Community Health Terms Chapters 1-9

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Community Health Terms Chapters 1-9
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Community Health Terms Chapters 1-9
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Community Health Terms Chapters 1-9
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  1. • Public Health
    o actions that society takes collectively to ensure that the conditions in which people can be healthy can occur; most inclusive term
  2. • Community Health
    o health status of a defined group of people and the actions and conditions to promote, protect, and preserve their health
  3. • Population Health
    o Health status of people who are not organized; have no identity as a group or locality and the actions and conditions to promote, protect and preserve their health
  4. • Global Health
    • health problems, issues, and concerns that transcend national boundaries
    • May be influenced by circumstances or experiences in other countries
    • Best addressed by cooperative actions and solutions
  5. • Personal health activities
    • Individual actions and decision making that affect the health of an individual or his or her immediate family members or friends
    • Preventive and curative actions that do not affect others (eating well =wearing seat belt)
  6. • Community/public health activities
    • oActivities aimed at protecting or improving the health of a population or community
    • Maintaining birth and death records, protecting food and water supply, etc.
  7. Dr. John Snow
    interrupted Cholera outbreak in London 1854, by removing handle to pump where contaminated water originated
  8. o1796-Dr. Jenner
    demonstrated process of vaccination against smallpox
  9. Louis Pasteur:
    germ theory of disease
  10. Robert Koch:
    criteria for establishing that a bacterial agent causes disease
  11. •FDR New Deal
    = control of malaria, building hospitals and labs and construction of municipal water and sewage
  12. •Social security act of 1935
    = governments involvement in social issues
  13. • WWII: Discovery
    of Penicillin and DDT insecticide
  14. • Period of Health Promotion (1974-present)
    o Identification that premature death traceable to lifestyle and health behaviors- Healthy People made
  15. largest department in federal government
    • HHS 25% of federal budget- 25% of federal budget
    • 11 operating agencies; 10 regional offices
  16. • Quasi-governmental
    • o Some official health responsibilities; operate more like voluntary health organizations
    • o Operate independently of government supervision
    • o Derive some funding and work from government
    • o Examples: American Red Cross, National Academy of Sciences, National Science Foundation
  17. o Professional Heath
    • Made up of health professionals who have completed specialized training and have met standards of registration/certification or licensure for their fields
    • Mission: to promote high standards of professional practice
    • Funded primarily by membership dues
    • Examples: American Medical Association, American Public Health Association
  18. o Philanthropic Foundation
    • Endowed institutions that donate money for the good of humankind
    • Fund programs and research on prevention, control, and treatment of many diseases
    • Some have broad support, others very specific
    • Examples: Bill and Melinda Gates Foundation, Commonwealth Fund, Robert Wood Johnson Foundation, local Community Foundations
  19. o Service, Social and Religious Organizations
    • Many do not have health as primary mission, but make significant health-related contributions
    • • Examples: Kiwanis, Elks, Shriners, Lions, FOP
    •  Contributions of religious groups to community health substantial
    • • History of volunteerism, influence families, donation of space, sponsorship of programs (food banks, shelters)
  20. o Corporate Involvement in Community Health
    • Biggest role is provision of health care benefits
    • Worksite health promotion programs aimed at lowering health care costs and reducing absenteeism
    • Safety, counseling, education courses, physical fitness centers
  21. Epidemiology:
    • study of distribution and determinants of health related states or events in specific populations and the application of this study to control health problems
    • • Goal, essentially, is to limit undesirable health events in a community
  22. Epidemic:
    an unexpectedly large number of cases of an illness, specific health-related behavior, or other health related event in a particular population at a particular time and place
  23. Endemic disease:
    disease that occurs regularly in a population
  24. Epidemiologist
    : studies disease occurrence in defined populations
  25. Pandemic: outbreak of a disease over a wide geographical area, such as a continent
    • Example: avian influenza, which the books list as being the next possible agent to reach pandemic proportions.
  26. History of Epidemiology: 300 B.C., late 1600’s, 1849:
    • : Hippocrates suggests link between disease and environment
    • •Regression until late 1600’s; return to spiritual-causation belief
    • •1849: John Snow studies epidemiology of cholera and extinguishes London outbreak, thereby limiting death and preserving health
  27. •Natality:
    births / total population
  28. •Morbidity:
    number of sick / total population at risk
  29. •Mortality:
    • number deaths / total population at risk
    • Based on population risk: those who are susceptible to a disease in a given population
  30. Incidence rate:
    number of new health related cases of a disease / total number in population at risk
  31. The Importance of Rates Prime importance:
    • •Number of events
    • •Number of cases: the number of people who are sick
    • •Number of deaths
  32. •Acute disease:
    lasts less than 3 months
  33. •Chronic disease:
    lasts longer than 3 months
  34. •Attack rate:
    • incidence rate calculated for a specific population for a single disease outbreak expressed as a percentage
    • oEx: number of people on a flight become sick, and it is suspected that the flight caused the illness. Attack rate could be calculated for the passengers to express who became ill.
  35. •Prevalence rates:
    • all current cases / total population
    • oUseful for chronic diseases: know how many are suffering
  36. •Crude rate:
    denominator includes total population
  37. oCrude birthrate:
    • # births in a year / mid year population
    • +: easy to obtain, good for comparing populations
    • -: misleading if populations differ in age/attributes
  38. •Age-adjusted rate:
    rate used to make comparisons between groups over time when groups differ in age structures
  39. •Specific rates:
    measures morbidity or mortality for particular populations or diseases
  40. Cause specific mortality rate (CSMR):
    • death rate due to a particular disease
    • Number of deaths by disease / total population
  41. Case fatality rate (CFR):
    • percentage of cases of a disease that result in death
    • # deaths in specified time / number of cases in same period
  42. Proportionate mortality ratio (PMR):
    • percentage of overall mortality in a population that is attributable to particular cause
    • # deaths due to specific disease / total number of deaths from all causes in same population in the same period of time
  43. notifiable diseases problems
    • • sometimes only 35% of cases with diseases are reported
    • • clinics may be too busy to report every case
    • • patients can recover before treatment and may not seek care
    • • reporting depends on disease severity
  44. most reliable indicator of a population health’s status
    mortality statistics
  45. • Age adjusted rates show ...
    • what death would be if no changes occurred in the age makeup of a population
    • o they are a better indicator for examining changes in risk of death over a period of time
  46. -Life expectancy:
    • average number of years a person from a specific cohort is projected to live from a given point of time
    • • has generally increased in America
  47. -Years of potential life lost (YPLL):
    • subtracting a person’s age at death from a predefined, standard age
    • •age 75 often used as the standard
    • operson dies at 59. 75-59 = 16 years
    • vary depending on cause
    • Accidents, cancer kill younger so higher YPLL
  48. -Disability adjusted Life years:
    • measure for the burden of disease that takes into account premature death and loss of healthy life resulting from disability
    • •mortality does not express burden of disease
    • Ex: polio causes loss of healthy life but not reflected in death tables
  49. Health-adjusted life expectancy (HALE):
    sometimes referred to has healthy life expectancy, number of years of healthy life expected, on average, in a given population
  50. -US Census: taken every 10 years; enumeration of the population living in the US
    • •data: income, employment, family size, education, dwelling type, and many other social indicators
    • •used for calculating disease and death rates for program planning
  51. Vital statistics:
    • statistical summaries of vital records; records major life events
    • •births, deaths, marriages, divorces
    • birth: maternal and prenatal care, delivery
    • deaths: rates, expectancy, leading causes, infant mortality
  52. Morbidity and Mortality Weekly Report
    -reported diseases are shown weekly
  53. -National Health Surveys:
    • •health interviews of people
    • •clinical tests
    • •survey of places where care is received
  54. -NHANES: National health and nutrition examination survey
    • •health/nutritional of the general US Population
    • •based on PE, clinical and lab tests, and related procedures
    • o most authoritative source of clinical info on American people
  55. -Behavioral Risk Factor Surveillance System:
    state-based telephone survey to ascertain prevalence of high risk behavior, like smoking or drinking
  56. -Youth Risk Behavior Survey (YRBS): six categories of risks in youth
    • •behaviors that contribute to unintentional violence and injuries
    • •tobacco use
    • •alcohol and drug use
    • •STIS and pregnancy
    • •HIV
    • •Unhealthy dietary habits and physical inactivity
  57. -National Health Care Survey (NHCS):
    nine different national surveys that gather info on nation’s healthcare system
  58. -Descriptive studies:
    • describes disease with respect to person, place, and time (the extent, essentially)
    • First studies carried out on diseases!! Valuable info on detection patterns.
    • Who: head count, as well as age, sex, race, marital status, etc.
    • When: categorized by time of occurrence
    • Summarized by year, for example
  59. Common source epidemic curve:
    graphic display of disease where each case can be traced to a single source of exposure Used to calculate incubation period
  60. incubation period:
    time between exposure and onset of symptoms
  61. Point source:
    exposure occurs at a single point in time
  62. Continuous source:
    • exposure is intermittent
    • Need to discover these to prevent future exposure
  63. Propagated man parts: epidemic curve depicting distribution of cases traceable to multiple sources of exposure
    • Primary cases appear at one end, secondary cases after primary, and tertiary further along the graph
    • Where: residential addresses, travel history are recorded
    • Restaurants, shopping, etc.
    • •Limitations of descriptive studies: not applicable to outbreaks elsewhere and cannot provide info on disease trends.
  64. -Analytic studies:
    test hypotheses about relationships between health problems and possible risk factors
  65. • Risk factors
    • • increase probability of disease
    • o Ex. Does smoking increase risk of lung cancer?
    • • Two different types of analytic studies exist:
  66. Observational studies:
    • investigates natural course of disease
    • Observational studies can be divided into:
  67. Cross sectional:
    info about exposure and disease are collected at the same time
  68. Case/control:
    • seeks to compare diagnosed with a disease and those who are not for prior exposure to specific risks
    • • Familial, behavioral links
    • • Don’t prove causation alone, but indicate future direction of question
  69. o Cohort studies:
    • cohort is classified by exposure to one or more risk factors and observed to determine the rates at which the disease develops in each class
    • Can be prospective (observing a group to see if cigarette smoking leads to disease) or retrospectively (exposure and outcome has already happened)
  70. o Case controls cannot calculate the
    o rate of development of a disease, as the patients already have it
  71. Odds ratio:
    probability about association between risk factors and developing a disease
  72. Cohort studies can
    calculate incidence rate
  73. Relative risk:
    statement of relationship between risk factor and disease (more definitive)
  74. Cohort disadvantages:
    expensive, not practical for rare cases, and take many years to complete
  75. Experimental studies:
    • carried out to identify cause of a disease or determine effectiveness of an intervention
    • Use of control and experimental groups, placebo, etc.
  76. Randomization:
    assigning subjects to treatments in a non-organized manner
  77. Blinding:
    subject remain uninformed and unaware of groups

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