Public Health Midterm

Front 1

Ogden v. Gibbons

Back 1

-1824
- i. Federal law protects the pursuit of happiness unless endangering the public good, then the states can use their police powers

Front 2

Queenside v. NYC

Back 2

-1946
- Anyone running hostels/lodges has to spend money improve the water system
- ii. USSC held up this ruling because even though the company has individual rights in terms of their funds, but they pose a public health concern
- iii. “The police power is one of the least limitable governmental powers…and the states possess extensive authority to protect public health and safety.”

Front 3

Jacobson v. MA

Back 3

- 1905
- Jacobson did not want to vaccinate his child for small pox
- USSC upheld decision that he needed to vaccinate his child
- cannot physically restrain but can make it mandatory for children enrolling in school

Front 4

What has Jacobson upheld?

Back 4

- Flouridation of water
- Fortification of foods and beverages
- seat belts/helmets
- USSC has recently expanded the right to privacy and individual rights
- economic incentive behind these laws as well
- lower morbidity leads to lower premiums

Front 5

Griswold v. CT

Back 5

- Debate about legality of prescription contraceptives
- Medical Sovereignty
- Zones of Privacy (limit to police powers in terms of family matters)
- creation of the private sphere
- doctors now had more freedom of how to treat patients

Front 6

Wisconsin v Yoder

Back 6

-1972
- Amish children exempt from school so they could work at home
- found it lawful for parents to do this because they do not want to violate the 'preferred position of religion
- do not want to violate the freedom of religion

Front 7

Price v. MA

Back 7

-1943
- “The right to practice religion freely does not include liberty to expose the community to communicable disease”
- Common good outweighed the “preferred position”
- do we get to choose our health?

Front 8

-Church of Lukumi Babalu v. Hialeah 1993

Back 8

- 1993
- They will not use police power to stop them from slaughtering the chicken
- Different trend than in the past

Front 9

14th Amendment

Back 9

All citizens have equal protection and amenities under the constitution
- due process is also included in this

Front 10

Yick Wo v. Hopkins
(14th Amendment)

Back 10

- 1886
- San Fran banned wood building materials for laundromats
- even though it economically burdens a particular group of people, it is necessary for the public well being

Front 11

Brown v. Board of Education

Back 11

- 1954
- separate and unequal is violation of 14th

Front 12

Checking for scalp ringworm in African Americans

Back 12

- cannot pose a tax on public space, but if there is an outbreak of something, it may be applicable to use police force

Front 13

Phases of Public Health History

Back 13

- General Health protection (Pre-1800s)
- The Sanitary Movement (early 1800s
- Bacteriological Revolution (1880's-1900's)
- International Public Health (today)

Front 14

General health protection

Back 14

- Religious/cultural practices (kosher/chastity)
- Quarantine

Front 15

What causes an epidemic?

Back 15

- Changes in demography
- Agriculture
- Climate
- Travel and Trade
- Host population resistance and pathogen evolution
- ONLY ONE OF THESE THINGS IS RELATED TO BIOMEDICINE

Front 16

Leprosy

Back 16

- occurred mainly during the General health protection movement
- leper colonies
- difficult to diagnose specifically, often it was mistaken
- spread through the crusades
- low mortality, high morbidity
- comorbidity caused by colonies
- majority of people are immune to leprosy
-

Front 17

Social Death and Leprosy

Back 17

- Keeping the rest of society clean from a particular person
- social exile
- Role of Leviticus
- Major killer in 1700s

Front 18

Small pox mortality and symptoms

Back 18

- 30% mortality
- 80% for at-risk groups
- blindness, scarring
- often confused for leprosy

Front 19

Bubonic Plague

Back 19

- transmission through fleas
- brought to Europe through the crusades and cross-continental trade
- 1300s 1/3 population died in Europe
-

Front 20

Social Responses to Diseases

Back 20

- confusion
- Destroying all crops
- massacres of certain populations (disease is seen as inherent in particular people)
- animal genocides
- expanded border patrols
- creation of national health boards

Front 21

Quarentena

Back 21

- Economic impact: mecantilism, health becomes issue between states and merchants, right of state to constrict market?, need to generate productive policy to keep workers healthy and keep economy strong
- social/medical impact: rise of the black market, breeds disease instead of quelling it
- contention between city states and merchants:
- impact on international trade: rise of international free trade agreements, globalizing public health

Front 22

Lasting Impact of Epidemic Era

Back 22

- fear/lack of knowledge
- vulnerable populations are often disproportionally affected
- governmental/institutional efforts to control disease
- organized responses

Front 23

Elizabethan "Poor Laws"

Back 23

- marks a political shift in history in terms of the role of government
- State taking an active interest in the well being of the people
- Rise of the merchant and capitalism
- wealth now accumulated through the population instead of through crusades
- state becomes the population, not the monarch

Front 24

Prison and Asylum Reform

Back 24

- separation of the two institutions
- Raises the question...who can be rehabilitated?
- Disparity in treatment/methodology of rehabilitation

Front 25

James Lind

Back 25

- 1716-1794
- Worked with Scurvy
- example of medical advancements through militaristic needs
- case control study dealing with tropical fruit
- found that soldiers who lacked vitamin C were contracting the disease

Front 26

Moving into the modern era

Back 26

- Poor Laws
- Prison and Asylum Reform
- Scientific Enlightenment
- Medical Professionalization
- Military/navy medicine
- collection of vital stats
- Rise of voluntary associations
- rise of international trade, nationalism etc....

Front 27

Florence Nightengale

Back 27

- 1820-1910
- use of imagery to represent data
- Hospitalism (why are people dying in hospitals)
- used patient files as a means of medical research

Front 28

Basics of Cholera

Back 28

- vibrio bacteria
- waterborne vector
- diarrhea and vomiting
- high mortality
- water is the cause and the treatment
- epidemics during the 1800's (England, Paris, India, Moscow)
- Fear and anxiety in the community

Front 29

John Snow

Back 29

- 1813-1858
- Field based epidemiology
- 1848 outbreak: noticed unequal distribution associated with water sourcing, Lambeth switched (control) and Soutwark didn't (still had dirty water)
- used "matching"
- idea of the natural laboratory

Front 30

"matching"

Back 30

- compares identical people in different districts and compares how they fared in an epidemic

Front 31

William Budd

Back 31

- 1811-1880
- Believed in germ theory
-"Each specific agent of contagion multiplies at certain sites within the sick host, is eliminated and transported by definite routes, and can be destroyed or interrupted in its passage to other susceptible hosts.” (William Budd)

Front 32

Shift Towards Germ Theory from Miasma

Back 32

- New focus on vectors of transmission and the at-risk population
- Importance of stats and records
- control of disease rather than the quarantine is becoming the predominant practice

Front 33

Urbanization

Back 33

- rise of the bourgeois
- 1776 Wealth of Nations (Smith) brought about the idea that the economy is run by the people
- flocks to the cities to make a living
- labor incentivized, welfare is hard to come by
- Urban population in England doubles 17%-30%

Front 34

Ignoble Origins of Public Health

Back 34

- modern public health begins in England where modern industry begins
- economic incentive to clean up vices
- economically favorable to invest in prevention

Front 35

Edwin Chadwick

Back 35

-1800-1890
- Focused on links between poverty and disease
- social reforms as a way to control infection disease and improve economy
- Registration of Births and Deaths Act (1836)
- reformed the Poor Laws

Front 36

Registration of Births and Deaths Act

Back 36

- registration of causes of diseases, deaths and births
- helped to compare healthfulness of different areas

Front 37

The Sanitary Idea

Back 37

- 1800's
- Urban planning and engineering
- cleaning up streets, social projects, filth management, smell management
- a. “The great preventives, drainage, street and house cleansing by means of supplies of water and improved sewage, and especially the introduction of cheaper and more efficient modes of removing all noxious refuse from the towns, are operations for which aid must be sought from the science of the engineer, not from the physicians.” – Edward Chadwick, Report (1840s)

Front 38

Emergence of Modern Public Health

Back 38

- 1848 - General oard of Health and local health boards
- waves of public health survey and research

Front 39

Public Health as Power

Back 39

- a. Public health = in synergy with growing economies…mobilizes large components of the population…frees them to participate in society
- Defines who we are, what our categories are, how we define ourselves and our bodies, if we are healthy/normal
-Right now the role of government is to improve biology and psychology

Front 40

Leewenhoek

Back 40

- observed first microorganism under the microscope
- 1632-1723

Front 41

Pettenkofer

Back 41

- 1818-1901
- miasmist
- wager with koch

Front 42

Koch

Back 42

1843-1910
- Public health leaders...German Cholera Commission in Egypt and India in 1880s
- invention and application of slow sand water filtration process

Front 43

Pasteur

Back 43

1822-1885
- experimented with changing temperatures in beverages that contained bacteria
- figured out a way to intervene in the food system that can make food last longer
- economic impact

Front 44

Lister

Back 44

- 1827-1912
- Hospitalism
- sanitizing open wounds it crucial to health of patient

Front 45

Koch's postulates

Back 45

a. Microorganisms are found in abundance in diseased organisms
b. They can be isolated from the organisms, grown in a pure culture, and reintroduced into healthy organisms to induce sickness
c. Disease-causing microorganisms are sometimes also found in abundance in asymptomatic individuals

Front 46

Typhoid Mary

Back 46

- asymptomatic carrier of typhoid and spread it to the families for which she worked as a maid
- New and important information for screening and treatment

Front 47

Cholera Vibrio Wager

Back 47

1892
- Pettenkofer vs. Koch
- ii. Takes a cholera sample and Pettenkofer consumes it to prove that this is not the cause of disease
iii. He got sick but did not die → that’s the tragedy

Front 48

Miasma to Germs

Back 48

- i. Not simply as engineering but more as a paramedical/medical profession that focuses on containing transmission of small living organisms
- Social reform is still part of public health
- idea of structural violence (comes out of miasma). Calls attention to the fact that external contexts are part of chain of causation of disease

Front 49

Changing the Paradigm of HIV Testing – The End of Exceptionalism (Bayer)

Back 49

- Exceptionalism: approach previously taken towards HIV testing, requirement of counseling and express written consent before testing to avoid discrimination, stereotyping and stigma
- shift from stringent consent to an informed right of refusal
- used to be a common belief that HIV testing required consent especially because there was not much one could do to treat the disorder
- Now that there is more treatment..."...complex chronic condition requiring long-term, ongoing clinical management means that the limits imposed when medicine had little to offer have outlived their justification."

Front 50

Yellow Fever

Back 50

- Mortality Rate [only 15% go into second stage, 3% mortality, 20% in clinical cases without treatment)
- lifelong immunity
- Outbreak during the building of the Panama Canal (20% mortality)
-"White Man's Grave"
-
-

Front 51

Carlos Finlay

Back 51

-1833-1915
- Cuban Physician in military medicine during Spanish American War
- worked with Walter Reed

Front 52

Walter Reed Commision

Back 52

- 1/2 people put in room with mosquitoes, 1/2 put in room with infected people
- realized that mosquitoes were the transmission vector
- Scientists also participated in the study and finishing this project (panama canal) lead to a huge economic boom...was it still ethical?
- common thought that these kinds of studies were okay if they were for the common good

Front 53

Nazi Medicine

Back 53

- trials done on people who were in concentration camps to investigate how the body responded to certain phenomenon
- lots of our military equipment came from these studies when we took over the camp
- Nuremberg trials

Front 54

Tuskegee Syphilis Study

Back 54

- 1930's - 1950;s
- Hundred of AA males recruited with the promise of free treatment and a funerary fund
- targeted sharecroppers who were poor, illiterate and had no healthcare access
- "bad blood", "last chance for special free treatment"
- Arguments for ethical nature of study: wouldn't get care anyways, no existing care, free check-ups, never to be repeated opportunity, natural laboratory, seen as subjects not humans
- purposefully withheld penicillin (known treatment as of 1950) so as not to mess up study
- Formation of IRB's

Front 55

Standard of Care Argument

Back 55

Not okay to enroll people in a placebo study if there is already a standard of care available

Front 56

IRBs

Back 56

Institutional Review Boards
- 1970s they came about
- not always legitimate...3rd world countries could create ones that are not legitimate in order to reap economic gains of a study
- what is informed consent? How do you judge a rational decision?

Front 57

The Growing Need for Public Health

Back 57

- international trade and commerce
- national economies were suffering due to illness and disease

Front 58

Edward Jenner

Back 58

- 1749-1823
- Realized milkmaids had low rate of small pox, especially variola major
- discovered that the exposure to cows was the basis for the development of an immune response in the milkmaid population

Front 59

Three strands of small pox

Back 59

- variola major [80% mortality untreated] (10-20% infected)
- variola minor [low mortality, like a common cold]
- variola vaccinae [cow pox]

Front 60

Variolation

Back 60

- taking the contents of an infected person's pustule and rubbing it in another's wound in hopes they would contract a mild form of the disease and thus, resistance
- moved through the trade networks during 1100s-1300s

Front 61

Inoculation

Back 61

- introduction of a substance or microorganism into the human body to generate the growth of various kinds of biochemical agents that aid in immunity and prevention
- in this dose and in this way, something dangerous becomes safe

Front 62

Why was small pox a good disease for eradication?

Back 62

- no animal resevoir
- little to no latency period (if you were showing symptoms, you were recently infected)
- no asymptomatic carriers (few)
- infection --> immunity
- advances in vaccine storage and transport

Front 63

Challenges of eradication of small pox

Back 63

- WHO credibility
- heavy emphasis on treatment in tropical disease science (due to colonial structures of economic production)
- low estimates of number affected in certain countries
- logistical issues
- lack of police power of WHO

Front 64

Logistics of Eradication Campaign

Back 64

- cultural epidemiology: navigating the geopolitical space, linguistic and cultural barriers, working in countries with little to no infrastructure
- Incentivizing people to get vaccinated: more frugal to pay people to get vaccinated then to pay for their health care
- Police power: eventually given to WHO, many were vaccinated by force
-"triumph of management not medicine"

Front 65

Eradication timeline

Back 65

last outbreak in 1975 (campaign started in 1960s)

Front 66

Costs and Benefits of eradication

Back 66

- Cost less to eradicate than it did to manage the disease on a yearly basis
- increased worker productivity, better for economy

Front 67

Management not medicine

Back 67

• “A triumph of management not medicine”
o resource mobilization
o science and technology
o cross cultural infrastructure
o human capital