Assignment Code: BANS-184/ASST/TMA/2022-23

Course Code: BANS-184

Assignment Name: Public Health and Epidemiology

Year: 2022-2023

Verification Status: Verified by Professor

Total Marks: 100

There are two Sections in the Assignment. You have to answer all questions in all the Sections.

Assignment – I

Answer the following in about 500 words each. 20X2= 40

a. What is Epidemiology? Briefly examine various categories of Observational studies.

Ans) Epidemiology is the method used to find the causes of health outcomes and diseases in populations. In epidemiology, the patient is the community and individuals are viewed collectively. By definition, epidemiology is the study (scientific, systematic, and data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (neighbourhood, school, city, state, country, global). It is also the application of this study to the control of health problems.

Descriptive Studies

Case Reports

Case reports describe incidents of unusual symptoms, signs, or deaths that occurred during clinical practise and include the clinician's presentations that can be used to define newly discovered clinical diseases or entities. These case reports are helpful for developing hypotheses in clinical practise and for investigating in epidemiological studies. Consider a patient with renal failure who has coagulopathy.

Case Series

Case series are new clinical entities, new cases, or new deaths that share similar traits, symptoms, or signs and are compiled by a single clinician or group of clinicians. They are helpful for defining new cases, for understanding the range of symptoms and signs, and when patients are followed until their deaths, they are helpful for examining the natural history of disease. In cases of sudden deaths within a specific geographic area, the data are typically gathered from clinicians and occasionally from populations. The distribution of disease by location, time, socioeconomic status, religion, and ethnicity can be determined using data from case series.

Analytical Studies

Ecological Studies

This kind of research examines the relationship between the frequency of a disease or outcome and the degree of exposure in groups within or between populations. In this type of study, the population, not the individual, serves as the unit. Grouping can be done based on socioeconomic status, time, place (birthplace, residence, factory, or school), or a combination of place and time. Ecological research is used to develop hypotheses.

Case-control Studies

These studies look into the causes of disease, are appropriate for studying uncommon and long-lasting (chronic) diseases, are affordable, require fewer subjects, are simple to conduct, don't expose subjects to risk, don't show any sign of subject dropout, have few ethical issues, and can be finished quickly. The individual is the study's unit. Newly diagnosed cases are contrasted with healthy subjects. By reviewing case sheets, speaking with patients, patients' relatives, or controls, or by running biochemical tests, it is possible to determine how exposed both cases and controls were to potential risk factors.

Cross-sectional Studies

These studies look at exposure and the result (disease) simultaneously. There are no discernible temporal relationships between exposure (risk factors) and results. Individuals make up the study's unit. These studies are helpful for examining chronic illnesses and fixed exposures like age, gender, ethnicity, and genotype, as well as for concurrently examining many risk factors.

Cohort Studies

Longitudinal incidence studies are what these studies are known as. Cohort refers to a population group. Birth cohorts, marriage cohorts, decade cohorts, occupation cohorts (doctors, lawyers, engineers, teachers), city populations (such as Delhi), etc. can all be used to create groups. Cohort subjects share similar traits, circumstances, and conditions. A group is chosen for the study, and within that group, exposed and non-exposed cohorts are found and monitored for a specific amount of time. This cohort is compared to an external cohort that matches all characteristics except exposure if exposure is uncommon. Depending on the exposure level and outcome, different subgroups of the same cohort can be created. At the start of the study, the diagnostic criteria for the desired outcome are chosen.

b. Briefly discuss the core disciplines of Public Health.

Ans) The biological, physical, and mental health of every member of society is the aim of public health. Public health professionals need to have a broad range of disciplinary understanding to accomplish this broad and difficult goal. To anticipate, identify, and prevent problems, to identify solutions to these problems, to put these solutions into practise, and then to assess the efficacy of those solutions, it is necessary to have a multidisciplinary understanding. It's important to keep in mind that the concept of public health requires a multidisciplinary approach.

To address the issues and problems at the population level, which are multifactorial, multidimensional, and multifaceted, a multidisciplinary team effort is required. The practise of public health involves many different professional disciplines. It also calls for expertise in the physical and social sciences. Therefore, a wide range of academic specialties are represented in the scientific knowledge that underpins public health. Below are specifics on the fundamental fields of public health:

Epidemiology

It is the examination of the prevalence, distribution, and causes of health-related conditions or occurrences in particular populations, with the goal of using the results of this investigation to manage health issues. Researchers in the field of epidemiology look at the 5 Ws: diagnosis or health event (what), person (who), place (where), time (when), and causes, risk factors, and modes of transmission (why/how).

Nutrition

It deals with the science of food, including its nutrients and other ingredients, as well as how those elements act, interact, and balance in relation to health and disease. The study of behaviour and social factors as they relate to dietary decisions is also included in nutrition science.

Environmental Health

Public health's fundamental field heavily utilises the natural sciences. Environmental health specialists keep an eye on pollution levels and research the effects of the environment on human health.

Health Education

Through education-driven voluntary behaviour change initiatives, health education promotes health and prevents disease, disability, and premature death. It does this by drawing from the biological, environmental, psychological, physical, and medical sciences. Health education is any set of educational activities intended to help people and communities live healthier lives by enhancing their knowledge or modifying their attitudes.

Behavioural Science

It is a field of science that focuses on human action and frequently makes generalisations about how people behave in society (like psychology, sociology, or anthropology). Public health professionals influence people to make healthy decisions by using their knowledge of human interaction, decision-making, and group processes. Health education and behavioural sciences are closely related, both in theory and in practise.

Health Services Administration/Management

This discipline is all about encouraging people to collaborate effectively and use resources wisely in order to accomplish goals. Planning, leading, and coordinating medical and health services are all part of the health services administration process. Health service managers are in charge of the business of providing healthcare.

Biostatistics

It is the application of statistics to issues in biology and medicine. When tackling issues that affect a larger population, statistical methodologies are among the most crucial tools used by researchers across all disciplines.

Health Economics Public Health

It is focused on the efficient use of economic resources like human, material, and financial resources as well as alternative uses of resources in the health services sector.

Demography

It is the study of populations, particularly their size and density, as well as their growth, age distribution, migration, and interactions with societal and economic factors.

Assignment – II

Answer the following in about 250 words each. 10X3=30

a. National Health Programmes in India.

Ans) To improve people's health, the federal (central) government has taken a number of actions. The National Health Programs stand out among these measures. Numerous international organisations, including the WHO, UNICEF, UNFPA, etc., are also offering material and technical support for the implementation of these programmes. The primary healthcare system in India is its foundation, particularly in rural areas. At the village level, it consists of trained Dais, Anganwadi, and Village Health Guides (From Integrated Child Development Scheme). The Primary Health Care Centers and the Sub-Centers support, oversee, and coordinate this.

National Health Programs are vertical programmes that the federal (central) government plans, develops, implements, and funds to fight specific diseases like leprosy and malaria, among others. In the sections that follow, we will examine these national programmes in greater detail. Since gaining its independence, India has developed and implemented a number of national health programmes that have significantly improved the nation's health status.

The following characteristics are shared by all national programmes:

1. focusing on one illness Typically, a national health programme is designed to focus on a single disease. For instance, the National Malaria Programme concentrated only on the disease.

2. Vertical in nature, each national programme has its own staff, funding, research institutions, etc., and is typically not integrated with the general health system. However, almost all national programmes are integrated with the overall national health services under the National Health Mission (NHM) umbrella.

3. Through surveillance mechanisms, the effects of national health programmes are constantly monitored. This is done to assess the effect on the burden of disease.

4. They concentrate on both curative and preventive aspects. Both curative and preventive components will be included in the programme.

b. Discuss the role played by Government of India in the management of COVID- 19

Ans) Thermal screenings of travellers arriving from China, the country from which the coronavirus disease 2019 originated, as well as travellers arriving from other countries, were among the first responses of the Indian government to the COVID-19 pandemic in the nation. The Indian government recommended social isolation measures and implemented travel and entry restrictions as the pandemic spread across the globe. A number of shutdowns and business closures were started throughout March 2020, and by the end of the month, the Indian government had imposed a general lockdown. In May 2020, a financial package was announced.

The COVID-19 pandemic, which has affected the majority of countries worldwide across continents, has had a negative impact on the global macroeconomic outlook for the current financial year 2020–21. The pandemic has disrupted global trade, supply chains, and production, casting a shadow over many economic activities. The spread of COVID-19 in India and its mitigation plan, which includes a 40-day nationwide lockdown from 25 March to 3 May 2020 and the potential for further lockdown extensions by several State Governments, are likely to have a significant impact on a number of economic sectors.

By releasing notifications, amendments, and circulars outlining steps to improve the business environment in India, the Indian government has been preparing strategies and action plans to address these challenging times. These plans include those for business continuity and sectoral revival. The central government, Reserve Bank of India, Securities & Exchange Board of India (SEBI), Insurance Regulatory and Development Authority (IRDAI), and sectoral ministries have taken a number of special measures to encourage business in India, some of which are listed below. Thermal screenings of travellers arriving from China, the country from which the coronavirus disease 2019 originated, as well as travellers arriving from other countries, were among the first responses of the Indian government to the COVID-19 pandemic in the nation.

c. Discuss the impact of Globalisation on Human Health.

Ans) Although the concept of globalisation is not new, the term is. In the west, it rose to popularity in the 1970s. It continued to pick up steam in various parts of the world during the 1980s and 1990s. It deals with how people conduct business, communicate with one another, and cross international borders. It improved interconnectedness while also increasing interdependence.

Furthermore, it is crucial to realise that globalisation encompasses more than just the movement of people or the exchange of goods. It also concerns the discussion of ideas. Nowadays, ideas are spreading globally at a much faster rate. Additionally, it indicates that people are creating universal values.

We can state that there have been significant improvements in life expectancy over the past century and that good health for all populations has become an accepted international goal. However, there are still disparities in health between the rich and the poor, and future health prospects are becoming more and more dependent on the relatively recent processes of globalisation.

In the past, globalisation was frequently considered to be primarily an economic process. It is now seen as a more all-encompassing phenomenon that is influenced by numerous factors and events that are rapidly changing our society. The conceptual framework for the impacts of globalisation on population health is described in this essay. The framework serves as a "think-model" and a foundation for the creation of future health-related scenarios.

Many academics and activists, including labour unions, believe that globalisation is a movement against democracy that will weaken the nation-state in favour of the superpowers. No matter how it is defined, there is no denying that globalisation is a fact of life today and is having a significant impact on the world.

Answer the following in about 150 words each. 5X6=30

a. Epidemic and Pandemic

Ans)

Epidemic:

The term "epidemic" refers to the process of an infectious disease rapidly spreading over a large population in a short amount of time and spreading to multiple countries or continents. Epidemic, which means upon or above people, is derived from a Greek word. Some common examples of epidemics include the bubonic plague, cholera, influenza, and smallpox.

Pandemic:

A pandemic is the rapid global spread of a new disease. a pandemic is an epidemic that is more severe. In other words, a pandemic is what happens when an epidemic spirals out of control. If an epidemic affects numerous nations and crosses continents, it is likely to be a pandemic. Pandemics can take many different forms. HIV or AIDS serves as a prime illustration of one of the worst global pandemics in recorded history.

The primary cause of epidemics and pandemics are pathogenic or harmful microorganisms like bacteria, viruses, and other parasites that can spread from person to person either directly or indirectly through the air, water, or other modes of transmission.

b. Infectious Diseases

Ans)

Retrospective Cohort Study

This type of research design is beneficial for studying the outbreak with a small sample size. Contact is made with members of the defined population to learn more about their exposure to sources and vehicles and to assess their likelihood of contracting the disease under investigation. Calculations are made for both attributable and relative risk. Test the relationship between exposure and disease by comparing the attack rate in the exposed group to the unexposed group using relative risk.

Case-control Study

This study design is the best option for a quick investigation of an outbreak. Comparisons between patients and healthy controls are made, and inquiries into exposure are made of both groups. Exposure is thought to be linked to disease if it is higher in patients than in controls. The controls should be a cross-section of the population; they could be patients from the same hospital, friends of the patients, or neighbours.

c. Random sampling

Ans) By using a random or lottery-style mechanism, the population members (units) in this method are added to the sample. It eliminates personal bias when choosing study participants. It is the best method for coming to objective conclusions. The following techniques for random sampling are available.

Simple Random Sampling

With this approach, each unit of the population will have an equal chance of being chosen for the sample. It is applicable in situations where the population is uniform in terms of age, gender, body mass, education level, and other characteristics.

Stratified Random Sampling

This approach is used when the population units are heterogeneous, such as when there are differences in socioeconomic status, level of education, and place of residence, among other factors. Every group is referred to as a stratum, and sampling must include every stratum (pleural of stratum) in order to prevent over representation of a few groups.

Systematic Sampling

This approach is used when the population units are already arranged in a sequential manner, such as the residential buildings in a colony that are numbered 1, 2, 3, 100. An individual is chosen at random to begin a systematic sampling, which then chooses a fixed number of houses in succession.

d. Environmental Health

Ans) Let's try to comprehend the idea of environmental health now that we have independently learned the two terms. The WHO stated that it "constitutes those aspects of human health and disease that are determined by factors in the environment" in 1989. It also refers to the theory and practise of identifying and minimising environmental elements that might negatively affect health.

A meeting of WHO European member states in 1993 resulted in a more recent attempt to define the term. They offered the following definition of environmental health: "Environmental health comprises those aspects of human health, including quality of life, which are determined by physical, biological, social, and psycho-social factors in the environment. Assessing, resolving, and preventing environmental factors that may have a negative impact on the health of current and future generations are also included in this definition.

It is believed that policymakers should work to enhance environmental health in order to achieve the Sustainable Development Goals. This can be done on three different levels: to fix past harm, to reduce present risk, and to stop future issues.

e. χ² test

Ans) Chi-squared (χ2) Test is a technique used in probability & statistics to check if the results of χ²-distribution is statistically significant under null hypothesis. χ²-distribution is a collection of data which is not uniformly distributed over the period of time. Chi-squared test requires χ²-statistic χ²0 & critical (table) value of χ²-distribution χ²e at a stated level of significance (α = 1%, 2%, 3%, 4%, 5%, 10%, 25%, 5% etc or α = 0.01, 0.02, 0.03, 0.04, 0.05, 0.1, 0.25, 0.5 etc) for the test of hypothesis (H0) in statistics & probability surveys or experiments to analyse samples which is not distributed uniformly or normally. Critical value of χ2 from χ2-distribution table represents the rejection area of distribution.

The estimated value of χ² or chi-squared statistic (χ²0) is compared with the critical value from χ²-distribution p-value table at a stated level of significance to check if the test of null hypothesis accepted in statistical experiments. Users may use this below χ²-test calculator to estimate χ²-statistic (χ²0), critical value (χ²e) & hypothesis test (H0) to test the significance between two or more samples which are not normally or uniformly distributed over time.

f. Gender and Health

Ans) Men and women's socially and culturally defined roles and responsibilities are referred to as gender. Through socialisation in various social institutions, gender roles are learned. Gender inequality is the practise of discriminating against individuals based on their sex when it comes to opportunities for the distribution of resources, benefits, or access to services. Gender equality is the absence of discrimination in opportunities, in the distribution of resources or benefits, or in access to services based on a person's sex.

Women-specific projects and programmes are frequently needed to address existing inequities in order to achieve gender equity, which is defined as fairness and justice in the distribution of rights and obligations between men and women. According to men, women consistently fall short in many societies in obtaining or exercising certain fundamental human rights.

The mortality, morbidity, and disability rates are frequently impacted by the health status of women and issues related to that status. Limited sexual and reproductive autonomy: According to Indian tradition, women are not allowed to make decisions about when to get married, how many children to have, how many years to wait between children, etc. These situations almost never involve women in decision-making, which has a significant negative impact on women's bodies and minds.