Determinants, Equity & Interventions Flashcards
What are the steps of Maslow’s Hierarchy?
Physiological ->safety -> love/belonging ->esteem -> self-actualisation
What are the factors that make up the physiological section of Maslow’s hierarchy?
Breathing, food, water, sex, sleep, homeostasis, excretion
What are the factors that make up the safety?
Security of body, of employment, of resources, of morality, of the family, of health, of property
What are the factors that make up the love/belonging section of Maslow’s hierarchy?
Friendship, family, sexual intimacy
What are the factors that make up the esteem section of Maslow’s hierarchy?
Self-esteem, confidence, achievement, respect of others, respect by others
What are the factors that make up the self-actualisation section of Maslow’s hierarchy?
Morality, creativity, spontaneity, problem solving, lack of prejudice, acceptance of facts
What is the definition of epigenetics?
The way that genes and the environment interact and affect each others
What is the theory behind epigenetics?
The expression of the genome depends on the environment. No individual ever has the same experience as another. We are each unique and need to be regarded as such. Genetic predisposition, not determination is the key.
How is biology and biography relayed to epigenetics?
The human organism relates to, and is integrated with, it’s environment. Lived experience affects human biology. Both interact to contribute substantially to health and disease.
What is allostasis?
Stability through change. Our physiological systems have adapted to react rapidly to environmental stressors. They are programmed to be turned on and off efficiently, but not too frequently
What is the population perspective?
Think in terms of groups rather than individual
What are the determinants of health?
Genes, environment (physical, social and economic), lifestyle and health care
What are the three stages of health determinants?
Individual lifestyle factors -> social and community networks -> general socio-economic, cultural and environmental conditions
What sort of thing makes up the general socio-economic, cultural and environmental conditions?
Agriculture & food production; education; work environment; unemployment; water and sanitation; healthcare services; housing
What is the difference between equity and equality?
Equity is about what is fair and just. Equality is concerned with equal shares
What is horizontal equity?
Equal treatment for equal need e.g. patients with pneumonia (with all other things being equal) should be treated equally
What is vertical equity?
Unequal treatment for unequal need e.g. individuals with common cold vs pneumonia need unequal treatment. e.g. areas with poorer health may need higher expenditure on health services
What are the different forms of health equity?
Equal expenditure for equal need; equal access for equal need; equal utilisation for equal need; equal healthcare for equal need; equal health
What are the dimensions of health equity?
Spatial (geographical) or social (age, gender, socio-economic class, ethnicity)
How do you examine health equity?
Supply of health care; access of health care; utilisation of health care; health care outcomes; health status’ resource allocation (healthcare vs other areas); other wider determinants of health
What are the wider determinants of health?
Diet, smoking, healthcare seeking behaviour; socio-economic and physical environment
How do you assess health equity?
Typically you assess inequality. then if it is inequitable then you need to explain the inequalities
What is the issue in assessing equity?
Equity is often defined in terms of equal access for equal need. But it is usually determined using utilisation, health status or supply
What are the three domain in public health practice?
Health improvement, health protection and improving services
What is health improvement concerned with?
Concerned with social interventions (not primarily delivered through health services) aimed at preventing disease, promoting health and reducing inequalities
What is health protection concerned with?
Concerned with measures to control infectious disease risks and environmental hazard
What is improving healthcare services concerned with?
Concerned with organisation and delivery of safe, high quality services for prevention, treatment and care
What are the areas involved with health improvement?
Inequalities, housing, education, employment, lifestyles, family/community
What are the areas involved with health protection?
Infectious diseases, chemicals and poisons, radiation, emergency response, environmental health hazards
What are the areas involved with improving healthcare services?
Clinical effectiveness, efficiency, service planning, audit and evaluation, clinical governance and equity
What interventions may improve public health?
Health service/public health interventions; non-health interventions which have an impact on public health
At what levels would interventions that improve public health be delivered?
Individual level; community level; ecological (population) level
What is allostatic load?
The price we pay for allostasis. Long term overtaxation of our physiological system leads to impaired health
What is an example of allostasis in the cardiovascular disease?
Works to maintain our erect posture, and enable physical exertion
What is an example of allostatic load in cardiovascular disease?
Over-activation leads to hypertension, stroke, MI
What is an example of allostasis in the metabolic system?
Activating and maintaining energy reserves, including energy supply to the brain
What is an example of allostatic load in the metabolic system?
Obesity, diabetes, atherosclerosis
What is an example of allostasis in the immune system?
Response to pathogens, tumour surveillance
What is an example of allostatic load in the immune system?
Inflammatory and auto-immune diseases
What is an example of allostasis in the central nervous system?
Learning, memory, neuroendocrine and autonomic regulation
What is an example of allostatic load in the central nervous system?
Neural atrophy, death of nerve cells, impairment of memory and executive function
What is salutogenesis?
Favourable physical changes secondary to experiences which promote healing and health
What are the main causes of homelessness?
RELATIONSHIP BREAKDOWN Caused by Mental illness/breakdown, Domestic abuse Disputes with parents Bereavement- more than half say they have ‘no family ties’
What are some health problems faced by homeless adults?
Infectious diseases including TB and hepatitis Poor condition of feet and teeth. Respiratory problems. Injuries following violence, rape Sexual health, smears, contraception Serious mental illnesses – schizophrenia as well as depression and personality disorders. Poor nutrition Addictions/substance misuse
What are some barriers to healthcare faced by the homeless population?
Difficulties with access to health care - due to opening times, appointment procedures location and perceived or actual discrimination.
Lack of integration between mainstream primary care services and other agencies (housing, social services , criminal justice system and voluntary sector).
Other things on their mind- people do not prioritise their health when there are more immediate survival issues.
May not know where to find help.
What are some barriers to healthcare faced by the gypsy population?
Reluctance of GPs to register Gypsies and Travellers, and to visit sites.
Poor reading and writing skills. Many are illiterate.
Communication difficulties
Too few permanent and transient sites
Mistrust of professionals
Lack of choice
What is a refugee?
An adult or child who, owing to a well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion is outside the country of his nationality, and is unable, or owing to such fear, unwilling to avail himself of the protection of that country
What is an asylum seeker?
Someone who has submitted an application to be recognised as a refugee and is waiting for their claim to be decided by the home office.
The UK has signed the 1951 Convention on Refugees, which means that by law, anyone has the right to apply for asylum in the UK and remain until a final decision on their application has been made
What are the barriers to healthcare for asylum seekers?
Lack of knowledge of where to get help Lack of understanding how NHS works Language / Culture / Communication Hyper-mobility Not homogenous group Health not priority
What is humanitarian protection?
Failed to demonstrate claim for asylum but face serious threat to life if returned. Usually 3years then reapply
What are the physical consequences of loneliness?
Earlier death Take more risks Harder to self regulate Physical changes which can bring on poor health Health risk = 15 cigarettes a day Bigger problem than obesity
How do you recognise loneliness?
Body language, Appearance, Talkative, Clinging Denial, ‘Boredom’ Live alone Male 50+ Bereavement, recent transition? Mobility Sensory impairment Regular times away from house? Close family nearby? Quality not quantity of social contact
What is social exclusion?
The dynamic process of being shut out, fully or partially, from any of the social, economic, political or cultural systems which determine the social integration of a person in society
What are the causes of social exclusion?
Poor Health, Sensory Impairment, Poverty, housing issues, fear of crime Transport, problems on the roads, Discrimination (Internalised), sexuality, gender, ethnicity, belief Services: insufficient range. Fragmentation. Lack of imagination. Bureaucracy Poor coordination, Lack of information, Fragility of networks
What are the aims of treating substance abuse?
To reduce harm to user, family and society
To improve health
To stabilise lifestyle and reduce the amount of illicit drug use
Reduce crime
What are the modalities of treating substance abuse?
Harm reduction (especially for non-opiate users)
Detoxification (lofexidine, buprenorphine)
Maintenance: methadone (full agonist), buprenorphine (partial agonist/antagonist)
Relapse prevention (naltrexone)
Psychological interventions
Alternative therapies
Referral for allied problems (Hep C, STDs etc)
What should you offer a newly presenting drug user?
Health check
Screening for blood borne viruses and referral for positive result (Hep C, HIV treatable)
Contraception, smear
Sexual health advice
Check general immunisation status and Hep A/B
Signpost to additional help (counselling, benefits, housing)
Information on local drugs services including needle exchange
What actions can you take to prevent death in substance abuse?
not injecting or injecting more safely
- not mixing respiratory depressants - not using drugs alone - reducing amount taken after intervals where tolerance is lost - call an ambulance if necessary
What actions can you take to prevent transmission of blood borne virus transmission?
not sharing needles etc
- safer sex (condoms) - provision of Hepatitis A and B vaccination - Blood borne virus screening including Hepatitis C
