Case 5- Public health

Question 1

Exercise guidlines for adults

Answer 1

All adults aged 19 years and over should aim to be active daily. Over a week this should be up to at least 150 minutes of moderate intensity exercise in bouts of 10 minutes or more. Comparable benefits can be achieved through 75 minutes of vigorous intensity exercise or a combination of both. All adults should also undertake physical activity to improve their muscle strength on at least 2 days. They should minimise the amount of time being sedentary.

Question 2

Exercise guidlines for the elderly

Answer 2

Older adults (65+) who are at risk of falls should incorporate physical activity to increase balance and coordination on at least 2 days a week. Individual physical and mental capabilities should be considered when interpreting guidance.

Question 3

What is moderate intensity physical activity

Answer 3

Anything which leads to faster breathing, increased heart rate and feeling warmer, such as walking 3-4mph or mowing the lawn

Question 4

What is vigorous intensity physical activity

Answer 4

Anything that leads to very hard breathing, shortness of breath, rapid heart rate and should leave a person unable to maintain a conversation comfortably, such as running at 6-8 mph, cycling at 12-14mph or swimming a slow front crawl (50 yards/minute).

Question 5

Physical activity birth to 5 years

Answer 5

Aim to be active for at least 180 minutes a day

Question 6

Physical activity for 5-18 year olds

Answer 6

Active for at least 60 minutes a day

Question 7

How to talk to a patient about loosing weight?

Answer 7

Get the patient to suggest things they would be willing to do.

Question 8

Health promotion

Answer 8

The process of enabling people to increase control over and improve their health. If a patient discusses their weight themselves, acknowledge their concerns and ask them whether they ‘want to take action’. Suggest interventions that corelate with their lifestyle.

Question 9

How is a healthy weight achieved

Answer 9

A healthier weight is primarily achieved through strategies including a healthier diet, portion control and being more physically active. Setting weight loss goals is useful. Potentially having a weigh in every month at the GP or calling up the GP to record your weight over a set time period.

Question 10

The factors that form health beliefs

Answer 10

• Perceived benefit vs perceived barrier
• Perceived threat- seriousness and susceptibility
• Self-efficacy- whether they think if the intervention will be successful
• Cues to action- someone you know being diagnosed with diabetes

Question 11

Cycle of change

Answer 11

Precontemplation -> Contemplation -> Preparation -> Action -> Maintenance/relapse prevention

Question 12

Ten factors that influence illness behaviour

Answer 12

1) Visibility of signs and symptoms
2) Perceived seriousness of the symptoms based on perceptions of present and future probabilities of danger
3) Amount of disruption caused by the symptoms to work, family etc
4) Frequency and persistence of symptoms
5) Tolerance threshold of person exposed to symptoms
6) Knowledge information and assumptions of the evaluator
7) Basic needs leading to denial
8) Needs leading to competition with illness
9) Competing interpretations assigned to symptoms once recognised
10) Availability of treatment- access, cost (not only financial but also emotions)

Question 13

Patients and their symptoms

Answer 13

Patients will have had a long experience with their symptoms and consulting with doctors and may have accessed information and advice from a variety of sources which may not be reliable

Question 14

Health protection- public health

Answer 14

1) Screening program
2) Infection control
3) Appropriate use of antibiotics
4) Radiation protection

Question 15

Wider determinants- public health

Answer 15

1) Influencing strategy
2) Promoting healthy environments
3) Access to education and employment
4) Supporting vulnerable communities

Question 16

Health care- public health

Answer 16

1) Early diagnosis and interventions
2) Supporting self-management
3) Rehabilitation and enablement
4) Management of chronic conditions

Question 17

Health improvement- public health

Answer 17

1) Falls prevention
2) Making every contact count
3) Health improvement campaigns
4) Occupational health ergonomics
5) Community development programmes

Question 18

What is included under public health

Answer 18

1) Health protection
2) Wider determinants
3) Health improvements
4) Health care-public health

Question 19

The EAST behaviour change model

Answer 19

In order for people to change their behaviour it must be: easy, attractive (benefit), social (other people are doing it) and timely (when the patient is receptive

Question 20

The rose hypothesis

Answer 20

Because risk factors for diseases are often normally distributed, normally distributed programmes will have a greater effect on health at the population level rather than targeted approaches

Question 21

The prevention paradox

Answer 21

Actions to reduce the risk of a disease or illness across the population may successfully reduce the populations overall risk wile providing only a minimal effect to each individual. For example, though vaccination provides herd immunity it probably doesn’t effect the individual that much.

Question 22

The rose hypothesis vs the prevention paradox

Answer 22

Preventative measures offer a large benefit to the community but offers few benefits to the individual

Question 23

The health belief model

Answer 23

The likelihood of behavioural change is influenced by perceived benefit vs cost and the perceived threat of the disease. This is influenced by perceived seriousness, cues to action (education, media) and non modifiable factors like age, personality, knowledge and socio-economic status

Question 24

Problems with the health belief model

Answer 24

• Focus’s on the conscious processing of information, people don’t always make rational decisions
• Emphasis on individuals and not social influences, easier to eat healthier if your family is.
• Hard to measure relationship between core beliefs
• Absence of emotional factors (fear)

Question 25

The theory of planned behaviour

Answer 25

Attitudes- belief of outcome
Subjective norms- motivation to comply
Perceived behavioural control- perceived likelihood of occurring
These are all effected by external variables and come together to influence intentions which will effect behavioural change

Question 26

Criticism of the theory of planned behaviour

Answer 26

There is a gap between intentions and behaviour, social influences are also limited

Question 27

Health psychology

Answer 27

Considers how psychological processes inform experiences of and attitudes towards health

Question 28

Parson’s sick role

Answer 28

Two rights:

1) Exemption from blame for having the illness
2) Exemption from normal responsibilities such as work

Two responsibilities:

1) Duty to seek medical assistance
2) Duty to want to get better

Question 29

Lay referral network

Answer 29

Talking to family members or friends about symptoms

Question 30

Deviance

Answer 30

People who deviate from the norm are deviants. In medicine illness is a form of deviance where the doctor is an agent of social control (restricting access to sick role). Being labelled as a deviant may reinforce ‘deviant behaviour’ and have implications for their role in society. Primary deviance is a symptom secondary deviance is a diagnosis. This particularly relevant to psychiatric disorders and addiction where it could unhelpful.

Question 31

Stigma

Answer 31

Acquiring a diagnostic label may result in felt and/or enacted stigma.

Question 32

Felt stigma

Answer 32

What you feel, could be shame or depression and withdrawal from society

Question 33

Enacted stigma

Answer 33

The stigma people enforce on you such as fighting or not being allowed health care

Question 34

Adherence behaviour

Answer 34

The extent to which the patients behaviour matches agreed recommendations from the prescriber. Adherence is important for patient recovery. People are more likely to adhere if they are satisfied, understand the information given and recall the information. There can be unintentional and intentional nonadherence. May have to give a blister pack or write down the information so that they can remember the medication.

Question 35

How to measure the health of a nation

Answer 35

• Census data
• Surveys
• Mortality data- death certificates
• Morbidity data- disease registers, QOF
• Surveillance data- for example for notifiable diseases
• Research data- quantitative and qualitive
• Life expectancy

Question 36

Chalanges of measuring global health

Answer 36

• Civil registration systems are inadequate in many settings.
• International co-ordination is difficult.
• Digitalisation of data is difficult in low-income settings.
• Informal health care is difficult to measure/quantify.

Question 37

Communicable and non-communicable diseases

Answer 37

Non-communicable diseases have increased in western countries whilst communicable diseases are more prevalent in sub-sahra Africa. In more deprived areas chronic diseases may present earlier

Question 38

Stage of epidemiologic transition

Answer 38

1) Pestilance and famine- high death and birth rate
2) Receding pandemics- death and birth rate start to decrease, the death rate more quickly
3) Degenerative and man made diseases- the gap between birth and death rate gets smaller
4) Delayed degenerative diseases and emerging infections- birth and death rate are very low.

Question 39

The double burden of disease

Answer 39

Refers to the coexistence of communicable and non-communicable diseases in low and middle income countries, especially in sub-sahra Africa

Question 40

Health system

Answer 40

All activities whose primary purpose is to promote, restore and maintain health

Question 41

The 5 ways health systems are funded

Answer 41

• General Taxation
• Social health insurance
• Private health insurance
• Out of Pocket payment
• Donations to charity

Question 42

How public health plans and evaluates health services

Answer 42

• Health Protection- recording and preventing communicable diseses
• Health Promotion- diet and exercise
• Healthcare public health- reducing health inequalities by prioritising recources. It focuses on population do the services meek the publics demand. Also has a role in prevention like screening and immunising. Provides care to those who need it. How to ration recources.

Question 43

WHO model for the essential component’s of a health system

Answer 43

• Service Delivery- the facilities available
• Health workforce- staff, they provide the care
• Health information systems- you can adapt to changes and see rises in different cases, meeting the demand in the future.
• Access to essential medicines
• Financing
• Leadership and governance- ensure a safe and efficient system within the legal framework

Question 44

Tax based finance

Answer 44

Administered by the government, economies of scale. Pooling of risk across the whole country, we don’t know who will get ill but we all pay a little bit to make sure our health care is paid for. Progressive taxation, people who earn more contribute more. Choice limited, you get what you are given. You get a common package; everyone gets the same level of care. Funds for healthcare is competing with other areas like education and defence. Responsiveness can be slow.

Question 45

Social health insurance

Answer 45

Bismarck model. Initially created to ensure labourers were ensured by employers in case of illness. Both employer and employee contribute. Health funds are kept separate from other sectors. Heavily regulated by the Government. Choice for healthcare, expensive to administrate. Contributions are not based on health risk.

Question 46

Private financing of healthcare

Answer 46

Insurance premiums. Premiums are based on personal risk, usually to voluntary to contribute. Payments are not linked to earnings. Poorer people who have a higher risk have to pay a higher premium. Fuels health inequalities, costly administration.

Question 47

Out of pocket payments for healthcare

Answer 47

No pooling of money at all, you pay for treatment when you need it. It is a sudden expense, often unaffordable