HLTC07 Review/Summary of all midterm content- needed for cumulative final

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Health Studies
Caroline Barakat

HLTC07 Lecture 1: Introduction Definitions: Epidemiology o Epidemiology addresses human populations with respect to their health o Frequency quantified - Rate of its occurrence o Prevalence proportion of individuals afflicted by the illness at a particular time; all cases o incidence proportion of individuals that receive the illness at a particular time; new cases o incidence density e.g. 10 000 person-years Features of Epidemiology o Endemic: Present in a community at all times but in relatively low frequency. Something that is endemic is typically restricted or peculiar to a locality or region. o Epidemic is a sudden severe outbreak within a region or a group, as with AIDS in Africa or AIDS in intravenous drug users. o Pandemic occurs when an epidemic becomes very widespread and affects a whole region, a continent, or the entire world o Knowledge base - research and science. o Causation- etiology / etiogenesis or illness - E.g. causal (attributable) rate ratio such as the study of cigarette smoking in the etiology of lung cancer - Aggregate of differentiated sub disciplines Definitions: Demography o Demography the study of populations o 60 years - population more than doubled to exceed 7 billion o Growth rates- 2% in the late 1960s o Currently about 1.2%/yr 70 million people each year o high projection - around 2.6 children per woman o in the medium - 2.1 children per woman o the lowest assumes about 1.6 children per woman o Dynamics of population growth : BIRTHS NATURAL CHANGE DEATHS POPULATION CHANGE INCREASE OR DECREASE GROSS IMMIGRATION NET MIGRATION GROSS EMIGRATION The Demographic Transition o Transformation of a population o Youth bulge o Replacement fertility - represents the number of children a couple needs to have in order to replace themselves o Range from 2.04 to 3.35 (Engelman and Reahy, 2005) What influences population growth? CMGMG o Contraceptive prevalence o Mortality from HIV/AIDS and other infectious diseases o Gender equity o Migration o Government policies Impacts of population growth: why does it matter? o Health - adverse impact especially on women and children o Poverty o Natural resources o Conflict and security Definitions: Public Health o Health of people at large o Health - more inclusive than medicine o Who are Public health professionals? o What are the actions of public health? - Education - Regulations - Service Main Messages o World is demographically complex and diverse DEMOGRAPHY EPIDEMIOLOGY PUBLIC HEALTH Failure of Academic Epidemiology: witness for the prosecution o Academic epidemiology has failed to serve as the basic science of public health; and failed to develop the scientific methods and knowledge base to support the public health mission of preventing disease and promoting health through organized community efforts o Epidemiology should attempt to understand health and disease from a community and ecologic perspective as a consequence of how society is organized and behaves, what impact social and economic forces have on disease incidence rates, and what community actions will be effective in altering incidence rates o Rather than enabling public health to develop community intervention programs, academic epidemiology research methodologies have served the clinicians interest o It focuses on the individual rather than the population level o It needs to study characteristics of populations, not individuals th o First epidemiologic evolution- discovery of the causes of disease epidemics prevalent in the 19 century o Second epidemiological evolution- it developed methods to indentify risk factors for chronic diseases which served as a basis for preventative actions at individual and societal level o Epidemiologic methods are being used more widely by clinicians in their efforts to practice an evidence based clinical medicine o Epidemiology is the study of the distribution and determinants of disease in populations o It should be redefined as a study of the distribution and societal determinants of the health status of populations; which provides a stronger link to the primary mission of public health and places emphasis on soc, econ, envir, and cultural determinants of pop health Basic public health science vs. biomedical science primarily concerned with etiology of disease in individuals o The ecology of human health and societal context is not addressed o Epidemiology needs to incorporate the principles and methods of these disciplines in order to study disease as a consequence of social, economic, cultural and environmental forces that account for pop diff in disease rates o It has limited itself to a narrow biomedical perspective- leading to the fallacy- the error in inferring that risk factors for diseases in individual can be summed to understand the causes of diseases in pop, health pop can be explained in terms of characteristics of individual o The societal and environmental determinants of disease are the principal objects of public health policy and practice o Provides no clues as to what organized efforts society should undertake to promote health and prevent disease o Cross cultural studies are needed to understand the role of diff social, cultural, economic and physical environments in the incidence of disease at population level o Epidemiology has remained at the individual and micro-level in which it has neither been a study of disease in pop or served the needs of the practicing public health community, it needs to develop a macro-epidemiology to integrate knowledge from social, environmental, and biologic sciences to help us understand pop health, disease and wellbeing o Needs to consider disease within the context of the total human environment rather than abstracting it from this environment o Development of the appropriate knowledge base for public health action requires a response in three broad areas: 1. an extension of the search for causes of disease from the individual to the community and sociopolitical system 2. a broadening of the methods of epidemiologic research to include qualitative and participatory research methods 3. Integrating lay knowledge with scientific knowledge, to take account of the richness and complexity of community life. o To accomplish this widening of scope and methods, epidemiology needs to adopt principles and methods from more disciplines, particularly from the population sciences that include economics, sociology, demography, anthropology, ecology, and political science. o Epidemiological research should be explicitly designed for public heath action which often implies social and environmental change o Should be clearly relevant to prevention and intervention and policy application
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