W.H.O definition of health:
State of compelete physical,mental or social well being and not merely the absence of disease
Ottawa charter for health promiotion definition of health:
Resource for everyday life and not the objective living
How does Patterson define health:
He defines it as an ability to be able to perform certain valued social roles
Turnock definition of health:
It is that disease is a relatively onjective pathologic phenomenon where as health and illness are subjective
What are the component of illness-wellness continum
- This shows that illness and wellness are in a continioum and are evolving concepts
What are the theories of disease causality throughout history?
- Sins and the wrath of gods ( disease due todecline in mortality and religion)
- Origins of environmental theory ( variety of environmental influances on human disease)
- Humoral theory ( disease due to imbalance in 4 circulating fluids)
- Mysticism and church ( demonology was cause of diease, touturing body, later prayers)
- Scientific revolution (the body was seen as machine)
- Germ theory ( pasture, father of microbiology behaviors influancing transmission of the disease) the epidimiological triangle ( host, agent , environment)
- multicasul theory ( more than one factor must be present for development of the disease, web of causation)
What conditions are now considered disease that were not seen as such before?
- Premenstrual syndrome
What is Public health mission?
Fullfillment of society's interest in assuring the conditions in which people can be healthy
What does it mean by using the term fullfillment?
Public health mission is not done and compelete till the goal has been achieved. Also there is a mean to measure and evaluate succecss at achiving the agenda ( healthy people 2010)
What is healthy people?
- National prevention initiative
- Id opportunities to improve American's health
- Scoreboard for monitoring health status
- Contribution to health for all strategy
What are the major goals of healthy people 2010?
- Increase quality and Years of healthy life
- Quality of life( Overall well being, individual- Pleasant and supportive environment-community)
- Eliminate health disparities ( Infant mortality, cancer screening, cardiovascular,diabetes, HIV,immunization)
What are the disciplines comprising the profession of public health?
- Epidemiology (Study of distribution and determinant of the disease)
- Biostatistics( making inferences from small to large group)
- Health policy and administration ( focus on organization, access, quality, types of services)
- Environmental health services( focus on environment)
- Social and behavioral sciences (focus on factors that shape and reinforce individual and behavior)
What are the conditions that must be met in the mission of public health?
- Conditions of where we live
- ( Natural vs. Built environement)
- Conditions affecting our behavior
What is the challange of public health"
- Develope health promoting behavior
- Abandoning behavior that pose threat
- Maintain behavior change
TO be healthy implies that :
Health is a multidimensional subject
What are substances associated with public health?
- Organized community effort is to prevent disease and promote health
- Cadre of public health professionals moblized to engage in prevention activities
What is the paradox of public health?
That the success is measured by absence of symptoms
According to IOM what are the determinants of population health?
- Living and working conditions
- Social economical and cultural
What are the principals associated with public health?
- Population based
- Evidence based
- Social Justice
What does population based mean?
- Total Population
- -total key indicator
- -person level factor( sociodemographic)
- -defined by place
What does evidance base include?
- Rigor ( objective, dispassionate,observer)
- Vigor( Passionate,advocate,subjective)
What are the prevention base principal include?
- Primary, secondary, tertiary prevention
- Most of the focus is on primary prevention
What does social justice entail
- founding principle
- assures conditions that eliminate disparities
What is inequity?
Being unjust and unfair. Paying woman less then men
What is the social justice philosophy?
- it is bedrock of public health
- argues that public health is a public matter
- dictates fairness in distribution of benefits and burdens
- health itself
- factors within the society impede the fair distribution of public health benefits and burdens
- resolution of inequity needs more action
10 points to know about public health
- health is more than healthcare
- health is tied to the distribution of resources
- racisim imposes health burden
- choices we make is shaped by what we have
- high demand, low control= stress
- chronic stress can be deadly
- inequality is bad for us
- social policy is health policy
- health inequalities are not natural
- we all pay the price for poor health
What is health equity?
When people are able to achive their full state of health and no one is disadvantaged
What are the top 3 leading causes of death in US?
- Heart Disease
What are the 10 achievements of public health?
- Motor vehicke safety
- Control of infectious disease
- Decline in death from stroke and heart disease
- Healthier food
- Healthier mothers and babies
- Family planning
- Floridation of drinking water
- Tabbaco as health hazard
What are the contemporary challanges of public health?
- Resurgence of infectious disease ( globalization, drug resistant microbes, bioterrorism)
- Pass success give raise to new threats ( industrialization, deforestation, global warming)
- Challange of understanding and altering behavior
- Continued emphasis on creative medicine
What is the ignored determinant of nation's health?
What are the issues of class?
- We are uncomfortable with the concept of class
- Class is difficult to define
- SES or class exhibits a strong inverse , stepsise relationship with health
- Brings prestige and income
- Offers access to healthcare
Is income the most important factor in health income?
- Low income is the most important predictor of mortality
- Inequitable distribution of income and wealth potent factor
What is the role of education in health outcome?
- It opens doors of opportunity
- Key to economic and social advancement
- Instills values and understanding of health advancement
What is the role of stress?
- This is the most important mechanism
- Lack of control
- Social isolation
- Chronic physiologic arousal
What are the 21 century public health challanges?
- Describe mechanism
- Tie mechanism to health outcome
- Remove/Eliminate inequalities
What are the greek roots of the word epidemiology:
- epi: upon
- demos: people
- ology: study of
What is the modern definition of epidemiology:
- distribution of health determinants
- determinants of disease
- application of control of health problem
- Study of distribution and determinants of disease and injury in humans and application of study to control health problems
What are the most used data sources in epidemiology
- disease reporting
- disease registries
- medical care settings
- population survays
What is morbidity and its two categories:
- Morbidity is a disease
- Incidence (number of new cases/ population at risk) over time
- Prevalance ( number of existing/ average total population) at one point
What is mortality and its two cases?
- Mortality is death
- CDR ( # of death per year/ average total population that year)
- PMR ( # of death from specific disease/ total number of death in population over time)
What are the two domains of epidemiology?
what is descriptive statistic?
Examines distribution of disease in population and observe basic features of distribution ( person, place and time) case reports
What is analytic statistic?
Tests specific hypothesis anout relationship of disease to hypothesised cause (how , why) observational study, case control and before after studies
What can epidemiology do?
- Determine the impact of disease in people
- Detect changes in occurance of disease in population
- Measure exposure between exposure and disease
- Evaluate the efficiacy of the intervention/treatment
What can't epidemiology do?
- can't tell an individual the cause
- can't prove particular exposure casued illness based on single study
- provide credible science w/o good measurement of exposure
What are the five step process for solving community health problems?
- Define the problem
- Id risk factors
- Develop and test interventions
- Implement intervention
- Monitor and evaluate
- enabling constructs in educational
- environmental diagnosis and evaluation
- organizational constructs in educational
- environmental development
What are the diagnostic elements of proceed/precede?
- Social assessment
What was the institute of medicine report findings?
- capacity of GVPT agencies to perform essential health functions was lacking
- emphasized on assuring the conditions so people can be healthy
What are the core functions of public health?
- Assessment ( collection /analyse/communicate)
- Policy development ( setting priorities & developing strategy in collaboration with leaders and community)
- Assurance ( assuring services are available)
What are the components of the community driven process?
- Moblize and engage in the community
- Action with and by the community
- Plan driven by the community
- Partnership strengthen
What are the 10 essential public health services?
- Monitor health status to ID community health problems
- Diagnose and investigate health problems
- Evaluate effectiveness, accessibility and quality
- Mobilize community partnership
- Develope policy and plans
- Inform, educate,empower
- Link people to needed health services
- assure a competant public health work place
- Enforce laws/ regulations that protect safety
- Research for new insights
What are the two roles of public health practicionars:
- Advocate role
- vigor, passion (subjectivity) address social determinant, eliminate disparities
- Practitioner rule
- rigor,dispassionate(objectivity), scientific method,high risk focus
What is type three error?
Getting the right answer to the wrong question
What does it mean by the cloak of onjectivity?
Rigor of research design, method Vs. Inherent ( easily seen) bias in research question , theoretical frameworks and methods
When would be possible to say pursuit of science is value free and objective?
- If health care and public health were not embeded in the society and if health care and public health professionals were not trained and did not work within these institutions
- since this is not the case, science is free of bias and not so much objective
Why should individuals be held responsible for health behaviors and outcomes ?
- It is our cultural preference ( ethic of individuality)
- Maverick (someone who thinks dependently and does not conform to norm)
- Picking up by your bootstraps ( start from nothing)
- Personal habits are disease culprits ( behavioral pathogens)
- individuals can play role in modifying risk
What are behavioral pathogens?
- sexual behavior
- motor vehicle injuries
- illicit use of drugs
What is the limitation to the individual right argument?
- Danger of overemphasizing individual responsibility
- - bootstraps
- -a tale of 3 tails ( focus on high risk groups, tail end of causality, tail chasing its tail/ risk factor tail)
- Poverty causes diminished opportunity for control
- Takes the GVPT of the hook
What is a more balanced approach in dealing with public health problem?
Educating : informing individuals about risks
What are the assumptions with educationg people?
- Information is understandable
- Health and well being are shared priorities
- Information alone ( healthy behavior)
- ** provision of info will empower individuals
What is another balanced approach in dealing with public health problems?
Regulation: take decision making out individulas hands
What is the assumption that is made with regulation?
- Consensus exist on the need for extent
- Available scientific info to guide regulation
- Decision making is objective
- ** regulation will guid behavior and discourage reckless behavior
What are the consensus on regulation to protect against:
- Direct harm to other person/property
- Harm to the environment
- Harm self
What is the principle agency for protecting health of all americans?
Department of health and human services
What are the public health service component of health and human services?
- Agency for toxic substances and disease registry
- Center for disease control
- Indian health services
- Agency for health care research and quality
- Health resources and service administration
- Office of global health affairs
- Substance abuse and Mental health services
- Office of assistant sercretary for preperedness
What office is the focal point for medical and behavioral research?
What are NIH goals?
- Foster research medical and scientific knwledge and their applications
- Develop, maintain, renew scientific resources
- Reflect and promote the highest level of scientific integrity, public accountibility and social responsibility
What Ail FDA?
- atmosphere stifles debate
- atmosphere that discourage discussion within FDA
- leadership vaccume
- antiregulatory philosophy
What is needed not to AIL FDA?
- culture that encourages scientific exchange
- culture that respect alternative view point
- culture that value transparency
- better surveillance of approved drugs
- strong and independent leadership
What are FDA's key principles?
- health is key outcome
- agency must look to prevent problems
- consider both benefit and risk approvals
- collaborate with other public health agancies
- communicate risk clearly
- integrity and transparancy
What is the mission of NIH?
science in pursuit of fundamental knowledge about nature and behavior of living system
To collaborate to create the expertise information and tools that people and communities need to protect their health through health promotion, prevention of disease, injury and disability and preparedness of new health threats
State level Public health office
Maryland department of health and mental hygiene
What is the organization of public health professionals?
American public health association
What are 2010 public health priorities for APHA?
- strengthen the nation's health system
- increase funding for vital public health agencies
- adress public health implications
- give FDA authority to regulate Tabacco products
- adress public health impacts of climate change
What does term Anti-minotaur mean?
Facts and values can not be separated in scientific research.
What is the power of FDA on regulation of Tabacco products?
- Removing hazard ingrediants
- Focusing on limiting the impact of advertising on youth
- Expanding warning lables
- Stopping use of characterization