Public HLT

Read Me First

Week Two

INTRODUCTION

Now that the historical development and a foundational review of government structure and functions related to public and community health has been established, you focus on methodologies used to identify and measure health events and risks to the public’s health. This approach integrates evidence to define health problems, to understand the cause of the disease and recommendations for addressing problems, and to implement programs and evaluate the effects. New terms include epidemiology and surveillance. These concepts are critical, as we monitor disease patterns and assess or predict the effect on communities.

Epidemiology is the study of factors affecting the health and patterns of illness across communities and countries. Epidemiology is a platform of data, information, and research that supports specific disease treatments, interventions, and prevention or evidence-based medicine. Through diseases, patterns are identified, beginning with outbreaks, to data collection and analysis, including statistical models to validate the effect of the disease and the treatment’s effectiveness. Surveillance is the monitoring, systematic collection, analysis, and distribution of health data. Surveillance usually refers to observing individuals or groups and monitoring a disease’s progress in a community. Epidemiology and surveillance evolve around data, incidence, census, case tracking, or reporting.

THIS WEEK IN RELATIONSHIP TO THE COURSE AND THE PROGRAM

A major responsibility in health care administration is assessing and identifying needs, prioritizing them, determining interventions, and allocating resources. Course content covers tools that carry out these functions using an evidence-based approach.

· Surveys

· Self-monitoring

· Sentinel monitoring

· Single case reporting

· Statistics

· Surveillance

The PERI model is shared as a method of organizing data to understand the nature of a problem and its underlying causes.

Thus, this course provides a foundation on which subsequent courses are built. This week, you develop a better understanding of data, where to find data, how to use data, who collects data, how it is used to determine the effect of the event or incident, and a treatment, intervention, or control plan. An example was the recent outbreak of swine flu. There was prompt identification of the symptoms and communication to communities to watch for cases, collecting essential data to support the people affected and clinical testing to isolate the organism to identify transmission characteristics and a treatment plan. Organizations included the Centers for Disease Control and Prevention, community health departments, and community hospitals.

HINTS FOR A READING STRATEGY OF THE ASSIGNED MATERIALS

The text provides an effective explanation of epidemiology and surveillance, and contains useful tables of terms and websites. Read the assigned chapters before the articles. The articles provide practical and interesting applications of concepts covered in the text. The text and articles cover mortality, morbidity, incidence, prevalence, and contributing causes.

SOME QUESTIONS TO ASK AS YOU HONE YOUR CRITICAL THINKING

This may be your first exposure to epidemiology and surveillance, aside from an occasional news report about an emerging disease or a health risk. As you read about surveillance, consider how it differs from research. Consider what the case definition might be and the role of person, place, and time to the investigation. As you review commonly used epidemiologic measures, think about how they might be used in determining health risks, measuring the effectiveness of interventions, or molding policy decisions.

· How is data collected to support or understand the epidemiological issue being investigated?

· How does an incident or outbreak lead to developing evidence practice?

· What does the term contributory causes imply, what does it not imply, and why is it important in public health?

· What factors affect how public health information is perceived?

· What information is used to make public health decisions?

SUMMARY

After this week, you should have an appreciation of methods used to understand and measure health risks. This information is used to develop risk reduction strategies and health promotion. These are critical endeavors in ensuring the public’s health.

Weekly Overview

Epidemiology is the study of disease frequency and determinants of health within a population and is one of the many components that fall under the umbrella of public health. The fundamental concepts of this science were developed in the late 1800s by the Father of Epidemiology, John Snow. Epidemiologists are involved in surveillance, data collection and interpretation, and education. These three activites are vital to controlling disease and promoting prevention within populations.

What you will cover

1. Epidemiology Concepts – Measurement of Health Status

a. Define epidemiology and its relationship to public health.

1) Study of disease distribution or health determinants in populations; application of this study to controlling health problems

2) What epidemiology is used for

a) Describing the health status in populations

b) Explaining the etiology of diseases in populations

c) Predicting the distribution of health and disease in populations

d) Controlling the distribution of health and disease in populations

3) Steps in the epidemiologic process

a) Describe the effect of a disease-occurrence and change in frequency or pattern.

b) Are there differences in the distribution of the disease? Can these differences lead to understanding or identifying a cause?

c) Person includes demographic characteristics that describe people, as in age, gender, and socioeconomic factors. This includes behaviors or exposures.

d) Scientific approach: Are the problems real or artificial?

4) Person and place used to determine patterns or associations in a disease’s frequency

5) Define surveillance: the ongoing systematic collection, analysis, and distribution of health data to those who need to know

6) What surveillance is used for

a) Planning, implementation, and evaluation of public health practice

b) Identifying public health problems

7) Relationship of surveillance to public health: essential to making well informed public health policy decisions based on quantitative data

a) Terms to understand

(1) Burden of disease: the extent to which a disease affects the health care delivery or public health system, which may be frequency or intensity

(2) Mortality: the condition of being mortal or susceptible to death; the opposite of immortality

(3) Morbidity: illness or disease

(4) Incidence: measure of the risk of developing a new condition in a specified period of time

(5) Risk indicators: a measure used in management to indicate how risky an activity is; in disease, a list of conditions, habits, or symptoms more likely to result in the disease

(6) Distribution of disease: the extent to which a disease is present across populations

(7) Prevalence: the total number of cases of the disease in the population at a given time, used as an estimate of how common a condition is in a population over a specific period of time

(8) Contributory: a cause that precedes the effect, altering the effect; statistical data used to confirm the relationship in epidemiology

b) Four questions for PERI model

(1) Problem: What is the health problem?

(2) Etiology: What is or are the contributory causes?

(3) Recommendation: What works to reduce the health effect?

(4) Implementation: How can we get the job done?

c) Classification of evidence-based recommendations

(1) Grades

(a) A: This is a strong recommendation.

(b) B: In general, the intervention should be used unless there are reasons or contraindications for not doing so.

(c) C: The use of judgment is often needed on an individual basis.

(d) D: There is enough evidence to recommend against using the intervention.

(e) I: The evidence is inadequate to make a recommendation for or against the use of the intervention at the time.

(2) Who develops evidence-based recommendations?

(a) Government

(b) Practitioner-oriented organizations

(c) Consumer-oriented organizations

(d) Organized health care systems

(e) For-profit organizations

d) Interventions and implementation of recommendations: when, who, and how structure

(1) Primary: prior to disease or condition

(2) Secondary: prior to symptoms

(3) Tertiary: prior to irreversible damage

b. Discuss the uses and effects of demographic data, surveillance data, and vital statistics in public and community health.

1) Demographic data: age, gender, race and ethnicity, and socioeconomic status

2) Surveillance data

a) Numbers and rates

(1) Numbers: number or count of a health event and cases, not taking into consideration the size of the population

(2) Rates: the frequency of a health event, such as birth, death, and a particular disease, in a defined population during a defined period of time per a standardized number of the population

(a) Example: 10 cases of tuberculosis per 1,000 = rate of 10

(b) More significant than 2000 cases of tuberculosis per 100,000= rate of 0.02

(c) A rate of 10 is more significant than .02. This knowledge can alert the public and identify precautions to control the spread of the disease.

(3) Case definition: a set of standardized criteria determining whether a person should be categorized as having a particular disease

b) Sources of data

(1) Census data

(2) Vital records: births and deaths

(3) Case reporting

c) 6 S’s of sources of public health data

(1) Single case or small series

(2) Statistics

(3) Surveys

(4) Self-reporting

(5) Sentinel monitoring

(6) Syndromic surveillance

d) Terms to review

(1) Disability-adjusted life years

(2) Health-adjusted life expectancy