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COH603: Public Health Biology

Matthew Kinseth. COH603: Public Health Biology. 3 behaviors Four preventable diseases Resulting in 50% of preventable deaths worldwide. The Behaviors:. Smoking Inadequate diet Lack of exercise. The Chronic Diseases:. Heart Disease Lung Disease Type-II Diabetes Some cancers.

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COH603: Public Health Biology

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  1. Matthew Kinseth COH603: Public Health Biology

  2. 3 behaviors • Four preventable diseases • Resulting in 50% of preventable deaths worldwide

  3. The Behaviors: • Smoking • Inadequate diet • Lack of exercise

  4. The Chronic Diseases: • Heart Disease • Lung Disease • Type-II Diabetes • Some cancers

  5. The Result:

  6. Worldwide Deaths for 2008:

  7. Top 10 Causes of Death by Income

  8. The Public Health Triad

  9. Determinants of Health • The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health. • www.healthypeople.gov

  10. Healthy People 2020 • Healthy People 2020 is based 4 previous Healthy People initiatives: • 1979 Surgeon General’s Report, Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention • Healthy People 1990: Promoting Health/Preventing Disease: Objectives for the Nation • Healthy People 2000: National Health Promotion and Disease Prevention Objectives • Healthy People 2010: Objectives for Improving Health

  11. www.healthypeople.gov/2020 • Focus on interventions to reduce or eliminate illness, disability, and premature death among individuals and communities. • Others issues include: • Eliminating health disparities. • Addressing social determinants of health. • Improving access to quality health care. • Strengthening public health services. • Improving the availability and dissemination of health-related information.

  12. Determinants of Health • Determinants of health fall under several broad categories: • Policymaking • Social factors • Health services • Individual behavior • Biology and genetics

  13. Policymaking • Policies at the local, State, and Federal level affect individual and population health. • Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products. • Some policies affect entire populations to help change individual behavior. • the 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and regulate standards for motor vehicles and highways. • Increased safety standards for cars, including seat belts, which reduced rates of injuries and deaths from motor vehicle accidents.

  14. Social factors • Social determinants of health reflect social factors and the physical conditions in the environment in which people are born, live, learn, play, work and age. • Also known as social and physical determinants of health • impact a wide range of health, functioning and quality of life outcomes.

  15. Social Determinates • Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods • Social norms and attitudes, such as discrimination • Exposure to crime, violence, and social disorder, such as the presence of trash • Social support and social interactions • Exposure to mass media and emerging technologies, such as the Internet or cell phones • Socioeconomic conditions, such as concentrated poverty • Quality schools • Transportation options • Public safety

  16. Physical Determinants • Natural environment, such as plants, weather, or climate change • Built environment, such as buildings or transportation • Worksites, schools, and recreational settings • Housing, homes, and neighborhoods • Exposure to toxic substances and other physical hazards • Physical barriers, especially for people with disabilities • Aesthetic elements, such as good lighting, trees, or benches

  17. The Public Health Triad: • Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment.

  18. Health Services • Access to health services and Quality of health services can impact health. • Lack of access, or limited access, to health services greatly impacts an individual’s health status. • individuals lacking health insurance are less likely to participate in preventive care and are more likely to delay medical treatment.

  19. Barriers to Health Services • Lack of availability • High cost • Lack of insurance coverage • Limited language access

  20. These Barriers lead to: • Unmet health needs • Delays in receiving appropriate care • Inability to get preventive services • Hospitalizations that could have been prevented

  21. Individual Behavior • Individual behavior also plays a role in health outcomes. • Positive changes in individual behavior can reduce the rates of chronic disease in this country. • Examples of individual behavior determinants of health include: • Diet • Physical activity • Alcohol, cigarette, and other drug use • Hand washing

  22. Biology and Genetics • Some biological and genetic factors affect specific populations more than others. • Examples of biological and genetic social determinants of health include: • Age • Race/Ethnicity • Gender • HIV status (Immuno-compromised) • Inherited conditions or family history of disease

  23. The Socio-Ecological Model

  24. We have lots of data! • www.healthypeople.gov/2020 • www.who.int/en/ • www.cdc.gov/ • www.ncbi.nlm.nih.gov/ • www.hhs.gov

  25. Bridging the Gap between Science and Society

  26. The Problem: • Most public health or medical health information is written for professionals by professionals. • Peer-reviewed journals

  27. NCI Pink Book Approach • The four stages of constructing a targeted campaign • Planning and Strategy Development • Developing and Pretesting Concepts, Messages, and Materials • Implementing the Program • Assessing Effectiveness and Making Refinements

  28. Is this One-Stop Shopping? • How do cultural influences affect information campains? • How do socio-economic affect this? • Other factors worth considering: • Doctor-patient trust • Access to information/language barriers • Health beliefs (spiritual, cultural, familial)

  29. Health Literacy • The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. • Poor health literacy is a stronger predictor of a person's health than age, income, employment status, education level, and race

  30. Health Literacy Issues • Patients are often faced with complex information and treatment decisions. • Tasks include: • evaluating information for credibility and quality, • analyzing relative risks and benefits, • calculating dosages • interpreting test results • locating health information.

  31. What needs to be done • Individuals may need to be: • visually literate (able to understand graphs or other visual information), • computer literate (able to operate a computer), • information literate (able to obtain and apply relevant information), and • numerically or computationally literate (able to calculate or reason numerically).

  32. National Assessment for Adult Literacy • Reported using four performance levels: • Below Basic • Basic • Intermediate • Proficient. • Approximately 36% of adults in the United States have limited health literacy • 22% have Basic, 14% have Below Basic health literacy • 5% of the population is not literate in English. • Only 12% of the population has a proficient health literacy level.

  33. Vulnerable Populations • Elderly (Age 65+) • Immigrant Communities • Minority Populations • Low Income

  34. Health Literacy and Income • Low health literacy is a major source of economic inefficiency in the U.S. health care system. • The cost of low health literacy to the U.S. economy is between $106 billion to $238 billion annually. • equal to the cost of insuring every one of the more than 47 million people who lacked coverage in the United States in 2006. • Improving health communication reduces health care costs and increases the quality of health care.

  35. Research has shown • People with low health literacy have a lower likelihood of getting flu shots, understanding medical labels and instructions, and a greater likelihood of taking medicines incorrectly compared with adults with higher health literacy. (Bennett IM, et al., Annals of Family Medicine, 2009 and Soroui JS, et al., Annals of Family Medicine, 2008) • Individuals with limited health literacy reported poorer health status and were less likely to use preventative care (Nielson-Bohlman, Panzer, and Kindig (2004) • Individuals with low levels of health literacy are more likely to be hospitalized and have bad disease outcomes (Baker et al., 1998, 2002) and (Schillinger et al., 2002) • After controlling for relevant covariates, lower health literacy scores were associated with high mortality rates within a Medicare managed care setting (Baker et al 2007)

  36. Health Literacy and Disease • Cancer and Treatment • Diabetes • Athsma • Hypertension

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