Determinants, Equity and Interventions

Question 1

What is the definition of public health?

Answer 1

The science and art of PREVENTING DISEASE, PROLONGING LIFE, and PROMOTING HEALTH, through organised efforts of society

Question 2

What are the key determinants of health as outlined in the Lalonde report, 1974?

Answer 2

1. genes
2. environment - physical, social and economic
3. lifestyle
4. health care

Question 3

Give more specific examples of the social determinants of health

Answer 3

housing
water and sanitation
unemployment
education and health literacy

Question 4

Define primary prevention and give examples

Answer 4

Prevention of disease or injury before it occurs

• Making seatbelts compulsory
• Ban on asbestos use in buildings
• immunisation

Question 5

Define secondary prevention and give examples

Answer 5

Aims to reduce the impact of a disease or injury that has already occurred by detecting and treating illness as soon as possible or halt/slow its progress to prevent long term problems
- breast cancer screening
- NHS health check - screening for diabetes, hypertension
(may also be preventing a similar event from happening again eg an MI - check notes on the lec)

Question 6

Define tertiary prevention and give examples

Answer 6

Aims to reduce the impact of a long term condition

• cardiac/stroke rehab programs
• support groups

Question 7

What is the difference between equality and equity?

Answer 7

Equality concerns that shares are equal
Equity concerns that shares are fair and just

Remember that equality may not be equitable, if everyone is treated the same, but their needs are different then this is unfair

Question 8

What is horizontal equity?

Answer 8

Equal treatment for equal need

- eg individuals with pneumonia with all other things being equal, should be treated the same

Question 9

What is vertical equity?

Answer 9

Unequal treatment for unequal need

• eg individuals with the common cold versus pneumonia
• areas with poorer health may need higher expenditure on services

Question 10

What are the dimensions of health equity

Answer 10

Spatial (geographical) 
Social: 
- age 
- gender 
- socioeconomic class 
- Ethnicity

Question 11

What factors can we use to examine whether a service is equitable?

Answer 11

• provision
• access
• utilisation
• healthcare outcomes
• health status
• resource allocation
• wider determinants of health

Question 12

What are the three domains of public health practice (important ques)

Answer 12

1. health improvement
2. health protection
3. improving services (health care)

Question 13

What is health improvement?

Answer 13

societal interventions aimed at preventing disease, promoting health and reducing inequalities

Question 14

What is health protection?

Answer 14

Measures to control infectious disease risks and environmental hazards

Question 15

What does the domain ‘improving healthcare services’ involve?

Answer 15

The organisation and delivery of safe, high quality services for prevention, treatment and care

Question 16

Give terms that come under the health improvement domain of public health (come back to this from PH assignment instructions)

Answer 16

Reducing inequalities 
Education
Housing 
Employment 
Lifestyles

Question 17

Give terms that come under the health protection domain of public health (come back to this from PH assignment instructions)

Answer 17

Infectious disease
chemicals and poisons 
Radiation
Emergency response 
Environmental health

Question 18

Give terms that come under the health care domain of public health (come back to this from PH assignment instructions)

Answer 18

Clinical effectiveness
Safety
Service planning 
Audit and evaluation
Clinical governance - ensures that the standards of care are maintained and improved 
Equity

Question 19

What types of interventions may be delivered within public health?

Answer 19

Health service interventions

Non-health interventions that may have an impact on public health eg increasing cycle lanes within cities

Question 20

At what levels may an intervention be delivered at?

Answer 20

Individual
Community
Ecological (population)

Question 21

Give an example of an individual intervention

Answer 21

Coronary angioplasty
Appendectomy
Psychological support eg CBT

Question 22

Give an example of a community intervention

Answer 22

Clean air spaces
Youth centres
Health library
Park run

Question 23

Give an example of a population intervention

Answer 23

Sugar tax

Banning smoking in public places