Exam Note 4 - Exam notes PDF

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Exam 4

Health and LGBT Communities Health disparities of LGBT communities - Assessing health needs and barriers to care of LGBT population is CHALLENGING due to historical lack of data collection on sexual orientation and gender identity - Experience and impact of discrimination, stigma, and ostracism affect health outcomes, access and experience with health care.

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Have more chronic conditions and have higher prevalence and earlier onset of disabilities. Report more asthma diagnosis, headache, allergies, osteoarthritis, and gastrointestinal problem 2/3X more likely to attempt suicide Experiencing serious psychological distress Experience higher rates of sexual (Rape/sexual violence) and physical violence (hate crime) two-half times likely to experience depression, anxiety and substance misuse Not covered by health insurance, limited access to care, disrespectful treatment by providers and staff Poverty rate and homeless rate are higher Gay and bisexual men accounted more than half (56%) of all people living with HIV in US, and two-thirds (66%) of new HIV infections. Transgender have high prevalence of HIV, victimization, mental health issues and suicide, and are less likely to have health insurance Elderly LGBT- isolation and lack of social service and culturally competent providers LGBT population have highest rates of tobacco, alcohol and other drug use.

Exam 4 Sexual orientation vs gender identity  Sexual Orientation- describes a person's enduring physical, romantic, and/or emotional attraction to another person (Heterosexual, bisexual, homosexual)  Gender Identity- is an individual’s internal sense of being male, female or something else. (Transgender, Woman, gender queen, man) - Transgender people may identify as heterosexual, lesbian, gay, or bisexual, or somewhere else along the spectrum of sexual identity. Effects of stigma and LGBT health - Higher risk of experiencing distress and adverse psychological outcomes - Outlawed same-sex marriage is directly linked to chronic social stress and psychological problems, and NOT due to pre-existing psychological outcomes or other factors Difference of children’ cognitive between same-sex parents and heterosexual parents - Children raised by same-sex couples are equivalent to heterosexual partners in terms of psychological adjustment, cognitive abilities and social functioning.

Substance Use Disorders (SUDS) What leads and/or contributes to the development of SUDs? - Factors: Person’s genes, the action of the drug, peer pressure, emotional stress, anxiety, depression and environmental stress - Children who grew up seeing their parents using drugs may have a high risk of developing substance abuse problems later in life for both environmental and genetics reasons. - Start with experimental use in social situation or - Begin with exposure to prescribed medications from friends or families who has been prescribed the medication What are some physical bodily effects of substance use disorders? Physical Effects of Substance Abuse Neurological and emotional effects - Depression - Organ damage - Anxiety - Hormone imbalance - Memory loss - Cancer - Aggression - Pre-natal and fertility issues - Mood swings - Gastrointestinal disease - Paranoia - HIV/AIDS Legal Repercussions - Probation and arrest records that make it difficult to find a job - Driver licence suspension and transportation difficulty - Large fines - Extensive jail sentences - Strict community service requirements

Exam 4 What is the role of dopamine in SUDs? - Dopamine isn’t the sole cause of addiction, its motivational properties are thought to contribute to addiction by inducing a desire to seek out that same pleasure, resulting in an uncontrollable urge. - Consistent drug misuse eventually leads to overstimulation in the reward centre. Its pathways become overwhelmed, making it harder for it to handle the high levels of dopamine being released. - Drug abuse Dopamine release in the mesocorticolimbic pathway  increased activation of pathway  sensation of reward - Meth creates 1200% of Dopamine level (highest), followed by cocaine (350%) Sex (100%) and food (50%) Solutions - Education and Public Information are popular options but NOT EFFECTIVE for SUD solution. - Solutions: Detoxification, behavioural counselling, medication, evaluation and treatment for co-occurring mental health issues, long term follow up What are successful public health initiatives related to reducing/controlling SUDsRat Park Study - Creates massive program of Re-introduce addicts into a connected society: job creation for drug addicts and microloans for addicts to set up a small businesses. And decriminalize drugs - How did this program changed the drug addicts?: Rediscovering purpose, rediscovering bonds and relationships with wider community - Results over past 15 years: Decrease in abusing injecting drug use by 50%. - Importance of social recovery, connection with people

Disaster Preparedness and Response Emergency VS Disaster 1. Emergency (Sufficient resources are available to deal with it) - Is sudden, urgent and unexpected events requiring immediate actions, usually requiring help 2. Disaster ( A response need is greater than the Resources that are available) - A destructive incident that impairs the community's normal functioning and cannot be efficiently handled by routine processes or services and necessitates outside assistance. - Types of disaster – Natural, Pandemics, Transportations, Technological and Terrorism (diff. types  diff. health risks, illness and injuries) - Disaster and health- Injuries, environmental exposure, malnutrition, excess mortality, mental health, communicable disease outbreaks (after/from the events)

Phases of disaster

Exam 4 Preparation- To take actions ahead of time to be ready for an emergency - Include hosting training, education, drills, tabletop exercise - Evacuation shelters, emergency communication plan, preventive measures to prevent spread of disease, public education - Preparedness involves Risk communication Risk communication Goals 1. Enhance knowledge and understanding 2. Build trust and credibility 3. Encourage appropriate behaviors and levels of concern 4. Prepare or know how to respond to the risk 5. Provide cues to action Response- to protect people and property in the wake of an emergency, disaster or crisis - Phase occurs in the immediate aftermath of a disaster - Activities a hospital, healthcare system, or public health agency take immediately before, during, and after a disaster or emergency occurs Recovery- To rebuild after a disaster in an effort to return operations back to normal. – Debris Removal – Care and Shelter – Damage Assessments – Funding Assistance Mitigation- To prevent future emergencies and take steps to minimize their effects - Occurs before a disaster take place. - The organization’s main goal is to reduce vulnerability to disaster impacts (such as property damage, injuries and loss of life) - Activities that reduce or eliminate hazards: Prevention and Risk Reductions Example: - Immunization programs - Public education - Rebuilding stronger structures - Quality Improvement through After-Action Reports

Exam 4 State of an Emergency- What is it? When is it “called”? What is state of Emergency - The Governor declares a state of emergency when he or she suspects a disaster has occurred or is imminent that would necessitate State assistance to augment local services in preventing or alleviating damages, injury, distress, or suffering. - This declaration empowers the Governor to expedite assistance from State agencies to communities in need. When is it “called”? Department of Homeland Security helps out when 1. Federal department or agency requests assistance 2. Resource of state & local authorities are overwhelmed 3. More than 1 federal department or agency has become involved 4. DHS has been directed to assume responsibility Who first responds to disasters? - Local First Aid Responders responds to disasters

Exam 4

Global Health Millennium Development Goals Goal 1: Eradicate hunger How hunger and poverty affect health - Undernutrition which includes fetal growth restriction, stunting, wasting and deficiencies of vitamin A and zinc, along with suboptimal breastfeeding; is the underlying cause of death in an estimated 45% of all deaths among children under 5 years of age - rate of progress is close to the rate required to meet the MDG target, however improvements have been unevenly distributed between and within different regions Goal 2: Achieve Universal Primary Education - Barriers: Poverty, child labour, Gender discrimination, conflict, disabilities, language challenges - Enrolment in Primary education has reached 91% (2015) Goal 3: Promote Gender Equality Strategy - Strengthen nutrition, disease prevention, and maternal health programs - Ensure education and life skills - Promote access to credit and economic opportunity Goal 4: Reduce Childhood Mortality - Between 1990 and 2013, under-5 mortality declined by 49% - achieving high levels of immunization coverage Strategy - Strengthen national health systems - Expand immunization programs - Ensure the survival and health of mothers - Protect the poor form ill health and unaffordable costs of treatment Goal 5: Improve Maternal Health Leading cause of death 1. Pre-existing conditions 2. Severe bleeding 3. Pregnancy-induced high blood pressure Strategy 1. Quality care before, during and after childbirth 2. Essential medicine 3. Safe blood supplies Goal 6: Combat HIV/AIDS, Malaria, and Other Diseases Strategy - Mass mosquito net campaigns - Community health workers + technology - Free HIV treatment campaigns - Training nurse and midwives in preventing mother-to-child HIV transmission

Exam 4

Goal 7: Ensure Environmental Sustainability Goal 8: Enhancing Partnerships for Development Global partnership for development - Promote debt relief - Develop IT infrastructure - Expand trade agreements - Improve access to affordable drugs - Increase poverty-reducing expenditures Know the key health status Indicators - Infant mortality rate - Life expectancy at birth - Maternal mortality ratio - Neonatal Mortality Rate - Under-5 Mortality Rate

Climate change and Sea Level Rise Why are rising sea levels a public health concern? 1. Natural disaster- Amplified flooding, storm surge, hurricane  climate change and sea-level rise can increase destructive potential 2. Shoreline erosion and degradation, and permanent inundation 3. Sea water intrusion - Invasion of seawater into fresh water and brackish areas  interfere with coastal ecosystem reduce and destroy biodiversity  impacts on community who relies their food source and water that are potential to get destroyed by sea water intrusion. 4. Change in disease pattern  Mosquito Borne disease: Malaria and Dengue - Sea level rising cause water to be stagnate Warm, stagnant and brackish water is perfect breeding grounds for disease-bearing mosquitoes.  Sea-borne disease - Cholera- sea-dwelling bacterium. Sea-level rise in connection with changes in connection with changes in currents and sea temperatures could promote the spread of cholera. - Sea water level rise could lead consequences by contamination of drinking water supplies which cholera spreads to drinking water. - Vibro vulnificus- another bacterium, found in most ocean waters  cause wound infections where open wound is exposed to seawater  amputation and/or death - Links to sea temperature. - Algae Blooms- increased by temperature, nutrients from agricultural run-off and other ocean properties. - Some algae produce toxic chemicals which can affect humans and animals when present in high concentrations.

Exam 4

5. Increase chemical contamination/toxicity of rising waters - Flooding covers the chemical plants, petroleum facilities and contaminated sites. - Commercial establishments such as pest hazardous chemicals are released into floodwaters. - Flooding added oil and gasoline and biological wastes  - These waters showed excessive levels of E.coli and lead  risks for emergency response workers and resident  worsening spread of toxic and contagions - Soil contaminations still pose risks of longer-term poisoning. How is human health threatened by rising sea levels? 1. Floods, droughts and storms immediate effects of physical injury and morbidity and mortality through to potentially long-lasting effects on mental health. It also increases risk of drowning. Floods increase diarrheal and respiratory diseases. 2. Changes in temperature and rainfall affect distribution of disease vectors (Malaria and dengue) 3. Climate change involves more hunger and malnutrition. Reducing the impact on sea level rising? - Initiating a coastal retreat policy - Work towards to reduce Co2, such as hydrogen fuel-cell vehicles. Renewable energy such as Photovoltaic, solar thermal, wave and wind power, and dams for generation of hydropower. Know the international agreements 1. Montreal Protocol - is a global agreement to protect and restore the ozone layer by phasing out the production and consumption of ozone-depleting substances such as chlorofluorocarbons and halons 2. Kyoto Protocol - The Kyoto Protocol is an international agreement that called for industrialized nations to reduce their greenhouse gas emissions significantly. - Aim to reduce carbon dioxide emission and the presence of greenhouses gases in the atmosphere. 3. Paris Climate Agreement - Legally binding international treaty on climate change - Goal is to limit global warming to well below 2, preferably to 1.5 degrees Celsius, compared to pre- industrial levels.

Exam 4

Future Public Health and Revisiting Major Public Health Topics Reductionist VS System Thinking- know this well Reductionist - Often usen in public health and medicine to search for one-and-only answer to the why, etiology and answer to what should be done to improve outcome - Looks at one factor or variable at a time - Reduces the problem to one potential “cause” and one potential “effect”

System Thinking Increasingly important that to look at the impacts of multiple factors and see how they work together as part of the system Goes beyond reductionist thinking to look at multiple factors that cause disease and disease outcomes. Focus on multiple factors and how they fit together that distinguishes reductionist thinking from systems thinking.

Public health “mistakes from the past” – lessons we learned from them 1. Intervention VS Preparation - Lessons: Avoid implementing interventions when preparation is enough 2. Safety of Large Scale Interventions - Dalkon Shield- helps prevent pregnancy. This caused cause major complications of infections. - Lessons: Make sure interventions do more good than harm 3. Expectations of disease elimination - Lesson learned: Control of disease is often possible, elimination is rarely realistics Three major types of “transitions” that will affect the future of public health (it is also the causes of non-communicable disease) 1. Demographic Transition explain the changes in the population - As aging population increase, Non-communicable diseases increase in developed countries. The demographic Transition shows in societies with advanced technology, education and economic development have low birth rate and low death rate. Less developed countries otherwise. 2. Nutrition Transition - model used to describe the shifts in diets, physical activity and causes of disease that accompany changes in economic development, lifestyle, urbanisation, and demography.

3. Epidemiological Transition

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Describes the changing pattern of disease as the countries have experienced social and economic development.

Revisiting Major Themes of the Class Frieden’s Health Impact Pyramid, social determinants of health - Exam 3 Notes Belmont Report - Exam 2 Notes PERIE - Exam 1 Notes Socio-ecological model of health

studies how behaviors form based on characteristics of individuals, communities, nations and levels in between. In examining these intervals and how they interact and overlap, public health experts can develop strategies to promote wellbeing It addresses the importance of interventions directed at changing interpersonal, organizational, community, and public policy, factors which support and maintain unhealthy behaviors. The model assumes that appropriate changes in the social environment will produce changes in individuals, and that the support of individuals in the population is essential for implementing environmental changes....