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HLTH 391

Health “A state of complete physical, mental, and social well being and not merely the absence of disease and infirmity” (WHO, 1947)
Community Group of people who have common characteristics; can be defined by location, race, ethnicity, age, occupation, interest, or other common bond
Characteristics of communities 1. Membership 2. Common symbol system 3. Shared values and norms 4. Mutual influence 5. Shared needs and commitment 6. Shared emotional connection
Public health “what we as a society do collectively to assure the conditions in which people can be healthy” (IOM, 1988
Community health the health status of a defined group of people and the actions and conditions to promote, protect, and preserve their health
Population health the health status of people who are not organized and have no identity as a group or locality and the actions and conditions to promote, protect, and preserve their health
Personal health activities Individual actions and decision-making that affect the health of an individual or his or her immediate family
Community health activities Those aimed at protecting or improving the health of a population or community
Physical factors industrial development, community size, environment, geography
Social and cultural factors beliefs, traditions, and prejudices; economics; politics; religion; socioeconomic status; social norms
Community organization identify problem, mobilize resources, work toward change
Individual behaviors takes the concerted effort of many—if not most—to improve community health
Epidemiology “the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control health problems” (Last, 2001)
Endemic Diseases diseases that occur regularly in a population as a matter of course
Epidemic An unexpectedly large number of cases of an illness, specific health-related behavior, or other health-related event in a particular population
Epidemiologist “an investigator who studies the occurrence of disease or other health-related conditions or events in defined populations” (Last, 2001)
Epizootic outbreak of disease that begins in animals and spreads to humans
Pandemic outbreak of disease over a wide geographical area such as a continent (flu pandemic of 1918-19 killed 25 million people worldwide)
Cases those afflicted
Rates the number of events that occur in a given population in a given period of time; three categories– natality (birth), morbidity (sickness), & mortality or fatality (death) rates
Importance of Rates allows for a comparison of outbreaks that occur at different times or in different places
Incidence rate the number of new health-related events or cases of a disease in a population exposed to that risk in a given time period
Prevalence rate calculated by dividing all current cases of a disease (old & new) by the total population
Attack rate a special incidence rate calculated for a particular population for a single disease outbreak expressed as a percentage
Acute diseases those that last three months or less
Chronic diseases those that last three months or longer
Crude rates those in which the dominator includes the total population
Age-adjusted rates those used to make comparisons of relative risks across group & over time when groups differ in age structure
Specific rates measure morbidity or mortality for particular populations or diseases
Notifiable diseases infectious diseases which health officials request or require reporting
National Electronic Telecommunications System (NETS) the electronic reporting system used by state health departments and CDC
Morbidity and Mortality Weekly Report (MMWR) a report of CDC used to present notifiable disease data
Mortality statistics single most reliable measure of population health
Life expectancy average number of years a person from a specific cohort (e.g., born in 2008) is projected to live from a given point in time (e.g., birth, age 65, age 75)
Years of potential life lost (YPLL) number of years lost when death occurs before age 65 or 75
Disability-adjusted life years (DALYs) measure of the burden of disease that takes into account premature death & loss of healthy life resulting from disability
Health-adjusted life expectancy (HALE) number of years of healthy life expected on average in a given population
U.S. Census Conducted every 10 years; enumeration of population
Statistical Abstract of the United States a book published annually that includes statistics on social, political, and economic organization
Monthly Vital Statistics Report Statistical summaries of records of major life events
Morbidity & Mortality Weekly Report (MMWR) Prepared by the CDC & reports cases of notifiable diseases in the U.S.; also includes articles on other public health problems
Epidemic curve a graphic display of the cases of a disease according to the time or date of onset
Point source epidemic an epidemic curve depicting a distribution of cases which all can be traced to a single source
Propagated epidemic curve an epidemic curve depicting a distribution of cases traceable to multiple sources of exposure
Odds ratio a probability statement about the association between a particular disease & specific risk factor resulting from a case/control study
Relative risk a statement of the relationship between the risk of acquiring a disease when a specific risk factor is present and the risk of acquiring that same disease when the risk factor is absent
Communicable caused by specific biological agent or its product and can be transmitted from infected to susceptible host
Noncommunicable one that cannot be transmitted from infected to susceptible host
Acute last < 3 months
Chronic last > 3 months
Infectivity the ability of a biological agent to enter and grow in a host
Pathogenicity the capability of a communicable disease agent to cause disease in a susceptible host
Agent (Communicable Disease Model) the element that must be present in order for cause of the disease to occur
Host (Communicable Disease Model) Any susceptible organism invaded by an infectious agent
Environment (Communicable Disease Model) All other factors that inhibit or promote disease transmission
Pathogen (Chain of Infection) the disease-causing agent (e.g., virus, bacteria, rickettsiae, protozoa, fungi & yeasts, nematoda)
Reservoir (Chain of Infection) the habitat in which an infectious agent normally lives & grows
Human Reservoir Anthroponoses; symptomatic or asymptomatic
Animal Reservoir Zoonoses
Environmental Reservoir Plants, soil, & water
Portal of exit (Chain of Infection) the path by which an agent leaves the source host
Modes of Transmission (Chain of Infection) how pathogens are passed
Direct (immediate transfer) direct contact, droplet spread
Indirect airborne, vehicleborne, vectorborne (mechanical & biological)
Portal of entry agent enters susceptible host; means (respiratory, oral, skin, intravenous, gastrointestinal)
New host final link is a susceptible host
Coronary heart disease (CHD) Characterized by damage to the coronary arteries; also called coronary artery disease; #1 killer
Atherosclerosis Narrowing of the blood vessels resulting from the build-up of fatty deposits on the walls of the blood vessel
Cerebrovascular disease (stroke) Blood supply to the brain is disrupted; #3 killer
Cancer occurs when cells lose control over their growth and division; develop into a tumor; #2 killer
Metastasis parts of the tumor break off & travel to the rest of the body’s organs & continue their growth
Stages I, II, III, & IV; most curable in early stages
Leading causes of death CHD, cancer, stroke
Years of potential life lost cancer, CHD, unintentional injuries
Economic cost to society alcohol and other drugs
Prevention the planning for & taking of action to forestall the onset of a disease or other health problem (e.g., immunization)
Intervention taking action during an event (e.g., taking an antibiotic)
Control containment of disease; limiting transmission
Eradication total elimination of the disease
Primary Prevention measures that forestall the onset of illness or injury during the pre-pathogenesis period (e.g., immunizations)
Secondary Prevention measures that lead to early diagnosis & prompt treatment of a disease or injury to limit disability or prevent more severe pathogenesis (e.g., screenings)
Tertiary Prevention measures aimed at rehabilitation following significant pathogenesis (e.g., physical therapy)
Community Organizing “A process through which communities are helped to identify common problems or goals, mobilize resources, and in other ways develop and implement strategies for reaching their goals they have collectively set” (Minkler & Wallerstein, 2005)
Community capacity Community characteristics affecting its ability to identify, mobilize, & address problems (Goodman et al., 1999)
Empowered community “One in which individuals and organizations apply their skills and resources in collective efforts to meet their respective needs” (Israel et al., 1994)
Participation & relevance “Community organizing that starts where the people are and engages community members as equals” (Minkler & Wallerstein, 2005)
Social capital “relationships and structures within a community that promote cooperation for mutual benefit” (Minkler & Wallerstein, 2005)
Locality development based on the concept of broad self-help participation from the local community
Social planning is heavily task oriented, stressing rational-empirical problem solving & involves various levels of participation from many people & outside planners
Social action a technique that involves the redistribution of power & resources to disadvantaged segments of the population
Recognizing the issue (Generic Approach to Community Organizing) From the inside– grass-roots, citizen initiated, bottom up From the outside– top down
Gaining entry into the community (Generic Approach to Community Organizing) Gatekeepers Being culturally sensitive & working toward culturally competent
Organizing the people (Generic Approach to Community Organizing) Executive participants Networking & expanding the constituencies Creating an association, task force or coalition
Assessing the community (Generic Approach to Community Organizing) Needs based vs. assets based; mapping Community building: “an orientation to community that is strength-based rather than need-based & stresses the identification, nurturing, & celebration of community assets” (Minkler, 2005)
Primary building blocks located and controlled in the neighborhood: individuals (skills), organizations
Secondary building blocks assets located in the neighborhood, but controlled outside: schools, hospitals, housing, social services
Potential building blocks resources outside the neighborhood and controlled outside: welfare, public information
Determining the priorities & setting goals (Generic Approach to Community Organizing) Build ownership 5 criteria for selecting problem: winnable, simple & specific, must unite, affect many & build community, & part of larger plan (Miller)
Arriving at a solution & selecting intervention strategies (Generic Approach to Community Organizing) Create an intervention Avoid turfism
Health education “any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills to make quality health decisions” (Joint Committee, 1991)
Health promotion “any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to health of individuals, groups, and communities” (Joint Committee, 1999)
Maternal, Infant, and Child (MIC) Health the health of women of childbearing age from pre-pregnancy through pregnancy, labor, and delivery, the postpartum period and the health of the child prior to birth through adolescence
Family “A group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including subfamily members) are considered as members of one family.” – U.S. Census Bureau
Family “Two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of a family.” – Friedman
Unmarried mothers (compared to married mothers) are more likely to have Lower education Lower incomes Greater dependence on welfare
Teenagers who become pregnant and have a child are more likely than their peers who are not mothers to: Drop out of school Not get married or have a marriage end in divorce Rely on public assistance Live in poverty
Roe v. Wade A 1973 Supreme Court decision that made it unconstitutional for state laws to prohibit abortions
Pro-life A medical/ethical position that holds that performing an abortion is an act of murder
Pro-choice A medical /ethical position that holds that women have a right to reproductive freedom
Maternal health The health of women in the childbearing years, including those in the pre-pregnancy period, those who are pregnant, and those who are caring for young children
Maternal mortality The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental cau
Family and Medical Leave Act (FMLA) Grants 12 weeks of unpaid leave to men or women after the birth of a child, an adoption, or in the event of illness in the immediate family
Family Support Act Provides funding for child care assistance to welfare parents who are employed or participating in an approved training program
Adolescents & young adults 15–24 yrs. of age
Adults 25–64 yrs. of age
Puberty to maturity face hormonal changes, physical maturation, & frequent opportunities to engage in risky behavior
Young adults face many physical, emotional, & educational changes (e.g., completion of physical development & maturity, marriages, starting families & careers)
Number of Adolescents and Young Adults Peaked at 21% in 1979 with baby boomers; in 2005 the number was just over 14%; ~66% were white
Living Arrangements In 2005, 32% lived in single-parent homes; 66% of black children lived in single-parent homes
Employment Status has remained relatively constant since 1980
Created by: Kasmyrk