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Phase I: H&S > Block 1 & 2 > Flashcards

Block 1 & 2 Flashcards

1
Q

Define eugenics

A

“when a specific intervention is considered which seeks to improve the genetic heritage of a child, a community or humanity in general” - Mackellar and Bechtel 2014

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2
Q

Give examples of eugenics policies

A
  • genetic screening
  • birth control, promoting differential birth rates, compulsory sterilisation, forced abortions, forced pregnancies
  • marriage restrictions, immigration control
  • segregations (e.g. racial, based on mental health etc)
  • genocide
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3
Q

Why is evidence based decision making important?

A
  • it’s a way of dealing with the uncertainty that is inherent in medical practice:
    > medical knowledge is incomplete
    > it’s not possible to know everything
    > there is a constant need for innovation and improvement
  • it’s seen as a way of increasing efficiency in health services
  • can reduce variations in practice among providers
  • improves patient care by ensuring they get the most appropriate treatment as recommended by research
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4
Q

How is evidence based decision making implemented?

A
  • through evidence based clinical guidelines e.g. NICE guidelines
  • summaries of evidence are provided to practitioners
  • practitioners can access research evidence and evaluate it for themselves
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5
Q

What is opportunity cost?

A
  • the value of what you give up when you make a treatment decision
  • can be measured in terms of the resources given up (£cost) or in terms of the foregone health for another patient
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6
Q

Why is the demand for healthcare increasing?

A
  • technological change
  • multiple morbidities
  • increases in the size of the population
  • changes to the composition of the population
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7
Q

How is the NHS funded?

A
  • from general taxation

- small elements of national insurance and patient payments (e.g. prescription charges, dental charges)

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8
Q

Define epidemiology

A

The study of the distribution and determinants of health-related states and events in populations and the application of this study to the control of health problems.

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9
Q

How is incidence calculated?

A

incidence = number of new cases of disease in a define period / number initially free of the disease

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10
Q

How is prevalence calculated?

A

prevalence = number of people with the disease at a particular point in time / total population

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11
Q

What does the symptom iceberg show?

A

That most disease is undiagnosed or wrongly diagnosed.

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12
Q

Give definitions of illness behaviour

A
  • “the ways in which symptoms may be differentially perceived, evaluated and acted upon (or not acted upon) by different kinds of persons” - Mechanic 1962
  • “not a simple decision about professional help-seeking but a multifaceted, protracted career composed of a plurality of strategies [… invoked] during the process of coping with symptoms” - Biddle et all 2007
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13
Q

Name five structural patterns that illness behaviour might vary by

A
  • Gender
  • Age
  • Social Class
  • Race
  • Culture
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14
Q

Describe types of lay referral systems

A
  • relatives and friends
  • alternative therapists
  • NHS online, other internet based advice
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15
Q

Describe the differences between old world and new world medicine

A

Old world (Industrial Age):

  • patients do not have easy access to knowledge base that doctors have
  • assumption that the doctor is the smartest
  • professional care is encouraged

New world (Information Age):

  • self care is encouraged
  • patients have as much access to the evidence base as doctors do
  • emphasis that the patient is “smarter” as they have more knowledge about their own condition
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16
Q

What triggers people to go to the doctors?

A
  • interference with work or physical activity
  • interference with social relations
  • interpersonal crisis
  • putting a time limit on symptoms
  • sanctioning

(Zola, 1973)

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17
Q

Describe barriers to seeking help for health

A
  • attitudes of staff (e.g. receptionists)
  • geographical distance (e.g. time and effort required)
  • transport availability and cost (e.g. car owner vs rely on infrequent bus service)
  • previous bad experiences (e.g. long wait times)
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18
Q

What is the WHO definition for social determinants of health?

A

The social determinants of health are:

  • the conditions in which people are born, grow, work, live and age
  • and the wider set of forces and systems shaping the conditions of daily life

These forces and systems include:

  • economic policies and systems
  • developmental agendas
  • social norms
  • social policies
  • political systems
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19
Q

Give examples of social determinants

A
  • Gender
  • Race
  • Sexuality
  • Disability
  • Geography
  • Education
  • Employment status
  • Employment conditions
  • Housing
  • Social network
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20
Q

What were the “three great classes” in the 1840s?

A
  • gentry and professional
  • farmers and tradesman
  • labourers and artisans
21
Q

What were the big killers in the 1840s and who was most affected?

A
  • infectious diseases e.g. TB, cholera, diphtheria

- greatest toll on infants and young children

22
Q

What was the average age of death by social class in York in the 1840s?

A
  • gentry and professional - 49
  • farmers and tradesmen - 31
  • labourers and artisans - 24
23
Q

Describe the Registrar General’s social class classification

A

I - professional occupations e.g. doctor
II - managerial and technical occupations e.g. manager
III - skilled occupations e.g. electrician
IV - partly skilled occupations e.g. porter
V - unskilled occupations e.g. cleaner

24
Q

When was the Registrar General’s social class classification first used and why? What did it show?

A
  • in the 1911 census
  • to measure inequalities in infant mortality
  • greater infant mortality with decreasing social class level of father
25
Q

What were the Black Report’s explanations of health inequalities?

A
  • a statistical artefact (not real)
  • people’s health drives their social class (result of health-related social mobility)
  • result of differences in health behaviour
  • result of broader social inequalities in peoples lives
26
Q

Explain what is meant by an artefact, in relation to the Black report and the dominant view on this explanation

A
  • states that the relationship between class and heath is artificial and comes about due to inadequate measurement of class, health, both or the relationship between the two
  • dominant view: limitations are insufficient to account for consistency and scale of relationship
27
Q

Explain health related social mobility (“health selection”) in relation to the Black report and the dominant view on this explanation

A
  • health determines class
  • ill-health can push people down the class ladder and into poverty
  • dominant view: health selection is important at an individual level but makes only a modest contribution to overall gradient in health
28
Q

Describe the health behaviour explanation of health inequality proposed by the Black Report and the dominant view on this now

A
  • poor health is caused by people’s behaviour (e.g. high-fat diet, physical inactivity, smoking) and this is linked to social class
  • dominant view: social gradients in health behaviours contribute significantly to gradients in health but health behaviours are themselves shaped by people’s circumstances (e.g. inseparable from 4th explanation - broader social inequalities)
29
Q

Describe the fourth explanation of the Black Report

A
  • health is determined by a persons position in social structure (the circumstances into which they are born and their occupation and income in adulthood)
  • circumstances in early life are particularly important
30
Q

Give examples of social contexts which could contribute to poorer health outcomes

A
  • poverty
  • unemployment
  • family discord
  • restricted educational opportunities
  • customs and fashion
31
Q

What did Graham (1984) say about family poverty?

A
  • family poverty is extricably linked to employment policy and income maintenance policy for those not in paid employment
  • families outside the labour market are particularly vulnerable to poverty
  • employment remains the most effective guarantee against poverty and the ill -health with which it is associated
32
Q

How can a persons circumstances be measured?

A
  • household income (asking wealth related questions in questionnaires tends to reduce response rate)
  • educational level
  • occupational status
  • housing tenure
  • area deprivation
33
Q

Why is housing tenure a less sensitive measure of current circumstance than previously?

A
  • “right to buy” policy
  • mortgage debt is a serious problem for many
  • rent often at least as expensive as a mortgage
  • referencing procedures in private sector may discriminate against those with low income
34
Q

What is the IMD?

A
  • The English Index of Multiple Deprivation
  • the official measure of relative deprivation for small areas in england
  • ranks all areas from most deprived to least, each area with around 1500 people
35
Q

What are the 7 domains included in the IMD?

A
  • income
  • employment
  • education
  • health
  • crime
  • barriers to housing and services
  • living environment
36
Q

Give examples of downstream approaches to health interventions

A
  • drugs and medical equipment
  • hospitals
  • specialist training
37
Q

What is the WHO definition of health promotion?

A

Health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interactions.

38
Q

What are the 5 aspects of health promotion according to WHO?

A
  • healthy public policy
  • supportive environments
  • community action
  • personal skills
  • reorienting health services
39
Q

What is the HEE definition of health education?

A

Any combination of learning experiences designed to facilitate voluntary actions conducive to health.

40
Q

Give examples of the different stages of disease prevention

A

Primary: prevent disease onset e.g. immunisation, screening for risk factors, supportive environments, health education

Secondary: detect and cure disease at an early stage e.g. screening for disease

Tertiary: minimise the effects or reduce the progression of the disease e.g. hip replacement, palliative care, HIV antiretrovirals

41
Q

Describe Beattie’s typology

A

Individual -> Collective Focus
Authoritative -> Negotiated Intervention

IA - Health persuasion
CA - Legislative action
IN - Personal counselling
CN - Community development

42
Q

Give two examples of health persuasion

A
  • HIV leaflets

- 5 a day fruit and veg campaign

43
Q

Give two examples of legislative action

A
  • Smoking ban
  • Fluoride in water
  • Car seat belts
44
Q

Describe personal counselling

A

Opportunistic prevention in consultations

45
Q

Give two examples of community development

A
  • Trussell Trust food banks

- locally based credit unions

46
Q

Give arguments for limiting treatment to certain groups e.g. smokers, obese people

A
  • lifestyle led to the disease in the first place
  • lifestyle will limit the effect of the treatment
  • a poor outcome will result in the need for more treatment
  • treatment is expensive and resources so they should be targeted where they are most likely to be effective
47
Q

Give arguments against limiting treatment to certain groups e.g. smokers, obese people

A
  • doctors have an ethical obligation to treat on basis of need and best available treatments
  • slippery slope to excluding or wrongly excluding others e.g. drunk drivers, sky divers, suicide attempts, self harm)
  • poor people more likely to be excluded than rich people
  • value judgements, who decides who is deserving and undeserving
48
Q

Define ethnicity

A

“A socially constructed difference used to refer to people who see themselves as having a common ancestry, often linked to a geographical territory, and perhaps sharing a language, religion and other social customs” - Dyson 2005

Phase I: H&S (12 decks)

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