Description
Review Chapters 1 – 3. Based on the power point presentations, please submit a 250 words summary of these chapters including the main idea (content) for each chapter.
CHAPTER 1
Public Health:
Science, Politics,
and Prevention
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
What Is Public Health?
▪ 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.”
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ C.E.A. Winslow provided the definition of public health in 1920 that is still valid
today.
Core Functions of Public Health
▪ Core functions of public health:
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– Assessment
– Policy development
– Assurance
Public Health Versus Medical Care
▪ 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ In medicine, the patient is the individual; in public health, the patient is the
community.
Public Health: Science and Politics
▪ 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Science is how we understand threats to health, determine what interventions
might work, and evaluate whether the interventions worked.
Public Health Disciplines
▪ Epidemiology
▪ Biomedical Sciences
▪ Environmental Health Science
▪ Social and Behavioral Sciences
▪ Health Policy and Management
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Statistics
Epidemiology
▪ Epidemiology is the basic science of public health.
– 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”
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ The study of epidemics:
Statistics
▪ Governments collect health data on the population.
▪ 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ These numbers are diagnostic tools for the health of the community.
Biomedical Sciences
▪ A major portion of human disease is caused by microorganisms.
▪ Biomedical research remains important to understanding and control of new
diseases and noninfectious diseases.
– Chronic diseases
– Genetics
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Control of infectious diseases was a major public health focus in the 19th and
early 20th centuries.
Environmental Health Science
▪ A classic component of public 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– Much of the public health improvement in the U.S. in the 20th century was due to
improved environmental health.
Social and Behavioral Sciences
▪ Behavior is now the leading concern of factors that affect people’s health.
– 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ A theory of health behavior is that social environment affects people’s behavior.
Health Policy and Management or Health Administration
▪ This area of study examines the role of medical care in public health.
▪ 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Cost of medical care in the U.S. is out of control.
Public Health: Prevention and Intervention
▪ Primary prevention prevents an illness or injury from occurring at all.
▪ Tertiary prevention minimizes disability by providing medical care and
rehabilitation services.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Secondary prevention minimizes the severity of the disease or injury once it has
occurred.
Public Health Approach
▪ Define the health 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Identify risk factors associated with the problem.
Chain of Causation
▪ Chain of Causation involves:
▪ 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– Agent
– Host
– Environment
Public Health and Terrorism
▪ 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Events of 9/11 and the anthrax letters highlighted the importance of public
health.
Discussion Question 1
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ 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 are the six disciplines of public health used to accomplish the core
functions?
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ How do these functions compare with the functions of medical care?
Discussion Question 3
▪ Identify a health problem in your community.
▪ Suggest a possible intervention that the community could take to ameliorate the
problem.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ What are some risk factors associated with the problem?
Discussion Question 4
– 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.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Visit the website for American Public Health Association (APHA),
www.apha.org.
CHAPTER 3
Powers and
Responsibilities
of Government
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
Federal Versus State
▪ Reserve clause is interpreted to mean that, since health is not mentioned in the
Constitution, responsibility for public health primarily belongs to the states.
▪ Interstate commerce provision justifies the activities of the Food and Drug
Administration (FDA).
▪ Power to tax and spend is widely used by federal government to control public
health policy.
– The federal government provides 65% of the funding for Medicaid.
▪ The New Federalism limited Congress’s powers and returned authority to the
states.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ U.S. Constitution states that a fundamental purpose of the government is “to
promote the general welfare.”
Branches of Government: Federal, State, and Local
▪ Legislative
▪ Executive
– Public health agencies carry out the law.
– They may issue regulations consistent with statutes.
▪ Judicial
– Laws and regulations can be challenged in court.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– Legislature passes statutes.
Local Public Health Agencies
▪ Local county and city health departments are often responsible for:
▪ Funding sources are variable.
– City or county legislatures may not understand the importance of core functions.
– Mandates may be funded from state or federal governments.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– Day-to-day public health tasks
– Core public health functions
– Providing medical care for the poor
State Health Departments
▪ Coordinate activities of local health agencies and provide funding
▪ Provide laboratory services
▪ Manage Medicaid
▪ License and certify medical personnel, facilities, and services
▪ Handle environment, mental health, social services, and aging issues, possibly
through separate state agencies
▪ Provide funding to hospitals to reimburse them for treating uninsured patients
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Collect and analyze data provided by the local agencies
Federal Agencies
▪ Department of Health and Human Services (HHS)
▪ Centers for Disease Control and Prevention (CDC)
– www.cdc.gov
▪ National Institutes of Health (NIH)
– www.nih.gov
▪ Food and Drug Administration (FDA)
– www.fda.gov
▪ Centers for Medicare and Medicaid Services (CMS)
– www.cms.gov
▪ Agency for Healthcare Research and Quality (AHRQ)
– www.ahrq.gov
▪ Indian Health Service
– www.ihs.gov
▪ Environmental Protection Agency (EPA)
– www.epa.gov
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– www.hhs.gov
Federal Agencies (cont.)
▪ Occupational Safety and Health Administration (OSHA)
▪ Department of Agriculture (USDA)
– www.usda.gov
▪ Department of Transportation
– www.transportation.gov
▪ Department of Labor
– www.dol.gov
▪ Department of Veterans Affairs
– www.va.gov
▪ Department of Defense
– www.defense.gov
▪ Department of Homeland Security
– www.dhs.gov
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– www.osha.gov
Centers for Disease Control and Prevention
▪ CDC is the main epidemiologic and assessment agency for the nation.
▪ CDC’s National Center for Health Statistics collects data on the U.S. population
concerning all aspects of health.
▪ CDC also has centers to address infectious diseases, chronic disease, injury
prevention, and other issues.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ CDC publishes Morbidity and Mortality Weekly Report (MMWR).
National Institutes of Health
▪ NIH is the largest biomedical research complex in the world.
▪ National Library of Medicine is an NIH institute.
▪ NIH has laboratories in Bethesda, MD and provides grant funding to
researchers at universities and research centers.
▪ NIH has a clinical center where medical researchers test experimental
therapies.
▪ NIH enjoys strong Congressional support.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Institutes exist for cancer; heart, lung, and blood; diabetes; aging; child health
and human development; and other topics.
Nongovernmental Public Health Organizations
▪ Organizations that focus on specific diseases include:
▪ Professional membership organizations include:
– American Medical Association
– American Nurses Association
– American Public Health Association
▪ Organizations that play an important role in defining the future of public health
include:
– National Association of City and County Health Officers
– Association of State and Territorial Health Officers
– Association of Schools and Programs of Public Health
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– American Cancer Society
– American Heart Association
– American Diabetes Association
– Alzheimer’s Association
Philanthropic Foundations
▪ Rockefeller Foundation
▪ Pew Charitable Trusts
▪ Kaiser Family Foundation
▪ Commonwealth Fund
▪ Bill and Melinda Gates Foundation
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Robert Wood Johnson Foundation
Discussion Question 1
▪ Choose a specific health problem.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ How might federal, state, and local levels of government divide responsibility for
addressing it?
Discussion Question 2
▪ Choose a federal public health agency and visit its website.
▪ Discuss any controversies that may be involved in actions that the agency has
taken or might need to take.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Identify an issue that it is currently dealing with and describe reasons for current
concern.
Discussion Question 3
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Why is it important for nongovernmental organizations to be involved in public
health activities?
Discussion Question 4
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Choose one of the philanthropic foundations listed on Slide 11 and visit its
website to learn more about the foundation’s activities.
CHAPTER 2
Why Is Public
Health
Controversial?
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
Social Justice Versus Market Justice
▪ Differences:
▪ Questions about the scope of public health
▪ Importance of economic factors for health
– Politically controversial
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– Social justice: The common good
– Market justice: Individual responsibility
Sources of Controversy
▪ Economic impact
▪ Moral and religious opposition
▪ Political interference with science
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Individual liberty
Economic Impact
▪ Businesses often resist public health measures because they affect profits.
▪ Those who must pay may not be the ones who benefit.
▪ Costs may be short-term, while benefits may be long-term.
▪ Costs are easier to calculate than benefits.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Most public health measures have a negative economic impact on some
segment.
Tragedy of the Commons
▪ Is exemplified in many environmental laws
▪ Do laws overly restrict “freedom” to pollute?
▪ What should be included among protected resources?
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Freedom of individuals should be restricted for the well-being of the population.
When Can Government Restrict Individual Freedom?
▪ Restrictions to prevent harm to others is generally acceptable.
– For protecting individuals from their own actions? (Libertarians are opposed.)
▪ Libertarian view has a strong tradition in the U.S.
▪ Argument for restrictions for the “common good” leaves lots of room for
controversy.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Paternalism is only acceptable for laws concerning children.
Moral and Religious Opposition
▪ Concerns:
▪ AIDS, STDs, teenage pregnancy, and low birth-weight babies are major U.S. public
health concerns.
▪ Public health solutions are often viewed as promoting immoral behavior.
– Alcohol and drugs
▪ Such opposition may discourage scientists and funding agencies from
conducting research on many important health problems.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
– Sex and reproduction
Politics Versus Science
▪ There is always the possibility of tension.
▪ Under Bush administration, EPA changed a section of a major report.
▪ Obama administration made efforts to inform policy decisions based on honest
science.
▪ Under Trump administration, EPA director proposal would bring politics into
initial review and synthesis of research step.
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Conservative control of federal government intensifies the conflict.
Discussion Question 1
▪ Which is likely to lead to greater improvements in public health?
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Do you agree that the philosophy of social justice is preferable to the
philosophy of market justice?
Discussion Question 2
▪ Who would benefit?
▪ Who would pay the cost?
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Give an example of a measure that would benefit public health but that might
be expensive to implement.
Discussion Question 3
▪ Who would benefit?
▪ Whose freedom would be limited?
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ Give an example of a measure that would improve public health but that might
limit some people’s freedom.
Discussion Question 4
Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
▪ How far do you believe government should go in advocating and/or enforcing
moral behavior?
Purchase answer to see full
attachment