e-lecture notes chapter 1
e-lecture notes chapter 1 1101
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This 6 page Study Guide was uploaded by Gabriela Saint-Louis on Wednesday January 28, 2015. The Study Guide belongs to 1101 at George Washington University taught by Tamara Henry in Spring2015. Since its upload, it has received 204 views.
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Date Created: 01/28/15
New 21St century de nition of public health called population health quotthe totality of all evidencebased public and private efforts that preserve and promote health and prevent disease disability and deathquot This de nition enlarges the traditional scope of public health to include the full range of 0 Environment social and economic determinants of health 0 Interventions to address health issues including healthcare delivery systems 0 The role of public policies Eras of Public Health Initiatives Health protection Going back to ancient times organized community efforts promoted health protection through authoritybased control of individual and community behaviors The earliest human civilizations integrated concepts of prevention into their culture their religion and their lives 0 Rooted in religious and cultural practices and prohibited behaviors o Quarantine for epidemics sexual prohibitions dietary restrictions to reduce food borne diseases etc The hygiene movement of the mid 18005 focused on sanitary conditions as the basis for improved health 0 John Snow 18505 known as the father of epidemiology 0 Established importance of careful data collection and documentation of rates of diseases 0 Known for efforts to close down broad street pump which supplied water contaminated by cholera Contagion control then became the focus of public health initiatives as the germ theory demonstrated the infectious origins of disease During the 19505 to mid19805 public health39s focus was on ling the holes in the healthcare system including the integration of control of communicable diseases modi cation of risk factors and care of highrisk populations as part of medical care Health promotion and disease prevention in the mid19805 through 2000 focused on individual behavior and disease detection in vulnerable and general populations Today population health management includes the coordination of public health and healthcare delivery based upon shared evidencebased systems thinking Summary of the eras of public health Health Promotiondisease prevention Focused on individual behavior and disease detection in vulnerable and general populations Contagion Control Fueled by the germ theory which demonstrated the infections origins of disease Population Health Includes the coordination of public health and healthcare delivery based upon shared evidencebased systems thinking Filling holes in the medical care svstem Included the integration of control of communicable diseases modi cation of risk factors and care of highrisk populations as part of medical care Health Protection Organized community efforts promoted health protection through authority based control of individual and community behaviors integrating concepts of prevention into their culture their religion and laws Hygiene movement Focused on sanitary conditions as the basis for improved health 0 In recent years the concept of population health has emerged as a broader concept of public health that includes all the ways that society as a whole or communities within society are affected by health issues and how they respond to these issues 4 Key components of population health 1 Health Issues For most of history of public health the term health focused solely on physical health Mental health has now been recognized as an important part of the de nition 2 Populations For most of recorded history a population was de ned geographically cities states countries The current de nition of population has expanded to include the idea of a global community recognizing the increasingly interconnected issues of global health Also focusing more on nongeographic communities 3 Society39s shared health concerns Historically public health and communicable disease wer nearly synonymous In recent decades the focus of societywide concerns has greatly expanded to include toxic exposures from the physical environment transportation safety and the costs of health care In the 200500 resurgence in concern over emerging infections diseases HivAids pandemic u etc Additional concerns ranging from the impact of climate change to the harms and bene ts of new technologies are altering the meaning of societywide concerns 4 Society39s Vulnerable groups For most of the 19005 public health cofused on maternal and child health and highrisk occupations as the operational de nition of vulnerable populations Additional groups now receive more attention in addition to the above mentioned including persons with disabilities the frail elderly and those without health insurance Attention is also beginning to focus on the immunosuppressed among those living with HIVAIDS who are at higher risk of infection and illness and those whose genetic code documents their special vulnerability to disease and reactions to medications Public health is often confronted with the potential con ict of focusing on the needs of vulnerable populations vs focusing on everyone and societywide concerns Three general areas provide an overview of what falls under the umbrella of population health 1 Health care a b c For those who are sick or disabled with illness or diseases For those who are asymptomatic Delivered as part of clinical prevention i Vaccinations ii Behavioral counseling iii Screening for disease iv Preventive medications 2 Traditional Public health a b c d e Communicable disease control Reduction of environmental hazards Food and drug safety Nutritional risk factors Behavioral risk factors 3 Social interventions a b Increase education c Alter access to affordable and nutritious food d e Globalize and mobilize goods and populations Improve the built environment Address socioeconomic disparities through changes in tax laws Disease Determinants Understanding of the forces that determine disease and the outcome of disease including morbidity and mortality Contributory causes immediate causes of disease Eg HIV and cigarette smoking are two ell established contributory causes of disease disability and death Need to know what determines whether people ill smoke or come in contact with the HIV What determines their course once exposed to cigarettes or HIV Determinatns Underlying factors or causes of causes that ultimately bring about disease are at work often years before a disease develops No one determinant alone explains the bqu of the disease The large number of determinants and their interactions provide opportunities for a range of healthcare traditional public health and social interventions i These de nitions are based on the example in text Jennifer and her mom smoking and Jennifer develops asthma 1 Behavior a Behavioral factors play an important role in the development of asthma attacks and in their complications Cigarette smoking makes asthma attacks more frequent and more severe Behavior also in uences the response to treatment when individuals do not adhere to prescribed treatments 2 Infection a Infection is a frequent precipitant of asthma and asthma increases the frequency and severity of infections Infectious diseases especially pneumonia can be life threatening in asthmatics requiring prompt and highquality medical care The increasing development of antibioticresistant infections poses special risks to those with asthma 3 Genetics a Genetic factors predispose people to childhood asthma However many children and adults without a family history develop asthma 4 Geography a Asthma is more common in geographic areas with high levels of naturally occurring allergens due to owering plants However today even populations in desert climates in the US are often affected by asthma as irrigation results in the planting of allergenproducing trees and other plants 5 Environment a The physical environment including that built for use by humans has increasingly been recognized as a major factor affecting the development of asthma and asthma attacks Indoor air pollution is the most common form of air pollution in many developing countries b Along with cigarette smoke air pollution in ames the lungs acutely and chronically c Mold exposure to et dander roaches in old buildings 6 Medical Care a The course of asthma can be greatly affected by medical care management of the acute and chronic effects of asthma can be positively affected by efforts to understand an individual39s exposures reducing the chronic in ammation with medications managing the acute symptoms and avoiding lifethreatening complications 7 Socioeconomiccultural a Disease and disease progression are often in uenced by an individual39s socioeconomic status Air pollution is often greater in lower socioeconomic neighborhoods of urban areas Mold and cockroach infestations may be greater in poor neighborhoods Access to and the quality of medical care can be affected by social economic and cultural factors Changes in Population A number of important trends or transitions in the composition of populations that affect the pattern of disease have been described in recent years 1 Demographic Demographic transition describeds the impact of falling childhood death rates and extended life spans on the size and the age distribution of populations i Birth rates tend to remain high for years or decads after the decline in deaths ii High birth rates paired with lower death rates lead to rapid growth in population size iii Decline in births also gradually leads to aging of the populations iv Populations with a large number of elderly relative to the number of younger individuals have a heavier burden of disease and create the conditions for aging to become a public health issue 2 Epidemiology o The epidemiological or public health transition implies that as social and economic development different types of diseases become prominent Deaths in less developed societies are often dominated by epidemic communicable diseases and diseases associated with malnutrition and childhood infections As a country develops communicable diseases often come under control and noncommunicable and chronic disease such as heart disease often predominate 3 Nutritional The nutritional transition implies that countries frequently move from poorly balanced diets often de cient in nutrients proteins and calories to a diet of highly processed food including fats sugars and salt The consequences of both under and overnutrition affect and will continue to affect the public39s health will into the 20005
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