nursing homework

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 science of public health.

The study of epidemics:

Focuses on human populations, usually starting with an outbreak of disease in a community

Looks for common exposures, seeking the causative factor

Deciphers causes of new disease and prevents spread of old, well-understood diseases

Epidemiologists are mainstays of local public health departments.

“Shoe-leather epidemiology”

Statistics

Governments collect health data on the population.

These numbers are diagnostic tools for the health of the community.

The science of statistics is used to calculate risks and benefits.

Statistical analysis is an integral part of any epidemiological study seeking the cause of a disease.

Statistical analysis is an integral part of any clinical study testing the effectiveness of a new drug.

Biomedical Sciences

A major portion of human disease is caused by microorganisms.

Control of infectious diseases was a major public health focus in the 19th and early 20th centuries.

Biomedical research remains important to understanding and control of new diseases and noninfectious diseases.

Chronic diseases

Genetics

Environmental Health Science

A classic component of public health:

Much of the public health improvement in the U.S. in the 20th century was due to improved environmental health.

Health is affected by exposure to environmental factors:

Air quality

Water quality

Solid and hazardous wastes

Safe food and drugs

Global environmental change

Thousands of new chemicals enter the environment every year, and little is known about their effect on human health.

Social and Behavioral Sciences

Behavior is now the leading concern of factors that affect people’s health.

A theory of health behavior is that social environment affects people’s behavior.

Major health threats are tobacco, poor diet, and physical inactivity and injuries.

Blacks have a lower overall life expectancy than whites even when incomes are similar.

Other ethnic minority groups are also at increased risk for a variety of health problems.

Health Policy and Management or Health Administration

This area of study examines the role of medical care in public health.

Cost of medical care in the U.S. is out of control.

U.S. has a high percentage of population without health insurance.

These people often lack access to medical care.

Quality of medical care can be measured and is often questionable.

Medical care has eaten up profits that could be used more beneficially for education, housing, and the environment.

Public Health: Prevention and Intervention

Primary prevention prevents an illness or injury from occurring at all.

Secondary prevention minimizes the severity of the disease or injury once it has occurred.

Tertiary prevention minimizes disability by providing medical care and rehabilitation services.

Public Health Approach

Define the health problem.

Identify risk factors associated with the problem.

Develop and test community-level interventions to control or prevent the cause of the problem.

Implement interventions to improve the health of the population.

Monitor interventions to assess their effectiveness.

Chain of Causation

Chain of Causation involves:

Agent

Host

Environment

This is a traditional approach to dealing with infectious diseases.

Interventions can focus on any of these targets.

This model can also be used for other kinds of illnesses or injuries.

Public Health and Terrorism

Events of 9/11 and the anthrax letters highlighted the importance of public health.

Public health response to disasters, natural and man-made, helps to control the damage and to prevent further harm to survivors and rescuers.

Public health response to 9/11 was essentially the same as needed for other disasters, such as factory explosions and plane crashes.

Bioterrorism is recognized primarily through classic public health measures similar to those used for natural epidemics.

The threat of bioterrorism did more to teach the public about public health than any educational program.

Discussion Question 1

Describe actions that governments have taken to ensure that people are safer and healthier today than people were 100 years ago.

Discussion Questions 2

What are the three core functions of public health?

How do these functions compare with the functions of medical care?

How are the six disciplines of public health used to accomplish the core functions?

Discussion Question 3

Identify a health problem in your community.

What are some risk factors associated with the problem?

Suggest a possible intervention that the community could take to ameliorate the problem.

Discussion Question 4

Visit the website for American Public Health Association (APHA), www.apha.org.

Read the highlights from the current issue of the American Journal of Public Health.

Which of the public health sciences does each of these articles belong to?

Visit the website for The Nation’s Health, the official newspaper of APHA, thenationshealth.aphapublications.org/.

Read the headlines of the current issue to get an idea of the range of topics encompassed by the field of public health.

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