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Chapter 1

Chapter 1

9 Pages
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Department
Health Studies
Course Code
HLTA02H3
Professor
Toba Bryant

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Chapter 1: Epidemiological Approaches
Epidemiology: study of health and its determinants in specified populations with goal of improving
health
Root word: epidemic
oOrigins come from the study of causes of diseases
Mainly concerned with illness or disease rather than health and well-being
Early epidemiology
oJohn snow, plotted incidence of death on maps between deaths and drinking water, then
removed the handles of water pumps, resulted in less deaths
oEpidemiology sometimes overlooks improving health after cause of disease is identified
oMostly conducts studies and report results, action not usually considered
oWilliam Farr, registrar-general of London recognized that poverty was an important
associate of poor health
Health as a concept differs on the level being considered
oCellular level
Glucose is key nutrient or energy substance
Consume as much food as possible to get as much glucose as we can, then each cell
would be healthy
But excessiveness is bad
Obesity, high concentrations of oxygen over long time can lead to lung disease
and babies go blind with pure oxygen
oIndividual level
Exercise and eat right
oKeep individual and cellular level advice different
oJapan smokes the most but are also the healthiest
oConsiders risk factors in an individual that produce unhealthy organs
Risk Factors: a behaviour or other characteristic that is associated with the
condition studied
Removing the pump handles may be more preferable to teaching people to boil water
The Cause of the Cause
oClifford Geertz, recounts story of how the world rests on a number of infinite turtles
oDiscussion of disease and its causes limited by societal norms
Population Health Epidemiology
oJohn Snow did shoe leather epidemiology went door to door to collect info
oStudying diseases must be done in context, hard to find risk factor of lung cancer in a
population where everyone smokes
oAlso involved with development of powerful computers
oMust control for socio-economic status to find an effect
oHomosexuality is not a disease in Canada. Fibromyalgia and Chronic Fatigue Syndrome
are not recognized as diseases yet.
oPluto: for democracy to work, gap between rich and poor should be no more than 1 in 4
oRudolph Virchow: politics is medicine practiced on larger scale
oJohn Snow: published book on pump handle
Learning from Health Data on Populations
oWHO: Health is a state of complete physical mental and social well-being and not merely
the absence of disease or infirmity
oLife expectancy calculated from death rates of people and ages in a given year
Number of years lived by a person of a hypothetical population will give you the
number of life expectancy
www.notesolution.com
UN human development report lists range as from 81.5 years in Japan to 32.7 for
Zambia
Female life expectancy of Japan rose faster than all other countries from 1960-1990,
to overtake Sweden
oUS health has declined over the years since 2002, Japan is the highest.
If US eliminated Heart Disease, that still would not be enough to overtake Japan
oEpidemiologists also collect data on: measures of health care, air pollution, smoking rates,
economic growth, dietary habits, education.
oUS spends half of the worlds health care budget, USD $6300 per person
oRichard Wilkinson: linked income distribution and life expectancy, did a study that
correlated gap between rich and poor with populations health. Studied bottom 70% of least
well off families. Led to study of population health today
his graph shows how west germany had lowest life expectancy with lowest
percentage of income. Sweden was highest with second highest income received
oAssociation does not apply causation
o Dose response relationship: more of one [effect] should produce more of the other [effect]
oRelative poverty is bad for your health, in any condition, being lower in SES is bad for you
oPoorer people have different body chemistry and physiology than those well off
oPoverty has effect that is not just related to personal behaviours of rich or poor people
oInstitute of medicine in US states: more egalitarian societies have better average health,
because a dollar at the bottom buys more health than a dollar at the top
oUS has highest child poverty rate among rich countries
oCanada better than US but worse than European countries
oyou get sick if you are poor, rather than the other way around
oCortisol production from the adrenal gland is regulated by the hippocampus, this pathway
may lead to worse health when higher levels of cortisol are sustained (like chronic stress)
oIn developed nations like Canada: other factors are more important than medical care
Oxford Textbook of public health: ...difficult to demonstrate conclusively the impact
of these medical advances on the health of whole communities
Medical care is a leading cause of death whenever it has been studied (hospital
chart reviews or doctors’ strikes)
Bunkers 2001 study: 5 years life expectancy gain from curative and preventative
health care. [author says this study is suspect in light of his views...]
Inequality in society is bad for your health
oIncome differences
A flawed measure because there are behind the scenes redistribution mechanisms in
different countries
Through tax transfers, Sweden reduces poverty rate by 80% versus only 20% for US
For US: cities with a small gap between rich and poor have same mortality, same is
true for big gaps between rich and poor cities. Rich may be as affected as the poor.
Ecological fallacy for population findings: could be that rich individuals have poor
health, and areas with a lot of poor also have a lot of rich people.
Basic Needs
oIn Nepal, highest infant mortality rate found in districts with most egalitarian structure,
having food takes precedence over economic justice.
Low GDP countries, show effect of increase in life expectancy with increase in GDP
After countries can feed people, level of hierarchy or economic justice will matter
more in producing health
Methods used in Epidemiology (page. 26)
oObservational ecological studies
www.notesolution.com
oCohort studies
oCross-sectional study
oMulti-level modelling
Natural Experiments in Population Health Epidemiology
oAgriculture
With domestication of plants and animals, our health declined, in hunter gatherer
societies, everyone shared the most valuable commodity of food
With agriculture, a food surplus was produced, lords took over the production and
profit from food surpluses, poverty appeared
Food variety declined, diets changed, famines began
Living in close proximity to domestic animals made it easier to transmit infections
throughout recorded history until last century, health of human populations have
been less than that of primitive societies
Recent improvements in health have come from social redistribution which benefit
the poor
oJapan at the end of the second world war
Japan became healthiest country because of economic policies resulting from US
occupation
Douglas MacArthur administered:
1) demilitarization, Japan forbidden to have army, resolve disputes
peacefully
2) democratization, people could vote and form unions, public health
constitution, maximum wage of 65000 yen per year
3) decentralization, dismantled the 11 large family corporations (zaibatsu)
Land reforming program, took their land from them, and made them pay him back
for it
After dismantled Japans hierarchy, health improved best versus any country of that
time
oThe Former Soviet Union
Demonstrated what can happen when huge hierarchies created overnight
Command economy in Russia dismantled wealth gap so that in 1960 Russia was on
par with US for comparable health indicators
But soon a gap appeared in Russia as former soviet union was dismantled and
wealth started to accumulate
Life expectancy in Russia dropped about 7 years for men and somewhat less for
women
Gap today is greater than Tsarist times
Health decline in Russiaabsolute, more deaths than before
Health decline in US relative, health as not improved as much as other rich
countries
What produces health in a population
oBasic needs (food, water) are met
oNext comes, political power, status of women, health care, distribution of wealth, etc.
oMore egalitarian societies have better health
Conclusions
oPositive, action-oriented approach needed to produce better health
oGaps between rich and poor result from lack of egalitarian policy frame
Readings 1: Heggenhougen, The Epidemiology of inequity: Will research make a difference?
www.notesolution.com

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Description
Chapter 1: Epidemiological Approaches Epidemiology: study of health and its determinants in specified populations with goal of improving health Root word: epidemic o Origins come from the study of causes of diseases Mainly concerned with illness or disease rather than health and well-being Early epidemiology o John snow, plotted incidence of death on maps between deaths and drinking water, then removed the handles of water pumps, resulted in less deaths o Epidemiology sometimes overlooks improving health after cause of disease is identified o Mostly conducts studies and report results, action not usually considered o William Farr, registrar-general of London recognized that poverty was an important associate of poor health Health as a concept differs on the level being considered o Cellular level Glucose is key nutrient or energy substance Consume as much food as possible to get as much glucose as we can, then each cell would be healthy But excessiveness is bad Obesity, high concentrations of oxygen over long time can lead to lung disease and babies go blind with pure oxygen o Individual level Exercise and eat right o Keep individual and cellular level advice different o Japan smokes the most but are also the healthiest o Considers risk factors in an individual that produce unhealthy organs Risk Factors: a behaviour or other characteristic that is associated with the condition studied Removing the pump handles may be more preferable to teaching people to boil water The Causeof the Cause o Clifford Geertz, recounts story of how the world rests on a number of infinite turtles o Discussion of disease and its causes limited by societal norms Population Health Epidemiology o John Snow did shoe leather epidemiology went door to door to collect info o Studying diseases must be done in context, hard to find risk factor of lung cancer in a population where everyone smokes o Also involved with development of powerful computers o Must control for socio-economic status to find an effect o Homosexuality is not a disease in Canada. Fibromyalgia and Chronic Fatigue Syndrome are not recognized as diseases yet. o Pluto: for democracy to work, gap between rich and poor should be no more than 1 in 4 o Rudolph Virchow: politics is medicine practiced on larger scale o John Snow: published book on pump handle Learning from Health Data on Populations o WHO: Health is a state of complete physical mental and social well-being and not merely the absence of disease or infirmity o Life expectancy calculated from death rates of people and ages in a given year Number of years lived by a person of a hypothetical population will give you the number of life expectancy www.notesolution.com
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