What is the WHO definition of Health?
Health is a state of complete physical, mental or social well-being and not merely the abseence of disease
1988 ottawwa charter for health promotion definition of health?
Health is seen as a resource for everyday life, not the objective living.
Parsons deinition of health?
Health is the ability to perform certain valued social roles.
Turnock Definition of health?
Disease is a relatively objective, pathologic phenomenon, whereas health and illness are subjective experiences.
illness- wellness continuum
Pre/mature death...signs, symptoms, disability. Awareness, education, growth High health wellness
Diease seen as the due to imbalance in the 4 circulating fluids. restore balance amoung the humors.
1 agent- 1 disease
Influence of the renassaince
body concieved as a machine. mind and body were seen as separate but linked through pinel gland.
Multi- casual Theory or etiology of disease
The notion or requirement that more than one factor must be present for disease to develop, referred to as multiple causation. A basic tenet of epidemiology is that an ecological approch is necessary to explain the occurance of disease.
Web of Causation
Has disease at center. Revolving include microbes, phenotype, genes, unknown factors, social orgainazation, enviroment, behavior, workplace
Public Healths Mission
The fullfillment of societies interest in assuring the conditions in which people can be healthy.
Mission not complete until GOAL HAS BEEN ACHIEVED.... implies there is a means to measure and evaluate success at achieving this national agenda, Healthy people 2010
What is Healthy People?
- National pervention initiative.
- : identifies opportunities to improve Americans health
Health People Goal 1
increase quality and years of healthy Life
Healthy people Goal 2
Eliminate Health Disparities. within infant mortality, cancer screening, cardiovascular disease, diabetes, HIV/Aids, childhood and adult immnizations
Disciplines that comprise Public Health
The study of the distribution and determinannts of disease and injury in human populations
Making inferences from a small group to a larger population.
Health Policy and administration
Focus on the organization, access, quality, financing, affordability, types of services delivery, marketing
Public healths mission " Conditions"
Natural enviroment: Air, Water, soil
Built enviroment: Public health institutions, schools, buisenesses
Disiplines that comprises Public health
Enviromental Health Sciences
focus on the natural and built enviroment
Disiplines that comprise public health
Social and Behavioral sciences
Focuses on th efactors that shape and reinforce individual and collective behavior
Name all 5 disciplines that comprise Public Health
- 1. epidemiology
- 2. Biostatistics
- 3. Health policy and administration
- 4. Enviromental health sciences
- 5. Social an behavioral sciences
Public healths Mission
" health is a multi dimentional concept"
An interesting paradox......" when Public health is working, nothing happens...
we measure our success by the absence of symptoms
Key Public health concepts
- 1.population Based
- 2. Evidence based
- 3 prevention
- 4. social justice
Population based- concepts
Total population : key health indicators- life expectancy, infant mortality, Top 10 causes of mortality
Sub population: person level factors- age, gender, religion(sociodemographics)
A guide to thinking about the Determinants of population health ( IOM)
from center: innate individual traits: age, sex,race- individual behavior- social behavior, family and community networks-living and working conditions- broad social, economic, cultrul, health, and enviroment (over a life span)
Contrasting public health and medicine
- Public health: population
- community settings
- surveillence, education, intervention, research policy development, oversight
- epidemiology, biostatistics, public health policy and administation, enviromental science, behavioral science
- Medicine: Induvidual, research labs, Md offices, hospital, patient care/ rehabilitation, disease managemnent, organ systems, cellular
- Internal medicine, OBGYN, Pediatrics, cardiologist
Key Public Health concepts
- rigorous methods, objectivity
- evidence to inform policy and practice
Levels of prevention
Primary- secondary- Tertiary
Primary prevention: health screening, specific protection( immunization), enviromental control measures
Secondary prevention: screening, early diagnosis, minimizes disability
Tertiary prevention: Rehabilitation, min disability
Key public health concepts
Social justice is public healths founding principle eliminating disparities "assuring the condition"
Involves examination of how society is organized and how this organization affects the health status of the public
social justice philosophy continued
- social justice argues that public health is a public matter
- justice in society dictates fairness in distribution of benefits and burdens
- Must do more with tools accessable, overcome social and political barriers
What is Health Equity?
"When everyone has the opportunity to attain their full health potential and no one is disadvantaged from acheiving this potential because of thier social position or other socially determined circumstances".
What is health inequity ?
Differences in population health that can be traced to unequal economic and social conditions and are systemic and aviodable, thus are inharently unjust and un fair.
Ten Great Public health achievements in th e20th century
- motor vehicle saftey
- workplace saftey
- control of infectious diseases
- declines in death from heart disease and stroke
- safer & healthier foods
- Healthier mothers & babies
- family planning
- Fluoridation of drinking water
- Tabacco as a health hazard
- resurgence of infectious disease
- Globalization drug resistance microbes, bioterrorism
- Past successes give to threats
- Industrialization, deforestion, global warming
- Challenge of understandig and altering behavior
- Behavioral pathogens, reformulation of risk
Continued emphasis on curative medicine
Class, the ignored determinant of the nation health
- The gap in health between" haves" and "have nots" has largely been ignored
- concentrating on race downplays the importance of SES
Issue of Class
- 1. we are uncomfortable with the concept of class
- 2. class is dificult to define
- 3. SES or class exhibits a strong inverse relationship with health
- 4. Pathways expalining this relationship are less clear
Is employment the most inprotant factor?
employment brings prestige and income
Employment offers access to health care
Is Income the most important factor?
- 1.Low income most important predictor of mortality
- 2. Inequitable distribution of income and wealth potent factor
Is education the most important factor ?
- 1. education opens doors of opportunity
- 2. Key to economic and social advancement
- 3. instills values and understanding of health information
The Role of Stress?
- Stress may be one of the most important mechanisms
- 1. lack of control
- 2. social isolation and anxiety
- 3.chronic physiologic arousal
Epidemiology Viewpoints? What does epi, demos, and ology mean?
Disease is a nonrandom occurance
- demos- the people
- ology- study of
How do we determine who in a population is at risk for developing a disease or dying permaturely?
Collect data and analyze data. census,
What does the last line of the U.S standard certificate of death say?
Underlying cause of death.
What do epidemiologist do with data?
- Compute rates
- 1. incidence- the # of new cases of a disease (over a period of time)
- 2. Prevelence- The # of existing cases of a diseaes(at a point/ period of time)
- Mortality= Death
- Crude Death rate-# of deaths per year
- PMR-# of deaths from a specific cause/disease(over a period of time)
What are the Two Broad Domains of Epidemiology?
Discriptive Epidemiology and Anayltic epidemiology
Discriptive- examines the distribution of a disease in a population, and observing the basic features of its distribution in terms of person, place and time
Analytic Epidemiology- Testing specific hypothesis about the relationship of a disease to a hypothesized cause, by conducting an epidimiological study that relates the exposure of interest to the diesase of interest
What can an Epidemiologist Do?
- Determine the impact of disease in groups of people
- Detect changes in diesease occurance in groups of people
- measure relationships between exposure and disease
- evaluate the efficacy of health interventions and treatments
What cant an epidemiologist?
Cannot tell individual the cause of his or her disease
cannot prove a particular exposure caused an illness based on a single study
cannot provide crediable science without good measurement of exposure and disease