Block 1

Question 1

What is statistical normality?

Answer 1

Based on the normal distribution that 95% of the population should be within ± 2.5 standard deviations of the mean

Question 2

What is social normality?

Answer 2

What society finds acceptable or desirable. Changes within a given society, culture, and time.

Question 3

What is optimal normality?

Answer 3

‘Normal’ value is determined by what is required for optimal health, not the mean/median of a population.

Question 4

2 models of health?

Answer 4

Medical model and Social model

Question 5

Define illness

Answer 5

Subjective experience, varying between people. One can be ill in the absence of disease.

Question 6

Define sickness

Answer 6

A social role given to or taken on by a person perceived to be ill.

Question 7

Define disease

Answer 7

Objective diagnosis using specific signs and symptoms. Deviation from the biological norm. Changes with medical advances.

Question 8

Outline medical model

Answer 8

Health stems from biology and is the absence of disease. Medical model therefore shows that it is the health profession’s job to cure or treat to lessen symptoms.

Question 9

Disadvantages of medical model of health

Answer 9

Power is in the hands of the medical profession.

• doesn’t include chronic disease.
• doesn’t consider the social influences on health.

Question 10

Outline social model of health

Answer 10

Health is a social construction and is determined by a range of external factors. It is determined by the social and cultural, socioeconomic influences.

Question 11

WHO definition of health

Answer 11

WHO: A state of complete social, physical and mental wellbeing and not merely the absence of disease or infirmity.

Health as absence from disease.
Health as functionality (ADLs.)
Health as freedom.
Health as an equilibrium.

Question 12

What can influence people views on their health?

Answer 12

Age, gender, ethnicity and socioeconomic status

Question 13

Define demography

Answer 13

The study of size, structure, dispersement and development of human populations.

Question 14

What is the UN definition of a census?

Answer 14

The simultaneous recording of demographic data by the government at a particular time, pertaining to all the persons living in a particular territory.

Question 15

What is CART(A)?

Answer 15

Assesses quality of health information. Completeness, Accuracy, Representativeness/Relevance, Timeliness, Accessibility

Question 16

Low enumeration groups for UK Census

Answer 16

Travellers, migrants, undocumented, homeless, some students

Question 17

Crude birth rate equations

Answer 17

Crude birth rate = Live births/1000 people in population.

Question 18

General fertility rate equation

Answer 18

Live births/1000 women in pop. Of childbearing age. (Aged 15-44.)

Question 19

Total fertility rate equation

Answer 19

The number of live babies that would be born is every woman lived to menopause and gave birth in accordance with the current, age-specific fertility rate.

Question 20

2 types of death certificate?

Answer 20

Medical certificate of Cause of Death (Doctor) and Coroner’s certificate

Question 21

Population estimate equation

Answer 21

Pop estimate = Census baseline + births – deaths ± migration.

Question 22

Population projection in the UK

Answer 22

Longer lives, more elderly = more elderly care services, more chronic condition management, increased mental health issues e.g. dementia

Question 23

4 sources for morbidity data.

Answer 23

Cancer registration system, hospital episode statistics, quality and outcomes framework (QoF) and Notifications of Infectious Diseases

Question 24

2 Data coding systems

Answer 24

ICD-10 - conditions treated and investigated

OPCS-4 - operation details

Question 25

Define prevalence

Answer 25

A measure of how common a disease is, as a proportion. (% or number in 1000/10000 etc.) - burden of disease

Question 26

3 types of prevalence

Answer 26

1. Point prev. = proportion of individuals with the condition at a specific point in time. 2. Period prev. = proportion of individuals with a condition at any time during a specified time interval. 3. Lifetime prev. = the proportion of individuals with the condition at any point during their lives.

Question 27

Prevalence equation

Answer 27

P= (no. people with disease/total number of people) x 100 (for a %) or x 1000/10000 etc.

Question 28

Define incidence

Answer 28

The rate at which new events occur in a population, over a defined period of time. Either expressed as per n people of n years, or as n-person years (essentially the same thing!)

Question 29

Person years equation

Answer 29

person-years = no. of people x no. of years

Question 30

Incidence equation

Answer 30

(number of new cases)/(no. people observed x years observed) x units (eg, 1000 for per 1000 people etc)

Question 31

Factors affecting prevalence (4)

Answer 31

Incidence, recovery rate, death rate, transfer/migration rate

Question 32

Define point estimate

Answer 32

Our best guess based on sample data.

Question 33

Define sampling error

Answer 33

Difference between sample point estimate and the truth

Question 34

Define standard error (SE)

Answer 34

Numerical value to represent sampling error.

Question 35

Confidence interval equation (95%)

Answer 35

CIs= p ± (1.96*SE.)

Question 36

How do you know if it is plausible that there is a difference between 2 populations?

Answer 36

Confidence intervals do not overlap.

Question 37

What is infant mortality a good indicator of?

Answer 37

Health of a population. Correlates well with other proxy measures. Highly sensitive to social determinants and epidemics

Question 38

Define epidemiological transition

Answer 38

Often indicates the socio-economic climate of a country, as once a country develops from pre-industrial to industrial economies, see a change in demography. Less acute deaths, less communicable disease, less deficiency disease, and longer life expectancy. But chronic disease and non-communicable disease rates become higher.

Question 39

Main causes of death in the UK

Answer 39

Men: Dementia, Cancer (lung, prostate, bowel,) circulatory system, resp system. Women: Dementia, Cancer (lung, breast, bowel,) circ system, resp system.

Question 40

Define health inequality

Answer 40

Systematic differences in health and illness between different social groups. Variations are not random, and some groups live longer than others. Gender, age, ethnic group and geography

Question 41

What is social gradient?

Answer 41

Clear, stepwise gradient in health. With each step down the social ladder, health becomes poorer. Not just between the most privileged and most deprived groups, but evident across the whole spectrum. (infant mortality / male life expectancy etc.).

Question 42

What are the social gradient exceptions?

Answer 42

Prostate, breast and skin cancer

Question 43

Types of inequalities?

Answer 43

Geographical, socioeconomic, gender, ethnicity

Question 44

How is socioeconomic status measured?

Answer 44

A number of ways: occupation, income, education, access to or ownership of assets (housing, car), index of multiple deprivation. BUT The Registrar General’s socio-economic classification is based on occupation, which is proxy for status, income, education etc.

Question 45

Why is there cultural/behavioural inequalities?

Answer 45

Variation in health behaviours and lifestyle. Increased cognitive load due to social circs - worry about future health.

Question 46

Why is there material/nanomaterial inequalities?

Answer 46

Access to resources, income, housing, food, fuel for heating, transport, healthy meals, social activities, exercise facilities. Health = direct effect of poverty and deprivation. Shaped by broader factors, such as place in society, policies

Question 47

Why are there psychosocial inequalities?

Answer 47

how their environment makes them feel. Direct = “allostatic load” physical disease and the link to the neuroendocrine pathway. Indirect = adoption of unhealthy behaviours such as smoking. Stresses of everyday living on low income and poorer material environments explain poorer health.