Block 1 & 2 Flashcards
Define eugenics
“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
Give examples of eugenics policies
- 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
Why is evidence based decision making important?
- 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
How is evidence based decision making implemented?
- 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
What is opportunity cost?
- 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
Why is the demand for healthcare increasing?
- technological change
- multiple morbidities
- increases in the size of the population
- changes to the composition of the population
How is the NHS funded?
- from general taxation
- small elements of national insurance and patient payments (e.g. prescription charges, dental charges)
Define epidemiology
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.
How is incidence calculated?
incidence = number of new cases of disease in a define period / number initially free of the disease
How is prevalence calculated?
prevalence = number of people with the disease at a particular point in time / total population
What does the symptom iceberg show?
That most disease is undiagnosed or wrongly diagnosed.
Give definitions of illness behaviour
- “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
Name five structural patterns that illness behaviour might vary by
- Gender
- Age
- Social Class
- Race
- Culture
Describe types of lay referral systems
- relatives and friends
- alternative therapists
- NHS online, other internet based advice
Describe the differences between old world and new world medicine
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
What triggers people to go to the doctors?
- interference with work or physical activity
- interference with social relations
- interpersonal crisis
- putting a time limit on symptoms
- sanctioning
(Zola, 1973)
Describe barriers to seeking help for health
- 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)
What is the WHO definition for social determinants of health?
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
Give examples of social determinants
- Gender
- Race
- Sexuality
- Disability
- Geography
- Education
- Employment status
- Employment conditions
- Housing
- Social network
What were the “three great classes” in the 1840s?
- gentry and professional
- farmers and tradesman
- labourers and artisans
What were the big killers in the 1840s and who was most affected?
- infectious diseases e.g. TB, cholera, diphtheria
- greatest toll on infants and young children
What was the average age of death by social class in York in the 1840s?
- gentry and professional - 49
- farmers and tradesmen - 31
- labourers and artisans - 24
Describe the Registrar General’s social class classification
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
When was the Registrar General’s social class classification first used and why? What did it show?
- in the 1911 census
- to measure inequalities in infant mortality
- greater infant mortality with decreasing social class level of father
What were the Black Report’s explanations of health inequalities?
- 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
Explain what is meant by an artefact, in relation to the Black report and the dominant view on this explanation
- 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
Explain health related social mobility (“health selection”) in relation to the Black report and the dominant view on this explanation
- 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
Describe the health behaviour explanation of health inequality proposed by the Black Report and the dominant view on this now
- 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)
Describe the fourth explanation of the Black Report
- 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
Give examples of social contexts which could contribute to poorer health outcomes
- poverty
- unemployment
- family discord
- restricted educational opportunities
- customs and fashion
What did Graham (1984) say about family poverty?
- 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
How can a persons circumstances be measured?
- household income (asking wealth related questions in questionnaires tends to reduce response rate)
- educational level
- occupational status
- housing tenure
- area deprivation
Why is housing tenure a less sensitive measure of current circumstance than previously?
- “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
What is the IMD?
- 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
What are the 7 domains included in the IMD?
- income
- employment
- education
- health
- crime
- barriers to housing and services
- living environment
Give examples of downstream approaches to health interventions
- drugs and medical equipment
- hospitals
- specialist training
What is the WHO definition of health promotion?
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.
What are the 5 aspects of health promotion according to WHO?
- healthy public policy
- supportive environments
- community action
- personal skills
- reorienting health services
What is the HEE definition of health education?
Any combination of learning experiences designed to facilitate voluntary actions conducive to health.
Give examples of the different stages of disease prevention
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
Describe Beattie’s typology
Individual -> Collective Focus
Authoritative -> Negotiated Intervention
IA - Health persuasion
CA - Legislative action
IN - Personal counselling
CN - Community development
Give two examples of health persuasion
- HIV leaflets
- 5 a day fruit and veg campaign
Give two examples of legislative action
- Smoking ban
- Fluoride in water
- Car seat belts
Describe personal counselling
Opportunistic prevention in consultations
Give two examples of community development
- Trussell Trust food banks
- locally based credit unions
Give arguments for limiting treatment to certain groups e.g. smokers, obese people
- 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
Give arguments against limiting treatment to certain groups e.g. smokers, obese people
- 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
Define ethnicity
“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
