Homework

Assignment 1 is Available. Review Chapters 1 – 5. Based on the power point presentations, please submit a 250 words summary of these chapters including the main idea (content) for each chapter.

CHAPTER 1

Public Health: Science, Politics, and Prevention

What Is Public Health?

C.E.A. Winslow provided the definition of public health in 1920 that is still valid today.

IOM’s The Future of Public Health refocused attention on public health and revitalized the field.

Mission is “fulfillment of society’s interest in assuring the conditions in which people can be healthy.”

Substance is “organized community efforts aimed at the prevention of disease and the promotion of health.”

Core Functions of Public Health

Core functions of public health:

Assessment

Policy development

Assurance

Public Health Versus Medical Care

In medicine, the patient is the individual; in public health, the patient is the community.

Public health diagnoses the health of the community using public health sciences.

Treatment of a community involves new policies and interventions.

Goal of medicine is to cure; goal of public health is to prevent disease and disability.

Less than 3% of the nation’s total health spending is devoted to public health.

Life expectancy of Americans has increased by 30 years over the 20th century, and only 5 of the 30 years are attributed to modern medicine.

Public Health: Science and Politics

Science is how we understand threats to health, determine what interventions might work, and evaluate whether the interventions worked.

Politics is how we as a society make decisions about what policies to implement.

Politics is part of both the policy development and assurance functions of public health.

Community pays for public health initiatives through taxes.

Public Health Disciplines

Epidemiology

Statistics

Biomedical Sciences

Environmental Health Science

Social and Behavioral Sciences

Health Policy and Management

Epidemiology

Epidemiology is the basic sci

CHAPTER 2

Why Is Public Health Controversial?

Social Justice Versus Market Justice

Differences:

Social justice: The common good

Market justice: Individual responsibility

Questions about the scope of public health

Importance of economic factors for health

Politically controversial

Sources of Controversy

Economic impact

Individual liberty

Moral and religious opposition

Political interference with science

Economic Impact

Most public health measures have a negative economic impact on some segment.

Businesses often resist public health measures because they affect profits.

Those who must pay may not be the ones who benefit.

Costs may be short-term, while benefits may be long-term.

Costs are easier to calculate than benefits.

Tragedy of the Commons

Is exemplified in many environmental laws

Freedom of individuals should be restricted for the well-being of the population.

Do laws overly restrict “freedom” to pollute?

What should be included among protected resources?

When Can Government Restrict Individual Freedom?

Restrictions to prevent harm to others is generally acceptable.

Paternalism is only acceptable for laws concerning children.

For protecting individuals from their own actions? (Libertarians are opposed.)

Libertarian view has a strong tradition in the U.S.

Argument for restrictions for the “common good” leaves lots of room for controversy.

Moral and Religious Opposition

Concerns:

Sex and reproduction

AIDS, STDs, teenage pregnancy, and low birth-weight babies are major U.S. public health concerns.

Public health solutions are often viewed as promoting immoral behavior.

Alcohol and drugs

Such opposition may discourage scientists and funding agencies from conducting research on many important health problems.

CHAPTER 4

Epidemiology:
The Basic Science of Public Health

Epidemiology

Is the diagnostic discipline of public health

Is a major part of public health’s assessment function

Investigates causes of diseases

Identifies trends in disease occurrence

Evaluates effectiveness of medical and public health interventions

Patterns of Disease Occurrence

From the following information, epidemiologists can infer why a disease is occurring:

Who is getting the disease?

When did they get the disease?

Where is the disease occurring?

The ultimate goal is to use this knowledge to control and prevent the spread of disease.

Epidemic Surveillance

Is a major line of defense in protecting the public against disease

Important terms are:

Endemic versus epidemic

“Notifiable” diseases

“Shoeleather epidemiology”

System was created to control spread of known disease but also aids in recognizing new disease.

Importance has increased with threat of bioterrorism.

John Snow and Cholera

First example of use of epidemiology to study and control a disease was by Snow for cholera.

London had Cholera epidemics in mid-1800s.

Snow suspected an association with the water supply, the Thames River.

He conducted a “natural experiment”:

He questioned households where cholera death had occurred.

Most deaths were associated with one water supply company.

Outbreak Investigation

Verify the diagnosis.

Construct a working case definition.

Find cases systematically.

Apply active surveillance.

Ask who, where, and when questions to describe the epidemic by person, place, and time.

Consider the incubation period.

Look for a common source of exposure.

Epidemiology and Chronic Diseases

Identify risk factors.

Observe long-term trends.

Epidemiologic studies

CHAPTER 3

Powers and Responsibilities of Government

Federal Versus State

U.S. Constitution states that a fundamental purpose of the government is “to promote the general welfare.”

Reserve clause is interpreted to mean that, since health is not mentioned in the Constitution, responsibility for public health primarily belongs to the states.

Interstate commerce provision justifies the activities of the Food and Drug Administration (FDA).

Power to tax and spend is widely used by federal government to control public health policy.

The federal government provides 65% of the funding for Medicaid.

The New Federalism limited Congress’s powers and returned authority to the states.

Branches of Government: Federal, State, and Local

Legislative

Legislature passes statutes.

Executive

Public health agencies carry out the law.

They may issue regulations consistent with statutes.

Judicial

Laws and regulations can be challenged in court.

Local Public Health Agencies

Local county and city health departments are often responsible for:

Day-to-day public health tasks

Core public health functions

Providing medical care for the poor

Funding sources are variable.

City or county legislatures may not understand the importance of core functions.

Mandates may be funded from state or federal governments.

State Health Departments

Coordinate activities of local health agencies and provide funding

Collect and analyze data provided by the local agencies

Provide laboratory services

Manage Medicaid

License and certify medical personnel, facilities, and services

Handle environment, mental health, social services, and aging issues, possibly through separate state agencies

Provide funding to hospitals to reimburse them for treating uninsured patients

Federal Agencies

Department of Health and Human Services (HHS)

www.hhs.gov

Centers

CHAPTER 5

Epidemiologic Principles and Methods

Definition of Epidemiology

Epidemiology is defined as “the study of the distribution and determinants of disease frequency in human populations.”

Step 1: Define the Disease

Death is easy to determine.

A death certificate states cause of death.

A blood test or stool culture is needed to verify a diagnosis of certain diseases.

Some diseases are hard to define.

EMS and SARS

Sometimes a definition changes as more is learned.

AIDS

Other health outcomes include injuries and risk factors.

Disease Frequency

Count the number of people with a disease and relate that to the population at risk (PAR).

PAR (denominator) may be the total population or exposed population, or one gender or age group.

PAR often comes from a census.

Two ways to measure frequency are:

Incidence, the number of new cases

Prevalence, the number of existing cases

Incidence is used for studying causes of disease.

Disease Frequency (cont.)

Prevalence depends on incidence and prognosis.

If causes or risk factors increase, incidence and prevalence increase.

If ability to diagnose increases, incidence and prevalence appear to increase.

Prevalence rates are most useful in assessing the societal impact of a disease and planning for healthcare services.

Mortality rates are used to measure frequency for diseases that are often fatal.

Distribution of Disease

Who:

Sex, age, occupation, race, and economic status

When:

Looks for disease frequency over time: Season, year (long-term trends), elapsed time since an exposure (epidemic curve)

Is crucial in tracking an outbreak of infectious diseases such as hepatitis and legionellosis

Where:

Neighborhood (e.g., clusters), latitude (climate), urban vs. rural, national variations

Looks at comparisons of disease frequency in different countries, states, counties, or other geographical divisions

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