11.5 Public Health
Katie Baker
The CDC Foundation (CDCF, n.d.) defines public health as “the science of protecting and improving the health of people and their communities.” When you think of public health, you may envision mobile units that screen for breast cancer, hearing screenings in local elementary schools, vaccination initiatives, or county and state health departments that support local doctors in preventative care and the promotion of health through community outreach. These, and many more programs, fall under the umbrella of public health and prevention.
In the 19th century, local public health agencies were created in the United States to address communicable diseases. Since then, public health has also addressed workplace safety, environmental exposures, health education, and access to clinical care (CDCF, n.d.). The history of public health is one of heartbreak and triumph, as agencies have fought to provide clean water and air, immunizations, and access to contraception for individuals and families across the nation.
Public health-funded immunization drives in the 1950s encouraged and provided polio vaccinations through clinics in public school gymnasiums. Prior to the creation of the vaccine by Dr. Jonas Salk, the polio virus killed or paralyzed over 500,000 people annually (WHO, n.d.), sometimes via contaminated food and water.
During the recent COVID-19 pandemic, public health took center stage as government funding provided for public testing, masks, at-home tests, vaccine research, and free meals for children who were no longer in school. The effects of COVID-19 highlighted the interconnectedness of physical and financial health and demonstrated how integral public health is to a functioning society.
In addition to these projects, public health organizations were also integral in addressing disparities between urban and rural health. Rural areas often have populations at higher risk for COVID-19, as they tend to be older, have lower socioeconomic status, and lack access to quality healthcare (Melvin et al., 2020).
Funding for Public Health Programs
Public health is funded through local, state, and federal sources, as well as revenue streams such as the marijuana tax in Washington State, which pays for Medicaid, substance abuse education, and treatment programs. Private grant money is also an important source of public health funding.
In Washington State, the Department of Health is divided into 35 public health districts and local health departments that serve its 39 counties. Other states may divide public healthcare by city or county. In addition, many public partners, such as universities, collaborate with state and local health departments to provide care and research opportunities. For over a decade, Washington has also partnered with federally recognized tribal organizations for public health service delivery.
On the federal level, public health organizations such as the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (DHHS), and the National Institutes of Health (NIH) collaborate with state and local agencies to acquire funds and provide care to communities across the United States.
Many decisions about public health funding are based on politics surrounding specific programs and conditions. For example, in the 1980s, support for HIV/AIDS research was unpopular due to stigmas surrounding the virus and its association with the gay community. As a result, tens of thousands of patients died before effective drug cocktails could be developed.
Public health safer sex initiatives face similar uphill battles for funding in more socially conservative areas, even though school districts that teach abstinence-only sex education have higher rates of teen pregnancy and sexually transmitted infections (STIs) than those that provide contraception education. In the U.S., the congressional budget for abstinence-only education is currently 85 million per year, with prohibitions against teaching about contraception, except for its failure rates, imposed on all states receiving this funding. As a consequence, the rate of formal instruction in birth control methods dropped from 81% for men and 87% for women in 1995 to 55% for men and 65% for women between 2011 and 2013. Meanwhile, the gap between first sexual intercourse and marriage has grown to 11 years for men and 8 years for women (Columbia University, 2017).
Due to these funding limitations, over half the states reject federal money for human sexuality education. Despite these challenges, research shows that comprehensive sexuality education significantly benefits teen pregnancy rates, HIV status, and STI transmission rates, while abstinence-only education shows no benefits in these areas (Chin et. al., 2012).
In another example, the Dickey Amendment, passed in 1996 as part of the congressional omnibus spending bill, prohibited the use of federal funding for “advocating or promoting gun control” (Omnibus Consolidated Appropriations Act, 1997), and the funds were reallocated to research on traumatic brain injuries. In 2018, a report was added to the amendment, clarifying that gun research was not prohibited by the amendment, and the congressional budget now allows the Centers for Disease Control and Prevention (CDC) to study and compile statistics about gun violence in the United States, provided they have the necessary funding.
As we can see, public health can be funded publicly or privately at the local, state, or federal levels. Government funding often comes with restrictions, but popular public health projects can significantly benefit future generations and have a profound impact on communities.
Public Health and Epidemiology
The COVID-19 pandemic catapulted public health into the center of discussions on infectious disease prevention, but many people are still unclear about its role in healthcare.
Public health is a field that promotes and protects the health of individuals and the communities where they live, learn, and play. The American Public Health Association (APHA) is the leading professional organization in the United States, offering valuable information on public health and how to get involved.
Unlike the individual-focused approach commonly seen in medicine, nursing, and pharmacy, public health takes a population-based approach to health interventions. There are many roles in public health, including public health nurses, physicians, social workers, first responders, restaurant inspectors, health educators, scientists, researchers, epidemiologists, community planners, nutritionists, public policy makers, sanitarians, and occupational safety professionals.
Public health offers many government employment opportunities at the national level, including positions at the Centers for Disease Control and Prevention (CDC) and the Commissioned Corps of the U.S. Public Health Service. State and local public health departments also employ public health professionals. Beyond government employment, public health careers include professionals involved in disease identification, policy creation, and interventions that promote health and wellness at the population level.
According to the CDC (2020), the following 10 Essential Public Health Services (EPHS) outline the public health activities that all communities should undertake:
- Assess and monitor population health status, factors that influence health, and community needs and assets.
- Investigate, diagnose, and address health problems and hazards affecting the population.
- Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it.
- Strengthen, support, and mobilize communities and partnerships to improve health.
- Create, champion, and implement policies, plans, and laws that impact health.
- Utilize legal and regulatory actions designed to improve and protect the public’s health.
- Assure an effective system that enables equitable access to the individual services and care needed to be healthy.
- Build and support a diverse and skilled public health workforce.
- Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement.
- Build and maintain a strong organizational infrastructure for public health.
The science of public health relies heavily on epidemiology, which the Dictionary of Epidemiology defines as the study of the distribution and determinants of health-related states among specific populations and the application of that knowledge to control health problems. “Distribution” refers to the frequency or pattern of disease, while “determinants” are the causes or risk factors of diseases and other health-related events. Some examples of public health investigations are provided below.
Epidemiologists are sometimes called “disease detectives” because they investigate the causes of diseases, identify people who are most at risk, and determine how to stop the spread of or eradicate diseases. They often work hand-in-hand with other disease detectives trained in public health principles, including veterinarians, nurses, physicians, scientists, and nutritionists.
In public health, disease detectives investigate the causes and spread of both communicable and noncommunicable diseases, as well as non-disease hazards that can impact health, such as noise pollution, sun exposure, smoke inhalation, or even legal, socioeconomic (such as poverty and access to healthcare), and structural factors.
Public Health and Disease Prevention
Prevention can be categorized into primary, secondary, and tertiary interventions. Primary interventions involve avoiding disease and maintaining good health. Secondary prevention occurs when a provider diagnoses and treats a disease as early as possible to prevent more serious complications or sequelae. Tertiary prevention involves managing chronic illnesses in a way that enhances quality of life and improves longevity.
Primary interventions require the evaluation of individual risk factors, such as smoking, high-risk jobs, risky behaviors, and other diet and lifestyle factors. After evaluating these risk factors, decisions can be made about preventive programs that address the specific diseases or conditions that people with these risk factors are more likely to develop. For example, smoking cessation programs may be instituted to prevent lung cancer and other adverse effects of tobacco use. These programs can be promoted in primary care clinics and high schools in communities where adolescent tobacco use is prevalent. Additional examples include community vaccination drives for polio, flu, and COVID-19 vaccines. The next time you are watching television or using social media, pay close attention to any public service announcements you see. Many are directed toward primary disease prevention.
Secondary intervention, which prevents diseases from becoming more serious, can be seen in the many cancer screening programs at free clinics and in provider offices nationwide. Mobile clinics, such as those providing mammograms, provide secondary preventive services to underserved rural and low-income urban areas. Another example is contact tracing, which has become more common since COVID-19 but has long been used for sexually transmitted and other infectious diseases. This process allows public health providers to notify individuals who have been exposed to a disease so they can get tested and treated.
Finally, tertiary interventions focus on improving the quality of life and longevity of people with chronic illnesses. For example, blood sugar management and diabetic foot care programs for people with type 1 and type 2 diabetes can have positive effects on their condition and its progression. Individuals who participate in diabetic foot care programs at senior centers or long-term care facility, for example, are less likely to develop unnoticed ulcers that could otherwise lead to gangrenous wounds requiring amputation.
Primary, secondary, and tertiary prevention programs are all part of public health. Programs may be funded at the city, county, state, regional, or federal levels, either through existing programs or through grant funding for new projects (CDC, 2013).
Skill Stitch: Advocating for Your Patient
Healthcare is a polarizing topic in the United States, and so are protests. However, protests are one of the many ways in which healthcare providers can advocate for their patients on a large scale.
In your workplace, you can advocate for patients by making sure they are being heard and that any safety risks are understood by decision-makers such as managers, providers, patient ombudsmen, and social workers. Practicing before speaking to a supervising physician or other authority figures can boost your confidence and make you a more powerful advocate for patient safety. Another key strategy is to offer potential solutions when raising concerns. This can make it easier for these concerns to be successfully addressed.
Outside of your workplace, you can also advocate for patients in the community. As a healthcare professional, your reputation can lend weight to your opinion on health-related matters such as public health efforts, climate change, voting access, and drug policy.
If large protests are not your style, you can participate in voter registration efforts, phone banking for local nonprofits that support or oppose current legislation, or letter-writing or texting campaigns to engage elected officials.
For more involved efforts, consider volunteering or working for nonprofits whose healthcare goals align with your own. You could also collaborate with your coworkers to conduct research and collect data that supports patient-centered improvements in your workplace or community.
In this section, you will practice writing out what you want to say to an office manager to advocate for a patient who has difficulty with her healthcare. After reading the scenario, write down the concerns you have and how you would like to see them addressed. Include a suggestion for how to prevent this situation from happening in the future.
Cleo is an 86-year-old transgender female patient being seen in your clinic for primary care. She has been a patient for decades and is always polite and friendly to the staff. Lately, you have noticed with some concern that she appears worried when she comes in to see the new provider assigned to her care. Although she does not complain, she seems less enthusiastic about seeing this new provider than she did about her previous one, who has retired. She has been struggling to comply with her provider’s directions and often seems on the verge of tears when leaving the clinic. She frequently pays her outstanding balance with small bills and change, promising to bring more money at the next visit.
What are some possible concerns about Cleo’s medical care and daily life? What allies (persons who support the rights of another group or individual) might you find in your office to help support her? What barriers might you face when advocating for Cleo? How do you feel about advocating for a patient whose needs may extend beyond medical care? How could you address this situation and prevent similar ones in the future?
Attributions
- Figure 3.3: CloseTheCamps_30Days_Day18_IMG_2861-1 by Peg Hunter is released under CC BY-NC 2.0
INFECTIOUS DISEASES THAT CHANGED THE WORLD
Unit Authored by:
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Sharon Beaumont-Bowman, SLP.D. Graduate Program Director, Department of Communication Arts, Sciences, and Disorders, Brooklyn College.
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Michael Bergen, AuD, CCC-A. Director, Speech Language Hearing Center, Brooklyn College and CUNY Doctoral Audiology Program, Founding Faculty Member.
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Lesley L. Green-Rennis, EdD, MPH, MCHES. Chairperson, Professor, Health Education Department, Borough of Manhattan Community College – City University of New York.
Goals:
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To examine major pandemics throughout history, their impact, and the public health response to each.
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To examine the impact of social phenomena on the origin, transmission, and control of infectious disease pandemics.
Learning Objectives:
Students will:
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Have an awareness and understanding of pandemics throughout history.
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Think critically about key issues related to the public health management of pandemics.
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Describe the social and economic impact of pandemics on societies and populations.
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Compare major infectious disease pandemics and their public health response to COVID-19 and its public health response.
Throughout history, epidemics have had an historical impact equal to that of wars, revolutions and economic crises. In The Historical Importance of Epidemics, Professor Frank Snowden explains the significant impact of pandemics throughout history and warns that epidemic diseases still pose a major threat to human well-being. According to Snowden, infectious diseases are too important to leave solely to doctors. They are part of the big picture of historical change and have had an impact on religion, the arts, colonial expansion, the establishment of New World slavery, the rise of modern medicine and on strategies of public health.
Disease can be thought of existing in levels within communities. These levels help understand the potential threat of disease and dictate the public health response. The Centers for Disease Control and Prevention’s (CDC) Epidemic Disease Occurrence explains that disease can be sporadic, endemic, or hyperendemic and can rise to the level of an epidemic or pandemic.
Many infectious diseases are zoonotic, caused by microorganisms that spread between animals and people. Zoonotic diseases can spread from animals to humans through direct contact, indirect contact, via vectors, or through food and/or water systems. Pandemics happen when new (novel) disease causing agents emerge which are able to infect people easily and spread from person to person in an efficient and sustained way (https://www.cdc.gov/flu/pandemic-resources/basics/index.html).
Though science has come a long way in understanding infectious diseases, diseases of the past as well as novel emerging diseases, are a constant threat to public health (https://www.coursera.org/learn/epidemics). Complex issues related to social networks, food safety and security, and environmental ecosystem destruction necessitate a holistic, not siloed approach to understanding and addressing epidemic diseases.
(Bats, Ducks, and Pandemics: An Introduction to One Health Policy). According to Snowden, how we deal with infectious diseases may be an important factor in whether and how we survive as a species (The Historical Importance of Epidemics)
Infectious diseases are experienced differently from chronic disease and give rise to distinctive fears and anxiety. Chronic diseases can have massive impact, but do not give rise to scapegoating, mass hysteria, outbursts of religiosity, or works of literature and art. Epidemic diseases are distinctive and leave a particular legacy in their wake. Throughout human history, infectious diseases have been the most important cause of suffering and death (The Historical Importance of Epidemics).
Infectious diseases are one of the major causes of death, responsible for a quarter to one-third of mortality worldwide. People living in low-income countries are far more likely to die of a communicable (infectious) disease than a noncommunicable (chronic) disease. Despite a global decline from the years 2000 to 2019, six of the top 10 causes of death in low-income countries were communicable diseases.
A Historical Guide to Pandemic Responses is a series of short essays written by medical historians on previous epidemics and our responses to them. The essays act as “signposts” to highlight historical research on prior responses to rapidly spreading disease among populations (https://www.hopkinsmedicine.org/news/articles/a-historical-guide-to-pandemic-responses).
Pandemics not only have social and public health effects, but also impact the economy as well.
In Pandemics and Financial Assets, Dr. Nzar Mohammad Alsharari discusses the ill effects of pandemics on the economy and presents how the financial markets and financial institutions were influenced by and responded to pandemics.
The CDC outlines the public health response to pandemics in their e-learning course Introduction to Public Health.
| Time Period | 1331-1770 |
| Causative Agent | Yersinia Pestis |
| Transmission | Bubonic is transmitted through exposure to infected material through a break in the skin or from the bite of an insect, Pneumonic plague is transmitted from person to person through respiratory droplets via coughing or sneezing |
| Symptoms | Flu-like, fever, headaches, vomiting, swollen lymph nodes |
| Epidemiology | 40-60% of Europeans died from 1347-1352; mortality rate of 30-75% |
The bubonic plague is a highly infectious disease caused by the bacteria, Yersinia Pestis. Archaeological evidence suggests its existence as far back as 542 C.E. Symptoms include fever, headaches, vomiting, swollen and painful lymph nodes (buboes) and acral necrosis (dark discoloration of the skin) (https://www.cdc.gov/plague/symptoms/index.html). There are three common clinical forms of the plague: 1) Bubonic; 2) Pneumonic; and 3) Septicemic. Plague symptoms and clinical manifestations depend on how the patient was exposed to the plague bacteria. Most victims of the plague died within four to seven days after infection.
The Black Death was the devastating epidemic of the bubonic plague which struck Asia and Europe in the mid-1300s. The great pandemic of the 14th century is also known as the “Great Pestilence,” the “Great Plague,” and the “Great Mortality.” It began in 1331 in Southwestern China and spread through Asia to the Mediterranean via trade routes. In October 1347, a Genoese ship docked in Messina, Sicily, bringing with it rats infected with the bubonic plague (Brief History of Pandemics-Pandemics Throughout History).
As a result, both of its extreme virulence and the strictness of the measures imposed to combat it, the plague significantly disrupted traditional customs of dealing with death. This disruption made itself felt not only in religious belief and burial practices but also in art, architecture, and literature. European culture was profoundly shaped by the experience of the plague, as witnessed by the advent of symbols such as “vanitas” and the danse macabre in iconography, as well as the visual representations associated with the new cults of plague saints. The successful containment of the plague might be seen to have exercised a similarly powerful effect in shaping the philosophical project of the Enlightenment, in that the measures taken to ward off death gave material substance to theoretical claims of progress. (Open Yale Course: HIST 234: Epidemics in Western Society Since 1600, Lecture 5). The period of the Black Death was the first time society implemented organized anti-plague measures (i.e., quarantine, isolation, and systems of sanitation control that included observation stations, isolation hospitals, and disinfection procedures)
In Pandemic Disease in the Medieval World: Rethinking the Black Death, writers compare the Black Death and Ebola epidemics. Each essay focuses on a different aspect of comparison. For example, one essay analyzed the impact of the Black Death on the Jewish community in Tarrega as an example of how the pandemic lead to escalating attacks on social minorities The essays highlight the need to understand local outbreaks and how mathematical modeling can be used to detect early, “silent” phases of transmission.
| Time Period | 4th century CE- 1977 |
| Causative Agent | Variola virus |
| Transmission | Droplets from the nose or mouth (cough & sneeze) |
| Symptoms | Fever, headache, severe fatigue, severe back pain, vomiting |
| Epidemiology | Naturally occurring smallpox was eradicated worldwide by 1980 |
Smallpox is a serious infectious disease caused by the variola virus. While the origin of smallpox is unknown, the growth of civilizations and exploration is blamed for the global spread of the virus. People who had smallpox had a fever and a distinctive, progressive skin rash. Once the first sores appeared in the mouth and throat, they were contagious and remained contagious until their last smallpox scab fell off. The virus was spread when they coughed or sneezed and droplets from their nose or mouth spread to other people. Most people with smallpox recovered, but about 3 out of every 10 people with the disease died. Many smallpox survivors have permanent scars over large areas of their body, especially their faces. Some were left blind. Smallpox was eradicated as a result of vaccination: the last natural outbreak of smallpox in the United States occurred in 1949. https://www.cdc.gov/smallpox/about/index.html
In the eighteenth century, smallpox succeeded plague as the most feared disease.
Smallpox is viral and transmitted by contact and airborne inhalation. Unlike plague, smallpox can exist as an endemic as well as an epidemic disease, https://oyc.yale.edu/history/hist-234/lecture-6
The COVID-19 pandemic marks the 300th anniversary of the Boston smallpox epidemic of 1721. The epidemic ultimately resulted in an early effort at preventive medicine through vaccination, resulting in a successful public health campaign to eradicate the disease. https://cuny-bc.primo.exlibrisgroup.com/permalink/01CUNY_BC/ljnr3v/cdi_proquest_miscellaneous_2622961987
| Time Period | 1817- |
| Causative Agent | Vibrio cholerae bacteria |
| Transmission | Food or water contaminated with cholera bacteria |
| Symptoms | Vomiting, profuse diarrhea, thirst, leg cramps, restlessness or irritability |
| Epidemiology | At-risk areas include peri-urban slums, and camps for internally displaced persons or refugees, where minimum requirements of clean water and sanitation have not been met. |
Cholera is an acute diarrheal illness caused by infection of the intestine with Vibrio cholerae bacteria. People typically get sick when they swallow food or water contaminated with cholera bacteria. The resulting infection is often mild but can sometimes be severe and life-threatening. Large epidemics are often related to fecal contamination of water supplies or street vended foods. https://www.cdc.gov/cholera/general/index.html
Asiatic cholera was the most dreaded disease of the nineteenth century. An intense fear provoked by the disease was its symptoms: not only did cholera exact a degrading and painful toll on the human body, it also struck suddenly, and was capable of reducing the seemingly healthy in a period of hours. A second major reason for the disease’s significance was its overwhelming predilection for the poor, https://oyc.yale.edu/history/hist-234/lecture-10
Seven pandemics of cholera have been recorded since the first pandemic in 1817. Overcrowding, poverty, insufficient water, and sanitation facilities increase the risk for cholera outbreaks, https://pubmed.ncbi.nlm.nih.gov/31395455/. Cholera persists as a major cause of illness and death worldwide, with more recent epidemics in Zimbabwe (2008-2009) and Haiti (2010), https://pubmed.ncbi.nlm.nih.gov/22099113/
| Time Period | 1700s-Present, 1918 Pandemic (1918-1919) |
| Causative Agent | Segmented negative-sense RNA virus, of the influenzavirus genus in the Orthomyxoviridae family. |
| Transmission | Droplets from the nose or mouth (cough & sneeze) |
| Symptoms | Very high fever, dry cough, headache and body aches, sore throat, chills, runny nose, loss of appetite, extreme fatigue |
| Epidemiology | Persons of all ages, estimated incidence of approximately 8% in the U.S. |
The diagnosis of the flu is not a new one and while a single case of the flu does not cause alarm, the potential for widespread exposure and illness does. Professor Robert Dingwall, of Nottingham Trent University, provides an historic overview of the seasonal flu, avian flu and a flu pandemic (https://www.oercommons.org/courses/flu-pandemic-how-prepared-are-we-3)
Records of influenza, dating back to the 1700s, suggest a pattern of one major pandemic every century. Among the pandemics for which there is documentary evidence, the outbreak of 1918-1920 is by far the greatest, https://oyc.yale.edu/history/hist-234/lecture-20
Dr. Michael Gregor provides an interesting overview of the birth of influenza, that was presumed not to exist before the domestication of animals. While this is an older source, the information remains relevant when discussing the history of influenza. https://youtu.be/7_ppXSABYLY
The Influenza Encyclopedia is a storehouse for stories about the places, people, and organizations that battled the American influenza epidemic of 1918-1919. Included are stories from all 50 U.S. states and documents how communities across the country did what they could to stem the rising tide of illness and death as well as how many gave their time and their lives to care for the ill. (Influenza Encyclopedia).
In an historical retrospective review of the impact of the 1918-1919 influenza pandemic, a panel of experts discusses how the pandemic affected daily life in the United States and what lessons can be learned and applied to planning today. Pandemic Influenza-Past, Present, Future: Communicating Today Based on Lesson from the 1918-1919 Influenza Pandemic U.S. Department of Health and Human Services Centers for Disease Control and Prevention October 17, 2006 The Oak Ridge Institute for Science and Education
| Time Period | Descriptions of polio-like illnesses have been around since antiquity with multiple epidemics in the 19th and first half of the 20th century |
| Causative Agent | Poliovirus |
| Transmission | Person to person spread via fecal-oral or oral-oral routes |
| Symptoms | Low grade fever, sore throat, stiffness of the neck, back, or legs, headache, vomiting, possible paralysis |
| Epidemiology | 70% of infections in children are asymptomatic |
The Open Yale Course: Poliomyelitis describes the history of poliomyelitis, better known as polio, focusing on the large public health campaign designed to eradicate it. The campaign was modeled after the successful smallpox initiative, although due to differences in the diseases, was more limited in success. Sanitary improvements in many nations across the globe helped to contribute to it being considered a “social disease in reverse” in that large populations in more industrialized nations had no natural immunity to the virus, resulting in outbreaks in these areas. Diagnosis was also often delayed or not correctly made because physicians were not trained or expecting to identify it. Additionally, incorrect assumptions were made about transmission, slowing development of a vaccine. The video further describes the steps leading toward the successful development of vaccines, the involvement of Salk and Sabin, the impact of the March of Dimes, the fact that the US President (FDR) had been paralyzed from polio, as well as the large-scale vaccination initiatives implemented within schools and elsewhere.
The World Health Organization (WHO) website provides an overview with symptoms and treatment, and highlights how two of the three types of polio have been eradicated, while poliovirus type 1 continues to be present in Pakistan and Afghanistan.
ASBMB Today (American Society for Biochemistry and Molecular Biology) highlights how the polio vaccine made its way from lab to public distribution with video, data and photos which describe the large public health campaign designed to eradicate the disease.
| Time Period | Peak 18th-19th centuries |
| Causative Agent | Mycobacterium tuberculosis |
| Transmission | Respiratory droplets |
| Symptoms | Persistent cough, chest pain, coughing up blood, weight loss, no appetite, fever, chills, night sweating, fatigue |
| Epidemiology | One of the most common infections in the world. Estimated that about ¼ of the world’s population are infected. |
The CDC highlights that the history of tuberculosis (TB) can be traced back more than 9000 years in humans, via remains of a mother and child found in the Middle East region. Written descriptions of TB can be found as early as 3300 years ago in India. It is estimated that from the 1600s to the 1800s, approximately 25% of all deaths in Europe and the US were attributable to TB, a form of which during that period was frequently referred to as “consumption.”
The Open Yale Course Tuberculosis (I): The Era of Consumption traces the earlier history of the pulmonary disease consumption, discusses whether it should be classified as epidemic, endemic, or both, and follows its progression and upsurge in increasingly industrialized areas. The video covers the earlier history of transmission and symptomatology through discovery of the mycobacterium tuberculosis in 1882 by Robert Koch, as well as the varied ways it can be transmitted, and the various organs and tissues of the body it can impact, as highlighted by images within the presentation. The video additionally covers the social impact of the disease, with references to sweatshop factories, cramped living conditions in homes and within institutions such as prisons, and to well-known people, such as royalty and famous writers who contracted the disease. It also describes how individuals who contracted the disease sometimes made “health migrations,” in search of an environmental climate more conducive to respiratory health. It also describes how TB influenced romantic works such as those from Emily Bronte and Victor Hugo.
While consumption was sometimes romanticized during the period leading up to Koch’s discovery, the Open Yale Course: Tuberculosis (II): After Robert Koch highlights a shift in the way in which TB was addressed once it more consistently became known as an infectious danger. What is referred to as the “war on TB” resulted in an increase in sanatoria, an international movement which became a growing way to address the disease via dietary changes, isolation, and increased outdoor time which served as a quarantine treatment for the disease. The video covers research and treatment through the earlier part of the 20th century until the ultimate introduction of antibiotics in the 1940s. While not eradicated (despite projections that it would be eliminated in the US by 2010), antibiotics did result in significant decline in TB cases from the 1950s through 1985. However, starting in the 1950’s drug-resistant TB strains began to increase. Between 1970 and 1990 there were numerous outbreaks of drug-resistant tuberculosis. A rise in drug-resistant TB increased numbers worldwide, with pandemic levels in Europe and sub-Saharan Africa. As with other diseases, there has been an overrepresentation of the disease in minority and other underserved populations. The CDC differentiates Active vs Latent TB in this article.
| Time Period | 1981-Present |
| Causative Agent | Human immunodeficiency virus |
| Transmission | Via bodily fluids (i.e., blood, semen, rectal fluids, vaginal fluids, breast milk) |
| Symptoms | Fever, chills, rash, nigh sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, mouth ulcers |
| Epidemiology | AIDS-related deaths have been reduced by 64% since the peak in 2004 and by 47% since 2010. In 2020, around 680,000 people died from AIDS-related illnesses worldwide, compared to 1.3 million in 2010 |
Chris Beyrer described four decades of the emergence, impact, and response to the global HIV/AIDS pandemic in a Lancet article which compares and contrasts various aspects of COVID-19, including issues of equity, geography, and the focus of research scientists on development of treatments and vaccine. The trials, tribulations and timeline of a COVID-19 vaccine compares development to that of an HIV vaccine.
The video Open Yale Course: AIDS covers the background, transmission, scale, epidemiology, societal effects, and public health strategies associated with HIV/AIDS through 2010. The outbreak began in the early 1980s, peaked approximately ten years later before declining until 2001; however, it then experienced an upturn which continued into the 2010s. It is now common knowledge that HIV can be transmitted via the exchange of infected bodily fluids such as blood, breast milk, and semen. As we have seen with other pandemics, early reports of the disease created uncertainty which delayed response to its spread. In this case, since early reports were of infections among gay men, the stigma attached to the media coverage focused on this population while the spread was not limited to a singular population or geography.
While advancements have been introduced which have limited deaths, living with HIV as a chronic disease presents challenges, including those associated with the expanded use of expensive drug cocktails. The Yale Course additionally highlights how the disease continues to be rampant in sub-Saharan Africa, where half of the world’s HIV infections exist, and life expectancy at birth dropped to below 50 years of age (and, in some areas, to below 40 years of age) for the first time since the 1950s, largely due to HIV. The AIDS pandemic has currently globally stabilized but it has also transformed with concerning spread in certain parts of the world and with increased impacts to ethnic minority populations.
A Timeline of HIV and AIDS covers the history of HIV/AIDS in the U.S. from the first reported cases in 1981 to present day.
| Time Period | 2019-Present |
| Causative Agent | SARS-CoV-2 |
| Transmission | Respiratory droplets and contaminated surfaces |
| Symptoms | Fever, chills, cough, loss of taste or smell, sore throat, nausea or vomiting, fatigue, muscle aches, headache, diarrhea, shortness of breath |
| Epidemiology | Globally, as of 7:41pm CEST, 18 May 2022, there have been 520,372,492 confirmed cases of COVID-19, including 6,270,232 deaths, reported to WHO |
In December, 2019, a cluster of patients in Wuhan, Hubei Providence, China were diagnosed with pneumonia of unknown etiology. All the cases were connected to the Huanan Seafood Wholesale Market in Wuhan. January 2020, Chinese authorities identified and isolated the novel coronavirus as the causative agent of the outbreak. The first confirmed case in the U.S. was discovered in Washington state, later in January. In March 2020, the World Health Organization declares COVID-19 a pandemic. (https://www.cdc.gov/museum/timeline/covid19.html). Despite significant advances in science and medicine, the COVID-19 pandemic spread rapidly and caused major impacts around the world.
The highest percent of COVID-19 cases are among non-Hispanic White people. However, racial and ethnic minority groups are disproportionately represented among COVID-19 cases. The percent of cases for racial and ethnic minority groups are higher than the percent of these populations within the total U.S. population. Comparing the percent of cases and the percent of the total U.S. population by race and ethnicity provides an indication of disparities. This comparison is not exact because not all geographic areas report COVID-19 case data by race and ethnicity. Non-Hispanic White people represent a majority of the U.S. population (60%), followed by Hispanic or Latino people (18%), non-Hispanic Black people (12%), non-Hispanic Asian people (6%), non-Hispanic people who identify with more than one race (3%), American Indian or Alaska Native people (1%), and Native Hawaiian or other Pacific Islander people (less than 1%). Among people aged less than 50 years, and notably among children aged less than 18 years, a noticeably higher percent of COVID-19 cases are among Hispanic or Latino people compared with the percent of the total U.S. population. Hispanic or Latino children represent 25% of the U.S. population aged less than 18 years (https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/increased-risk-illness.html).
Recent studies have consistently found that among those tested for COVID-19, non-Hispanic Black, Hispanic or Latino, and people who identify with more than one race and are non-Hispanic were more likely to have positive test results as compared with non-Hispanic White or non-Hispanic Asian people. Comparing percent of COVID-19 test results that were positive (percent positive) among racial and ethnic populations can be helpful for understanding the spread of COVID-19 in the community. It is important to continue to monitor access, testing, and results to understand trends in transmission and groups that may be disproportionately affected by COVID-19. It is important to understand why people are getting tested and to recognize if reasons change over time or are different for particular groups. For example, people who have easier access to testing may be more likely to get tested sooner after onset of symptoms or known exposure or more often. People who do not have easy access to testing may wait until they are sicker before getting tested (https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/increased-risk-illness.html).
The social distribution of COVID-19 exposure factors (density of place of residence, overcrowded housing and working outside the home) are described in detail by Bajos et. al (https://bmjopen.bmj.com/content/11/11/e052888). Multinomial regressions were used to identify changes in social variables (gender, class and race) associated with symptoms of anosmia/ageusia (partial or full loss of smell/loss of taste). Women were more likely to report symptoms during the peak and after. Racialized minorities accumulated more exposure risk factors than the mainstream population and were at higher risk of anosmia/ageusia during the peak and after. By contrast, senior executive professionals were the least exposed to the virus with the lower rate of working outside the home during lockdown. They were more affected than lower social classes at the peak of the epidemic, but this effect disappeared after the peak.
As of April 2022, COVID-19 is the third leading cause of death after heart disease and cancer. Like past pandemics, the COVID-19 outbreak has been particularly detrimental to members of those social groups in the most vulnerable situations, (i.e., people living in poverty, older persons, persons with disabilities, and indigenous peoples). Early on, evidence indicated that the health and economic impacts of the virus were borne disproportionately by poor people. Overall death rates are highest among non-Hispanic American Indian/Alaskan Native and non-Hispanic Black or African American people.
As demonstrated by the 2020 COVID-19 global crisis, communicable diseases – especially those caused by respiratory pathogens – can spread wider and faster across countries and continents than ever before, in large part due to increased global travel and trade. In the last decades, other diseases such as influenza, SARS, MERS, Ebola, Zika, plague and yellow fever have been examples of high-impact, fast-spreading diseases causing frequent outbreaks which are increasingly difficult to manage. Urbanization and population growth, climate change and other environmental issues may also augment the risk of threats having a potentially high cost for human health and a severe impact on economies and societies (https://drmkc.jrc.ec.europa.eu/initiatives-services/epidemic-intelligence-from-open-sources#documents/1033/list).
The Epidemic Intelligence from Open Sources (EIOS) initiative is a unique collaboration between various public health stakeholders around the globe. It brings together new and existing initiatives, networks, and systems to create a unified all-hazards, One Health approach to early detection, verification, assessment, and communication of public health threats using publicly available information (https://www.who.int/initiatives/eios).
This course demonstrates how to conduct epidemiologic surveillance to gather data to inform decision-making and planning. It uses the polio eradication effort as a case study (https://www.futurelearn.com/courses/collecting-and-using-data-for-disease-control).
Chapter 1
- compassion and empathy
- D. All of the above
- True
- E. All of the above
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- Courses that must be completed prior to applying for enrollment in a specific program. Often include science courses like biology, chemistry, anatomy and physiology.
- Job security, high pay for level of education, flexible schedules and varied work settings, potential for travel
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Chapter 2
- Triage
- The key difference between an emergency room and an urgent care center is that urgent care centers are designed to care and treat non-life-threatening conditions, whereas, emergency rooms treat conditions that are severe enough to be considered life-threatening.
- True
- C. Ambulatory Care Center
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- C. skilled nursing facility
- Physical therapist, occupational therapist, or speech therapist.
- AMI and SMI
- True
Chapter 3
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- A. You have a family history of heart disease and therefore have an increased risk of heart attack
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Chapter 4
- A. PHI
- B. Electronic health records
- D. All of the above
- B. Patient
- A. True
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Chapter 5
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- C. Arterial blood gas
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Chapter 6
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Chapter 7
- C. x-ray
- MRI
- CT
- Cardiovascular Technician
- Medical Laboratory Technician
- RDMS
- True
- Cardiac Echocardiogram
- Doppler
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Chapter 8
- The Medical Director defines the guidelines that advanced level providers can function within. These medical physicians conduct quality review of critical care. And are involved in quality improvement of prehospital emergency care.
- The components of the prehospital medicine system are first response, basic life support ambulance, advanced life support care, emergency department, trauma and tertiary care centers. Each of these components treat patients is various ways and locations.
- The different modes of transportation are ambulance, helicopter and fixed-wing boat.
- There is a large difference in educational requirements between an EMT and a paramedic. Paramedics require significantly more training hours and perform significantly more advanced skills.
- Nationally Registered Paramedics (NRP), Nationally Registered EMTs (NREMT) and Nationally Registered Advanced-EMTs (NRAEMT) are required to renew their certification every two years. The number of continuing education credits is between 40 and 60, the latter end being paramedic certifications.
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Chapter 9
- Dental Assistant
- Dental Hygienist.
- Denturists
- Dental Therapist
- True
- Dental Assistant
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- True
- A. Hospital
- RDH
Chapter 10
- Health education is the promotion of health and the prevention of disease and disability.
- Prior to earning the SUDP title, many people become an SUDP trainee. This allows the trainee to earn practical field experience as they are pursuing their SUDP credential.
- Having a high school diploma is a requirement to work as a pharmacy technician in WA. Attending a college program and becoming certified will provide more opportunity in the field.
- LEP’s are individuals where English is not their first language.
- To work as a social worker, depending on the state, a bachelor’s of master’s degree is required along with a national certification.
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Chapter 11
- Debrief
- A
- Options could include online modules, webinars, in person conferences, reading professional journals, joining professional organizations for the healthcare specialty and networking with members.
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- Closed loop
- Clarify, Articulate, Request, and Encourage
- Keeping the patient informed reduces anxiety as they know what to expect, then they see that the healthcare team is reliable.
- These could include positive attitude,
- Role Play. Potential script-Ranjeeta (employee) “Molly, I am really upset. I think my schedule is very unfair. I have had to work 3 weekends in a row. Also, I asked if I could have Wednesdays off for a class but it is not consistent.” Molly “I can see that you are upset and I am sorry you are frustrated. I do have to make sure the unit is covered for weekends, but you should only have to work 2 a month, so I will make sure that gets fixed. Would you be willing to help me out by asking your co-workers if anyone can work Wednesdays? When we know who can take the Wednesday spots then I can arrange that for you.” Ranjeeta “Thank you for listening and helping me out. Yes, I will talk to my co-workers. When do you need to know by?”
- Answers will vary, personal opinion. Could include taking deep breaths, excusing yourself for a drink of water, writing out what you might say to someone, practicing it with a trusted person. If you are angry, it is best to wait until you have cooled down to address the issue so you can be more rational.
Chapter 12
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Chapter 13
- A. True
- C. 3
- C. Career
- Subject
- B. False
- A. True
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Chapter 14
- A. Arrive 15 minutes early
- A. Behavioral
- A. All of the above
- A. Two to three weeks
- A. True
- A. Practice interviewing with friends
- B. Entries focus on skills and education
- D. All of the above
- A. Explain why the candidate is a good fit for the position
- C. LinkedIn
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