Block 2 Flashcards

Question

What is the importance of social capital for health?

Answer 1

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

Answer 2

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)

Answer 3

To yield a more equal distribution of health across social groups i.e reduce the gradient

Answer 4

1. Reduce the social gradient 2. Action across all social determinants (i.e low education, unemployment, low pay, poor material environments, pollution and assess to services) 3. Six key policy objectives 4. Action across all sectors (i.e health, education, social services, housing, employment and environment) 5. Participatory decision making at local level

Answer 5

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

Answer 6

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

Answer 7

Improvement of health for those who are worst off. Adopts a group specific approach. The bad way to tackle health inequalities

Answer 8

**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)

Answer 9

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

Answer 10

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

Answer 11

Downstream approaches: · Mass media campaigns on stop smoking and folic acid Work place smoking bans

Answer 12

**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

Answer 13

**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

Answer 14

**Primary prevention** *Immunisation, alcohol education in schools* Public Health, GP **Secondary prevention** *Screening/case detection programmes, Brief interventions, Adequate treatment* GP, Hospitals **Tertiary prevention** *Rehabilitation programmes, Pain management* Rehab and palliative services, Hospitals

Answer 15

1. Individuals at high-risk of disease (aim: bring preventitive care to those at high risk; requirements: detection of high risk individuals) 2. Whole population (aim: direct at everyone irrespective of individual risk levels)

Answer 16

**Pros:** Appropriate to indivdual High patient motivation High doctor motivation Cost-effective? **Cons:** Hard to idenify high risk Medicalise prevention Stigmatise individuals Limited effects on population level

Answer 17

**Pros:** High benefit for population as whole Attacks root cause Shifts cultural norms Can work passively **Cons:** Benefit is small for each person Low subject motivation Costly?

Answer 18

**Medical** *Screening/immunisation* Early detection of smoking related disorder eg. spirometry **Behavioural change** *Encourages healthier behaviours* Smoking cessation support **Educational** *Provide information/informed choices* Giving information on health effects of smoking in schools **Client centred** *Health issues identified by client/community* Client identifies what they want to know/do about smoking **Societal change** *Change in physical, social and economic environment (making healthier choices)* No smoking policies/taxation

Answer 19

1. Build healthy public policy 2. Create supportive environments 3. Reinforce community actions 4. Develop perosnal skills 5. Reorient health services

Answer 20

1. Advocate for health based on human rights and solidarity 2. Invest in sustainable policies, actions and infrastructure to address the determinants of health 3. Build capacity for policy development, leadership, health promotion practice, knowladge transfer and research and health literacy 4. Regulate and legislate to ensure a high level of protection from harm and enable equal opportunity for health and well-being for all people 5. Partner and build alliances with non-governmental public, private and international organisations and civil society to create sustainable actions

Answer 21

Refers to those characteristics between males and females that are biologically determined

Answer 22

Refers to the social and cultural meanings assigned to being male or female

Answer 23

Biological features whereas gender is socially constructed

Answer 24

Men more likely to die at all stages of lifecourse (differences pronounced in youth and early adulthood) MEN – lower than women - 76 years WOMEN – higher than Men - 81 years

Answer 25

**Cancer** Men more likely to die from cancer but it is also gender specific i.e prostate cancer kills men and breast cancer kills women **CHD** Men more likely to die from CHD at all stages of lifecourse expect after 75 years of age (biological reasons) Women have lower cardiovascular reactivity to stress Oestrogen protects women before menopause Men have greater sensitivity to certain damaging metabolities Men’s susceptibility due in part to central obesity

Answer 26

Younger men (16 to 34 years old) at higher risk of death from accidents (involved in car crashes – speed and alcohol) Rates of accidental death among men exceeds those in woman at all ages except towards the end of the lifecourse

Answer 27

Men more likely (4 times) to commit suicide than women Men tend to use more violent and lethal methods of suicide

Answer 28

Women 3/4 times more likely to self-harm than men

Answer 29

Men smoke more than women

Answer 30

Men nearly twice as likely as women to exceed the recommened daily limits of alcohol comsumption Men more likely to binge drink Strong assocaition between heavy drinking, depression and suicide in men

Answer 31

**Overweight** More men than women are overweight in all age groups **Obesity** Similar proportions of men and women are obese but women become obese 10 years later than that for men

Answer 32

More likely to consult their GP High attendance of well person checks More likely to seek help early Less likely to be diagnosed with CHD Less likely to be hospitalised Less likely to receive invasive treatment More likely to be prescribed psychotropic drugs

Answer 33

More likely to use locums and A&E services Low well person checks More likely to leave health problems late Men more likely to die from skin cancers despite a lower incidence rate of the disease among men Structural and institutional barriers inhibit men from assessing health services

Answer 34

Doctors more likely to perceive a physical illness as a psychological one when it’s a woman Women are more likely to seek help - due to social stigma Medical advertising reinforces this perception This type of medication more socially acceptable for women than for men

Answer 35

Increased risk of dying from accidents due to increased exposure to occupational accidents and diseases Health behaviours seen as a way to express ‘masculinity’ – a way to gain status as men They use ‘masculine-sanctioned’ coping behaviour to relieve stress despite potential damaging consequences – turn to drink and drugs Men taught to be ‘self-sufficent’, not to complain and to be strong minded – prevents them comsulting when health problem arise Perceive themelves as less vulnerable or susceptible to illness than women Normalise their symptoms and fear wasting doctors time Less likely to accept emotional pain as valid

Answer 36

More vulnerable to poverty and bear the burden of low income within households Maintaing the material and psychosocial environment of the house increases social isolation and denial of self (Linked to higher rates of depression and anxiety)

Answer 37

Concept that concentrates on assumed biological or genetic differences between groups of people

Answer 38

Was used to support racist views towards ethnic miniority groups. No scientific basis for the notion that different ‘races’ share biological or genetic features significant for health

Answer 39

Defined by two main common characteristics that separate one ethnic group from another: 1. Long shared history – the group is conscious of it and the memory of which it keeps alive 2. A cultural tradition of its own including family, social customs and manners

Answer 40

Concentrates on shared experiences, beliefs and values

Answer 41

Ethnic minority groups generally have poorer health than majority white population but within the ethnic minority groups the distribution of health inequalities is not uniform **CHD:** people born in Bangladesh and Pakistan have highest rates of death from CHDs and stroke **Circulatory disease:** people born in India, East Africa and Ireland have higher than average mortality rates from circulatory diseases · **Hypertension/Strokes:** highest amongest people born in the Caribbean and West/South Africa **Diabetes:** high but variable ratees of diabetes across all non-white groups

Answer 42

Based on the notion of ‘genetic homogeneity’ Some disease strongly linked to gentic factors but cannot be used to explain ethnic health inequalities Concentrating on the genetic factors ignores wider causes of ill health that affect more people in these groups

Answer 43

Seek to locate the poorer health of ethnic minority groups in the nature of what it is to be a member of that particular group Concentrate on health beliefs and behaviours of ethnic minority groups Assumes other features of particular cultures also harmful or that harmful factor is somewhat inherent in those people ‘cultural blaming’ Neglect the fact that the major health problems in these ethnic groups are the same as for the general population

Answer 44

Migrants selected by the health characteristics – usually have better health among population of origin Health of these migrants tends to revert back to mean standard of the population of origin hence lead to a relative decline in health compared to health in country of destination Salon Bias phenomenon – people returning home when ill could also reduce the mortality rate of the migrant populations

Answer 45

Ethnic patterns of health mirror the broad patterning of socio-economic inequality among minority groups These factors make a major contribution to ethnic differences in health and these factors are more important than other factors (cultural/genetic)

Answer 46

Conducts/words/practices that disadvantage people based on their colour, culture or ethnic origin. Daily occurrence for many people of ethnic minority groups, and whether overt or subtle, it is just as damaging.

Answer 47

Social deprivation

Answer 48

In general terms consists of conduct, words, practices which disadvantage people because of their colour, culture or ethnic origin.

Answer 49

**1. Direct racism:** People are treated less favourably due to their ethnicity or religion **2. Indirect racism:** People unaware their actions are undermining the position of people from ethnic minority groups **3. Institutional racism:** The collective failure of an organisation to provide an appropriate and professional service to people based of their colour, culture or ethnic origin.

Answer 50

Direct racism and racial harassment and indirect experiences = health differences * A fear of racism creates worry and stress = damaging to health

Answer 51

Physical illness caused by lifestyle factors. Ill health is very preventable and susceptible to health promotion, and how a patient views their health Helping people develop well being, decreases diseases

Answer 52

Used to explore patients perceived susceptibility, severity, benefits and barriers. Model helps educate for perceptions of threat and goal setting/action planning and problem solving to help overcome barrier. This model does not take into account social behaviour

Answer 53

1. Explore perceived susceptibility and severity 2. Educate patient about risk which can increase susceptibility and severity 3. Explain pros and cons 4. Any barriers to stopping 5. Work with patient to problem solved and overcome barriers 6. Reinforce education of benefits

Answer 54

Used to explore intentions. 1. Explore intentions 2. Explore perceived behavioural control 3. If control low, further explore by asking why 4. If percieved control high, ready to attempt behaviour change 5. Work with patient and plan

Answer 55

Applied to a range of illnesses to help understand adaption and coping. Helps develop appropriate management plan while working with the patient

Answer 56

DALS = sum of YLL + YLD for a particular condition

Answer 57

Key features of stages to change (transtheoretical model) **1. Precontemplation** Never thought about changing factor **2. Contemplating** Thought about what to change **3. Preparation** Preparing to change the factor **4. Action** Putting into action their preparation **5. Maintenance** Maintaining the change **6. Relapse** Going back to old habbit

Answer 58

**Health belief model** can be used to educate a person of certain factors ie smoking **Theory of planned behaviour** can be used to assess patients current intentions **Transtheoretical model** can be used to help assess the patient current stage with respect to the factor in question

Answer 59

**Structure** Focuses on the way in which society is constituted which influences or limits the choices and opportunities available **Agency** Focuses on the capacity of individuals to act independently and to make their own free choices **Relevance** Underpinned by certain philosophical assumptions, ontological, epistemological and methodological – both effect health

Answer 60

Peoples common-sense understanding and knowledge about health and illness Generally rooted in peoples own experiences (it is not always different from medical understandings)

Answer 61

1. Personal knowledge and experience 2. Previous medical encounters 3. Folk knowledge 4. The media and internet 5. Spiritual beliefs 6. Alternative and complementary medicine

Answer 62

Help doctors to better understand peoples illness related behaviour Helps gain insight into the needs of patients and their expectations of doctors Taking lay beliefs into account = more satisfied patients and doctors

Answer 63

**People usually seek advice from others before consulting a doctor – *called the lay system*** **Triggers include:** Interpersonal crisis Interference with social or personal relations Sanctioning (being told to go) Interference with vocational or physical activity A temporalising of symptomatology (when it doesn’t get better by a certain data)

Answer 64

Only the tip of the iceberg actually come to the GP, the rest of population do nothing/self-medicate/see somebody else. The decisions to consult are influenced by perception, explanation and evaluation.

Answer 65

Encouraging people to make healthier choices for better health by: Systematically promoting the benefits of healthy living Asking individuals about their lifestyles, responding appropriately and taking appropriate action. It’s a “chat for change.”

Answer 66

Tackles lifestyle factors such as: Maintaining a healthy weight and diet Stopping smoking Drinking in moderation Mental health Sexual health.

Answer 67

**Smoking** Do not do it **Drinking** 14 units weekly for male and female. Binge drinking is 6 units or more in women and 8 units of more in men. 2 days detox per week. **Weight/healthy eating** 0.5-1kg per week = healthy weight loss. Normal BMI is 18.5-25. **Physical activity** 30mins x 5days per week. Lower risk of many chronic diseases, depression, dementia, stress.

Answer 68

Threat Fear Barriers Benefits Subjective norms Response efficacy Attitudes Intentions Cues to action.