Kleinman explanatory Model
Eliciting the patient’s (explanatory) model gives the physician knowledge of the beliefs the patient holds about his illness, the personal and social meaning he attaches to his disorder, his expectations about what will happen to him and what the doctor will do, and his own therapeutic goals
Cultural competence
Cultural competence is defined as “a dynamic, fluid, continuous process whereby an individual, system or health care agency find meaningful and useful care delivery strategies based on knowledge of the cultural heritage, beliefs, attitudes, and behavior of those to whom they render care”
Cultural Awareness
:Self-examination of one’s own prejudices and biases toward other cultures. An in-depth exploration of one’s own cultural/ethnic background.
Cultural humility
A lifelong commitment to self-evaluation and self-critiques, redressing the power of imbalances in the patient- physician dynamic, developing mutually. Beneficial relationships.
Cultural Knowledge
Obtaining a sound educational foundation concerning the various worldviews of differences cultures. Obtaining knowledge regarding biological variations, disease and health conditions and variation in drug metabolism.
Cultural Skill:
Ability to collect culturally relevant data regarding the client’s health history and presenting problem. Ability to conduct culturally based physician assessments. Conducting these assessments in a culturally sensitive manner.
Cultural Desire
Motivation of the healthcare provider to “want” to engage in the process of cultural competence, characteristics of compassion, authenticity, humility, openness, availability, and flexibility, commi tment and passion to caring, regardless of conflict.
ethnicity
as “the aggregate of cultural practices, social influences, religious pursuits, and racial characteristics shaping the distinctive identity of community”
Cultural competence in nursing consists of four principles.
Care is designed for the specific client.
Care is based on the uniqueness of the person’s culture and includes cultural norms and values.
Care includes self-employment strategies to facilitate client decision making to improve health behaviors.
Care is provided with sensitivity and is based on the cultural uniqueness of clients.
The APN may also use the Kleinman Explanatory Model of Illness (1978). Below are the questions that can be utilized.
What do you call your problem?
What do you think caused your problem?
Why do you think it started when it did?
What does your sickness do to you?
What do you fear most about your sickness?
What are the chief problems your sickness has caused you?
What kind of treatment do you think you should receive?
What is the most important result you hope to receive from the treatment?
According to Giger and Davidhizer (2000), although cultures differ, they all have the same basic organizing factors that must be assessed in order to provide care for culturally diverse patients. These factors include
communication (verbal and nonverbal);
personal space;
social organization;
time perception;
environmental control; and
biological variations.
The National Center for Cultural Competence (NCCC) provides national leadership and contributes to the body of knowledge on cultural and linguistic competency within systems and organizations. Major emphasis is placed on translating evidence into policy and practice for programs and personnel concerned with health and mental healthcare delivery, administration, education, and advocacy.
The NCCC uses four major approaches to fulfill its mission, including
Web-based technical assistance, (2) knowledge development and dissemination, (3) supporting a community of learners, and (4) collaboration and partnerships with diverse groups.
These approaches entail the provision of training, technical assistance, and consultation and are intended to facilitate networking, linkages, and information exchange. The NCCC has particular expertise in developing instruments and conducting organizational self-assessment processes to advance cultural and linguistic competency.
Epidemiological Triad:
host, agent, environment
Genetics is considered an agent in the epidemiological triad
Genetics
The study of individual genes and their impact on relatively rare single gene disorders
Genomics
The study of all genes in the human genome as well as their interaction with other genes, the individual’s environment, and the influence of cultural and psychosocial factors
Genetic epidemiology
the link of epidemiology and genetics
Absolute risk
is the probability of an event, such as illness, injury, or death
Absolute risk
gives no indication of how its magnitude compares with others.
The odds ratio
closely approximates the relative risk if the disease is rare.
Odds ratio and the relative risk are used
to assess the strength of association between risk factor and outcome.
Attrubutible risk
is used to make risk-based decisions for individuals.
Population-attributable risk measures
are used to form public health decisions
EGAPP:
Evaluation of Genomic Applications in Practice and Prevention
GAPPNet
Genomic Applications in Practice and Prevention Network (established in 2009) is a collaborative initiative involving partners from across the public health sector working together to realize the promise of genomics in health care and disease prevention.
GEDDI
Genetics Early Disease Detection Intervention project (GEDDI) (established in 2009) developed a model strategy for using clinical, genetic, and family history information to reduce the risk of disease, death, and disability in affected individuals, family members, and populations.
HuGENet
Human Genome Epidemiology Network (HuGENet) (established in 1998) helps translate genetic research findings into opportunities for preventive medicines and public health by advancing the synthesis, interpretation, and dissemination of population-based data on human genetic variation in health and disease. HuGENet reviews are systematic, peer-reviewed synopses of the epidemiologic aspects of human genes, including prevalence of allelic variants in different populations, population-based information on disease risk, evidence for gene-environment interaction and quantitative data on genetic tests and services carried out according to specific guidelines.
NHANES III
DC’s Office of Public Health Genomics (established in 2002) formed a multidisciplinary working group with members from across CDC. It developed a proposal to measure the prevalence of selected genetic variants of public health significance in a representative sample of the U.S. population and to examine the association between the selected genetic variants and disease outcomes available in NHANES III data.
The World Health Organization defines a pandemic
as a global epidemic that spreads to more than one continent (WHO, 2009). One of the more recent pandemics that you might be familiar with is the H1N1 influenza outbreak of 2009.
Outbreak
the occurrence of disease within persons in excess of what would normally be expected in a clearly defined community, location, or time of year. An outbreak may only last for a matter of days or weeks, but may last for years
Quarantine
the separation and restriction of the movement of people who were or are exposed to a contagious disease for a set period of time, to see whether they become ill
Isolation
the separation of sick people with a contagious disease from those who are not ill
Disaster epidemiology
“Disaster epidemiology is defined as the use of epidemiology to assess the short- and long-term adverse health effects of disasters and to predict consequences of future disasters. It brings together various topic areas of epidemiology including acute and communicable disease, environmental health, occupational health, chronic disease, injury, mental health, and behavioral health”
Antigenic drift
is a term describing the changes that occur within virus’s ribonucleic acid that changes the virus. Typically, these changes create seasonal changes or new strains of a virus
WHO Pandemic Phases
Phase 1—None of the current viruses circulating in animals have been reported to cause infection in humans.
Phase 2—An animal-based influenza virus is known to have caused infection in humans and is considered a potential pandemic threat.
Phase 3—An animal- or human-animal-based virus has caused some clusters of cases in people, but has not caused human-to-human transmission that is significant enough to cause community-level outbreaks.
Phase 4—Human-to-human transmission of an animal or human-animal virus is causing community outbreaks and sustained disease. This is a significant shift in risk and any country with such an outbreak should consult with WHO.
Phase 5—There is human-to-human spread of the virus in at least two countries. This phase means that pandemic is imminent and that community action and implementation of planned mitigation procedures is needed.
Phase 6—This is the pandemic phase, characterized by outbreaks in more than one WHO defined region in addition to all Phase 5 criteria (WHO, 2009)
Phase 1
None of the current viruses circulating in animals have been reported to cause infection in humans.
Phase 2
An animal-based influenza virus is known to have caused infection in humans and is considered a potential pandemic threat.
Phase 3
An animal- or human-animal-based virus has caused some clusters of cases in people, but has not caused human-to-human transmission that is significant enough to cause community-level outbreaks.
Phase 4
Human-to-human transmission of an animal or human-animal virus is causing community outbreaks and sustained disease. This is a significant shift in risk and any country with such an outbreak should consult with WHO.
Phase 5
There is human-to-human spread of the virus in at least two countries. This phase means that pandemic is imminent and that community action and implementation of planned mitigation procedures is needed.
Phase 6
This is the pandemic phase, characterized by outbreaks in more than one WHO defined region in addition to all Phase 5 criteria (WHO, 2009).
Pandemic Severity Index
Category 1—case fatality ratio of less than 0.1% and fewer than 90,000 U.S. deaths
Category 2—0.1%-0.5% case fatality ratio and 90,000-450,000 U.S. deaths
Category 3- 0.5%—1% case fatality ratio and 450,000-900,000 U.S. deaths
Category 4—1-2% case fatality ratio and 900,000-1.8 million U.S. deaths
Category 5—greater than 2% case fatality ratio and more than 1.8 million U.S. deaths (CDC, 2014).
SDG’s
- No poverty
- Zero hunger
- Good health and wellbeing
- Quality education
- Gender equality
- Clean water and sanitation
- Decent work and economic growth
- Peace, justice and strong institutions
The Sustainable Development Goals (SDGs), otherwise known as the Global Goals, are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity.
Health effects of climate change
increasing temperatures, extreme weather, desertification, and flooding on asthma, chronic obstructive lung disease, and respiratory infections
History of WHO
1945: charter of the United Nations; article calling for establishment of health agency with wide powers
1946: UN representatives created and ratified the constitution of WHO
1948: constitution went into force and WHO began work\
The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO played a leading role in the eradication of smallpox. Its current priorities include communicable diseases, in particular HIV/AIDS, Ebola, malaria and tuberculosis; as well as the mitigation of the effects of non-communicable diseases such as sexual and reproductive health, development, and aging; nutrition, food security and healthy eating; occupational health; substance abuse; and driving the development of reporting, publications, and networking.
Call to action
It falls to nurses and midwives, the most numerous and arguably most patient-centered component of the health workforce, to assume a leadership role in addressing planetary health. Leadership begins with educating ourselves, students, staff, patients, and communities. Engagement in political and policy processes are needed-and can take many forms. Even small measures may have impact. Local level sustainability and readiness is meaningful at one’s university, hospital, and or health system levels.
Learn
Communicate
Find common ground
Nurses may want to consider assessing the environment where patients live and work (or go to school, for pediatric patients), including air quality by noting the proximity to emissions from cars (living close to highways) or factories and their mass transit accessibility. Teaching families how to assess allergen exposure and palliative measures are also important steps nurses can take.
Health Outcomes
defined as an end result that follows some kind of healthcare provision, treatment, or intervention and may describe a patient’s condition or health status
outcomes may be classified into categories by describing
who is measured, such as individuals, aggregates, communities, populations, or organizations; by identifying the “what” or the type of outcome, such as care, patient, or performance-related outcomes determining the “when” or the time it takes to achieve an outcome, such as short-term, intermediate, or long-term outcomes
three components: structure, process, and outcome. Structure refers to healthcare resources, such as the number and type of health and social service agencies, and can also include utilization indicators. Process describes how the healthcare is delivered, and outcome refers to the change in health status related to the intervention provided
Domain 1
DOMAIN 1: Capacity Strengthening
Capacity strengthening is the broad sharing of knowledge, skills, and resources for enhancement of global public health programs, infrastructure, and workforce to address current and future global public health needs.
1.1Design sustainable workforce development strategies for resource-limited settings.
1.2Identify methods for assuring health program sustainability.
1.3Assist host entity in assessing existing capacity.
1.4Develop strategies that strengthen community capabilities for overcoming barriers to health and well-being.
Domain 2
DOMAIN 2: Collaborating and Partnering
Collaborating and partnering is the ability to select, recruit, and work with a diverse range of global health stakeholders to advance research, policy, and practice goals, and to foster open dialogue and effective communication.
2.1Develop procedures for managing health partnerships.
2.2Promote inclusion of representatives of diverse constituencies in partnerships.
2.3Value commitment to building trust in partnerships.
2.4Use diplomacy and conflict-resolution strategies with partners.
2.5Communicate lessons learned to community partners and global constituencies.
2.6Exhibit interpersonal communication skills that demonstrate respect for other perspectives and cultures.
Domain 3
DOMAIN 3: Ethical Reasoning and Professional Practice
Ethical reasoning and professional practice is the ability to identify and respond with integrity to ethical issues in diverse economic, political, and cultural contexts, and promote accountability for the impact of policy decisions on public health practice at local, national, and international levels.
3.1Apply the fundamental principles of international standards for the protection of human subjects in diverse cultural settings.
3.2Analyze ethical and professional issues that arise in responding to public health emergencies.
3.3Explain the mechanisms used to hold international organizations accountable for public health practice standards.
3.4Promote integrity in professional practice.
Domain 4
DOMAIN 4: Health Equity and Social Justice
Health equity and social justice is the framework for the analysis of strategies to address health disparities across socially, demographically, or geographically defined populations.
4.1Apply social justice and human rights principles in public health policies and programs.
4.2Implement strategies to engage marginalized and vulnerable populations in making decisions that affect their health and well-being.
4.3Critique policies with respect to impact on health equity and social justice.
4.4Analyze distribution of resources to meet the health needs of marginalized and vulnerable groups.
Domain 5
DOMAIN 5: Program Management
Program management is the ability to design, implement, and evaluate global health programs to maximize contributions to effective policy, enhanced practice, and improved and sustainable health outcomes.
5.1Conduct formative research.
5.2Apply scientific evidence throughout program planning, implementation, and evaluation.
5.3Design program work plans based on logic models.
5.4Develop proposals to secure donor and stakeholder support.
5.5Plan evidence-based interventions to meet internationally established health targets.
5.6Develop monitoring and evaluation frameworks to assess programs.
5.7Utilize project management techniques throughout program planning, implementation, and evaluation.
5.8Develop context-specific implementation strategies for scaling up best-practice interventions.
Domain 6
DOMAIN 6: Sociocultural and Political Awareness
Sociocultural and political awareness is the conceptual basis with which to work effectively within diverse cultural settings and across local, regional, national, and international political landscapes.
6.1Describe the roles and relationships of the entities influencing global health.
6.2Analyze the impact of transnational movements on population health.
6.3Analyze context-specific policy-making processes that impact health.
6.4Design health advocacy strategies.
6.5Describe multiagency policy making in response to complex health emergencies.
6.6Describe the interrelationship of foreign policy and health diplomacy.
Domain 7
DOMAIN 7: Strategic Analysis
Strategic analysis is the ability to use systems thinking to analyze a diverse range of complex and interrelated factors shaping health trends to formulate programs at the local, national, and international levels.
7.1Conduct a situation analysis across a range of cultural, economic, and health contexts.
7.2Identify the relationships among patterns of morbidity, mortality, and disability with demographic and other factors in shaping the circumstances of the population of a specified community, country, or region.
7.3Implement a community health needs assessment.
7.4Conduct comparative analyses of health systems.
7.5Explain economic analyses drawn from socioeconomic and health data.
7.6Design context-specific health interventions based on situation analysis.
The WHO conceptual framework for social determinants of health identifies five multifactorial components of population health that impact health outcomes
biology and genetics, individual behavior, social environment, physical environment, and health services.
USAID
Activating a Disaster Assistance Response Team (DART) staffed by the CDC, in Monrovia, Liberia, and Guinea, to coordinate planning, operations, logistics, administrative issues, and interagency work
•Saving more than 3 million lives with immunization programs
•Reaching over 850,000 people with HIV-prevention education after establishing programs in 32 countries since 1987; training over 40,000 people to support HIV/AIDS programs in their own countries
•Providing family planning to more than 50 million couples worldwide
•Training 21,000 Honduran farm families to prevent soil erosion
•Providing oral rehydration therapy in Bangladesh; saving tens of millions of lives worldwide with this program
•Providing loans and operating costs to Bolivian Banco Solidario (BancoSol), which is the first self-sustaining commercial bank in Latin America to focus on microbusiness (small business loans averaging $200 each)
USAID works with WHO to promote and protect health as an essential element for human welfare, economic, and social development (WHO, n.d.-a). The WHO was created in 1946, as part of the UN, to find solutions for post-World War II Europe
WHO global outbreak
global Outbreak Alert and Response Network (GOARN), which initiates an international disease outbreak alert, technical support, vaccines, drugs, specialists, and equipment, to prevent spread, such as the plague in India, in 1995, which had an economic cost of over $1.7 billion
•Chemical Incident Alert and Response System (ChemiNet): initiates alerts of industrial accidents, chemical, water, sanitation, radionuclear or environmental health emergencies
•Global network of national health systems
•Global Polio Eradication Initiative Network (GPEIN)
•Global Influenza Surveillance Network (GISN)
•FluNet
•H5N1 Avian flu tracking
•XDR-TB drug-resistant tuberculosis tracking
•Containment of 21st-century threats of bioterrorism (anthrax, etc.), SARS, and toxic chemical waste dumping, such as the 2006 illegal dumping of 500 tons of chemical waste in Abidjan, Cote d’Ivoire
•WHO Foreign Policy and Global Health (FPGH) Initiative
•Coordination of responses to natural disasters, with concomitant infectious diseases, malnutrition, mental illness, and displacement of large numbers of people
Millenium Development Goals (MDGs)
The UN’s creation of eight goals for economic development and social progress in 2000. Members agreed to reach the goals by 2015.
Eradicate extreme poverty and hunger.
2.Achieve universal primary education.
3.Promote gender equality and empower women.
4.Reduce child mortality.
5.Improve maternal health.
6.Combat HIV/AIDS, malaria, and other diseases.
7.Ensure environmental sustainability.
8.Develop a global partnership for development
iceberg concept
in counting incidence and prevalence of disease it is not sufficient to count only clinically apparent cases, but those who are asymptomatic or exposed without infection is the
Clinical disease
disease characterized by signs and symptoms
Preclinical disease
disease that is not yet clinically apparent, but is destined to progress to clinical disease
Subclinical disease
disease that is not clinical apparent, not destined to become clinically apparent
Pandemic
excessive occurrence of disease present globally
Endemic
habitual presence of disease within geographic area
common-vehicle exposure
group of people are exposed to a substance/organism that causes common illness
Epidemic
occurrence of disease in community/geographic area in excess of normal expectancy
Herd immunity
resistance of group of people to disease because large portion of population is immune
Incidence
number of new cases of a disease, during a set period of time, in a specific population who is at risk for the disease
Epidemiology
the science of public healht
Population Health
Focuses on risk, data, demographics and outcomes
Aggregate
A defined population
Community
Composed of multiple aggregates
Data
Compiled information
Prevalence
Measures the existence of the disease
Incidence
Measures the appearance
Surveillance
Collection, Analysis, dissemination of data
High Risk
Increased chance of poor health outcome
Morbidity
Presence of illness in a population
Accomadation
Cultural Awareness
:Self-examination of one’s own prejudices and biases toward other cultures. An in-depth exploration of one’s own cultural/ethnic background.
Cultural competence in nursing consists of four principles.
Care is designed for the specific client.
Care is based on the uniqueness of the person’s culture and includes cultural norms and values.
Care includes self-employment strategies to facilitate client decision making to improve health behaviors.
Care is provided with sensitivity and is based on the cultural uniqueness of clients.
The APN may also use the Kleinman Explanatory Model of Illness (1978). Below are the questions that can be utilized.
What do you call your problem?
What do you think caused your problem?
Why do you think it started when it did?
What does your sickness do to you?
What do you fear most about your sickness?
What are the chief problems your sickness has caused you?
What kind of treatment do you think you should receive?
What is the most important result you hope to receive from the treatment?
According to Giger and Davidhizer (2000), although cultures differ, they all have the same basic organizing factors that must be assessed in order to provide care for culturally diverse patients. These factors include
communication (verbal and nonverbal);
personal space;
social organization;
time perception;
environmental control; and
biological variations.
The NCCC uses four major approaches to fulfill its mission, including
Web-based technical assistance, (2) knowledge development and dissemination, (3) supporting a community of learners, and (4) collaboration and partnerships with diverse groups.
Epidemiological Triad:
host, agent, environment
Genetics
The study of individual genes and their impact on relatively rare single gene disorders
Absolute risk
is the probability of an event, such as illness, injury, or death. Gives no indication of how its magnitude compares with others
The odds ratio
closely approximates the relative risk if the disease is rare.
Odds ratio and the relative risk are used
to assess the strength of association between risk factor and outcome.
How is Attributible risk used
is used to make risk-based decisions for individuals.
Population-attributable risk measures
are used to form public health decisions
EGAPP:
Evaluation of Genomic Applications in Practice and Prevention
GAPPNet
Genomic Applications in Practice and Prevention Network (established in 2009) is a collaborative initiative involving partners from across the public health sector working together to realize the promise of genomics in health care and disease prevention.
GEDDI
Genetics Early Disease Detection Intervention project (GEDDI) (established in 2009) developed a model strategy for using clinical, genetic, and family history information to reduce the risk of disease, death, and disability in affected individuals, family members, and populations.
HuGENet
Human Genome Epidemiology Network (HuGENet) (established in 1998) helps translate genetic research findings into opportunities for preventive medicines and public health by advancing the synthesis, interpretation, and dissemination of population-based data on human genetic variation in health and disease. HuGENet reviews are systematic, peer-reviewed synopses of the epidemiologic aspects of human genes, including prevalence of allelic variants in different populations, population-based information on disease risk, evidence for gene-environment interaction and quantitative data on genetic tests and services carried out according to specific guidelines.
NHANES III
DC’s Office of Public Health Genomics (established in 2002) formed a multidisciplinary working group with members from across CDC. It developed a proposal to measure the prevalence of selected genetic variants of public health significance in a representative sample of the U.S. population and to examine the association between the selected genetic variants and disease outcomes available in NHANES III data.
The World Health Organization defines a pandemic
as a global epidemic that spreads to more than one continent (WHO, 2009). One of the more recent pandemics that you might be familiar with is the H1N1 influenza outbreak of 2009.
Outbreak
the occurrence of disease within persons in excess of what would normally be expected in a clearly defined community, location, or time of year. An outbreak may only last for a matter of days or weeks, but may last for years
Quarantine
the separation and restriction of the movement of people who were or are exposed to a contagious disease for a set period of time, to see whether they become ill
Antigenic drift
is a term describing the changes that occur within virus’s ribonucleic acid that changes the virus. Typically, these changes create seasonal changes or new strains of a virus
WHO Pandemic Phases
Phase 1—None of the current viruses circulating in animals have been reported to cause infection in humans.
Phase 2—An animal-based influenza virus is known to have caused infection in humans and is considered a potential pandemic threat.
Phase 3—An animal- or human-animal-based virus has caused some clusters of cases in people, but has not caused human-to-human transmission that is significant enough to cause community-level outbreaks.
Phase 4—Human-to-human transmission of an animal or human-animal virus is causing community outbreaks and sustained disease. This is a significant shift in risk and any country with such an outbreak should consult with WHO.
Phase 5—There is human-to-human spread of the virus in at least two countries. This phase means that pandemic is imminent and that community action and implementation of planned mitigation procedures is needed.
Phase 6—This is the pandemic phase, characterized by outbreaks in more than one WHO defined region in addition to all Phase 5 criteria (WHO, 2009)
Phase 1
None of the current viruses circulating in animals have been reported to cause infection in humans.
Phase 2
An animal-based influenza virus is known to have caused infection in humans and is considered a potential pandemic threat.
Phase 3
An animal- or human-animal-based virus has caused some clusters of cases in people, but has not caused human-to-human transmission that is significant enough to cause community-level outbreaks.
Phase 4
Human-to-human transmission of an animal or human-animal virus is causing community outbreaks and sustained disease. This is a significant shift in risk and any country with such an outbreak should consult with WHO.
Phase 5
There is human-to-human spread of the virus in at least two countries. This phase means that pandemic is imminent and that community action and implementation of planned mitigation procedures is needed.
Phase 6
This is the pandemic phase, characterized by outbreaks in more than one WHO defined region in addition to all Phase 5 criteria (WHO, 2009).
Pandemic Severity Index
Category 1—case fatality ratio of less than 0.1% and fewer than 90,000 U.S. deaths
Category 2—0.1%-0.5% case fatality ratio and 90,000-450,000 U.S. deaths
Category 3- 0.5%—1% case fatality ratio and 450,000-900,000 U.S. deaths
Category 4—1-2% case fatality ratio and 900,000-1.8 million U.S. deaths
Category 5—greater than 2% case fatality ratio and more than 1.8 million U.S. deaths (CDC, 2014).
SDG’s
- No poverty
- Zero hunger
- Good health and wellbeing
- Quality education
- Gender equality
- Clean water and sanitation
- Decent work and economic growth
- Peace, justice and strong institutions
The Sustainable Development Goals (SDGs), otherwise known as the Global Goals, are a universal call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity.
History of WHO
1945: charter of the United Nations; article calling for establishment of health agency with wide powers
1946: UN representatives created and ratified the constitution of WHO
1948: constitution went into force and WHO began work\
The World Health Organization (WHO) is a specialized agency of the United Nations that is concerned with international public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO played a leading role in the eradication of smallpox. Its current priorities include communicable diseases, in particular HIV/AIDS, Ebola, malaria and tuberculosis; as well as the mitigation of the effects of non-communicable diseases such as sexual and reproductive health, development, and aging; nutrition, food security and healthy eating; occupational health; substance abuse; and driving the development of reporting, publications, and networking.
Call to action
It falls to nurses and midwives, the most numerous and arguably most patient-centered component of the health workforce, to assume a leadership role in addressing planetary health. Leadership begins with educating ourselves, students, staff, patients, and communities. Engagement in political and policy processes are needed-and can take many forms. Even small measures may have impact. Local level sustainability and readiness is meaningful at one’s university, hospital, and or health system levels.
Learn
Communicate
Find common ground
Health Outcomes
defined as an end result that follows some kind of healthcare provision, treatment, or intervention and may describe a patient’s condition or health status
outcomes may be classified into categories by describing
who is measured, such as individuals, aggregates, communities, populations, or organizations; by identifying the “what” or the type of outcome, such as care, patient, or performance-related outcomes determining the “when” or the time it takes to achieve an outcome, such as short-term, intermediate, or long-term outcomes
Domain 1
DOMAIN 1: Capacity Strengthening
Capacity strengthening is the broad sharing of knowledge, skills, and resources for enhancement of global public health programs, infrastructure, and workforce to address current and future global public health needs.
1.1Design sustainable workforce development strategies for resource-limited settings.
1.2Identify methods for assuring health program sustainability.
1.3Assist host entity in assessing existing capacity.
1.4Develop strategies that strengthen community capabilities for overcoming barriers to health and well-being.
Domain 2
DOMAIN 2: Collaborating and Partnering
Collaborating and partnering is the ability to select, recruit, and work with a diverse range of global health stakeholders to advance research, policy, and practice goals, and to foster open dialogue and effective communication.
2.1Develop procedures for managing health partnerships.
2.2Promote inclusion of representatives of diverse constituencies in partnerships.
2.3Value commitment to building trust in partnerships.
2.4Use diplomacy and conflict-resolution strategies with partners.
2.5Communicate lessons learned to community partners and global constituencies.
2.6Exhibit interpersonal communication skills that demonstrate respect for other perspectives and cultures.
Domain 3
DOMAIN 3: Ethical Reasoning and Professional Practice
Ethical reasoning and professional practice is the ability to identify and respond with integrity to ethical issues in diverse economic, political, and cultural contexts, and promote accountability for the impact of policy decisions on public health practice at local, national, and international levels.
3.1Apply the fundamental principles of international standards for the protection of human subjects in diverse cultural settings.
3.2Analyze ethical and professional issues that arise in responding to public health emergencies.
3.3Explain the mechanisms used to hold international organizations accountable for public health practice standards.
3.4Promote integrity in professional practice.
Domain 4
DOMAIN 4: Health Equity and Social Justice
Health equity and social justice is the framework for the analysis of strategies to address health disparities across socially, demographically, or geographically defined populations.
4.1Apply social justice and human rights principles in public health policies and programs.
4.2Implement strategies to engage marginalized and vulnerable populations in making decisions that affect their health and well-being.
4.3Critique policies with respect to impact on health equity and social justice.
4.4Analyze distribution of resources to meet the health needs of marginalized and vulnerable groups.
Domain 5
DOMAIN 5: Program Management
Program management is the ability to design, implement, and evaluate global health programs to maximize contributions to effective policy, enhanced practice, and improved and sustainable health outcomes.
5.1Conduct formative research.
5.2Apply scientific evidence throughout program planning, implementation, and evaluation.
5.3Design program work plans based on logic models.
5.4Develop proposals to secure donor and stakeholder support.
5.5Plan evidence-based interventions to meet internationally established health targets.
5.6Develop monitoring and evaluation frameworks to assess programs.
5.7Utilize project management techniques throughout program planning, implementation, and evaluation.
5.8Develop context-specific implementation strategies for scaling up best-practice interventions.
Domain 6
DOMAIN 6: Sociocultural and Political Awareness
Sociocultural and political awareness is the conceptual basis with which to work effectively within diverse cultural settings and across local, regional, national, and international political landscapes.
6.1Describe the roles and relationships of the entities influencing global health.
6.2Analyze the impact of transnational movements on population health.
6.3Analyze context-specific policy-making processes that impact health.
6.4Design health advocacy strategies.
6.5Describe multiagency policy making in response to complex health emergencies.
6.6Describe the interrelationship of foreign policy and health diplomacy.
Domain 7
DOMAIN 7: Strategic Analysis
Strategic analysis is the ability to use systems thinking to analyze a diverse range of complex and interrelated factors shaping health trends to formulate programs at the local, national, and international levels.
7.1Conduct a situation analysis across a range of cultural, economic, and health contexts.
7.2Identify the relationships among patterns of morbidity, mortality, and disability with demographic and other factors in shaping the circumstances of the population of a specified community, country, or region.
7.3Implement a community health needs assessment.
7.4Conduct comparative analyses of health systems.
7.5Explain economic analyses drawn from socioeconomic and health data.
7.6Design context-specific health interventions based on situation analysis.
The WHO conceptual framework for social determinants of health identifies five multifactorial components of population health that impact health outcomes
biology and genetics, individual behavior, social environment, physical environment, and health services.
USAID
Activating a Disaster Assistance Response Team (DART) staffed by the CDC, in Monrovia, Liberia, and Guinea, to coordinate planning, operations, logistics, administrative issues, and interagency work
•Saving more than 3 million lives with immunization programs
•Reaching over 850,000 people with HIV-prevention education after establishing programs in 32 countries since 1987; training over 40,000 people to support HIV/AIDS programs in their own countries
•Providing family planning to more than 50 million couples worldwide
•Training 21,000 Honduran farm families to prevent soil erosion
•Providing oral rehydration therapy in Bangladesh; saving tens of millions of lives worldwide with this program
•Providing loans and operating costs to Bolivian Banco Solidario (BancoSol), which is the first self-sustaining commercial bank in Latin America to focus on microbusiness (small business loans averaging $200 each)
WHO global outbreak
global Outbreak Alert and Response Network (GOARN), which initiates an international disease outbreak alert, technical support, vaccines, drugs, specialists, and equipment, to prevent spread, such as the plague in India, in 1995, which had an economic cost of over $1.7 billion
•Chemical Incident Alert and Response System (ChemiNet): initiates alerts of industrial accidents, chemical, water, sanitation, radionuclear or environmental health emergencies
•Global network of national health systems
•Global Polio Eradication Initiative Network (GPEIN)
•Global Influenza Surveillance Network (GISN)
•FluNet
•H5N1 Avian flu tracking
•XDR-TB drug-resistant tuberculosis tracking
•Containment of 21st-century threats of bioterrorism (anthrax, etc.), SARS, and toxic chemical waste dumping, such as the 2006 illegal dumping of 500 tons of chemical waste in Abidjan, Cote d’Ivoire
•WHO Foreign Policy and Global Health (FPGH) Initiative
•Coordination of responses to natural disasters, with concomitant infectious diseases, malnutrition, mental illness, and displacement of large numbers of people
Millenium Development Goals (MDGs)
The UN’s creation of eight goals for economic development and social progress in 2000. Members agreed to reach the goals by 2015.
Eradicate extreme poverty and hunger.
2.Achieve universal primary education.
3.Promote gender equality and empower women.
4.Reduce child mortality.
5.Improve maternal health.
6.Combat HIV/AIDS, malaria, and other diseases.
7.Ensure environmental sustainability.
8.Develop a global partnership for development
Clinical disease
disease characterized by signs and symptoms
Preclinical disease
disease that is not yet clinically apparent, but is destined to progress to clinical disease
Subclinical disease
disease that is not clinical apparent, not destined to become clinically apparent
Pandemic
excessive occurrence of disease present globally
Herd immunity
resistance of group of people to disease because large portion of population is immune
Epidemiology
the science of public health
Population Health
Focuses on risk, data, demographics and outcomes
Aggregate
A defined population
Community
Composed of multiple aggregates
Data
Compiled information
Prevalence
Measures the existence of the disease
Incidence
Measures the appearance
Surveillance
Collection, Analysis, dissemination of data
High Risk
Increased chance of poor health outcome
Morbidity
Presence of illness in a population
Cultural competence
A dynamic, fluid, continuous process whereby an individual, system or healthcare agency find meaningful and useful care delivery strategies based in knowledge of the cultural heritage, beliefs, attitudes, and behavior of those to whom they tender care
Norms and values
Specific practices that guide their actions and decisions of each person in a group based on their culture. Can be either learned or shared.
Kleinman Explanatory Model
A set of questions the advanced practice nurse can use in order to assess the culture of a patient and proposes that individuals have vastly different notions of health and disease.
Socio economic status
A measure that takes into account three interrelated dimensions: a persons income level, education level, and type of occupation. Some measures of socioeconomic status use only one dimension such as income.
Disparities
A higher burden of illness, injury, disability, or mortality experienced by one group in relation to another. ex. Socioeconomic, health, racial or ethnic
Food desert
Neighborhoods and communities that have limited access to affordable fresh and nutritious food
Social determinants of health
Things like poverty, education level, racism, income and poor housing that affect access to healthcare
Social justice theory
The goal that all people will have equal opportunity to healthcare access and quality of healthcare will be the same
Accommodation
To create an environment that accommodates health practice and ritual from other cultures within a plan of care
Acculturation
Degree To which an individual from one culture has given up the traits of that culture and adopted the traits of the dominant culture in which they now reside
Assimilation
This social, economic, and political integration of a cultural group into main stream society to which it may have emigrated
Genomics
The study of all genes in the human genome as well as their interaction with other genes, the individuals environment, and the influence of cultural and psychosocial factors.
Pharmacogenomics
Medication efficacy, toxicity, and drug interaction based on genetic variations
WHO
(World Health Organization) specialized agency of the United Nations that is concerned with international public health. The world health organization recognized that international collaboration could control infectious disease better than any single country.
Sustainable Development Goals (SDGs)
Goals resulting from a UN-led effort to end extreme poverty by focusing on 17 key indicators, the top five of which are no poverty, zero hunger, good health, quality education, and gender equality, with key benchmarks for 2030.
Universal declaration of human rights
All people have the right to a standard of living that guarantees health
Community health needs assessment
Assessing whether or not the region has the community resources that it needs.
situation analysis
To analyze and identify the relationships among patterns of morbidity, mortality, and disability within the demographic and other factors shaping thecircumstances of the population of a specified community, country, or region.
Culture
Practices, beliefs, values, norms (can be learned or shared) which guides the actions and decisions of each person in the group.
Cultural Organizing Factors
Communication, personal space, social organization, time perception, environmental control, and biological variations
Macro-scale influences
Broad understandings of illness, suffering and healing. Social roles and bureaucratic and economic context of health care services
Micro-scale influences
Face-to-face interaction at front-lines. Successful and failed communication efforts.
Cultural Humility
incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-clinician dynamic and to developing mutually beneficial and advocacy partnerships with communities on behalf of individuals and defined populations
Cultural Knowledge
obtaining a sound educational foundation concerning the various worldviews of different cultures. Obtaining knowledge regarding biological variations, disease, and health conditions and variations in drug metabolism.
Cultural Skill
Ability to collect culturally relevant data regarding the client’s health history and presenting problem and conduct a culturally sensitive assessment.
Cultural Desire
Motivation of the provider to want to engage in the process of cultural competence, characteristics of compassion, authenticity, humility, openness, availability, and flexibility, commitment, and passion to caring regardless of conflict.
4 principles of cultural competence
- Caring is designed for the specific client
- Care is based in the uniqueness of the person’s culture and includes cultural norms and values
- Care includes self-employment strategies to facilitate client decisions making to improve health behaviors.
- Care is provided with sensitivity and is based on the cultural uniqueness of clients.
Cross Cultural Health Care Program
Includes a plethora of materials to improve cultural competency among providers including training programs.
National Partnership for Action (NPA)
Mobilizes individuals and groups to work and improve quality and elimination of health disparities
National Priorities Partnership
Key private and public stakeholders who have agreed to work on major health priorities of patients and families, palliative and end of life care, care coordination, patient safety, and population of health
Quality Alliance Steering Committee (QASC)
Work to improve healthcare quality and costs
Office of Minority Health and Health Disparities
Resources used by APNs to obtain data that demonstrate how minority population compare with the US population as a whole.
Ethnicity
Aggregate of cultural practices, social influences, religious pursuits, and racial characteristics shaping the distinctive identity of community
race
A biological designation whereby group members share features (skin color, bone structure, genetic traits, blood groupings).
Nationality
Country of birth
Genetic Evaluation
Medical history, testing, counseling, next steps, family risk
Pandemic
Global epidemic of disease that spreads to more than one continent
Outbreak
The occurrence of disease within persons in excess of what would normally be expected in a clearly defined community, location, and time of year.
Quarantine
The separation and restrictions of the movement of people who were or are exposed to a contagious disease for a set period of time, to see whether they become ill.
Isolation
The separation of sick people with a contagious disease from those who are not ill.
Epidemiological Triangle
Explains causation
Caustive Agent
Those factors from which presence or absence cause disease
Susceptible host
Things such as she, gender, race, immune status, genetics
Environment
diverse elements such as water, food, neighborhood, pollution
Sustainable Development Goals
agreement between countries to create an environment at the national and global levels alike conductive to development and the elimination of poverty
Climate change
due to human activity, trigger global migration, and local relocation due to sea level rise.
Population health
the health outcomes of a group of individuals, including the distribution of such outcomes within the group. I.e. seatbelt laws, no smoking areas, allergy free schools.
Risk reduction
the health protection when individuals participate in behaviors that enable then to react to actual or potential threats
Assessment
the gathering of information abut a patient’s physiological, psychological, sociological, and spiritual status.
Outcomes
an end result that follows some kind of healthcare profession, treatment, or intervention and may describe a patient’s condition or health status
Public health policy
collected laws, regulations, and approaches taken to make a decision including a wide range of topics including health care reform, insurance reform with an eye to individuals who are not covered by an employer or a group, and the prevention and control of communicable diseases.
Ethics
practices with compassion and respect committed to patient, family, community, and population promoting, advocating, and protecting the rights, health, and safety of the patient.
Fairness
the state, condition, or quality of being fair or free of bias or injustice
unexposed incidence
incidence of new cases of disease in persons who were not exposed
unexposed incidence equation
number unexposed with disease / total number of unexposed
relative risk
risk of disease in one group versus another; risk of developing disease after exposure; 1 = no risk
relative risk equation
exposed with disease/total of all exposed // # unexposed with disease/total all unexposed
odds ratio
measure of exposure and disease outcome commonly used in case control studies
odds ratio equation
R(exposed)/1-R(exposed) / R(unexposed)/1-R(unexposed)
prevalence
number of cases of a disease in a given time regardless of when it began
prevalence equation
(persons with disease / total pop) x1000
primary prevention
preventing initial development of disease; action taken to prevent development of a disease in person who is well, does not have disease
secondary prevention
early detection of existing disease to reduce severity and complications (or) identifying people in whom disease process has already begun, but who have not developed symptoms
tertiary prevention
reducing impact of disease (or) preventing complications in those who have already developed signs and symptoms of an illness, have been diagnosed
T OR F: prevention and treatment of single specific disease are exclusive activities that do not occur together when providing care to patient
False
preclinical disease
disease that is not yet clinically apparent, but is destined to progress to clinical disease
subclinical disease
disease that is not clinical apparent, not destined to become clinically apparent
persistent (chronic) disease
disease/symptoms that persist for years or for a lifetime
latent disease
infection with no active multiplication of agent
pandemic
excessive occurrence of disease present globally
one medical advance associated with Black Death in Europe in late 1300s
incubation period for disease/infection was identified through isolation/quarantine of travelers entering seaport of Italy. it was found that 30 days was not enough time to isolate patient to prevent transmission of disease to others; time period lengthened to 40 days
passive surveillance
surveillance in which available data on a reportable disease is used to make note of or observe disease
prevalence
current number of all affected persons with a specific disease present in a population at a specific time period
two reasons that prevalence rate of a disease in a community could decrease
- cure of disease
- deaths of patients with disease
unexposed incidence
incidence of new cases of disease in persons who were not exposed
unexposed incidence equation
number unexposed with disease / total number of unexposed
incidence of disease
measure of risk; total number in population with disease divided by total number of population
incidence of disease equation
number with disease / total population
relative risk
risk of disease in one group versus another; risk of developing disease after exposure; 1 = no risk
relative risk equation
exposed with disease/total of all exposed // # unexposed with disease/total all unexposed
odds ratio
measure of exposure and disease outcome commonly used in case control studies
odds ratio equation
R(exposed)/1-R(exposed) / R(unexposed)/1-R(unexposed)
prevalence
number of cases of a disease in a given time regardless of when it began
prevalence equation
(persons with disease / total pop) x1000
attributable risk
difference in disease in those exposed and unexposed, calculated from prospective data; directly attributed to exposure (if exposure gone, disease gone)
attributable risk equation
R(exposed) – R(unexposed)
crude birth rate
number of live births per 1000 people in population
crude birth rate equation
(# of births/estimated mid-year population) x1000
case fatality rate
the percentage of individuals who have specific disease and diet within specific time after diagnosis
case fatality rate equation
(# of persons dying from disease after diagnosis or set period / # of persons with disease) x1000
primary prevention
preventing initial development of disease; action taken to prevent development of a disease in person who is well, does not have disease
secondary prevention
early detection of existing disease to reduce severity and complications (or) identifying people in whom disease process has already begun, but who have not developed symptoms
tertiary prevention
reducing impact of disease (or) preventing complications in those who have already developed signs and symptoms of an illness, have been diagnosed
T OR F: prevention and treatment of single specific disease are exclusive activities that do not occur together when providing care to patient
False
preclinical disease
disease that is not yet clinically apparent, but is destined to progress to clinical disease
subclinical disease
disease that is not clinical apparent, not destined to become clinically apparent
persistent (chronic) disease
disease/symptoms that persist for years or for a lifetime
pandemic
excessive occurrence of disease present globally
endemic
habitual presence of disease within geographic area
one medical advance associated with Black Death in Europe in late 1300s
incubation period for disease/infection was identified through isolation/quarantine of travelers entering seaport of Italy. it was found that 30 days was not enough time to isolate patient to prevent transmission of disease to others; time period lengthened to 40 days
passive surveillance
surveillance in which available data on a reportable disease is used to make note of or observe disease
incidence
number of new cases of a disease, during a set period of time, in a specific population who is at risk for the disease
prevalence
current number of all affected persons with a specific disease present in a population at a specific time period
two reasons that prevalence rate of a disease in a community could decrease
- cure of disease
- deaths of patients with disease
age-adjusted rates
eliminate effects of differences in age distributions of populations in comparing death rates
exposed incidence
incidence of new cases of disease in persons who were exposed
exposed incidence equation
number exposed with disease / total number exposed
unexposed incidence
incidence of new cases of disease in persons who were not exposed
unexposed incidence equation
number unexposed with disease / total number of unexposed
relative risk
risk of disease in one group versus another; risk of developing disease after exposure; 1 = no risk
relative risk equation
exposed with disease/total of all exposed // # unexposed with disease/total all unexposed
odds ratio
measure of exposure and disease outcome commonly used in case control studies
odds ratio equation
R(exposed)/1-R(exposed) / R(unexposed)/1-R(unexposed)
prevalence
number of cases of a disease in a given time regardless of when it began
prevalence equation
(persons with disease / total pop) x1000
attributable risk equation
R(exposed) – R(unexposed)
crude death rate
the number of deaths per 1000 people in population
crude death rate equation
(# of deaths/estimated mid-year population) x1000
fetal death rate
number of fetal deaths (20+ wk gestation) per 1000 live births
fetal death rate equation
(# of fetal deaths / # of live births+fetal deaths) x1000
annual mortality rate
usually an expression of a specific disease or can be all causes per 1000 people for a year
annual mortality rate equation
(# of deaths of all causes(or specific disease) / mid-yr population) x1000
primary prevention
preventing initial development of disease; action taken to prevent development of a disease in person who is well, does not have disease
secondary prevention
early detection of existing disease to reduce severity and complications (or) identifying people in whom disease process has already begun, but who have not developed symptoms
tertiary prevention
reducing impact of disease (or) preventing complications in those who have already developed signs and symptoms of an illness, have been diagnosed
T OR F: prevention and treatment of single specific disease are exclusive activities that do not occur together when providing care to patient
False
iceberg concept
in counting incidence and prevalence of disease it is not sufficient to count only clinically apparent cases, but those who are asymptomatic or exposed without infection
preclinical disease
disease that is not yet clinically apparent, but is destined to progress to clinical disease
subclinical disease
disease that is not clinical apparent, not destined to become clinically apparent
persistent (chronic) disease
disease/symptoms that persist for years or for a lifetime
pandemic
excessive occurrence of disease present globally
common-vehicle exposure
group of people are exposed to a substance/organism that causes common illness
epidemic
occurrence of disease in community/geographic area in excess of normal expectancy; Outbreak at a population level
one medical advance associated with Black Death in Europe in late 1300s
incubation period for disease/infection was identified through isolation/quarantine of travelers entering seaport of Italy. it was found that 30 days was not enough time to isolate patient to prevent transmission of disease to others; time period lengthened to 40 days
active surveillance
when project staff carries out current surveillance of disease through active field visits
passive surveillance
surveillance in which available data on a reportable disease is used to make note of or observe disease
prevalence
current number of all affected persons with a specific disease present in a population at a specific time period
two reasons that prevalence rate of a disease in a community could decrease
- cure of disease
- deaths of patients with disease
Chronic Disease indicators
Level of data: state, territory, select large metropolitan areas
The Chronic Disease Indicators enable public health professionals and policy makers to retrieve state and selected metropolitan-level data for chronic diseases and risk factors.
Interactive atlas of heart disease and stroke
Level of data: national, state, territory, county
The Interactive Atlas of Heart Disease and Stroke enables online county-level mapping of heart disease and stroke by race/ethnicity, gender, and age group. Maps can show social and economic factors and health services for the United States, specific states, or territories.
National Center for HIV/AID, viral hepatitis, STD, and TB prevention atals
Level of data: national, state, select territories
The Atlas provides interactive maps, graphs, tables, and figures showing geographic patterns and time trends of the reported occurrence of the following diseases: HIV, AIDS, viral hepatitis, tuberculosis, chlamydia, gonorrhea, and primary and secondary syphilis. The data are based on nationally notifiable infectious diseases in the United States and can be used to examine disparities.
National Environmental Public Health tracking network
Level of data: national, state, county
The Tracking Network is a system of integrated health, exposure, and hazard information and data from a variety of national, state, and city sources. Maps, tables, and charts with data about environmental indicators (e.g., particulate matter in the air) are available.
Social Vulnerability Index
Level of data: census tract
The Social Vulnerability Index uses U.S. census variables at tract level to help local officials identify communities that may need support in preparing for hazards, or recovering from disaster. Social vulnerability refers to the resilience of communities when confronted by external stresses on human health, stresses such as natural or human-caused disasters, or disease outbreaks. Reducing social vulnerability can decrease both human suffering and economic loss.
Vulnerable populations footprint tool
Level of data: state, county, city, census tract
The Vulnerable Populations Footprint Tool creates maps and reports that identify geographic areas with high poverty rates and low education levels—two key social determinant indicators of population health. Thresholds for target areas are adjustable, allowing the tool to be used in geographic areas where regional rates may be higher or lower than the national average.
Norms
rules and expectations by which a society guides the behavior of its members
Values
the ideas, beliefs, and attitudes about what is important that help guide the way you live
Socioeconomic status (SES)
Social standing or class of an individual or group. Measured as a combination of education, income, and occupation
Minorities
A category of people who experience relative disadvantages as compared to members of a dominant social group because of their physical or cultural characteristics
Social Determinants of Health
Aspects of society and the social environment that impact on health, such as poverty, early life experiences, social networks and support. Housing, education, access to public transportation, safe water, food, built environment
Social Justice
justice in terms of the distribution of wealth, opportunities, and privileges within a society.
Data sources that assess determinants of health
Chronic disease indicators, interactive atlas of heart disease and stroke, national center for HIV/AIDS, viral hepatitis, STD, and TB prevention atlas, National environmental public health tracking tool, The social vulnerability index, vulnerable populations foot print tool
Odds ratio
closely approximates relative risk if the disease is rare. Used with relative risk to assess strength of association between risk factor and outcome.
population attributable risk
Percentage of disease incidence that would be eliminated if the risk factor were removed. Used to form public health decisions.
Genetic risk assessment
The purpose is to determine individuals with greater than average genetic contribution to disease. DNA testing, family hx. Ex. cancer, diabetes, or cardiovascular disease
Genetic epidemiology
the link of epidemiology and genetics
Pharmacogenomics
how genetic variations affect medication efficacy, toxicity, and drug interaction outside of the drugs themselves
components of risk assessment
Family Hx, DNA testing
Genetics Nondiscrimination Act (GINA)
Enacted in 2008, is a federal law that protects individuals from genetic discrimination in health insurance and employment.
Pandemic
a global epidemic of disease that spreads to more than 1 continent
Outbreak
the occurrence of disease within persons in excess of what would normally be expected in a clearly defined community, location or time of year. An outbreak may only last for a matter of days or weeks but may last for years.
Quarantine
the separation of and restriction of the movement of people who were or are exposed to a contagious disease for a set period of time to see whether they will become ill.
Disaster epidemiology
the use of epidemiology to assess the short and long term adverse health effects of disasters and to predict consequences of future disasters. It brings together various topic areas of epidemiology including acute and communicable disease, environmental health, occupational health, chronic disease, injury, mental health and behavioral health
World Health Organization
Primary goal is to direct international health within the United Nations system and to lead partners in global health responses
SDG’s
Universal call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity
SDG’s list
- No poverty
- Zero hunger
- Good health and wellbeing
- Quality education
- Gender equality
- Clean water and sanitation
- Decent work and economic growth
- Peace, justice and strong institutions
Health effects of climate change
Cardiovascular and respiratory effects, Drowning, injury, GI illness, wound/ blood infections, vector-born illness, malnutrition, poverty, distress, grief, behavioral and social health consequence due to increasing temperatures, extreme weather, desertification, and flooding
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