What is Public Health
What is the difference between a community and a population?
Communities largely defined by: -Geography, Shared identity, Social connectedness
Populations: group sharing 1+ common characteristics or attributes. May be based on geography, socio-demographic factors, or health status/behaviors
What are the 5 levels of the socioecological model?
Intrapersonal (individual)
Interpersonal
Organizational/institutional
Community
Policy
What are health disparities & health inequities? How do they differ?
Disparities are differences in health outcomes between groups
Inequities are thought to be differences that are unfair, avoidable, and unjust.
This principle in public health ethics emphasizes individuals' right to make their own choices and decisions.
Autonomy/respect for persons
What are social determinants of health?
Conditions in which people are born, grow, live, work, and age. They play a significant role in shaping an individual's health outcomes. These factors can contribute to health disparities and inequities among different populations.
How do public health approaches differ from
medical approaches?
Public health has the focus of communities, populations, and groups of people when trying to reduce the disease bruden by promoting wellbeing via the various levels of the socioecological model.
Medicine, in contrast, focuses on the treatment of individuals who have been identified as sick or injured with diagnosis, and interventions (medicine, surgery)
Give an example of an intervention strategy at the community level?
A public health intervention at the community level of the socioecological model involves strategies that target community-wide factors to improve health outcomes. They may involve collaboration with local organizations, schools, or community centers to offer workshops, health screenings, or a community-wide social media campaign meant to change community norms
Give an example of a health disparity that is not considered a health inequity
Conditions or outcomes that are biological or genetic in nature.
Define Communitarianism
The collective responsibility to contribute to the common good
What are structural determinants of health?
Structural determinants of health are broader, overarching factors that influence social determinants of health and contribute to health disparities. These determinants are deeply embedded in social, economic, and political systems and structures, as well as social and cultural values
What do upstream vs downstream approaches signify in the ‘Parable of the River”?
Downstream (Reactive) Approach: Focuses on treating individual health problems after they occur (e.g., rescuing people from the river)) including treating diseases, providing emergency care, or addressing immediate health crises.
Upstream (Proactive) Approach: Seeks to address the root causes that lead to poor health in the first place (e.g., going upstream to find out why people are falling into the river). Involves tackling structural determinants (i.e., systems of power, governance, & norms that influence the distribution of resources & opportunities- like who decides where bridges get built) and the social determinants of health (i.e., conditions of daily life where people live, work, play, etc.)
Interventions at which level of the socio-ecological model tend to be the most effective?
Policy
Double Points!
Describe one criticism for each of the following terms:
1. Vulnerable population
2. Hard-to-reach population
The term vulnerable is stigmatized, overgeneralized, excludes context, and has unintended exclusion, focusing on deficits, and a shift in focus.
A hard-to-reach population places blame or responsibility on the population itself, rather than on the systems, institutions, or policies that fail to effectively engage or serve them.
What are some of the underlying factors that you found contribute to health disparities/inequities in general? For infant mortality, specifically?
Student-based response.
What is a common pathway through which many SDOH impact health outcomes?
Chronic, persistent stress
What is the difference between “high risk” and “at risk” approaches?
High risk: focuses on individuals who are at the highest levels of risk
At risk: emphasizes preventative measures aimed at the general population regardless of risk
What is an example for each level of prevention?
Student answer
Define Targeted Universalism
A policy and practice framework that sets universal goals for everyone in a community, but uses targeted, tailored strategies to help different groups reach those goals, acknowledging their unique structural and cultural barriers. It:
- Prevents unintended harm from one-size-fits-all policies
- reduces barriers for all -> improves overall population health
- avoids stigmatizing groups
- efficient use of resources
- encourages innovation by allowing tailored solutions
What is the “harm principle” and distinguish this from “harm reduction”
The harm principle can be applied to balance individual freedoms with the need to protect community health. Public health policies often aim to prevent harm to the population, but they can sometimes conflict with individual rights. The harm principle helps frame these debates by suggesting that interventions (like regulations or laws) should be justified when they prevent harm to others, while still respecting personal freedoms when no such harm is involved.
Harm reduction: a public health approach that aims to minimize the negative consequences of risky behaviors, particularly when it’s not feasible or realistic to eliminate the behavior entirely.
What is the difference betweeen "cumulative" effects vs "synergistic effects"?
Cumulative effects are additive (factors sum up), and they are a burden over time. (ex. long term exposure ot various polutants)
Sungeristic Effects are interactive (factors amplify each other), and they exceed the sum of individual effects. (ex. Smoking combined with radon exposure.
Name & describe the three levels of prevention
Primary Prevention - Prevents the Development of Disease
Secondary Prevention- Detects Disease Early and Slows Progression
Tertiary Prevention- Mitigate complications of diseases to optimize quality of life
What is the Prevention Paradox?
The majority of death, disease, and disability occur in those at moderate to low risk.
Distinguish between equity, equality, and justice in public health
Equality - the assumption is that everyone benefits from the same level of support.
Equity - Everyone gets the support they need.
Justice: The causes of the inequities are addressed, and the system barrier has been removed.
Double ISH points - Up to 800 Points!!!
Name as many levels of the Nuffield Intervention ladder as possible (100 points per level)
1. Eliminate Choice: Regulate or eliminate choice entirely
2. Restrict Choice: Regulate and restrict the options available to people
3. Guide choice through disincentives: use financial or other disincentives to influence people to not pursue certain activities
4. Guide choice through incentives: use financial and other incentives to guide people to pursue certain activities
5. Guide choice through changing the default: make healthier choices the default option for people
6. Enable choice: enable people to change behaviors
7. Provide Information: inform and educate people
8. Do nothing and monitor the current situation
Why is it difficult to study social determinants and “prove” that they impact health?
Complex Interactions: Social determinants often interact in complex ways, making it difficult to isolate the specific effects of one factor. For example, education, income, and housing quality are interrelated and can jointly influence health outcomes.
Longitudinal Data: Assessing the long-term impact of social determinants requires extensive longitudinal data, which can be hard to obtain and maintain over time. Health outcomes may take years or even decades to manifest.
Multifactorial Influences: Health outcomes are influenced by a multitude of factors, including genetic, behavioral, environmental, and social determinants. Disentangling the contribution of each factor is challenging.
thical and Practical Constraints: Conducting randomized controlled trials (RCTs) to study social determinants is often impractical or unethical. Unlike clinical trials, it’s not feasible to randomly assign people to different socioeconomic conditions.