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European Public Health > Case 1 > Flashcards

Case 1 Flashcards

EPH2022

1
Q

What is socioeconomic position?

A

Social class of an individual/group often measured as a combination of education, occupation and income

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2
Q

*What did the Whitehall study show?

A
  • Lower hierarchical occupational levels = worse health + shorter LE
  • SGH considers differences between social groups instead of between individuals.
  • SGH = health inequalities affect everyone differently

SGH = social gradient of health

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3
Q
A
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4
Q

What are 3 aspects of how the working world can affect your health?

A
  1. Employment relations
  2. Employment conditions
  3. Working conditions
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5
Q

How do employment relations affect health?

A

In developed countries jobs often with contracts/laws but often not in underdeveloped countries. Differs between countries

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6
Q

*How do employment conditions affect health?

A
  • Based on type of employment
    Informal employment has:
  • lack of social benefits
  • lower salaries
  • high turnover
  • lack of security
  • non-defined work-time
  • lack of compensation at firing

Risk of mental distress and psychological disorders

Child labour - majour cause of illiteracy, low education & low skilled workers

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7
Q

How do working conditions affect health?

A
  • tasks carried out by the workers
  • social environment, physical and chemical environment
  • way work is organised
  • technology used
  • poor relationship with employer can = stress = unhealthy lifestyle choices
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8
Q

What do unemployed people and precarious workers have in common?

A

Both share:
- insecurity
- low self esteem
- lack of control over work and home life
- stressful circumstances

= adverse health effects: anxiety, mental effects, depression

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9
Q

How does unemployment affect morbidity & mortality?

A
  • Financial problems = lower living standards = reduce social integration & lower self esteem
  • Can trigger distress, anxiety, depression also for family, partners, children of unemployed.
  • Increase smoking and alcohol consumption and decreased physical acitvity. Can be seen as a stress reliever for some people.
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10
Q

*what are the work and lifestyle factors contributing to SES inequalities?

Have I included correct info? and ses or sep?

A

https://research.vu.nl/en/publications/the-contribution-of-work-and-lifestyle-factors-to-socioeconomic-i

  • Gender stereotypes => gender inequality due to occupational segregation
  • Job resources (low SES workers have less reward & autonomy in work but high SES workers have higher work demands (work overtime/overload))
  • Inequality in exposure to risk (low SES jobs often dangerous, minimum protection)
  • Low occupational roles & poor working conditions more common for poeple with lower level of education & lower position in social graidnet.
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11
Q

Define horizontal segregation

A

where workforce of a specific industry/sector is mostly made up of one particular gender.

E.g. in construction, where men make up majority of industry’s workforce, whereas childcare is almost exclusively a female occupation

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12
Q

Define vertical segregation

A

situation where people do not get jobs above a particular rank in organizations because of their race, age, or sex:

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13
Q

What are the two hypotheses for explaining SES inequalities in the living and working environment?

A
  1. Mediation
  2. Moderation
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14
Q

Explain the mediation effect

A
  • relationship between SEP & health explained by work characteristics. Lower SEP=worse work characteristics = worse health

Focus on how .. impacts SEP & self-rated health:
- material factors (e.g. housing, physical demands on work, etc)
- behavioural factors (smoking & physical inactivity)
- psychosocial factors (lack of social support)

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15
Q

What is the relationship between SEP & health explained by?

IS THIS ANSWER CORRECT???

A

Explained by work characteristics.

Lower SEP = worse work characteristics = worse health

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16
Q

Explain the moderating effect

A

**- Looks at whether relationship between work characteristics & health are different for poeple with a higher/lower SEP **

  • Effects of unhealthy lifestyle and living and working conditions on health is larger in people with low SES.
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17
Q

Define work characteristics

A
  • work autonomy
  • task variety
  • task demand
  • hours
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18
Q

Define workplace health promotion (WHP)

A

Combined efforts of employers, employees and society to improve the health and well-being of people at work

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19
Q

How can WHP be achieved?

A

Combination of:
- Improving work organisation and working environment
- Promoting active participation
- Encouraging personal development

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20
Q

What does WHP include?

A
  1. Organisational commitment to improve health of workforce
  2. Appropriate info to employees + establishing communication strategies
  3. Involving employees in decision process
  4. Develop working culture based on partnership
  5. Organise work tasks & processes that contribute to health instead of damage
  6. Implement policies & practices enhancing employee health by making the healthy choices, the easy choice
  7. Recognise organisations have impact on people & is not always good for health & well-being.
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21
Q

*What is the PRECEDE-PROCEED model?

A

Framework for developing health promotion programs & apply theories. It is a planning model, not specific behaviour change theory.

Focuses on lifestyle but recognizes wider factors.

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22
Q

What is precede?

A

Before launching the intervention (what should you do)

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23
Q

What is proceed?

A

Steps to take to implement & evaluate intervention
- implementation
- process, impact, outcome evaluation (PIO)

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24
Q

What is phase 1 of the precede-proceed model?

A

Phase 1: Social assessment
- Potential areas for action
- Population priorities & needs

25
Q

What is phase 2 of the precede-proceed model?

A

Phase 2: epidemiological assessment
- Objective of change
- Social, political, economic determinants of health

26
Q

What is phase 3 of the precede-proceed model?

A

Phase 3: educational & ecological assessment

  • predisposing factors: individual knowledge, personal health promotion
  • Reinforcing factors: factors that allow a behaviour that determines whether a person receives + or - feedback on behaviour. Money can buy reinforcements. Lower SES often lack social support from important people to then
  • Enabling factors: resources required to make behavioural and environmental changes (availability, accessibility, affordability of products to have a healthy diet, money & the skills, enabling to make healthy decisions e.g. go to gym)
27
Q

What is phase 4 of the precede-proceed model?

A

Phase 4: Administrative & policy assessment and intervention alignment
-Meet objectives set in phase 1-3
-select interventions most likely to be successful

28
Q

What is phase 5 of precede-proceed model?

A

Implementation of intervention

29
Q

What is phase 6-8 of precede-proceed model?

A

Phase 6: process evaluation
Phase 7: Impact evaluation
Phase 8: outcome evaluation

30
Q

Why is there a large focus on lifestyle?

A
  • always relates to behaviours whether voluntary or not
  • based on biological & environmental factors?
  • focus re-emerged after WWII (see lecture EPH1021)
31
Q

What is the Lalonde report?

A

4 macro determinants:
- professional care
- genetics
- behaviour/lifestyle
- environment

These are in every single model of PH!

32
Q

What are the general trends in the EU?

A
  • more obesity (20-30%) compared to 1970s (5-15%) = big impact healthcare system
  • Life expectancy increasing
33
Q

What is Health in all Policies (HiaP)?

A

Collaborative approach which integrates & articulates halth considerations into policymaking across sectors to improve health of all communities & people.

34
Q

What are some examples & differences of health related lifestyles in the EU?

A

Smoking:
-not only causes problems with lungs but also heart attacks
- some countries higher tax influencing consumption of tobacco.

Physical activity:
- boys getting more physical activity than girls maybe coz of how world is socialised (boys maybe encouraged to do PA) or coz of biology (boys want to be more active)
- decrease in PA maybe due to improved technology (gaming, phones, etc)

Suicide rate:
- Started to increase after great recession in 2007-2009. Products/life more expensive = more financial difficulties but alcohol consumption decreased maybe coz it got more expensive

35
Q

What did Emily Durkheim say about suicide?

A
  • Society transcends the individual
  • Suicide is a “social fact”
  • showed rates of suicide differed between catholics & protestants & argued that act & choice of suicide is socially influenced
  • Groundbreaking insight to understanding suicide as a social phenomenon
36
Q

*What are EU policies on lifestyle? - read links in doc!

A
  • European 2020 & health => focused more on different aspects of lifestyle
  • 2013 investing in health => more idea that we need to work on health coz health necessary for wealth
  • 2007 together for health => 1st EU doc about lifestyle & lifestyle interventions
37
Q

What can we conclude about obesity, smoking, PA & suicide?

A
  • Differ greatly by EU country & combine to explain differences in LE
  • Cannot be separated from aspects of physical environment (e.g. availability of products, weather, etc)
  • Cannot be separated from aspects of social environment (e.g. cultural norms/values, history, national policies)
38
Q

What are approaches to changing “lifestyle”?

A

Approaches must take a two-pronged approach:
- focus on a given behaviour
- account for influence of broader set of factors that contribute to that behaviour.

39
Q

Define lifestyle

A

Describes behaviours that emerge through complex interrelationship among voluntary, biological & environmentally-induced factors.

40
Q

What is the component “develop personal skills” of the Ottawa charter?

A

Personal skills you need, health literacy & ability to learn about what is healthy & act upon it

41
Q

What is health literacy?

A

Degree to which individuals have the ability to find, understand & use the information & services to inform health-related decisions and actions for themselves and others

42
Q

What is the job of the health promoter according to Ottawa Charter?

A
  1. Enable - enable people to be healthy
  2. Mediating - mediated between people & authorities
  3. Advocating - policy advocacy level (try to create good public policies to create situations which protect & promote people’s health)
43
Q

What is SEP?

A

Social standing/social class of individual/group measured. ascombination of education, income & occupation

44
Q

What is lower SEP associated with?

A

Higher levels/rates of:
1. obesity
2. tobacco use
3. chronic diseases
4. depression
5. social problems
6. chronic stress

Less healthy life years & shorter lives

45
Q

What factors influence SEP & self-rated health?

A
  • Material factors (housing & physical work force)
  • Behavioural factors (smoking, physical inactivity)
  • Psychosocial factors (lack of social support)
46
Q

What is the difference between equity & equality?

A

Equality means each individual or group of people is given the same resources or opportunities.

Equity recognizes that each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome.

47
Q

According to the Council of PH & Society, how do. wedecrease halth inequalities?

A
  1. National & local policies to prevent health inewuality & **provide individual level support **with behaviour change.
  2. Decrease health inequalities should be aim of multiple ministries
  3. Policies with long duration (min 15 yrs)
  4. focus on geographic areas with biggest health inequalities
  5. More financial means for decreasing health inequalities
  6. Make legal duty to decrease halth inequalities with mandatory periodic progress reports
  7. Make environment healthier with less fast food stores & marketing sugar tax & cheapr healthy foods.
48
Q

Define job strain

A

Having demanding job but low control over it. See this often with people of lower SEP.

49
Q

*What do lifestyle & work characteriscis have to do with how health is treated differently?

A
  • Depending on lifestyle & work, may not prioritise health
  • People of higher SEP can be affected by bad work & life balance = affect health
  • unemployment = low self esteem, anxiety & depression & health not treated well

is it SEP or SES?

50
Q

What are the challenges for working world in the 21st century?

A
  • Globalisation
  • Unemployment
  • Increasing use of information technology
  • Changes in employment practice (e.g. short-term, parti-time employment)
  • Ageing
  • Increasing importance of service sector
  • Increasing # of people working in small & medium sized enterprises (SMEs)
  • Customer orientation & quality management
51
Q

What is a benefit of WHP?

A

Reduction in sickness related costs & increase in productivity. Results from healthier workforce with increased motivation, higher morale & imporved working relationships

52
Q

What is the Common Agricultural Policy (CAP)?

A
  • Aims to provide affordable, safe and high-quality food for EU citizens
  • But under current policies, stimulating production of food stocks making us obese (wine,sugar,tobacco & olive oil) and taking away probability to prevent cancer.
53
Q

What is intergenerational poverty?

A

Relentless cycle where poverty is passed down from one generation to next, indicating that** impoverished** parents = impoverishd children.

Cycle occurs coz lack of resources poor citizens receive, e.g. inadequate healthcare & education

54
Q

What are 4 steps to undertake health promotion & social support to help people reach ‘stairs’ towards healthy life?

A
  1. Creating mental space
  2. Making it attractive
  3. Removing barriers
  4. Active promotion
55
Q

How do you create a mental space in health promotion & social support?

A

Create ‘mental space’ by tackling people’s more urgent problems first before starting with health promotion.

Helping with money problems, housing, children, subsistence insecurity, etc that create stress & can decrease mental space.

56
Q

How do you make it attractive in health promotion & social support?

A
  1. Interesting & attractive to move in direction of stairs.
  2. Effective intervention not useful if nobody uses/many people drop out.
  3. Ask people themselves how to make intervention attractive.

Examples: (financial) incentives for participation, using experts by experience/ambassadors in recruitment, offer fun activities + health promotion intervention = positive approach.

57
Q

How do you remove barriers in health promotion & social support?

A
  1. Consider possible barriers to participation & systematically remove all of them
  2. Participation should be free of charge including help with reimbursement by health insurance.
  3. Offer help with signing up for health promotion interventions
  4. Distance/location = barriers, offer interventions close-by & non-threatening known location.
  5. Health promotion interventions at workplace & in working hours are very low-threshold.
58
Q

How do you actively promote health promotion & social support?

A
  1. Can’t expect people look for (& find) health promotion interventions. Should be offered support. e.g. on the street informing people reaches people with lower SEP but flyers, emails often only reach people with higher SEP. What if they are unemployed?
  2. Proactive and personal (one-on-one) recruitment is needed.
  3. Trusting relationship with person who recruits participants (e.g. a GP, nurse practitioner, team leader of work, religious leader)
  4. Passive versus active promotion of health interventions:
    - **Passive: **most often used, not very effective, reaching higher SEP
    - Active: less often used, very effective, reaching lower SEP.
59
Q

What do we need to do extra for people with lower SEP?

A

Group support
1. Social support needed
2. Group support with clear guidelines (sometimes can be kicked out if relapse) & offered at workplace

Professionals
1. Need right attitude, knowledge & skills
2. Need non-judgemental & respectful attitude

Connecting
1. Intervention should connect well with target group
2. Similar group of people
3. Flexible intervention & professionals
4. Experts with experience

Materials
1. Should be simple & suitable for poeple with low-literacy (picture books, audio, etc)
2. Develop materials together with target group

Incentives
1. Financial/non-monetary incentives for quit success.

More intensive
1. Low SEP = more intensive intervention especially at start. (combination of weekly group meetings, individual support & whatsapp contact)
2. Year long support instead of few weeks

Stress & help
1. Learn to deal with stressful situations
2. Professionals listen & pay attention

European Public Health (7 decks)

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