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What are the ten essential services of public health?
- 1. Monitor health status.
- 2. Diagnose and Investigate health problems.
- 3. Inform, educate, and empower people about health issues
- 4. Mobilize community partnerships
- 5. Develop policies and plans that support individuals/communities
- 6. Enforce laws and regulations that protect health
- 7. Link people in need of services and assure the provision of care
- 8. Assure competent healthcare workforce
- 9. Evaluate effectiveness, accessibility, and quality
- 10. Research new insights into health problems.
What are the five levels of the socio-ecological model?
- 1. Individual
- 2. Social Network (family, friends, etc.)
- 3. Institution (school, workplace)
- 4. Community (local government and agencies)
- 5. Society (policy, culture, environment, engineering and policy reform)
What are the three frameworks of public health?
- Mission of public health: The fulfillment of society’s interest in assuring the conditions in
- which people can be healthy
- Substance of public health: Organized community efforts aimed at the Prevention of Disease and
- Promotion of Health. It links many disciplines and rests upon the science
- of epidemiology.
- Organizational Framework: Both activities undertaken within the
- formal structure of government and the associated efforts of private and
- voluntary organizations and individuals.
What role does the federal government take in Public Health and why?
- mostly under the state or local control
- 10th amendment: the federal government has control over all powers not previously given to the federal government
- Commerce Clause: the federal government has the right to regulate commerce, and thus it can be involved in public health issues
- Power of the Purse: much of public health is funded by federal money so they have control over it
Federal agencies involved in public health
- Health and Human Services (HHS): includes CDC, FDA, Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMSHA)
- Research: NIH, Agency for Healthcare Research and Quality (AHRQ)
- Data Collection: National Healthcare Surveys (NHCS) and Behavioral Risk Factor Surveillance System (BRFSS)
What are the main roles of government in public health?
assessment, policy development and assurance
Public Health in the 19th century
- The age of Epidemics
- intervention: quarantine
- causes: industrialization and urbanization; over-crowding of living spaces; lack of sewer system
- endemic diseases: malaria, TB, MMR, pneumonia, flu,
- epidemic diseases: cholera, typhoid, salmonella
- NOTE: John Snow was the first epidemiologist in 1830 he determined that a cholera outbreak could be traced back to a specific water pump that was contaminated by a dirty diaper
- Late 19th century: Sanitation Movement (upper class and missionary led movement; disease control focused on "cleanliness and godliness"; London set up a board of health and a board of sanitation; focus on prevention)
The Bacteriology Revolution
- Luis Pasteur discovered bacteria
- increased diagnostic tests, identification of organisms, development of interventions (immunizations and water purification)
- led by scientists
- US Public Health Service established in 1912 and more power given to the surgeon general
What are the two definitions of quality of healthcare?
- IOM definition: Extent to which health services
- increase the likelihood of desired health outcomes and are consistent with
- current professional knowledge (evidence based medicine)
- Rodman Definition: the right care to the right people at the right time and in the right setting
What are the steps involved in quality improvement?
- get the data
- analyze the problem
- plan a solution
- do the solution
- check the progress and measure outcomes
- act acoordingly to modify the plan as needed
What is the Pareto Principle?
20% of the causes account for 80% of the problems
What was Olmstead v. LC?
case that ruled that you cannot institutionalize a disabled person who is able to live in the community provided they have the proper support they need
Structure of health care in Germany
- semi-private, mostly employer based insurance
- emplyees and their employers pay about half and half into non-profit "sickness funds"; the unemployed or disabled pay into the sickness funds via government subsidies
- 90% of people are covered by the sickness fund; wealthy and armed forces can opt out of it but cannot buy into it later
- after retirement, 60% of things are paid for by the sickness fund and the rest by the person's pension plan
- key points about service: GP's cannot work in hospital; hospital doctors are salaried; others paid eith global or FFS; PCPs are not gatekeepers
Structure of healthcare in Canada
- single-payer, public, tax-financed system
- can purchade private insurance to cover the gaps in care but providers cannot bill private insurance companies for services covered by the public program
- GPs are gatekeepers
- most physicians get paid on a FFS basis while hospitals are paid global
Structure of Healthcare in the UK
- single-payer, public, tax-funded system
- ability to purchase private insurance that can be used for any services
- GPs are gatekeepers and paid for performance and via capacitance
Structure of healthcare in Japan
- mostly employment-based social insurance
- there is a public option for those not offered insurance through their employers
- more decentralized and entrepenerial; many physicians run or own hospitals and clinics (usually small scale)
- government sets the pay scale and primary care is paid pretty high