Key Determinants

When analyzing a public health problem, it is important to consider the key determinants that cause the issue. In the case of my final paper, which examines racial disparities in infant mortality rates, it is especially important to consider the wide array of factors that could cause infant mortality to occur so much more frequently in the black population than in the white. In this blog, I will discuss many of the factors that may contribute to this disparity. Since this blog is mostly a thinking exercise, meant to provide many possible intervention points, I will not fully describe to what extent each factor contributes to the problem. This will be done in my final paper. Key determinants can be divided into many categories. I will describe the determinants of racial infant mortality disparities in terms of these categories.

Biological Determinants: Genetics, body type, age

Developmental Determinants: conditions of both mother and child's development, was mother educated about safe sex practices? did mother's first sexual contact occur at a young age? did child progress to developmental goals in a timely manner (both in utero and after birth)?

Environmental Determinants: pollution, exposures in urban areas vs. suburban vs. rural, access to affordable health care, distance from closest health care center

Social and Cultural Determinants: cultural beliefs about where children should sleep, cultural customs regarding the necessity of childcare, age of first child, education

Economic Determinants: Socioeconomic status, hospital conditions, affordability of health care, affordability of cribs, proper nutrition, and vitamins

Political Determinants: availability of services, resources allocated to prevent disparities

Behavioral Determinants: Crib use, pre-natal doctor's visits, pre-natal vitamin use, child's sleep customs, healthy eating habits

All of these determinants are a very good point from which to design the intervention I will be discussing in my paper. Now its time for me to get back to my paper! It's due next week.

How bad is it?

This week, we were asked to further analyze the problem that is the focus of our final papers. This week's theme is "magnitude and indicators." In order to effectively tackle a public health problem, it is necessary to understand the magnitude of the problem. You need to know how many people are affects, to what degree, and what the costs of the problem are. Also, in order to track the problem (before, during and after intervention) you need to identify which variables serve as indicators. These indicator variables show whether the situation is improving, worsening, or staying the same.


Surveillance is used to keep track of indicators and determine the magnitude of the problem. In this case, hospital surveillance can be used to track the total # of live births and the # of infant deaths. Since the problem I am focusing on is a health disparity, the data collection would also have to include race and/or ethnicity.

I have collected some data that outlines the magnitude of this problem.
According to the Annie E. Casey Foundation: African-American infants in Baltimore City are 2.8 times more likely to die than white infants from 2006-2008.
According to the Maryland Babies Born Health Initiative: The percent of women receiving prenatal care in the first trimester of pregnancy has been dropping since 2000, reaching a low of 79.5% in 2007. Among white women in the state, 82% received early prenatal care, compared with 73.5% of Black women and only 63% of Hispanic women.
Also According to the Maryland Babies Born Health Initiative: African-American infants are at greater risk of poor infant health, with a disparity of nearly to 2:1 in prematurity rates, and over 2:1 in infant death rates. Between 2006 and 2007 the disparity in infant deaths increased to 3:1.
According to the Baltimore City Health Department: Short gestation and low birth weight are most responsible for the elevated infant mortality rate in Baltimore.
Also according to the Baltimore City Health Department: The infant mortality rate in Baltimore City is 11.3 deaths per 1000 live births. This is much higher than the US and Maryland averages. Much of this rate is driven by an even higher rate among African Americans.

In my paper, I will need to focus both on direct and indirect indicators. For example, low birth weight is a direct indicator of a high risk for infant mortality. Lack of prenatal care also contributes directly to a higher risk of infant mortality. On the other hand, SES may make a person less likely to receive prenatal care or have prenatal vitamins or sufficient food. Therefore, SES is an indirect indicator of infant mortality rate.

In order to write a strong research paper, it is important to evaluate the strength of your sources and consider any biases they may have. The Annie E. Casey foundation is a charity that seeks to improve health conditions for kids. In order to receive more funding it is in their best interest to use the rates that make the problem seem the most severe. The Maryland Babies Born Health Initiative probably uses fairly accurate numbers because they need to both give an accurate picture of the extent of the problem and continue to collect data that shows that their initiative is succeeding. The Baltimore City Health Department would probably like to minimize the problem in order to make it look like their department is doing a good job.

That's it for this week. Check back next week for more about infant mortality.

Defining the Problem

This week we were asked to develop a problem definition for our final paper. A good public health problem definition targets a population and is very specific. It is important to create a good problem definition in order to have a solid starting point from which to develop the rest of the paper.

My problem definition: From 2006-2008 African-American infants were 2.8 times more likely to die than white infants in Baltimore City.
Information from Annie E. Casey Kids Count Data Center http://datacenter.kidscount.org/data/bystate/Rankings.aspx?state=MD&ind=4514

I chose this topic because, in my opinion, health disparities are one of the largest problems with the current American health care system. Infant mortality rate has traditionally been considered a reliable indicator of overall population health. Therefore, if the African-American community experiences significantly worse infant mortality, this is a good predictor that the overall community experiences poor health.

I chose to focus on Baltimore because the city has historically tense race-relations which have resulted in large differences in living conditions between black and white Baltimoreans. These differences have resulted in particularly drastic health disparities. Also, in my volunteer experiences I have seen firsthand the campaigns to improve infant mortality rates and am surprised they have not had more success. I would like to analyze the true cause of this problem and brainstorm possible effective solutions.

I chose to focus on the years 2006-2008 because I wanted to focus on a problem that was still relevant but also wanted to ensure that enough data would be available. By focusing on the years 2006-2008, I can address a problem which is still a significant issue in Baltimore while using reliable information.

Beginning of the end...

This week, we were asked to start thinking about our final paper. The assignment is to choose a public health issue and write a term paper which assesses the problem and designs an intervention. I will be writing about infant mortality rates among the urban African-American population in Baltimore. In Maryland, the total infant mortality rate is about 7.4 deaths per 1000 live births. However, the infant mortality rate for African Americans is almost twice that (13.1 deaths per 1000 live births). Within Baltimore City, the disparity is even more severe. African American infants are almost three times as likely to die as white infants.

One of the goals of public health is to diminish health disparities. It is unjust that within Baltimore City, the African American community faces an infant mortality rate similar to many developing nations. Infant mortality rates are a very important indicator of overall health and if the health system is failing to provide adequate pre and post natal services, the health of the entire community suffers. There are many programs within Baltimore that seek to address this problem but so far there has not been much significant improvement. I think that this will be an interesting topic to examine deeper due to the complex factors that cause the disparity. It is also socially relevant since, as our country begins to implement health reform and works to improve overall population health, it will become extremely important to improve the health of underserved population groups. Until these disparities are addressed, it will be impossible for the overall health of the population to improve significantly.

Yesterday...

It's hard to believe that spring semester is already halfway done! Since most of the lectures in the class are over, this is a good time to look back on the semester and consider what has changed since I wrote my first blog. This semester's lecture topics have covered a huge area of information. It is extremely impressive to consider how far public health reaches. From chronic and infectious disease, to injury prevention, to statistics, and even to matters of national security like bioterrorism prevention, public health professionals work every day to promote the health of the population.

One of the lectures I found most interesting was the one that focused on injury prevention. It was really amazing to see the impact of increased speed (even of just 10 more miles per hour) has on injury. Also, I had previously kind of considered injuries to be accidents and had not thought of all the resources that can be used to prevent them. When the lecturer described the Haddon Matrix, I was blown away by all of the variables that can be assessed when considering what factors cause an injury. The focus on texting while driving was also very interesting and made the lecture seem more compelling since this is an issue which is currently up for debate in many state legislatures.

Some of the course material was very surprising. Specifically, I found the surveillance responsibility aspect of public health shocking. It is amazing the number of things public health professionals track very closely. To think that even purchases of over-the-counter drugs are tracked in order to identify trends and possible outbreaks is an awe inspiring glimpse into the amount of data that must be collected, organized, and analyzed. The bioterrorism lecture was also surprising to me. I had not previously considered the role of public health in national safety. However, when you think about it, one of the most effective ways to cripple a country would be to cause widespread health issues.

One of the main reasons I took this course was because I will be attending medical school in the fall and think that public health knowledge will help me be a more well rounded physician. I am still confident that this is true. Without a working knowledge of the US health system and the ongoing reform movement, it would be very difficult to navigate the field. Also, the information we have learned about vulnerable populations and health disparities will help me to better serve my patient population.

At the start of the course, I was most interested in the health reform movement and issues of global maternal and child health. Now, after the signing of the health reform bill, I am more interested in evaluating the strengths and weaknesses of the changes than in researching other reform possibilities. However, I remain deeply interested in global maternal and child health. The information given in the lecture about international health supported this interest and detailed many of the factors that contribute to inflated maternal mortality and other poor health outcomes among women and children in the developing world. I especially found it interesting that education and contraceptive availability were so highly correlated with improving health.

That's all for this week, I'm ready to get back to enjoying the beautiful spring weather!

Yes We Can Reform Healthcare

This Sunday the US Congress passed a groundbreaking health reform bill. The reform bill seeks to extend health insurance coverage and control medical costs. Firstly, the bill includes an expansion of Medicaid and SCHIP. This means that more severly impoverished families will receive goverment health insurance. The bill also hopes to improve options for people looking to purchase health insurance individually. The bill established a cooperative where consumers can go to purchase health insurance. This is especially important for people that are unemployed, self-employed or do not work full-time. Also, health insurance companies will no longer be able to deny anyone insurance because of a pre-existing condition or high-risk situation. In order to create an insurance group that reflects the population (both high and low risk), the bill also requires that everyone purchase insurance. Those who choose not to follow this mandate will pay extra taxes. In order to help people afford insurance plans the government plans to subsidize insurance payments for low-income families and individuals. There will also be employer "pay or play" provisions which means that an insurer will either have to provide insurance for its employees or pay into a government pool. In addition, there will be tax increases for high income (above $250,000 per year) individuals.

The bill was passed with no republican support. The republican party takes issue with this reform both because it generally opposes big government and because opposition is a good way to undermine President Obama's efforts as a reformer. Although some democrats felt that this bill was not radical enough, most supported the effort to reduce the number of uninsured people and the efficacy of our health care system. Although many insurance companies do not like the government interfering in their business and not allowing them to refuse consumers with pre-exisiting conditions, the mandate to buy health insurance does greatly increase their consumer population. Health care providers are an important stakeholder group that has a somewhat complex view of this bill. On one hand, expanding insurance coverage helps doctors be able to provide quality care. However, there is some discomfort with government setting limits on how they care for their patients (i.e. prescriptions, expensive diagnostic tests). The US population can be broken down into many small interest groups. However, generally uninsured people should welcome a solution to their problem. Most Americans should recognize the overall good this will bring the country. Also, there will be some opposition from people who are already well-insured and those in high-income groups.

Overall, I think this is a very important bill. The healthcare system in this country has been struggling and changes were definitely necessary. This reform may help to lower the huge number of uninsured people in this country and to increase the quality of health outcomes for every dollar spent. Personally, I would have liked to see some more radical reforms (i.e. the inclusion of a public option or a larger emphasis on reducing administrative costs). However, I recognize that these would have been politically unpallatable and therefore were not an option this time. I think that this bill is definitely a step in the right direction. Hopefully the bill will lead to health improvements and the public will form a more positive opinion of government involvement in healthcare. The provision in this bill that allows children to stay on their parents insurance until 26 will most likely effect me. Also, the fines for those who choose not to buy insurance would definitely persuade me to stay insured through my 20s.

Dollars and Sense: The US Healthcare Debate

Okay, it's time for another blog. This week, we read an article outlining the impact of the recession on health economics. As we've learned in the course, health spending in the US makes up an enormous percentage of GDP. According to this article, that number will only continue to increase. An interesting point made in the article was that although overall spending may be decreasing, health care spending most likely will slow, but not decrease. Health care spending is usually effected by recessions over the long term (i.e. people will save less and thus spend less on health care in the next few years). Another interesting point is that as a result of the recession, more people are shifting from out-of-pocket payment plans to Medicaid. The government needs to plan to accomodate this extra cost.

This increase in health spending in the public sector has serious consequences. If health care spending continues to occupy more and more of the GDP, the nation is in essence spending all of its money on a service good, something that is not exportable or particularly profitable. And, as the proportion of the health spending that is done by the public sector increases, the US government (already in serious debt) continues to spend more and more money it does not have on an inefficient system. If the government is going to spend so much on health care, it makes sense to shift to a single payer system. At least that would eliminate the enormous administrative costs associated with the current system. As the government continues to shoulder more of the cost burden of the health care system, it seems they should be given the opportunity to have some administrative power in a system that is costing them so much.

Within the health care debate, there are many key issues. In many ways, the debate is rooted in the US value system. Our society values instant gratification and people feel they deserve immediate access to the best and newest technologies. The decision to shift to a government-run system would require an ideological shift. Another key issue is centered around reimbursement rates for physicians. In this country many medical students incur large debts to obtain a degree. It is important that these professionals are compensated appropriately for their efforts and advanced knowledge.

Although there are many more issues involved in the health care debate, if I had the ability to change one thing, it would be eliminating the uninsured portion of the American population. Sixteen percent of Americans are uninsured (more than 46 million people). This is not only a social injustice (in my opinion health care should be a human right) but it also has serious economic consequences. These people are highly unlikely to access primary care and thus receive little preventative care. Therefore, when they become ill, it is usually fairly serious, and many times could have been completely avoided. Then, when they finally seek help, it is usually in an emergency room. Visits to the emergency room cost the system many times more than visits to general practitioners. Finally, since these people often cannot pay the costs incurred during their visit, these costs are shifted to insured patients. It is through this system that the health care system accrues enormous extra costs.

That's all for this week. I will be back with more intro to public health blogs after Spring Break.

Global Health: The Challenges of Fund Allocation

Hi and welcome back to my Intro to Public Health blog. This week, we were asked to read an article about global health and development by Laurie Garret, an expert on Global Public Health who works for the Council on Foreign Relations. The article addresses the fact that in recent years health aid money to developing countries has increased tremendously. However, Garret expresses the concern that this money may not be improving health as well as it could be. The paper outlines some reasons for this, and explains how some organizations may actually be detrimental to local health. The author talks about the fact that donor money is often "stovepiped" to one very specific goal. For this reason, aid is given without building the infrastructure necessary to sustain a high-functioning health system. Also, developed countries tend to draw health care workers from the developing world. This "brain drain" is a major cause of poor health because nations are being stripped of their health work force. Another issue is that when all resources focus on one issue others are sure to cause problems. For example, the attention given to the HIV/AIDS pandemic has taken attention away from the severity of the emergence of multidrug resistant tuberculosis.

When considering the reasons for continued worsening health in the developing world, it seems that the most important is the failure to focus on infrastructure building. Although it is noble and important to focus on individual goals, it is impossible to promote health without a strong health care delivery system. The author cited an example of a country that was given vaccines, and yet could not vaccinate children due to a lack of facilities and workers. Also, it has been proven that education is one of the most effective ways to improve health in a nation. This is especially important in eliminating the tremendous gender inequities in health status.

Another significant problem is the issue of the "brain drain." In order for developing countries to support themselves, it is crucial that they have sufficient professionals. However, the numbers of physicians who train in developing nations and then emigrate is staggering. In order to promote improved health outcomes, aid organizations must both dedicate resources to creating incentives for doctors to stay in their home countries and regulate the methods which developed countries can use to draw talent away from the developing world.

The author states that there are two markers that should be considered when evaluating health: maternal survival and life expectancy. Although it is impressive to reduce AIDS transmission or increase polio vaccine coverage, if life expectancy is not increasing than health is not actually improving. Maternal mortality is a good health indicator because maternal mortality has been found to be directly correlated with the stability and quality of the health system (i.e. good hospitals, sufficient doctors, clean operating rooms). Similarly, life expectancy is crucial because it is sensitive to the rates of children (especially those under 5) who die. In countries with strong infrastructures (clean water, sanitation, proper food supply, health care access), life expectancies improve. In countries that lack these things, they flounder.

The author gave some examples of times when aid has actually damaged health. In one case, a strain of multidrug resistant tuberculosis caused devastation in a South African community. This virus emerges as a result of people not completing the antibiotic treatment regimen for TB. Since the country lacks the resources to ensure that the patient takes all doses, the distribution of antibiotics was actually detrimental. Another example occurred in Haiti. There, aid organizations funded a successful campaign to improve Haitian access to ARVs and to decrease prevalence. Although these goals were realized, Haitian health markers decreased in every other category. By creating a successful separate system of care, aid workers drew talent and resources away from the established health system and indirectly caused the country's overall health status to worsen.

That's all for this week, Bye!

Individual Rights vs. Public Health

Hi! This week we were asked to read an important court decision in public health. In this case, a woman suffering from leprosy, Mary Kirk, was fighting the Board of Health's decision to mandate her to move to the contagious division of the city hospital. At this time, the city pest houses were very dirty places. This particular one was also very close to the garbage dump and filled with people infected with small pox. Since Ms. Kirk was a woman of high social standing, the city offered to build her a cottage outside the city where she could live. However, since the cottage would not be ready immediately, the Board of Health requested that Ms. Kirk live in the hospital as temporary housing. Ms. Kirk argued that her leprosy was not a very contagious type and felt that being forced to live in the hospital was a violation of her personal rights. The courts ruled that it was within the powers of the Board of Health to decide what steps are necessary to protect the health of the public. Also, the court ruled that the individual rights to liberty and property do not hold when exercising this right harms others.

First of all, when talking about this case, it is important to make a distinction between quarantine and isolation. Quarantine is used when describing someone that has been (or may have been) exposed to a disease, but does not yet show symptoms. For example, United States immigration officials often quarantine entrants to the country that come from areas with high rates of endemic infectious disease. In this case an immigrant from an area with high malaria rates might be held for a period of time in order to ensure that he or she will not develop malaria and spread it. On the other hand, isolation refers to a person who already has an infectious disease. In this case, although the term quarantine is used, it would probably be more accurate to say that Ms. Kirk was ordered into isolation due to fears that she would cause others to contract the disease she already has (leprosy).

The decision of when an individual should be quarantined is a difficult one. In my opinion, the health department should set guidelines for when a person should be quarantined. These guidelines should be based on research regarding infection rates and virulence of different diseases. It is extremely important that these decisions be made based on scientific evidence. Physicians should be educated on these rules and asked to enforce them. Then, when a physician sees someone that should be quarantined, he or she can inform the patient and take the necessary steps.

While deciding who should be quarantined is a scientific decision, figuring out how to balance individual and community rights is more of an ethical and legal issue. These decisions should be made by the court system. It is the responsibility of the courts to interpret the constitution and decide when allowing an individual to exercise his or her rights violates the public well-being and vice versa. Another difficult decision is whether or not to err on the side of individual or public rights. In this case, I think it is important to do what is best for the most people. Of course, reason must be used to ensure that individual rights are not needlessly violated.

That's it for this week. Bye!

Sizing up the Competition

This week's assignment is very seasonal. In the spirit of the Olympic Games (GO USA!!!), I will be blogging about an article comparing the US's health care performance to that of the 29 other members of the Organization for Economic Cooperation and Development. As I watch Lindsey Vonn ski for the gold I can only hope our health care system competes nearly as well.

Some measures were not too surprising. The United States spends more on health care and pharmaceuticals, per capita, than any other country. The US spends 16% on healthcare whereas the average of the other countries is about half that. Also, the US has the lowest percentage of population of daily smokers. This is a testament to one of the greatest public health achievements of the last fifty years. In the next fifty years I think the other countries listed will improve on this statistic. Unfortunately, I was not surprised to find that the United States has the highest obesity rate of any of the countries. I think that this public health challenge will be integral in improving US health in the next 50 years.

I was surprised to find that the United States is well below average in doctor consultations per capita. This is especially surprising given the amount of money Americans spend on healthcare. I was also surprised to find that the United States is below average in the number of practicing physicians per 1,000 population. Usually, news reports highlight the shortage of primary care doctors and excess specialists. I was not aware that there is an overall shortage of US doctors.

Two of these measures will have a tremendous impact on the future of American public health. One is the fact that the United States spends the most per capita on health care but the least percentage of government funds. This system is unsustainable and does not lead to health outcomes better than those of other countries that spend significantly less. Health care reform is a very difficult and divisive issue. However, in my opinion, it is a social injustice for the United States to continue to have approximately 15% of the country uninsured. I think that any restructuring of the health care system needs to take into account providing dependable coverage for this group. An interesting part of this debate is that the CDC has not been more involved in lobbying for a system that provides more satisfactory health outcomes.

The obesity epidemic is another factor that is influencing American rate at an increasing rate. Obesity causes heart disease, diabetes, and other serious illnesses. Programs such as the NYC trans fat ban, the decision in many cities to include nutritional info on menus, and interventions aimed at increasing physical activity levels. In my opinion, to be effective, programs need to begin in schools and stress healthy eating and high physical activity levels from a young age. The CDC should make sure that foods offered at school are healthy and balanced and that children are taught the importance of frequent physical activity and proper nutrition habits.

P.S. Lindsey Vonn and Julia Mancuso, both of the US, won gold and silver in the women's downhill!

Top Ten Greatest Public Health Interventions

Hi all,

This week's blog is about the top ten greatest public health interventions of the 1900s. Too bad one of them wasn't an instant snow remover or a fireplace I can use in my apartment. It's the snow-pocalypse out there! Anway, hopefully this blog will keep someone occupied as we wait out the blizzard.

The Top Ten Interventions are:
1. Vaccination
2. Motor Vehicle Safety
3. Safer Workplaces
4. Control of Infectious Diseases
5. Decline in Deaths from Coronary Heart Disease and Stroke
6. Safer and Healthier Foods
7. Healthier Mothers and Babies
8. Family Planning
9. Flouridation of Drinking Water
10. Recognition of Tobacco Use as a Health Hazard

Wow! Public Health sure has accomplished alot in the last century. What really shocked me is that since 1900, average life expectancy has grown by more than 30 years! Public Health is responsible for 25 of those years which is truly a feat to be proud of.

One of the most interesting things about this list is that almost everyone has been effected by most if not all of the interventions. We all benefit from the flouridation of drinking water, healthier foods, and safer workplaces. Also, infant and child mortality declines were helped by maternal health reforms and vaccination campaigns which have eradicated or severely lessened many diseases that were previously devastating. As any high school graduate can tell you, education programs regarding motor vehicle safety and tobacco as a health hazard are unavoidable. Also, when purchasing a new car, we often take for granted the anti-lock brakes, side-impact air bags, and seat belts that have saved so many lives. Next, as a woman, I particularly value the family planning interventions that were integral in both improving women's health and facilitating the women's liberation movement. Finally, since cardiovascular disease is currently the number one killer in the United States, any interventions that reduce the number of people dying from these diseases are important to all Americans.

Today, I will take just two of these interventions and elaborate on how they are particularly powerful: Vaccinations and Healthier Mothers and Babies.

Since the first time my pediatrician explained the reason I had to get a certain shot before entering a new school, I have found vaccinations to be extremely interesting. It seems amazing that just 100 years ago, I would have known people suffering from measles, mumps, and small pox whereas today those diseases sound as antiquated as the Bubonic Plague. It is even more impressive that a disease that was a part of the normal elementary school experience when I was younger, chicken pox, is now joining that list. Last year, I was extremely impressed with the speed and precision with which the H1N1 vaccine was developed and produced. It is fascinating to think of what infamous global pandemics could have been avoided if today's vaccination technology had been in place (the Spanish Flu, the small pox plagues that decimated Native American populations, etc.).

Today, many activists have been campaigning against vaccines due to concerns about a link between vaccination and autism. However, the Lancet journal article that initially sparked this concern was recently retracted due to inappropriate research methods. This means there is absolutely no proof supporting this claim. If vaccination rates were to drastically decline in the future, the public health of the US population would be seriously at risk.

Interventions regarding healthier mothers and babies also have a strong impact on the population level. The past century has seen tremendous improvements in this area. However, my interest in this intervention is mostly centered on the work still to be done. The US is 45th on the list of countries with the lowest infant mortality rates. This is well behind almost every European country and many countries that could be considered "less developed" than the US. The high infant mortality rate in this country is mainly due to a health disparity. African-American infants and infants with low SES have much higher rates of infant mortality than almost all other American groups. In fact, the infant mortality rate in East Baltimore is worse than many extremely impoverished nations. In the next century, I believe public health interventions will be integral in eliminating this disparity.

One Public Health intervention that I was surprised not to see on the list is air quality improvement. Although this is still an uphill battle, the 20th century saw key legislation, supported by public health experts, to improve the quality of the air. The most important of these may have been the ban of leaded gasoline. Since the switch to all unleaded fuels, air quality has improved dramatically. Also, indoor air quality has been improved by indoor smoking bans that have been quickly gaining popularity throughout the country. Although initially laws simply segregated smokers and nonsmokers within a restaurant, today many cities ban smoking indoors altogether. Maybe this intervention will have a place on the top ten for the next century.

That's all for this week. Stay warm!

First Impressions

Hi everyone. My name is Michelle Perez and I am a senior public health and spanish major at Johns Hopkins University. This blog is an assignment for the course "Intro to Public Health." In this blog, I will tackle issues discussed weekly in class, as well as bring in my own opinions and political views. I hope this blog will tie in-class academic discussions to real issues in public health around the world.
Obviously, as a public health major, I am invested in public health issues. I will be attending medical school in the fall and feel that my public health background has made me a more well-rounded individual. Also, it is important to consider the health of the public as a whole when making individual patient-centered choices. Public health offers the unique opportunity to influence health on a population level and to work towards eliminating social injustices and health disparities.
Firstly, for those of you who are unfamiliar with public health, I'd like to explain exactly what it is. An important aspect of public health is that it is focused on the health of the population as a whole. Public health studies and initiatives are aimed at improving health at the macro level. Also, public health takes a proactive approach. Goals include preventing unhealthy conditions instead of just resolving issues after they occur. In summary, public health focuses on supporting the conditions which lead to good health on the population level.
Within public health, I find many areas very interesting. These include maternal and child health in developing nations, refugee health issues, and healthy policy issues (including issues surrounding the restructuring of the American health care system). I think that these three areas provide a good summary of the diverse array of issues public health can be used to address. The first, maternal and child health, can be seen as a fairly straightforward issue of health access and education in developing nations. The problem-solving methods employed by public health programists must focus both on developing access points, financing care, and building a structure that can be sustainable. The second issue, refugee health, combines a health problem with a political one. Refugees often suffer poor health as a result of being forced from an unstable political climate. Within public health, it is necessary to both identify the population and identify their specific health needs. Lastly, health policy issues tap the economic and political aspects of public health. In developing public health policy, experts must consider various stakeholders and attempt to make decisions that benefit the most people.
So far, class has been very interesting. The first day broke down the important parts of public health and explained each. One of the most interesting things about public health is the way natural science focused disciplines, such as epidemiology and biostatistics are blended with more social science focused disciplines such as law and politics. I also found it extremely interesting to note that public health changes in the areas of santitation, food and water quality, and urban overcrowding were the cause of the major mortality dip in the 1900s. I also enjoyed the analysis of what goes into a policy (science, culture, and politics). I think that people too often focus on only one of these and forget that policy is normally a conglomerate of these competing factors. I hope to learn more about these issues and much more throughout the course.
Thanks for reading! Until next time....