KNES 400: Foundations of Public Health Week 1 & 2 Lecture Notes
KNES 400: Foundations of Public Health Week 1 & 2 Lecture Notes KNES 400
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This 5 page Class Notes was uploaded by Victoria Dassing on Sunday September 11, 2016. The Class Notes belongs to KNES 400 at University of Maryland taught by Shannon Jette in Fall 2016. Since its upload, it has received 75 views. For similar materials see Foundations of Public Health in Kinesiology at University of Maryland.
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Date Created: 09/11/16
First Class: Introduction Monday, August 29, 2016 11:04 AM I Paradox a Life expectancy in the US is lower than developing and developed countries even though we spend 2x as much on healthcare i Only 3% goes to prevention b US spends 2x more i Due to a privatized system ii Highly reliant on electronics/technology- less exercise iii High administrative costs in US 1 1/4 of spending goes to administration ii Bad eating habits iii Drug costs 1 Liability culture- a lot of test required to be "sure" ii High insurance rates II Pre-Affordable Care Act a 3% of budget went into prevention, education, etc. b 2.5 million dollars went into Emergency care c 75% of costs go into chronic diseases II Federal Poverty Levels- Disparities in Mortality by SES a The more money you make, the longer the life expectancy II Percent of Americans meeting physical activity guideline by income level a The more money you make, the more physically active they are II This course will cover: a Underlying poor health outcomes in US b Disparities in health outcomes within US c Determinants of health and physical activity d How can we intervene? II Assignments a Weekly Quizzes - every Monday i First 5 mins of class - look thru notes and discuss ii Best 10 out of 12 will be graded b Final "Exam" - similar to quizzes c 2 Papers d Documentary Mini-Reflections e Participation The State of Public Health: Health Disparities Wednesday, August 31, 2016 11:03 AM I Review from last class i Health Paradox in the US 1 Us has one of the lowest life expectancies while spending 2x more on healthcare compared to other developed countries a Only 3% goes to prevention ii History of the 20th Century: Health Victories 1 Life expectancy in US increased by 30 years 2 Decrease in infant mortality rates 3 Improvements mostly made in the first half of century, due to: a Vaccinations b Improved living conditions 1 Sanitations- clean water 2 The second half of the century focused on treating chronic diseases and controlling the associated factors a Ex. Cancer 2 Improvements due to field of medicine or public health knowledge? STILL UNKNOWN II PH in Relation to Medicine i Divide recent: medicine grew in dominance in 1920-1950's ii By the 1950's the biomedical paradigm II In-Class Video: Doctor Hotspot i Notes 1 Atul Gawande found that the police left an injured person unattended in Camden, NJ 2 Brought upon the question of what brought society to this point? 3 Found that those who owed the most money to the hospitals were getting worse care 4 An individual named Derrick suffers from asthma and epilepsy 5 After a group of trained nurses/doctors visited these sick individuals, there was a 40-50% reduction in cost and visits 6 What if hotspots were put up in every community around the US? a Benefits vs. Loses ii In-Class Discussion 1 Why might there be resistance to the Hotspotting model? a A focus on particular areas that may be poorer and have more health disparities b Funding 1 Is it feasible to provide this care? II IOM conducted study in 1988 i Overall US health was good 1 However, major health disparities lingered 2 AIDS epidemics ii Public Health's Mission: "fulfilling society's interest in assuring conditions in which people can be healthy" (ION, 1988). i Buzzwords: health equity, reducing health disparities, community engagement II Health Disparities/Inequity i Defined: "a particular type of difference in health between social groups". 1 Viewed as social justice issue --> differences are avoidable and rooted structural inequities 1 Differences in health outcomes within different groups of individuals II Healthy People 2020 (LHI's) i Released by the Department of Health and Human Services ii General goal: to improve the health in the US iii Focus on: 1 Access to health services 1 Clinical preventive services 1 Environmental quality 2 Injury and violence 3 Maternal, infant, and child health 4 Mental health 5 Nutrition, PA and obesity 6 Oral health 7 Reproductive and sexual health 1 Social determinants 1 Substance abuse 2 Tobacco Epidemiology: What is it and how is it relevant to PA and Public Health? Wednesday, September 7, 2016 11:01 AM I Quiz Next Class covers sessions 2 and 3, lectures, readings, and required reading of that day II Defining Epidemiology a Epi: above b Demos: people c Logos: study of something d Definition: "the study of that which befalls the people" i The application of the scientific method to the study of the distribution and determinants of health-related states or events in a population, and the application of this study to prevent/control health problems ii Health-related states or events -- b 3 Main Goals i Describe distribution of a disease or events (frequency and pattern) 1 Descriptive epidemiology - who, what, where, when, how many? ii Analyze how/if exposure to factor (determinant) is associated with an increased probability of occurrence of health-related event 1 Analytic epidemiology - how and why? ii Application of this knowledge to prevent disease occurrence by modifying identified risk factors II Sanitary Science Epidemiology a Spreading of diseases due to lack of sanitation and myastha? b Cholera Outbreak i Dr. John Snow ii Outbreak in London iii Waterborn iv Analysis: water from a particular pump on Broadstreet v Application -- took handle off pump so people could not use it II Eras in Epidemiology a ERA ANALYTIC APPLICATION/PRE APPROACH VENTION Sanitary Demonstrate Sanitation- statistics clustering of cleaning up mortality Infectious Laboratory Interrupt disease isolation of transmission epidemiol culture from (vaccination, ogy disease site; isolation, experimental antibiotics) transmission Chronic Longitudinal Modify lifestyle Disease studies -- Risk: do those exposed to a factor have greater chance of outcome? b Primary Goal of Chronic Disease Epidemiology i To identify an association between exposure and outcome 1 Risk ratio - # of association ii The "science" of public health I Scope of Physical Activity Epidemiology a Behavioral Pattern <--> Physical Activity <--> Determinants of Physical Activity <--> Physical Activity <--> Health and Disease Outcomes i ALL CONNECTED ii As exposure: focus on Physical Activity and Health and Disease Outcomes a Physical Activity as Exposure or Determinant of Health Outcome i Seminal study in 1950s by Jeremy Morris 1 Conductors working on London's double-decker buses who climbed around 600 stairs per day had less than half incidence of CHD as compared to their sedentary co-workers (drivers) 2 Paffenbarger, Jr. conducted observational cohort studies that allowed hi to more precisely identify amounts and type of physical activity a San Francisco Longshoremen study b Harvard alumni study 2 Others: Nurses' Health study; Aerobics 3 Limitations: the subjects have to answer honestly and remember how much PA they get and it is restricted to rich, white men that attended Harvard b Physical Activity as Outcome or Behavior i 1990's: Behavioral scientists began to explore determinants of physical activity and inactivity and how inactive people could increase PA behaviors 1 Dominant focus? a Intrapersonal-level factors (self-efficacy) b Theoretical perspectives (reasoned action, planned behavior) c Interventions ii More Recently: recognition that we need to explore mediators at levels beyond the personal (individual) b Physical Activity ad Descriptive Epidemiology i Starting in 1980's: Implementation of "surveillance" systems to monitor PA amounts 1 Surveillance is repeated over time at determined intervals ii 3 Aims: 1 Trends: identify emerging issues comparison between groups, regions, over time 2 Planning/provision health services 3 Possible future study
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