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FPH exam > 4a concepts of health and illness > Flashcards

4a concepts of health and illness Flashcards

1
Q

What are the 4 social sciences

A
  1. Psychology (Study of individual mental processes and behaviours)
  2. Sociology (study of social processes and interactions in societies, groups and institutions)
  3. Anthropology (study of cultures)
  4. History (study of past events)
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1
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A
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2
Q

what do the social sciences seek to understand

A

The social sciences seek to understand the attitudes, motivations and behaviours of human social behaviour and why these change over time

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3
Q

Why are the social sciences relevant to public health?

A

The social sciences can help explain:
- behaviour of individuals
- behaviour of groups within a population
- behaviour of healthcare organisations

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4
Q

Terminology in social sciences: what is epistemology and describe the epistemological spectrum

A
  • epistemology is the study of knowledge. How we know things
    -Contructivism and positivism are at opposite ends of the epistemological spectrum

CONSTRUCTIVISM
- there is not one knowable truth. Our understanding of the world is constructed by reflecting our own experiences

POSITIVISM
- there is one true reality and we can study that reality objectively

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5
Q

Terminology in social sciences: Theoretical perspective

A
  • the philosophical stance that guides the research design and methodology
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6
Q

Terminology in social sciences: methodology

A
  • the strategy behind the choice of methods to answer the study question
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7
Q

Terminology in social sciences: Ontology

A
  • the study of the nature of existence and being. Ontology considers whether facts are constructed in people’s minds of whether they exist in the real world
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8
Q

Terminology in social sciences: Reflexivity

A
  • this acknowledges that the process of observation effects the environment under study

Reflexivity is explicitly considered in research that takes a constructivist approach

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9
Q

What are the 3 major theoretical perspectives in sociology

A
  1. Structural functionalism
  2. Social conflict
  3. Interpretivism
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10
Q

Theoretical perspectives in sociology: structural functionalism

A
  • views society as an objective reality
  • society is a complex system whose parts work together to promote stability
  • closely linked to the positivist epistemology
  • Positivists believe the social world can be studied in the same way as the material world- hypothesis can be tested according to observable facts
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11
Q

Theoretical perspectives in sociology: Social conflict

A

-individuals within a society interact on the basis of conflict rather than consensus
- competition for resources and material production for wealth is the major goal for society
- the result is industrialisation and establishment of different social classes
- groups attain differing amounts of material and non-material resources and more powerful groups will tend to use their power to retain power and exploit groups with less power

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12
Q

Theoretical perspectives in sociology: interpretivist

A
  • this perspective focuses in individual or small scale social interactions and how this influences the way that people interpret society subjectively
  • labelling is an important aspect of this perspective
  • eg a persons identity may be influenced by a label such as a diagnosis
  • a related epistemological stance is constructivism
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13
Q

methods of studying human behaviour: Quantitative

A
  • surveys
  • questionnaires
  • routine data sources
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14
Q

methods of studying human behaviour: Qualitative

A
  • interviews
  • focus groups
    -ethnography (participant or non-participant observation)
  • case studies (multiple data collection methods to generate a picture of a bounded system (bounded by time and activity ie a GP surgery implementing a new system), can include qualitative and quantitative data.)
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15
Q

Define sickness

A
  • term that covers both illness and disease
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16
Q

Define illness

A
  • a persons subjective experience of mental or physical sensations or states
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17
Q

Define disease

A
  • abnormality in form or function of an organ or body system that clinicians diagnose and treat
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18
Q

What is the ‘sick role’ and who first conceptualised the model

A
  • because illness is itself a social role there is a notion that people who feel ill and those who care for them will behave in ways that are related to society’s implicit idea about what it means to be sick
  • parsons described this as ‘the sick role’
  • people who are ill have certain rights and responsibilities that work together in the interest of society
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19
Q

What are the rights and responsibilities of the sick role?

A
  • these rights are all universal but all temporary

RIGHTS
-exemption from blame for being sick
- to be exempt for normal duties ie work

RESPONSIBILTIES
- to seek medical attention
-to want to get better

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20
Q

what are the strengths and weaknesses of the sick role model?

A

STRENGTHS
- applies well to acute infections (ie flu)

WEAKNESSES
Applies less well to diseases where:
- lifestyle choices have played a part in disease development (ie obesity, STIs)
- medical attention is not seen as helpful or necessary (ie cold/ D+V)
- exemption from normal duties (ie work) is not necessary (ie well controlled diabetes)
- people don’t see a need to ‘get better’ ie obesity

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21
Q

Doctor- patient relationship: give an example of when a doctor may face conflict between a patient’s best interest and society’s best interest

A

ie if a lorry driver was having black outs and didn’t want to stop driving as livelihood

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22
Q

Doctor- patient relationship: Describe features of doctor centred care (nomenclature, decision making, patients role, written communication, consultation style)

A

NOMENCLATURE
patient

DECISION MAKING RESPONSIBILTY
doctor-led

PATIENT’S ROLE
passive recipient of care

WRITTEN COMMUNICATION
notes and correspondence are not shared with the patient

CONSULTATION STYLE
active (doctor)/ passive (patient)

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23
Q

Doctor- patient relationship: Describe features of patient centred care (nomenclature, decision making, patients role, written communication, consultation style)

A

NOMENCLATURE
patient, expert, consumer

DECISION MAKING RESPONSIBILTY
shared

PATIENT’S ROLE
self care, active monitoring of disease, source of expertise

WRITTEN COMMUNICATION
Notes freely available to patient and letters CC’d to patient

CONSULTATION STYLE
listening, reflecting, probing, silence, facilitating, interpreting

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24
Q

What is the WHO 1948 definition of health

A

’ a state of complete physical, mental and social wellbeing, not merely an absence of disease or infirmity’

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25
Q

what are the strengths and weakness of the WHO 1948 definition of health

A

STRENGTHS
1. explicitly links health and wellbeing
2. simple, widespread appeal across cultures
3. influential in shaping health policy beyond disease
4. conceptualisations health as a human right that requires physical and social resources

WEAKNESSES
1. not objective or measurable
2. leaves most of us as ‘unhealthy’ most of the time
3. contributes to the medicalisation of society

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26
Q

what is Canguilhem’s definition of health 1943

A

’ the ability to adapt to one’s environment’

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27
Q

What are the strengths and weaknesses of Canguilhem’s definition of health

A

STRENGTHS
1. Allows people to determine their own health needs
2. more appropriate for the current public health burden of chronic disease

WEAKNESSESS
1. very individualistic, ignores the socio-political environment in which people are embed
- little scope to promote health as a human right

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28
Q

How do different people define wellbeing

A
  • the well being institute

’ positive sustainable characteristics which enable individuals and organisations to thrive and flourish’

  • others argue that wellbeing is a social and cultural construct
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29
Q

what is deviance and who first described it

A
  • first described by becker
  • behaviour that is seen as being unacceptable within a particular culture
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30
Q

how is deviance linked to labelling theory

A
  • people who deviate form the normal are labelled as being abnormal on some way
  • what is unacceptable in one culture might be normal in the next
  • on being recognised as deviant behaviour might be subject to:
    1. punishment
    2. sanctions
    3. correction
    4. treatment
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31
Q

how is deviance linked to the sick role and who linked the two?

A
  • Parsons
  • Considered illness as a form of deviance where the doctor is the agent of social control (ie the doctor restricts access to the sick role by labelling people as either sick or healthy)

ie with the use of illicit drugs, this deviant behaviour can either be punished through criminal justice and detention or through drug rehabilitation requirements. These explicitly link the deviant behaviour to the sick role and requirement s to undergo treatment

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32
Q

Who described primary and secondary deviance

A
  • Lemert
33
Q

What is primary deviance

A
  • this is the deviant BEHAVIOUR before labelling has occurred
  • by itself the behaviour may only have minor implications for the individual
34
Q

what is secondary deviance?

A

Secondary deviance relates to the individual’s STATUS once they have been publicly labelled as deviant ie schizophrenic
- the label may become a self fulfilling prophercy and reinforce the deviant behaviour
Can have greater impact on the individual beyond the inital deviant behaviour in terms of self identity, self esteem and social role

Ie schixophrenia

35
Q

What is stigma and why does it occur

A
  • stigma is a mark of disgrace or infamy
  • it is an undesirable characteristic in a particular context
  • importantly what is undesirable in one culture may be normal in another
  • stigmatisation occurs as a consequence of labelling (secondary deviance)
    ie a disease label can lead to society treating a person differently (ie schizophrenic)
    Often driven by inequalities eg marginalised groups such as transgender people, fear and misinformation
36
Q

What causes stigma/ what 3 things does stigma thrive on?

A
  • stigma is rooted in cultural norms
    -Stigma thrives on:
    1. Inequalities (ie marginalised groups are often subject to stigma ie LBQT+)
    2. Fear (fear of having to deal with an epileptic fit)
    3. Misinformation (ie misconception that schizophrenic means ‘dual personality’)
37
Q

In what 2 ways can sitgma be manifested and what does each term mean?

A

FELT STIGMA (refers to the shame/expectation of discrimination)
1. shame and guilt
2. self-stigmatisation
3. depression
4. unwillingness to speak up
5. withdrawal from society

ENACTED STIGMA (refers to the experience of unfair treatment by others)
1. loss of job
2. violence
3. abuse
4. Quarantine
5. refusal of health services

38
Q

Tackling stigma: what is the virtuous cirlce

A
  • the virtuous circle can be established where positive attitudes can lead to reduced felt stigma, which in turn can lead to reduced enacted stigma
  1. stigmatised group –>
  2. Reduced felt stigma –>
  3. Reduced enacted stigma –>
    Stigmatised group
39
Q

Tackling stigma: strategies to tackle stigma

A

PELTEL

  1. PUBLIC ACKNOWLEDGEMENT OF DIAGNOSIS
    - ie celebrities acknowledging illness
  2. EDUCATION
    - challenging native stereotypes and raising illness awareness ie world AIDS day
  3. LANGUAGE
    - challenging the language that is used to describe an illness ie person with schizophrenia rather than schizophrenic can encourage the person not to be defined by their illness
  4. TREATMENT
    - advances in illness management can help change the image
    ie advances in antipsychotics without classical parkinsonian side effects
  5. public acknowledgement of EXPOSURE
    - Public campaigns encouraging discussion of potentially embarrassing symptoms (ie bowels) or deviant risk factors ie England’s ‘sex: Worth talking about’ campaign
  6. LEGISLATION
    - certain manifestations of stigma can be outlawed
    - ie UK Equality ACT 2010 provides legal framework for safeguarding the rights of people with protected characteristics including disability
40
Q

What is the international classification of functioning, disability and health and what are its core domains

A
  • framework for describing and organising information on an individuals function and disability
  • it can be used to measure an individuals health/disability through surveys
    -can also be used in clinical settings for assessment
  • conceptualises a persons level of functioning as a dynamic interaction between:
    1. Health condition (disorder or disease)
    2. Body functions and structures
    2. Activities
    2. Participation
    3. environmental factors
    3. personal factors
41
Q

International classification of functioning, disability and health: what is included in the body structures and functions section?

A

Includes pathology and clinical measures

ie temp, BP, examination findings

ie prostate enlarged on exam

42
Q

International classification of functioning, disability and health: what is included in the activities section?

A

symptoms and health status. Self reported measure of what the person can do

ie activities of daily living scale

eg. self report of number of trips to the toilet a day (prostate enlarged)

43
Q

International classification of functioning, disability and health: what is included in the participation section?

A

Effect of disability on life
usually self reported this is the extent to which the condition effects the persons normal life

ie Health related quality of life score

eg. cannot go to the cinema as needs to toilet too often

44
Q

International classification of functioning, disability and health: what is included in the environmental factors section?

A

Barriers/ facilitators to function and participation in the environment.

Self reported or observed

eg workplace only has one toilet (barrier) enlarged prostate

45
Q

Define: Impairment

A

-definition from WHO international classification of impairment, disabilities and handicap (superseded by International classification of functioning, disability and health)

  • A loss or abnormality of a body function (anatomical, physiological or psychological)
    ie a malfunctioning body part or system such as an above knee amputee
46
Q

Define: Disability

A

-definition from WHO international classification of impairment, disabilities and handicap (superseded by International classification of functioning, disability and health)

  • An inability or restricted ability to perform an activity (in the normal human range)

ie activities a person cannot do such as walking

47
Q

Define: handicap

A

-definition from WHO international classification of impairment, disabilities and handicap (superseded by International classification of functioning, disability and health)

A disadvantage due to an impairment or disability that limits the role of an individual

ie social sequel of impairment or disability such as difficulties accessing the work place

48
Q

Measuring disability: name and describe a commonly used index, how it is scored and what scores indicate

A
  • Barthel Activities of Daily Living Scale is commonly used by hospitals
  • ADL is also used in ‘activities’ section of ICF
  • independence is assessed across 10 domains
  • scored out of 20 and indicates the amount of support a person is likely to need:

10 = likely to need maximum care at home
>10= likely to need residential or nursing home care

49
Q

What are the 10 domains assessed in the ADL scale

A

Bouncing Bunnies with steadfast bravery function tremendously despite great trials

Bathing
Bowels
Walking
Stairs
Bladder
Feeding
Transfer
Dressing
Grooming
Toileting

50
Q

Name an index for measuring handicap

A
  • the London Handicap scale
  • domains include mobility, physical independence, occupation, social functioning and economic self sufficiency
51
Q

What is the social model of disability (what is it, what 2 types of barriers are considered, who promotes its use?)

A
  • Considers how society disables people with physical impairments through a variety of barriers
  • Barriers may be ENVIRONMENTAL 9ie lack of ramps) or CULTURAL (ie patronising attitude towards people with impairments)
  • in England the government Office for Disability promotes use of the social model for disability
52
Q

What is iatrogenesis, what are the three types and who introduced the concept?

A

Iatrogenesis= disease caused by medicine
- first introduced by Illich
- He described three ways in which medicine can cause illness

  1. Clinical iatrogenesis
  2. Social iatrogenesis
  3. structural iatrogenesis
53
Q

Iatrogenesis: what is clinical iatrogenesis?

A
  • medical treatments sometimes worsen or cause new illnesses

ie
- Adverse drug reactions
- side effects of medications (ie steroids –> diabetes)
- nosocomial infections

54
Q

Iatrogenesis: what is social iatrogenesis

A
  • Describes the way in which wide spread health care provision may encourage overmedicalisation and can lead to people feeling less healthy even when normal

ie rather than normal births people have C-sections by demand
ie rather than ageing normal people have cosmetic surgery

Social iatrogenesis is reflected in the growing proportion of GDP that is spent on some areas of healthcare

55
Q

Iatrogenesis: what is structural iatrogenesis?

A
  • this is the impact that the medical profession has on the population
  • as a result of reliance upon medicine the public has lost its traditional ways of coping with illness, pain and death
56
Q

the role of medicine in society: what area is particularly contested and name 3 areas that were not previously in the remit of medicine but now are

A
  • the role of medicine in society is repeatedly challenged
  • the role of medicine has expanded to areas which were not previously within its remit ie childbirth, abortion and euthanasia
  • The role of biomedicine (the branch of medical science that applies biological and physiological principles to clinical practice- ie not a psychosocial approach!) is particularly challenged
57
Q

Name 3 key challenges to the role of medicine in society

A
  1. Clinical iatrogenesis
  2. The antipsychiatry movement
  3. Patients as active consumers
58
Q

Key challenges to the role of medicine in society: clinical iatrogenesis

A
  • the dominance of biomedicine and its role in society has been increasingly challenged as awareness of the dangers of clinical iatrogenesis has increased
  • risks of polypharmacy have been increasingly documented
  • over prescribing of antibiotics has been associated with the rise of antimicrobial resistances
  • the harm of over-diagnosis and over-prescription to human health is increasingly documented
  • today there is an increasing focus on medicine optimisation (the right person, getting the right medicines, at the right time)
59
Q

Key challenges to the role of medicine in society: anti-psychiatry movement

A
  • the antopsychiatry movement has challenged the biomedical or psychiatric model of treatment for mental illness and perhaps represents the biggest challenge to biomedicine
  • Liang questioned the concept of mental illness as a medical phenomenon, instead framing it as a valid reaction to lived experience rather than a symptom of underlying pathology
  • despite challenges the biomedical model still dominates as the model of care for people with mental illness, however there are arguments for a biopsychosocial approach
60
Q

Key challenges to the role of medicine in society: patients as active consumers

A
  • patients are themselves challenging the role of medicine in society as means of self care increases and dependence on clinicians decreases
  • traditionally doctor consultations are now only one of many sources of health care and health information
  • the internet provides a wealth of health information
  • diagnostic services are available without referral
  • over the counter treatment availability has increased
  • complementary approaches have also shown pervasive popularity despite supporters of the biomedical approach citing their lack of evidence
61
Q

Social patterns of illness: what variation in illness exists across society?

A
  • subjective (experienced health differs markedly from measures of disease
  • just because a person has symptoms doesn’t mean they seek health advice
  • different patterns of illness are seen amongst different social groups in society (across ages, men/women, ethnic minorities, social classes, employed/unemployed)
  • some explanations for the differences seen include:
    1. BIOLOGY (genetic differences)
    2. BEHAVIOUR (difference between health seeking/promoting behaviours and risk taking behaviours between groups)
    3. SOCIAL CIRCUMSTANCES eg disproportionate effects of poverty on health
    4. ARTEFACT - the different patterns of illness are not truly there but a just due to the way these concepts are measured
62
Q

Social patterns of illness: Gender (why are different patterns of illness seen between genders, what is an inequality and what is an inequity)

A
  • BIOLOGY: some disease exclusively effect women (endometrosis) and others exclusively affect men (prostate cancer). This is an inequality but not an inequity.
  • BEHAVIOURAL AND CULTURAL: women live longer than men but in worse health. This is often seen as an inequality due to genetic differences but social factors likely play a role. Women are more likely to report illness. Men are more likely to take risks and less likely to seek health care.

Gender roles may have big impacts on social patterns of illness.

Women are recognised as having much greater rates of depression. In the past hormonal reasons have been cited as the cause of this difference. More recently it has been postulated that the changing gender roles for females and the increasing demands of managing career and family is a contributory factor.

63
Q

Social patterns of illness: Ethnicity

A

BIOLOGY: some illnesses effect ethnic minorities more commonly due to genetics (ie sickle cell trait)

ARTEFACT: Ethnic minority groups more commonly live in deprived areas, some illness are seen more commonly in ethnic groups because of their experience of deprivation rather than because of their ethnicity

BEHAVIOUR AND CULTURE: differing patterns of behaviour ie diet/ smoking can lead to differing disease prevalence

MIGRATION: ethnic minorities are more likely to be migrants , they therefore may have experienced loss of social capital or the healthy migrant effect

RACISM- can lead to stress and social isolation (increased disease). As with all forms of discrimination can be direct or indirect.

64
Q

Direct discrimination

A
  • occurs when someone treats a person less favourably than they would a person from a different group
65
Q

Indirect discrimination

A

Occurs when rules, systems or procedures have different effects on people from a particular group

66
Q

Social patterns of illness: employment status

A
  • employment that is secure and fulfilling provides not only material resource but also psychological benefits and social support
  • In contrast, unemployment can lead to:
    1. worse physical health (higher rates of CV mortally)
    2 worse physical health ( people who are unemployed or have insecure income are more prone to depression and suicide)

However the relationship between work and health is complex as in some instances work can lead to poor health

67
Q

Social patterns of illness: social class

A
  • social gradients in health exist at every age and for all major causes of death
  • In the UK the black report found pronounced disparities in health and illness across the social classes
  • since the black report numerous epidemiological studies have linked social class and health outcomes
  • the ongoing inequities in health have be highlighted in the marmot report
68
Q

Social patterns of illness: Age

A

BIOLOGY: clearly there are different patterns of mortality at different ages

However, social factors such as differences in access to treatments may also contribute to worse health outcomes in older people ie poorer survival from cancer in the older age group may also be due to undertreatment compared with younger people

Stereotypes about the needs of older people may also reduce the availability of services (ie tendency to focus on dementia means other common mental health illnesses can be neglected)

69
Q

What 4 possible explanations for the pronounced health differences between social classes did the Black report give and which was accepted as the most likely?

A
  1. ARTEFACT
    the association between health and social class is an artefact of the way in which these concepts are measured
  2. SOCIAL SELECTION
    Health determines social class ie People with worse health cannot earn money and tend to slip down the social gradient
  3. BEHAVIOURAL AND CULTURAL
    Social class determines health through differences in health damaging or health promoting behaviours (eg assoc between lower social class and smoking)
  4. MATERIALISTIC - the reason felt most contributory by the Black report
    - social class determines health through differences in the material circumstances of life (ie poor housing, diet, lack of social capital)
70
Q

Social factors in the aetiology of disease: social factors

A
  • the wider determinants of health tell use there are many social factors that influence health
  • these include:
    1. early life experiences
    2. employment
    3. social capital
    4. transport
    5. stress
71
Q

Social factors in the aetiology of disease: cultural factors

A

cultural factors may influence beliefs about the aetiology of disease including lay concepts about what causes illness (ie it runs in the family)

72
Q

Social factors in the aetiology of disease: psychological factors

A
  • the whitehall II study identified 2 key aspects of stress at work that are associated with physical and mental illness:
  1. effort/reward imbalance
  2. demand/control imbalance

Difficult jobs where the worker has little autonomy over what they do are associated with higher rates of stress and ill health

73
Q

Social factors in the aetiology of disease: family relationships

A
  • families provide social support that can protect against stressors
74
Q

what is social epidemiology?

A
  • the study of the social determinants of the distribution of disease within a population
  • social epidemiology assumes that the distribution of advantages and disadvantages in society reflect the distribution of health and diseases
  • it proposes to identify societal characteristics that affect the pattern of disease and health distribution in a society and its mechanisms
  • the central question of social epidemiology is what affect do social factors have on individual and population health
75
Q

What activities may social epidemiology involve? (name 3)

A

1 surveillance (ie monitoring health inequalities)
2. Aetiological investigation (ie determining the social explanations for causes of ill health it SE status, behaviour, social support)
3. designing and evaluating interventions to reduce social inequalities in health

76
Q

What is social capital? What 2 things does it promote?

A
  • social capital attributes a value to the social networks within which an individual lives
  • these networks promote NORMS (ie defined limits of acceptable behaviour) and SANCTIONS when these boundaries are crossed (ie social exclusion, gossip, stigma)
77
Q

In what 2 ways does social capital function?

A

BONDING: social capital strengthens the links between members of families and tight knit communities, thereby providing social support

BRIDDING: social capital strengthens the links with members outside the group (ie networking)

78
Q

At what levels can social capital be considered to operate? (3)

A

Micro (individual)
Meso (community)
Marco (national)

At all levels it is associated with greater economic affluence, lower crime, better education and better health

The WHO considers social networks a social determinant of health

79
Q

What is labelling and who proposed the theory?

A

Becker
Labelling occurs when individual attributes and characteristics are identified by others and given a negatice label

FPH exam (29 decks)

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