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96 Cards in this Set
- Front
- Back
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Healthy People 2010
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• Multi-billion dollar project funded by department of health
• Set 10 year (from 2000-2010) goals to meet for entire population • gap between healthiest and least healthy has widened significantly in the last 10 years… and since 1980 |
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Life expectancy women vs. men
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women have a higher life expectancy than men. both have risen greatly over the past decade.
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Eight Americas
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- study done by Chris Murray
• “eight Americas: investigating mortality disparities across races, and race-countries in the US” • data from census and NCHS • 3,141 U.S. counties merged into 2072 units, then dividable into 8 large segments • defined based on race, geographical location, population density |
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Eight America Populations
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• Asian
o Asians living in counties where pacific islanders make up less than 40% of total Asian population • Northland low-income rural white o Whites in northern plains and Dakotas • Middle America o All other whites not including americas 2 and 4, asians in America 1, and native Americans no in America 5 • Low-income whites in Appalachia and Mississippi valley o Whites in Appalachia and the Mississippi valley • Western native American • Black middle America • Southern low-income rural black • High risk urban black |
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CDC
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-Center for disease control
-located in Atlanta, Georgia |
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DALYS
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-Disability Adjusted Life Year
o Not mortality o Refers to amount of suffering/disability that is cause by these conditions o Mental health and neurological conditions account for substantial and not proportional DALY compared to mortality • Formula: (YLD[LE-age])*i o Years lived with disability o i = weight of disability o LE = life expectancy |
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MDR-TB
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-Multiple Drug Resistant Tuberculosis
-first line treatment resistant -for MDR-TB and XTR-TB: 54% of all cases…95% in poor countries…50% mortality rate |
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Drug Resistance
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-When a disease strand no longer responds to treatment
-due to adaptations/mutations of disease -can be caused by medical non-adherence in drug regiments |
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Drug Adherence
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-taking drugs regiments on schedule and finishing prescribed medications
-applies to all types of medication, but particularly important in antibiotics used to treat infectious diseases like HIV and TB because non-adherence can lead to mutations and strengthening of disease strands |
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Dawa
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-insecticide in which mosquito nets are soaked
-locals view dawa as a poison -leads to non-adherence in malaria mosquito nets |
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Mosquito Nets
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-Prevention measure used for malaria in Africa
-Nets soaked in pesticide that are hung over house to prevent malaria vector of mosquito |
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vector
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-medium of transmission of a disease or virus
-blood born -waterborne -zoonotic (animals/insects) -food born |
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typhoid mary
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-asymptomatic carrier of typhoid
-worked as a maid for many families in NYC --> all families developed typhoid cases for unknown reason. -it was determined she was was the vector of transmission and she was quarantined for life |
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HAIs
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-hospital acquired infections
-higher rate in US than in countries with universal health care because w/ universal health care there is more emphasis on primary care and less incentive to hospitalize patients |
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selection bias
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bias in the methods you are using the select or recruit people into the study
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reporting bias
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-occurs on side or informant
-Informant give an answer that is not totally accurate |
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controlling bias
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-Ethnography itself
-Creating a no judgment zone → more informal and therefore more likely to get the truth |
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Framingham Study
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• Framingham Massachusetts
• Study of IHD (ischemic heart disease) risk factors by NIH • Studied 4 generations • Discovered relationship between cholesterol and heart disease → heart disease is associated with cholesterol build up o Body mass index greater that 30 kg/m^2 at age 40 reduces life expectancy in non-smokers by about 7 years (13 years for smokers) |
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Whitehall I
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• Whitehall, London ⇒ where you work for government; civil servants
• 1967: 18,000 men 20-64 • high stratification environment with full and equal healthcare access o big difference between high level employees and low level employees o healthcare = control variable o allows them to look at people whose health difference cannot be attributed by lack of access to healthcare • higher mortality in lower grade employment ranks • controlling for risk factors accounted for only 40% of the differential (RR still 2.1 for IHD) |
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Whitehall II
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• 1985: 10,000 men and women
• focus on work, stress and health • causal modeling of pathophysiology and sub/clinical disease markers associated with relative status impacts: -myth dispelled that only men who are bosses of companies get heart attacks→ managerial stress -universal health care access does not assure health equality -Dynamic relationships between social environment, physiology, and psychology |
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General Health Questionaire (GHQ-12)
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o List of questions/survey
o Focused on feelings of stress → not sources of stress o No questions of what person thinks about the stress or how stressors could be changed • Used for diagnosing depression • Main way psychiatric disorders are looked at epidemiologically |
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Diagnostic and Statistical Manual of Mental Disorders (DSM IV)
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• Book of psychology that contains all the diagnoses
• Specific criteria for mental disorder diagnoses |
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Four Filters of Mental Health
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• 0. Population ⇒ 33% has some conditioned (unfiltered)
• 1. Attention in primary care → 23% of population being reached through primary care • 2. Specialized mental health services → 10% getting specialized treatment • 3. Hospitalization → 2.35% end up in emergency room for some reason • 4. psychiatric inpatient → 0.6% institutionalized |
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Inpatient vs. Outpatient Care in Psychiatry
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inpatient:
-inpatient care is very expensive (85% of all costs) -alienation and segregation in many institutions outpatient: -focus on prevention -focus on prevention in communities -public health focus -prevention of hospilitization and suicide -holistic approach |
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suicide prevention
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-Essential to intervention ⇒ recognizing at-risk population
-Clinical care and medication -Social support -Job, housing, and family stability -Gun control -School and workplace surveillance |
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William Farr
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-1807-1883
-Founder of environmental health -Study of cancer and British metal miners o First study that looks at workplace and occupational health and safety as public health issue o Government has a concern in safety of workers |
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Lead (poisoning)
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How does lead enter the body:
o Inhalation o Ingestion o Water o In-utero How to control/prevent lead exposure: o Occupational controls o Removal of lead paint from older homes o Regulation of lead levels in water o Special effort to reduce exposure to pregnant women |
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Four step process in environmental inspection of workplace facility
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•hazard identification
•dose-response relationship o higher the dose → does response change? o Is there a safe dose? •exposure assessment o within that environment, what is exposure and thus level of risk in environment? •risk characterization o how many people are effected? What is their risk compared to wider society |
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Dose Response
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• If linear, then no threshold
• if non-linear, then there is a threshold exposure dose o After certain level of exposure, there is an exponential increase in risk for disease o Threshold = turning point |
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Human Genome Project
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-global collaborative project to map the human genome
-analyze all of human DNA and map human genes |
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Huntington’s disease
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-Onset between ages of 30 and 50,
-symptoms: involuntary movements, intellectual deterioration, psychiatric issues→ eventual death -Each child has a 50% chance of having disease if parent has gene -controversy of being tested--> receiving death sentence or not |
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New Born screening
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• Public health mandate of preventing death and disability from many genetic diseases can be fulfilled only by predicting and preventing birth of affected children
• Ethical issues of screening--> abortion, false positives |
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Asbestos
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-had many uses, because of its strength and fire resistance
-but caused lung scarring and cancer, so was banned. -Asbestos Hazard Emergency Response Act passed to have all schools checked for asbestos. |
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Sanitary Landfills
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• Must meet federal standards
• Often there is a shortage of space for these landfills • NIMBY phenomenon (Not in my backyard phenomenon) – nobody wants a landfill in their area. |
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Firearm Injuries
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•More than ¼ deaths from a firearm are suicides
•More than 2/3 death from a firearm are homicides •The death rate from firearms is 6 times greater for men than women •About 1/3 of US households possess firearms o Preventative measures would be to more strictly regulate the possession of firearms o Political powers forbade CDC from funding promotions for gun control •Perhaps it is not just gun control that needs improvement, but the engineering of guns themselves → lower amount of firearm related injuries |
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HPV Vaccination
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• Prevents an STI which can cause cervical cancer, genital warts, etc.
• Not believed the expense for the vaccination is justified because of those infected, not many get cervical cancer • Promotes sexual promiscuity • There has been a shortage because manufactures produce insufficient supplies because they understand it doesn’t benefit them financially |
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The Clean Air Act
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-requires monitoring and regulation by the EPA of six common air pollutants known to be hazardous to health and the environment.
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Clean Water Act
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• Set national goals that all lakes and rivers should be fishable and swimmable and that all pollutant discharge should be eliminated. Requires pretreatment of industrial waste that is discharged into sewers.
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Safe Drinking Water
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•Outbreaks of waterborne illness are still common in the U.S.
•Safe Drinking Water Act o Requires the EPA to set standards for local drinking water systems and requires states to enforce these standards o Ineffective. EPA has been lax in enforcing laws and states have not been following them. |
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Indoor Air Quality
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•May have even more significant effects on health than outdoor air, since people often spend more time indoors and indoor pollutants are trapped inside in higher concentrations.
•Common indoor pollutants o Tobacco smoke o Radon gas o Consumer products that release chemicals o Biological pollutants (bacteria, mold, etc.) |
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Secondhand Smoke Awareness
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• “Nonsmokers rights movement”
• 1992 – EPA declares environmental tobacco smoke a carcinogen • 1974 – States, beginning with CT, start restricting indoor smoking |
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Ecological Model of Health Behavior
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•Five levels of influence
oIntrapersonal factors • Encompasses the knowledge, attitudes, and skills of the individual • Individual psychology oInterpersonal factors • family, friends, and coworkers • especially affect behavior early in life • provides social support oInstitutional factors • School, workplace • People spend about 1/3 to ½ of one’s waking lives in these institutions oCommunity • Organizations can work together in a community to jointly promote healthy goals oPublic policy • Regulations and limitations on behavior • Local, state, and national government |
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Department of Health and Human Services
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•$700 billion annual budget
•65,000 employees •largest grant making agency in the world (60,000 per year) o heavy influence on what kind of research is done in US because provides much of the funding |
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Indian Health Service (IHS)
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• Division of DHHS that provides health care services to native Americans
• Significantly underfunded |
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Medicaid
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-acts as a “Medigap” policy for poor elderly
• Intended to serve poor (especially poor children) • More used to pay for elderly healthcare not covered by Medicare • Growing and unmet need for nursing home care • Costs increasing faster than Medicare |
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Social Security
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-retirement system for elderly
• Both feeling strain of aging population • Number of people is growing and costs are increasing |
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Medicare
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-federal program that pays medical bills for elderly
• Only pay 49% of healthcare costs of enrollees |
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Preterm Birth
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• Responsible for many more infant deaths than any other cause
• Younger women or unexpected older women are more likely to birth a smaller child • Primary Prevention o Social and financial support for low-risk pregnant women • Secondary prevention o Identifying women at risk of giving birth too early and reducing their risk • Tertiary prevention o Improving outcomes for the infants born prematurely • Preterm birth is a social problem rather than a health problem |
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OSHA (Occupational Safety and Health Act)
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-empowered the federal government to set standards for workers’ exposure to toxic substances
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NIH
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-National Institute of Health
-NIH gives out grant money for research --> responsible for decided what does and does not get funded |
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Legionnaires’ Disease
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•July 1976 American Legion conference
•August 150 cases and 20 deaths o From unknown bacteria infection that up to that point had never been seen o Investigation realized that when they looked at bacteria that it was identical to an unknown bacteria seen several years before •Descriptive epidemiology? o Bacteria was in the air conditioning in one of the conference hotel o Used phone calls to ask other attendees which hotel they stayed in and looking at where they sick persons and non sick persons had stayed o Discovered leak in exhaust system in one of the air conditions on top of one hotel •Cause? o Rare bacteria that exists in cold conditions (air conditioning unit) |
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Ebola virus
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-symptoms = fever and severe bleeding;
-found in humans and monkeys, -outbreaks as late as 1995 |
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DOTs
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-Directly Observed Therapy
-Program started to increase adherence in TB patients in their drug regiments, and decrease prevalence of MDR-TB -Nurse goes to house and delivers medication and makes sure that patient takes medicine on time every day - |
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Surgeon General's report of 1964: Smoking and Health
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-summary of evidence to date as approved by panel of 10 renowned scientists
-said smoking caused lung cancer and was strongly associated with cancer of mouth, throat, and larynx. -very influential report that caused a lot of smokers to quit and desire to impose controls on tobacco companies |
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Tobacco Regulation
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o Federal Trade Commission required warning labels
o Federal Communications Commission – ads must also have PSA about harmful effects (“Fairness Doctrine”) • 1971 – total ban on cigarette advertising on radio & TV • Companies shifted to print ads, sponsorships, billboards o All states have laws prohibiting sale of tobacco to minors – enforcement varies o Raising taxes on cigarettes – effective in reducing smoking among teens and adults -FDA Regulation o 2009 – Family Smoking Prevention and Tobacco Control Act • Gave FDA authority to regulate tobacco products and restrict ads and promotions • Can now gradually reduce amount of nicotine – less addictive • Bans candy-flavored cigarettes |
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FDA
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-food and drug administration
-the federal agency that ensures the safety and nutritional value of the food supply; evaluates new drugs, food additives, and colorings; and regulates medical devices, vaccines, diagnostic tests, animal drugs, and cosmetics |
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self-efficacy
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-sense of having control over one’s life
-affects how confident people are with their ability to adopt a healthy behavior |
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Poisoning
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• Dramatic increase in poisoning fatalities as a result of legal and illegal drugs
• Much of it is to be blamed on the recreational use of prescription drugs → need for safety regulation of opiates by the Drug Enforcement Agency |
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Traumatic Brain Injuries (TBI's)
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• Severe traumatic brain injuries (TBI) may cause permanent disability
• The two leading causes of TBIs are motor vehicle incidents and falls; more recently it has also begun to be a major risk factor if participating in athletics |
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Air Pollutants
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• Particulates (smoke, soot, and ash)
o Reduces visibility, forms layers of grime on buildings and streets, and corrodes metals. • Sulfur Dioxide o Fro coal combustion o Creates acid rain • Carbon Monoxide o Produced from motor vehicle exhaust • Nitrogen Oxides (Smog) • Ozone o An important protective aspect of the upper atmosphere but at low altitudes is harmful. • Lead o Highly toxic metal that can damage the nervous system, blood and kidneys. |
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Motor Vehicle Safety
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• National Highway Traffic Safety empowered a new set of standards for vehicles
• Promoted road safety • Prevention methods: o Primary prevention includes preventing crashes from occurring in the first place o Secondary prevention includes establishing requirements to better protect the occupant in the car • Preventative measures include: turn signals, break lights, highway design, road signs, seat belts, helmet, drinking laws |
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Common indoor pollutants
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o Tobacco smoke
o Radon gas o Consumer products that release chemicals o Biological pollutants (bacteria, mold, etc.) |
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Reduce-Reuse-Recycles
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-Alternatives to Landfills
• Reduce waste by taking measures such as eliminating excessive packaging and charging consumers for disposal by volume. • Recycling and use of reusable rather than disposable products |
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Social Cognitive Theory
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-Knowledge of health risks
-benefits of change -self-efficacy -outcome expectations -facilitators and barriers ==> behavior |
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Transtheoretical Model (stage of change)
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precontemplation --> contemplation --> preparation --> action --> maintenance
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Health Promoting Behaviors
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-refrain from smoking and other tobacco use
-exercise regularly -eat a healthy diet filled with fruits and veggies -consume alcohol only in moderation -drive within the speed limit -wear a seatbelt consistently -avoid guns -practice abstinence or safe sex -abstain from using illicit drugs |
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Burden of Disease
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-The WHO global burden of disease (GBD) measures burden of disease using the disability-adjusted life year (DALY).
-This time-based measure combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health. TOP FIVE: -heart disease -infectious diseases -cancer -respiratory infections -unintentional accidents/injuries |
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MMWR
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-Morbidity and Mortality Weekly Report
-Released weekly by the CDC |
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Compliance
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-adherence
• Patients who take their medication properly • Following the doctors orders • Related to costs because if non-adhering patients do not take medication properly is increases costs (take more medications, disease becomes stronger) • Huge issue in clinical medicine |
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Co-morbidity
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-when two or more medical conditions compound/occur in one individual at the same time
-common: mental health + disease -ex: bernadette had STD and mental health co-morbidity |
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Accompaniment
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-Paul Farmer version of DOTs
-more intensive and humane relationship between patient and nurse -takes into account reasons why patient may not be taking medication --> i.e. structural violence -shown to be very effective in increasing adherence |
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IMR (Infant Mortality Rate)
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-most important measure taken into account when accessing the health of a given population
-largely influenced by socioeconomic factors (SES) |
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YPLL
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-years of potential life lost
-measure of the impact of disease or injury in a population -years of life lost before a specific age (usually 75) -places additional value on deaths that occur at an earlier age |
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Chain of infection
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-pathogen (what causes disease--bacteria, virus, etc.)
-reservoir (where pathogen lives and multiplies) -method of transmission (vector) -susceptible host (pathogen must gain entry, and host must be susceptible to disease) |
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Love Canal
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-Niagra Falls 1978
-abandoned industrial dump that had been intended to be a canal had been used as chemical waste disposal sight for ten years, then heavy rains brought chemicals to surface and residents started experiencing severe side effects -declared federal disaster area and residents were evacuated -follow up with residents showed women were more likely to give birth to babies with congenital malformations and people were more likely to develop certain cancers |
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greenhouse effect
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-refers to atmospheric carbon dioxide acting as glass of greenhouse--> allowing sunlight to enter but trapping heat inside
-main cause of global warming--> leading to warmer temperatures on earth's surface |
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Dartmouth Study
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-1996 Dr. John Weinberg Dartmouth medical school
-study on how prevalence of certain medical treatments differ across the country -found major discrepancies in frequency and types of procedures being carried out in different locations -lead to development of health research field--> studies the effectiveness, efficiency, and equity of the health care system -tries to access quality of medical care |
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Compression of mortality
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-deaths concentrated in short age range
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Compression of morbidity
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-diseases prevalent, but not as disabling
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Natural v. manmade/technological disasters
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-Disasters – large scale injuries, death, diseases, and property damage
-Many natural disasters are predictable (hurricanes) - There are usually plans – evacuation of vulnerable populations etc. - Unpredictable natural disasters: - Earthquakes, building standards, other protections -Technological disasters – industrial explosions, bridge collapse, plane crash, etc. - Presence of Nuclear plants à Should prompt community emergency planning |
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Mechanical Transmission
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-pathogen directly implanted in host
-ex: flea picks up pathogen from feces and bites human and vomits in wound |
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USDA
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-United States Department of Agriculture
-aims to meet the needs of farmers and ranchers, promote agricultural trade and production, work to assure food safety, protect natural resources, foster rural communities and end hunger in the United States and abroad. |
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Modes of Transmission
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-Direct (STD, blood transfusion, mosquitoes)
-Indirect (airborne, waterborne) -Vertical (mother to child) |
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threshold
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-maximum amount of exposure before effects become detrimental
-related to dose-response (i.e. how much dose can be given before at risk for overdose) -does not apply is there is a linear relationship between dose and effect; must be exponential (threshold = turning point/drastic increase) |
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"Bioterrorism as a Public Health Threat" (Henderson)
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-bioterrorism is one of biggest threats facing the globe today
-anthrax and smallpox = main players -needs to be taken more seriously than it currently is and international effort to prevent bioterrorism/defensive measure need to be put in place |
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"The Threat of Multidrug Resistance: Is TB Ever Untreatable or Uncontrollable?" (Gleissberg)
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-MDR-TB is a big problem in both developing work and developed world
-need more funding to combat disease -DOTS and accompaniment are key to success |
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"Breaking the Silence" (Ainsworth)
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-HIV/AIDS disproprotionately effects developing countries
-Policy/action has thus far been ineffective because of lack of direction and lack of addressing prevention measures by governments -in order to be more successful policy should have smaller focus and fewer priorities --> leads to greater impact |
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"The New World of Public Health" (Cohen)
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-global public health organizations being looked at critically and being questioned of what they are really accomplishing
-donors also benefit from philanthropy in number of ways -some programs also have limitations (PEPFAR) |
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"The Global Impact of HIV/AIDS" (Piot)
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-HIV/AIDS has major impact globally
-even as more funding is being provided, incidence/prevalence is not decreasing -effective control requires unified national planning, access to prevention and care, and inclusive social environment for HIV positive people and those most at risk. -stigma also huge barrier to effective action |
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"Concerns About Immunization" (Bedford and Elliman)
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-vaccines are public health measure that has saved most lives other than sanitation of water
-people object to vaccinations based on: -disease being vaccinated against is rare and not serious -other methods are better for treating the disease -vaccines are dangerous and cause other illnesses -vaccines are actually good and very safe and should be taken advantage of by all |
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"Immunization and the American Way: 4 Childhood Vaccines" (Baker)
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-British and Americans have very different approaches to immunizations/vaccine development
-British used more methodical approach to development; Americans used strategies more suitable to wider application --> Americans developed faster, but both reached same conclusion eventually -Diseases we have vaccines to (in chronological order of development): diptheria, pertussis, polio, measles -polio = convergence of british method and american methods (wide scale, but good experimentation) |
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"Global Mental Health" (Kastrup, Ramos)
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-examines the global epidemiology of the most important psychiatric disorders: Schizophrenia, Affective Disorders, Anxiety Disorders, PTSD, Alcohol Abuse, and Suicide.
-discusses current statistics related to each disorder calls for more prevention and treatment efforts to help combat the projected increase in global burden of disease percentage in mental health |
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"Mental and Social Health During and After Acute Emergencies: Emerging Consensus? (Von Ommerren)
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-addresses the debate over the methods of mental health care programs during and after acute emergencies by proposing a treatment method that considers pre-existing human and community resources, social interventions, and care for people with pre-existing mental disorders.
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"Relationship Between Poverty and Psychopathology: A Natural Experiment" (Costello)
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-addresses the debate between social selection and social causation as explanations for the link between poverty and mental illness.
-Social selection: in terms of gene-environment correlation, affected individuals and their family members drift down into poverty and thus into an environment that further increases risk for mental illness. -found that oppositional and deviant behavior was caused by social situations but anxiety and depression were not |
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"Medicine and Public Health, Ethics and Human Rights" (Mann)
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-• The relationship between Public Health and ethics has become more evident in out modern world through events such as HIV/AIDS and the numerous genocides seen throughout the past several decades
-human rights takes ethics more into account and protecting human rights equates to promoting ethics |
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PEPFAR
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-President's Emergency Plan for AIDS Relief
-commitment of $15 billion over five years (2003–2008) from United States President George W. Bush to fight the global HIV/AIDS pandemic. -Mainly based in Africa, ARTs provided -Limitations: focuses on abstinence only programs, prostitution must be legal, and doesn't spend on needle exchange programs -also bush did not negotiate prices with prescription companies so spending more than we need to on drugs |
