HES 37

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Public Health Subdisciplines: Biostatistics
Environmental Health
Epidemiology
Health Administration
Health Promotion & Education
Nutrition
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: community
worksite
medical/clinical
schools
places of worship
colleges/Universities
retirement/nursing
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)
-Accupuncture
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: -Sanitation
-City of Rome could support up to 800K people
-Sewage pipes, garbage systems, venhilation systems
-bathers
-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 -England: England:
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 (1880-1910): -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 1960-1975: -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 1975-Present: -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 continued: 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: 40-50
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
-Pharmaceuticals
-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?
Premium: what people pay
Dr. P-$200
FU-$300
Deductible: 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
co-payment: -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
HMO: Health Maitenance Organization-uses higher premium and co-payments-often a narrow choice of physicians
PPO: Preferred provider Organization-combination of HMO & Traditional Plan
Medicare: for retired citizens (65 plus yrs. or disables) and those with kidney disease
Medicaid: -For medically indigent & single parent families, closely tied to states
indigent-chronic diseases, i.e. cancer
Personnel: -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
Hospitals: -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
technology-computers/robots/etc.
Other HC models: Sweeden: Federal program paid by taces serves all SES groups
-physicians paid by gov't
-high citizen confidence level

Canada:
-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
fecundity: actual rate at which biotic potential lives out
ZPG: 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
host-person
agent-mosquito
encironment-warm,moist,humid
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
morbidity: disease/illness rates. i.e. cancer, flu
mortality: death rates
incidence: # of cases of disease or deaths in a given time period
prevalence: # cases at any one point in time
-primarily used w/infectious diseases
rate: # of events per population at risk
examples of rates: crude death rate
age-specific
race-specific
disease-specific
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
lifespan: 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: -Gender-women
-Genetics-predisposition to diseases
-Race- lower socioeconomic-lower life expectancy
-occupation-preachers
-income-higher
-marital status-married
-body composition
-lifestyle habits

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