Public Health 101 Notes PDF

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Thursday, January 30, 2020

Public Health 101 Chapter 2: Evidence-Based Public Health P.E.R.I.E Process -

Problem Etiology Recommendations Implementation Evaluation

Describe a Health Problem - Burden of disease • Morbidity • Mortality - Course of disease • Incidence • Prevalence • Case fatality rate - Distribution of disease • Who? • Where? • When? • Person, time, place

Distribution of Disease and Hypothesis Development - Person, place, and risk indicators (aka risk markers) • Person - Demographics and behaviors • Place - Geographic location - Risk indicator = when a disease occurs more frequently with certain -

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demographics, behaviors, and/or geographic locations, the marker is considered a risk indicator Myocardial infarction (heart attack) risk indicators • High blood pressure • Unhealthy cholesterol Lebel • Diabetes mellitus • Obesity • Low levels of physical activity • Alcohol abuse • Tobacco use • Genetics

Thursday, January 30, 2020

Etiology: Establishing Contributory Cause

- Three criteria for establishing cause • Cause is associated with the effect at the individual level - Cause and potential effect occur more frequently than expected by chance • Cause precedes the effect in time - The potential cause is present an an earlier time the potential effect • Altering the cause alters the effect - When the potential cause is reduced or removed, the potential effect is also reduced or eliminated

What id You Cannot Find a Contributory Cause?

- Four widely used criteria for supportive evidence • Strength of relationship - How closely related is a risk factor to a disease • A probability question • Dose-response relationship - Is more exposure to a risk more likely to result in the illness? • Consistency of the relationship - Are exposures and outcomes consistent across geographic regions? • Biological plausibility - Does it make sense that the health outcome could happen more among exposures to a specific?

Hierarchy of Evidence

- Group association (hypothesis generation) • population/ecological studies - Individual association (requirement 1) • Case-control studies - “Cause” precedes “effect” (requirement 2) • Cohort studies - Altering the “cause: alters the “effect” (requirement 3) • Randomized controlled trial or natural experiments - Contributory cause or efficacy • Supportive criterion - Consistency - Strength - Dose response - Biological plausibility

Intervention Levels

- Primary • Takes place before onset of disease/health problem - Secondary • Occurs after the development of disease, but before symptoms appear 2

Thursday, January 30, 2020

- Tertiary • Occurs after symptoms start bit before irreversible disability

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