Public Health Week 4 Schneider Ch 4-8 PDF

Public Health Week 4 Schneider Ch 4-8 South College Where Dreams Find Direction  Learning Objectives Compare a range of determinants of disease (LO1-3) Illustrate an approach used in public health to identify a contributory cause...

Public Health Week 4 Schneider Ch 4-8 South College Where Dreams Find Direction  Learning Objectives Compare a range of determinants of disease (LO1-3) Illustrate an approach used in public health to identify a contributory cause of a disease or other condition and establish the efficacy of an intervention (LO 2) Interpret an approach to identify options for intervention based on “when, who, and how” (LO 1) Analyze basic types of public health data (LO 4) Differentiate ways that perceptions affect how people interpret information. (LO 3) interpret key principles that underlie the ethics of human research. (LO 4) analyze principles of public health ethics. (LO 6) distinguish between a risk assessment, a public health assessment, and an ecological assessment (LO 3)  Learning Objectives (cont) analyze the meaning of interactions and how they may impact the size of risks (LO 2, 3) analyze how systems thinking differs from reductionist thinking (LO 1) illustrate characteristics of a system (LO 1) analyze the steps in systems analysis using systems diagrams (LO 1) demonstrate the meaning of interactions between factors (LO 1) illustrate the meaning of bottlenecks and leverage points (LO 1) analyze the uses of systems thinking in public health (LO 1) illustrate and employ One Health as an example of systems thinking (LO 1)  Social Determinants of Health Social Determinants of Health: Non-medical factors that affect health outcomes Five domains (Healthy People 2030) 1. Economic stability 2. Neighborhood and built environment 3. Education access and quality 4. Social and community context 5. Healthcare access and quality  Economic Stability 1 in 10 live in poverty (US) Goal: Steady employment to reduce # who live in poverty Less likely to live in poverty, more likely to be healthy Many people have trouble finding and keeping a reliable job. Employment programs, career counseling, and high-quality child care opportunities help more people find and keep jobs  Neighborhood and Built Environment Goal: Create neighborhoods and environments that promote health and safety Interventions and policy changes at all levels (local, state, and federal) can help reduce health and safety risks and promote health Ex. Providing opportunities for people to walk and bike in their communities (sidewalks, bike lanes) to increase safety and improve quality of life  Education Access and Quality Goal: increase educational opportunities and help children and adolescents do well in school Higher education 🡪 healthier, live longer Children from low-income families, children with disabilities, and children experiencing bullying and other forms of discrimination struggle in school and are less likely to graduate high school and college Leads to less safe, lower-paying jobs  Social and Community Context Goal: Increase social and community support Positive interactions and relationships can have a major impact on health and well-being and can reduce the negative impacts from challenges and dangers in the community  Health Care Access and Quality Goal: Increase access to comprehensive, high-quality health care services 1 in 10 do not have health insurance Strategies to increase insurance coverage are critical for everyone to get the care they need PERIE Approach  Interventions-When, Who and How? When- timing in the course of the disease to implement the intervention Primary - before onset of the disease Secondary – after development of the disease, but before symptoms Tertiary - after initial symptoms, but before irreversible disability Who – at whom should the intervention be directed? Individuals, groups, vulnerable populations, everyone, community wide How – education, motives/incentives, obligation/requirements  Types of Public Health Data 1. Single case or small series case reports from 1 or a small series of cases Ex. SARS, anthrax, mad cow disease- Alerts to new diseases, resistant diseases or spreading of diseases. 2. Vital statistics and reportable diseases Ex. vital stats: birth, marriage, divorce, death and some communicable and non-communicable diseases. Helps to identify leading causes of deaths, track reportable diseases 3. Surveys and sampling Disease registries, cancer registry, National Health and Nutrition Examination Survey (NHANES.) can draw conclusions about populations, but very difficult to capture data from every qualifying patient.  Types of Public Health Data (Cont) 4. Self-reporting monitoring for individual patient side effects can help identify unusual events. typically incomplete data and relies on compliance of individual patients. 5. Sentinal Monitoring monitoring for the beginning of expected outbreaks to detect the start and changes in virus or disease type. Must have in depth knowledge of disease patterns. 6. Syndromic Surveillance use of patterns of symptoms in addition to sales data of increase in use of certain OTC drugs. Can be used to detect unexpected outbreaks or bioterrorism based on commonly occurring symptoms. Does not provide a diagnosis but can be an early warning.  How do Perceptions Affect Interpretation of Information? 1. Dread effect information that produces visual and feared consequences or fear of catastrophic events Ex. shark attacks more feared than drowning in swimming pool 2. Unfamiliarity effect things one is familiar with may be perceived as bigger threat Ex. family/friend died from melanoma or that only happens to other people not me if one can’t identify someone they know who has suffered from the hazard (“tanning beds are fine”) 3. Uncontrollability effect things in our control seem less threatening than things out of our control Ex. MVA vs airplane crash Bioethical Principles  Nuremberg Trials Ethics and Research reviewed Crimes from the Nazi concentration camps Established 10 principles: The Nuremberg Code  Tuskegee Syphilis Study 1932: “Tuskegee Study of Untreated Syphilis in the Negro Male” 600 black men. 399 with syphilis. Received free medical exams, free meals and burial insurance 1940: penicillin available but not given  Belmont Report Institutional Review Application of Boards (IRBs) Developed Principles 1. Respect for persons 1. Risk/Benefits 2. Beneficence Assessment 3. Justice 2. Selection of Participants 3. Informed Consent  Risk Assessment Risk assessment aims to measure the potential impact of known hazards (inherent danger of an exposure) through the quantity, route, and timing of the exposure. Examples of Occupational investigations: Chimney sweeps and increased incidence of testicular cancer in the 1700s due to high-dose carbon residue exposure Radiation exposure in workers who painted watches with radiation-containing paint and increased levels of cancer Ship workers in WW2 who were exposed to high levels of asbestos and were later diagnosed with cancer Chemical workers who were exposed to benzene and an increased incidence of leukemia Occupational Safety and Health Administration (OSHA) established in 1971  Four Step Risk Assessment Hazard Dose-Response Exposure Risk Identification Relationship Assessment Characterization What health What are the How much of What is the effects are health the hazard are extra risk of caused by the problems at people exposed health pollutant? different to during a problems in exposures specific time the exposed period? population How many people are exposed Benzene  Public Health Assessment Public Health Assessment includes data on actual exposure in a community. Addresses not just the risks in a specific location, but also the risks to large numbers of individuals and often to the population as a whole. Can take years/decades to complete Public Health Assessment: Lead  Public Health Assessment: Lead In 2015, over 100,000 people in Flint, MI were exposed to high levels of lead in drinking water including a number of children  Ecological Risk Assessment Ecological risk assessment examines the impacts of contaminants on ecological systems ranging from chemicals, to radiation, to genetically altered crops https://www.eea.europa.eu/publications/GH-07-97-595-EN-C2/chapter6h.html  Ecological Risk Assessment: Mercury Mercury risks in the environment Mercury from industry contaminated the Great Lakes in the 1800s and 1900s. It has been filtered by fish who absorbed the mercury in their fat. Certain species absorb more mercury than others. This poses a risk for many reasons… Birds eat the fish… so birds are in danger. There is no feasible method of removing mercury from bodies of water. Low levels pose risks to fetuses (neurological damage) so recommendations for limiting fish consumption during pregnancy are a mainstay Avoid shark, swordfish, marlin, king mackerel, and tilefish Limit salmon, pollock, catfish, and canned light tuna  Multiplicative Interaction There are often interactions between exposures that lead to an impact much greater than the estimate (multiplicative interaction) Ex: the multiplicative interactions between radon and cigarette smoking Radon is a naturally occurring colorless, odorless gas that emits ionizing radiation during its radioactive decay and is found all over the country The second leading cause of lung cancer (after cigarettes) and most common cause in nonsmokers According to the EPA