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87 Cards in this Set
- Front
- Back
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Definition of Public Health
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-"science & art of preventing disease"-Winslow
-"organized community efforts aimed @ the prevention of disease and promotion of health" |
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Biomedicine definition
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-medecine as practiced in western world
-germ theory/bodily cause of diseases |
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Biomedicine characteristics
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-who: individual
-where: clinic -why: diagnose + treat -when: emergency -how: technology |
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Public Health characteristics
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-who: population
-where: community -why: govern -when: prevention -how: policy |
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McKeown Hypothesis
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-studied role of medicine in societal improvement
-disease improves before medical advancements (b/c sanitation, safer food, housing codes) -pop. growth/falling mortality not due to medicine -medicine may be "nemesis" (i.e. invest only in phealth) or "mirage" (i.e. mistaken cultural beliefs about its benefits) |
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Impacts of medicine
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-emergency care
-obstetrics/maternal care -pharma -acute care/treatment -immunology -generation of cultural images of western healers (as heroic, dramatic, attractive, @ bedside) |
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Social medicine
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-concept: medicine divorced from the community detracts from its ability to treat it
-goal: connect clinic work and community work -e.g: directly observed therapy; used to ensure drug adherence in TB programs |
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Structural Violence
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“Social structures – economic, political, legal, religious, and cultural – that stop individuals, groups, and societies from reaching their full potential. Disparate access to resources, political power, education, healthcare, and legal standing are just a few examples” -- Paul Farmer
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medical anthropology
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-study of beliefs/cultural practice/ideas about health, disease, and healing
-helps inform public health -e.g. anthro of epilepsy in china revealed family context & stigma |
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Liberation theology
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-Paul Farmer
-Catholic movement -- bible as social critique -community as sacred, thus structures that violate it are unjust/troubling -provides alternative view/approach to health |
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Fields of Public Health
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-basic science (chem/bio)
-biostatistics (patterns, risk) -epidemiology (disease monitoring/spread) -behavioral/social science (anthro, psych) -environmental health (toxicity, disease contributors) -health services administration |
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"Second sight"
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-ability (proposed by Winslow) to translate public health success in a way that we could see people as still living because of some public health measure
-illustrates how public health results in silent victories |
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Core functions of public health
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-Assessment
-Assurance -Policy Development |
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Assessment
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-Monitor population (surveillance)
-diagnose problems & respond -research |
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Policy development
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-educate
-work within community -help meet needs/provide resources |
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Assurance
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-enforcement (laws, programs)
-workforce (to run programs) -ensure availability of services -evaluation/adjustment of programs |
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CDC (NY County Fair) Case Study
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-high incidence of diarrheal hospitalizations
-E.Coli found in stools -case-control study comparing vendor A (using well) and vendor B (not using well) -vendor A showed higher morbidity --> suggests well as potential disease source -further confirmed by enviro study -- contamination by nearby farm |
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Elements of disease prevention
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-immunization/vaccination
-screening -enviro modification -treatment -prohibitive policies -primary vs. 2nd vs. tertiary |
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screening
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-prevents spread and worsening of systems
-2nd prevention |
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Health promotion
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-media/PR (PSAs)
-education/behavior modification (buckle seatbelt) -product info -economic incentives -workplace info |
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primary vs. 2nd vs. tertiary prevention
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-1=prevent illness
-2=early detection/prevent spread -3=early treatment |
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Important developments in Public Health
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-1830s-50s: early health boards
-1850s: sanitation improvements - |
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Contentious issues in public health
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-crime & punishment: phealth problems treated as crime (e.g. drugs/alcohol)
-health funding: often misdirected -placebo use: (un)ethical w/established standard of care or low-income countries |
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Political hindrances to public health
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-politcal protection/importance of autonomy in US can hurt health of population:
-individuals don't want to assume economic responsibilty -balance needed to respect moral/religious beliefs and protect public health -e.g. mandatory HIV screening -short-sightedness caused by desire for reelection -little support for long-term projects |
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Gibbons vs. Ogden
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-1824
-established police powers -NY trying to shut down's Gibbons ferry across Hudson -Chief Justice John Marshall |
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Police power
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-state govt.s posses police powers
-powers of enforcement, particularly enforcing laws for public good -includes: inspections, quarantine, health laws |
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Queens Realty vs. NY Housing
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-1946
-police powers confirmed -NY can force hotels/housing to improve sanitation |
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Jacobsen vs. MA
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-1905
-Jacobson tried avoiding smallpox vaccination for religious regions -Supreme court ruled MA can force vaccination for the common good |
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Implications of Jacobsen
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-flouridation of water system
-fortification of foods -seat belt laws -motorcycle helmet laws -idea of "public good" |
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Griswald vs. CT
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-1965
-debate over legality of Rx contraceptives -Supreme court: bill of rights (specifically search & seizure) amount to a certain "right to privacy" -granted medical sovereignty |
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"Right to privacy"
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-bill of rights as whole grants this right (even though not specifically in constitution)
-"zones of privacy": reproductive; family; medicine -limit to police power |
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Wisconsin vs. Yoder
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-1972
-Amish exempt from compulsory education -e.g. when violation of rights > harm caused by not attending high school |
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Prince vs. MA
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-1943
-"preferred position" does not outweigh public good -cannot expose community to communicable disease |
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"preferred position"
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-avoid violating individual liberties
-applies to religion; e.g. Wisc vs. Yoder |
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Lukumi Babalu vs. Hialeah
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-1993
-allowed church to make chicken sacrifices -exemption of food safety laws |
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Cox vs. NH
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-1941
-upheld requirement for parade permits -cannot exercise free speech if it endagers others |
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14th Amendment/"Due Process"
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-full & even treatment under the law/equal access to govt. asst.
-Yick Wo vs. Hopkins -Brown vs. Board |
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Yick Wo vs. Hopkins
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-1886
-San Fran prohibits wooden laundromats -plaintif claimed this was undue burden on one racial group (Chinese) -ruled in favor of SF |
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Brown vs. Board
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-1954
-underfunded, segregated schools are violation of due process |
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Private property & public health
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-govt. can interfere w/private property at times to ensure public health
-responsible land use -livestock/animal laws -prohibition (of substances/activities) |
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Phases of public health protection
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-General health protection
-Sanitary movement -Bacteriological Revolution (1880-1940s) -International Public Health |
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epidemic
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-high concentration of incidence
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incidence
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-new cases/population or area over a period of time
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general health protection
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-lack of formal public health
-social structures/practices that are beneficial to health -e.g. kosher, religious/culture traditions, vows of chastity |
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pandemic
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-epidemic on a large, international scale
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endemic
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-high prevalence
-consistently high rates of disease over period of time |
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prevalence
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# of cases/population
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quarantine
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-"40 days"
-preventing contact in order to prevent spread of disease |
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Causes of an Epidemic
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-demography: increased human contact
-agriculture: increases disease spread, animals -climate -trade, travel -host population resistance -pathogen evolution |
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Leprosy
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-leper colony
-biblical uncleanly -social death -disproportionately affects the poor |
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smallpox
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-highest killer in the middle ages
-clustered down the social ladder -blindness, scarring, stigma -variola major, variola minor, vaccinae -vaccine from vaccinae=cowpox<--Jenner |
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bubonic plague
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-fleas (rat-->flea-->human)
-mechanical transmission -brought to Europe through cross-continental travel -~100% mortality |
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Medieval response to epidemics
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-confusion about disease cause
-animal extinctions/human genocide -expanded border patrols -first national-level health boards |
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isolation
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-used to separate ill persons who have a communicable disease from those who are healthy
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quarantena
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-to separate and restrict the movement of well persons who may have been exposed to a communicable disease to see if they become ill
-ships forced to wait 40 days before coming in to port -response to mercantilism -economic impact on merchants -led to corruption -actually increased disease |
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impacts of epidemic era
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-led to first public health responses
-fear/lack of knowledge -vulnerable populations -govt./institutional efforst needed to control infectious disease |
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Bayer
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-HIV testing
-exceptionalism=historical approach requiring consent, in place to avoid discrimination -current shift away from exceptionalism |
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eradication
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worldwide reduction of incidence to zero with no further intervention needed
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Smallpox eradication
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-Pratt article
-ideal disease (human vector, no asymptomatic carriers, immunity) -tech advances (freeze-dried, bifurcated needle) -WHO eradicated in 1979 |
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inoculation
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-introduction of agent to human in order to help grant immunity
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sanitary movement
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-effects of urbanization, overpop.
-Edwin Chadwick -registration of birth/death act -sanitary idea -phealth as power (rise of health dept.) |
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Edwin Chadwick
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-introduced idea of link between poverty & disease
-social reform as way to control disease |
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sanitary idea
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-disease as closely connected to socioeconomic status, urban enviro
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variolation
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-old practice of purposefully infecting people with smallpox to give them immunity
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vital statistics
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-taking data about population unheard of pre-1800s
-began recording births, deaths, etc |
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Bacteriological Revolution
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-period of discovery
-shift from miasma-->germ theory |
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Leuwenhoek
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-advances in microscopes
-first to see cell & bacteria |
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Pasteur
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-pasteurization
-microorganisms in living in things we drink: beer, milk |
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Lister
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-hospitalism
-alcohol/antiseptics kill bacteria -reverse trend of high hospital disease rates |
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Koch
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-microorganisms high in diseased individuals
-microorg. can be grown, reintroduced, and cause infection -asymptomatic carriers exist |
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Von Pettenkofer
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-consumed feces of cholera victim to try and prove miasma
-got sick, didn't die, later committed suicide |
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typhoid mary
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-housemaid
-asymptomatic carrier -families got sick |
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Carlos finlay & panama canal
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-workers dying of yellow fever
-room w/healthy+sick or health+mosquitos -discovered mosquito as vector |
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Nazi Medicine
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-inhumane experiments inhumane on people to see how body reacts
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Tuskegee syphilis study
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-completely unethical study of syphilis in black sharecroppers
-recruited with funeral fee and free check-ups -deceptive, penicillin withheld -no consent, coercion |
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sensitivity
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-true positive/(true pos+false neg)
-tests ability to ID people if they have the disease |
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specificity
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-true neg./(true neg.+false pos)
-tests ability to show up neg. if no disease |
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NCHS health surveys
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-NCHS=National center for health statistics
-NHIS (national health interview survey, 50,000) -NHANES (Nat. Health and Nutrition Exam Survey, 5,000) -BRFSS (Bheavior Risk Factor Surveillance Survery, telephone) |
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western blot test
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-2nd line HIV test
-1st line: 95% specificity & 98% sensitivity -If test positive in first line, do western blot (99.99% specificity) to weed out false positives -lots of false neg. |
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NHIS male/female mental help seeking
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-parents seek more help for boys than girls
-girls have less access to mood disorder drugs -need for diversification/greater access |
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descriptive epidemiology
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-basic/common practice in phealth
-begins with John Snow -Low back pain <-- nonbio factors - |
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epidemiology
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-practice-oriented research
-research-based policy -surveillance -baseline -morbidity/mortality -prevalence-incidence |
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Legionnaire's disease case study
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-July 1976 American Legion
-high incidence/morbidity of unknown bacteria -discovered cause: bacteria thrives in cold of a/c system |
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general fertility rate
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-live births/women of childbearing age (15-45)
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crude birth rate
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-live births/total population
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relative risk
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-ratio of prob of two events
-p(a)=p & p(b)=q then the relative risk = p/q -e.g. RR of death for men on titanic = p(dying if man)/p(dying if woman) |
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odds ratio
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-p(a)=p & p(not a)=q
-odds ratio=p/q -e.g. men on titanic: #dead/#alive |
