Pubh 102 1nd EditionFINAL EXAMWhat is PH?- Definition – o Fulfilling society’s interest in assuring conditions in which people can be healthyo To promote health and quality of life by preventing and controlling diease, injury, anddisabilityo Successive re-defining of the unacceptableo ‘The P’s’ – prevention, protection, promotion, prolonging, product safety, physical social and economic environments, population- Determinants of health (“bullseye”)o Risk Factors of health – set of common causes of death, disability, illness and injury (behavioral – smoking, poor diet, lack of physical activity, alcohol consumption, etc.) more likely to be under the control of individuals at risk. o Risk conditions of health – More distal risk factors: biological (age, sex, genetics); environmental (safe community/ worksite; adequate housing); enforcement of policies and regulations; less likely to be under the control of individualso Lifestyle – pattern of behavior; more complex, lifetime habits and social circumstances- What ‘kills us’ then and nowo 1900- TB, gastroenteritis, diphtheria, polio, influenza/pneumoniao 2010 – heart disease, cancer, COPD, stoke, accidents, Alzheimer’s, diabetes, kidney disease, flu/pneumonia, suicide- Levels of preventiono Primary- action taken to avert occurrence of diseaseo Secondary- action taken to identify diseases at their earliest stages and to apply appropriate treatments to limit their consequences and severityo Tertiary- specific interventions to assist diseased or disabled persons in limiting the effects of their diseases or disabilities; also may include activities to prevent recurrence of a disease.- Socio-Ecological Modelo “Bull’s-eye” – individual traits (age, sex, race, and biological factors). The biology of disease.o Ecological perspective – multiple factors and pathwayso Risk factors – increase the likelihood of condition or diseaseo Social and cultural determinants – social status and standingo Global health influences – population, pollution, poverty and more- Ten Great Achievements in PH, 1900-19991. Vaccination2. Motor-vehicle safety3. Safer workplaces4. Control of infectious diseases5. Decline in deaths from coronary heart disease and stroke6. Safer and healthier foods7. Healthier mothers and babies8. Family planning9. Fluoridation of drinking water10. Recognition of tobacco use as a health hazardEPI Basics- PERI – defined & exampleso Problem – the what, who, and where. 1. What I the burden of disease in terms of mortality, morbidity and has it changed over time?2. Person and place – description and distribution (spread)3. Look for patterns and associations in the occurrence of disease/ condition so we can come up with hypotheses, ideas about the cause.o Etiology – the why.1. What are the contributory causes?2. ‘Determinants of Health’ (underlying conditions – not just causes)3. Risk – probability (chance) an event will happen4. Risk factors/conditions – exposure that is statistically related in some way to anoutcome. ‘things’ whose presence are associated with increased chance that diseas/ condition will develop later. It can be environmental, social & behavioral influences – not just individual behavior. It can be modifiable (susceptible to change) or non-modifiable (immutable to change). It is more likely to be under control of an individual (doesn’t mean it is EASY to change though.).o Recommendations for Reducing/ Eliminating the PH Problem –1. What works to reduce the health impacts?2. What is the quality of the evidence for the intervention?3. What is the impact of the intervention in terms of benefits and harms?4. What do we know based on past experience?o Implementation – 1. How can we get the job done?2. When should the implementation occur?3. At whom should the implementation be directed?4. How should the intervention(s) be implemented?- Criteria for establishing causeo Has an association been established at the individual level?o Does the cause precede the effect?o Has altering the cause been shown to alter the effect?- Why measure health?o To track diseases and condition, to monitor health and quality of life, to identify opportunities for prevention and protection, to create ‘surveillance systems’ and large national data bases and distribution of resources- Types of Commonly Used Measureso Rates – a measure of some event, disease, or condition in relation to a unit of population, along with some specification of time. To calculate a rate, you must have accurate counts for – numerator denominator, a defined population, and a specified period of time. Formula for rate= (# of events/cases/deaths)/(population in the same area in aspecified time period).o Incidence – number of new health-related events of cases of a disease in a population exposed tot hat risk in a given time period Formula= (# of new health related events/cases of a disease)/(# of people exposed to risk during this period)o Prevalence – calculated by dividing all current (existing) cases of a disease (old and new) by the total population- 3 Major US Trends (since 1900)o Causes of mortalityo Life expectancy Another common measure for health status. Average number of years of life remaining to a person at a particular age – may be determined by race, sex, or other characteristics using age-specific death rates fro the populations with that characteristic (ex. Life expectancy at birth) Overall health status improving, specifically life expectancy at birth (increasing), birth outcomes better, years of healthy life increasing (racial/ethnic disparities exist)o Increasing Health Disparities Increasing in/ by – ethnic and racial groups; age groups; gender; SES/poverty; Educational AttainmentGov’t, Law, & Public Health- Social Justice & Market Justice Perspectivesoooo- Role of law/gov’t in PHo To protect and promote health (police and general welfare powers)o Ensure rights of individuals- Roles of health agencies – o Local – local public health agencies, often called local health departmentso State – state health agencies such as health departments and humans service agencieso Federal – National health agencies, such as DHHS and its components  Forces shaping governmental PH – ‘science and social values’ = 1. Nature and perceived importance of threats and 2. Relationships among levels of government “Health” is hard to find in the US