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H312 AIDS and STIs in Modern Society

Winter 2014 / Sec. 001

Annie Larson, MPH

What does it mean to be HEALTHY??

Health is a state of complete physical, mental and social well-being and not merely the absence of disease. World Health Organization (WHO), 1948
Physical

Mental

Social

Public Health
The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort for the sanitation of the environment, the control of community infections, the education of the individual, the organization of medical services for early diagnosis and preventive treatment of disease and the social machinery to ensure every individual a standard of living adequate to the maintenance of health. Winslow, 1920

What is

Public Health?

The mission of public health is to fulfill societys interest in assuring conditions in which people can be healthy.
- Institute of Medicine, Committee for the Study of the Future of Public Health

Public Health Organizations


Oregon State University Student Health Services (SHS) Benton County Health Department Oregon Health Authority - Public Health Division (OHA) U.S. Centers for Disease Control and Prevention (CDC) Food and Drug Administration (FDA) National Institute of Health (NIH) U.S. Department of Agriculture (USDA) Oregon Department of Environmental Quality (DEQ) Occupational Safety and Health Administration (OSHA) World Health Organization (WHO) UNAIDS

Public Health Terms


Etiology The cause, set of causes, or manner of
causation of a disease or condition

Epidemiology the study of the distribution and

determinants of health-related states or events and the application of this study to the control and prevention of disease (WHO, 2012) than the expected rate in any well-defined geographical area.
population group.

Epidemic When the incidence of a disease are higher Endemic prevalent or peculiar to a community or

Public Health Terms


Pandemic epidemic that crosses national borders 1918 Spanish Influenza Pandemic (over 50 million died worldwide)

1990s HIV/AIDS
2003 Severe Acute Respiratory Syndrome (SARS) 2009 H1N1 Swine Flu

Public Health Terms


At-risk populations Individuals in a condition marked by a high level of susceptibility to diseases. Risk factors Any action or circumstance that would increase susceptibility to diseases. Comorbidity When a disease simultaneously exists with another medical condition.

Incidence - the number of new cases of disease that develop in a population of individuals at a specified time interval. Prevalence the total number of people in a given population affected by a disease at a given time.

The Focus of Public Health


The focus of public health is on prevention of disease (vs. treatment) and reduction of health inequalities in populations (vs. individuals). Core functions of PH
Assess and monitor the health of communities and population and identify health problems and priorities. Create public policy in collaboration with community and government leaders. Assure Access to appropriate and cost-effective care and services for all populations.

10 Essential Services

Basic Public Health Principles

Socioecological Model

Ecological Framework
Levels of Prevention

Epidemiological Triangle

Socio-Ecological Model
A multi-faceted approach to promoting health within a population

Public Healths Ecological Framework


Ecology - n. 1. The science of the relationships between organisms and their environments. - The American Heritage Dictionary

Prevention Is Where Its At


Three levels of prevention Primary (steps to avoid so you dont get hurt, sick or die) Secondary (activities aimed at early detection) Tertiary (after the fact treatment and rehabilitation)
Public Health
Monitor, address population risk factors Work in communities, mobilize partners

Primary Care
Monitor, address individual risk factors

Works with patients to prevent, detect, treat and manage disease

Promote community change through policy, Promote changes in individual behavior system and environments
Uses data based on epidemiology, demographics, and economics Develops, implements and enforces and evaluates health policies Uses data based on patient history and medical science Develop and implement practice policies informed by evidence-based guidelines and policies

Levels of Prevention

Tertiary Preventio n

Secondary Prevention
Primary Prevention

Public Health Approach


The epidemiological triangle
Pathogen is any disease producing microorganism or substance Virulence is a pathogens ability to successfully invade and sustain itself in a host

Immunocompetency Co-morbidity Age Gender Lifestyle Ethnicity

Environment
Social, political, cultural, physical

What Makes Public Health so Controversial?

WHAT DO YOU THINK? GROUP ACTIVITY


1. Bicycle helmets should be required for all
citizens, of any age, at all times

2. All OSU students should be required to provide


proof of health insurance

3. Tax payer money should be used to treat


persons with STIs

WHAT DO YOU THINK?


1. Do you think that all people deserve the
same health care?

2. Do you think its the nations responsibility


to provide health care?

3. Why or Why not?

SOCIAL JUSTICE
"Social justice is an underlying principle for peaceful and prosperous coexistence within and among nations. We uphold the principles of social justice when we promote gender equality or the rights of indigenous peoples and migrants. We advance social justice when we remove barriers that people face because of gender, age, race, ethnicity, religion, culture or disability.
- United Nations

Concept of Social Justice


Allocation of goods and services according to an individuals needs.

Shared responsibility Concern for communal well-being Government ensures equity

Dorfman L, Wallack L, Woodruff K. More than a message. Health Educ Behav. 2005;32(3):320-336.

Basic Liberties?

freedom of thought; liberty of conscience as it affects social relationships on the grounds of religion, philosophy, and morality; political liberties (e.g. representative democratic institutions, freedom of speech and the press, and freedom of assembly); freedom of association; freedoms necessary for the liberty and integrity of the person (freedom from slavery, freedom of movement and a reasonable degree of freedom to choose one's occupation); rights and liberties covered by the rule of law. John Rawls, 1971

Is Social Justice a Basic Liberty?

Examples of Social Justice Movements


Political
United Nations (via Charters) Green Party

Gender Inequality
Womens rights
Gay rights

Corporate
Social responsibility Corporate watchdogs Greenpeace

Moral Issues that Drive Public Health


1. To advance human well-being by improving health
And

2. To do so particularly by focusing on the needs of the most disadvantaged


Gostin LO & Powers M. Health Affairs, 2006

PUBLIC HEALTH PHILOSOPHY IN THE US

A way of doing justice, a way of asserting the value and priority of human life

Or
The fundamental freedom to all individuals to be left alone
Beauchamp, 1974

Public Health: The Long Road



Long term solutions with little notable short-term gain In many cases, those that pay for public health measures are not the ones that directly benefit many lives will be saved or diseases prevented from public health policy?) Most public health measures have an economic impact

Costs are more concrete than benefits (e.g. how

Car manufacturers install emission detectors in cars Hepatitis B immunization required for school-aged children Mad cow disease in US beef supply

Right v. Wrong???

ENVIRONMENTAL FRAMEWORK
-Economic Environment

-Social Environment

-Physical Environment

-Service Environment

The Global Environment


Environmental factors responsible for increases in emergent / resurgent diseases

War / refugee migration, famine and disasters Irrigation, deforestation and reforestation Globalization Global Poverty

Global Poverty & Health

What are some of the ways that poverty impacts health?

Global poverty
20% of the worlds population consume 86% of the worlds resources. 1/5 of the worlds population is live in extreme poverty 40% of the worlds population accounts for 5% of global income.

Distribution of Wealth

~ 8 million people die annually because they are too poor to stay alive. ~ 2.8 billion live in relative poverty ($1-2/day) ~1.2 billion people worldwide (1 in 6) live in extreme poverty (less than $1/day)

What happens when PH succeeds!

Bringing it back to sexual health



All diseases (including STIs and HIV/AIDs) are the result of a pathogen, host, and environment There are many factors that influence health and well-being

Therefore many opportunities to intervene

Public Health Review


1. Define Healthy 2. Explain the mission and focus of public health. 3. How does public health meet its mission? 4. What is public healths ecological framework? 5. Be able to define and give examples of common public health terms. 6. Why do we discuss poverty in this class?

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