PH50B
Study Guides
Winter 2025
Section 1B
TA - Jessica Obidike
2 Volunteers to Share Screen & Progress Slides
Take 5 minutes to work on each question
(Do not copy and paste from articles)
Challenges in Public Health
Study Guide (Lecture 1)
Group 1 (Alana Cho, Orisha Lamon, Maria Kefalas, Marco Segovia, Morgan Moore, David Nguyen ):
1.
In the lecture, the terms “double burden” and “epidemiologic transition” were introduced. What do they refer to and how do they apply when comparing
highly developed, developing, and least developed countries?
Double Burden refers to the burden of having both chronic disease and infectious diseases in a population. This double burden is evident mainly in developing
countries (ex: India, Ghana). Developed countries primarily deal with chronic diseases, while newly developing countries deal with higher levels of infectious
disease due to poor infrastructure, poverty, inadequate healthcare, etc. - face burden of morbidity and mortality - in relation to epi transition
An epidemiological transition may be due to changing patterns of, population age distributions, mortality and causes of death, fertility and life
expectancy
When comparing between the highly developed, developing, and least developed countries:
An example may be within the developed world there are improvements within infrastructure such as sanitation and living conditions as a result of
the rising affluence of a developed country. In comparison to a developing country that may have less advanced infrastructure to keep up with the
globalized world, leaving populations susceptible to disease and increased burden
Epidemiologic transition describes differences of patterns of mortality, particularly due to disease, between developing and developed countries. Generally, a
developing civilization experiences a high risk of exposure to disease, as seen in the prevalence of cholera in many countries in Africa due to a lack of adequate
water treatment and sewage infrastructure, for instance. As a country becomes more developed, adequate infrastructure is built, population density generally
decreases, and treatments for many diseases become readily available.
The report on the Future of the Public’s Health in the 21st Century proposes six areas of action and change to be undertaken by all who work to
assure population health. What are these six areas?
-
adopting a population approach that considers the multiple determinants of health
strengthening the governmental public health infrastructure, which forms the backbone of the public health system
building a new generation of intersectoral partnerships that also draw on the perspectives and actively engage them in health action
developing systems of accountability to assure the quality and availability of public health services
making evidence the foundation of decision making and the measure of success
enhancing and facilitating communication within the public health system
Group 2 (Lonnie Chen, Maya Yates, Jennifer Antonio, Natalie Gomez-Aguilar, Melanie Gomez-Aguilar):
2. How do the health statistics for infant mortality rates, under 5 mortality rates, and life expectancy compare between the most highly developed and
the least developed countries?
●
●
●
Higher life expectancy in developed countries,
Mortality rates are lower in developing countries
Due to many factors
○
Nutrition
○
Accessibility to proper healthcare
○
Hygiene
○
Communicable Diseases
○
Health literacy
○
Access to immunizations (influenza, hep B, etc.)
○
Overall economic disparities
Group 3 (first, last name): Luella Messex, Jada Guzman, Saiya Shah, Mya Ferrer, Grace Jacildone
3. Why does the future of public health require partnerships beyond governmental public health agencies?
-
Growing recognition that individuals, communities, and social institutions can form powerful relationships to improve health
Public health is not always a government priority, especially depending on who is in office
Local organizations may have a better understanding of the issues within their community than the government
Holistic approach to health disparities
Public resources are finite, public health is just one of many priorities
Committee envisioned a system approach to creating a stronger public health system
FROM EXECUTIVE SUMMARY
First, public resources are nite, and the public’s health is just one of many priorities.
Second, democratic societies define and limit the types of actions that can be undertaken only by government and
reserve other social choices for private institutions.
Third, the determinants that interact to create good or ill health derive from various sources and sectors. Among other
factors, health is shaped by laws and policies, employment and income, and social norms and inuences
Fourth, there is a growing recognition that individuals, communities, and various social institutions can form powerful
collaborative relationships to improve health that government alone cannot replicate.
Group 4 (first, last name): Shreya Lakkaraju, Angela Perez, Vikram Senthil, Jasmine Lomeli, Holly Rahman
4. The report on the Future of the Public’s Health in the 21st Century proposes six areas of action and change to be undertaken by all who work to
assure population health. What are these six areas? *describe 2 examples of select findings for the 2nd and 3rd area of action/change
The six areas of action and change include:
(1) adopting the population health approach
(2)strengthening governmental public health infrastructure
(3) new intersectoral partnerships that draw on resources and perspectives of diverse communities to engage in health action,
(4)developing systems of accountability for public health services
(5) having evidence-based informed decisions and evidence-based measure of success,
(6)enhancing and facilitating the communication system within governmental public health, professionals, community members,
Findings:
(1)
Public health law at the federal, state, and local levels is often outdated and internally inconsistent
(a)
Leads to inefficiency and prevents immediate crisis response
(2)
The public health workforce must have appropriate education and training
(a)
All employees must demonstrate a mastery of core public health principles
*Media, healthcare systems, businesses for (3)
Group 5 (Jasmine Liu, Marlene Estrella, Juan Delgado, romina bigdeli, ashley munoz):
5. In the article on “Public Health 3.0: A Call to Action for Public Health to Meet the Challenges of the 21stCentury,” what were the recommendations
given to transform into the Public Health 3.0 model? *also define: public health 3.0 and how it relates to the CDC framework for prevention
Recommendations:
1.
Public health leaders should embrace the role of Chief Health Strategists, to form partnerships across sectors to better address the social
determinants of health.
2.
Public health departments should collaborate with both private and public sectors to create cross-sector partnerships and share resources
3.
Accreditation for health departments should be expanded to allow all communities to be served by accredited health departments
4.
Clear metrics and data access needs to be developed to allow communities to easily access timely and reliable data
5.
Funding for public health should be enhanced and modified to support Public Health 3.0 initiatives
Public health 3.0 is defined as a “new era of enhanced and broadened public health practice that goes beyond traditional public department functions
and programs.” It focuses on cross-sectoral collaboration focusing on upstream factors affecting health like education and housing stability.
It aligns with the CDC framework for prevention by placing emphasis on the second and third buckets by providing services outside a clinical setting
and implementing community wide interventions.
How it relates to the CDC framework for prevention: integration across
three areas of prevention:
traditional, innovative, total population.
Public Health Careers (class cancelled, fires)
NO Study Guide (Lecture 2)
Vet Public Health and One Health
Study Guide (Lecture 3)
1 Volunteer to Share Screen & Progress Slides
Thank you!
Group 1 (Alana Cho, Orisha Lamon, Maria Kefalas, Marco Segovia, Morgan Moore, David Nguyen ):
1.
In two sentences, describe the concept of “one health”. *Give an example
One health is the understanding that public health spans across human, animal, and environmental wellbeing & all should be considered in the
approach to protecting public health. It is important to consider the interaction between all three aspects to maximize healthy outcomes. One
example is the interaction between mosquitoes and mosquito-borne diseases, humans, and the environmental conditions that affect mosquito
populations.
Group 2 (first, last name): Maya Yates, Lonnie Chen, Melanie Gomez-Aguilar, Natalie Gomez-Aguilar, Jennifer Antonio
2. Discuss one example of a public health issue that crosses across boundaries of animal, human, and environmental health, then share out to the
group. *discuss 3 examples
●
●
●
Antimicrobial resistance AMR
○
Animal:
■
Livestock
●
Resistance and contaminations from animal to human
■
Diary
○
Human:
■
Common infections: ear infections, UTI, flu
○
Environmental:
■
Clean water (contamination)
●
Fluoride
Zoonotic Diseases
Group 3 (first, last name): Grace Jacildone, Jada Guzman, Saiya Shah
3. What are some challenges and benefits to the interdisciplinary, collaborative approach of One Health?
Challenges
Disbelief of climate change and the negative effects on human and animal health may cause people to dismiss One Health
Having a hard time engaging human medical doctors
Purely human medicine, veterinary medicine, ecological approaches alone are not sustainable
Antimicrobial resistance requires ecological, human and veterinary medicine perspectives
Different sectors have different goals and priorities, veterinarians have different priorities than medical doctors
Communications can also be difficult because it is different in practice
Benefits
Optimal health outcomes recognizing the interconnection between people, animals,plants, and their shared environment’
Able to connect trade policy concerns with trade relating to AMR in the food chain to public health policy
Form lasting bridges between veterinary science, human medicine, and ecological studies
Whole picture issue as opposed to only looking at humans or animals. Helps with understanding root issue
Group 4 (first, last name):
4. Using the topic of antimicrobial resistance, answer the following questions
a. Briefly explain the problem (antimicrobial resistance)
b. List at least 3 stakeholders that may need to be involved in addressing antimicrobial resistance.
c. Determine the interests/positions of each stakeholder you listed. Think: Do they have economic reasons for taking that position? What other
motivations might they have? Is their position at odds with another stakeholder you listed? Are they causing the problem, or helping to solve it?
d. Come up with a strategy that might help all the stakeholders you listed work together to address this public health issue.
Vaccine Preventable Disease
Study Guide (Lecture 4)
Group 1: Ashley Munoz, Angela Perez, Luella Messex, Maria Kefalas
1.
Explain what is meant by the “economic burden” of vaccine preventable diseases? (3-4 sentences)
Economic burden of vaccine preventable disease indicates that the less individuals are getting vaccinated, the more prone they are to morbidity in
the context of deaths and disabilities and an increase in health expenditures. Low rates of vaccine uptake lead to costs to individuals which are
avoidable, and they create economic losses from doctor visits, hospitalizations, and lost income because the disease prevent them from going to
work. According to the article in 2015 there was an approximate economic burden of $9 billion in indirect with inpatient and outpatient treatments and
direct costs of the individual’s wage loss.
Group 2: Jasmine Liu, Natalie Gomez-Aguilar, Holly Rahman, Shreya Lakkaraju
2. What are some issues of inequality/inequity in vaccine distribution globally? How does that affect global health?
-
Benefits of vaccines are not spread equally. 70% of children who are unvaccinated resided in middle-income countries in 2018.
Reaching all people will require higher national vaccination coverage, but also less subnational inequity.
-
Inability to access vaccines in poorer countries, rural areas
Conflict between countries when it comes to vaccine distribution (wars → lead to healthcare shortages, and difficulties accessing vaccines)
Wealthier countries tend to have access to vaccines first before low/middle income countries
-
It affects global health by not giving priority to populations that don’t have access to vaccines, which means that these populations will have
higher death rates related to the disease that burdening these populations
Higher income countries tend to receive vaccines first than lower income countries
-
Group 3: Grace Jacildone, Jasmine Lomeli, Jada Guzman, Juan Delgado
3. What are some issues of inequality/inequity in vaccine distribution that we’ve seen in the United States? How has this affected US public health?
-
“In 2018, 70% of unvaccinated children lived in middle-income countries…”
Cost
“Commercialized” free vaccines
SES
Access to healthcare services (i.e. proximity to a pharmacy, urgent care, hospital)
Lack of trust and confidence in the health system
Health literacy and disinformation
Knowledge gaps
This has led to substantial economic burden, specifically $9 billion is attributed to vaccine-preventable disease — with $7 billion being
attributed to unvaccinated individuals.
Group 4: Melanie Gomez-Aguilar, Marco Segovia, Orisha Lamon, Morgan Moore, Alana Cho
4. What are 3 barriers to addressing vaccine preventable diseases that we have seen in the context of the COVID-19 pandemic globally?
-
Practical barriers including quality access, supportive, social influences, and infrastructure, and responses to adverse events
-
Innovative approaches utilizing evidence based research and efforts of outreach to marginalized groups
-
Age, location, social and cultural and gender-related factors
-
Public trust in vaccines, reaching herd immunity -> huge complication for the COVID-19 pandemic particularly within the United States.
-
In the context of the COVID-19 pandemic globally 3 barriers can be identified looking at the lack of supportive infrastructure such as
staffing and quality of care in primarily unevenly developed nations, alongside examining demographic factors such as age, gender
and geography that may create difficulty in accessing and approaching care due to hesitancy.
-
Amount of dosages, patents of vaccines and production, and continuation of disease and area vulnerability given disparity
Group 5: Lonnie Chen, Maya Yates, Marlene Estrella, Vikram Senthilkumar, Saiya Shah
5. What are 3 barriers addressing vaccine preventable diseases that we have seen in the context of the COVID-19 pandemic in the United
States?
1.
2.
Accessing accurate information by trusted resources: rise in social media influence (can cause public hesitancy due to mistrust)
Physical Access/ Inequitable Access: unable to go to a vaccination center, Inequitable access in underserved communities: Distribution is
not as prominent in rural areas
Cost: Some vaccines are costly (Vaccine for Adult program is a lot more underfunded)
3.
Supply chain and logistical issues:The sources emphasize the importance of a reliable global supply of appropriate, affordable, innovative
vaccines.
Mental Health
Study Guide (Lecture 5)
Group 1: Ashley Munoz, Angela Perez, Luella Messex, Maria Kefalas
1.
Mental health is defined as…
Mental health has been defined recently as “a state of well-being in which the individual realises his or her own abilities, can cope with the normal
stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO)
2. What is mental health promotion?
Mental health promotion is the goal of improving mental health and wellbeing. It reflects on the connection between mental and physical health. Aims
to transform mental health issues into top priorities for people. By increasing mental health literacy, reducing risk factors, and creating safe and
healthy environments (policy making and promotion, social platforms), overall mental and physical health can improve.
3. List at least six early signs/symptoms of mental disorders.*give examples of 3 mental disorders and defining features of each
Early Signs/Symptoms
1. Loss of interest in activities that are normally pleasurable.
2. Consistently low energy, fatigue and sleep problems.
3. Feeling as if nothing matters.
4. Persistent sadness or depressed mood and anxiety.
5. Marked behavioural changes; neglecting usual responsibilities
related to work, school, domestic or social activities.
6. Agitated, aggressive behaviour, decreased or increased activity.
7. Hearing voices or seeing things that are not there.
3 Mental Disorders
1. Bipolar I and II: mania, hypomania, depression
I (more severe): manic episodes, hypomania, depression that
last weeks to months
II (less severe): hypomania, depression (no manic episodes)
2. Generalized anxiety disorders:
Distressing and unpleasant emotional state of being.
Nervousness and unease
Excessive or daily anxiety for over 6 months
3. Depression
Melancholic: Loss of pleasure in nearly all activities, inability to
respond to pleasurable stimuli
Classic view
Group 2:
4. What are the three levels/types of stigma associated with mental health disorders? *give 2 examples of each
1.
2.
3.
Structural Stigma: Systemic policies that disadvantage people with mental health disorder.
a.
when laws, policies, and practices unfairly target the group of people who require mental health access.
b.
Unequal access to mental health care
Self stigma: feelings/stereotypes about oneself that are negative and lead to low self-esteem
a.
Refusing to take medication believing they won’t help
b.
Negative beliefs that people may have about oneself/ Feeling like they are a burden
Public stigma: The negative attitude and stereotype that people tend to have about people with mental health disorders.
a.
Assuming someone is “crazy”
b.
Assuming someone is incapable if they have anxiety disorder.
Group 3: Jada Guzman, Jasmine Lomeli, Juan Delgado, Grace Jacildone
5. Integrated treatment plans are necessary for the management of mental disorders. *describe the 4 types of treatment plans
Pharmacological treatment: This includes the use of medication to treat certain mental health disorders. An example includes the prescription of lorazepam to treat
general anxiety disorder.
Psychological interventions: This is individual-focused psychological treatment that can include a wide-variety of therapies. Examples include CBT, psychoeducation,
psychotherapy, exposure therapy and others.
Social: social skills training, appropriate housing supported employment and adaptation to life in the community
Physical:electroconvulsive therapy (ECT)
List the various approaches to managing mental health disorders (See Herman, Box 1). *The prompt below is an example of what type of integrated treatment plan?
1.
2.
3.
Universal prevention → directed towards the whole population
a.
School based interventions / policy actions
Selective prevention → targets vulnerable groups / sub-groups of populations at risk
a.
Interventions that provide family support for young, single, poor, first time pregnant women
Indicated prevention → targets high risk individuals who already have experience with mental disorder symptoms
a.
Promotes coping strategies / supports individuals with depression or anxiety symptoms
Below would be an example of universal prevention:
“South Africa developed its National Mental Health Policy
Framework and Strategic Plan 2013–20205 with the aim of
addressing neglected mental health care. This policy framework
aimed to realise the integration of mental health care into a
comprehensive primary health care (PHC) approach enshrined in
the Mental Health Care Act no 17 of 2002.6,7 In order to ensure the
integration of mental health as outlined in the policy framework,
expert committees will be established within the National Health
Insurance (NHI) system, to develop guidelines for integrating
mental health into PHC where there is limited service provision.7”
- snippet from reading: Overview of mental health: A public
health priority
Group 4: Melanie Gomez-Aguilar, Marco Segovia, Orisha Lamon, Morgan Moore, Alana Cho
6. What are the United Nations Sustainable Development Goals pertaining to mental health? SDG3: Ensure healthy lives and wellbeing for all at all ages *Additionally, what
roles can pharmacists play in addressing mental health?
●
●
●
●
●
●
●
Target 3.4:
○
all countries should “by 2030 reduce by one third premature mortality from non-communicable diseases (NCDs) through prevention and treatment, and
promote mental health and wellbeing”
Target 3.5:
○
countries should “strengthen the prevention of substance abuse, including narcotic drug abuse and harmful use of alcohol”
Target 3.8:
○
countries should “achieve universal health coverage for physical and mental disorders, including financial risk protection, access to quality essential
health-care services and access to safe, effective, quality, and affordable essential medicines and vaccines for all”
Pharmacists are described as the first point of contact with the healthcares system, so uniquely well equipped to complete these tasks:
Pharmacists can play a role in addressing mental health by conducting
○
proper medication education to people to receive medications for a mental health diagnosis
○
being sure to emphasize what to expect, side effects, proper dosages, and
○
knowing how to recognize warning signs for adverse reactions to a medication.
○
Educate on the interaction of medications
There are also pharmacological causes of depression and mania such as: “hormonal therapies, antibacterial medications, antineoplastic drugs, and
Anticholinesterase insecticides” (Meyer et. al).
Overall, pharmacists are tasked with
○
helping to avoid drug related issues
○
can work with a medical care team to provide constructive advice
○
can provide risk assessments/screenings for mental health disorders and provide references to resources to address the disorders
○
Destigmatize the public perception of mental health disorders
Group 5: Lonnie Chen, Maya Yates, Marlene Estrella, Vikram Senthilkumar, Saiya Shah,Romina Bigdeli
7. According to the Meyer article, what are the stages of mental disorder? *Walk us through the stages and explain in detail.
Stage 0: Asymptomatic
No treatment/intervention
No signs of mental distress
Stage 1a: Non-specific mental distress
Identifying/exposure to stressful environments in day-to-day life
Exploring coping strategies and interventions
Mental health literacy/finding support through informal networks
Stage 1b: Subsyndromal or subthreshold symptom profile
Seeking psychosocial support from primary health care (PHC)
Identifying high-risk individuals and monitoring
Stage 2: Full defined syndrome
Receive first treatment for episode in primary care
Specialty care is available for primary health services
Referral is sent for complex cases
Stage 3: Recurrence, persistence
Community and multi-sectoral (healthcare, social services, education) support
Specialist and services in collaboration with primary health care
Stage 4: Treatment resistance
Rehabilitation and receive support from the community
Specialist mental health services are collaborated with primary health care
Disease & Health Conditions SURVEILLANCE
Study Guide (Lecture 6)
Group 1: Luella Messex, Ashley Munoz, Angela Perez, Maria Kefalas,
1. Explain the scope of public health surveillance.
1b. Explain the scope of PH surveillance at the various levels of government (local, state, federal)
Public health surveillance is the collection and analysis of health data to assess and monitor public health events. Surveillance plays a
key role in communicating health data between different health entities such as local health departments and the CDC.
Local: (infectious)
●
First public officials that receive personal health data on infectious disease.
●
Have knowledge of local medical community and can better interpret changes in data
●
Lead responsibility for further investigation
●
Promote community health and safety; Local infectious disease surveillance systems are closely associated with local disease control programs.
State: (chronic)
●
Coordinate statewide surveillance activity and information
●
Compile statewide surveillance reports about health data
●
Report appropriate surveillance data to the CDC
Federal:
●
The CDC and other federal health agencies monitor health trends and coordinate multistate outbreak responses
●
They conduct national-level surveillance programs, such as the National Health and Nutrition Examination Survey.
●
The federal government provides financial and technological support to enhance surveillance capabilities at the state and local levels.
2. Describe the three points featured in the 1995 “Blueprint”.
1.
Surveillance addresses a multitude of conditions and variety of methods for measuring and monitoring disease → straying away
from JUST disease reporting
2.
Resources are needed to support the different goals of all levels of government (federal or state), especially if one level of
government needs more support such as data collection from another level
3.
The conditions for national surveillance should be determined by collaboration of the CDC, states, and coordinated through the
Council of State and Territorial Epidemiologists (CSTE, who created the blueprint for the 21st century)
Group 2: Shreya Lakkaraju, Marco Segovia
3. Describe the goals of surveillance, which were updated at the 2011 CSTE meetings. *provide examples of how
surveillance systems are used for 2 of the goals listed (please, pull from the Groseclose reading for the examples - see table
1)
Goals of surveillance
-
-
-
to provide actionable health information to public health staff, government leaders and the public to guide policy and programs
to recognize cases or clusters of disease or injury to trigger investigations to prevent disease transmission or morbidity and mortality
Example: Supporting early detection of gonorrhea
to measure trends and characterize diseases, injuries, and risk factors and identify high-risk population groups or areas that need
interventions
Example: Detect disparities in prevalence of overweight populations/obesity based on socioeconomic status
to monitor the effectiveness of public health programs, prevention, and control measures, and public health strategies
Example: monitoring 3 million who received the H1N1 vaccine by linking data from private health plans and public immunization
registries; analysis of data to identify time-invariant confounders and comparison of current and historical data
to develop hypotheses leading to analytic studies about risk factors
to provide information to enable individuals to make informed decisions on their behavior and to health care professionals to ensure they
base their care on the most recent information
Group 3: Alana Cho, Juan Delgado, Orisha Lamon, jennifer Antonio
4. Describe both the traditional data sources and the data sources that are not directly linked to measurements of disease and injury.
*give 2-3 examples
The traditional data sources are vital statistics, reportable diseases, registries, surveys, and administrative data systems (claims, EHR)(what doctors
are looking t once in the office.
EX: vital statistics(names, births, deaths) reportable diseases-mandated disease reporting(often infectious diseases), Registries may include cancer,
immunizations and congenital malformations. Surveys may include public health conducted telephone/school based surveys and national clinical
surveys,(NHIS), administrative data may consists of claims(bills and charges after receiving care) and services medical claims have demographic,
service cots, insurance companies use data to create programs for membership base, observe uptakes in conditions)
Additional data sources are marketing data, environmental monitoring, weather reports, elements of community design, and census data.There has
been a recent trend of integrating data from multiple sources into one synthesized analysis.
EX: marketing data on health related items such as tobacco and unhealthy foods, remote sensing and climatological monitoring, urban planning and
design
Group 4: Morgan Moore, Mya Ferrer, Natalie Gomez-Aguilar, David Nguyen, Melanie Gomez-Aguilar
5. Describe the 3 major influences affecting public health surveillance.
-
-
Policy and Legislation
Government regulations, funding allocations and public health policies influence and scope the effectiveness of
surveillance efforts
Privacy laws
Technological Advancements
Emerging Health Threats
6. According to the paper, what does it propose public health epidemiologists to take to strengthen the surveillance system?
Evaluation of surveillance systems: decide which conditions to surveil, assess the value of data sources, measure cost and benefit of
surveillance systems
national standardization of surveillance systems: coordinate the creation of standards to streamline data collection
Focus on guiding principles and training that help address the demands of the 21st century: they must be open to new technologies,
approaches, and perspective while adhering to core principles and purposes that have guided surveillance in the past.
Hone their skills in disseminating their message and assess how well surveillance information is used for in regards to public action
Group 5: Romina Bigdeli, Maya Yates, Lonnie Chen, Saiya Shah
7. Stakeholder engagement in surveillance systems is important. Who are the typical stakeholders that need to be engaged?
Stakeholders in public health surveillance systems are those who contribute data or resources, act upon the information generated, or
use the information to advocate for prevention and control efforts. Stakeholder engagement is critical for surveillance systems to achieve
their greatest impact. Typical stakeholders who should be engaged in the surveillance process include:
Public health practitioners
•Health care providers
•Policy makers
•Members of affected communities
•Academia
•Professional associations
•Private industry
•Not-for-profit advocacy organizations
8. Identify what kinds of opportunities exist for enhancing surveillance practices.
Broader scope (multiple sectors) and expanded partnerships
• Increased integration with healthcare systems (e.g., electronic case
reporting)
• Premium on timeliness (real-time data) and increased data granularity
(community-level data)
• Capitalize on advances in information technology and the advent of “big
data
• Increased focus on health equity and social determinants of health
• Data security challenges
• Need for international cooperation in an era of growing nationalism
Acute Communicable Disease Control
Study Guide (Lecture 7)
****Students to complete on their own time (class voted to prioritize Qs
regarding politics analysis paper)****
Group 1:
1. (Pandemic Preparedness in the US). Briefly explain the roles of CDC epidemiologists and CDC in relation to pandemic
preparedness.
CDC epidemiologists: bolster outbreak response and disease control, identify unusual clusters of
disease, enact travel and trade restrictions, and identify tainted food products.
Group 2:
2. (Critical Deficiencies in Current Pandemic Preparedness). According to the paper, what specific deficiencies exist in current
pandemic preparedness?
Group 3: Alana Cho,
3. (Critical Deficiencies in Current Pandemic Preparedness). Describe the consequences of the politicization of public health
decisions.
A decline in funding for pandemic prevention research & emergency response preparation and lack of representation in the white
house – lead to unpreparedness in the US.
Efforts that move toward underfunding public health initiatives that are a result of geopolitical politicization and supply demands
EX: spread of COVID-19 politicized rather than informed by scientific evidence, nonpharma interventions, and anti science rhetoric
that disregard the evidence based approaches and severity of pandemics
Additionally the US manufacturing of important emergency response equipment such as PPE has greatly declined in overall capacity
due to cuts in possible federal partnerships.
Group 4:
4. (The Role of a One Health Strategy to Tackle Pandemics). Describe a One Health Strategy, and the benefits of adopting this
strategy to tackle pandemics in the United States.
5. (Six Steps to Strengthen US Pandemic Resilience). Describe the six steps proposed by the author to strengthen US pandemic
resilience.
1.
2.
3.
4.
5.
6.
Launch a National Pandemic Preparedness Commission
○
Independent body to assess COVID-19 response failures and recommend long-term improvements.
○
Led by the National Academies of Science, Engineering, and Medicine.
Modernize Public Health and Healthcare Systems
○
Restore White House Directorate for Global Health Security and Biodefense.
○
Secure funding for federal, state, and local health agencies.
○
Improve data-sharing across agencies to enhance real-time surveillance.
Reaffirm U.S. Leadership in Global Health
○
Rejoin the WHO and commit to global pandemic preparedness initiatives.
○
Support revisions to the International Health Regulations to enhance pandemic response frameworks.
Strengthen Science-Based Public Health Policy
○
Establish a permanent White House advisory committee for evidence-based pandemic decision-making.
○
Implement campaigns to counter misinformation and vaccine hesitancy.
Enhance Funding for Pandemic Research and Innovation
○
Increase NIH, CDC, and USAID funding for emerging disease research.
○
Invest in global research partnerships for vaccine and therapeutic development.
○
Support U.S. laboratories in disease hotspots to improve early detection capabilities.
Adopt a Comprehensive One Health Strategy
○
Form an interagency One Health task force at the White House.
○
Strengthen wildlife disease surveillance at ports of entry.
○
Expand collaboration with global agencies to mitigate zoonotic disease emergence.
Group 5: Romina Bigdeli, Maya Yates, Saiya Shah
6. Describe emerging global challenges with regard to infectious disease.
Challenges include urbanization, climate change, increased human-animal interactions, and globalized travel, all of which amplify
disease transmission risks. Weak health systems and antimicrobial resistance further exacerbate these issues.
7. Describe the responses to proactively reduce the risk posed by infectious disease threats and prepare for inevitable outbreaks.
(Table 4)
Sexually Transmitted Infections
Study Guide (Lecture 8)
Group 1:
1.
Causes of sexually transmitted infections
-
Risky Sex
Unprotected sexual contact
Lack of education on Sex Ed
Bacteria, viruses, parasites, fungi
Chlamydia trachomatis: Causes chlamydia, the most common bacterial STI.
Human papillomavirus (HPV): The most common viral STI
Human immunodeficiency virus (HIV)
2.
Distinguish between sexually transmitted infection and sexually transmitted disease
The term sexually transmitted infection (STI) refers to a virus, bacteria, fungus, or parasite that has infected a person's
body via sexual contact, whereas the term sexually transmitted disease (STD) refers to a recognizable disease state that
has developed from an STI. Some stakeholders commonly use the term STI, and some commonly use the term STD. This STI
Plan generally uses the term STI because the goal is to prevent and treat infections before they develop into a disease state.
However, the term STD is used when referring to data or information from sources that use the term STD.
3.
●
●
Recognize the difference between bacterial and viral infections
Bacterial infections → treated with antibiotics which fight the bacteria
Viral infections → incurable ones are HIV, HPV, Herpes, Hep. B (vaccine only for prevention), the rest can be treated via
vaccination
Difference is that bacteria is a living organism and can reproduce on their own, while virus require a cell to replicate
Both are microbes, both cause disease ( pathogens )
●
●
Group 2: Grace Jacildone, Juan Delgado
4. Distinguish between prevention, treatment, and cure for sexually transmitted infections
Prevention: condoms to protect against STIs, vaccines to prevent hepatitis B and HPV,
Treatment: Chlamydia, gonorrhea, and syphilis (bacterial STIs) can be cured using with antibiotics. Herpes and HIV cannot be cured but can be
managed with antivirals. Antivirals can help fight Hepatitis B as well and slow damage to the liver caused by Hepatitis B.
5. Identify the populations who face higher risk of contracting infections
According to the U.S. Department of Health and Human Services, adolescents and young people, American Indians and African Americans, men
who have sex with men, and pregnant persons are the most impacted and at-risk for the four most common STIs.
Group 3: Alana Cho, Orisha Lamon, Shreya Lakkaraju
6.Recognize the barriers faced by the public and healthcare system in controlling the spread of infections
-Regarding the control of infectious spread, assessing deficits in testing, rapid testing, self testing, lack of technological investment, screening and
counseling, recognizing leverage points, cross cutting different infections for others, AMR(gonorrhea), may be asymptomatic and symptoms may not
show until later
Social and health equity barriers such as stigma, biased cultural conditions, health care access, lack of transportation, lack of childcare, etc
- individual, community, and structural factors and inequities that contribute to the spread of STIs
7. Identify solutions for controlling the spread of infections
-
safe sex practices
Condoms (female & male)
vaccination (HPV, HBV)
regular screening and early treatment
Antibiotics for bacterials and antivrials for viral STIs*** cannot be fully cured though
public awareness and education
Societal destigmatization
Telehealth
Develop cheaper & faster diagnostic tools
Public Health Laboratory
Study Guide (Lecture 9)
Group 4: Marco, Melanie, Natalie
1.
Describe the operational challenges experienced by Public Health Laboratories (PHL) during the pandemic.
a.
PHL mandate
i.
Difficulty making short-term decisions and determining long-term strategy amidst political interference and lack of guidance
b.
Jurisdictional leadership
i.
Leaders could facilitate creative problem solving and coordinare partnerships or sabotage response efforts with undue interference
c.
Federal Mismanagement and regulation
i.
Regulatory hurdles exacerbated supply chain issues and no national strategy
ii.
Limited guidance that often changed
d.
Outside labs
i.
Other labs provided technical support and problem solving
ii.
Challenge with working with new or inexperienced testing partners
e.
Material needs
i.
Inability to acquire and maintain supplies in sufficient quality or quantity, exacerbated by suppliers and federal government
ii.
Insufficient place to meet distancing and equipment requirements
f.
Information systems
i.
Outdated systems lead to slower testing and data sharing and difficulty in producing usable analysis
g.
Workforce
i.
Difficulty hiring and onboarding qualified staff
ii.
Burn out, poaching by private sector, danger of COVID, fear of political backlash
h.
Funding
i.
Not enough funding, too much red tape around funding, slow disbursement, limited access to PHL funding
2.
(Description of local PHL services). Describe different services local PHLs have including testing capabilities.
●
Testing capabilities and organization structure
●
Point of care testing
●
Support sexually transmitted infection clinic
●
Large lab providing comprehensive testing services.
PHLs provide on site patient testing in setting like TB diagnosis and treatment programs , STI Clinics, and blood lead poisoning screening and
prevention programs
Group 5: Maya Y and Romina B
3. (Supporting local public health services and programs). Describe the roles of local PHLs in supporting local public health
departments that are differ from clinical laboratories.
local PHLs differ from clinical laboratories in that they often serve confidential service
Local PHLs prioritize population-based disease control rather than individual patient care. They provide confidential services, such as
STI and HIV screenings, where patients may seek care outside the private sector. Local PHLs are directly involved in public health
program implementation, including outbreak investigations, food safety, and water contamination monitoring. They offer specialized
public health training for epidemiologists, health inspectors, and community health workers.
Group 5: Maya Y and Romina B
4. (Role within the state public health laboratory system & Role within the national laboratory system). Describe the roles of
local PHLs within the state and national laboratory systems.
Local PHLs collect and forward specimens to state PHLs for additional testing. They participate in the Laboratory Response Network
(LRN) to detect and respond to biological and chemical threats. Some local PHLs serve as regional reference laboratories, providing
specialized testing services for smaller labs. They collaborate with CDC and national surveillance networks, such as PulseNet, to track
foodborne illnesses and emerging infectious diseases.
-State: Local PHL are essential components of contributors to state PH laboratories, SPH laboratories goal is to support all 10 essential
public health services.
-
National : As components of the National Laboratory System, local PHLs serve as feeders to federal laboratories, such as the
Centers for Disease Control and Prevention. Larger local PHLs may participate in national/global laboratory networks, such as
PulseNet, the LRN, and the data exchange system/reporitory known as eLEXNET
Group 5: Maya Y and Romina B
5. What are the eleven core functions of public health laboratories?
1. Disease Prevention, Control, and Surveillance: Conduct testing to monitor and control infectious and chronic diseases.
2.Integrated Data Management: Collect and analyze laboratory data to support public health decision-making.
3.Reference and Specialized Testing: Perform advanced and confirmatory testing for complex diseases.
4.Environmental Health and Protection: Analyze environmental samples for toxins, contaminants, and pollutants.
5.Food Safety: Detect and respond to foodborne illnesses and contamination incidents.
6.Laboratory Improvement and Regulation: Promote quality control, training, and regulation compliance.
7.Policy Development: Contribute to public health policies through research and laboratory expertise.
8.Public Health Preparedness and Response: Provide rapid laboratory support for bioterrorism, outbreaks, and natural disasters.
9.Public Health-Related Research: Develop and evaluate new diagnostic methods and public health interventions.
10.Training and Education: Train health professionals and laboratory personnel.
11.Partnerships and Communication: Collaborate with local, state, and federal agencies to enhance public health efforts.
Reproductive Health
Study Guide (Lecture 10)
Group 6:
1.
Briefly explain why “reproductive health” is no longer under the umbrella of “maternal and child health”.
2.
- reproductive health: not only targeted towards women, men also have reproductive health needs Not focused on the health of maternal and
children, but it’s about the reproductive system
“The Unfair Burden on Women: Men have their own sexual and reproductive health needs relating to sexuality, protection against sexually
transmitted infections, infertility prevention and management, and fertility regulation.”
“The needs of women were submerged in their needs as mothers.”
Focusing on healthy children as the outcome rather than “health risks mothers are liable” during pregnancy leads to high rates of maternal
mortality
3.
Explain what is meant by “reproductive health” * be thorough
-
World Health Organization (WHO)
State of complete physical, mental, social well-being not merely the absence of disease or infirmity, in all matters relating to the
reproductive system and to its functions and processes
People are able to have satisfying and safe sex life
Capability to reproduce and the freedom to decide when and how
Right of women and men to be informed and have access to safe, effective, and affordable reproductive products
“Fertility regulation” → positive outcomes
Intentional use of contraception to prevent preganancy
Having control over your own fertility
-
Group 7: Luella Messex, Maria Kefalas, Marlene Estrella
3. In pairs, spend 5 minutes discussing how reproductive health may be a human rights concern. Then share out to the group what you’ve
discussed.
4. What are 5 indicators used in reproductive health and what does each mean? WHO lists 17. **list all 17
*Indicators are not all specific to women
1. Total fertility
3. MMR
9. Birth weight
11. Anemia levels
16. HIV prevalence in pregnant women
Group 8: Holly Rahman, Ashley Munoz, Angela Perez
5. What are the public health effects of restricting abortion access? *And how does it align with the WHO global health strategy (which entails)?
Human rights dimension, development dimension, unsafe abortion, family planning, etc.
Estimated 22 million abortions are performed under unsafe conditions and 47,000 women die every year from the complications of unsafe abortions, 5
million are left disabled .
WHO strategies: improving prenatal postpartum and newborn care, providing high quality services for family planning, including infertility services,
eliminating unsafe abortion, combating STIs → HIV, reproductive tract infections, cervical cancer and other gynecological morbidities and promoting
sexual health
6. In 4 groups, spend 5 minutes discussing the determinants of reproductive health (behavioral, social, economic, and health system). Then share out to
the group what you’ve discussed and fill in the chart below with examples
Behavioral
Social
Economic
Health System
Reproductive Health Behaviors
Ex: in developing countries women who
get STIs from their husbands are usually
due to the behavior of the husband having
multiple sexual partners
Gender is a social construct which
includes codes of behavior
considered appropriate to each
gender. Imposed codes are
embedded into the law. Gender
division of labor assigns dif values
to segregated tasks which work
against equality between men and
women.
Some developing countries
have been more successful
than others in translating
economic growth into health
gains. Pregnant women and
children are the first to suffer
under poor economic
conditions.
No health intervention is done to
avert maternal death, natural
mortality is around 1000-1500 per
100,000 births. Sexual and
reproductive health services are still
deficient for a majority of the
world’s population.Services may be
poor quality, not accessible, or
underused due to cultural norms.
Female genital mutilation/female cutting
(FGM/FC) in developing countries for
women without a choice
Midterm Exam
Lectures 11+
Climate Change
Study Guide (Lecture 11)
Group 1: Juan Delgado, Grace Jacildone
1.
Identify and assess the goal of the 2015 Paris Agreement.
The 2015 Paris Agreement was ratified by 195 countries. Legally binding and science-driven, it commits governments to pursue
efforts to limit global mean temperature rise to 1.5°C; protect the human right to health; prevent harm; and promote the right to a
clean, healthy, and sustainable environment.
Group 2: Marco, Natalie, Melanie, Alana, Orisha
2.
Identify the environmental and societal consequences (e.g., on work) of climate change.
●
●
●
Environmental
●
Increase in droughts, heating seas, melting ice bodies.
●
Increase risk of wildfires
●
Rise in extreme weather events (heatwaves, precipitation, etc)
Societal
●
Reduces labor productivity and puts workers’ health at risk
1.
Agricultural, construction
2.
Construction most impacted in US
●
Increase in heat-related deaths
●
Rise in infectious disease transmission due to changing climate conditions
Both: sea level rise
●
Loss of food source (fish) (food productivity)
●
Loss of connection (cultural/economic/food) and reliance on water bodies
Group 3: Maya, Luella, Morgan, Jasmine
3.
Considering the immediate consequences of climate change, hypothesize the distal outcomes of climate change.
Extreme weather events (hurricanes, wildfires, droughts), rising sea levels, biodiversity loss.
-
Ocean levels will rise: endangering coastal towns and cities (tens of millions of people)
Destruction of animal habitat from drought, flood, or fire results in the migration of animals and insects into human spaces,
increasing risk of zoonotic diseases such as malaria/dengue/west nile virus.
-
Vector-borne and water borne diseases will enlarge their territory, spreading even to industrialized countries.
Increased chronic diseases (respiratory illnesses, malnutrition) from worsened air quality
Food supply would be affected due to a shift in rainfall patterns which would cause many fields to dry.
-
3 out of 4 people living in poverty rely on agriculture and natural resources for survive
Extreme weather conditions can destroy crops resulting in starvations and even death
Group 4: Marlene Estrella, Jasmine Liu, Holly Rahman, Romina Bigdeli
4.
Define the specific consequences of climate change on health.
●
●
●
●
Heat related mortality - Africa experienced the biggest heat related mortality rate 2000-5
Infectious diseases - “The changing climatic conditions are also putting more populations at risk of
life-threatening infectious diseases, such as dengue, malaria, vibriosis, and West Nile virus. “cases of dengue
have doubled every decade since 1990, and almost half of the world population is now at risk of this
life-threatening disease.”
Food insecurity - due to limitations on food production caused by extreme drought
Water safety - water shortage and affected water
Populations most affected by changing climate: populations experiencing poverty, elderly, people who work outdoors,
larger cities due to less green space, individuals with pre-existing conditions (diseases,etc), people with disabilities
Group 5: Shreya Lakkaraju, Jada Guzman, Lonnie Chen
5.
Discuss individual, local, and global approaches for slowing climate change.
Individual – using public transportation, saving energy (LED lights & solar panels), diets/healthy eating (plant-based foods)
Local – low-carbon diets that meet local nutritional and cultural requirements can contribute to mitigation
Global – fossil fuels, reducing greenhouse gas emissions, following the Paris Agreement & United Nations Framework
Convention on Climate Change (UNFCCC)
“ban and cease funding to all new oil and gas projects. Prioritise actions that both accelerate the transition away from fossil fuels, and can deliver health
co-benefits and reduce socioeconomic and health inequities.”
Food Insecurity
Study Guide (Lecture 12)
Group 1: Lonnie Chen, Jada Guzman
1.
Distinguish between food security and nutrition security. *define both and differentiate
Food Security: An economic and social condition of limited or uncertain access to adequate food, has been key to developing
screening tools, surveillance, research, referral systems, and policies
Emphasizes hunger, not the quality of food
Nutrition Security: "consistent access, availability, and affordability of foods and beverages that promote well-being and
prevent and if needed, treat disease."
Nutrition security places emphasis on the nutritional value and preventative qualities of food. Essentially, this is quality
over quantity, that food security focuses on. It is not just about the access to food to eat, but rather food that is actually
going to keep populations healthy.
2.
Identify health outcomes related to food insecurity. *how does food insecurity increase risk for listed outcomes?
Hunger
Dietary quality
“Poor nutrition is a leading cause of illness, health care
Quantity of food intake
spending, and lost productivity in the US and globally… These
burdens disproportionally harm lower-income, less-educated,
Chronic diseases
and minority racial and ethnic groups, contributing to health
Diabetes, obesity, cancer, cardiovascular diseases,
disparities. Nourishing foods throughout the lifespan, starting in
utero, are foundational to achieving health and well-being for all
hypertension
people.”
Food insecurity DOES NOT CAUSE chronic disease. Is a major contributor
Food insecurity heightens the inability to have proper access to nutritious foods. Major goal is to satisfy hunger rather than to
prioritize well-balanced meals with healthy foods.
Group 2: Ashley Munoz, Angela Perez, Marlene Estrella, Holly Rahman
3.
What is the limitation of major clinical and public health tools?
What (new) tools potentially address this limitation?
-
Major clinical and public health tools are used to assess food security, but don’t consider nutritional quality.
Department Of Agriculture's (USDA's) US Household Food Security Survey assessment
includes no questions about nutritional quality
Shorter food security screening tools, most often used in public health and clinical practice,
also contain no information on nutritional quality
-
Screening tools for nutrition security have not been implemented at scale
Cross-sectional studies are used to collect data and make generalizations, but are not representative of food security
-
The Nutrition Security Screener and Gretchen Swanson Center for Nutrition are both newly implemented screening tools
to help address the limitation of focusing on food security. They assess access, availability, and affordability of healthy
foods that help to promote well-being and prevent disease.
Health-system based interventions: medically tailored meals, produce prescriptions, and nutritional education.
Population-level policies: Implementing stronger nutritional standards in schools and government assistance programs.
-
Group 3: Jasmine Liu, Juan Delgado, Mya Ferrer, David Nguyen
4.
Why is it challenging to assess diet quality?
It is challenging to assess diet quality, particularly when gathering data surrounding habitual diet, because diet assessment tools
(24-hour recall, food frequency questionnaires, short diet quality screeners) have to be revisited and repeated multiple times by
participants in order to get an accurate picture of habitual diet.
*what is the gold standard for measuring diet quality?
24-hour recall is considered to be the gold standard for measuring diet quality. It is resource intensive, demanding time and staff
expertise—and may be limited when assessing habitual diet unless repeated over time.
Group 4: Melanie Gomez-Aguilar, Marco Segovia
5. Outline the approaches that can be undertaken in a health care setting to achieve nutrition security . *And describe
one of the approaches (i.e., medically tailored meals) - google, if needed.
Medically tailored meals: some insurances for Medicare advantage for the elderly have medically tailored meals that are brought
to these meals to them.
Senate Bill 2133 was created to provide and deliver medically tailored meals to individuals with diet impacted disease after they
have been discharged from the hospital.
Group 5: Romina Bigdeli
6. What are some population-level strategies for increasing nutrition security?
Population-level programs and policies can improve nutrition security by influencing the community, socioeconomic circumstances, and larger
living and work environments of people. Some strategies include:
•Strong nutritional standards for food procurement by worksites, schools, early child care, prisons, and other institutions.
•Retail and restaurant labeling and guidelines to inform consumers and lower additives such as salt and sugar.
•Tax credits and other incentives to support healthier food access.
•Support for local and regional food sector innovation and entrepreneurship.
•Using soda or junk food taxes to disincentive intake and raise revenue for nutrition security programs in low-income populations.
•Population-wide policies are also important because nutrition insecurity and poor diet quality are not solely the domain of low-income groups or
households experiencing food insecurity.
•Combined, multisector health system, policy, and population interventions can advance nutrition security and health equity, aiming for
equitable access to and greater consumption of healthier foods and beverages and fewer unhealthy foods and beverages
Substance Use
Study Guide (Lecture 13)
Group 1: Luella Messex, Maria Kefalas
1. Briefly explain what about the problem of substance use makes the authors Lo, Yeung, and Tam call for “a
multidisciplinary approach” to researching the issue.
Substance abuse is not limited to particular social groups. Researchers must understand the unique psychological,
personality, cognitive, socioeconomic, familial and cultural differences of various social groups. It is necessary to explore what
common and unique characteristics they hold in terms of the initiation, processes and consequences of substance abuse
Substance abuse has many layers, including individual development, family and social influences, cultural values, and
environmental conditions.
Need to use a multilevel research perspective to analyze its cause, maintenance, and consequences
Substance abuse has been an issue for a long time that continues to evolve
Requires multilevel research and involvement overtime to observe these changes
Must be a partnership between different fields such as psychology, social work, environmental health, education, etc.
Group 2: Marlene Estrella, Angela Perez, Ashley Munoz, Holly Rahman
2. What do you think Lo, Yeung, and Tam mean when they say that substance abuse/misuse is a “chronic relapsing
disease”?
The term “chronic relapsing disease” indicates how substance abuse and misuse can be viewed as a chronic disease where the
abuse and addiction occur for a long period of time. When the individuals comes off the drug there are high relapse rates of
56.8% to 81.8% where the individuals continues the cycle of abusing and misusing the substance.The authors emphasize how
substance abuse is a cross disciplinary research topic and a multilevel perspective is needed to reduce rates of relapses by
increasing public awareness of abuse and addiction and providing support for abstinence.
Additionally, substance abuse/misuse varies within social groups. Therefore, the authors believe that comparative and
longitudinal research is more useful and insightful in helping to configure effective approaches.
**cross-sectional studies interview a fresh sample of people each time they are carried out, whereas longitudinal studies follow the same
sample of people over time.
Group 3: Jasmine Liu, Juan Delgado, Mya Ferrer, David Nguyen
3.
What are some economic and social factors that may be related to rates of substance abuse/misuse?
-
Economic Factors:
Poverty and Financial Stress
Unemployment and Job Security
Working in factories → higher risk of substance abuse
Healthcare Access
Cost and Availability of Substances
-
Social Factors:
Family and Childhood Environment
Peer Influence and Social Networks
Mental Health Issues
Social Norms
Community Environment
Group 4: Natalie Gomez
4. What are some health or socioeconomic consequences of the opioid epidemic in the United States? List at least 3.
1990s economic recession and big pharmaceutical corporations lead on campaigns of drug promotion and opioid
misinformation, officially declared a crisis in 2017 after almost half a million attributed deaths
Has become a drag on the economy and a threat to national security because opioid misuse is costing the US billions of
dollars yearly in regards to weakened workforce and health care expenses.
-
allowed the influx of cheaper illicit opioids (fentanyl, heroin) -also observing the conditions in which these are most
accessible
COVID19 pandemic also a catalyst for influx of overdose deaths, lack of safe injection sites, practices, all could be
in relation to health and funding concerns
lobbying and lax of policy up until the 2010s-20s
Causes high rates of hepatitis C, HIV, and other diseases
Neonatal abstinence syndrome
Increase in Children in foster care
-opioid misuse sums up to $78 billion of lost healthcare productivity, treatment programs, legal response
$1 trillion alone in 2017 from misuse and fatal overdose
The opioid mortality rate has contributed to a decrease in life expectancy in the US
Group 5: Romina Bigdeli
5. Explain policy and public health challenges that you think may arise from addressing the opioid epidemic and what
you might suggest to overcome those challenges. Think about community, state, and federal level challenges. (5-7
sentences).
Several policy and public health challenges may arise when addressing the opioid epidemic at the community, state, and federal levels, including
balancing public health and individual liberties when implementing prevention and treatment strategies. A significant challenge involves
coordinating efforts across different levels of government and various agencies to ensure a cohesive response. Furthermore, stigma
associated with substance use disorders can deter individuals from seeking treatment, necessitating targeted public health campaigns to
reduce negative perceptions and encourage help-seeking behaviors. To overcome these challenges, a multi-pronged approach is needed
that includes implementing evidence-based prevention programs, expanding access to treatment and recovery services, and addressing the
underlying socioeconomic factors that contribute to substance abuse. Cross-disciplinary collaboration among researchers, practitioners,
educators, and policymakers is crucial for developing and implementing effective strategies. Additionally, policies should be informed by research
that considers the unique characteristics and needs of various social groups affected by the opioid epidemic.
Timing of laws passed in each state
Additionally, the criminalization of substance use often discourages individuals from seeking help, perpetuating cycles of incarceration rather than
treatment.
Policy reforms that prioritize rehabilitation over punishment, along with increased funding for community-based support programs, can also
enhance treatment outcomes. Public education campaigns can further help reduce stigma and encourage those struggling with addiction to seek
help.
Homelessness
Study Guide (Lecture 14)
Group 1: Luella Messex, Maria Kefalas, Lonnie Chen, Jada Guzman
Q1: Please identify the following from the Homelessness, Discrimination, and Violent
Discrimination in Los Angeles paper by Padwa et al. (2024):
a. What was the purpose of the article (i.e., research question)?
Research question: What are the past-month experiences of discrimination and violence among people experiencing homelessness in LAC?
Purpose: Understand and assess PEH recent encounters with discrimination, physical violence, and sexual violence. Aimed to measure the impacts on
physical and mental health
b. Where was the data for this study sourced from?
PATHS survey from 2023 provided the data for this study
c. What were the primary outcomes of the study? (Table 1)
1.
Psychological distress
2.
Discrimination by homeless status
3.
Experiences with sexual violence
d. How large was the total sample enrolled?
A total of 707 PEH (People Experiencing Homelessness) were enrolled in this study. (332 in analytic sample)
e. What was the inclusion criteria for being in the study (4)?
(1) lived in a homeless shelter or unsheltered setting for at least one night in the past month; (2) resided in LAC; (3) were at least 18 years old; and (4)
had access to a smartphone.
f. How were the contributions of the study different from other studies on the topic?
This study's main contributions include its recency (data collected in 2023), its methodology (using validated measures), and its collection of information
about recent discrimination and violence.
Demographic (race/ethnicity, sexual identity/orientation, age)
Health (mental illness, substance misuse, physical disability)
Homelessness (time experiencing homelessness, unsheltered homelessness)
Characteristics with discrimination and violence
Group 2: Ashley Munoz, David Nguyen, Mya Ferrer
Q2: How did researchers measure or operationalize the primary study OUTCOMES (2)?
Prospective cohort study, trained fieldworkers conducted in-person recruitment from December 2021 to May 2023.
Questions covered demographics, history of homelessness, and health, with discrimination/violence being added April
2023
Eligible participants answered a baseline survey, followed by monthly follow-up surveys
Perceived discrimination was measured using 5-item Everyday DIscrimination Scale (EDS)
EDS captures self-reported frequency of routine and subtle discriminatory experiences in everyday situations from
the past-month
Responses = reverse-coded & summed to generate composite scores (0-15) w higher vals being greater
perceived discrimination. Respondents also chose from 16 characteristics they believed were the main reasons for
discrimination faced
-
Experiences of Violence
Measured using questions adapted from the U.S Bureau of Justice Statistics’ National Crime Victimizations
Participants were asked if they have been physically attacked or hurt in the past 30 days
Participants were asked if they had been sexuall attacked, abused, harassed, or coerced in the past 30 days
Responses were binary (yes/no)
Group 3: Grace Jacildone, Juan Delgado, Jennifer Antonio, Jasmine Lomeli
Q3
Table 1 shows the distribution of demographics, health status, and experiences of discrimination of the study sample.
a. How large was the final analytic sample?
332 respondents
b. What are key findings from Table 1?
Over one-third had a physical health condition, over half reported moderate/severe psychological distress, and many
reported weekly cannabis and/or illicit drug use. Approximately one-third of the sample (34.0%) spent most of the
previous month unsheltered outdoors, 29.2% were unsheltered in a vehicle, 16.0% were sheltered, and 19.6% were
not homeless for the majority of the previous month.Nearly half of respondents who reported experiencing
discrimination (49.6%) believed that their housing situation was the reason they were targeted Victimization was also
common. Being sheltered, as opposed to not sheltered, was protective against everyday discrimination and physical
violence experienced monthly.
Group 4:
Q4: As it relates to the everyday discrimination results, what were the key findings?
The 5 item Everyday Discrimination Scale (EDS) captures the everyday discriminatory experiences, on a six point likert
scale to measure participants discrimination the results show out of the 332 total individuals the EDS mean is 5.5.
Comparing folks who were sheltered and those unsheltered the findings present differences of 5.3 (sheltered) and 6.8
(outdoor/no vehicle/makeshift shelter). In comparison to folks that are not unhoused the EDS mean was at 3.5.
“Among respondents who reported experiencing discrimination because of housing status, the majority (84.4%) indicated
another reason for being discriminated against, most commonly their financial situation (63.3%), racial identity (39.1%), or
physical appearance (33.6%).”
Not homeless group-control/reference group
Group 5: Morgan Moore,
Q5 In the multivariate analyses (i.e., adjusted for demographic and health status characteristics), what factors
were associated with increased odds of experiencing:
a.
Sexual violence: Approximately one out of every 14 respondents (7.5%) reported experiencing past-month sexual violence.
Female/other/unknown gender was associated with an increased risk of sexual violence
(aOR=3.14, 95% CI 1.17–8.48, p<0.05).
Being unsheltered outdoors (aOR=5.42, 95% CI 1.09–27.09, p<0.05) was associated with increased adjusted
odds of sexual victimization compared to those who were no longer homeless.
-
b.
Physical violence:• (16% in past month reported)
-
Being sheltered.
Being unsheltered outdoors.
Having a physical health conditionat baseline.
Experiencing moderate/severe psychological distress
Q6 What did the authors of the study conclude?
The authors of the study concluded that those experiencing homelessness are subjected to a higher rate of discrimination
that adversely affects health and wellbeing. The authors assert that since poorer health outcomes are already present in those
newly facing homelessness, exacerbation of negative outcomes is likely to occur with prolonged homelessness.
Gun Violence
Study Guide (Lecture 16)
*Questions 4 & 6 think about on your own
Group 1:
1. Briefly explain how gun violence is a public health issue in the United States (2-3 sentences).
Gun violence is a public health issue, that is especially prevalent in the US. Among other high-income countries (France, Italy, Spain, UK,
and Australia) 82% of the combined firearm deaths occur in the United States. Also the economic burden that gun violence has in the
united states that cost $280 billion annually. ( Mortality, Morbidity, insurance, decrease of life experience)
2. What accounts for the largest share (60% before 2020) of all firearm deaths in the United States? *And according to the
American Public Health Association's (APHA), why do they believe such types are most fatal?
a.
According to the APHA, suicide by firearm accounts for 60% of gun-related deaths in the United States. Compared
to other methods used to die by suicide, firearms are 82% more likely in resulting in a fatal outcome.( compared to
just 3% for other methods such as drug overdose.)
Group 2: Marco, Morgan, Natalie, Melanie
3. Think, pair, share: What are some ways that gun violence may cause costs to the US society and to the economy? We call this
the social and economic “burden” of gun violence. *what do these costs amount to annually in the US?
-
-
Costs $280 billion annually
Due to work loss, medical/mental health care, emergency transport, police/criminal justice activities, insurance claims
processes, employer costs, and decreased quality of life
Other expenses
Congress provided $23.5 million to the National Violent Death Reporting System Fund in all 50 states
Congress provided $25 million to the CDC and NIH for gun violence prevention research
Group 3: Ashley Munoz, Saiya Shah, Angela Perez
5. What are Extreme Risk Protection Orders (ERPOs)?
Extreme Risk Protection Orders. ERPOs allow family members or law enforcement to petition a judge to temporarily remove a firearm from a
person deemed at risk of harming themselves or others. Sixteen states and the District of Columbia have laws authorizing courts to issue an
ERPO. Incentivizing more states to enact ERPO laws could prevent further gun violence.
-
-
-
*Discuss what APHA deems common sense gun policies?
requiring criminal background checks for all firearms purchases, including those sold at gun shows and on the Internet
Currently unlicensed private firearms sellers are exempt from conducting criminal background checks on buyers at gun shows or
over the Internet, giving felons, the severely mentally ill and others prohibited from owning firearms access to weapons
reinstating the federal ban on assault weapons high-capacity ammunition magazines
In March 2021, the U.S. House of Representatives passed H.R. 8, the Bipartisan Background Checks Act, which would expand
background checks for all firearm purchases with limited exceptions. We strongly urge the Senate to pass this important legislation
without further delay.
*Discuss APHA’s stance on what can be done as it relates to more research?
laws have effectively restricted federally funded research related to gun violence, as well as access to complete crime gun data, which has
resulted in a significant gap in available research into the causes of gun violence.
EX. almost no credible evidence that right-to-carry laws increase or decrease violent crime; almost no empirical evidence to support
dozens of violence prevention programs for children; scant data on the effects of different gun safety technologies on violence and crime; and
scant data on the link between firearms policy and suicidal behavior. We are extremely pleased that in FY 2020 and FY 2021, Congress provided
a total of $25 million to the Centers for Disease Control and Prevention and the National Institutes of Health for gun violence prevention research.
We must expand the collection of data and research related to gun violence and other violent crime deaths and injuries in order to better
understand the causes and develop appropriate solutions.
Unlicensed firearm sellers are exempt from background checks.
Group 4: Luella Messex, Maria Kefalas
5. What are Extreme Risk Protection Orders (ERPOs)?
ERPOS allow family members or law enforcement to ask a judge to temporarily remove a firearm from a person who is deemed a risk to
themselves or others. 16 states, along with DC, have laws that authorize courts to issue ERPOs
-
-
*Discuss what APHA deems common sense gun policies?
APHA Supports: Criminal background checks for ALL firearm purchases (including gun shows and internet sales)
Current: no background checks online or at gun shows gives access to felons, people with severe mental illnesses, or others
not allowed firearms.
APHA: Reinstating federal ban on assault weapons and high capacity ammunition magazines
Expired 2004
House of Reps passed HR8: Bipartisan background checks act to expand background checks for ALL firearm purchases
Group 5:
No questions - see Racism slides.
ON YOUR OWN:
4. In groups, explain how one of the following public health approaches could help address gun violence AND at least 2 barriers or
challenges to that approach (each group focuses on either surveillance, research, policy).
a. How could your chosen approach (surveillance, research, policy) help address gun violence?
b. What are at least 2 barriers or challenges to that approach?
6. Think, pair, share: What are two examples of how the US political system makes it difficult to enact policy to address gun violence
the way policies were enacted for other issues like traffic fatalities (i.e., requiring seatbelts) or smoking. Think about what might
differentiate the US from other comparable countries.
Racism
Study Guide (Lecture 17)
Group 1:
1. Describe and distinguish between the 3 levels of racism as outlined by Dr. Jones.
institutionalized, personally mediated, and internalized
Institutionalized: manifests in material conditions and hierarchical relations and power.
Personally mediated: prejudice and differential assumptions about the abilities, motives, and intentions alongside differential
behaviors directed toward those that are racialized (intentional, unintentional, acts of commission, acts of omission, maintains
structural barriers, condoned by societal norms), dehumanization
Internalized racism: acceptance by members of stigmatized racism acknowledging negative messages about their own abilities,
acceptance of limitations and right to self-determination
2. Provide examples of behaviors for each level of racism.
Institutionalized: Quality of education, employment, housing, medical access, healthy environments, historical privileges, structural
representation, control/influence over such sectors –differential access and opportunities of racial category and race, physical and
geographic separation from resources and infrastructure
Personally Mediated: lack of respect (poor / no service, failure to communicate options), suspicion (shopkeeper’s vigilance,
avoidance, street crossing, purse clutching, standing when there are empty seats on the bus to purposely avoid), devaluation
(surprise at competence), scapegoating, and dehumanization such a police brutality, sterilization abuse, and hate crimes.
Internalized: embracing of whiteness and conditions associated with whiteness as a standard, self hatred and self devaluation, limiting
oneself
3. Identify examples of the types of racism from current events or even your own lived experience.
Recent legislation concerns institutionalized racism in the university setting targeting minority and low income students
Group 2:
4. Summarize Dr. Jones’ allegory about the flower boxes.
The first allegory:
●
Gardner prefers red over pink flowers
○
They plant the red flowers in the rich and nutrient soil while the pink ones in the poor nutrient and rocky soil.
○
Year after year, the red flowers grow strong while the pink flowers grow to mid height and weakly. The gardners
then states she was right to prefer red over pink
■
This is an example of institutionalized racism because there were structural barrier wouldn’t allow the pink
one to properly grow.
●
Second:
○
Bee coming to pollinate the pink flowers and the gardner not wanting the bee to do that because they prefer red
■
Example of internalized racism
●
Third:
○
The gardener own dislike and disdain for pink flowers in the beginning. They pluck them out before they can even
seed or plucks the pink seed flowers out the rich soil when blown from the wind
■
Example of mediated racism
The gardener is:
●
The government
○
b/c it has the power to decide, power to act, and control resources and uphold these structures that are put into
place
○
It can be dangerous when the government is allied with one group and is not concerned with equity
Group 3: Angela Perez, Ashley Munoz
“Call to Action: Structural Racism as a Fundamental Driver of Health Disparities”
5. Define
●
Structural racism: The normalization and legitimization of an array of dynamics that routinely advantage White ppl while producing
chronic adverse outcomes for ppl of color. Has been and remains a fundamental cause of persistent health disparities in the US.
●
Allyship: The practice where a person on group in a privileged position or position of power wants to operates as an ally/ solidarity
with a marginalized person or group (ex: BLM protest or LGBTQ which doesn’t impact you but you support)
●
Discrimination: In appropriate treatment of people because of their actual or perceived group membership and can include overt or
covert behaviors, including microaggressions or indirect or subtle behaviors that reflect negative attitudes or beliefs about a non
majority group
●
Health disparities: A particular type of health difference that is closely linked with social, economic, and environmental
disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health
based on their racial or ethnic group or other characteristics historically linked to discrimination or exclusion
●
Health inequities: systemic differences in the health status of different populations, the inequities have significant social and
economic costs to both individuals and societies
●
Prejudice: is "irrational or unjustifiable negative emotions or evaluations toward persons from other social groups". It is a primary
determinant of discriminatory behavior
●
Race: Social construct based on phenotype, ethnicity, and other indicators of social differentiation; results in varying power & social
& economic resources
●
Racism: Anti-Black racism: attack, erode, and limit the humanity of Black people (Also cultural, personally mediated racism,
internalized racism, and institutionalized racism. Refer to table on page 3)
●
Social determinants of health : are "the conditions in the environment where people are born, live, learn, work, play, worship, and
age that affect a wide range of health, functioning, and quality-of-life outcomes and risks".
Group 4:
6. What are the 3 levels of racism as outlined in the article? (list only, do not define)
1.
2.
3.
Institutionalized
Personally mediated (also known as interpersonal)
Internalized.
7. What are the racial disparities in mortality and morbidity attributable to cardiovascular disease, stroke, and vascular risk factors?
Mortality related to CVD, stroke, and vascular risk factors remain high among Black Americans compared to non-Hispanic White Americans,
even as mortality rates have declined overall. Disparities in risk factors and outcomes are well-studied, but the impact of the SDOH and
structural racism are less studied. POC experience a lower median income, higher unemployment, higher rate of being uninsured
8. How have social determinants of health (SDOH) come to be associated with disparities by race/ethnicity?
-
-
Structural/systemic racism has created unequal access to access to care/resources across historically marginalized groups
Education
Health literacy
Social
Institutionalized racism
Must acknowledge that these structural elements work as designed, in ways that perpetuate the advantages White Americans have
over other racial and ethnic groups
Group 5: Jasmine Liu, Marlene Estrella, Holly Rahman, Shreya Lakkaraju
9. Identify the historical policies and events that have contributed to structural racism in the U.S.
-
Compromise at 1787 Constitutional Convention: 37 enslaved Black people were denied all human rights, counted as ⅗ of a person
Civil Rights Act of 1866: gave black people the same legal rights, but still cannot vote or hold political office; followed by emergence
of Ku Klux Klan
Jim Crow Laws: institutionalizing disadvantages for Black people under the guise of separate but equal
The Chinese Exclusion Act of 1882: prohibited Chinese immigration to the US
10. The article proposes 5 political approaches and interventions at the individual, community, and population levels to address
structural racism and to enhance health equity across diverse populations. Describe these approaches.
1.
2.
3.
4.
5.
To eliminate structural racism, there needs to be restructured systems that promote health and reduce health disparities in
marginalized workplaces, neighborhoods and schools.
Policies that improve the quality of housing and neighborhood environments
Policies that provide inequities in access to and quality of healthcare need to be eliminated.
Dismantling of structural racism is predicated on understanding race and transforming attitudes about it (fostering allyship between
racial and ethnic groups)
Future research on racism needs to examine the multiple domains and intersections of racism and the effect they have on health
outcomes and disparities.