Defintions Flashcards
Public health
The art and science of preventing disease, prolonging life and promoting Heath through the organised efforts of society
The three domains of public health
Health improvement
Health protection
Healthcare public health
Health improvement
Preventing ill health and promoting wellbeing by commissioning and providing services that fit with the need of our population
E.g. sexual health
Drugs and alcohol
Quitting smoking
Health protection
Ensuring that the risks to health from communicable disease/environmental hazards are minimised
Healthcare public health
Making sure we have the right health services in place for the population and that these are effective and accessible to all those who need them
E.g prioritisation
Needs assessment
Service design
Primary prevention
To prevent the onset of disease or injury by reducing exposure to risk factors
E.g immunisation
Posters/campaigns
Health related behaviours - smoking
Environmental factors e.g.asbestos
Precautions w/ communicable disease
Secondary prevention
To detect and treat a disease or its risk factor at an early stage in order to prevent progression or potential future complications of the disease
E.g. screening for cancer
Monitoring and treating blood pressure
Tertiary prevention
To minimise the effects of established disease
E.g. surgery
Medication
Biomedical model
Disease is caused by pathogens, injury, physiological change or damage.
Individuals not to blame - causes out of their control
Treated through intervention - surgery, drugs
Medical team solely responsible for treatment
Pyschology (mood) as an effect of illness not a cause.
Biopysocosocial model
Disease is caused by biological, psychological and social factors
E.g pathogens, genetics, physiology
Behaviour, emotion
Socioeconomic status, housing, support
Health status is a consequence of a variety of factors including lifestyle
Treat physical illness + helping with housing, anxiety, loneliness
The medical team and patient responsible for treatment
Psychosocial factors are an effect but also a cause for illness
Health inequalities
Uneven distribution of health or health resources as a result of genetic + other factors or the lack of resources
Unfair/avoidable differences in life expectancy, mortality, morbidity or disability between groups within the same country
Equality = sameness
Inequity
Unfair and avoidable differences arising from poor governance, corruption or cultural exclusion
Equity = fairness
Socio economic status measurement
Individual occupation
The area in which people live - index of multiple deprivation
Health measurement
Life expectancy
Infant mortality
Black report
Explanations for health inequalities:
- artefact
- social selection
- behavioural-cultural
- materialist
+ psychosocial
+ income distribution
Artefact
Health inequalities are evident due to the way statistics are collected
Social selection
Direction of causation is from health to social position
Sick individuals move down social hierarchy, healthy individuals move up
Behavioural cultural
Ill health is due to peoples choices/decisions, knowledge and goals
E.g. people from disadvantaged backgrounds tend to engage in more health damaging behaviours
Materialist
Inequalities in health arise from differential access to material resources
Pyscosocial
Unequal distribution of the social determinants of health, such as education, housing and employment, drives inequalities in physical and mental health. There is also extensive evidence that ‘psychosocial’ factors, such as work stress, influence health and wellbeing.
Income distribution
Relative, not average, income affects health
Countries with a greater income inequality have greater health inequalities
The most egalitarian societies, not the richest, that have the best health
Measuring access to healthcare
Based on UTILISATION which measures receipt of services
Difficult to interpret
Lay beliefs
Constructed beliefs about health and illness by people with no medical knowledge
Draw upon cultural,social, personal knowledge and own biography
Health
State of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity
Negative health
Health equates to the absence of illness
Functional health
Health is ability to do certain things
Positive health
Health is a state of wellbeing and fitness
Health behaviour
Activity undertaken for purpose of maintains health and preventing illness
Illness behaviour
Activity of ill person to define illness and seek solution
Illness iceberg
Most symptoms never get to a doctor
Sick role behaviour
Formal response to symptoms including seeking formal help and action of person as a patient
Lay referral
The chain of advice seeking contacts which the sick make with other lay people prior to or instead of seeking help from healthcare professionals
Early presenters
Experienced significant and rapid impact on functional ability
Delayers
Often developed explanations for symptoms that related to preceding activities
Recognition that this explanation was inadequate to explain symptom progressions prompts consultation
Perceptions of typical victim and typical symptoms are wrong - don’t recognise use variation and mildness of some symptoms
Deniers
Don’t accept they have the illness
Acceptors
Accept and take their treatment
Pragmatists
Accept illness but not in all circumstances i.e asthma not a long term illness therefore only use relief medication
Long term condition
Long term
Profound influence on lives of sufferers
Often co-morbid conditions
Illness narratives
Refer to the story telling and accounting practices that occur in the face of illness
Much sociological research on LTCs is based on this
Illness work
Diagnosis
Mangaging the symptoms
Self management
Coping and dealing with the physical manifestations of the illness. Body changes might lead to self conception changes
Everyday life work
Coping - cognitive roles involved with dealing with illness
Strategy - actions and processes involved in managing the condition and its impact
Try to keep preillness lifestyle or redesignate your new life as ‘normal life’
Emotional work
The work people do to protect the emotional well being of others
Deliberately maintains normal activities
Withdraw from social terrain
Downplaying pain and presenting as cheery
Biographical work
Loss of self
Former self image crumbles away without simultaneous development of a new one
Interaction between body and identity
Identity work
Establishment and maintenance of an acceptable identity
Stigma
Discreditable
No illness can be seen but if found out, can affect patients even more due to the stigma of their condition
E.g. aids, mental illness
Discredited
Physically visible characteristic or well known stigma that sets them apart
E.g physical disability, epilepsy
Felt stigma
Fear of enacted stigma
Fear of discrimination and prejudice whilst also encompassing a feeling of shame
Enacted stigma
The real experience of prejudice, discrmation and disadvantage as a consequence of a condition
Classical conditioning
Environmental or emotional cues linked to a behaviour
Operant conditioning
Behaviour is shaped by consequences
Social learning
People can learn vicariously - from observation/modelling
Theories linked to behaviour
- Learning theories
- classical conditioning
- operant conditioning
- social learning
- Social cognition models
- cognitive dissonance theory
- health belief model
- theory of planned behaviour
- COM-B model
Cognitive dissonance theory
Discomfort when hold inconsistent beliefs or actions/events don’t match beliefs
Reduce discomfort by changing beliefs or behaviour
Health belief model
Beliefs about health threat
Beliefs about health related behaviour
Cues to action
Theory of planned behaviour
Attitude toward behaviour
Subjective norm
Percieved control
LEADS TO INTENTION but not necessarily action
COM - B
Behaviour linked between:
Capability - physical and psychological
Motivation - reflective and automatic
Opportunity - physical and social
Substance abuse
The harmful/hazardous use of psychoactive substances including alcohol and illicit drugs
Dependence syndrome
Cluster of behavioural, cognitive and physiological phenomena that developed after repeated substance abuse
- strong desire to take the drug
- withdrawal state
- higher priority than other symptoms
- increased tolerance
- difficulties in controlling its use
- persisting even when knowing consequences
Physical dependence
Experiencing symptoms associated with withdrawal
Psychological dependence
Impaired control (addiction)
Compliance
The extent to which the patient complies with medical advice
Adherence
The extent to which a persons behaviour corresponds with agreed recommendations from a healthcare provider
E.g taking medication, following a diet, lifestyle change
More patient centred
Concordance
The negotiation between the patient and doctor over treatment regimes, implies patient is active and in partnership with the doctor
Unintentional non-adherence
Practical problems
E.g poor memory, difficulty administering treatment, inability to pay, poor comprehension of instructions
Intentional non-adherence
Patients don’t want to adhere
Conscious decision not to follow treatment based on beliefs, attitudes and expectations
Adherence model
Patient factors Psychosocial factors Healthcare factors Treatment factors Illness factors
Inclusion health
A service, research and policy agenda that aims to prevent and redress health and social inequalities among the most vulnerable and excluded
Health promotion
The process of enabling people to increase control over and improve their health
Universal health promotion approaches
Aim to reduced risks across the whole population
E.g. sugar tax
Targeted health promotion approaches
Aim to identify those most at risk and then tailor messages and approaches to that group/groups
E.g. breast feeding indicative in young mums
Harm paradox
Population risk is affected but individual risk for many is not and this then affects percieved credibility
Social policy
Local, national or international culture and policy
E.g. smoking ban in public places
Fiscal approaches
Taxation or other approaches to discourage harming health behaviours
E.g. tax on cigarettes and alcohol
Bans and restrictions
Reducing availability, using legal powers, restricting use in certain areas
E.g. making substances illicit, restricting sales of alcohol and cigarettes
Obesity
An abnormal or excessive fat accumulation that presents a risk to health
Criteria for screening
- condition
- test
- intervention
- screening programme
- implementation
Lead time bias
Early diagnosis falsely appears to prolong survival
Length time bias
Screening programmes between at picking up slow growing, unthreatening cases than aggressive, fast growing ones
Selection bias
Studies of screening often skewed by ‘heathy volunteer’ effect- those who have regular screening are also likely to do other things to protect them from disease
Sensitivity
The proportion of people with the disease who test positive
Specificity
The proportion of people without the disease who test negative
Positive predictive value
Probability that someone who has tested positive actually has the disease
Negative predictive value
Probability that someone who test negative for the disease doesn’t actually have the disease
Explicit rationing
The use of institutional procedures for the systematic allocation of resources within the healthcare system
Technical processes - assessments of efficacy and equity
Implicit rationing
The allocation of resources through individual clinical decisions without the criteria for this decisions being explicit
Scarcity
Need outstrips resources - prioritisation is inevitable
Efficiency
Getting the most out of limited resources
Equity
The extent to which distribution of resources is fair
Effectiveness
The extent to which the intervention produces a desired outcome
Utility
The value an individual places on a health state
Opportunity cost
Once you have used a resource in one way, you no longer have it to use in another way
Measured in benefits foregone
Technical efficiency
Most efficient way of meeting a need
E.g. antenatal care be community or hospital based
Allocative efficiency
Choosing between the many needs that need to be met
E.g. fund hip replacements or neonatal care
Economic evaluation
Compares inputs/resources and outputs/benefits of alternative interventions
- Cost minimisation analysis
- Cost effectiveness analysis
- Cost benefit analysis
- Cost utility analysis
Patient reported outcomes
Any report of the status of a patients health condition that comes directly from the patient, without interpretation by a clinician or anyone else
Patient reported outcome measures
The tools or instruments used to measure PROs - turn subjective experiences into numerical scores that can easily be utilised
Quality of life
Multi-dimensional concept that includes domains related to physical,mental,emotional and social functioning
Health related quality of life
The functional effect of an illness and its consequent therapy upon a patient, as perceived by a patient.
Reliability
Is the instrument accurate over time and internally constant
Validity
Does the instrument actually measure what is intended to measure
Specific PROMs
Disease specific
Site specific
Dimension specific
Reflective motivation
Self beliefs, attitudes and evaluations of exercise
Automatic motivation
Fears and inhibition
Implementation intentions
Simple plan in the form of ‘if X, then i will Y’
X = relevant situation Y = response
Stigma
The identification or recognition of a negatively defined condition, attribute, trait or behaviour in a person or group of people.
Features of Ottawa charter
Enabling people to increase control over and improve their health
Maximising social and personal resources, as well as physical capacities
Goes beyond healthy lifestyles to encompass well being more broadly
Uptake
The proportion of those invited who take up the invitation to participate
Coverage
The proportion of eligible population who have been screened within a given time period
Limitations of parsons sick role behaviour theory
- Not all illness are temporary
- Does not acknowledge the difference between people
- Does not acknowledge individual agency in defining and coping with illnesses
Screening
The presumptive identification of unrecognised disease or defective by conducting test, examinations or procedures
Rapidly sort out symptom free people who do and do not have the disease
