Medsoc 12-5-07 Public Health

Front 1

Appreciate the history of public health
Understand the accomplishments of the 20th century and the challenges of the 21st Century
Comprehend infant maternal mortality rates and interventions to lower those rates
Know the impact of Sanitation Movement on health
Learn how fluoridation of water has affected public health and how it is a model for public health interventions
Understand the health effects of smoking and importance of smoking cessation efforts
Appreciate the importance of prevention programs for heart disease
Learn how epidemiology is an important tool in public health, including preventing conditions not related to infectious disease
Appreciate how a public health model saves lives with motor vehicle safety interventions

Back 1

Objectives

Front 2

Appreciate how public health has improved living conditions
Understand the relationship between federal, state and local governments in public health practice
Comprehend public health practices in dealing with past and present problems
Understand how social policy affects application of scientific principles in the public arena
Understand how scientific principles were applied in the 19th and 20th Centuries and how new scientific knowledge can improve public health

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More objectives

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Rudolph Virchow – science of ____

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pathology

Front 4

Joseph Lister 1827-1912
C_________ acid

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Carbolic

Front 5

William Halsted 1852-1922
surgeon who washed his hands b/w surgeries.

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-

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European cities filthy with waste everywhere
Small pox, cholera, typhoid, and _________ were common
before English sanitary reforms occured

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tuberculosis

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Edwin Chadwick 1842 England
More than half of the children of the working class died before their WHICH birthday?

Life expectancy related to social standing

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5th

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Willie Lincoln 1850-1862 (Pres's son)
He got Typhoid fever (_______ typhi) from all the dirty soldiers camped out in D.C.

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Salmonella

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Infant mortality rate 1900 __/1000
Now Decreased by 90%

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100

Front 10

Maternal mortality rate 1900 __/1000
Decreased by 99%

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7

Front 11

Declining _____ rates contributed to decreased infant mortality

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fertility

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P__________ of milk began in Chicago in 1908

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Pasteurization

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1945 f__________ of drinking water began

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fluoridation

Front 14

Minimum standard for military was to have ___(#) opposing teeth
Leading cause of rejection from military service in both world wars

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six

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Dr. Frederick McKay – stained enamel but a reduction in ____

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caries

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Dr.F.L. Roberson noted stained teeth
Had water analyzed
F______ noted
Dr. McKay had Colorado water analyzed.
Dr. H Trendley Dean, NIH Dental Unit perform epidemiological studies

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Fluoride

Front 17

21st Century challenges:
View that dental c_____ are no longer a problem
Unsubstantiated claims about problems associated with f________ in water
Cost in small water systems

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caries

fluoride

Front 18

Smoking and lug cancer was studied by
Ernst Wynder
Evarts Graham
Case Control

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-

Front 19

Richard Doll
Prospective Cohort Study
using British physicians
Smokers & non smokers

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-

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Leading preventable cause of death and disability in the United States.

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Smoking

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Anti-smoking:
1964 Surgeon General’s report
F_______ Doctrine
Counter advertisements
Banning of TV adds in 1971

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Fairness

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Anti-smoking:

1998 Master S______ Agreement ($206 Billion)

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Settlement

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Anti-smoking:

American L_____ Foundation (education programs)

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Legacy

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Smoking causes the following:
Lung cancer
Heart disease
Atherosclerotic p______ v_______ disease

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peripheral vascular

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Smoking causes the following:
L_____ cancer
Oral cancer
Es________ cancer
Chronic obstructive pulmonary disease

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Laryngeal

Esophageal

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Somking causes the following:
Intrauterine growth r_______
Sp________ abortion
Pre-term birth
Low birth weight

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retardation

Spontaneous

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2nd hand smoke (involuntary smoking)
Quantified by measuring serum and u______ nicotinine levels

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urinary

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Environmental tobacco smoke (ETS) can cause the following:

Lung cancer
A_______
Respiratory infections
Decreased pulmonary function

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Asthma

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Stopping smoking reduces the risk of heart disease
__ years nearly same risk as non-smokers

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2

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Reduction in risk of lung cancer gradual
Approaches the non-smoking risk in __ years

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17

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Relative risk (RR) about __
Risk of death from cancer among current or former smokers compared to nonsmokers
Annual deaths (89,900 for men)

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20

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Smoking attributable mortality (SAM)
annual number of deaths from lung cancer in the United States caused by smoking (79,000)

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-

Front 33

Population attributable risk (PAR)
Percentage of deaths from Lung cancer due to smoking.
Approximately 89,900 men die of lung cancer each year in the United States.
About 79,000 lung cancer deaths among men are caused by smoking

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-

Front 34

Smoking causes about __% of lung cancer deaths among men
(100 times 79,000 divided by 89,900).

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88

Front 35

Years of potential life lost (YPLL) estimates life shortening due to lung cancer for men
____________

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1,113,644

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Breast exams should be every __ years in women aged 20-39

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3

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Breast exams should be every __ years in women aged 40+

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1

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_____ disease -
Leading cause of death in the US since 1921

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Heart

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S_____ –
Third leading cause of death since 1938

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Stroke

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Since 1950 death rate from CVD has declined ___%
In 1996 - 621,000 fewer deaths from coronary heart disease than expected (based on 1963 peak rate)
a) 20
b) 40
c) 60
d) 80

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60

Front 41

Stroke rate declined __% from 1950 to 1996
88.8 per 100,000 1950
26.5 per 100,000 1996
a) 30
b) 50
c) 70
d) 90

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70

Front 42

F_______ Heart Study
Began in 1948
USPHS and Harvard Medical School
Identified risk factors
Established the major risk factors
High blood cholesterol
High blood pressure
Smoking
Dietary factors
Dietary cholesterol, fat, and sodium
Risk factor concept
Biologic
Lifestyle
Social conditions
Associated with increased risk for disease
CVD epidemiology

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Framingham

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Ancel Keys
Nutritionist
K-_______ and Mediterranean Diet

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rations

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Compared Minnesota businessmen to post WWII Europe
Findings counterintuitive
Subsistence living in Europe - less ______ disease

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CVD

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Strong associations between the CVD rate and average serum _________
Per capita intake of saturated fatty acids

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cholesterol

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Heart disease and _____ remain leading causes of disability and death

Prevalence disparities

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stroke

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70% of hypertensive people do not have less than 140/__

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90

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Small pox eradicated
Polio (wild) eliminated, other strains rare
Haemophilus _________ type b (Hib) invasive disease among children aged less than 5 years reduced to record low

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influenza

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Future challenges:
Education of parents concerning conditions
Innovation in delivering v_______
Decreasing complexity of vaccine schedules

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vaccines

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Vaccine-preventable disease still occurring with what disease for example

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(Hepatitis B)

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1925 18 per 100 million vehicle miles t_______ (VMT)
1997 1.7 per 100 million VMT
90% decrease

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traveled

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Passed Highway Safety Act created the National Highway Safety Bureau (NHSB), which later became the National Highway t_______ Safety Administration (NHTSA)

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Traffic

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Dr. William Haddon
Defined interactions between host (human), agent (vehicle) and environment (______)
Before, During and After crashes.

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highway

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21th Century challenges:
Alcohol
Teenage issues
P_______ safety
Alternative modes of transportation
Seat belts usage
Child safety and booster seats
Surveillance system

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Pedestrian safety