H312 AIDS and STIs in Modern Society

Winter 2014 / Sec. 001

Annie Larson, MPH

What does it mean to be

‘HEALTHY’??How do you

define

‘health’?

Health is a state of complete physical, mental and social well-

being and not merely the absence of disease.

World Health Organization (WHO), 1948Physical

Mental Social

The science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community

effort for the sanitation of the environment, the control of community

infections, the education of the individual, the organization of medical services for early

diagnosis and preventive treatment of disease and the social machinery to ensure

every individual a standard of living adequate to the maintenance of health. –

Winslow, 1920

Public Health

What is Public Health?

“The mission of public health is to fulfill society’s interest in assuring conditions in which people can be healthy.”

- Institute of Medicine, Committee for the Study of the Future of Public Health

Public Health Organizations• Oregon State University Student Health Services (SHS)

• Benton County Health Department• Oregon Health Authority - Public Health Division

(OHA)• U.S. Centers for Disease Control and Prevention

(CDC)• Food and Drug Administration (FDA)• National Institute of Health (NIH)• U.S. Department of Agriculture (USDA)• Oregon Department of Environmental Quality

(DEQ)• Occupational Safety and Health Administration

(OSHA)• World Health Organization (WHO)• UNAIDS

Public Health Terms• Etiology – The cause, set of causes, or

manner of causation of a disease or condition

• Epidemiology – the study of the distribution and determinants of health-related states or events and the application of this study to the control and prevention of disease (WHO, 2012)

• Epidemic – When the incidence of a disease are higher than the expected rate in any well-defined geographical area.

• Endemic – prevalent or peculiar to a community or population group.

Public Health Terms• Pandemic – epidemic that crosses national borders

– 1918 – Spanish Influenza Pandemic (over 50 million died worldwide)

– 1990s – HIV/AIDS

– 2003 – Severe Acute Respiratory Syndrome (SARS)

– 2009 – H1N1 “Swine Flu”

Public Health Terms• At-risk populations – Individuals in

a condition marked by a high level of susceptibility to diseases.

• Risk factors – Any action or circumstance that would increase susceptibility to diseases.

• Comorbidity– When a disease simultaneously exists with another medical condition.

•Incidence - the number of new cases of disease that develop in a population of individuals at a specified time interval.

•Prevalence – the total number of people in a given population affected by a disease at a given time.

The Focus of Public Health•The focus of public health is on

prevention of disease (vs. treatment) and reduction of health inequalities in populations (vs. individuals).

•Core functions of PH– Assess and monitor the health of

communities and population and identify health problems and priorities.

– Create public policy in collaboration with community and government leaders.

– Assure Access to appropriate and cost-effective care and services for all populations.

10 Essential Services

Basic Public Health Principles

•Socioecological Model

•Ecological Framework

•Levels of Prevention

•Epidemiological Triangle

Socio-Ecological ModelA multi-faceted approach to promoting health within a

population

Public Health’s Ecological Framework

Ecology - n. 1. The science of the relationships between organisms and their environments.

- The American Heritage Dictionary

Prevention Is Where It’s AtThree levels of prevention

Primary (steps to avoid so you don’t get hurt, sick or die)

Secondary (activities aimed at early detection) Tertiary (after the fact – treatment and

rehabilitation)Public Health Primary Care

Monitor, address population risk factors Monitor, address individual risk factors

Work in communities, mobilize partners Works with patients to prevent, detect, treat and manage disease

Promote community change through policy, system and environments Promote changes in individual behavior

Uses data based on epidemiology, demographics, and economics

Uses data based on patient history and medical science

Develops, implements and enforces and evaluates health policies

Develop and implement practice policies informed by evidence-based guidelines and policies

Levels of Prevention

Tertiary Preventi

on

Secondary Prevention

Primary Prevention

Agen

t (p

atho

gen)

Host

Environment

Pathogen is any disease producing microorganism or substance

Virulence is a pathogen’s ability to successfully invade and sustain itself in a host

ImmunocompetencyCo-morbidityAgeGenderLifestyleEthnicity

Social, political, cultural, physical…

The epidemiological triangle

Public Health Approach

What Makes Public Health so Controversial?

WHAT DO YOU THINK?GROUP ACTIVITY

1. Bicycle helmets should be required for all citizens, of any age, at all times

2. All OSU students should be required to provide proof of health insurance

3. Tax payer money should be used to treat persons with STIs

WHAT DO YOU THINK?

1.Do you think that all people deserve the same health care?

2.Do you think it’s the nation’s responsibility to provide health care?

3. Why or Why not?

SOCIAL JUSTICE "Social justice is an underlying principle for peaceful and prosperous coexistence within and among nations. We uphold the principles of social justice when we promote gender equality or the rights of indigenous peoples and migrants. We advance social justice when we remove barriers that people face because of gender, age, race, ethnicity, religion, culture or disability.”

- United Nations

Concept of Social JusticeAllocation of goods and services according

to an individual’s needs.

•Shared responsibility•Concern for communal well-being•Government ensures equity

Dorfman L, Wallack L, Woodruff K. More than a message. Health Educ Behav. 2005;32(3):320-336.

Basic Liberties?• freedom of thought;

• liberty of conscience as it affects social relationships on the grounds of religion, philosophy, and morality;

• political liberties (e.g. representative democratic institutions, freedom of speech and the press, and freedom of assembly);

• freedom of association;

• freedoms necessary for the liberty and integrity of the person (freedom from slavery, freedom of movement and a reasonable degree of freedom to choose one's occupation);

• rights and liberties covered by the rule of law.

John Rawls, 1971

Is Social Justice a Basic Liberty?

Examples of Social Justice Movements

•Political• United Nations (via Charters)• Green Party

Gender InequalityWomen’s rightsGay rights

CorporateSocial responsibilityCorporate watchdogs Greenpeace

Moral Issues that Drive Public Health

1. To advance human well-being by improving health

And

2. To do so particularly by focusing on the needs of the most disadvantaged

Gostin LO & Powers M. Health Affairs, 2006

PUBLIC HEALTH PHILOSOPHY IN THE US

“A way of doing justice, a way of asserting the value and priority of human life”

Or“The fundamental freedom to all individuals

to be left alone”Beauchamp, 1974

Public Health: The Long Road• Long term solutions with little notable short-term gain

• In many cases, those that pay for public health measures are not the ones that directly benefit

• Costs are more concrete than benefits (e.g. – how many lives will be saved or diseases prevented from public health policy?)

• Most public health measures have an economic impact

• Car manufacturers install emission detectors in cars• Hepatitis B immunization required for school-aged

children• “Mad cow” disease in US beef supply

“Right” v. “Wrong”???

-Economic Environment

-Social Environment

-Physical Environment

-Service Environment

ENVIRONMENTAL FRAMEWORK

•Environmental factors responsible for increases in emergent / resurgent diseases

– War / refugee migration, famine and disasters

– Irrigation, deforestation and reforestation

– Globalization

– Global Poverty

The Global Environment

•What are some of the ways that poverty impacts health?

Global Poverty & Health

Global poverty

• 20% of the world’s population consume 86% of the world’s resources.

• 1/5 of the world’s population is live in extreme poverty

• 40% of the world’s population accounts for 5% of global income.

Distribution of Wealth

How might this influence he

alth?

• ~ 8 million people die annually because they are too poor to stay alive.• ~ 2.8 billion live in relative poverty ($1-2/day)•~1.2 billion people worldwide (1 in 6) live in extreme poverty (less than $1/day)

What happens when PH succeeds!

Bringing it back to sexual health

• All diseases (including STIs and HIV/AIDs) are the result of a pathogen, host, and environment

• There are many factors that influence health and well-being

• Therefore many opportunities to intervene

Public Health Review1. Define Healthy2. Explain the mission and focus of

public health.3. How does public health meet its

mission?4. What is public health’s ecological

framework?5. Be able to define and give

examples of common public health terms.

6. Why do we discuss poverty in this class?