of "Health Promotion" ?

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The process of enabling people to increase control over their health and its determinants, and thereby improve their health.

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What is community organizing?

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A process through which communities are helped to identify common problems, or goals, mobilize resources, and in other ways develop and implement strategies for reaching their goals they have collectively set.

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Healthy People 2020

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4 Overarching goals:

-Attain high-quality, longer lives free of preventable disease, disability, death, injury, & premature death.
-Achieve health equity, eliminate disparities, &improve the health of all groups.
-Create social and physical environments that promote good health for all
-Promote quality of life, health development, &healthy behaviors across all life stages.

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Governmental Health Agencies

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-Part of governmental structure
>Federal, state or local
-Funded primarily by tax dollars
-Managed by government officials
-Authority over some geographic area
-Exist at 4 levels
>International, national, state, local
-Ex: NIH, CDC

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International Health Agencies

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-WHO is the most widely recognized international governmental health org.
>HQ in Geneva, Switzerland
>6 regional offices around the world
>Not oldest world health-related agency, but largest

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National Health Agencies

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-Each nation has a department/agency within its government responsible for protection of health and welfare of its citizens.
-Dept. of Health & Human Services (DHHS)
>U.S primary national health agency

-Other federal agencies contribute to health
>Dept. of Agriculture, EPA, OSHA, DHS

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Operating Agencies of the DHHS

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-Admin. on Aging (AoA)
-Admin. for Children and Families (ACF)
-Agency for Healthcare Research & Quality (AHRQ)
-Agency for Toxic Substances & Disease Registry (ATSDR)
-Food & Drug Admin. (FDA)
-Centers for Medicare/Medicaid Services (CMS)
-Health Resources & Services Admin. (HRSA)
-Indian Health fjgkjslkgs?

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State Health Departments

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-Usually headed by a medical director
-Plays many different roles
>Can establish health regulations
> Provide link between federal & local
>Serve as conduits for federal funds aimed at local health depts.
>Have laboratory services available for local health depts.
-Ex: Dept. of Health & Environmental Control (DHEC)

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Local Health Departments

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-State mandated services provide locally:
>restaurants, public buildings, and public trans. inspections, detection & reporting of certain diseases, collection of vital stats.

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Quasi-Governmental Health Organizations

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-Operates more like voluntary health org.
-Operates independently of govnt.
-Derives some work/funding from govnt.
-Ex: National Academy of Sciences, National Science Foundation, American Red Cross

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The American Red Cross

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-Official duties include providing relief to victims of natural disaster and members of armed forces & their family during emergencies
-Non-gvnt services: blood drive, volunteer services, etc.

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Nongovernmental Health Agencies

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-Funded by private donations/membership dues
-Arose due to unmet health needs
-Operate free from govnt. interference

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Voluntary Health Agencies

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-Created by citizens because a health need was unmet by govnt. agencies
-Purpose (4):
>Raise $ to fund programs/research
>Provide edu. to pros and public
>Provide services to those afflicted
>Advocacy
-Fund raising is primary activity
-Ex: ACS, AHA, March of Dimes, MDA

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Professional Health Organizations

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-Made up of health pros who have gone through training, certification, licensure, etc.
-Mission: to promote high standards of professional practice
-Funded primarily by membership dues
-Ex: AMA, Amer. Pub. Health Association

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Philanthropic Foundations

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-Endowed institutions that donate $
-Fund programs/research on prevention, control, and treatment of diseases
-Ex: Bill & Melinda Gates Foundation, Commonwealth Fund, Robert Wood Johnson Foundation, local Community Foundations

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Social, Service, & Religious Organizations

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-Many do not have health as a primary mission, but make significant health-related contributions
>Ex: Kiwanis, Elks, Shriners, Lions, FOP

-Religious: history of volunteerism, influence families, donation of space, sponsorship

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Corporate Involvement in Community Health

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-Biggest role is provision of health care benefits
-Worksite HP programs aimed at lowering health care costs
-Other measures: use of natural resources, discharge of wastes, safety of work environment

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Herd Immunity

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The resistance of a population to the spread of an infectious agent based on the immunity of a high proportion of individuals

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What is evidence-based practice?

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Defined as the application of the best evidence supplied by medical and research experts in making decisions

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Why evaluate HP programs?

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-To improve the process of edu. individuals about how to prevent disease & complications
-The funders/public want to know to what extent was their program effective & whether they're getting the best value for their $
-Health edu. programs need to be evaluated before they are funded & implemented
-For your self-satisfaction

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Why do we need Prevention Programs?

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-To curb the rising costs of health care services

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Proper use/value of evidence

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-You want evidence to see that it works before putting the HP program to use
-Can help the HP specialist in the prioritization of the choice of disease & high-risk health behaviors on which to concentrate on
-People need to be aware of what interventions have the best success so they can prioritize
-When you have evidence that it works, its easier to attract the resources/talent needed to ensure a successful intervention

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Most valuable preventative services (3)

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- Daily aspirin therapy

-Immunizing children

-Smoking cessation programs

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Goals of Prevention Programs

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-Encourage the practice of healthy lifestyles
-Identify individuals who could benefit from interventions for a condition of which they are unaware

-Prevent complications among individuals who already have an established disease

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Epidemiology

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Study of distribution and determinants of health-related states or events in specified populations

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Epidemic

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Unexpectedly large # of cases in an illness, specific health-related behavior or event, in a particular population

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Endemic

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Disease that occurs regularly in a population as a matter of course

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Pandemic

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Outbreak over wide geographic area

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Importance of Rates

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-Rates allow for comparison of outbreaks at diff times or in diff places

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Incidence

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-# of new health-related events/cases of a disease in a pop. exposed to that risk during a particular period of time
-Ex: you don't feel well so you visit the doc and they diagnose you w/ diabetes (statistic/case)

-Incidence rates important to study of acute diseases

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Prevalence

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-# of new and old cases in a given period of time

-"pool"

-Rates useful for study of chronic diseases

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Sources of Standardized Data

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-U.S Census (every 10yrs)
-Statistical Abstract of the U.S
-Morbidity & Mortality Weekly Report (MMWR)

-Monthly Vital Statistics Report

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Types of health surveys (3)

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-Health interviews of people

-Clinical tests, measurements, and physical examination

-Surveys from places where people receive medical care

-Questionnaires are common & cheap, massive amount of data available

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Some national health surveys

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-National Health Interview Survey (NHIS)

-National Health & Nutrition Examination Survey (NHANES) *largest data questionnare

-Behavioral Risk Factor Surveillance Sys (BRFSS)

-Youth Risk Behavior Surveillance Sys (YRBSS)

-National Health Care Survey (NHCS)

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Epidemiological Studies (2)

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-Investigations carried out when disease or death occurs in unexpected or unacceptable #s

-2 types: Descriptive & Analytic

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Descriptive Studies

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-Describe the extent of disease in regard to person, place, and time (who, when, where)

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Analytic Studies (2)

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-Aimed at testing hypotheses between health problems & possible risk factors
-2 types: observational & experimental

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Observational Studies (3)

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-Investigator observes natural course of events, noting exposed vs. unexposed & disease development.

-3 types: cohort, cross-sectional, case/control studies

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Cross-Sectional Study

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-Gives us prevalence data

-Exposure & outcome measured at same time
-Best for quantifying the prevalence of a disease/risk factor & for quantifying the accuracy of a diagnostic test
-Ex: association between increased intake of fried foods & CVD

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Case Control Studies

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-Compares those w/ disease to those w/out but with similar background and/or prior exposure to certain risk factors

-First you look at outcome & then whether or not they were exposed

-Best for rare diseases bc all you need is 100 ppl w/ disease to compare whereas in cohort study you may not find 100 ppl w/ disease

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Cohort Studies

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-Observe exposure 1st & then look at rate of disease development

-Cohort: group of ppl who are exposed

-Ex: if you were exposed to 2nd hand smoke, they'd observe to see if you developed disease (cancer)

-Not a good design for rare illnesses

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Experimental Studies (2)

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-Shows causation/causality

-Investigator allocates exposure and follows development of disease
-Carried out to identify disease/determine effectiveness of vaccine

-Control & placebo

-2 types: Randomized Control (RCT) which is Gold Standard bc of ability to show causation & crossover

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Crossover Design

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-"order effect"

-Comparing individuals to themselves

-Ex: test Gatorade, run a mile

-washout: amount of time taken to return to baseline

-benefit: you need 1/2 as many people bc you're comparing the person to the same person

-you can't do this for an intervention w/ lasting effects

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Prioritizing Prevention & Control Efforts

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-Criteria used to judge importance of a disease to a community

-# of ppl who will die from a disease (leading cause of death)

-# of yrs of potential life lost (issues w/ various groups)

-Economic costs associated w/ disease ($ spent at various levels of govnt)

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Primary level of prevention (communicable)

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-Forestall onset of illness/injury

-Individuals: hand washing, using condoms, properly cooking food
-Community: chlorinating H20 supply, inspecting restaurants, immunization programs, vector control, solid waste disposal

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Secondary level of prevention (communicable)

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-Early diagnosis & prompt treatment before disease becomes advanced and severe

-Individuals: self-diagnose, self treatment w/ home remedies, antibiotics
-Communities: controlling/limiting extent of an epidemic, maintaining records, investigating cases

-Isolation, quarantine, disinfection

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Tertiary level of prevention (communicable)

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-Aimed @ rehabilitation (retrain, reeducate, rehabilitate)

-Individuals: recovery to full health; return to normal activities

-Communities: preventing recurrence, removal, burial of dead, reapply primary & secondary measures

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Primary (noncommunicable)

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-Individuals: edu. & knowledge about health/disease prevention, eating properly, adequate exercise, driving safely
-Communities: adequate food & energy supplies, efficient community services, edu opportunities, employment, housing

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Secondary (noncommunicable)

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-Individuals: Personal screenings, regular med and dental checkups, pursuit of diagnosis and prompt treatment
-Communities: provision of mass screenings for chronic disease, case finding measures, equipment, facilities

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Tertiary (noncommunicable)

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-Individuals: Significant behavioral/lifestyle changes, adherence to prescribed meds, following rehab requirements

-Communities: adequate emergency med personnel & services (hospitals, surgeons, nurses, ambulance services)

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Community Organizing

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-Process through which communities are helped to identify common problems/goals, mobilize resources, and develop and implement strategies for reaching the goals they have set

-An art of consensus building