PHPH 101
Section III: Preventing Disease, Disability and Death (team leader: Baumgartner)
Unit Central Question:
Chapter 6: Non-Communicable Diseases
Chapter Central Question:
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Learning Objectives (paraphrased from p. 87 of text)
o Describe the burden of non-communicable diseases in US
o Describe the epidemiologic transition
o Describe the best criteria for screening
o Explain multiple risk factor intervention for non-communicable disease control
o Describe cost-effectiveness of prevention vs care
o Describe ways that genetic intervention can affect the burden of NC disease
o Describe ways that population interventions can be combined with individual
interventions to reduce the burden of disease
Class 1 (RB and EPH Faculty)
 The “Epidemiologic Transition”
 Terms, Concepts and Methods
o What is a “non-communicable disease”?
 Acute vs. Chronic
o What is “Burden of Disease”?
 Prevalence vs Incidence
 Uses: estimation of costs for prevention, treatment and care
o What is “Surveillance”?
 Cancer Registries
o What is “Screening”?
 Population Surveys
 Criteria: burden of disease, prospect for prevention with early detection
 Screening Methods (not the same as “diagnosis”)
 Sensitivity/Specificity
o Validity and bias
 Feasibility
 Acceptability and cost
 Comparative examples (p. 91 Table 6-1 expanded)
 Genetic screening: ethical issues, pros and cons
 Examples and discussion (Table 6-1, p. 91)
Chapter 6: Non-Communicable Diseases
Class 2 (RB and EPH Faculty)
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Description of major non-communicable diseases
o Rank by morbidity, mortality and health care costs
o Sources of “vital statistics”
Risk factor identification
o Role of analytical epidemiology
 Study designs, strengths and weaknesses
 Risk factors (“determinants”) vs causal factors (“actual causes”)
 “Web” of causation
 Limits of causal inference
o Confounding
 Measures of Relative Risk, Attributable Risk, and Preventable Fraction
o Example: Framingham Heart Study
Risk factor intervention
o Population vs Individual Levels (“Water Flouridation” vs “Toothbrush”)
 Primary prevention
 Secondary prevention
 Tertiary: Clinical Treatment
Single vs multiple risk factor reduction
o Altering a few risk factors may reduce many non-communicable diseases
 Energy balance (obesity)
 Smoking
 Alcohol/drugs
Cost-effectiveness analysis (Figure 6-1)
Reality: politics, laws, ethics and unintended consequences
o The Tobacco story
Chapter 7: Communicable Diseases
Chapter Central Question:
Learning Objectives (paraphrased from p. 99 of text)
 Describe the burden of communicable diseases
 Identify the role of barrier protection (prophylaxis) in prevention
 Identify the role of vaccination
 Identify the roles of screening, case finding, contact treatment
 Identify the conditions for eradication
 Describe range of options for controlling HIV/AIDS
Class 1 (RB and EPH Faculty)
 The “Epidemiologic Transition” revisited
o Example
 The decline and re-emergence of TB
 The McKeown Thesis: a public health controversy
 The decline and re-emergence of malaria
 The “Silent Spring” story
 Terms, Concepts and Methods
o What is a “communicable disease”?
 Infectious, acute, chronic
o How are “communicable diseases” transmitted?
 Agent
 Host
 Reservoir/Carrier
 Vector
o What factors modify risk for “communicable diseases”?
 Susceptibility and resistance
 Individual vs “herd” immunity
 Passive and active immunity
 Antibiotics
 Immunization
 Virulence (example flu vs ebola)
o How do we control “communicable diseases”?
 Quarantine
 Barriers (Prophylaxis)
 Vector control
 Vaccination
Chapter 7: Communicable Diseases
Class 2 (RB and EPH Faculty)
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“How do they know when there is an outbreak or epidemic”?
o Group discussion topics
 What is meant by an “excess” of cases?
 What is the difference between an “outbreak” and an “epidemic”
 What is the meaning of “endemic”
o Exercise – Modeling an epidemic
“What do they do when they detect an outbreak”?
o Case Studies
 Sin Nombre (Hanta virus)
 Salmonella in cucumbers
 Mad-cow disease
 Student-generated examples
Can we truly “eradicate” communicable diseases?
o Group discussion topics
 Conditions for eradication (Table 7-1, p. 105)
 The Antibiotic Conundrum (nasty little bacteria evolve!)
 Small pox vs HIV vs Flu (all viruses are not the same!)
Chapter 8: Environmental Health and Safety
Chapter Central Question:
Learning Objectives (paraphrased from p. 111 of text)
 Define the scope of morbidity and mortality caused by the physical environment
 Identify the range of interactions that occur between human being and the physical
environment
 Identify the components of environmental risk assessment and apply them to an environmental
hazard, such as lead
 Distinguish between a risk assessment, a public health assessment, and an ecological
assessment
 Discuss the meaning of interactions and how they may impact the size of risks
 Illustrate how safety issues, such as motor vehicle injuries, have been addressed using a systems
thinking approach
Class 1
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Terms, Concepts and Methods
o What is the “environment”? (Figure 8-1)
 Natural
 Earth, wind and fire (ancient Greeks)
o Student generated examples
 Altered
 “Man-made” (un-natural) chemicals, radiation, biological products
o Student generated examples
 Built
 Results of human construction – buildings, transportation media,
communication media
o Student generated examples
o How do we assess the impact of the environment on health?
 Risk assessment
 Environmental “hazards” (Historical example: Percival Potts – chimney
sweeps)
 Approach
o Identification
o Quantification of dose-response
o Route and timing of exposure at individual/group levels
o Determinants/modifiers of susceptibility (stage of life,
genotype, phenotype, co-morbidity)
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o Characterization of risk (group vs individual level)
 Case Studies
o Benzene (“altered” or man-made)
o Radon (“natural”)
o Student-generated examples
Public health assessment
 Population risk, public policy and intervention
 Case studies
o Lead (Box 8-3 and Table 8-2)
o Fluoride (not all physical elements are “hazards”)
o Student-generated examples
Ecological assessment
 Humans as part of a biological ecosystem
 Case Studies
o Silent Spring – DDT, mosquitos, malaria and birds
o Student generated examples
Class 2
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Systems thinking in environmental health
o Terms and concepts
 Levels
 Feedback
 Interaction and effect modification
o Case Studies
 Radon and smoking on lung cancer (Box 8-5)
 Solar radiation, ozone and melanoma
 Student-generated examples
Teaching Methods:
iClickers - prompting questions for each section: pre and post lecture
Group breakout discussions for case studies
Groups may generate additional topics?
Homework on definition and calculation of basic quantitative measures: incidence, prevalence, relative
risk
Homework with epidemic modeling program