Fact Sheet Based on Pre-Readings

Mission of public health- create conditions so people can be healthy by addressing

broader health issues and underlying causes
o Upstream strategy (prevention) vs. downstream strategy (intervention)
o How we use population health (the health outcomes and determinants) to
create healthy conditions for individuals and environment
Public health dept. partner with clinicians to reorient towards prevention and wellness
Collaboration between clinical care and public health
o Link community with clinicians to provide services public health did before (but
wont now due to ACA policies)
o Increase role in monitoring community and monitoring cost, access, and quality
of treatment
History of practices
o Early 1900s to 1950s- racial zoning practices and racially restrictive covenants
o 1940s to 1970s redlining and mortgage security/federal loan maps
disinvestment
o Present concentrated poverty areas, infant mortality rates, teen pregnancies,
low life expectancy, lead levels, food deserts, accesshistorical disadvantages
because of policy carried over
Population health goal distribution of health outcomes across a geographically defined
area and how individual biology/behavior, socioeconomic cultural factors, and public
health/healthcare effectiveness contribute to those outcomes
o Measured by morbidity/health status (quality of life) and mortality (length of
life) these are health outcomes
o Health outcomes + determinants
Health value combo of improved population health outcomes + sustainable health
costs
o Triple aim improve population health, improve individual care,
decrease/sustain health costs (hitting everything basically)
Incidence-rate of new (or newly diagnosed) cases of the disease (# new cases/
population)
o Prevalence: # people with disease / # people examined, how much of disease is
there at particular point in time
Case-centered approach: individuals, determinant of individual case, treat the
symptoms/conditiondownstream
o Vs. population approach: determinants of incident rate, address underlying
causesupstream
Bioethics
o Emotional engagement influences moral judgments (not solely rationalism)
Preventive medicine care of individual patient + public health
o Similarity of preventive medicine and public health promotion of health,
prevention of diseases, application of epidemiology
 o Differences preventive medicine enhance individual lives by helping them
improve their health, public health promote health in populations through
community organized efforts
o Primary prevention = health promotion
o Promote quaternary prevention through narrative based medicine (trust,
listening) and evidence based medicine (probabilities of therapy/tests,
pros/cons)
o value based judgment judgment based on a particular set of values or on a
particular value system.
Pandemic Ethics
o Privacy may need to change slightly because need to collect pandemic data and
share it, so autonomy may need to be shifted
o Quarantine, isolation may limit personal freedom for the benefit of larger society
o Shift from personal freedom/autonomy to community needs/benefits (ex:
mandatory vaccinations? Resource allocation?)
o Resource allocation
Utilitarianism- medical utility vs. social utility
Egalitarianism- lottery
o Triage
Clinical triage (most urgent treat) vs. battlefield triage (most useful treat)
o isolation - someone is actually ill and we have separated them
o quarantine- may have been infected, watching them to see if they get sick and
separating them from others to monitor them