Introduction to Public FiFth Edition Health Mary-Jane Schneider, PhD Clinical Associate Professor Department of Health Policy, Management, and Behavior School of Public Health University at Albany, State University of New York Rensselaer, New York with Henry S. Schneider, PhD Assistant Professor of Economics Johnson Graduate School of Management Cornell University Ithaca, New York Drawings by Henry S. Schneider World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 [email protected] www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com. Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. 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Bolduc © Arthimedes/Shutterstock Production Editor: Dan Stone Media Development Editor: Shannon Sheehan Senior Marketing Manager: Sophie Fleck Teague Printing and Binding: RR Donnelley Manufacturing and Inventory Control Supervisor: Amy Bacus Cover Printing: RR Donnelley Library of Congress Cataloging-in-Publication Data Names: Schneider, Mary-Jane, 1939- , author. | Schneider, Henry S. Title: Introduction to public health / Mary-Jane Schneider, with Henry S. Schneider ; drawings by Henry S. Schneider. Description: Fifth edition. | Burlington : Jones & Bartlett Learning, MA, [2017] Identifiers: LCCN 2016001765 | ISBN 9781284089233 Subjects: | MESH: Public Health | Public Health Practice Classification: LCC RA425 | NLM WA 100 | DDC 362.1--dc23 LC record available at http://lccn.loc.gov/2016001765 6048 Printed in the United States of America 20 19 18 17 16 10 9 8 7 6 5 4 3 2 1 Dedication To Augustus Anthony Edison Schneider May he live a long and healthy life Contents Preface xiii Prologue: Public Health in the News xv Part I: What Is Public Health? 1 1 Public Health: Science, Politics, and Prevention 3 What Is Public Health? 4 Public Health Versus Medical Care 5 The Sciences of Public Health 7 Prevention and Intervention 10 Public Health and Terrorism 11 Conclusion 13 References 13 2 Why Is Public Health Controversial? 15 Economic Impact 16 Individual Liberty 18 Moral and Religious Opposition 20 Political Interference with Science 22 Conclusion 23 References 23 3 Powers and Responsibilities of Government 25 Federal Versus State Authority 26 How the Law Works 28 How Public Health Is Organized and Paid for in the United States 29 Nongovernmental Role in Public Health 36 Conclusion 37 References 38 Part II: Analytical Methods of Public Health 39 4 Epidemiology: The Basic Science of Public Health 41 How Epidemiology Works 42 A Typical Epidemiologic Investigation—Outbreak of Hepatitis 43 Legionnaires’ Disease 44 Eosinophilia-Myalgia Syndrome 47 Epidemiology and the Causes of Chronic Disease 49 vi Contents Heart Disease 49 Lung Cancer 51 Conclusion 53 References 54 5 Epidemiologic Principles and Methods 57 Kinds of Epidemiologic Studies 62 Conclusion 67 References 68 6 Problems and Limits of Epidemiology 69 Problems with Studying Humans 69 Sources of Error 71 Proving Cause and Effect 73 Epidemiologic Studies of Hormone Replacement Therapy—Confusing Results 74 Ethics in Epidemiology 75 Conflicts of Interest in Drug Trials 78 Conclusion 80 References 81 7 Statistics: Making Sense of Uncertainty 83 The Uncertainty of Science 84 Probability 86 The Statistics of Screening Tests 88 Rates and Other Calculated Statistics 90 Risk Assessment and Risk Perception 94 Cost–Benefit Analysis and Other Evaluation Methods 98 Conclusion 99 References 100 8 The Role of Data in Public Health 103 Vital Statistics 104 The Census 104 NCHS Surveys and Other Sources of Health Data 107 Is So Much Data Really Necessary? 108 Accuracy and Availability of Data 109 Confidentiality of Data 111 Conclusion 111 References 112 Part III: Biomedical Basis of Public Health 115 9 The “Conquest” of Infectious Diseases 117 Infectious Agents 118 Means of Transmission 120 Contents vii Chain of Infection 121 Rabies 125 Smallpox, Measles, and Polio 126 Fear of Vaccines 129 Conclusion 131 References 132 10 The Resurgence of Infectious Diseases 135 The Biomedical Basis of AIDS 135 Ebola 140 Other Emerging Viruses 144 Influenza 146 New Bacterial Threats 148 Multidrug-Resistant Tuberculosis (MDR TB) 150 Prions 154 Public Health Response to Emerging Infections 155 Public Health and the Threat of Bioterrorism 156 Conclusion 157 References 157 11 The Biomedical Basis of Chronic Diseases 163 Cardiovascular Disease 165 Cancer 169 Diabetes 171 Other Chronic Diseases 172 Conclusion 172 References 173 12 Genetic Diseases and Other Inborn Errors 175 Environmental Teratogens 176 Genetic Diseases 177 Genetic and Newborn Screening Programs 180 Genomic Medicine 184 Ethical Issues and Genetic Diseases 185 Conclusion 187 References 188 Part IV: Social and Behavioral Factors in Health 191 13 Do People Choose Their Own Health? 193 Education 197 Regulation 200 Does Prohibition Work? 201 Conclusion 203 References 203 viii Contents 14 How Psychosocial Factors Affect Health Behavior 205 Health of Minority Populations 207 Stress and Social Support 208 Psychological Models of Health Behavior 209 Ecological Model of Health Behavior 211 Health Promotion Programs 213 Changing the Environment 215 Conclusion 216 References 217 15 Public Health Enemy Number One: Tobacco 219 Biomedical Basis of Smoking’s Harmful Effects 221 Historical Trends in Smoking and Health 221 Regulatory Restrictions on Smoking—New Focus on Environmental Tobacco Smoke 225 Advertising—Emphasis on Youth 226 Taxes as a Public Health Measure 227 California’s Tobacco Control Program 228 The Master Settlement Agreement (MSA) 230 FDA Regulation 232 Electronic Cigarettes 233 Conclusion 233 References 234 16 Public Health Enemy Number Two and Growing: Poor Diet and Physical Inactivity 237 Epidemiology of Obesity 238 Diet and Nutrition 242 Promoting Healthy Eating 243 Physical Activity and Health 247 How Much Exercise Is Enough, and How Much Do People Get? 249 Promoting Physical Activity 250 Confronting the Obesity Epidemic 252 Conclusion 254 References 254 17 Injuries Are Not Accidents 259 Epidemiology of Injuries 260 Analyzing Injuries 263 Motor Vehicle Injuries 264 Pedestrians, Motorcyclists, and Bicyclists 267 Poisoning 268 Firearms Injuries 269 Occupational Injuries 271 Injury from Domestic Violence 272 Contents ix Nonfatal Traumatic Brain Injuries 272 Tertiary Prevention 274 Conclusion 275 References 276 18 Maternal and Child Health as a Social Problem 281 Maternal and Infant Mortality 282 Infant Mortality—Health Problem or Social Problem? 283 Preventing Infant Mortality 285 Family Planning and Prevention of Adolescent Pregnancy 290 Nutrition of Women and Children 292 Children’s Health and Safety 293 Conclusion 296 References 297 19 M ental Health: Public Health Includes Healthy Minds 301 Major Categories of Mental Disorders 301 Anxiety 302 Psychosis 302 Disturbances of Mood 302 Disturbances of Cognition 302 Epidemiology 302 Causes and Prevention 303 Children 306 Eating Disorders 307 Mental Health in Adulthood 308 Mental Health in Older Adults 310 Treatment 310 Conclusion 311 References 311 Part V: Environmental Issues in Public Health 313 20 A Clean Environment: The Basis of Public Health 315 Role of Government in Environmental Health 316 Identification of Hazards 317 Pesticides and Industrial Chemicals 321 Occupational Exposures—Workers as Guinea Pigs 324 New Source of Pollution—Factory Farms 325 Setting Standards—How Safe Is Safe? 326 Risk–Benefit Analysis 327 Conclusion 327 References 328