Block 2 Flashcards
Why is infant mortality used as an indicator of health of population?
- Good proxy for population health
- Correlates well with other proxy measures but easier to measure
- Highly sensitive to social determinants of health and disease epidemics
(Hence good marker for showing what is happening ‘now and here’)
Over the last century there has been a decrease in the infant mortality rate
Define infant mortality rate
The number of babies that die within 1 year of life per 100,000
Define child mortality rate
The number of deaths of children between the age of 1 and 18 per 100,000
What does life expectancy at birth measure?
Life expectancy at birth is a measure for the average number of years that a newborn baby can expect to live
If they pass through life subject to the age specific mortality rates of the time.
What is meant by disability free life years?
Number of years an individual can expect to live without a limiting chronic illness or disability
What does disability free life years indicate?
Gives an indication of how demand on health and social services may increase in future years.
Current results show:
That men and women are living more of their lives disability free
Women live longer but more years with a limiting chronic ill/disability than men
Define health inequality
Is the systematic differences in health and illness across social groups
Factor that influence health inequalities include:
Age
Gender
Ethnicity
Geography
Socio-economical status
As a result of these differences some groups live longer and experience less morbidity than other groups
What is meant by the social gradient in health?
Stepwise (Linear) gradient in health
With each step down the socio-economic ladder, health becomes poorer
Inequalities occur across the whole range of socio-economic groups not only in rich and poor
Evident across almost all indicators
What are the exceptions to the social gradient in health?
1. Breast cancer
(higher in least deprived groups)
2. Malignant melanoma of skin
(higher incidence in least reprived groups)
3. Prostate cancer
(men in least deprived deprivation more likely to have prostate cancer)
What are the general patterns of health inequality of the main causes of death/health indicators?
Infant mortality rate: children in lowest socio-economic households have highest infant mortality rates
Occupation: poorer health in those who are classes in the lowest occupational group
Geography: lowest death rates in those who live in least deprived areas. In UK, higher death rates in north, west and in urban areas
Lung cancer: increased incident of disease as you move down deprivation list
Age: stepwise health inequalities in all ages (birth to old age) but greatest seen in childhood
Gender: less steep health inequalities for women than men. Women live longer
Ethnicity: people from black and minority ethnic groups living in the UK are more likely to be diagnosed with mental health problems and report poorer self-assessed health. Become more pronounced with age
How can socio-economic status be measured?
Occupation
Income
Education
Access to or ownership of assets (house, car)
Index of multiple deprivation
Explain the index of Multiple Deprivation?
Provides relative composite measure of deprivation for small areas
Combines 7 different indicators (social, economic and housing) into a signle deprivation scare for each small area
Areas are ranked from least deprived to most deprived at local authority level
What are the main models of doctor-patient relationships?
- Paternalistic (doctor-led)
- Shared (partnership)
- Informed (patient-led)
What are the key features of the paternalistic model?
1. Information flow largely from doctor to patient
(little information given by patient)
2. Doctor makes the decision about what is best for the patient
(assumes that the doctor is best placed to make the decision regarding the treatment)
3. Expectation that patient will agree as ‘doctor knows best’
When is the paternalistic model appropriate?
- In medical emergencies
- If patient wants this model
What are the key features of the shared model?
- Two way exchange of information between patient and doctor at all stages
- Both participants seen as bringing expertise (medical and personal expertise)
- Patient and doctor reach a decision together about best course of action
- Depends on building a consensus on appropriate treatment
- Challenge for doctor to create an environment in which patient feels able to express treatment preferences
- If disagree, process becomes a negotiation
What are the key features of the informed model?
- Doctor communicates all relevant information and treatment options and the risks/benefits to patient
- Doctor gives patient enough information to make an informed treatment decision
- Patient is active and expects to make the decision
- Decision making is sole perogative of the patient
What are the three main type of explanations of the social gradient in health?
Behavioural/cultural
Material/neo-material and life course
Psychosocial
Outline the Behavioural/cultural explanation of the social gradient in health
Health inequalities due to social variations in health-related behaviors.
Assumed to be the result of individual choice i.e smoking
(linked to lower social groups, people in these groups are more likely to smoke at younger age then those in higher social groups)
Clustering of unhealthy behaviours
(smoking, excessive alcohol use, poor diet and low levels of physical activity has decreased in recent years – greatest reduction seen in those from higher social groups)
Outline the Material/neo-material and lifecourse explanation of the social gradient in health
Health inequalities are due to social differences in material circumstances related to income:
Poor housing (damp, mould growth, excessice heat/cold, asbestos) linked to increased incidence of certain diseases (asthma, infection, RT diseases) and accidents (falls, fires and electrical hazards)
Nutrition – the poorer you are the more likely you are to eat less healthy; poor diet increases the risk of diseases such as CHD, diabetes and cancer
Neo-material approach:
The effect of material circumstances on health reflects a lack of resources.
It is related to the underinvestment in physical, health and social infrastructure
Life-course approach:
Exposure to one form of material deprivation increases the risk of exposure to others
i.e parental disadvantage is transmitted in utero, early years of life influence later health outcomes.
Outline the Psychosocial explanation of the social gradient in health
Based on the impact of psychosocial effects of stressful conditions at work/home or of low self esteem
Affects health in two ways:
Indirectly (i.e smoking)
Directly (increased vulnerability to mental and physical illness via neurological pathways)
People lower down the social structure tend to face negative circumstances more frequently
Define absolute poverty
The minimum standards of food, shelter and clothing necessary to sustain life
Define relative poverty
Below acceptable standards of living, which prevents people participating in community life
What is social capital?
Defined in terms of both social networks (high levels of participation in community groups) and norms (high levels of trust and reciprocity amongst community memebers) that faclitate co-ordination and co-operation
Two types:
- Bonding (feel others are there)
- Bridging (communities feel isolated, not part of wider communities)
What is the importance of social capital for health?
Evidence suggests that social capital can have benefical effects on health
Psychococial interpretation: income inequalities can lead to reduced community involvement (people percevies their position in social hierarchy is low down)
Neo-materialist interpretation: lack of health enhancing resources at an individual level, deprived social resources and neglected infrastructure at the community level leads to a decline of social capital and health
Why should doctors be concerned of health inequalities?
Health inequalities have a profound effect on peoples lives
Health is a human right (all systematic differences in health between social groups is unfair)
To reduced the costs assocaited with premature deaths and illness
Good medicial practice can make a difference
Key theme in government health policies (royal colleges see it as a role of doctors)
What is the aim of tackling health inequality?
To yield a more equal distribution of health across social groups
i.e reduce the gradient
What are the main recommendations of the Marmot Review on health inequalities?
- Reduce the social gradient
- Action across all social determinants (i.e low education, unemployment, low pay, poor material environments, pollution and assess to services)
- Six key policy objectives
- Action across all sectors (i.e health, education, social services, housing, employment and environment)
- Participatory decision making at local level
What are the 6 key policy objectives outlined in the marmot review?
Six key policy objectives
i. Give every child the best start in life
ii. Enable all children, young people and adults to maximise their capabilities and have control over their lives
iii. Create fair employment and good work for all
iv. Ensure healthy standard of living for all
v. Create, develop healthy and sustainable places and communities
vi. Strengthen the role and impact of ill health prevention
What is meant by tackling the social gradient?
Progressive Universalism - good way!
Improvement for all social groups not only those worst off.
Adopting a population wide strategy that seeks to obtain highest health standard for all
What is meant by tackling social disadvantage?
Improvement of health for those who are worst off.
Adopts a group specific approach.
The bad way to tackle health inequalities
What is meant by upstream and downstream approaches to tackling health inequalities?
Upstream Approaches:
Approaches that tackle wider influences on health through public policy approaches
(reducing poverty, taxation, reducing price barriers, reducing unemployment via national policies)
Downstream Approaches:
Approaches that tackle individuals
(health behaviours, lifestyle factors – smoking, diet, assess to care)
What is the role of doctors in reducing health inequalities?
As clincians: access to high quality health care for vulnerable groups
As advocates for development of services/programs for better health outcomes
As managers and clincial leads: model employer ·
As educates: placements in disadvantaged areas, investigate social determinants, local projects
Give examples of interventions that have been shown to reduce health inequalities
Upstream approaches:
housing interventations
improve standard of living
increased choice
water fluoridation
free folic acid supplements
tobacco price increase
improvement in education for children and young people
Give examples of interventions that have been shown to increase inequalities
Downstream approaches: ·
Mass media campaigns on stop smoking and folic acid
Work place smoking bans
What is the difference between health promotion and disease prevention?
Health Promotion:
Process of enabling people to increase control over their health and its determinants and thus improving their health.
It offers a positive and inclusive concept of health as a determinant of the QoL and encompassing mental and spiritual wellbeing
Disease Preventation:
Actions aimed at eradicating, eliminating or minimising the impact of disease and disability
What are the three levels of prevention?
Give the stage of disease and the aim of treatment .
Primary Prevention:
Pre-disease
Preventing disease in the first place.
Secondary Prevention:
Early stage of disease
Find and treat disease early in order to halt or slow the progression of disease
Tertiary prevention:
Symptomatic disease (irreversible disease of disability)
Manage associated health problems of the disease to: Prevent further deterioration, Achieve high a level of functioning as possible, Maximise quality of life
What is Beattie’s model of health promotion?
What are the key features and steps of the self-regulatory model?
Applied to a range of illnesses to help understand adaption and coping.
Helps develop appropriate management plan while working with the patient
