Adobe Captivate Thursday, August 25, 2016Adobe Captivate Thursday, August 25, 2016 Page 6 of 20 Slide 6 Slide notes: This definition says that a person is healthy if he or she is satisfied

Adobe Captivate Thursday, August 25, 2016

Page 1 of 20

Slide 1


Page 2 of 20

Slide 2

Slide notes: The highlighted objectives are covered in this module.

These objectives relate to the following M2 ICE Core Objective:

#4. The student will utilize community and public health resources at the local, state, and national levels as applied to the health of individuals and populations.

Text Captions: Goals/Objectives

The student will:

Define/distinguish clinical preventive medicine and public health.

Define health according to the WHO and discuss the implications of this definition upon the practice of health care providers; discuss limitations of this definition.

Describe the relative influence of the five domains of health.

List/discuss the most common general cause of death in the U.S. in 1900.

Describe the major factor(s) that led to the decline of the most common cause(s) of death in 1900 in the U.S.

List/discuss the general causes of death today and the general nature of their risk factors.

Discuss the importance of distinguishing between the top 10 causes of death by diseases and the top 10 risk factors (actual causes of death).

State the percentage of deaths in the U.S. that are premature and discuss its significance.

State the approximate percentage of health care costs that is spent on public health and discuss the implications for total health care.

Discuss Healthy People 2020 and Guide to Community Preventive Services.

Discuss the historical relationship between medicine and public health and the importance of this relationship in today’s society.

Discuss the Community Oriented Primary Care (COPC) process/cycle, principles, and the role and value of COPC in the health care system.

Using information from the presentation, Healthy People 2020, Guide to Community Preventive Services, and County Health Rankings & Roadmaps, propose an evidence-based plan to address a health problem using a population approach.


Page 3 of 20

Slide 3

Slide notes: What is the goal of Preventive Medicine?

To paraphrase, the goal of prevention is to understand risk factors, morbidity, mortality and then to modify these risks so people can live better and longer.

This can be done at two levels, 1, at the population or community level with a public health approach,

and 2, at the individual or clinical level, which is where physicians and other health care providers primarily provide preventive services.

Text Captions: What is the Goal of

Preventive Medicine?

Seeks to understand the risk of disease, disability, and death and to modify or eliminate this risk at the population (public health) level as well as the individual (clinical) level.


Page 4 of 20

Slide 4

Slide notes: You are going to become health care providers? What is this thing called health that you are going to be providing?

Even if you don't know the "correct" answers, please answer the questions in the modules to the best of your ability.

Text Captions: Short Answer

What is health?

Question 1 of 2


Page 5 of 20

Slide 5

Slide notes: According to the World Health Organization in 1946, health is a state of complete physical, mental, and social well being

and not merely the absence of disease or infirmity.

This is a comprehensive and a fairly idealistic definition.

There are other definitions of health out there, and I will give you another one, as an example.

Text Captions: What is health?

"A state of complete

PHYSICAL,

MENTAL, and

SOCIAL

WELL-BEING and

NOT merely the absence

of disease or infirmity”

(World Health Organization, 1946)


Page 6 of 20

Slide 6

Slide notes: This definition says that a person is healthy if he or she is satisfied with how well they function, and if others, namely society, agree.

Using this definition, someone can have a disease, such as diabetes, but still be healthy if they can fully function to the satisfaction of themselves,

and also to the satisfaction of family and other members of the community.

Text Captions: Another definition…

Satisfactory Functioning

Ability to function in a manner that is acceptable to the person and society


Page 7 of 20

Slide 7

Slide notes: The traditional medical model would say that one is healthy as long as there is no disease. But is that good enough?

Text Captions: Traditional Treatment/Curative Medical Model


Page 8 of 20

Slide 8

Slide notes: The wellness model, which became popular in the 1970's, would expand or move health to the right in this diagram.

To be healthy one needs to not only have basic needs met, such as, food, shelter, etc., but also to reach their full potential as a human being.

Text Captions: Wellness Model


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Slide 9

Slide notes: One of the first symptoms of this new disease Mr. Ziggy, is a feeling of general well being!


Page 10 of 20

Slide 10

Slide notes: Another way to look at health is the 5 domains of health, a method of comparing the relative contributions of these 5 areas to health, which are also called determinants of health.

The genetic domain is basically what you are born with and so far is not directly modifiable although social and environmental factors can affect genetic expression.

Social issues are modifiable, and clinicians must be aware of social circumstances and their influence on health care, but their modification is not primarily the clinician's job, but society's.

Environmental factors collectively affect our health, and many are monitored and regulated by governmental agencies.

Behavioral choices are by definition all modifiable. Clinicians do have a major role to play in helping individuals to modify their behaviors, but social factors are also very important.

Medical care includes lack of insurance or other access and quality issues, such as medical errors among other things.

Text Captions: Relative influence on health today?

5 Domains (Health Determinants):

Genetics & biology

Gestational endowment/predisposition

Social & economic circumstances

Education, employment/income, cultural issues

Violent crime, social cohesion/isolation

Environmental conditions/exposures (physical environment)

Natural environment: Air/water quality, toxins/chemicals, microbes

Built environment: Structural hazards

Behavioral choices/lifestyle patterns

Tobacco/drug abuse, diet/exercise, sexual practices

Medical care shortfalls

Access and quality of care issues


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Slide 11

Slide notes: Match each of the domains with its percentage influence on health.

Text Captions: Matching

Match each domain with its % influence on health.

Genetic

Social

Environmental

Behavioral

Medical

A) 5%

B) 10%

C) 15%

D) 30%

E) 40%

Correct - Click anywhere or press ‘y’ to continue.

Incorrect - Click anywhere or press ‘y’ to continue.

You must answer the question before continuing.

Question 2 of 2


Page 12 of 20

Slide 12

Slide notes: Here's the answer. Behavioral aspects range from 40-50%, depending on the source.

Genetics is second at 30%.

Social factors are number 3 at 15%,

while medical and environmental factors are 10% and 5%, respectively.

Text Captions: From McGinnis, Williams-Russo, Knickman. The Case for More Active Policy Attention to Health Promotion. Health Affairs. March/April 2002; 21(2): 78-93.


Page 13 of 20

Slide 13

Slide notes: Whoa!. What's going on here? These percentages are not the same as in the previous pie chart!

Well, it's not as black and white as previously suggested. Statistics can be interpreted differently. Later, I'll show you another even different pie chart.

But the point I want to address here is primarily the overlap of individual health behaviors and the social environment.

For example, although individuals can decide or choose not to eat healthy foods or not exercise, their social environment plays a big role in those decisions.

Lack of green spaces to play or walk (physical environment) and commercials encouraging unhealthy food choices (socioeconomic environment) also play a major role.

In other words, social/environmental factors overlap with personal health behaviors to affect health as depicted in the biopsychosocial model.

This helps to explain why using only a clinical approach to help patients change their behavior is difficult and not sufficient.


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Slide 14

Slide notes: Here's another way to look at DOH; this model adds a new one, namely population health/policies.


Page 15 of 20

Slide 15

Slide notes: Let's take a look at one practical application that uses the health determinants or domains of health.

The County Health Rankings & Roadmaps program looks at the health of counties throughout the U.S.

Text Captions: Application of Health Determinants

http://www.countyhealthrankings.org/#app/


Page 16 of 20

Slide 16

Slide notes: This graphic shows some of the items that they look at in evaluating the health of each county.

Note that the percentages they use for each domain are different than those previously presented.

Part of the difference is removing "Genetics", but they also put much more weight on social factors.

They explain their rationale for the percentages at their web site.

Also, note that they look at mortality (length of life) and morbidity (quality of life) in their health outcomes.


Page 17 of 20

Slide 17

Slide notes: This table lists the methods they used to estimate morbidity and mortality.

We will use the County Health Rankings again later in this session.

Text Captions: Application of Health Determinants


Page 18 of 20

Slide 18

Slide notes: Here are more details on the weights that they put on different components for each domain.


Page 19 of 20

Slide 19

Slide notes: Here's the remaining health determinants and their relative weights.


Page 20 of 20

Slide 20

Slide notes: That wraps up the first module. Here are the objectives that were addressed.

Text Captions: Goals/Objectives

The student will:

Define/distinguish clinical preventive medicine and public health.

Define health according to the WHO and discuss the implications of this definition upon the practice of health care providers; discuss limitations of this definition.

Describe the relative influence of the five domains of health.

List/discuss the most common general cause of death in the U.S. in 1900.

Describe the major factor(s) that led to the decline of the most common cause(s) of death in 1900 in the U.S.

List/discuss the general causes of death today and the general nature of their risk factors.

Discuss the importance of distinguishing between the top 10 causes of death by diseases and the top 10 risk factors (actual causes of death).

State the percentage of deaths in the U.S. that are premature and discuss its significance.

State the approximate percentage of health care costs that is spent on public health and discuss the implications for total health care.

Discuss Healthy People 2020 and Guide to Community Preventive Services.

Discuss the historical relationship between medicine and public health and the importance of this relationship in today’s society.

Discuss the Community Oriented Primary Care (COPC) process/cycle, principles, and the role and value of COPC in the health care system.

Using information from the presentation, Healthy People 2020, Guide to Community Preventive Services, and County Health Rankings & Roadmaps, propose an evidence-based plan to address a health problem using a population approach.

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Adobe Captivate Thursday, August 25, 2016Adobe Captivate Thursday, August 25, 2016 Page 6 of 20 Slide 6 Slide notes: This definition says that a person is healthy if he or she is satisfied