CH1: Public health and population health
What is health?
Classic definition from the Constitution of the WHO, defining health as:
•a state of complete physical, mental, and social well-being
•not merely the absence of disease or infirmity
•a fundamental right of every human being
•regardless of race, economic or social condition, religion, or political belief
What is life course perspective?
–Our health is produced throughout the sequential phases of our life
What are two core principles of public health?
prevention and health equity
What are the consequences of low health literacy on patient outcomes?
•Decreased use of preventative services
•Poor management of chronic conditions
•Increased preventable emergency visits
•Increased preventable hospital admissions
•Increased patient medication errors
•Poor understanding of nutrition labels
•Increased mortality
What is a population?
•First, a population requires more than one individual.
•Second, these individuals share one or more common characteristics.
What is social determinants of health?
–“the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”
what is a Prevention-based Public Health Approach?
•Concerned with populations.
•Aims to minimize the need for clinical interventions.
•Works through:
üidentifying a health problem
üidentifying the causes or determinants of the problem
üdeveloping and testing interventions to prevent or control these determinants
üimplementing and monitoring these interventions to assess their effectiveness
Who are populations at the highest risk for low health literacy?
•Living in poverty
•Education
•Race/ethnicity
•Age
•Disability
What’s the difference between public health and population health science?
Public health is the science of protecting and improving the health of families and communities through the promotion of healthy lifestyles, research for disease and injury prevention, and detection and control of infectious diseases.
Population health science is the study of 1) the conditions that shape distributions of health within and across populations, and 2) the mechanisms through which these conditions manifest as the health of individuals
Population health science provides us with the science and tells us what we need to know to understand what it is that causes health, so that then, in public health, we can intervene to make populations better.
What is the Accumulation of Risk VS Chain of risk model? Give examples
Cumulative exposures and shocks occur throughout life course; irrespective of timing; increase risk of disease later in life.
A cascade of health-promoting behaviors that escalates to a serious or fatal outcome. Domino-like; ex/ Socioeconomic disadvantage → smoking → drinking/marijuana → polydrug/opioid abuse → opioid overdose
What’s the difference between universal, selective, indicated prevention? Give examples
Universal: general population
•Selective: target those at higher-than-average risk for the disease
•Indicated: target those who already have subclinical symptoms or are engaged in high-risk behaviors
How do we teach back? Give examples
•We reviewed a lot of information and I want to make sure I was clear. Can you tell me in your own words what you have to do when you get home?
•Since your wife isn’t here with you to get these instructions, can you tell me how you will explain things to her later?
•Many patients have trouble understanding this information. Would you tell me how you will take your medicine tomorrow?
•What questions do you have for me?
•What would you like to know more about?
What are leading Causes of Death in the United States in 1900s vs. 2000s?
infectious diseases (i.e. pneumonia/influenza, tuberculosis, gastrointestinal infections, and diphtheria)---> lifestyle-related NCD (i.e. Cardiovascular diseases), pneumonia/influenza
What are critical VS sensitive periods? Give examples
Critical periods- the model suggests that certain exposures, if they occur at a certain if they occur at certain exposures, if they occur at a critical development moment can influence future health outcomes.
Sensitive- denote periods in the life span when exposures have greater impact than others.
What’s the difference between health equity and equality? health inequity and inequality?
Health equality means everyone receives the same care (empiric-based)
•Health equity means everyone receives needed care to reach the highest level of health (value-based)
Health inequality : any differences between two groups.
Health inequity comes from modifiable systematic health inequalities between more and less advantaged social groups; are avoidable, unnecessary, and unfair health inequalities
What are the main focus of US public health services over time (i.e. early 20th century and now)
n the early 20th century the focus was to…
Prevent and slow down the effect of infectious diseases by focusing on maintaining sanitary conditions, a clean water supply, and sewage disposal
The focus has shifted towards…
Organizations and schools dedicated to educating and implementing public health in communities
Promoting healthy lifestyles and safety
Developments in technology to help research and detect diseases
Specialization with the public health sphere
What is multilevel eco-social perspective? Give examples using four eco-social levels.
The eco-social perspective examines how health is produced at multiple levels.
Individual Behavior
Family/Social Network
Neighborhood/Cities
Country/Society
What’s the difference between primary, secondary, tertiary prevention?
Primary (upstream): target general (healthy) population, e.g. community-based or nation wide health promotion program, health related policy (e.g. cigarette tax)---prevent diseases (lower incidence)
•Secondary (midstream): target those with early sign/symptoms but the disease has not been diagnosed yet, e.g. screening----early detection early treatment (lower disease prevalence)
•Tertiary (downstream): those with diagnosed diseases or disease at advanced stage, e.g. promoting adherence to medication, rehabilitations