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HLTH 101 (119)
Glenn Ward (53)

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HLTH 101
Glenn Ward

TOPIC 3: CAUSES OF CHANGES IN HUMAN HEALTH STATUS Recall 1st principle # 2: WE CAN LEARN THE CAUSES OF CHANGES IN HEALTH  Over the past 150 y, there have been greatly reduced infectious disease rates in developed countries  Why?  At least 4 possible reasons: CAUSES OF THE EPIDEMIOLOGIC TRANSITION 1.socioeconomic development 2.improved nutrition 3.advances in public health 4.advances in biomedicine 1. Socioeconomic Development  Beginning in the late 1700, but accelerating during the 1800's, there was increased social activism leading to improved working conditions, better labour laws, more universal education, etc.  These changes lead to a reduction in some aspects of socioeconomic inequality, and we know that such inequality affects health status o Even today, the gains made during the last two decades in reducing mortality due to heart disease is only now filtering down to the lowest social classes  Problem: how does socioeconomic status (SES) affect health?  Perhaps through increased nutrition and creation of public health measures  as female literacy goes down, infant mortality rates go up 2. Improved Nutrition  Malnourishment is a common factor leading to increased mortality from disease o Measles, diarrhea, and TB are all diseases known to be more severe, or even fatal, for individuals who are malnourished o The Irish potato famine of the 1800's was associated with increased incidence rates of typhus and dysentery 3. Advances in Public Health  Advances in public health resulted from sociopolitical efforts begun in the 1800’s  There were at least two main aspects to these advances: i. Increased sanitation o The 1850's was the decade of widespread acceptance of the "germ theory of disease" o Now that the reality of contagions was recognized, efforts could be made to reduce exposure to those contagions  In hospitals, this led to the use of antiseptics and acceptance of the importance of cleanliness, leading to  Increased maternal/post-operative survival  Increased infant survival  In government, this led to increased understanding of the role of separation of the water supply from sewers (primarily in the prevention of cholera) ii. Increased legislation towards health o As stated above, the government recognized it’s potential role in sanitation o As a result, governments took increased control over aspects of sanitation, such as being able to shut down water supplies that were unsafe o Governments also began to take a role in the quarantining of those with contagious diseases  In the early 1900's in many regions, boards of health were created  Part of their responsibility was to report all cases of infectious disease  This reporting was associated with reductions in the scale and frequency of many common epidemics 4. Advances in Biomedicine  Although biomedicine is often credited for the increased average lifespan seen today, the evidence supporting such an attribution is actually rather weak  There are at least 4 sources of evidence against the view that biomedical advances are behind much of today’s improvements in health: 1. reduction of mortality rates prior to biomedical advances 2. resistance to effective methods by medical practitioners 3. reduction in diseases for reasons other than treatment 4. poor association between treatment and disease reduction i. Disease incidence and/or mortality rates were usually significantly reduced prior to the advent of the most-cited medical advances o Example: diphtheria in Massachusetts  In 1890 Massachusetts State officials made mandatory the reporting of all new cases of diphtheria  Over the next 10 years, the incidence rate was reduced considerably  Diphtheria antitoxin became available after 1900  Immunization became available after 1920  A study done in the 1970's reported that less than 14% of the reduction in mortality was due to medical advances (the antitoxin and immunization)  More than 86% of the reduction was due to other factors o Example: TB  TB rates are highly susceptible to social conditions  The incidence rate was gradually reduced beginning around 1840  Antibiotics for TB were developed about 100 years later, in the 1940's  Less than 10% of the reduction can be traced to medical intervention o Other examples: scarlet fever, typhoid, pneumonia, measles o the fall of the standardized death rates (due to vaccines and cures, however they came along while the trend was already in decline?) o small pox is the exception because the vaccine came during the peak of the epidemic o low correlation between spending on medical care and mortality rates ii. Public health measures associated with improvements in health have generally been resisted initially by the medical profession o Rather than being the driving force behind innovations in public health, medical practitioners were often the major obstacles to such innovations o Examples of historical innovations that medical practitioners resisted include  Antiseptic practices in the 1800’s  Contagion theory in the 1850’s  Reporting of infectious diseases in the late 1800’s o Even today, lack of enthusiasm by physicians is hindering the acceptance of such commonly accepted public health issues as: a) The risks of overuse and lack of monitoring of antibiotics b) Importance of such basic procedures as hand washing between patients in the prevention of the spread of infectious disease c) Use of computer technology
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