PHPH 101

Section III: Preventing Disease, Disability and Death (team leader: Baumgartner)

Unit Central Question:

Chapter 6: Non-Communicable Diseases

Chapter Central Question:

  • Learning Objectives (paraphrased from p. 87 of text)
  • Describe the burden of non-communicable diseases in US
  • Describe the epidemiologic transition
  • Describe the best criteria for screening
  • Explain multiple risk factor intervention for non-communicable disease control
  • Describe cost-effectiveness of prevention vs care
  • Describe ways that genetic intervention can affect the burden of NC disease
  • Describe ways that population interventions can be combined with individual interventions to reduce the burden of disease

Class 1 (RB and EPH Faculty)

  • The “Epidemiologic Transition”
  • Terms, Concepts and Methods
  • What is a “non-communicable disease”?
  • Acute vs. Chronic
  • What is “Burden of Disease”?
  • Prevalence vs Incidence
  • Uses: estimation of costs for prevention, treatment and care
  • What is “Surveillance”?
  • Cancer Registries
  • What is “Screening”?
  • Population Surveys
  • Criteria: burden of disease, prospect for prevention with early detection
  • Screening Methods (not the same as “diagnosis”)
  • Sensitivity/Specificity
  • Validity and bias
  • Feasibility
  • Acceptability and cost
  • Comparative examples (p. 91 Table 6-1 expanded)
  • Genetic screening: ethical issues, pros and cons
  • Examples and discussion (Table 6-1, p. 91)

Chapter 6: Non-Communicable Diseases

Class 2 (RB and EPH Faculty)

  • Description of major non-communicable diseases
  • Rank by morbidity, mortality and health care costs
  • Sources of “vital statistics”
  • Risk factor identification
  • Role of analytical epidemiology
  • Study designs, strengths and weaknesses
  • Risk factors (“determinants”) vs causal factors (“actual causes”)
  • “Web” of causation
  • Limits of causal inference
  • Confounding
  • Measures of Relative Risk, Attributable Risk, and Preventable Fraction
  • Example: Framingham Heart Study
  • Risk factor intervention
  • Population vs Individual Levels (“Water Flouridation” vs “Toothbrush”)
  • Primary prevention
  • Secondary prevention
  • Tertiary: Clinical Treatment
  • Single vs multiple risk factor reduction
  • Altering a few risk factors may reduce many non-communicable diseases
  • Energy balance (obesity)
  • Smoking
  • Alcohol/drugs
  • Cost-effectiveness analysis (Figure 6-1)
  • Reality: politics, laws, ethics and unintended consequences
  • The Tobacco story

Chapter 7: Communicable Diseases

Chapter Central Question:

Learning Objectives (paraphrased from p. 99 of text)

  • Describe the burden of communicable diseases
  • Identify the role of barrier protection (prophylaxis) in prevention
  • Identify the role of vaccination
  • Identify the roles of screening, case finding, contact treatment
  • Identify the conditions for eradication
  • Describe range of options for controlling HIV/AIDS

Class 1 (RB and EPH Faculty)

  • The “Epidemiologic Transition” revisited
  • Example
  • The decline and re-emergence of TB
  • The McKeown Thesis: a public health controversy
  • The decline and re-emergence of malaria
  • The “Silent Spring” story
  • Terms, Concepts and Methods
  • What is a “communicable disease”?
  • Infectious, acute, chronic
  • How are “communicable diseases” transmitted?
  • Agent
  • Host
  • Reservoir/Carrier
  • Vector
  • What factors modify risk for “communicable diseases”?
  • Susceptibility and resistance
  • Individual vs “herd” immunity
  • Passive and active immunity
  • Antibiotics
  • Immunization
  • Virulence (example flu vsebola)
  • How do we control “communicable diseases”?
  • Quarantine
  • Barriers (Prophylaxis)
  • Vector control
  • Vaccination

Chapter 7: Communicable Diseases

Class 2 (RB and EPH Faculty)

  • “How do they know when there is an outbreak or epidemic”?
  • Group discussion topics
  • What is meant by an “excess” of cases?
  • What is the difference between an “outbreak” and an “epidemic”
  • What is the meaning of “endemic”
  • Exercise – Modeling an epidemic
  • “What do they do when they detect an outbreak”?
  • Case Studies
  • Sin Nombre (Hanta virus)
  • Salmonella in cucumbers
  • Mad-cow disease
  • Student-generated examples
  • Can we truly “eradicate” communicable diseases?
  • Group discussion topics
  • Conditions for eradication (Table 7-1, p. 105)
  • The Antibiotic Conundrum (nasty little bacteria evolve!)
  • Small pox vs HIV vs Flu (all viruses are not the same!)

Chapter 8: Environmental Health and Safety

Chapter Central Question:

Learning Objectives (paraphrased from p. 111 of text)

  • Define the scope of morbidity and mortality caused by the physical environment
  • Identify the range of interactions that occur between human being and the physical environment
  • Identify the components of environmental risk assessment and apply them to an environmental hazard, such as lead
  • Distinguish between a risk assessment, a public health assessment, and an ecological assessment
  • Discuss the meaning of interactions and how they may impact the size of risks
  • Illustrate how safety issues, such as motor vehicle injuries, have been addressed using a systems thinking approach

Class 1

  • Terms, Concepts and Methods
  • What is the “environment”? (Figure 8-1)
  • Natural
  • Earth, wind and fire (ancient Greeks)
  • Student generated examples
  • Altered
  • “Man-made” (un-natural) chemicals, radiation, biological products
  • Student generated examples
  • Built
  • Results of human construction – buildings, transportation media, communication media
  • Student generated examples
  • How do we assess the impact of the environment on health?
  • Risk assessment
  • Environmental “hazards” (Historical example: Percival Potts – chimney sweeps)
  • Approach
  • Identification
  • Quantification of dose-response
  • Route and timing of exposure at individual/group levels
  • Determinants/modifiers of susceptibility (stage of life, genotype, phenotype, co-morbidity)
  • Characterization of risk (group vs individual level)
  • Case Studies
  • Benzene (“altered” or man-made)
  • Radon (“natural”)
  • Student-generated examples
  • Public health assessment
  • Population risk, public policy and intervention
  • Case studies
  • Lead (Box 8-3 and Table 8-2)
  • Fluoride (not all physical elements are “hazards”)
  • Student-generated examples
  • Ecological assessment
  • Humans as part of a biological ecosystem
  • Case Studies
  • Silent Spring – DDT, mosquitos, malaria and birds
  • Student generated examples

Class 2

  • Systems thinking in environmental health
  • Terms and concepts
  • Levels
  • Feedback
  • Interaction and effect modification
  • Case Studies
  • Radon and smoking on lung cancer (Box 8-5)
  • Solar radiation, ozone and melanoma
  • Student-generated examples

Teaching Methods:

iClickers - prompting questions for each section: pre and post lecture

Group breakout discussions for case studies

Groups may generate additional topics?

Homework on definition and calculation of basic quantitative measures: incidence, prevalence, relative risk

Homework with epidemic modeling program