Public Health / Public Works Introduc6on, reitera6on + Lessons 1-2. Pioneer Winter IDH 3034, IDH 4007

Transcription

1 Public Health / Public Works Introduc6on, reitera6on + Lessons 1-2 Pioneer Winter IDH 3034, IDH 4007

2 What s the purpose of this class? Learning Objec6ves Understand the principles of public health, epidemiology, and health promo6on and disease preven6on. See the benefits of interdisciplinary approaches to problem- solving. Understand how community art and public art can be integrated into health educa6on, community assessment, preven6on of disease and disease spread, and promo6on of healthy living. Competency in social awareness and accuracy when developing marke6ng criteria and approaching a sensi6ve popula6on group.

3 What s the purpose of this class? Learning Objec6ves, cont d Appreciate the breadth of the performing / visual arts as cultural mediums (including the limita6ons) for accessing popula6ons inherently resistant to conven6onal health educa6on methodology. Understand basic program evalua6on methodology and how it can apply to both program prac6ce and hands- off social marke6ng approaches. Learn about the many local efforts and projects that incorporate public works into public health educa6on, along with the ability to evaluate na6onal efforts and their regional strengths and limita6ons.

4 What is Public Health? 1923 C.E.A. Winslow defined public health as the science and art of (1) preven6ng disease, (2) prolonging life, and (organizing community efforts. the organized applica6on of resources to achieve the greatest health for the greatest number (Brotherton, 1967) the fulfillment of society s interest in assuring the condi6ons in which people can be healthy organized community efforts aimed at the preven6on of disease and promo6on of health. It links many disciplines and rests upon the core of epidemiology (Inst. Medicine, The Future of Public Health, 1988).

5 Which community efforts? Sanita6on of the environment Control of communicable diseases Educa6on of the individual in personal hygiene Org of medical and nursing services for the early diagnosis and preven6ve treatment of disease. Dx of the social machinery to ensure everyone a standard of living adequate for the maintenance of health.

6 Health Dispari6es What is a disparity? Have you ever experienced disparity? List a few health dispari6es you know of that effect different segments of the popula6on. What are a few solu6ons to these health dispari6es? Did your annotated bibliography cover any disparity among the popula6on most at- risk for your public health concern?

7 What is epidemiology? Epi on or upon (Greek) Demos people Logos the study of Epidemiology is the study of the distribu6on of determinants of health- related states or events in specified popula6ons, and the applica6on of this study to the control of health problems.

8 More on what epidemiology entails A quan6ta6ve basic science built on a working knowledge of probability, sta6s6cs, and research methodology. A method of causal reasoning based on developing and tes6ng hypotheses pertaining to occurrence and preven6on of morbidity and mortality. A tool for public health ac6on to promote and protect the public s health science, causal reasoning, aaaaaaaaand common sense.

9 Examples of applied epidemiology Monitoring of reports of HIV/AIDS in a given community. Whether a par6cular dietary component influences risk of dx cancer. Evalua6ng the effec6veness / impact of a smoking cessa6on program or cholesterol awareness program. Analysis of historical trends and current data to project future public health resource needs.

10 What is a distribu6on? Remember, epi cares about freq and pahern of health events in a popula6on. Freq = # of such events in a popula6on as well as rate/risk of disease in that popula6on.

11 What is a rate? Rate = # events / size of popula6on Rate is 6ed to finding or ascertaining a known pahern. This pahern may then be used for surveillance. Pahern refers to the occurrence of health- related events by 6me, place, and personal cx.

12 Determinants Knowing the descrip6ve epidemiology enables the epidemiologist to decipher causes and other factors that influence the occurrence of health events.

13 Time annual occurrence, season occurrence, and daily/hourly occurrence during an epidemic. Place includes geographic varia6on, urban- rural difference, and loca6on of worksites or schools, etc. Personal characteris6cs demographics (age, race, sex, marital status, SES + behaviors and environmental exposures (i.e. second- hand smoke)

14 Describing the Distribu6on Descrip6ve epi what, who, when, and where Analy6c epi why and how à compares groups with different rates of disease occurrence and with differences in demographic cx, gene6c or immunologic make- up, behaviors, enviro exposures, etc.

15 Examples Based upon what you learned through compiling your annotated bibliography, what are the descrip6ve co- factors of your event?

16 Health- related states Health related states or events first only included epidemics of communicable diseases à endemic communicable diseases à non- communicable diseases injuries, birth defects, occupa6onal health, environmental health. Individual vs. collec6ve society clinicians are concerned with the health of the individual. Epidemiologists care about the collec6ve s health.

17 Info generated by epidemiologic methods - USES Popula6on / community health assessment Individual decisions Comple6ng the clinical picture

18 Popula6on / community based assessment Assess the health of a popula6on or community in order to determine whether the current health services are available, effec6ve, and efficient? Policy and programs are then planned to help. What are the actual and poten6al health problems? Where are those problems? Who is at- risk? Are there any problems that are declining with 6me? Are there any problems increasing with 6me (or have poten6al to increase)? Leads to informed decisions.

19 Individual decisions People (laymen) use epidemiology to make their decisions on a daily basis. Stairs not elevator. Smoking cessa6on. Salad instead of French fries. Contracep6on.

20 Comple6ng the clinical picture Epidemiologists contribute to physicians understanding of the clinical picture and natural history of a disease. Documenta6on from ini6al exposure to the development of a wide variety of clinical syndromes.

21 Search for causes Causes factors influencing of risk Epi can never truly prove a causal rela6onship between exposure and disease.

22 Case Study John Snow (1854), London Cholera dx in Golden Square, London Where do these events (person who ve developed cholera) live/work? Mapped distribu6on of cases (spot map)

23

24 Snow, cont d. Snow believed contaminated water was at the source of the infec6on for cholera. Marked pump loca6ons + looked at distribu6on of dwellings of cholera- cases, rela6ve to the pumps A > B, C

25

26 More Snow Why not B or C? B visibly contaminated, C to far away, inconvenience Hasty conclusions? Spot map shows no cholera cases to the east of pump A (Broad Street). Why? Snow found that to the east was a brewery with a privately owned well where those employees could get water (plus a daily quota of malt liquor - unrelated)

27 Backwards? To confirm poten/al causality, Snow ques6oned where people with cholera got their water. Pump A was the main factor.

28 Wrap- Up John Snow removed the pump handle. Taking a specific brand of tampon that was linked to toxic shock syndrome. Removal of soda from a high school or pizza as an op6on on the menu.

29

30 How an Epi determines the who, what when, where Case defini6on Time (descrip6ve epi epi variables) Place (descrip6ve epi epi variables) Person (descrip6ve epi epi variables) Causes

31 Case Defini6on Set of standard criteria for deciding whether a person has a par6cular disease or other health- related condi6on. Standardiza6on ensures consistent diagnosis When we find a difference in disease occurrence, we know it is likely a REAL difference, not human error of dx.

32 Measles, case defini6on We might classify a person with a fever and rash. This can only be probable, un6l lab run. If there s an outbreak, labs can t be completed for everyone involved (6me, $) so case may remain suspect/probable and never moves to confirmed or not a case

33 Case defini6ons Sensi6ve vs. specific Sensi6ve (rapid containment) is a loose defini6on, most oqen used for severe communicable diseases where they want to cover all their bases so suspect or probable cases are looked at closely. Specific is a strict defini6on, certainty of disease presence

34 Ex: outbreak, salmonella agona (no death, so you not a gonna?) More likely to iden6ty the source of the infec6on if they ONLY included persons confirmed to have been infected with that organism. Rather than ANYONE with diarrhea, because acute diarrhea has many causes. Disadvantage? Strict case defini6on may lead to underes6mate the total number of cases.

35 Time Disease rates change over 6me. Some are regular changes (predictable), some are unpredictable. By examining events that happened before a rate increase or decrease, we could possibly iden6ty causes / decide ac6on to control or prevent further occurrence.

36 Time, cont d. Epidemic period Secular trends long- term Seasonality (influenza in the winter)

37 Place Assessing geographic extent of the event or health problem. Possibly where the infec6on was acquired. Geography could point to demographic. Host factors we can infer that factors that increase the risk of the disease are present either in the persons living there or Environment or Both.

38 Example Diseases that are passed from one person to another spread more rapidly in urban areas than rural areas crowding leading to suscep6bility Animals to humans rural areas, greater/ more frequent contact (remember the primary host) Spot map comes in handy in determining geographic co- factors

39 Person Age all events/states vary with age Sex - generally, death/illness rates: M>F gene6c hormonal anatomic other Ethnic / racial groups race, na6onality, religion, local reproduc6ve or social groups/ tribes SES socioeconomic status (occupa6on, educa6onal achievement)

40 NEXT WEEK Analy6c epidemiology Bring in (not to turn in, necessarily) analy6c epi on your topic. Remember: why and how à compares groups with different rates of disease occurrence and with differences in demographic cx, gene6c or immunologic make- up, behaviors, enviro exposures, etc. Experimental vs. observa6onal techniques Cohort study vs. case- control study (observa6onal) The Environmental Triad Agent, Host, Enviro Causa6on

41