Week 14: Intentional and Unintentional Injuries

Goals

Define

• Unintentional injuries are those that occur without a person intending to cause harm
• Intentional injuries are the result of a deliberate use of violence

Week 13: Environmental Health including Climate Change

• waste is bad

Week 12: Healthcare Delivery, Insurance and Health Policy

By the end of this module, you should be able to

• Describe the eligibility requirements in general terms, and compare the coverage, of three long-standing public health insurance systems: Medicaid (Medi-Cal, in California); Medicare; and CHIP.
• Discuss briefly the history of healthcare in the United States and how it is evolving.
• Describe the basic characteristics of Healthy San Francisco program and how it differs from health insurance.
• Contrast different solutions to provision of healthcare based on insurance system (e.g., mixed public-private system in the U.S., national system in U.K., single-payer system in Canada, and regulated private system in Germany)
• Characterize the spectrum of healthcare delivery, including public health practice; medical practice; long-term care or practice; and end-of-life care or practice.
• Give examples of healthcare providers and distinguish their roles, including whether they can practice independently (as medical doctors and oestopaths can, for example) or under the supervision of a provider with higher training; whether they practice in allopathic medicine or alternative/complementary medicine; and generally what they do, as a doctor, nurse, physician’s assistant, allied health or public health professional.
• Describe different types of healthcare facilities and their functions (inpatient, outpatient, acute care, long-term care).
• Identify some major concerns with the health care system in the United States.
• Discuss the various ways of reimbursing health care providers, including the concept of insurance.
• Explain what a health insurance policy is, including terms like deductible, co-insurance, copayment (copay), fixed indemnity, exclusion, and pre-existing condition.
• Define managed care (e.g, HMO or PPO) and discuss some of the advantages and disadvantages of managed care.
• Define the terms health maintenance organization (HMO), preferred provider organization (PPO), and point-of-service option.
• Discuss what the Affordable Care Act, or ACA (“Obamacare”) does and how it works.
• Describe Covered California, the healthcare marketplace or exchange set up under the ACA in California.
• Describe the legal challenges to the law and the Supreme Court decision that upheld the ACA (in basic terms), as well as recent legal challenges that still may reshape the ACA.
• Compare the ACA with the proposed Republican replacement legislation – while the Republican bills in 2017 failed in the Senate and therefore did not become law, there are new promises from the Republican administration to replace the ACA, so some of these same ideas may be revived.
• Identify ways that the implementation of the ACA is changing under the Trump Administration, even while the ACA remains in effect.

Part 1 : 12.3 Lesson: Healthcare Delivery

• Safety Net Providers serve un/under insured / public health insurance
• Healthy SF: SF’s Health Access Program for uninsured SF Residents.
• socialized medicine: healthcare system that provides universal access (healthcare for everyone) and whose payment system is directly or indirectly controlled by the government.
• US fairly unique in it’s healthcare “system”. UK (national healthcare), Canada (single payer insurance), Germany/Switzerland/Netherlands ( privately run health insurance + providers )
  • ACA 2010: Extends coverage, curbs health insurance abuse, initiate QoC improvements
• Lack of insurance (2012 - 47m+ uninsured)
• Medicare: All citizens/legal residences > 65yr, who worked enough hours to be eligible; includes care, hospitalizations, prescription drugs. Some disabled condition coverage. Federal Government
• Medicaid (California: Medi-Cal): Low income, some disabled conditions; medical care/hospitalization/some dental/some inhome. Part fed gov, admin by states.
• CHIP (California: Healthy Families): Health insurance for children in familiies with income too high to qualify for Medicaid/MediCal but still under a certain amount. State Admin.

Week 11: Alcohol, Tobacco and Other Drugs

Goals

By the end of this module, students will be able to

• Identify personal and community consequences of alcohol and other drug abuse.
• Describe the trends of alcohol and other drug use by high school students, and by the US population as as whole.
  • Drug use is increasing
  • Highest among people in their late teens and twenties
• Define drug use, misuse, abuse and dependence.
• List and discuss risk factors for the abuse of alcohol and other drugs.
• Explain why alcohol is considered the number one drug abuse problem in the United States (even though tobacco causes more deaths, in the long run).
• Describe the health risks of tobacco.
• Define the terms over-the-counter drugs, prescription drugs, controlled substances, and illicit (illegal) drugs, and provide examples.
• List and explain four elements of drug abuse prevention and control: education, treatment, public policy and enforcement.
• Give an example of primary, secondary, and tertiary prevention activities in drug abuse prevention and control programs.
• Summarize the federal government’s drug abuse control efforts (at least, as they are summarized in ICPH).
• List and describe an effective community-based drug abuse prevention program and an effective school-based drug abuse prevention program.
• Discuss examples of substance abuse prevention and treatment programs, including workplace prevention programs, voluntary health agencies and self-help support groups.
• Discuss abstinence and harm reduction as two different frameworks, and some of the different approaches to the treatment of addiction.
• Discuss some negative health effects of the “war on drugs”
• Discuss the drivers of the opioid epidemic and its effects

Drug Abuse Specifics

Six Major Groups of Abused Drugs

1. Anabolic Steroids
2. Club Drugs/Designer Drugs
3. Dissociative (Detachment) Drugs
4. Illicit Opiates/Narcotics
5. Illicit Stimulants
6. Psychedelic (Mind-Altering) Drugs

Anabolic Steroids (roids, juice, gym candy, pumpers) Synthetic versions of the hormone testosterone.

Effects : No intoxication, easier to grow muscle

Administration: Injected, swallowed, Applied to skin

Dangers: Aggression, Cancer, Heart disease, Stunted growth; Males: prostate cancer, reduced sperm production, shrunken testicles, breast enlargement; Females: menstrual irregularities, development of beard and other masculine characteristics

Club Drugs/Designer Drugs

Drugs in this category tend to be used by young adults at bars, concerts, nightclubs, and parties. This class is especially dangerous as some are used in kidnappings, sexually assault, and rape.

Effects

Increased awareness of senses, Mild hallucinations, Increased tactile sensitivity, Empathic feelings

Administration Methods

Swallowed, Snorted, Injected

Dangers

Anxiety, Chills, Sweating, Muscle cramping, Sleep disturbances, Depression, Impaired memory, Fatal overdoses

Dissociative (Detachment) Drugs

These are drugs that give a person the feeling of being separate from their body and environment.

Effects

Analgesia Numbness Hallucinations

Administration Methods

Swallowed Smoked Injected

Dangers

Anxiety Tremors Memory loss Nausea Psychosis Aggression Violence Slurred Speech

Illicit Opiates

Opiates are a group of HIGHLY addictive drugs from the poppy plant.

They are used as pain relievers, anesthetics, and sedatives.

Illegal use of prescription opiates are considered illicit opiates.

Heroin

Effects

Euphoria Drowsiness

Administration Methods

Injected Smoked Snorted Swallowed

Dangers

Impaired coordination Sedation Slowed or arrested breathing Bloodborne diseases such as hepatitis & HIV Addiction Fatal overdoses

Illicit Stimulants

These are substances that excite the activity of the brain. eg. Cocaine, Amphetamines, Methamphetamines

Effects

Hyperactivity/talkativeness Increased energy & alertness Reduced appetite

Administration Methods

Snorted (cocaine only) Smoked Injected Swallowed

Dangers

Anxiety Irritability Suspiciousness Insomnia Increased heart beat Heart attack Fatal overdose

Psychedelics

These drugs alter your way of thinking and how you see the world. They can be broken up into:

• Cannabinoids (marijuana, hashish)
• Hallucinogens (LSD)

Marijuana

Effects

Euphoria Relaxation Distorted Sensory Perception

Administration Methods

Smoked Swallowed

Dangers

Impaired Learning & Memory Panic Attacks Lung Infections Lower Testosterone Levels and Sperm Numbers In pregnant women, it affects the fetus and results in developmental difficulties in the child

Hashish Active Ingredient: plant resins from Cannabis Plant (Boom, Gangster, Hash, Hash Oil, Hemp)

Effects

Euphoria Relaxation Slowed reaction time Distorted sensory perception Impaired balance and coordination

Administration Methods

Smoked Swallowed

Dangers

Increased heart rate and appetite Impaired learning & memory Anxiety Panic attacks Psychosis/cough Frequent respiratory infections

LSD - Lysergic Acid Diethylamide (Acid, Blotter, Cubes, Microdot, Yellow Sunshine, Blue Heaven)

Effects

Altered states of perception and feeling Hallucinations

Administration Methods

Swallowed Absorbed through mouth tissue

Dangers

Impulsive behavior Flashbacks Hallucinations Chronic mental disorders

Emerging Trends

Bath Salts

The term “bath salts” refers to an emerging family of drugs containing one or more synthetic chemicals similar to an amphetamine-like stimulant found naturally in the Khat plant. Remember, these are NOT for human consumption.

Krokodil (desomorphine)

This flesh eating opioid is similar to heroin but has gained attention due to the major damage it causes to veins and soft tissues in the body.

Week 10: Health of Racial/Ethnic Populations, Cultural Competency & Cultural Humility

Week 9: Older Adults

Week 8: Midterm and Obesity debate

Define

• healthy: [18.5, 24.9] BMI
• overweight: [25,29.9] BMI
• obese: [30,infinity) BMI
• Body Mass Index: ratio of height to weight

Discuss

• Obesity Debate
• the scientific disagreement about the health impacts of increased size
• Good nutrition

  • = 5 servings fruit/veg /day. Lean proteins, more whole grains, water

• Physical activity benefits
  • any activity that Enhances your overall fitness and well-being. E.g. walking to the store for pt. of milk or gardening
  • Benefits:Reducing stress, improving digestion, Increasing blood flow, Lowering blood pressure, improve flexibility, heart health, more.
  • CDC Recommends >= 1 hr/day, 30m/day adults
• Public health strategies for increasing access to good nutrition and physical activity through community level changes
  • eg Ban fast food, penalize parents of obese kids, tax soda

Obesity Bad View: American Weight Trends

• On average increasing
• Majority of Americans are overweight/obese
• Health Inequities:
  • More likely obese: Women -> Men; African Am, Latino, Native Ams, Pac. Islanders -> Whites/Asians; Lower Income -> Higher Income (except African Am/Latino where higher income -> more risk of obesity).
• Overweight/Obese Increased risk: Coronary heart disease, Type 2 diabetes, Cancers (endometrial, breast, and colon), Hypertension (high blood pressure), Dyslipidemia (for example, high total cholesterol or high levels of triglycerides), stroke, … and more

Obesity = Fatphobia and distracting from real issues View

• Dangers of increased size exaggerated
• Estimates of negative health impacts flawed. Also possible to be fat + fit/ thin + unfit
• Suggest widespread cultural bias against fat people
• Arguments they make:
  • Same period The average weight increased deaths from heart disease stroke decreased life expectancy grown
  • CDC Study: Overweight category longer life expectancy of the normal rate
  • overweight: Greater risk for diabetes + high blood pressure but lower risk osteoporosis/other conditions
  • By stigmatizing Thought we make fat peoples healthcare worse e.g. postponing visits to doctors

Health At Every Size alternative paradigm

• “Except at statistical extremes, body mass index (BMI) - or amount of body fat - only weakly predicts longevity. Most epidemiological studies find that people who are overweight or moderately obese live at least >= long as normal weight people
• Analysis of the National Health and Nutrition Examination Surveys I, II, and III, … determined that greatest longevity was in the overweight category
• Americans’ Changing Lives study: “when socioeconomic and other risk factors are controlled for, obesity is not a significant risk factor for mortality; and… for those 55 or older, both overweight and obesity confer a significant decreased risk of mortality.”
• Obesity Paradox: Obesity associated with longer survival in many diseases
• Assumption: Fat is significantly morbidity risk (causation less established)
• Weight cycling (lose,gain pretty common): Results in increased inflammation + lots of other things
• Type 2 Diabetes: Increasing evidence of poverty and marginalization more strongly associated type 2 diabeters, than conventional factors such as weight diet or activity
• Assumption: Weight loss prolong life. Evidence: Most observational studies suggest weight loss (in obese indiv.) increases risk of premature death
• Assumption: Anyone can lose weight and keep it off. Evidence: Long-term follow-up studies document majority of individuals regain most weight even if maintain diet/exercise program
• Assumption: Weight loss is a good goal. But: weight cycling risk to health, loss of bone mass, increased psych stress/cortisol, stigma/discrimination
• Assumption: Only way to improve health is to lose weight. But: so few people lose + keep off weight. Unknown if obese Individual weight loss reduces disease risk to same level As those who never obese. Most health indicators improved by changing health behaviors
• Danger of Focus on overweight/obesity: Overtesting healthy overweight, Undertesting unhealthy thin. Negative body image is a health risk.
• Health At Every Size: Encourages body Acceptance as opposed to weight-loss/Maintenance
  • Reliance on internal processes such as hunger vs diets
  • Supports active embodiments (joyful movement) vs structured exercise
  • Results: Improved eating habits, more frequent/sustainable physical activity, decreased depression, increased metabolic health

Obesity Contributors

• Sleep debt, Changes in breast feeding, Average maternal age (older mom correlates more obese child), Epigenetics (environment in utero affects genes), Heating/cooling (body spends less energy), Certain Pharmaceuticals, Cyclical dieting, Discrimination.

7 Health status by Age – of adolescents, young adults, and adults

Define

• risk factor: rait, behavior or condition associated with a higher probability of disease or injury
• protective factor: trait, behavior or condition associated with a lower probability of disease or injury/ faster recovery rate
• Adolescence: generally described as puberty to maturity

Goals

• Explain why it is important for community health workers to be aware of the different health concerns of the various age groups in the United States.

Many health beliefs, attitudes, and behaviors are adopted and consolidated during adolescence.

• Define by age the groups of adolescents, young adults, and adults.

Adolescents and young adults - ages 10-24 years Adults - ages 25-64 years Ages 15-64 considered most productive years

• Briefly describe key demographic characteristics of adolescents and young adults

  • (2010) 10-24 yr ~ 25% US Pop
  • Increasingly diverse: (2012) 55% non-hispanic white -> 44% (2050)
  • < 18 single parent home ⬆️

• Explain what the Youth Risk Behavior Surveillance System (YRBSS) and the Behavioral Risk Factor Surveillance System (BRFSS) are and what type of data they generate.

• Provide a brief behavioral risk profile for adolescents, young adults (including those attending college), and adults.

  • High Schoolers: - unintentional injuries: seat belt/bicycle helmet/motorcycle helmet use, Drinking+Driving/riding with drunk driver
    • violence: weapons, dating violence, physical fights, forced sexual activity, bullying, suicide ideation/attempts
    • tobacco: Widespread @ highschoolers: majority dependent before 18. smokeless tobacco
    • alcohol: experimentation @ [15-24]
    • drugs: 20% @ marijuana, 20% unprescribed drugs; others (cocaine…)
    • sex: Unintended Pregnancy + STD ~50% hs’ers; Improving rates @ contraceptives
    • Physical activity/sedentary: lack concerning. Males more likely > females; Screen time risk factor; physical activity linked to positive outcomes
    • Overweight: ⬆️ concern for age group. Risk factor @ chronic disease. rise in rate (steady @ 2011-; 17% overweight/obese). Dieting through unhealthy means + eating disorders.
  • College students: - unintentional injuries, violence, tobacco, alcohol/drugs, unint. pregnancies/STDs
    • vs peers: ⬆️ alcohol abuse, ⬇️violence
    • protective factors e.g. school connectedness, community service
    • main issue: alcohol.
  • Adults: - 25 to 64: leading cause cancer: - men: prostate, lung, and colorectal cancer - women: breast, lung, and colorectal cancer - 85% lung cancer ~ smoking
    • Also Cardiovascular diseases leading cause of death

• Outline the health profiles for the various age groups, listing the major causes of mortality, morbidity, and risk factors for each group (for example, list the 3 leading causes of death, the most common causes of illness or injury, and at least 4 leading risk factors for each group).

  • Most health threats are behavior not disease
  • 3/4 mortality: injuries (motor vehicle crashes, homicide, suicide); Health disparities by race/gender/social class
  • Adolescents/Young Adults highest risk @ STDs (~50%)

• Give examples of community health strategies for improving the health status of adolescents, young adults, and adults, including the use of health screenings and health promotion.

  • College students @ Alcohol:
    • Change the social norms about alcohol
    • Community-wide measures
    • Sustained over time
    • Foster institutional changes
    • Involve youth and young adults in finding and creating solutions to problematic alcohol use

  • Secondary Prevention: Screening high risk populations. eg hypertension, diabetes, cholesterol

  • Primary, secondary, and tertiary prevention programs a. Exercise and nutrition programs (primary prevention) b. Self or clinical screenings (secondary prevention) c. Medication compliance (tertiary prevention)
  • @seattle washington health care authority primary care: - zumba, food, doctor, help /w healthcare system, help /w languages

• Discuss tobacco control and prevention, including examples of strategies used to reduce tobacco use, as a means of improving adult health. While the diseases associated with tobacco usually start in adulthood, tobacco use usually starts in adolescence, so many prevention strategies address adolescents and young adults, to preserve adult health.

  • Widespread @ highschoolers: majority dependent before 18. smokeless tobacco.
  • Campaigns /w an effect - Lawsuits (which have attained limits on tobacco marketing practices and funded prevention efforts with money taken from the tobacco industry)
    • Taxes (by changing the cost)
    • Limits on sales to minors, and limits on where tobacco can be sold
    • Smoking bans in public spaces (eg ccsf is tobacco free)
    • Media campaigns: - The Truth Campaign: highlighted manipulation of youths by companies
  • Tobacco use: - varies by age: younger is less now
    • low income, less education more likely to use
    • highest in Native American

• Discuss e-cigarette usage and vaping of nicotine products as an emerging public health epidemic

  • Considered an epidemic. 20% of hs’ers. 75% high s growth, 50% middle s growth
  • produce ultra fine particles. not harmless.

Misc:

• The racial/ethnic group of high school students most likely to report current cigarette usage is: white americans

6 Maternal and Child Health

Maternal and Child Health is one of the oldest disciplines within public health

Goals

1. Define maternal, infant and child health

Maternal, Infant, and Child Health (MIC/MCH) focuses on the health of women of childbearing age - from pre-pregnancy through pregnancy, labor, delivery, and the postpartum period - and that of the child prior to birth through adolescence. A particular attention is placed on the perinatal period - the period just before pregnancy, during pregnancy and birth, and up through the first year of the infant’s life.

1. Explain the importance of maternal, infant and child health as indicators of society’s health

• MIC/MCH indicates effectiveness of disease prevention and health promotion services
• Healthy community = healthy moms + babies
• good Early childhood health -> good later health
• MIC Mortality rates important national health measure

1. Define family planning and discuss its importance

• Need to be cognisant of multiple definitions of family

1. Identify consequences of teenage pregnancies

• blessing and a joy
• high rates of teen births can also bring a significant social and financial burden on families and even on communities

1. Define legalized abortion and discuss Roe v. Wade and the pro-life and pro-choice movements

2. Define maternal mortality rate and identify some factors that influence it

3. Define prenatal care and discuss the influence this has on pregnancy outcome
4. List major factors that contribute to infant health and mortality

• Racial Inequalities: { Black women 3x, Am Indian/Alaskan Native 2x } death rate of White,
• Daily discrimination can increase risk of negative perinatal outcomes
• Maternal mortality ratios vary significantly by socioeconomic status and geography

1. Identify the leading causes of childhood morbidity (illness/injury) and mortality (death)
2. Discuss the importance of immunizations and health insurance to child health
3. Identify important governmental programs developed to improve maternal and child health
4. Briefly explain what WIC programs are and whom they serve
5. Name several groups that are recognized as advocates for children
6. Define what “low birth weight” means and why it is a health risk
7. Compare the prevalence of low birth weight babies born to African American mothers, compared to white mothers in the United States
8. Discuss factors, including chronic stress, that contribute to high rates of low birth weight births in the African American community
9. Discuss interventions to help prevent low birth weight, including actions that can be taken at the individual level and those at the community or societal level.

5 Community Organizing

“Communities are not only “where health happens”. It is also often the place where residents take action to alter the conditions that affect their health”

Define

• community organizing: “process by which community members come together to address a shared problem or opportunity, … to attain a change in their shared environment. … often involves working on a policy change at the local level…”
• community organizing: “defined as the process by which community groups are helped to identify common problems or goals, mobilize resources, and develop and implement strategies for reaching the goals they collectively have set”
• community capacity:
• community participation:
• community building:
• empowered community:

Strategies for community organization

• planning and policy practice:
• community capacity development:
• social advocacy:

needs-based vs strengths-based community organizing models:

Generalized model for community organizing/building steps

Common tools or tactics for community organizing

Case study of community organizing for health

Role of community health workers in community organizing for health

e.g. their role in informing, involving, collaborating and empowering community residents

empowerment: process by which individuals or communities take control over their lives and environment

(re empowerment): Either greater community problem-solving ability / change in conditions/relations of power. Community not strictly defined. Community organizing processes:

• Confrontational: Social Justice Advocacy/Alinksky Style (Saul Alinsky: Rules for Radicals)
• Consensus: Build in communities capacity to resolve challenges
• Using data + working /w Local Gov for new policies: (consensus also)
• In common: Recognizing the value of prevention and equity

Environmental Justice: seeks to ensure that the costs of our industrial society (noise, air pollution, water pollution, etc.) do not unfairly fall in a disproportionate way on communities of color and more generally, poor and working class communities (Principles of env justice: http://www.ejnet.org/ej/principles.html)

Environmental Health: sub-discipline within Public Health that examines the biological, physical and chemical factors in our environment that affect health.

The community action model is an interactive five-step process designed to address the fundamental determinants of population health through a community-based participatory process. The model was initially designed to address the social determinants of tobacco-related health disparities through grassroots efforts focused on policy and organizational practices and is applicable to other community issues.

The steps of CAM are as follows:

• Step 1: Dialogue of Concern and Issues/Skill-Based Training
• Step 2: Community Diagnosis
• Step 3: Analysis
• Step 4: Plan and Implement Action/Activity
• Step 5: Sustaining Action/Activity and Evaluate Action. The role of CHWs can be easily defined within the CAM

Through the use of CHWs for capacity building, the concepts of several theories such as the Health Belief Model (HBM), Self-Determination Theory (SDT), Transtheoretical Model (TTM), and self-efficacy are all taking place at different stages when community members interact with CHWs for extended periods of time.

Murphy, F., & MSPHyg, M. P. I. A. (Eds.). (2012). Community engagement, organization, and development for public health practice. Springer Publishing Company.

CHW Roles: Informing (which can include consulting), Involving, Collaborating, Empowering