The 5 Domains of Public Health

Social/behavioral theories:

• Social learning theory: (aka social cognitive theory) individuals learn behaviors through observing others perform such behaviors. Humans engage in modeling and imitating the behaviors of others.
• Socialization theory: norms and behaviors are learned through social interactions and relationships.
• Expectancy value model: people engage in healthy behavior if it provides a valued outcome and if said outcome is believed likely to happen
• Subjective expected utility theory: entails a simple process of decision making, that involves considering the attributes of a particular behavior and weighing costs vs benefits.
• Health belief model: consists of likelihood of committing a certain action, perceived susceptibility and severity of disease, perceived benefits of action in comparison to costs, environmental cues reminding one to take action, and self-efficacy.

Social & Behavioral Science:

• what is it? An interdisciplinary field that utilizes theory-driven research to investigate behavioral and social functioning (while considering social and biological context) to study how populations develop over the lifespan.

Key concepts of social/behavioral public health:

• There are several micro and macro factors that affect health and contribute to health inequalities both between countries and within countries. Some factors include: place, literacy, social environment, social influence, poverty, social class, social capital, racism, ethnicity, and disability.
• personal characteristics, the environment, and the degree of fit between the two play a role in well being.
• social behavioral science is founded on an ecological framework (introduced by Bronfenbrenner), which has been adapted by the CDC and WHO. The CDC includes 4 levels within the framework: individual, relationship, community, and societal.
• possible explanations for health disparity: psychosocial or micro-social status, psycho social macro level social cohesion, neomaterial micro individual level income, immaterial macro social investment, and health selection.

Steps of a research study:

Biostatiticians are involved in all of the steps of a research study...

• study design
• data collection
• data analysis
• presentation of results
• interpretation of results

Biostatistics:

• what is it? the organization of data so as to facilitate analysis to enhance understanding of the data and its implications. That is, the utilization of statistical and mathematical methods to help solve real world problems and make a difference in people's lives.

Public Health Management & Policy:

History of Public Health:

• 1850-1900: epidemics related to infections and poor sanitation; development of hospitals in urban areas; narrow and basic care; physicians + pharmacies
• 1900-1945: WWII, decline in acute epidemics; improved hygiene; increased social + gov involvement; 3rd party payment
• 1945-1980: biomedical + clinical research; 3rd party payment; Medicare + Medicaid
• 1980-present: emphasis on NIH research; electronic health information; technology

How does this relate to OT?

• what is it? plans and actions taken in order to accomplish certain health related goals for the betterment of society. Health policy addresses economic, scientific, and social issues, and establishes priorities and designated goals for the future.

The 5 Domains of Public Health

Application to OT...

• Public health management + policy: Rather than using a medical model approach in which I am concerned with the science and theory of my care, I can also focus on delivering patient-centered care that is interpersonal and that actively involves my clients. As a member of the health professions, I have a duty to represent health care positively by delivering the best care that I can to increase patient satisfaction.
• Social + behavioral sciences: this is very relevant to OT, as OT takes on a holistic perspective that looks at each individual as a whole. Thus, I will treat multiple domains including physical, social, cognitive, and emotional. Also, I will be sensitive to literacy and acknowledge that illiteracy is a common problem. Knowing that disability is a social factor associated with reduced access to health care, I will work with my clients to give them the necessary accommodations and to teach them to adapt to unaccommodating environments. I will advocate for individuals with disability to be treated equal.

• Environmental Health: As an OT, I need a good understanding of how the environment and humans interact. The Person-Environment-Occupation (PEO) model considers persons as embedded in a context. OTs seek to create a 'goodness of fit' between the person and environment to result in optimal performance.
• Epidemiology + Biostatistics: As an OT, I will want to utilize evidence based practice in which I base my interventions off of current research. I will need to be able to interpret research results and apply the knowledge to my patients. Not only can I evaluate research but I can actively be involved in conducting clinical trials to investigate certain inverventions that I am interested in using in my practice.

The health care system:

Factors affecting access to care:

• Individual characteristics, environmental policy related characteristics, and provider characteristics.
• depends on a fit between the provider and client: accessibility, affordability, accommodation, acceptability

Characteristics of good quality care:

• appropriate, technically excellent, accessible and acceptable, safe, effective, patient-centered, timely, efficient, and equitable

Evaluating quality of care:

• measurement of quality: structure, process, outcomes
• where to get info on quality: administrative + data systems, insurance or malpractice claims, medical and electronic health records, patient satisfaction surveys, evidence based research

Types of research studies:

Epidemiology

• Descriptive studies: evaluate existing data for trends and associations, often leading to the formation of a hypothesis (i.e. case reports, case series).
• analytical studies: studies used to test a hypothesis
• observational: researchers evaluate a natural occuring phenomenon
• cross-sectional study: study an exposure and outcome at one instance in time (take a "snapshot")
• ecological study: study exposure and outcome for an entire population.
• case control study: analyze the difference in patterns among a study group with a particular health outcome verses a control group.
• cohort study: study a group of people with a shared condition without intervening or providing treatment (i.e. prospective or retrospective).
• Experimental: the researcher conducts an experiment in which they control the exposure or intervention.
• randomized trials: 'the gold standard', involves the randomization of participants to a control group and intervention group--who receives a controlled intervention.

different environment perspectives:

what is it? Epidemiology is a science, aimed at the population level, and concerned with studying patterns of health and causes of disease, so as to guide interventions, manage epidemics, and enhance population health.

Environmental Health:

• regarding the human body there is an inner and outer environment, separated by 3 barriers- skin, GI tract, and membranes.
• The environment can also be viewed as a person's personal environment (control) and the outdoor environment (no control)
• The environment can be viewed in 3 forms: gas, solid, liquid
• 4 ways by which factors can affect health: chemical contaminants, biological contaminants, physical environment, and socioeconomic factors.

History of Epidemiology:

• Theory of Miasmas: (early 1800s) miasmas, or particles, were transmitted in the air and caused illness to those who came in contact with them.
• John Snow: mapped number of deaths from cholera according to geographic region. Concluded that a majority of deaths were clustered around the Broad Street water pump.
• John Graunt: utilized descriptive data methods by organizing the Bill of Mortality data so that it could be better analyzed.
• James Lind: conducted the first experimental study. To determine the cause of scurvy he divided patients into groups and provided differing treatments to differing groups. He determined that the group that ate citrus received the best results.
• Ignaz Semmelseis: investigated data on deaths related to childbed fever and linked lack of handwashing to increased death rates. Thus he instituted a policy of hand washing.
• William Farr: appointed to the general registry office, presented data as rates which helped to better see changes in the population.

• what is it? the study of the bidirectional interaction between humans and the environment. The goal is to protect human health and the environment through risk assessment and management procedures. careers in environmental health include: legislative careers, occupational health, research, and private industry careers.
• how is it studied? usually through epidemiological studies and clinical trials using rats as subects.

Models:

• Clinical intervention model: the aim is to prevent a disease from progressing to death
• The public health intervention model: the aim is to prevent disease altogether by addressing individual or environmental factors
• Environmental stewardship model: the aim is to protect man by preventing environmental deterioration and its consequent adverse effects on health

Current theories:

• carcinogenesis: the process by which normal cells develop into cancer cells
• mutagenesis: the process of reproductive toxicity
• teratogenesis: the process of developmental toxicity
• immunotoxicity: suppression of the immune system

Toxicology: the scientific study that seeks to protect humans and the environment from harmful effects of chemical and physical agents.