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HES 37


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Public Health Subdisciplines
Environmental Health
Health Administration
Health Promotion & Education
Themes in Modern Public Health
Knowledge doesn't equal behavior
Prevention vs. Treatment
Education vs. Regulation
Quality vs. Quantity of Life
An art and science
Settings for HRPE
places of worship
Primary prevention
Pre-disease state
i.e. keep non smokers from smoking
Secondary prevention
Clinical detection at early stages of the disease
i.e. bp screenings
Tertiary prevention
Disease is present and there is a need for rehabilitation
i.e. cardic rehab-for survivors of heart attack, prevents worsening condition
Public health in ancient China
-Confucionism relates to modern stress management with calming and quieting
-Tea and Chi (very few water born illnesses)
Public health in ancient India
-Yoga: Calming, quieting, stress management
-Surgery: means to deal with health concerns
Public health in ancient babylonia
-Code of Hammurabi contained laws for dealing with illness or disease
-cities-could not survive unless disease was under control
-bathing was a common practice
-preparation for war-men were physically fit
Public health in ancient Israel
Mosaic law-Leviticus: Gave detailed description what to eat, do in the event of an illness or death
Public health in ancient Egypt
-bathed regularly
-one of the 1st civilization to create written documentation to enforce alcohol regulation
Public health in ancient Greece
-Men were physically active-origin of olympics
-emphasis on keeping body, mind, and spirit healthy
-Galen-developed extensive sports medicine code
-Hippocrates-father of modern medicine
Public health in ancient Rome
-City of Rome could support up to 800K people
-Sewage pipes, garbage systems, venhilation systems
-aqueducts- capture melting snow to provide water for large population- some theories suggest it caused lead poisoning
Public health in Medieval Europe
-Scholasticism: philosophical mvt. saying education mind is more important that education one's body
-knights only physically active people
-Asceticism-power of Catholic Church-believe body is sinful and should not be naked-caused lack of bathing
-Bubonic plague- bacterial disease-passed easily
-Medieval indulgences-blamed sin for illness-sale of charms and potions to benefit health
Public health during the Renaissance Reformation
-Study of anatomy began
-Medical texts show study of body, and observations of disease
Public health in 1700s England
-Microscope invented-diseases has origins in bacteria-linked disease to living conditions
-blood pathways described
-vital statistics gathered-couting causes of death, disease rates
-Smallpos vaccine invented by Edward Jenner
Public Health in 1700s US Colonies
-Europeans brought disease and killed themselves and Native Americans
-disease was born or spread on ships
-US avg. age of death is 29 yrs.
-Wigs-people didn't clean hair
(wooden teath)
-Smallpox vaccinations
Early 1800s Industry
Edwin Chadwick
-Wars-started triage system
-Early deaths of writers & musicians-imagine work if longer life span
Early 1800s Industry
-United States
-Lemuel Shattuck-mant suggest as cornerstone of public health
-slight decrease in epidemics and increase in age span
-poor and dangerous factory conditions
Miasma phase
-Characterized by belief that disease came from bad odors-led to sanitation efforts
-APHA-1872 American Public Health Association
-Temperance Movements
-Nursing-Florence Nightengale
-John Snow discovered Cholera in water pump
-Muscular Christianity-emphasis on work ethic in colonies-body is a temple of God-beginning of sports-led to founding of YMCA and YWCA
Bacteriology Phase
-discovery of specific organisms causing a disease
-quarantine practiced
-better water treatment techniques discovered
-"The Jungle"-upton sinclair led to Pure Food and drug act-only modified 2x since creation
-Lister- antiseptics
-prohibition movement culminates
Health resources phase
-WWI and II caused need for surgery and rehab
-county health depts. developed (every 1-2 counties has a health dept.)
-health dept-provides food inspection, std treatment, food stamps
-Hill-Buurton Act-Poured tax dollars into developing hospitals
-WHO-1948 World Health Organization
-Children's health-reduction in mortality because of vaccinations and antibiotics
-health and disease foundations
-many medications and rehabilitation develop
Social engineering
-Kennedy/Johnson presidencies-many laws passed promoting health
-Medicare/Medicaid-Gov't insurance
-Private insurance
-Pres. council on physical fitness
-cold war- study showed ssoviet children more fit than American children
-Peace Corps- provides health needs
Health Promotion
-LaLonde Report-Canada-scientific report suggest relation between lifestyle and disease
-Prevention & health, everybody's busines
-Healthy People- US report-research to evaluate progress
Alma-Ata & Ottawa Summits- WHO- HOw to plan for health & healthcare
Health Promotion
Fittness mvt.- 1950s-60s-not socially acceptably to jog
-Kenneth Cooper-researched fitness reports and started aerobic institute in Dallas, TX
-Wellness Movement-looking at all aspects of well being
-AIDS-newest infectious disease
-antibiotics-not as powerful & effective
Health Promotion
continued again
-3 layers of the public health service:
CDC- vital stats, ed & outreach
Food & Drug Admin.-responsible for reviewing new drugs & food in grocery stores
NIH-funds health research
-State & community Agencies
SC: DHEC(dept. of health and environmental control) is the state agency
-county health departmens
-CHES(certified health education specialist)-public health professional
US infant mortality ranking
8th in world
US cancer mortality ranking
3rd in world
percentage of bankruptcies caused by health care costs
Health Care Costs
-Hostpital costs
-Paper work-$79 billion industry
-MD salaries & malpractice insurance
-unnecessary surgery
-insurance fraud-paying for tests & serviced that did not occur
-Medical equiptment & personnel
-largely unregulated industry
-lack of prevention of diseases & illness
Current US Health care System
-85% of US population covered with 70% being private and 15% is government
-15% uninsured is 44 million people who are unemployedm working people who can't afford it, part-time, or young adults
Current US System Continues
-Private insurance is tied to workplace
-Alternative Medicines are popular-most insurance plans do not cover
-1/3 Americans have tried alternatices
-Self-care and self-testing are popular--amnt of over the counter drugs have grown--pregnancy tests
-concerns with fraud and quackery in self care-informercials-how to regulate w/o eliminating capitalism?
what people pay
Dr. P-$200
Yearly amount of money that must be spent before insurance plan kicks in
-Usually Jan-Dec
Coverages & Exclusions
what the insurance provider will and will not pay for
i.e eyecare, dental, psychiatric
Pre-existing conditions
insurance company not accepting someone with cancer-company switching providers does not apply
Maximum out of pocket
-In major crisism, patient will not necessarily have to spend 20% if costs are over a certain amount
Maximum lifetime limit
-Usually one million dollars
-pre mature babies
-if over 1 million, must devest everything before receiving gov't aid
-higher premium but no deductibles
-still pay 20%
Traditional Plan or 80/20 plan
uses all terms but co-payment and DRG-allows for more dreedom of choice with physicians
Health Maitenance Organization-uses higher premium and co-payments-often a narrow choice of physicians
Preferred provider Organization-combination of HMO & Traditional Plan
for retired citizens (65 plus yrs. or disables) and those with kidney disease
-For medically indigent & single parent families, closely tied to states
indigent-chronic diseases, i.e. cancer
-Thension between primary & specialty care-more specialists in US than primary care
-Sweeden- Gov't pays for Med School-no differention of pay between primary & specialty care
-Primary care MD are 1/3 of force with most opting for urban specialties
-Nurses outnumber MDs 3 to 1 & okay a large role in patient education
-PAs & Nurse Practicioners- can diagnose, dispense, & refer to other physicians
-4 beds for every 1000 US citizens
-most have 2/3 occupance rate
-lots of pressure to discharge early
-emergency rooms are used for primary care more than emergencies - hospital has to absorb unpaid bills & charge insured people more later
-Nursing homes & rehabilitation centers
-home health care
Health Care Reform
-Methods to approach health care:
Business: pay or don't get it
Assist those who can't pay- raise taxesor redistribute
current tax base
single power for health care (i.e. the gov't like in other countries
-Methods to alleviate current situation:
education & prevention
Get MDs to practice health promotion
More regulation by gov't
consumer power-pressure the system-know exact charge for each MD or hospital visit
eliminate waste in paper & procedures
Other HC models
Sweeden: Federal program paid by taces serves all SES groups
-physicians paid by gov't
-high citizen confidence level

-gov't & provinces w/taxes
-primary care MD with referrals to specialist
-high citizen confidence level
-Model HPRE programs
Community Health
-Health promotion focuses on city, town, or country level
-physical factors-environment, geography, neighborhoods, etc.
-social/cultural factors-SES, religion, politics, etc.
-technology & agriculture-internet access, goods available & valued
-health field concepts & diagrams- not responsible for details of naturalm socialm & personal health histories
Promoting community health
-Quality of Health- balance of protection & promotion (i.e. safety of walking)
-coalitions-need for input from multiple layers(i.e. teen pregnancies in community)
-empowerment-inspire people to help
Diffusion of an idea
Figure 2-11-p. 54
-Innovators & early adopters
-Early & late majority
-Late adopters & hard to reach
Demography & Health
Seasonal-Fig. 3-1
-pregnancy rates higher after snow & ice storms
-certain diseases higher in summer
-population growth-Figs 3-2,3-3,3-4
biotic potential
chance for more children in community
actual rate at which biotic potential lives out
Zero Population Growth-some areas advocate small families because health care can't support more people-tax incentives-mor money for 2nd child
reductionist approach to epidemiology
reduce disease to smallest level. i.e. cause of AIDS, reduce to smallest level of source.
expansionist approach to epidemiology
Heart Attack-big clues for reason behind clogged artery
epidemiological triangle
ex. malaria
cross sectional studies
# cases per population at a given time. compare to other times and populations
case control studies
compare who has disease to who does not have disease
retrospective studies
drug to prevent miscarraige, later caused high risk for breast cancer
prospective studies
follow group over time and observe health and behavior-do not typically have disease-most studies have findings along the way
disease/illness rates. i.e. cancer, flu
death rates
# of cases of disease or deaths in a given time period
# cases at any one point in time
-primarily used w/infectious diseases
# of events per population at risk
examples of rates
crude death rate
birth rate
infant mortality
relative risk ratios
10x greater risk of getting lung cancer if a smoker
survival rates
people who live vs. people who die from certain cancers
humans have a potential to live 120 yrs
life expectance
avg. age of death=80
disability free longevity
new measure-most elderly people depend on assistance for basic needs for avg. 2 yrs.
yrs of potential life lost
looks at results of early age deaths
i.e SanFransisco- AIDS caused 5000 deaths of age 30-35
geographic differences
midwest-highest life expectance
Factors affecting life expecancy
-Genetics-predisposition to diseases
-Race- lower socioeconomic-lower life expectancy
-marital status-married
-body composition
-lifestyle habits

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