Encyclopedia of Public Health (D-K)

365 Pages·2002·3.174 MB·English

by  Lester Breslow

PHvol2 5/22/03 3:23 PM Page 1
Encyclopedia of
Public Health
Editorial Board
EDITOR IN CHIEF
Lester Breslow, University of California at Los Angeles,
School of Public Health
ASSOCIATE EDITORS
Bernard D. Goldstein, Graduate School of Public
Health, University of Pittsburgh
Lawrence W. Green, Centers for Disease Control and
Prevention
C. William Keck, Akron, Ohio, Health Department
John M. Last, University of Ottawa
Michael McGinnis, The Robert Wood Johnson
Foundation
ii
PHvol2 5/22/03 3:23 PM Page 3
Encyclopedia of
Public Health
Edited by Lester Breslow
Volume 2
D-K
Copyright © 2002 by Macmillan Reference USA, an imprint of the Gale Group
All rights reserved. No part of this book may be reproduced or transmitted in any
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Gale Group and Design is a trademark used herein under license.
Library of Congress Catalog in Publication Data
Encyclopedia of public health / edited by Lester Breslow.
p. cm.
Includes bibliographical references and index.
ISBN 0–02–865354–8 (set : hardcover : alk. paper) — ISBN 0–02–865350–5
(v. 1 : alk. paper) — ISBN 0–02–865351–3 (v. 2 : alk. paper) — ISBN 0–02–
865352-1 (v. 3 : alk. paper) — ISBN 0–02–865353–X (v. 4 : alk. paper)
1. Public health—Encyclopedias. I. Breslow, Lester.
RA423 .E53 2001
362.l’03—dc21 2002031501
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
D
DARWIN, CHARLES ROBERT after the Origin of Species. Evolution can no longer
be described as a mere theory. There is such a
Now recognized as a towering figure in the study huge body of hard scientific evidence, including
of biology, Charles Darwin had an undistinguished much recently acquired support from molecular
academic career during his own lifetime. Though genetics, that evolution may be considered a fun-
he barely scraped through his degree at Cam- damental fact of life.
bridge, Darwin was interested in natural history
from early childhood. From 1831 to 1836, he JOHN M. LAST
served as naturalist on HMS Beagle, a small ship
that circumnavigated the world, surveying to en-
hance the quality of navigational charts and gath- DATA SOURCES AND
ering scientific specimens for the advancement of COLLECTION METHODS
natural history. Darwin’s account of the voyage of
the Beagle was a literary success but contained little Health data are the facts that, when assembled and
hint of the paradigm shift in biological thought for analyzed, yield the information required by health
which Darwin soon became notorious. Darwin care planners, providers, and users in order to
reflected for over twenty years after returning
maintain effective and efficient public health ser-
from his travels, and before publishing On the
vices. Potential sources of information about health
Origin of Species by Means of Natural Selection (1859).
are numerous and diverse, but in practice four
In this and later works, Darwin developed his
main sources are used: medical records, certifi-
theory of evolution by drawing upon his empirical
cates of vital and other health-related events, re-
observations of wildlife, fossils, and the complex
sponses in surveys, and facts obtained in the course
relationships of localized variations in the anat-
of conducting research. An interesting fifth source,
omy of birds, butterflies, lizards, and other ani-
unobtrusive data, is also considered here.
mals to their environment. Darwin’s theory out-
raged orthodox religious beliefs in the creation
(based on the myths described in Genesis that God MEDICAL RECORDS
had created the world and all that lived in it in
seven days). For a time, he was reviled by a large Even the simplest medical records contain some-
proportion of the British establishment, but his thing in each of the following categories:
supporters, including the eminent physician and
1. Personal identifying data: name, age (birth
biologist Thomas Huxley (1825–1895), encour-
date), sex, and so on.
aged him and scientific evidence eventually pre-
vailed. Much further support for Darwin’s theory 2. Socio-demographic data: sex, age, occupa-
of evolution is contained in his prolific writings tion, place of residence.
307
DATA SOURCES AND COLLECTION METHODS
3. Clinical data: medical history, investiga- letters to identify each individual with a high de-
tions, diagnoses, treatment regimens. gree of precision. Death certificates contain a
great deal of valuable information: name at birth
4. Administrative data: referrals, sites of care.
as well as at death, age, sex, place of birth as well as
5. Economic data: insurance coverage,
death, and cause of death. The personal identify-
method of payment.
ing information can be used to link the death
6. Behavioral data: adherence to the recom- certificate to other health records. The reliability
mended regimen (or otherwise). of death certificate data varies according to the
cause and place: Deaths in hospitals have usually
In modern clinics and hospitals, and in many
been preceded by a sufficient opportunity for
public health departments, data in each of these
investigations to yield a reliable diagnosis, but
categories can be found in the records of individu-
deaths at home may be associated with illnesses
als who have received services there, but not all the
that have not been investigated, so they may have
data are in the same file. Administrative and eco-
only patchy and incomplete old medical records
nomic data are usually in separate files from clini-
or the family doctor’s working diagnosis, which
cal data; both are linked by personal identifying
may be no more than an educated guess. Deaths in
information. Behavioral information, such as the
other places, such as on the street or at work, are
fact that an individual did not obtain prescribed
usually investigated by a coroner or medical exam-
medication or fails to keep appointments can be
iner, so the information is reasonably reliable.
extracted by linking facts in a clinical record with
Other vital records, for example, marriages and
the records of medications dispensed and/or ap-
divorces and dissolution of marriages, have less
pointments kept. Records in hospitals and clinics
direct utility for health purposes but do shed some
are mostly computer-processed and stored, so it is
light on aspects of social health.
technically feasible to extract and analyze the rele-
vant information, for instance, occupation, diag-
nosis, and method of payment for the service that
HEALTH SURVEYS
was provided, or behavioral information. Such
analyses are often conducted for routine or for
Unlike births and deaths, health surveys are expe-
research purposes, although there are some ethi-
rienced by only a sample of the people; but if it is a
cal constraints to protect the privacy and preserve
statistically representative sample, inferences about
the confidentiality of individuals.
findings can be generalized with some confidence.
Survey data may be collected by asking questions
either in an oral interview or over the telephone,
RECORDS OF BIRTHS AND DEATHS
or by giving the respondents a written question-
Vital records (certifications of births and deaths) naire and collecting their answers. The survey data
are similarly computer-stored and can be analyzed are collated, checked, edited for consistency, proc-
in many ways. Collection of data for birth and essed and analyzed generally by means of a pack-
death certificates relies on the fact that recording age computer program. A very wide variety of data
of both births and deaths is a legal obligation—and can be collected this way, covering details such as
individuals have powerful reasons, including fi- past medical events, personal habits, family his-
nancial incentives such as collection of insurance tory, occupation, income, social status, family and
benefits, for completing all the formal procedures other support networks, and so on. In the U.S.
for certification of these vital events. The paper National Health and Nutrition Surveys, physical
records that individuals require for various pur-
examinations, such as blood pressure measure-
poses are collected and collated in regional and
ment, and laboratory tests, such as blood chemis-
national offices, such as the U.S. National Center
try and counts, are carried out on a subsample.
for Health Statistics, and published in monthly
bulletins and annual reports. Birth certificates Records of medical examinations on school
record details such as full name, birthdate, names children, military recruits, or applicants for em-
and ages of parents, birthplace, and birthweight. ployment in many industries are potentially an-
These items of information can be used to con- other useful source of data, but these records tend
struct a unique sequence of numbers and alphabet to be scattered over many different sites and it is
308
DECENTRALIZATION AND COMMUNITY HEALTH
logistically difficult to collect and collate them Webb, E. J.; Campbell, D. T.; and Schwartz, R. D. et al.
centrally. (1988). Unobtrusive Measures: Non-interactive Research
in the Social Sciences. Chicago: Rand McNally.
HEALTH RESEARCH DATA
DAYCARE
The depth, range, and scope of data collected in
health is diverse and complex, so it cannot be
See Child Care, Daycare
considered in detail here. Research on fields as
diverse as biochemistry, psychology, genetics, and
sports physiology have usefully illuminated as-
DEAFNESS
pects of population health, but the problem of
central collection and collation and of making
See Hearing Disorders
valid generalizations reduces the usefulness of
most data from health-related research for the
purpose of delineating aspects of national health.
DEATH CERTIFICATES
UNOBTRUSIVE DATA SOURCES AND See Certification of Causes of Death
METHODS OF COLLECTION
Unobtrusive methods and indirect methods can DEATH RATES
be a rich source of information from which it
is sometimes possible to make important infer- See Mortality Rates
ences about the health of the population or sam-
ples thereof. Economic statistics such as sales of
tobacco and alcohol reveal national consumption DECENTRALIZATION AND
patterns; counting cigarette butts in school
COMMUNITY HEALTH
playgrounds under collected conditions is an un-
obtrusive way to get a very rough measure of
Decentralization is the process of redistributing
cigarette consumption by school children. Calls to
administrative authority, and sometimes resources,
the police to settle domestic disturbances provide
to local communities for planning, program man-
a rough measure of the prevalence of family vio-
agement, and evaluation. Since the early 1960s in
lence. Traffic crashes involving police reports
the United States and the mid-1970s in Canada,
and/or insurance claims reveal much about as-
there have been notable efforts to shift decision-
pects of risk-taking behavior, for example, the
making authority away from central governments
dangerous practice of using cell phones while
to the local level in the area of community health.
driving. These are among many examples of unob-
trusive data sources, offered merely to illustrate Decentralization of public health and health
the potential value of this approach. planning is intended to facilitate public parti-
cipation; provide greater local and personal con-
JOHN M. LAST trol over the determinants of health; and spur
cooperative, intersectoral action among coalitions
(SEE ALSO: Birth Certificates; Certification of Causes of stakeholders at the local level. Demands for
of Death; National Health Surveys; Record Linkage; less involvement of “big government” in local is-
Registries; Vital Statistics) sues and a desire for self-determination fueled
the decentralization movement. By bringing deci-
sion making closer to home and involving local
BIBLIOGRAPHY people, decentralized approaches were expected
Last, J. M. (1997). Public Health and Human Ecology, 2nd to result in more appropriate decisions about
edition. Stamford, CT: Appleton and Lange. public health and health planning within local
Slee, V. N.; Slee, D. A.; and Schmidt, H. J. (2000). The communities. Decentralization was also intended
Endangered Medical Record. St. Paul, MN: Tringa Press. to enhance democratic principles and community
309
DECENTRALIZATION AND COMMUNITY HEALTH
empowerment, and to boost local people’s auton- The issues of ownership and goals becomes
omy and capacity to take control over the determi- problematic when the central funding source re-
nants of their own health. quires a health-specific commitment, but the local
population wishes to focus on a different problem
By increasing the decision-making power of
that is not a priority for the central funding bodies.
local communities, decentralized public health and
For example, a community group may receive
health-planning systems place greater fiscal re-
funding from a research-oriented agency to exam-
sponsibility for health on local governments and
ine health issues related to cardiovascular disease,
agencies. In the United States and Canada, decen-
while the community’s priorities may be focused
tralization of responsibility was achieved while
on creating jobs and stimulating the local econ-
leaving intact most of the highly centralized na-
omy or dealing with a teenage drug problem.
tional, state, and provincial taxation and corpo-
rate-financing mechanisms. Since the establish- Similarly, locally funded organizations may
ment of block grants in the United States in the not have enough expertise to provide the moni-
mid-1980s and revenue sharing in Canada in the toring most central funding mechanisms require
early 1990s, federal control has declined in both for accountability. These circumstances typically
countries, resulting in less central control. The prompt a rush of technical assistance from central
amount of money available to transfer from fed- to local organizations, welcomed or not. Outside
eral to state or provincial coffers, however, did experts often do not know enough about local
not always match the devolution of responsibil- circumstances to be as helpful as their substantive
ity. Therefore, many local health initiatives col- expertise might make them in more familiar terri-
lapsed because the pressure of greater responsibil- tory, or they are held at arm’s length from intrud-
ity was combined with fewer resources for program ing on local prerogatives.
managers.
Will public health and health-planning sys-
Managing increased responsibility within the tems continue to pursue decentralized decision-
context of scarce resources was not the only prob- making? Economic recoveries in many countries
lem that arose from efforts to decentralize au- have renewed hopes at the local level for increased
thority in health matters. Local public health and revenue sharing to support public health and health-
health-planning goals often conflict with each other planning initiatives. Financial resources represent
and with the rights of individuals pursuing their one part of the solution, but it remains to be seen
own well-being and happiness. The social fabric of whether communities can develop sufficient ca-
many communities can be badly torn when lo- pacity to take control over the determinants of
cal people engage in a decision-making process their own health. To date, the evidence has been
where there can be only one winner. For exam- inconsistent regarding the effectiveness of local
ple, local communities across the United States planning initiatives in achieving health objectives
and Canada facing decisions about whether to at affordable costs.
close or maintain hospitals often experience bitter
and emotional debates that may generate a sense JEAN A. SHOVELLER
of disempowerment for many local groups and LAWRENCE W. GREEN
individuals.
(SEE ALSO: Citizens Advisory Boards; Coalitions,
Successful decentralization of public health
Consortia, and Partnerships; Community Health;
and health planning depends on the provision
Community Organization; Health Goals; Healthy
of adequate and appropriate assistance to local
Communities; Participation in Community Health
communities. Providing resources, including both
Planning; Regional Health Planning)
expertise and time, is a critical ingredient for
successfully decentralizing responsibility. Many
communities lack the local resources to resolve the BIBLIOGRAPHY
complex problems they face and have limited con-
Givel, S., and Glantz, S. A. (2000). “Tobacco Control
trol over outside influences. As a result, they have and Direct Democracy in Dade County, Florida:
become increasingly beholden to external sources Future Implications for Health Advocates.” Journal of
of support. Public Health Policy 21:268–295.
310
DEMENTIA
Green, L. W. (1986). “The Theory of Participation: A Families are also slow to recognize the condition
Qualitative Analysis of Its Expression in National and and sometimes deny that there is a problem. There
International Health Policies.” Advances in Health is a common false myth that aging is synonymous
Education and Promotion 1, Pt. A:211–236. with poor memory. Although aging results in mild
Green, L. W., and Shoveller, J. A. (2000). “Balancing slowing for some cognitive functions, normal ag-
Community and Centralized Control in Planning.” ing does not cause significant memory loss. In
In Fatal Consumption: The Failure of Sustainable Devel- many cases, the deterioration is progressive. How-
opment, eds. R. F. Woollard, A. Ostry, and M. Carr. ever, some dementias have reversible causes, and
Vancouver, BC: University of British Columbia Press. this possibility must be investigated thoroughly
Moynihan, D. (1969). Maximum Feasible Misunderstand- when the person comes for treatment. Physicians
ing. New York: Free Press. should regularly screen patients who are sixty-five
years and older for dementia.
O’Neill, M. (1998). “Community Participation in Que-
bec’s Health System: Strategy to Curtail Community Alzheimer’s disease is the most common type
Empowerment?” In Health and Canadian Society: Socio-
of dementia in North America and Europe (50–60
logical Perspectives, 3rd edition, ed. D. Coburn et al.
percent of dementias). It is characterized by slow
Toronto: University of Toronto Press.
onset and gradual impairment of recent memory.
Piette, D. (1990). “Community Participation in Formal Long-term memory usually remains more intact.
Decision Making.” Health Promotion International This impairment progresses until death. It is
5:187–197.
thought to be caused by the accumulation of cer-
tain proteins in the brain. It is not clear what
causes this condition to occur. Alzheimer’s disease
DEMENTIA is usually diagnosed clinically by cognitive testing
rather than using laboratory tests.
Dementia is a condition characterized by a chronic
Dementia may also be caused by problems
decline in cognitive functions contrasted with a
with the vascular system, such as cerebrovascular
person’s usual state of functioning. It is seen most
accident (stroke), hypertension, and atherosclerosis.
often in people sixty-five years and older, and the
This is thought to make up 15 to 20 percent of
incidence increases with age. Dementia occurs in a
dementias in North America and Europe. These
stable level of consciousness and sensorium, un-
disorders are characterized by abrupt onset of
like delirium. There are various causes and types
cognitive dysfunction that progressively worsens
of dementia, but they have certain characteristics
in a step-wise pattern as multiple strokes recur and
in common. Persons with dementia often have
damage to the brain accumulates.
problems with short-term memory, such as forget-
ting names and recent events. They may have There are many other causes of dementia,
trouble with visuospatial processing, such as get- including trauma, metabolic imbalances, heredi-
ting lost in familiar places. Language may be af- tary illness, drugs (e.g., alcohol), toxins, and infec-
fected, causing difficulty in finding the right word tions (e.g., HIV [human immunodeficiency virus],
to use in a sentence. The affected person may have syphilis). Some of these causes are reversible with
difficulty with activities of daily living, such as medical treatment. Unlike Alzheimer’s disease,
balancing the checkbook or forgetting to turn off these conditions usually have rapid onset and pro-
the stove when cooking. This condition may also gression. Whenever dementia is diagnosed, these
be accompanied by alterations in personality and reversible causes must be ruled out promptly.
behavior. Persons with dementia often become
Parkinson’s disease is a movement disorder
depressed, irritable, or have unreasonable fears.
characterized by tremor, slow unsteady gait, and
They may also say or do inappropriate things in
a mask-like face. Decreased levels of a chemical
social situations. Visual or auditory hallucinations
called dopamine in the brain cause this condi-
sometimes occur.
tion. Approximately 30 percent of persons with
The onset of dementia is usually insidious. Parkinson’s disease also have dementia. This
Recognition of the condition is often delayed due dementia is characterized by fluctuations in alert-
to lack of insight on the part of the affected person, ness and cognitive abilities. It is also associated
who often does not notice that anything is wrong. with visual hallucinations. It can be treated with
311