Public Health 1 final study guide
Public Health 1 final study guide Public Health 1
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STUDY GUIDE for the FINALEXAM PH1 final exam key terms & ideas (from FINALCHAPTER 16 – FINALChapter 31) Ch. 16 – poor diet and physical activity BMI—one assessment to examine physical health; height (m) divided by weight (kg) squared healthy BMI is below 25; 25~29.9: overweight; 30 and above is obese. SES & overweight—Black women are more likely than white women to be overweight or obese; black men and white men have the same prevalence of overweight and obesity; higher SES is associated with lower rates of overweight and obesity, especially among women. WHR (waist/hip ratio)—pear shape vs. apple shape: waist to hip ratio.Apple shape is in higher risk of developing chronic diseases. Overweight in children—prevalence of overweight among 6 to 19 year olds increases from 5% to 15% between 1960s and 2000; high prevalence among MexicanAmerican boys andAfrican American girls; type 2 diabetes is being diagnosed in children. New pyramid—guideline for the public what is the type of food they should increase or decrease; potatoes with skin have lower GI than without skin; water can be changed based on the physical activity; high GI foods are on the top; fruits and veggies are on the bottom; each country have modification of the pyramid; multiple vitamins right below the top. Ecological model—intra-personal level (psychology); inter-personal level—family, friends, coworkers; institutional level—school, workplace; community level—churches, community organizations; public policy level—government regulations. Breastfeeding & obesity—social environment promotes overeating; advertising by food industry, including ads aimed at children so very difficult to change eating patterns, so best hope is to focus on children, starting with breast-feeding. Fast food lawsuits—it is important to protect the public by having lawsuits on deceptive advertising; need more food labeling; advertising should include information on calories, fat, and sugar content; taxes on soft drinks and other junk food; less availability of soft drinks and fast foods in school. Benefits of exercise—weight control works best when healthy eating is combined with physical activity; exercise promotes health independent of weight control; exercise helps to prevent heart disease, high blood pressure, improves cholesterol, diabetes, some forms of cancer. Environmental modifications—(these are modifications to promote physical activity) remove environmental barriers and provide places to exercise; suburban lifestyle—must drive everywhere (should build sidewalks, walking trails, bike paths, more mall walking in shopping malls); police surveillance and neighborhood watches in high-crime neighborhoods to promote physical activity; develop habits of exercise in children—physical education classes should focus on activities that can be practiced throughout one’s lifetime. Ch. 17 injuries are not accidents Groups at risk for injuries—injuries are the fifth leading cause of death in the U.S.; injuries are the leading cause of death among people ages 1 to 44; higher injury rates in groups with lower SES; males have higher injury rates than females; black have high injury rates than whites. injury pyramid: Deaths, Hospitalizations – include long-term disability, Emergency department visits, Episodes of injuries reported intentional (homicide and suicide) & unintentional injuries primary, secondary, & tertiary prevention of accidents—primary: conditions prevailing before the event (alcohol, anger, defective breaks, dark, rain); secondary: conditions prevailing during the event (airbag, seat belt, divided highway); tertiary: availability and quality of emergency care. 3 E’s: Education (alcohol consumption, manage anger…), Enforcement ( state and federal regulations on flammability of fabrics),Engineering (child proof caps, smoke detectors) Seat belts—education and enforcement; a public health approach to prevent motor vehicle injuries.Alcohol plays a major role in fatal crashes; second leading factor is youth and experience (graduated driver’s license; zero tolerance for blood alcohol). OSHA—Occupational Safety and HealthAdministration—regulatory agency; they go to the work sites and report injuries. Nat’l institute of occupational safety and health (NIOSH)—research agency Repetitive motion injuries—keep pounding keyboards too much, need relaxation of the arms. Motor vehicle injuries are the leading cause of death; second is falling objects, caught in running machinery; third is violence. Ch. 18 maternal & child health Children’s bureau—U.S. Children’s Bureau beginning in 1912 (children—a national resource and that their health—important for the progress of the society); child labor regulated by U.S. beginning in 1930s; ongoing conflicts over the role of government in protecting children (example: recent news on a cancer therapy); infant mortality rate has fallen over 20th century. Causes of intent mortality in U.S—birth defects—leading cause overall; prematurity and low birth weight was leading cause overall until recently and still leading cause among blacks. SIDS—Sudden Infant Death Syndrome—quite a big public health problem but almost eliminated by “back to sleep” baby position campaign (sleep on back, not stomach); SIDS rate has fallen by over 50%; just the change of position decreases the problem. Social factors in infant mortality—number one risk factor is poverty; reasons why low SES increases risk: environmental hazards, poor nutrition, maternal risk behaviors like smoking, alcohol and illegal drugs, social factors like young maternal age, violence, stress, lack of social support, and lack of prenatal care. LBW—preventing low birth weight—prenatal care; reducing adolescent pregnancy; causes of low birth weight are not well understood; recent increases in low birth weight due to multiple births because of reproductive technology. Prenatal care —provides women with information; diagnoses problems early; can often link poor women with social services; most states try to remove financial barriers; states and federal government collect data on prenatal care. Preventing birth defects—genetic and newborn screening; FDAregulations of teratogenic drugs; immunization of all children against rubella protects infants; dietary supplement with folic acid fortification; warnings against alcohol for pregnant women. teen pregnancy—adolescent pregnancy has physical and social risks for mother and child; sex education in schools is controversial (federal requirement for abstinence only programs; abstinence only education is less effective). Planned pregnancy—leads to healthier outcomes; controversy about government provision of family planning services. Contraception—sterilization: most common method, but permanent; oral contraceptives and other hormones; IUS; barrier methods: condom, diaphragm, cervical cap (prevent STD, used inconsistently and unreliably); “morning after pill” controversy. WIC—provides vouchers for nutritious foods for pregnancy women, lactating mothers, children up to 5—very effective. Other government nutrition programs: Food stamps & food insecurity (still common in U.S) & school meals program (provide fresh and nutritious food). “Vaccined for Children” program—immunizations required before entering school; public health efforts to vaccinate younger children; CDC tracks immunization rates Well baby care—screening in school U.S. Consumer Products Safety Commission—regulate toys and children’s furniture Chapter 19: Please note FINALchapter in pdf – mental health is chapter 19 in the textbook th edition 4 ) th Ch. 19 –clean environment –hazards ( chapter 20 in the 4 edition) Radiation (an environmental hazard)—ultraviolet light from the sun—skin cancer and melanoma; radon gas—natural radioactivity—lung cancer? Early scandals with patent medicines and radium led to regulation; X-rays used in medicine and dentistry; lessons on health effects of radiation learned from atomic bombings in Japan; irrational fears? (e.g. food irradiation) Mercury (an environmental hazard)—neurological damage in workers; Minamata 1950 (first Mercury related disease found in Japan: brain damage, neurological problems); emissions from coal-burning power plants in US leads to air pollution, water pollution, contamination of fish; concern about fever thermometers, school laboratory equipment, electronic equipment (like your phone screen); dental fillings; vaccines; coal-fired power factories. Lead (an environmental hazard)—harmful to brain and nervous system, especially of children; contamination of drinking water by lead pipes and lead solders for copper pipes; air pollutant from use in gasoline until banned in the 1980s; was used in paint until 1977—still a threat in old housing—peeling paint or contaminated dust; electronic products (solder); car batteries; young children should be screened for blood lead levels—permissible levels have been steadily lowered. 10 mcg/dL is intervention level in the US.Alice Hamilton. asbestos hazard emergency response act— DDT—a pesticide; now banned; was used against malaria spreading but was found out very fat soluble and stayed in soil; persist in environment, very stable. PCBs (polychlorinated biphenyl..)—and industrial chemical so industrial uses; Hudson River— contaminated fish; Yusho accident in Japan—contamination of cooking oil—other similar accidents; production halted in US by 1977. Pesticides and industrial chemicals : endocrine disrupters, affect reproduction, nervous system, immune system, maybe cancer. Occupational exposures - workers as guinea pigs, meaning that workers are often the first to suffer effects of an exposure; carcinogens recognized through occupational cancers: Mesothelioma (asbestos); scrotal cancer in chime sweeps; bladder cancer in dye factory workers, lung, lymphatic cancer from arsenic (copper smelters), angiosarcoma from vinyl chloride (plastics); neurotoxins also recognized through occupational illness: hexane (shoemakers), trichloroethylene (dry cleaners), pesticide applicators. Public health policy (surveillance and setting standards): Occupational Safety and HealthAct, Toxic Substances ControlAct, Federal Insecticide, Fungicide, and RodenticideAct – settings standards…, CleanAirAct—most chemicals have not been tested for health effects; process of standard setting is slow and always controversial. Risk-benefit analysis—absolute safety is impossible; over-regulation can cause under-regulation; must balance risk against other societal goals, including economic well-being; Bush administration and Republican Congress favored economic and business interests over environment and public health; hope for Obama administration to put more priority on public health. th Ch. 20 air pollution ( chapter 21 in the 4 edition) criteria air pollutants , Particulate matter, Sulfur dioxide, Carbon monoxide, Nitrogen oxides, Ozone, Lead Particulate matter (PM)—products of combustion; first regulated total particulates; Six Cities Study—death rates higher in most polluted cities; smaller particles penetrate deeper into lungs; 1987 set standards for PM10; 1997 set standards for PM 2.5; lung cancer, other hung disease, heart disease proportional to PM2.5. (particulates size…) Sulfur Dioxide—combustion of sulfur-containing fuels, especially coal; irritates respiratory tract; acid rain. Nitrogen oxides—motor vehicles, responsible for yellowish-brown smog; irritates respiratory tract; acid rain; contribute to ozone formation. Ozone—produced by sunlight acting on other air pollutants; irritating to eyes and respiratory system; increases mortality from cardiovascular and respiratory diseases. Lead—damage nervous system, blood, and kidneys; was used in leaded gasoline, banned in 1980s; has decreases dramatically as an air pollutant. Clean air act mandated—directed EPAto set standards for 188 others; as of 1993, only acted on asbestos, mercury, beryllium, benzene, vinyl chloride, arsenic, radionuclides, oven emissions; controversy over each standard. Toxics release inventory —strategies for motor vehicles —Tailpipe emission limits (catalytic converters and reformulated fuel); vapor recovery systems on gasoline pumps; inspection and maintenance requirements; requirements that auto makers develop zero emission vehicles; public transportation; encourage carpooling. —strategies for industrial sources —scrubbers on smokestacks; less polluting fuels (limit high-sulfur coal); pollution allowances bought and sold; new source review: industry has flouted the rules, lawsuits by states, Bush administration replaced this provision with weaker “Clear Skies Initiative”; Emergency Planning and Community Right-to-KnowAct. Indoor air pollution—most people spend more time indoors than out; sources of indoor air pollution: tobacco smoke, wood-burning stoves and fireplaces, gas ranges and furnaces; consumer products such as pesticides, dry-cleaning solvents, paint and paint thinners, hair spray, air fresheners should be used with caution; microbes such as legionella, hantavirus; allergens such as mold, house mites, animal dander. Radon—danger is unclear, seeps up from soil and rock, can be sealed out. Formaldehyde—from insulation, particleboard, plywood, some floor coverings and textiles; regulated by department of housing and urban development. Acid rain—damages forests and crops, turns lakes and rivers acidic, kills fish and plants. Ozone layer depletion—Montreal Protocol 1987, production of CFCs phased out, ozone layer has stabilized. CO 2 climate change—Carbon dioxide produced by burning fossil fuels causes greenhouse effect, global warming. Ch. 21- clean water (chapter 22 in the 4 edition) clean water act—1972, 1977, 1987—lakes and rivers should be fishable and swimmable; all pollution discharges should be eliminated Pretreatment —regulated contaminants—disinfectants: chlorine; disinfection byproducts: chlorite; inorganic chemicals: metals, asbestos, cyanide; organic chemicals: herbicides, pesticides, PCBs; microorganisms: bacteria, viruses, cryptosporidium; radionuclides; turbidity. Point source pollution • Point source pollution – Requirements for treating wastewater – Sewage treatment plants or septic systems – Treat with chlorine or other disinfectant – Sludge -- Congress prohibited ocean dumping – Pretreatment of industrial wastes • Non point source pollution – Agricultural runoff – Urban runoff – Air pollutants deposited by rain Community water treatment —to produce potable water: coagulation and flocculation; settling; filtration; disinfection Safe drinking water act (pg 374) —EPAshould set standards for local systems; states should enforce the standards. • Community water treatment to produce potable water – Coagulation and flocculation – Settling – Filtration – Disinfection th Ch. 22 solid and hazardous waste (chapter 23 in the 4 edition) Open dumps —before 1970s, outlawed by RCRA; coal ash usually stored in open dumps Resource Conservation and RecoveryAct (RCRA)—1976 Marine Protection, Research, and SanctuariesAct (1972)—pouring waste into rivers, lakes, or oceans was outlawed by Clean water act and this act. sanitary landfills—site should be dry, impervious clay soil; lined with plastic; drains for liquids; vents to control explosive gases; tipping fee: cost of disposing of one ton of municipal waste, highest cost is in northeast; NYC—fresh kills, Staten Island. NIMBY —Not In My Back Yard; thinking that we can just dump waste outside of my back yard Three R’s: Reduce, Reuse, Recycle—Reduce: buy only what’s needed; avoid excessive packaging; Reuse: use reusable items rather than disposable; Recycle: encouraged by deposits on bottles and cans, yard sales, composting Hazardous waste—Love Canal, New York 1978; Times Beach Missouri 1972-1976; RCRA, 1976 1984—all hazardous wastes accounted for “from cradle to grave”; wastes from petroleum refining, pesticide manufacturing, some pharmaceuticals; ignitable, corrosive, reactive, toxic wastes. “midnight dumping” Tracking & permitting Superfund sites—Comprehensive Environmental Response, Compensation, and Liability Act-1980; emergency cleanup of old waste sites, paid for by a tax on industry; mired in controversy, much effort focused on determining who is liable; tax not reauthorized in 1995. Ch. 23 safe food and drugs (chapter 24 in the 4 edition) Causes of food-borne illness: Salmonella —a bacteria; from egg, poultry and meat; E. coli O157:H7 —a bacteria; from ground beef, alfalfa sprouts, unpasteurized apple juice, raw milk, lettuce; HepatitisA—a virus; from green onions from Mexico, shellfish USDA—department of agriculture—meat, poultry, and eggs; has bigger budget, more authority; regulates 20% of food; detailed laws on regulation of meat. FDA—food and drug administration—all other foods; has smaller budget, less authority; regulates 80% of food; inspects only 1% proportion of imported food (55% of seafood is imported; 12% of vegetables; 30% of fruit). FDAsubject to intense political pressures; complaints it is too slow in approving drug; drug companies pay a fee to speed up review process; now complaints that the FDAis too cozy with industry Irradiation—kills bacteria, parasites, pests. Pesticide —FDAsets tolerance levels for pesticide residues Hormones—Estrogen banned in chickens; Bovine growth hormone allowed for cows (does not get into milk) Organic standards—USDAset standards in 2004 New DrugApplication —first prescribed, surveillance, and then become non-prescribed Three phases of trial —I. small number of subjects, measure absorption, distribution, metabolism, excretion; look for side effects and toxicities; II. signs of effectiveness; III. Clinical trial Pure food and drug act 1994 labeling regulations—FDAregulates labeling of foods with information on specifies nutrients, recommended daily intakes; FDAregulated labeling of drugs; labeling of over-the- counter drugs is by Federal Trade Commission Dietary supplement health and education act—forbids FDAfrom regulating herbs and food supplements; can remove substance from market only if proven harmful; ephedra removed only after many deaths Fen-phen—too many drugs found to be unsafe only after approved for marketing; famous for women to decrease weight, but it’s more important to see how the public is using; side effects could be seen from prolong usage of this drug; possible complication with cardiovascular disease; so FDAtook out Fen-phen from the market. th Ch. 24 population (chapter 25 in the 4 edition) S curve & J curve—patterns of population growth demographic transition —Thomas Malthus predicted in about 1800 that population growth would outgrow food supply; population growth has slowed, but many negative effects of overpopulation are occurring; public health has contributed to population growth by reducing death rates, especially among children, in developing countries; birth rates tend to fall as a result of falling death rates—demographic transition. HIV/AIDS —shortening life expectancies inAfrica Carrying capacity—number of organisms that can be supported without degrading environment Uneven distribution of resources across globe—depletion of global resources—fresh water (drinking, cooking, washing; agriculture; unevenly distributed); Fuel (deforestation leads to degradation of land);Arable land (amount of land under cultivation is declining); Food from the sea (decline of harvests of fish and shellfish). Climate change—greenhouse effect from burning fossil fuels; rise of 1 degree during 20th century; predict 3 to 7 degree rise during 21st century; US has 5% of world’s population, contributes 20% of greenhouse gases; China, with 20% of world’s population, has become the leading emitter, with 21%. Kyoto Protocol —Bush administration rejected th Ch. 25 Medical care system as PH issue (chapter 26 in the 4 edition) how is medical care paid for in the U.S—MostAmericans get health insurance through employer; charity care—long tradition (part time volunteer physician); public health clinics for communicable diseases (TBC); community health centers (by federal grant, public and private health insurances, in rural areas); medical profession has fought government attempts to provide universal insurance (as all other developed countries do) private practitioners: diagnosis and curing their domain. Medicare & Medicaid—passed in the 1960s. -Medicare: part of social security system; mandatory insurance for all workers; workers and employers required to pay in; everyone over 65 is eligible; also young people who are disabled; partA: hospital insurance; part B: voluntary, monthly premium; covers doctor bills and other outpatient costs; prescription drug plan effective 2006; required to pay deductible and co- payments). -Medicaid: welfare program for the poor; costs shared by federal and state governments; eligibility varies, determined by states; State Children’s Health Insurance Program (SCHIP) for families earning too much to qualify for Medicaid Licensing & regulation—states license physicians, nurses, dentists; states can discipline practitioners for incompetence or misconduct; states license and regulate hospitals and nursing homes; JCAHO: Joint Commission onAccreditation of Healthcare Organization; schools of medicine, nursing, public health…accreditation Ethical and Legal issue in medical care: -Abortion: Roe v. Wade—abortion illegal until 1973 in most states, women have constitutional right to an abortion, at least in the first trimester -Assisted Suicide: Dr. Jack Kevorkian—1990, 1999 administered a lethal drug -“Right to die”—KarenAnn Quinlan 1976 overdose from drugs, Nancy Cruzan 1990 automobile crash, Terry Schiavo—eating disorders, 2005 Right to life- —“living will” th Ch. 26- why the system needs reform (chapter 27 in the 4 edition) access to care —medical care rising more rapidly than general inflation; rising costs lead to lack of insurance leads to poorer health uninsured – disparities —over 15% of population is uninsured Why do costs rise? -Aging population— -New medical technology, including prescription drugs (high tech diagnostic equipment and procedures more profitable, than time-consuming practices of talking, listening, observing, touching.. -Administrative costs -Malpractice fears and defensive medicine —patients demand the best, not sensitive to price (bill paid by third party: the insurance company) —Fee-for-service—hospitals could charge higher rates to insured patients (from $5 to $20), to cover the costs of treating uninsured Controlling costs—some approaches worked for a while, but none controlled costs for the longer term -Price controls—tried in the 1970s: limit new facilities and technology—certificate of need (planning); 1980:limit the length of hospital stays, if hospital could cure the patient in a shorter time than average, it could keep the extra cash. If a longer stay was necessary the hospitals have to pay the additional cost -Managed care—1990s (bargaining with providers, doctors and hospitals, for discounts..) -PPOs—Preferred Provider Organization—patients must seek care from participating providers; participating providers agree to provide services at lower rates -HMOs—Health Maintenance Organization—acts as insurer and provider; agrees to provide all required for a fixed payment; physicians and other providers are on salary; incentives to deny care deemed unnecessary; incentives to limit access to specialists and technology; incentives to provide preventive care Oregon “experiment” w/ Medicaid (goal to cover all citizens whose incomes below poverty level, medical necessities …) page 461— rationing—try to cover more people by limiting services; rationing makes people uncomfortable; rationing by ability to pay is already taking place. Ch. 27 Health Services research (chapter 28 in the 4 edition) Small area analysis—large variations in practice style by geographical area; true of many medical conditions; more variation for conditions on which evidence for appropriate therapy exists; sometimes more than one therapy may be appropriate; doctors may adjust behavior when informed of other doctors; practice patterns. Field of dreams effect—availability of services leads to more use of these services (more back surgeons, more back surgeries; more hospital beds, more hospitalizations; more hospital beds, more patients die in hospital); evidence in some cases that financial considerations may affect medical decisions. Benign prostatic hypertrophy—high variation—watchful waiting vs. prostatectomy; prostatectomy—benefits are overstates, complications are understated; patients need to be informed so they can choose Medical Errors—medication errors, wronged surgeries; institute of Medicine report, 1999; errors cause 44,000 to 98,000 deaths per year; system is decentralized, fragmented, poor communication —focus on improving it; recommendations: Create Center for Patient Safety; Set national goals, track progress, research; errors should be reported and investigated; drug naming, packaging, labeling should be changed to minimize confusion. Contribution of medical care to health—managed care plans are easier to evaluate than there plans: data is available, accreditation of managed care organizations, annual reports; can evaluate quality of care for some procedures-New York State measures outcomes of coronary surgery: reports outcomes for individual hospitals and surgeons, reports led to improvement in outcomes, high volume surgeons and hospitals do better. Relationship of health & wealth —international comparisons show health is proportional to wealth (national GDP); health is not proportional to number of physicians; more spending does not improve health, may even increase mortality rate; RAND Health Insurance Experiment: for people with generous insurance, many health care services may be wasted; for poor and chronically ill, free care does improve health status; medical care is rationed by ability to pay; racial inequities in care, even when ability to pay is same; blacks and hispanics receive poorer treatment for many conditions; institute of medicine report: bias, prejudice, stereotyping Ch. 28- aging (chapter 29 in the 4 edition) Physiological vs chronological age —the physiological age is not the same as chronological age L. Hayflick—gerontologist—separated human cells in laboratory environment: 20 years. No: high fat diet, overeating, rush-hours, drinking, prime news, income taxes, aggravation…influence on speed at which cells wear out Theories about aging:Damage Theories &Program Theories Free radicals—atom with at least one unpaired electron highly reactive, usually seeks other electron to become paired; if antioxidants unavailable: free radicals suddenly multiply the cell’s functioning disrupted, cell components damaged, cell necrosis; free radical stress: lipid peroxidation, atherogenic activity, carcinogenic activity…; pro-oxidant effect: cigarette smoke, imbalanced diet, exhaustive exercise, environmental pollutants, psychological, emotional stress. Inflammation—a major source of oxidants; activates the arachidonic acid cascades Oxidative stress—inadequate dietary intake of antioxidant nutrients, or also chronic conditions as malabsorption syndrome Metabolic dysregulation—cumulative exposure to high levels of glucocorticoids; exposure to higher omega-6 fatty acids with decline in beta-6 desaturation Baby boomers—are approaching retirement “young old” —65~74—80% are in good, very good, or excellent health “aged”—75~84—71% are in good, very good, or excellent health “oldest old”—85 and older—18% live in nursing homes; 15% require assistance disuse syndrome— exercise and aging—sedentary + overweight = lose about 1/2 aerobic power between 35-70; who remain lean and active have only very slight declines compression of morbidity—biological life span has not changed; more people live to the end of biological span; does longer life mean more years of healthy life or more years of chronic disease? some evidence that older people are healthier now than in the past osteoporosis—can be caused by smoking; risk of broken bones leading to disability; falls Alzheimer’s and other Dementia—risk increases with increasing age; tremendous burden on caregivers; costs up to $100 billion per year in long-term care; biomedical research and epidemiological studies are beginning to give clues on risk factors; no effective treatment known, but some studies are giving hope; even delaying onset by a few years could substantially reduce the financial and personal burden Medicare—older people use more medical care; growth in cost of Medicare in unsustainable; Medicare enrollment has doubled since 1967 and will continue to grow; cost per enrollee is rising, even faster than health care costs in general; more of costs being shifted to the individual; Medicare does not pay for long-term care Ch. 29- emergency preparedness (chapter 30 in the 4 edition) Natural disasters—many are predictable; prior evacuation when possible Technological disasters—less predictable; include terrorism 9/11 response—13,000 to 15,000 people evacuated from towers; 2801 people died; many failures of communication and coordination; failure to protect rescue and cleanup workers from environmental hazards; victim location services; shelters for displaces residents; monitoring for biological agents Principles of Emergency Preparedness—importance of advance planning involving all agencies; practice at least once; importance of good communication; Incident Command System—puts a single person in charge at the scene; federal government has provided funding to states and metropolitan areas for planning; Strategic National Stockpile of medical supplies, antibiotics, vaccines, antidotes for chemical agents Bioterrorism agents—smallpox, antrax, plague, botulinum toxin, tularaemia bacteria, hemorrhagic fever viruses Bioterrorism preparedness—same as preparedness for natural epidemics; challenge to recognize an attack is occurring (public health surveillance is important); need for laboratory capability; need for public health laws enabling authorities to take action; problem of whether uninsured will seek care; need for coordination between public health and law enforcement Surveillance—emergency room visits; calls to 911 and poison control centers; pharmacy records; veterinary diseases Smallpox—highly contagious, no immunity in population; dark winter exercise (public health is a major national security issue; an attack could cause massive civilian casualties, breakdown in essential institutions, civil disorder, etc; vaccination campaign—military and health workers (resistance by civilians because of side effects and uncertainty of risk) Ch. 30- public health achievements (chapter 31 in the 4 edition) Top 10 Public HealthAchievements —1. routine use of vaccination 2. improvements in motor vehicle safety 3. safer workplaces 4. control of infectious diseases 5. decline in deaths from heart disease, stroke 6. safer and healthier foods 7. healthier mothers and babies 8. access to family planning and contraceptive services 9. Fluoridation of drinking water 10. recognition of tobacco use as a health hazard Challenges for the 21st Century—renewed threats from infectious diseases; climate change; rising costs of medical care for aging population; understanding and altering human behavior; need to strengthen public health system; persistent disparities in health Healthy people 2010—hope for the integration of public health and medical practice Biotechnology—unprecedented possibilities of genetic engineering, cloning, individualized medicines, etc. Ethical and legal issues. Can we afford it? Supplement- basic information: Latino Health Paradox PH achievements/challenges readings Video clips Book #2 power point slides (under readings) chapter in pdf – mental health (chapter 19 in the textbook edition 4 ) th
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