Public Health Finals Review PDF

Chapter 1: What is Public Health Study Notes: Goals: Maximize health of populations; Eliminate health disparities (age, gender, class, geographics) Core Functions: Assessment , Assurance, Policy Development Riegelman and Kirkwood (Reading): Core functions --> job cannot be delegated to othe...

Chapter 1: What is Public Health Study Notes: Goals: Maximize health of populations; Eliminate health disparities (age, gender, class, geographics) Core Functions: Assessment , Assurance, Policy Development Riegelman and Kirkwood (Reading): Core functions --> job cannot be delegated to other agencies or to nongovernmental organizations Assessment (Collect and analyze information): 1. Monitor health status (surveys, statistics, surveillance) 2. Diagnose and investigate health problems (epidemic investigation, public health laboratories). Policy Development (Developing evidence-based recommendations and analyses): 3. Inform/educate/empower people about the issue (health education campaigns) 4. Mobilize community partnerships (local community control programs) 5. Develop policies and plans that support community health efforts (testing and follow up programs) Assurance (Ensure that people have access to health services and that public interests are protected): 6. Enforce laws and regulations 7. Link people to needed personal health services (community health centers) 8. Ensure the provisions of a professional workforce (competent physicians, nurses, health professionals) 9. Evaluate effectiveness, accessibility, and quality 10. All three core function research for new insights and solution to problems Since the US constitution does not mention public health --> public health is a state responsibility Home rule (autonomy model) --> authority is delegated from the state to the local health Department Branch office model --> the local health department is viewed as branch office of the state agency with little or no independent authority or funding Chapter 2: Public Health Institutions Study Notes: Government agencies play a large role in public health→Ability to make regulations→ Authority comes from the Constitution US Constitution: No federal, state, or locals, regulations, or court decisions may contradict the constitution ○ States can actually do more than the federal government: Reproduction law (Roe v Wade), seatbelt laws Government actors and tools: Legislative branch (congress) ○ Passes laws (acts of congress) ○ Can tax, spend, regulate, interstate commerce ○ Can use spending power to coerce states to pass statutes e.g. drinking age in states Executive branch agencies ○ Carry out (execute) the law Judicial branch (supreme courts and lower federal courts) ○ Police power: "general power of the states to keep order and protect the health and safety of their own populations"; Includes taxing, spending, and much more Local government: ○ Typically consists of mayor, city council, board of health, local health department, and other boards of departments ○ Granted authority in state constitutions and by state laws ○ Makes local ordinances and regulations ○ Enforces both state and local laws/ regulations ○ Administers federal, state, and local programs ○ Closest to the people Government Policies and Programs: Laws (Legislature) and Regulations (Executive): ○ Requirements, prohibitions, standards ○ Mandatory ○ e.g. animal regulations, safety and environmental regulations Programs: ○ Provide funding for assistance, educational campaigns, service provision ○ Can be administered by government agencies or nongovernmental organizations ○ Generally voluntary ○ e.g. vaccination Taxes: ○ Incentives and disincentives  ○ e.g. cigarette tax (disincentive) ○ e.g. tax breaks if you're doing something energy efficient (incentive) No matter what the intention with one of these forms and someone will be affected in a way that will make them disagree with it (always potential for controversy) Controversies in health care: Abortion Cloning: Ethical? Interference with science --> science is supposed to be objective, but because we have to analyze our own findings so it may become subjective Needle exchange programs (places where you can get new, clean injecting equipment and advice for staying safe)--> stops spread of disease but doesn't stop any drug habits ○ Harm reduction strategy --> approach in which we try to reduce the negative consequences of a behavior, not change the behavior itself (often controversial because not addressing the behavior at the root cause) Not eliminating drug use, but trying to stop the sharing of intravenous needles Anything with money involved --> where are the resources coming from? - tax dollars ○ Government are more controversial compared to private actors: Tax Money Vaccine War: Public health doctors praise vaccines as the greatest thing the world 2010 first vaccine war --> parents Measles Outbreak: ○ Measles outbreak (spread to over 100 infections in different states)→A single person with the disease affects many people and is expensive to track and cure (Step 1, identify) ○ What allowed measles to spread was that there were children who were un-immunized (not vaccinated) (Step 2, Protective and Risk Factors) ○ CDC --> uses forensic techniques (Step 1, develop and test strategies) ○ Vaccines (step 3 )-MMR vaccines ○ Parents Arguments: People get sick for a reason --> children can fight off and grow more immune ○ Difficult for herd immunity-95% estimated needed to be vaccinated Jacobson vs Massachusetts (Colgrove): Jacobson v. Massachusetts upheld the authority of states to pass compulsory vaccination laws 1905 court case on smallpox vaccinations ○ Decision articulated that the freedom of the individual must sometimes be subordinated to the common welfare ○ Serves as the precedent in numerous cases that have challenged vaccination laws ○ It has however been recognized that when human rights are protected, fewer people become infected (AIDS/HIV): allows for better access to  healthcare, education, and social support systems, which are crucial for prevention and early detection of illnesses Chapter 3: Study Notes: Measuring health: “Complete physical, mental, and social well-being”-WHO Definitions Health Disparities(race, gender, geographic differences)--Always talk about race, class, gender as risk factors. Turmock 2016-measuring health population Metrics: Life expectancy (U.S. 2017: 78.6 years). Morbidity rates (e.g., arthritis prevalence: 21%). Health disparities (race, gender, geographic differences). Know the leading causes of death chart well!!! Leading causes of death: Heart disease, Cancer, COVID-19. Chronic disease dominates but emerging threats like covid-19 can reshape priorities. National Vital Statistics Reports. Morbidity - sickness Mortality - death Communicable disease ○ Spread from person to person, etc.  ○ Infectious disease Chronic disease ○ Non communicable disease Injury Infectious Diseases Defining Characteristic: ○ A pathogen is always the agent ○ A single exposure is often sufficient to cause illness ○ Symptoms usually develop shortly after exposure– (but not always - e.g. HIV; develop over years) Infectious disease are major public health concerns: ○ TB ○ Polio before vaccine ○ Malaria-parasitic disease ○ HIV/AIDs-gay men ○ SARs ○ Smallpox-no longer occur naturally ○ Influenza-new strains every year; must be vaccinated every year ○ Measles ○ HIV ○ Rabie ○ Lyme disease- KNOW THIS WELL!!! Epidemiological Triad: Epidemiological Triad for Infectious Disease: Disease results from an interaction between the host, agent, and environment Agent = pathogen ○ Pathogen --> organism that causes disease (Viruses, bacteria, parasites, fungi, prions ) Host = susceptible human ○ Host factors Immunization status (vaccinated?)  General health, immune system strength Age-Very young and very old are most susceptible Hand washing, IV drug use, condom use.. Environment = physical and social ○ Environmental Factors: Water- is it contaminated? Food - is it contaminated? Air - is it contaminated? Sanitation - is waste separated for people, water, and food? Vector breeding sites ○ Social Factors: Crowded living conditions present Access to health care Vector = carrier Key issues: What infectious agent is the cause? What is the means of transmission? Is it contagious when people are asymptomatic (HIV: yes; Ebola: No) Is a vaccination available? What other prevention measures work? Is a treatment or cure available? Drug resistance Chronic Disease (Non-Communicable) Defining Characteristics: ○ Multiple causes or risk factors Often no single cause ○ Exceptions: certain genetic disease like Huntington's Disease have a single cause ○ Usually develops over a long time period: Cumulative exposure Epidemiological Triad for Chronic Diseases: ○ Host - susceptible human ○ Agent - different for each disease (disease causing thing) e.g. carcinogens for cancer ▪ e.g. cholesterol ▪ e.g. sodium ○ Vector Cigarettes Tanning beds Junk foods General definition: an object that carries the agent to the host (vehicle) ○ Environment - physical and social Workplace (where you work) Exposure to harmful things: Smoking, excessive sun exposure Social support for healthy lifestyle ○ Key issues ○ What is the agent? ○ How much exposure is too much?  ○ What other risk factors are important? ○ How do you know when you are developing the disease? ○ Can the disease be managed with lifestyle changes? Medications? Injuries: Primary Prevention --> Activities that are intended to prevent the onset of a disease or injury. Secondary Prevention --> Activities intended to minimize the risk of progression of or complications from a disease or to minimize damage from an injury. Tertiary Prevention --> Activities intended to minimize disability caused by a disease or injury ○ Rehabilitation's one tertiary prevention activity. Significance: ○ 2 of the top 10 main killers in the country are injury-related ○ Causes of death ranked by age group --> for most age groups unintentional injury was the leading cause of death (everyone between the age 1 to 44 --> leading cause of death for young people is unintentional injury) ○ How should we measure loss of life? If an older person dies and a young person dies, are the two losses the same? ○ Years of potential life lost (YPLL) Based on age at death and life expectancy Life expectancy can be calculated empirically or set arbitrarily Gives more weight to causes of death that affect younger age groups Example: Assume life expectancy = 75 years Cause A - 100 deaths ○ Average age at death = 35 ○ Average YPLL = 40 ○ Total YPLL = 4000 (multiply by number of deaths) Cause B - 200 deaths ○ Average age at death = 65 ○ Average YPLL = 10 ○ Total YPLL = 2000 A leading cause of death and YPLL ○ Unintentional injury 4th leading cause of death in 2013 ○ #1 cause of death for younger people (age 1-44) in the US ○ an result in long-term disability, decreased quality of life ○ Can result in high healthcare costs Causes Fatalities ○ Motor vehicle traffic - have come down ○ Firearm - have come down ○ Drug poisoning - has gone up #1 cause of injury-related deaths ○ For younger children - drowning  Non-fatal ○ Unintentional falls Definitions Two major categories of injury ○ Traumatic injury Occurs immediately upon transfer of energy to the body (injury happens suddenly) Sometimes called acute traumatic injury Can be minor or life-threatening ○ Overuse injury (musculoskeletal disorders) Occurs over time, after repeated exposure Tend to be non-fatal Acute traumatic injury --> any unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen Nature of injury --> specific physiological outcome in terms of damage to the body e.g., fracture, laceration, contusion, suffocation, burn, electrocution Mechanism of injury --> an incident in which energy is released suddenly, with the potential to cause injury Aka external cause or event e.g., motor vehicle crashes ○ Fall from ladder ○ House fire ○ Boat capsizing ○ Football tackle ○ Assault Injury is not the same as an accident "Accident" implies random, uncontrollable, inevitable Injuries are predictable and preventable Epidemiology triad --> disease/injury results from an interaction between the host, agent, and environment ○ Host --> susceptible human ○ Environment --> physical, social ○ Agent --> the energy ○ Vectors --> an object that carries the agent to the host (vehicle) e.g., baseball bat if it’s being swung at you Motor vehicle you're riding in that’s going really fast and then suddenly stops  e.g., motor vehicles, firearms, machinery (power saw, lawnmower), appliances, etc ○ Host factors Age --> all ages, but different age groups tend to experience different types of injury Physical condition, comorbidities Medical use, alcohol use Occupation or leisure activities Risky behaviors (texting while driving) Safety behaviors (wearing a seatbelt) ○ Environmental factors Presence of potentially harmful sources of energy e.g., machinery, heights, motor vehicles Presence of safety products and features e.g., airbags, smoke alarms, handrails ○ Social support for safety behavior ○ Social pressure for risky behavior Key issues Injuries are not accidents Traumatic injury or overuse injury? What is the energy source/vector? Can the energy be reduced or blocked? Approach unintentional and intentional injuries the same way or different ways? Are emergency services and trauma centers nearby? Time is critical! Chapter 4 Study Notes: An aim of PH is to prevent disease What is the best way to prevent a disease or injury? ○ Possible intervention points --> hosts, agent, environment, vector/vehicle in the epidemiological triad Progression of disease/injury: generalized model ○ Exposure --> disease/injury process starts --> disease/injury symptoms --> death Latency/incubation period before disease/injury symptoms ○ Primary prevention --> disease/injury process does not start Prevent disease/injury process from starting, generally by limiting exposure to harmful things ○ Secondary prevention --> no disease/injury symptoms Prevent full-blown disease/injury after disease/injury process has already started Early detection/screening and early intervention ○ Tertiary prevention --> recovery or non-fatal health outcome Medical treatment and rehabilitation  Conceptual model for the progression of injury ○ Exposure --> Event occurs --> causes injury --> Death ○ Every step in this progression is a possible intervention point (3 chances) The most intervention point is preventing the event itself (primary prevention) Since it is hard to prevent every event itself (secondary prevention) ○ Try to prevent the injury from occurring after the event occurs ○ e.g., Seatbelt, airbag Sometimes there are large events and injuries (tertiary prevention) ○ Try to prevent death --> but there may still be some sort of temporary or permanent disability Public health prefers primary prevention! Conceptual model for the progression of chronic illness ○ Exposure --> accumulation --> disease symptoms --> death ○ Primary prevention --> no or slow accumulation Prevent development of disease in healthy individuals by limiting exposure to harmful agents e.g., reduce smoking Promote healthy diet and exercise Sunscreen use ○ Secondary prevention --> no disease/symptoms Screen individuals to detect disease process in its early stages and intervene early to prevent or advance diseases e.g., cancer screenings Blood pressure and cholesterol screening Blood sugar ○ Tertiary prevention --> maintenance Provide medical treatment to prevent death or complications and to maintain best health possible e.g., cancer surgery, chemotherapy, radiation Conceptual model for the progression of Infectious disease ○ Exposure --> transmission --> disease/symptoms --> death ○ Primary prevention --> no transmission Prevent transmission to healthy individuals by limiting exposure to pathogens e.g., avoid contact with sick people Hand washing Cleaning surfaces Vector control ○ Secondary prevention --> no disease/symptoms Screen individuals to detect infection, identify individuals who have been exposed, and intervene early to prevent more advanced disease e.g., HIV testing Contact tracing Rabies shots after exposure to rabid animal  ○ Tertiary prevention --> recovery Provide medical treatment to prevent death or complication and to restore best health possible Chapter 5 Study notes Epidemiology The study of the distribution and determinants of disease frequency in human populations ○ Determinants = risk factors/causes The study of the patterns and causes of diseases and injury (health conditions) in populations Incidence (Risk)→Measure of new cases of a disease or injury occurring in a population during a specified period of time ○ Infectious disease Prevalence (proportion)→ measure of persons in the population suffering from a disease or injury cases at a specified point in time ○ Chronic disease Step 2 : identify risk factors or causes ○ Is X associated with increased risk of Y? ○ Does X cause Y? How do we determine this? What kind of data do we need? Where/how do we obtain those data? ○ Cohort study Formal epidemiologic studies ○ Cohort studies ○ Case control studies Data sources ○ Researchers collect primary data ○ Surveillance data can sometimes be used Cohort study ○ Start with healthy people ○ Compare incidence of disease or injury over some follow-up time period in exposed and non-exposed individuals Calculate relative risk (RR)= ○ Relative Risk (RR) = incidence rate in exposed / incidence rate in non-exposed  Case control studies ○ Start by identifying cases, then find healthy controls ○ Compare past exposure in cases and controls ○ Calculate odds ratio (OR) Odds ratio (OR) = odds of exposure in cases/ odds of exposure in controls Odds = ratio of number of cases ○ Odds of exposure cases = #cases exposed / #cases not exposed ○ Odds of exposure control cases = #controls exposed / #controls not exposed  Case control vs. cohort ○ Cohort takes a long period of time ○ Case control - looking at people who are already sick and looking into their past Doesn't take as much time Less expensive What happens if lots of studies, both cohort and case control, on one topic and the numbers don't agree ○ Usually depends on how the study was done e.g., looked at different populations e.g., measurement of variables were different Step 3: develop and test interventions ○ Does X cause improvement in Y? ○ Evaluation studies or interventions studies ○ Experimental studies/randomized controlled trials You hear about this one the most Used for drug testing all the time Quasi experimental studies/observational studies ○ Some things just can’t be randomly assigned→comparing communities Step 4: assurance widespread adoption ○ Policy research What kinds of policies or programs assure that interventions reach people who can benefit from them (policy analysis)  What package of policies or programs gives us the best outcomes for a given amount of resources (cost-effectiveness analysis) ○ Implementation research What factors facilitate the implementation of policies and programs What barriers hinder the implementation of policies and programs Chapter 6: Study Notes Morbidity, mortality, leading causes of death --> these are diagnoses ○ Progression of disease/injury generalized model ○ "Actual causes of death" (2000) --> causes of the leading causes of death Tobacco Poor diet and physical inactivity Alcohol consumption Microbial agents Toxic agents Motor vehicles Firearms Sexual behavior Illicit drug use Epidemiologic triad ○ "Actual causes" = agents or environmental factors Vector Motor vehicles Firearms Host Behavior Genetics --> purposely left out of the "actual causes" Agent Microbial agents Toxic agents Environment Environmental hazards Social factors Medical care --> part of our infrastructure All of the policies around medical care are part of the social environment Determinants of health ○ Behavioral choices - 40% ○ Genetic factors - 30% ○ Social factors - 15% ○ Medical care - 10% ○ Environmental exposures - 5% ○ Behavior is a huge factor in health outcomes  Most important behavior we should focus on to improve health ○ Diet, exercise, sleep, stop smoking, driving, alcohol consumption Things that influence how you diet, exercise, etc. (behavior) ○ Individual/intrapersonal (host factors) Stress level Income Job Preferences Motivation/energy Dietary restrictions e.g., allergy Mental health Interpersonal ○ Friends ○ Family Institutional ○ Stressors - school ○ Workplace ○ Gym ○ Workplace policies supporting exercise ○ Vending machines Community Neighborhood ○ Supermarkets ○ Parks/gyms ○ Transportation Societal ○ Media - TV ○ Norms ○ Culture ○ Laws-taxes ○ Policies Host operating in the context of the environment, so both environment and host are important parts of what affects behavior Ecological model of health behavior!!! Public policy = societal level Chapter 7 Study notes Environmental factors play a large role in the actual causes of death e.g., microbial agents Environment --> everything outside the body Environmental health --> public health discipline concerned with preventing human disease and injury from hazards in the environment Emphasis on the impact in humans (not just environmental science) Environmental hazards Chemicals ○ Particularly when there is an unexpected release of chemicals e.g., chemical spills e.g., DDT Radiation ○ e.g., radon Metals ○ e.g., lead Particles and fibers  ○ e.g., air pollution Biological agents Toxins Environmental pathways --> carries the hazards Air Water (surface and groundwater) Soil Food Solid waste Non-food products Routes of exposure Inhalation (breathing) Ingestion (eating, drinking, hand-to-mouth) Absorption (contact with skin) Common health effects Cancer Neurological damage Poisoning Lung and kidney disease Skin problems Endocrine system disorders Birth defects Food- and water-borne diseases Air - air pollution Causes ○ Combustion Power plants, motor vehicles ○ Industrial processes Toxic chemicals ○ Livestock Gases from animal waste Clean Air Act (1970) ○ Required EPA to set air quality standards ○ EPA has set National Ambient Air Quality Standards for 6 common "criteria pollutants" ○ Also addresses hazardous or toxic air pollutants known to cause serious health problems ○ Clean air act = legislative, EPA = executive branch  ○ Criteria air pollutants Particulate matter Sulfur dioxide Carbon monoxide Nitrogen oxides Ground level ozone Lead Air pollution in the United States ○ Emissions have gone down despite the population going up ○ Progress on air pollution in US - figure in textbook Indoor air pollution ○ Tobacco smoke (second-hand smoke) ○ Radon gas ○ Formaldehyde from particleboard, plywood, and other building materials ○ Airborne microbes ○ Mold, dust mites, pet dander Water - water pollution Causes ○ Point-source pollution Sewage, industrial discharge ○ Nonpoint source pollution Runoff from farms and roads Clean Water Act (1972) ○ Originally the federal water pollution control act (1948) ○ Objective: "to restore and maintain the chemical, physical, and biological integrity of the nation's waters" ○ Set quality standards for surface waters Lakes, rivers ○ Imposed controls on point-source pollution into lakes and rivers ○ Authorized funding for municipal wastewater treatment facilities Safe Drinking Water Act (1974) ○ Authorized EPA to establish minimum standards for local drinking water systems ○ Required monitoring of water quality and reporting of results to state governments ○ Maximum contamination levels have been set for ~100 contaminants ○ Note: does not regulate private wells Solid waste - garbage Solid waste disposal ○ 1972 - Marine Protection, research and sanctuaries act (ocean dumping act) Generally prohibited dumping of waste in the ocean Not completely prohibited ocean dumping  Required EPA to develop criteria for evaluating permit applications for ocean dumping ○ 1976 - Resource conservation and recovery act Banned open dumps, set standards for sanitary landfills for municipal waste disposal Regulated handling of hazardous waste, requires tracking and permitting ○ 1980 - Comprehensive Environmental Response, Compensation, and Liability Act (superfund program) Required EPA to identify waste sites that threatened public health or the environment Authorized funding for emergency cleanup of these sites Food Food safety ○ Foodborne illness Salmonella, E. coli, listeria, norovirus, etc. ○ Pesticides ○ Mercury in fish ○ Other contaminants - anything that shouldn't be in your food and is harmful ○ Additives - vitamins/minerals, preservatives ○ Antibiotics and growth hormones ○ Genetically modified organisms? FDA ○ Created by federal food and drug act (1906) ○ Regulates the manufacture, labeling, and sale of food and drugs ○ Responsible for safety of produce, seafood, and most packaged food US department of Agriculture (USDA) ○ Responsible for safety of meat and poultry Why is there so much federal legislation concerning environmental health? ○ Sometimes it's hard for individual states to control natural things e.g., the air doesn't care, it's just going to move e.g., fire in Idaho - the smoke moves to different states ○ Keeping the environment clean The environment can be polluted by individuals, but it cannot be kept clean only by individual efforts Pollution is an "externality" = it has costs to people other than those who produce it Can polluters be expected to voluntarily limit their level of polluting? ○ Government regulation Some important federal agencies in the US EPA - air, water, waste disposal FDA - packaged foods, produce, drugs, cosmetics, medical devices USDA - meat and poultry  OSHA - workplace exposures CPSC - consumer products Set standards Limits for emissions, discharge, exposure Labeling requirements Safety specifications Government provision of services Water, sewer, trash collection Usually in metropolitan areas Laboratory testing Clean up spills Taxes, fees Research Identify hazards ○ How do we know something in the environment is harmful to human health? - epidemiology ○ When is exposure considered a public health problem - when a lot of people are affected Risk assessment ○ An analytic process leading to a judgment about the likelihood of adverse health effects to result from exposure to an agent in the environment ○ 4 steps Step 1 --> hazard identification Determining whether exposure to a particular agent causes adverse health effects in humans How? Epidemiological studies linking exposure to health outcomes Animal studies Step 2 --> dose-response assessment Determine the relationship between dose (amount of the agent) and response (adverse health effects) How much exposure to the agent is necessary before adverse health effects occur? Step 3 --> exposure assessment Estimate how many people are exposed to the agent and in what amounts Is the general population exposed? Is exposure limited primarily to people working in certain occupations? What is the duration of exposure? What concentrations of the agent are people exposed to? Step 4 --> risk characterization  Overall conclusion about the presence or absence of risk and nature of the risk based on synthesis of steps one to three ○ Limits and challenges Tens and thousands of chemicals used Only a fraction have been studied for human health risk Even fewer are regulated (exposure limits) Most studies have focused on individual agents --> little is known about health effects resulting from exposure to combinations of various agents Chapter 8 Study Notes Public health vs medicine ○ Public health: Populations Health determinants and primary prevention Wellness Health care system as a whole, financing ○ Medicine: Individuals Diagnosis and treatment Illness Single clinical setting Medicine and its relationship to public health ○ Medicine deals with secondary and tertiary prevention Last 3 boxes of the general progression of illness/injury model ○ Public health deals with the whole general progression of illness/injury model With an emphasis on primary prevention Medical care as a public health issue (? - how medicine crosses over to public health) ○ Preventive care Vaccine delivery Screening tests Prenatal care and well-baby care, anticipatory guidance Anticipatory guidance --> pediatricians telling you what to expect in the child's growth ○ Infectious disease control Vaccine delivery Screening tests Treatment for TB, HIV Isolation ○ Assuring quality and safety Gov't licensing and certification of providers Maintains minimum standards Accreditation of medical facilities JCAHO (Private, non-profit organization)  Government regulation of pharmaceuticals FDA approves and regulates drugs and medical devices e.g., recalls ○ Assuring access to health care Insurance coverage requirements (laws) Patient Protection and Affordable Care Act Government insurance programs ($) Medicare (elderly), Medicaid (low-income) Provision of care for certain groups Clinics and community health centers ("safety nets") Military and veteran health systems Emergency care ○ Controlling costs 95% on US spending on health goes to medicine and only 5% goes to public health How much is spent on healthcare in the US usually? Estimated 3 trillion spent on healthcare in the US in 2014 Why are healthcare costs so high? People are living longer (aging population) New medical technologies Prescription drugs Defensive medicine Traditional fee-for-service payment system Anytime the doctor sees you or does a service, they get paid Administrative costs to deal with complicated billing and payment systems 2 key questions Who pays for all of that medical care? (in the US) Should all individuals have access to the same medical care regardless of their ability to pay for it? Super controversial Market justice Health care is an economic good Care should be distributed based on ability to pay Assumes the health care market is a free market Social justice Health care is a basic right Care should be available to all, regardless of ability to pay Health care is a societal (govt) responsibility Elements of both in the US Market justice - insurance companies  Social justice - government paying for Medicare, Medicaid Examples: Lyme Disease Opioid COVID-19 Milwaukee Popcorn Worker Exam Notes: Focus on explaining concepts and giving examples for each things then focus on labs and readings and specificity