Public Health and key terms
A public health approach
Core function and essential services of PH
- Hazards Identification - Exposure Assessments -Dose-Response Assessments.
Policy Interventions and Co-benefits
Data statistical
General knowledge
PA , according to Clean Air Act regulate air pollutant with six criteria, so we will pay attention on two criteria: particular matter and ozone. So there are given the containing air pollution which is allowable and averaging period . We have a difference pollutant in different countries which is big challenges for 21th century. mg/m3= milligrams of pollutant per cubic meter of air at sea level atmospheric pressure here is a map given by EPA which represent how many countries are meeting with standard, how many are above the standard that’s been set and what kind of patterns do you notice in a map like this. Figure shows that big problems has in EastCoast and West-coast, it might be as a result of industry, lots of people, lots of car and some of this places loth of power plants!
This work is prepared by Bilal Semih Bozdemir for Nino Nizharadze Shota Rusteveli University Batumi Georgia
IIs able to seek new, original ways of solving complex problems, including conducting independent research using the latest methods and approaches; Can apply the principles of epidemiology and preventive medicine in public health practice; Is able to formulate clinical question correctly, ďŹ nd the newest and the best evidence in response to these queries,criticallyevaluatingthecredibility of the evidence, using – integrating this evidence with clinical experience,
Develop policies for the integration of physical and mental health services.
Establish partnerships with multiple sectors to address the health and social needs of people with severe mental disorders.
Include indicators that measure mortality and prevalence ofcardiovascular risk factors (e.g. hypertension, obesity, diabetes), infectious diseases and other relevant conditions in people with severe mental disorders within routine health information and monitoring systems
Allocate a greater share of available financial resources in the health budget towards mental health. • Seek and use development funding to build an integrated physical and mental health-care system. Invest in research to identify the barriers to implementation of evidence-based interventions for people with severe mental disorders, the impact of these interventions and the specific elements in multi-component interventions that have a beneficial effect.
additionalepidemiologic methods had beendeveloped andapplied to chronic diseases, injuries, birth defects, maternal-child health, occupational health, and environmental health. Then P/H workers began to look at behaviors related to health and well-being, such as amount of exercise and seat belt use. Now, with the recent explosion in molecular methods, epidemiologists can make important strides in examining genetic markers of disease risk.
Although P/H workers and direct health-care providers (clinicians) are both concerned with occurrence and control of disease, they differ greatly in how they view “the patient.”
clinician is concerned about the health of an individual; the epidemiologist is concerned about the collective health of the people in a community or population
other In other words, the clinician’s “patient” is the individual;theepidemiologist’s“patient” is the community.
Therefore , the clinician and the epidemiologist have different responsibilities when faced with a person with illness
Similarly
the epidemiologist uses the scientific methods of descriptive and analytic epidemiology as well as experience.
epidemiologic judgment, and understanding of local conditions in “diagnosing” the health of a community and proposing appropriate, practical,
acceptable public health interventions to control and prevent disease in the community.
Clinical care: prevention, treatment and management of illness and the preservation of mental and physical well-being through the services offered by medical and allied health profession.
he 1988 , the institute of medicine deďŹ ned three core functions of Public health agencies that must be carried out at all levels of government for the over PH system to work eectively. So assessment is knowing what need to be done and it’s based on the collection and analysis of the date. You have to have date before to do anything. Policy development is more broader than legislation of one, it include guidance, standard operating procedures, laws, rulls
Assurance is making sure that policy and programs get implemented by providing PH services to those it need them. PH is assuring condition in which people can be healthy
pidemiologists working in public health settings rarely act in isolation. In fact, field epidemiology is often said to be a “team sport.”
During an investigation an epidemiologist usually participates as either a member or the leader of a multidisciplinary team. Other team members may be laborato-
rians, sanitarians, infection control personnel, nurses or other clinical sta, and, increasingly, computer information specialists. Many outbreaks cross geographical and jurisdictional lines,so co-investigators may be from local, state, or federal levels of government, academicinstitutions,clinical facilities, or the private sector. To promote current and future collaboration, the epidemiologists need to maintain relationships with sta of other agencies and institutions. Mechanisms for sustaining such linkages include oďŹƒcial memoranda of understanding, sharing of published or on-line information for public health audiences and outside partners, and informal networking that takes place at professional meetings
Monitor health Diagnose and investigate Inform, educate, empower Mobilize Community partnership Develop policies Enforce laws Link to/provide care
Assure a competent workforce Evaluate Research Then essential Public Health services and epidemiology Those 10 core system of PH are important points and its show us how can be PH system delivered.
For example: the issue of tobacco use prevention under the function of assessment t first we need to monitor among people in different countries. For number 2- PH investigates risk factors associated with tobacco use, such as the risk factor develop of cancer. N3 – assessing the problem provides more date to inform policy development and that is core function oh PH. People must be informed and educated before they become empowered to make changes such as quitting tobacco use or never starting at all. Mobilize community includes the work of advocacy group to rally support about banning smoking in Public places . Policymakers should develop policies to accomplish that work. Often people might say , well raising tobacco taxes or not selling tobacco products the people under a certain age. N6 Laws and regulation can be enforced N7 to help smokers and consulting how they can stop smoking For N8 we need to ensure that the competent PH workforce is in place to help people quit smoking. For N9 we need assess how useful was our policy , how many people quit smoking, is really reduced the number of people who
bye it. We need evaluate our policy during and the end of the program, what it was supposed to do? Did the tobacco cessation program achieve its intended objectives? How successful was the policy what we implemented? So evaluation is critical throughout the entire process Researches is continually
informing everything , so think about new tobacco products are developed and there are new thinks coming out all of the time CDC’s laboratory are continuously conducting research of this new products to help us discover their potential negative health effects
80% of NCDs deaths occur in low- and middle-income countries. More than 9 million of all deaths attributed to NCDs occur before the age of 60.
Noncommunicable - or chronic - diseases are diseases of long duration and generally slow progression. The four main types of noncommunicable diseases are cardiovascular diseases (like heart attacks and stroke), cancer, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes.
INoncommunicable diseases (NCDs), primarily cardiovascular diseases, cancers, chronic respiratory diseasesand diabetes,are responsible for 63% of all deaths worldwide (36 million out 57 million global deaths).
INoncommunicable diseases, or NCDs, are by far the leading cause of death in the world, representing 63% of all annual deaths. Noncommunicable diseases (NCDs) kill more than 36 million people each year. Some 80% of all NCD deaths occur in low- and middle-income countries.
NCDs force many people into, or entrench them in poverty due to catastrophic expenditures for treatment. They also have a large impact on undercutting productivity
noncommunicable diseases were eliminated, at around three-quarters of heart disease,
The main determinants of NCDs and injuries can be grouped into environmental and behavioural risk factors, which are potentially modiďŹ able; non-modiďŹ able risk factors
stroke and type 2 diabetes would be prevented; and 40% of cancer would be prevented.
such as a person’s age, genes, and fetal origins; and physiological risk factors, such as obesity, hypertension, and adverse serum cholesterol concentrations
nact and enforce comprehensive bans on tobacco advertising, promotion and sponsorship
Eliminate exposure to second-hand tobacco smoke in all indoorworkplaces, public places, and public transport Implement eective mass media campaigns that educate the public about the harms of smoking/ tobacco use and
second-hand smoke -Increase excise taxes on alcoholic beverages -Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (acrossmultiple types of media) -Enact and enforce restrictions on the physical availability of retailed alcohol (via reduced hours of sale) -Reduce salt intake through the reformulation of food products to contain less salt and the setting of target levels for the amount of salt in foods and meals -Reduce salt intake through the establishment of a supportive environment in public institutions such as hospitals, schools, workplaces and nursing homes, to enable lower sodium options to be provided -Reduce salt intake through a behaviour change communication and mass media campaign -Reduce salt intake through the implementation of front-of-pack labelling.
evere mental disorders aect more than 4% of the adult population. People with severe mental disorders die on average 10-20 years earlier than the general population. The disparity is highest in low- and middle-in-
come settings. Most deaths are due to preventable physical diseases, especially cardiovascular disease, respiratory disease and infections. People People with severe mental disorders are 2-4 times more likely to die due to unnatural causes, including suicide, homicide and accidents, than the general population. In about 50% of those dying by suicide, a mental disorder was present. Many lives can be saved by ensuring that people with severe mental disorders receive treatment. Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves.
um rem entur as mos dolo ea quiantis aperum autatatibus, soluptatibus elestru pitassi con consectusdam a nimus volorro mo cullest laborerro beatem repudam nulla nihic tem solent. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. In the past three decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels.
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. For people living with diabetes, access to aordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025.
ublic support for such tax increases could be increased if the revenue they generate is earmarked for efforts to improve health systems, encourage healthier diets and increase physical activity. A number of countries have taken fiscal measures to protect people from unhealthy products.
These include Mexico, which has implemented an excise tax on non-alcoholic beverages with added sugar, and Hungary, which has imposed a tax on packaged products with high sugars, salt or caffeine levels. Countries, suchas the Philippines, South Africa and the United Kingdom of Great Britain and Northern Ireland have also announced intentions to implement taxes on sugary drinks.
One way of providing information on the state of the environment and its potential effects on health is in the form of indicators. WHO, through a participatory process, has developed a framework of children’s environmental health indicators.
Exposures Multiple Effects (MEME) model provides the conceptual and theoretical basis for the development, collection and use of children’s environmental health indicators. This model emphasizes the complex relationships between environmental exposures and child health outcomes. Individual exposures can lead to many different health outcomes; specific health outcomes can be attributed to many different exposures.
mprove assessment of children’s environmental health and monitor the success or failure of interventions Facilitate the ability of policy-makers to improve environmental conditions for children The implementation of this Initia-
tive is lead by the World Health Organization. It builds on existing international, regional and national work on child health and environmental indicators by initiating a series of regional pilots to develop, collect and report children’s environmental health indicators. The Initiative aims to ensure equal relevance of the indicators for the health and environment sectors so that both can monitor their efforts towards realizing healthy environments for healthy children. EPA , according to Clean Air Act regulate air pollutant with six criteria, so we will pay attention on two criteria: particular matter and ozone. So there are given the containing air pollution which is allowable and averaging period . We have a difference pollutant in different countries which is big challenges for 21th century.
mg/m3= milligrams of pollutant per cubic meter of air at sea level atmospheric pressure There is a map given by EPA which represent how many countries are meeting with standard, how many are above the standard that’s been set and what kind of patterns do you notice in a map like this. Figure shows that big problems has in East-Coast and West-coast, it might be as a result of industry, lots of people, lots of car and some of this places loth of power plants Impact of PM 2,5 particulate Matter is basically an umbrella term that encompasses wide array of materials that are classiďŹ ed by size. Our body has natural defense mechanisms to prevent us from inhaling larger product particles
Air pollution widely can cause range of documented impact : cancer, heart disease, exacerbation of asthma, stroke Just how small this particles are , this is a slide which shows that basically a grain on the lower left
and that’s roughly 90 microns in diameter. if we zoom it into the middle we see a human air which is roughly 70 microns diameter, if we go to the end the air you see pm10 so particles that are 10 microns are smaller in diameter and PM 2,5 is even smaller than that . The size is really important in causing adverse health effects and its actually only fairly recently that we have been able to actually detect particles at that size. So in this country we’ve been monitoring PM 2,5 since late 90s and in a lot of developing countries we’ve still monitoring PM10 because filter system are very expensive to monitor PM2,5 Ozone comes in two forms , so we have stratospheric ozone which is way up high in the atmosphere , that protects us from the suns’s harmful UV radiation, so we think about the hole in the ozone layer we’re talked about stratospheric ozone . Ground level is tropospheric ozone what’s referred to a smog and what we are concerned about and than we regulate in this country . Environmental conditions (temperature, water) play much role In the process of forming Ozone volatile organic compounds
Ozone is stimulated by sunlight and temperature, so the warmer it’s the more we’re gone see it. it’s a temporal characteristic of ozone formation and that’s priority problem especially I the summer and in the warmer months when
people are more outside so they are being exposed to ground -level ozone more There are 3 components given by EPA to estimate the risk. 1. hazards identifications and about prioritize different environmental issues.
exposure assessments containskey challenges inenvironmental epidemiology and done-response of air pollution. Because we are sort of still at the cutting edge, so we sort of combine this 3 components to come up with risk estimate. Team scientists around the world documented the changes related climate change, which cause temperature change and it’s impact oh the health of human, we started from1900 and there is two types of patterns for challenges On the left we have physical characteristicsofclimatechange, basically there are many complicated mechanisms by warming temperature.
In the middle on the top we have urban heat island eect which explains that when we pave more green area we change energy balance of system the reectivity of the Earth surface but when we
are reducing the green area we are capturing more heat. Climate change can cause more complication of Public Health system. We may have new vector and diseases which we never have seen before Natural disaster
Personal characteristics -Co-morbidities, genetic differences, immune status , Habits, -human behavior , access to social networks, Location, -spatial differences in vulnerability
And at the end clinical disease , this time depends on the time requires by data collection, conduct study, it might be a quite a bit , before you see an adverse health response associated your exposure of interest.
Gather Available Information and Data The first step in assessing exposures to environmental agents is to have a thorough understanding the processes, tasks, and contaminants to be studied. Information may be obtained through ...
The goal of defining SEGs is to minimize the variability of exposure monitoring data. For highly dynamic work sites where activities and related exposures may vary significantly from day-to-day
For example, welding has the potential of generating metal fumes and fluorides in addition to other gases. For this example, the SEGs may be defined by the specific welding technique, the type of material being welded and welding consumable, the welding task, the environmental agent, and the engineering controls. The objective in defining SEGs is to minimize the variation between air-sampling results.
y the Beijing Monitoring System for Cardiovascular Diseases, which covers all hospital admissions and deaths from IHD from Beijing’s population of 19.61 million.
Results The mean daily PM2.5 concentration was 96.2 µg/ m3 with a range from 3.9 to 493.9 µg/m3. Only 15.3% of the daily PM2.5concentrations achieved WHO Air Quality Guidelines target (25 µg/m3) in the study period.
A 10 µg/m3 increase in PM2.5 was associated with a 0.27 increase in IHD morbidity and a 0.25% increase in mortality on the same day. During the 3 years, there were 7703 cases and 1475 deaths advanced by PM2.5 pollution over expected rates if daily levels had not exceeded the WHO target.
pidemiologist try to move people away from the sources its energy which is harmful for health , to protect from exposures of particulates and carbon monoxide. he Centre for Environmental & Occupational Health (CEOH) is a new department at NCDC (INDIA), which has been established in the month of February 2015 with the following objectives.
nhance health-sector leadership for creating a healthier environment through intensifying primary prevention aimed at tackling the
root causes of environmental & occupational threats to health, and inuencing public policies in all sectors to respond to emerging & re-emerging consequences of development
In September 2015, Member States of the United Nations adopted the Sustainable Development Goals (SDGs), a set of aspirational global goals
to guide the international sustainable development and poverty alleviation agenda going forward to 2030. Household energy is explicitly addressed in SDG 7: “ensure access to affordable, reliable, sustainableand modern energyfor all”by 2030. One indicator for measuring progress toward this ambitious goal is the percentage of the global population relying primarily on clean fuels and technologies. The SDG targets reflect a new understanding that household energy is not just the province of environment and energy ministries, but a critically important consideration in many facets of human development, from health (SDG 3) to sustainable urban environments
(SDG 11) to gender equality (SDG 5) to climate action (SDG 13). Ground-level of Smog is formed when sunlight reacts with nitrogen oxides (Nox) and volatile organic compounds (VOCs) Secondary pollutant Exposure is associated with Asthma
bronchitis, heart attacks, increase to susceptibility with infections, premature mortality nitrogen oxides (NOx) and volatile organic compounds (VOCs) from industrial and automobile emissions, gasoline vapors, chemical solvents, and electrical utilities electricity generation, fossil-fuel combustion, industrial processes, automobile emissions
nterferes with the ability of certain plants to respire, leading to increased susceptibility to other environmental stressors (e.g., disease, harsh weather) contributes to formation of haze as well as acid rain, which changes
the pH balance of waterways and damages foliage, buildings, and monuments loss of biodiversity, decreased reproduction, neurological problems in vertebrates
inflammation and irritation of breathing passages breathing difficulties, particularly for people with asthma and heart disease reduced lung function; irritation and inflammation of breathing passages
So in USA we are relatively rich country so we currently experience a high burden non communicable disease chronic diseases diabetes, cancer, store.
there are sort of more tied to life style factors , in developing countries there is higher burden of infections diseases like malaria diarrhea which related to environmental conditions.
But there are countries were both , burden of communicable and non-comm. diases ar high due to different exposure factors (like India)
It considered different environments that we all spend our time in and how they shape our well-being, so a lot of the work in this field actually stems from occupational exposure and those were some of the those studies.
2007–2008
2001–2004
1984–2009
1979–2009
’s a temporal characteristic of ozone formation and that’s priority problem especially I the summer and in the warmer months when people are more outside so they are being exposed to ground -level ozone more. As we have mentioned environmental epidemiology is based on history of occupational exposures that is why we’ve started looking in terms what times of pollutants someone might be exposed to like if they were in a steel mill or a coal mine. ven the past few decades in particular we broadened our focus and Environmental epidemiology, to focus more on sort of general population level environmental
exposures, thinks like fluted air, fluted water. Global exposures means global climate change are expected to adversely affect human health. Team scientists around the world documented the changes re-
lated climate change, which cause temperature change and it’s impact oh the health of human, we started from1900 and there is two types of patterns for challenges
