IGNOU BANS 184 Free Solved Assignment 2022
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BANS 184
PUBLIC HEALTH AND EPIDEMIOLOGY
Programme: BAG/2021/2022
Course Code: BANS 184
Max. Marks: 100
BANS 184
Free Solved Assignment
Answer all
questions in this assignment.
a. What is
Public Health? Briefly discuss its importance in the management of COVID 19
Rural communities are heterogeneous. In 2010, 19.3% of the
US population resided in rural areas, compared with 54.4% in 1910, with the
highest concentration being in the southeastern United States. The southeastern
region includes Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi,
North Carolina, South Carolina, and Texas, and racial and ethnic minorities
make up 19% of the entire rural population. Socioeconomic characteristics
influence the risk of infection with severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2). For example, in Mississippi, approximately 20% of
the population lives in poverty. In 2019, Mississippi, Louisiana, Arkansas, and
Alabama were ranked as the country’s least healthy states. This statistic is
important, because the less healthy the population, the more likely the
epidemic is to have fatal consequences. In addition, the weaker the health
system, the harder it is to contain the virus.
Most of the states that make up the southeastern United
States are rural. Rural communities face a unique set of challenges in the face
of the coronavirus disease 2019 (COVID-19) pandemic. They are often areas
already affected by high levels of poverty, lower levels of access to quality
health care, lower levels of health literacy, and social stigma. Many elements
contribute to these problems, including a declining population; economic
stagnation; shortages of physicians and other health care professionals; a
disproportionate number of older, poor, and underinsured residents; and high
rates of chronic illness. This commentary will describe the challenges and
issues faced by rural communities in addressing the COVID-19 pandemic. It will
also show how the COVID-19 Community Vulnerability Index (CCVI) may be used as
a tool to identify communities at highest risk for COVID-19 on the basis of 6
clearly defined indicators.
Challenges for Rural Communities
As the COVID-19 outbreak continues to place a burden on
hospitals throughout the United States, concern is growing that many hospitals,
in particular rural hospitals, may not have the financial reserves to remain
fiscally viable. Most rural hospitals operate on tight budgets, and they rely
on high-profit services, such as elective surgery, to keep them in business.
For many rural hospitals, canceling these profitable services to cope with the
COVID-19 pandemic may result in financial catastrophe
The closure of rural health care facilities or the
discontinuation of services can negatively affect access to health care in a
rural community. People in rural areas who get sick with COVID-19 have fewer
hospitals to treat them. Compared with urban hospitals, rural hospitals are
smaller, have a higher proportion of primary care physicians and a lower
proportion of board-certified physicians on their medical staffs, have fewer
intensive care beds, and are less likely to have contracts with health
maintenance organizations and preferred provider organizations.
People living in rural areas are at increased risk of
COVID-19, because they are less likely to be employed and more likely have low
incomes than people living in other areas. They also face significant barriers
to accessing care, including provider shortages, recent closures of rural
hospitals, and long travel distances to providers. Local rural health care
systems are fragile; when one facility closes or a provider leaves, it can
affect care and access to care throughout the community. Furthermore, when a
hospital closes, access to nonhospital care can also decline, because many
specialists cluster around hospitals. Rural hospitals face severe financial
challenges, and they are also more likely than urban hospitals to close. For
example, 15 of 21 hospitals that closed in the United States in 2016 were in
rural communities, and since 2010, nearly 90 rural hospitals in the United
States have closed. Another financial challenge to rural hospitals is shrinking
populations, which means fewer patients to fill beds. Although populations in
urban counties have increased since 2000, populations in half of rural counties
in the United States have decreased, which has caused a reduction in revenue
for rural hospitals. Most recent hospital closings have been in states that
opted not to expand Medicaid under the Affordable Care Act, which means that a
significant portion of their health care costs remain uncompensated, thus
creating a financial burden for these states.
b. Define
environmental health. Discuss the effects of Biological, Chemical and Physical
agents in water on human health.
Environmental Health is the branch of public health
concerned with all aspects of the natural and built environment affecting human
health. Environmental health focuses on the natural and built environments for
the benefit of human health. The major subdisciplines of environmental health
are: environmental science; environmental and occupational medicine, toxicology
and epidemiology.
Other terms referring to or concerning environmental health
are environmental public health, and health protection. Environmental health
was defined in a 1989 document by the World Health Organization (WHO) as: Those
aspects of the human health and disease that are determined by factors in the
environment. It also refers to the theory and practice of assessing and
controlling factors in the environment that can potentially affect health.
Environmental health as used by the WHO Regional Office for
Europe, includes both the direct pathological effects of chemicals, radiation
and some biological agents, and the effects (often indirect) on health and well
being of the broad physical, psychological, social and cultural environment,
which includes housing, urban development, land use and transport
As of 2016 the WHO website on environmental health states
"Environmental health addresses all the physical, chemical, and biological
factors external to a person, and all the related factors impacting behaviours.
It encompasses the assessment and control of those environmental factors that
can potentially affect health. It is targeted towards preventing disease and
creating health-supportive environments. This definition excludes behaviour not
related to environment, as well as behaviour related to the social and cultural
environment, as well as genetics. The WHO has also defined environmental health
services as "those services which implement environmental health policies
through monitoring and control activities. They also carry out that role by
promoting the improvement of environmental parameters and by encouraging the
use of environmentally friendly and healthy technologies and behaviors. They
also have a leading role in developing and suggesting new policy areas. The
term environmental medicine may be seen as a medical specialty, or branch of
the broader field of environmental health. Terminology is not fully
established, and in many European countries they are used interchangeably.
Children's environmental health is the academic discipline that studies how
environmental exposures in early life—chemical, nutritional, and
social—influence health and development in childhood and across the entire
human life span.
Information from epidemiology, toxicology, and exposure
science can be combined to conduct a risk assessment for specific chemicals,
mixtures of chemicals or other risk factors to determine whether an exposure
poses significant risk to human health (exposure would likely result in the
development of pollution-related diseases). This can in turn be used to develop
and implement environmental health policy that, for example, regulates chemical
emissions, or imposes standards for proper sanitation.[5][page needed] Actions
of engineering and law can be combined to provide risk management to minimize,
monitor, and otherwise manage the impact of exposure to protect human health to
achieve the objectives of environmental health policy.
Assignment
– II
Answer the
following in about 250 words each.
a. Give an
account of globalization and its impact on health.
Every year, the same ritual takes place at changing
locations in the Western world. While the heads of the eight leading
industrialized nations meet at their annual G8 summit to discuss the global
state of affairs, a wide variety of organizations and protesters meet in
parallel to decry what they see as the negative effects of globalization.
Notwith-standing these protests, whether one sees globalization as a tool to
overcome poverty, hunger and disease in the world or whether one feels
threatened by its consequences, one thing is certain: globalization is here to
stay. Often narrowly defined as the increasing integration of the world's
economies, globalization is in reality a powerful development that presents new
challenges at the beginning of this millennium. One major problem is the
increasing internationalization of health risks. How-ever defined, this term
has many dimensions, including economic, technological, political, social,
scientific and cultural aspects. The links between globalization and health are
complex and globalization is a multifaceted phenomenon that can affect health
in myriad ways. Its consequences can be either direct, at the level of whole
populations, individuals and healthcare delivery systems, or indirect, through
the economy and other factors, such as education, sanitation and water supply
(Woodward et al, 2001). Given the enormous complexity and breadth of the
issues, our article cannot hope to cover the entire range of topics that link
globalization to health. Instead, we focus on those risks to health and health
care that are related to central aspects of the globalization process, namely
trade, travel and exchange of information.
A major factor for the liberalization of international trade
has been the multilateral trade negotiations during the past 50 years, which
culminated in the establishment of the World Trade Organization (WTO). Although
increasing trade is certainly good for economies, it also leads to a
globalization of health risks. Important examples of such risks include
tobacco, alcohol, global epidemics of non-communicable diseases and trade in
health services.
b. Briefly
discuss the role of Non-Governmental Organisations (NGO’s) in health sector of
India.
Apart from the federal (central) and state governments,
there are other stakeholders who are working in improving the health status of
people. Non-Governmental Organisations play an important role in reaching out
to the most underprivileged sections of the society. NGOs have long history of
active involvement in the promotion of human well-being. In particular, NGOs
provide important links between the community and government. They possess
certain strengths and characteristics that enable them to function as effective
and dynamic agents in this process. Their programmes ranging from research to
community-basedprojects cover the wide spectrum of human concerns and often
pioneer in the fields of health and developments..
i) Understanding of NGOs
Non-Governmental
organisations are called by various names across the world, such as third
sector organisations, non-profit organisation, voluntary organisation,
charitable organisation and community-based organisation. In India, they are
often called as not-for-profit institutions and officially defined as an
organisation that are – a) not-for-profit and ; b) by law or custom do not
distribute any surplus they may generate to those who own or control them; c)
are institutionally separate from the government; d) are self governing; e) are
non-compulsory in nature. NGOs generate funds from foreign funds, government
grants, corporate social responsibility funds, NGOs own fund generating
resources and other philanthropic/ individual charitable donations. Though the
nature and focus of activities has changed over the time, NGOs have gained
prominence in the wide spectrum of social life including health care. The World
Health Organisation has acknowledged NGOs in terms of increasing recognition to
complement government programmes and creating effective people’s voice in
respect of health service requirements and expectations.
ii)
Functions of NGOs in the Health System
The primary focus of NGOs in the health sector can be listed
as follows:
· Establishing health care institutions;
· Fulfilling health and social needs of groups like women,
elderly and vulnerable local communities;
· Dealing with specific health issues such as AIDS,
alcoholism;
· Promoting Health Rights;
· Performing preventive health programmes; and
· Managing health finance/ funding and administration.
Some NGOs operate internationally and are concerned with
global health issues. Some NGOs in India also play an important role in
providing health care at the time of emergencies/ natural disasters.
iii) The
Health Activities of NGOs in India
NGO run hospitals are heterogeneous and vary in terms of
ownership, financing and costs. In recent past, in about ten health–oriented
projects of Ministry of Health and Family Welfare, NGOs have actively taken
part as health service providers. All these NGO schemes are now under the
provision of flexi pools of National Health Mission. Besides, some NGOs
(especially the national counter parts of International NGOs) have their own
health financing schemes. In India, majority of these NGOs are covered under
the Societies Registration Act or Indian Trusts Act. In addition, there are
number of informal associations working at grassroots level without being
registered in the legal level. The study by das and Kumar (PHFI, 2016) shows
that one per hundred organisation primarily or subsidiarity is involved in
health activities has a hospital. An overwhelming number of NGOs about 84% are
found in outreach activities. The outreach activities are the main health
activity in which generating awareness to targeted population is the major
subcomponent of outreach for Indian NGOS.
Related Link:
MHI 01 Solved Assignment 2022-23
c. What is
epidemiology? Discuss randomized studies.
Randomized trials are epidemiological studies in which a
direct comparison is made between two or more treatment groups, one of which
serves as a control for the other. Study subjects are randomly allocated into
the differing treatment groups, and all groups are followed over time to
observe the effect of the different treatments. The control group may either be
untreated (placebocontrolled) or undergo a “gold standard” established regimen
against which the new regimen will be assessed (activecontrolled). Randomized
trials provide the most direct evidence for causality. However, they are also
fraught with a number of additional considerations not present for
observational research. For example, unless researchers are genuinely uncertain
about the potential harms or benefits of a treatment, it is unethical to assign
it to one group of people while withholding it from others (equipoise). This
limits the types of questions that can be answered using experimental studies.
A placebo-controlled randomized trial might compare the effect of vitamin E
supplement in one group of schizophrenia patients (the treatment group) against
the effects of a placebo on a separate group of schizophrenia patients (the
control group). An active-controlled randomized trial might compare diabetic
patients with implanted insulin pumps against diabetic patients who receive
multiple insulin injections (the control group). Randomization avoids bias by
eliminating baseline differences in risk between treatment and control groups.
Randomization, if done properly, should make both groups similar in terms of
the distribution of risk factors, regardless of whether these risk factors are
known or unknown (thus eliminating confounding due to both measured and
unmeasured variables). The larger the randomized groups, the greater the
probability of equal baseline risks. However, participants in RCTs are often
not representative of the target population, which introduces selection bias
and limits generalizability.
Answer the
following in about 150 words each.
a. Gender
and Health
Gender refers to the characteristics of women, men, girls
and boys that are socially constructed. This includes norms, behaviours and
roles associated with being a woman, man, girl or boy, as well as relationships
with each other. As a social construct, gender varies from society to society
and can change over time. Gender is hierarchical and produces inequalities that
intersect with other social and economic inequalities. Gender-based
discrimination intersects with other factors of discrimination, such as
ethnicity, socioeconomic status, disability, age, geographic location, gender
identity and sexual orientation, among others. This is referred to as
intersectionality. Gender interacts with but is different from sex, which
refers to the different biological and physiological characteristics of
females, males and intersex persons, such as chromosomes, hormones and
reproductive organs. Gender and sex are related to but different from gender
identity. Gender identity refers to a person’s deeply felt, internal and
individual experience of gender, which may or may not correspond to the
person’s physiology or designated sex at birth. Gender influences people’s
experience of and access to healthcare. The way that health services are
organized and provided can either limit or enable a person’s access to
healthcare information, support and services, and the outcome of those
encounters. Health services should be affordable, accessible and acceptable to
all, and they should be provided with quality, equity and dignity.
b.
Vaccination
Vaccination is the administration of a vaccine to help the
immune system develop protection from a disease. Vaccines contain a
microorganism or virus in a weakened, live or killed state, or proteins or
toxins from the organism. In stimulating the body's adaptive immunity, they
help prevent sickness from an infectious disease. When a sufficiently large
percentage of a population has been vaccinated, herd immunity results. Herd
immunity protects those who may be immunocompromised and cannot get a vaccine
because even a weakened version would harm them. The effectiveness of
vaccination has been widely studied and verified. Vaccination is the most
effective method of preventing infectious diseases; widespread immunity due to
vaccination is largely responsible for the worldwide eradication of smallpox
and the elimination of diseases such as polio and tetanus from much of the
world. However, some diseases, such as measles outbreaks in America, have seen
rising cases due to relatively low vaccination rates in the 2010s — attributed,
in part, to vaccine hesitancy.
c. Random
sampling
Random sampling is a part of the sampling technique in which
each sample has an equal probability of being chosen. A sample chosen randomly
is meant to be an unbiased representation of the total population. If for some
reasons, the sample does not represent the population, the variation is called
a sampling error. Random sampling is one of the simplest forms of collecting
data from the total population. Under random sampling, each member of the
subset carries an equal opportunity of being chosen as a part of the sampling
process. For example, the total workforce in organisations is 300 and to
conduct a survey, a sample group of 30 employees is selected to do the survey.
In this case, the population is the total number of employees in the company
and the sample group of 30 employees is the sample. Each member of the
workforce has an equal opportunity of being chosen because all the employees
which were chosen to be part of the survey were selected randomly. But, there
is always a possibility that the group or the sample does not represent the
population as a whole, in that case, any random variation is termed as a
sampling error.
d. Chronic
diseases
Chronic diseases/Non-communicable diseases are currently the
major cause of death among adults in almost all countries and the toll is
projected to increase by a further 17% in the next 10 years. Globally, approximately
one in three of all adults suffer from multiple chronic conditions. Six in ten
adults in the US have a chronic disease and four in ten adults have two or
more. It has been calculated that, of the 58 million deaths in 2005,
approximately 35 million will be as a result of chronic diseases. Health
damaging behaviours - particularly tobacco use, lack of physical activity, and
poor eating habits, excessive alcohol use - are major contributors to the
leading chronic diseases. The leading chronic diseases in developed countries
include (in alphabetical order) arthritis, cardiovascular disease eg.heart
attacks and stroke, cancer eg breast and colon cancer, diabetes, epilepsy and
seizures, obesity, and oral health problems. Each of these conditions plagues
older adults. This rise in Chronic diseases (CDs) is a very serious situation,
both for public health and for the societies and economies affected. Until recently,
the impact and profile of chronic diseases have generally been insufficiently
appreciated.
e.
Chi-square (X2 ) test
The statistical procedures that we have reviewed thus far
are appropriate only for numerical variables. The chi‐square (χ 2) test can be
used to evaluate a relationship between two categorical variables. It is one
example of a nonparametric test. Nonparametric tests are used when assumptions
about normal distribution in the population cannot be met. These tests are less
powerful than parametric tests. You would like to know if the choice of
favorite commercial was related to whether the child was a boy or a girl or if
these two variables are independent. The totals in the margins will allow you
to determine the overall probability of (1) liking commercial A, B, or C,
regardless of gender, and (2) being either a boy or a girl, regardless of
favorite commercial. If the two variables are independent, then you should be
able to use these probabilities to predict approximately how many children
should be in each cell. If the actual count is very different from the count
that you would expect if the probabilities are independent, the two variables
must be related.
f. SPSS
SPSS Statistics is a software package used for interactive,
or batched, statistical analysis. Long produced by SPSS Inc., it was acquired
by IBM in 2009. Current versions (post 2015) have the brand name: IBM SPSS
Statistics. The software name originally stood for Statistical Package for the
Social Sciences (SPSS), reflecting the original market, then later changed to
Statistical Product and Service Solutions. SPSS is a widely used program for
statistical analysis in social science. It is also used by market researchers,
health researchers, survey companies, government, education researchers,
marketing organizations, data miners, and others. The original SPSS manual
(Nie, Bent & Hull, 1970) has been described as one of "sociology's
most influential books" for allowing ordinary researchers to do their own
statistical analysis. In addition to statistical analysis, data management
(case selection, file reshaping, creating derived data) and data documentation
(a metadata dictionary is stored in the datafile) are features of the base
software.
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