Session 5

Read  Chapter 11: Public Health & The Role of Government

After this review students should be able to discuss the changing role of Prevention in the US

Look at the changing rates of death in the US:

Death Rates by Cause of Death, 1900–2001

(per 100,000 population)

Year

Tuberculosis,
all forms

Malignant
neoplasms
(cancer)

Major cardio-
vascular/renal
diseases

Influenza
and pneumonia

Motor
vehicle
accidents

1900

194.4

64.0

345.2

202.2

n.a.

1910

153.8

76.2

371.9

155.9

1.8

1920

113.1

83.4

364.9

207.3

10.3

1930

71.1

97.4

414.4

102.5

26.7

1940

45.9

120.3

485.7

70.3

26.2

1950

22.5

139.8

510.8

31.3

23.1

1960

6.1

149.2

521.8

37.3

21.3

1970

2.6

162.8

496.0

30.9

26.9

1980

0.9

183.9

436.4

24.1

23.5

1990

0.7

203.2

368.3

32.0

18.8

2000

0.3

200.5

340.4

24.3

15.2

2001

0.3

194.4

323.9

21.8

15.4

Source: 1900-1970, U.S. Public Health Service, Vital Statistics of the United States, annual, Vol. I and Vol II; 1971-2001, U.S. National Center for Health Statistics, Vital Statistics of the United States, annual; National Vital Statistics Report (NVSR) (formerly Monthly Vital Statistics Report); and unpublished data. From Statistical Abstract of the United States: 2003.

 

Read the editorial by McGinnis & Foege (JAMA 2004-291-p1263-1364) which discusses the value of examining death rates and the underlying cause of these deaths, which are mostly behavioral.

While death rates tend to look at the results of lifelong behaviors it is worth examining Guides from DHHS for improving the health of Adolescents & Young Adults in the US which continue to focus on behaviors as the diseases affecting the US have changed from the infectious diseases common in developing countries to the chronic diseases seen in the US and other developed  countries.

In the US and other developed countries diseases are often tracked by social class and income. This has been studied better in Europe but with the advent of  examination of small areas (areas less than a county or city) we have been better able to see how the health system in the US has led to disparate levels of health depending on income and environment.  Read the essay by Michael Marmot in JAMA, March 14 Vol. 295 pp 1304-1307. This discussion refers to the Whitehall study in the UK of civil servants and looks at disease based income and  environment.  As Geographic information systems have penetrated the health care field in  the US we are recognizing disparate levels of health status better among American sub populations. It is notable that Dr. Marmot comments of the wide gap in resources devoted to medical care in the US, compared to the focus on health care on most other countries,

After completing this session students should be able to discuss the issue of:

relation of income/environment to levels of health status

If you wish to test your knowledge you may place an essay, not to exceed 200 words, on the Discussion Forum for critique by your peers.