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POPLHLTH111 > Exam > Flashcards

Exam Flashcards

1
Q

Reasons for GBD project

A
  • Data from many countries was incomplete
  • Lobbying groups gave distorted images
  • Available data largely focused on deaths, little info on non-fatal outcomes
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2
Q

Aim of GBD

A

Use a systematic approach to summarise the burden of disease and injury at the population-based level

  • aid in setting health service and health research priorities
  • aid in identifying disadvantaged groups and targeting health interventions
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3
Q

DALY

A

Summary measure that combines data for both fatal and non-fatal outcomes to represent the health of a population as a single number

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4
Q

DALY Advantages

A
  • Draws attention to previously hidden burden of mental health and injury as a major public health problem
  • Recognizes NCDs as a major and increasing problem in LMIC
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5
Q

DALY Challenges

A
  • Criticised for the potential to represent people with disabilities as a burden
  • Disabilities are considered to be the same severity as someone living with an impairment relating to disease, and do not change with life circumstances
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6
Q

2 Measures of DALYs and data required to calculate them

A

YLL - years of life lost
(# of deaths from disease per year, years of life lost per death relative to an ideal age)
YLD - years lived with disability
(# of cases of disease, average duration until recovery/death, disability weight)

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7
Q

Medical model

A
  • Views disability as an individual problem,
  • Individuals are defined by their disability
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8
Q

Social model

A
  • Views disability as a social issue
  • Focuses on ridding social barriers
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9
Q

Double burden of disease

A

Top causes of DALYs in a country are both NCDs and CDs (usually occurs when a country transitions from lower to middle income)

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10
Q

Risk transition

A

Changes in risk factor profiles as countries shift from lower to higher incomes, where common risks for perinatal and CDs are replaced by risks for NCDs

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11
Q

Epidemiological transition

A

Characteristic shift in common causes of death and disability from perinatal and CDs to NCDs

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12
Q

Perceived ethnicity

A

The ethnicity others perceive you to be based on skin, dress, accent etc

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13
Q

Foregone healthcare

A

Inability to access healthcare when needed

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14
Q

Inverse care law

A

The availability of good medical or social care tends to vary inversely with the need for it in the population served

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15
Q

Snowflake hypothesis

A

Overprotection and low resilience affecting early development (parental monitoring, parental stress)

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16
Q

Igen hypothesis

A

Social media, internet access, phones affecting youth mental health (less physical activity, increased bullying, talking to parents less, less sleep, risk taking)

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17
Q

Doomer hypothesis

A

Impact of job insecurities, housing affordability, climate crisis, political polarisation, disinformation and misinformation on youth mental health

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18
Q

Youth 2000 Limitations

A

Recruitment: those not at school, those with certain disabilities and language barriers not included

Measurement: Students may not have answered honestly, so can never be certain data is entirely accurate

Reverse causality - difficult to establish temporality as outcome and exposure measurements taken at the same time

Inability to help youth whose responses indicated they were at risk

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19
Q

Youth 2000 strengths

A

Technology meant better response rates as students are more likely to enjoy experience

Reduced measurement bias due to survey being anonymous

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20
Q

Triple dividend

A
  1. Benefits for adolescents now
  2. Benefits for their future adult lives
  3. Benifits in outcomes for their future children
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21
Q

Key determinants of ethnic disparities

A
  • Differential access to healthcare
  • Differential access in quality of care recieived
  • Differential access to exposures/determinants of health
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22
Q

Key indicators of Maori health

A
  • Major causes of death
  • Patterns of morbidity and mortality
  • Life expectancy
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23
Q

Maori health is exemplified by disparities in:

A
  • Health outcomes
  • Health system responsiveness
  • Health system representation
  • Exposure to determinants of health
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24
Q

Land alienation is associated with:

A
  • Decreased fertility rates and mother:child ratio
  • Resentment from Indigenous people
  • Breakdown of political power & aliances
  • Poverty
  • Economic resource depletion
  • Overrepresentation of Maori in more deprived areas
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25
Q

Structural intervention

A

Physical approach/intervention - more lifeboats, no barriers, ensure equal access to safety/healthcare

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26
Q

Social intervention

A

Rights-based approach - equal rights to lifeboat

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27
Q

R2H: state is obligated to…

A

Respect (no discrimination)
Protect (no 3rd party interference)
Fulfil (adopt measures to achieve equity)

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28
Q

Instruments relevant to Maori health

A
  • TToW
  • Indigenous rights act
  • Human Rights Act
  • Te Pae Ora act
  • Code of patient rights
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29
Q

NZ Living standards frame work captures:

A
  • Resources and aspects of our lives important for wellbeing
  • Role of institutions in building and safeguarding our wealth and wellbeing
  • How wealthy we are in aggregate as a country
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30
Q

Wealth of Aotearoa

A

Natural, Human, Financial/physical, Social

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31
Q

Natural

A

All aspects of the living environment needed to support human life and activity

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32
Q

Human

A

Peoples skills, knowledge, physical and mental wellbeing

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33
Q

Financial/physical

A

Things that have a direct role in supporting incomes and material living conditions

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34
Q

Social

A

Norms and values that underpin society

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35
Q

Commercial determinants of health

A

Inherent tensions between public and commercial objectives in the consumption, affordability and availability of goods and services

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36
Q

Industry strategies

A
  • Shaping the evidence
  • Constituency building
  • Employing narratives/framing techniques
  • Policy substitution, development & implementation
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37
Q

Shaping the evidence techniques

A
  • Lobbying
  • Shaping research and funding priorities
  • Financing university chairs and programmes (2012-2018 Fonterra chair in human nutrition UoA)
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38
Q

Constituency building techniques

A
  • Partnerships with charities or health/education related foundations
  • Promoting/sponsoring efforts beyond core business (ANZ + cricket)
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39
Q

Employing narratives/framing techniques

A
  • Focusing on youth
  • Focusing on individual behaviour problems
  • Focusing on corporate social responsibility
  • Being apart of the solution
    E.g SMASHED - funded by the tmr project which is owned by NZ alcohol producing companies
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40
Q

Policy substitution, development and implementation techniques

A
  • Contributing to health policy consultations
  • Partnerships or voluntary agreements with the government (health star rating)
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41
Q

SEP definition

A

Social and economic factors which influence the position an individual or group holds within the structure of society

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42
Q

Why measure SEP

A
  • Allows us to see changes overtime
  • Allows us to see changes in population structure overtime
  • Quantify levels of inequalities
  • Understand relationships between health outcomes and other variables
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43
Q

Measure of SEP for individuals

A
  • Housing
  • Education
  • Occupation
  • Income
  • Assets + wealth
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44
Q

Measures of SEP for populations

A

Area: Deprivation & access
Population: GDP, literacy rates, income inequalities

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45
Q

Area level deprivation

A

State of demonstratable or observable disadvantage in relation to local community, wider society or nation to which an individual, group or family belongs - a way of measuring an individuals relative position in society

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46
Q

Global determinants of SEP

A

GDP, literacy rates, income inequalities, free trade agreements

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47
Q

Preston curve

A

Life expectancy (y), GDP per capita (x)

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48
Q

Lorenz curve

A

Measures level of income inequalities in a country (more concave = more unequal)

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49
Q

Gini coefficient

A

Measures relationship between Lorenz curve and line of perfect equality, A/(A+B), 0 = equal, 1 = unequal

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50
Q

Inequalities

A

Differences in health experience or outcomes between population groups (according to
SEP, area, age, disability, gender,ethnic group
i.e. ‘the social gradient’)

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51
Q

Inequities

A

Inequalities deemed unfair or stemming from kind of injustice.
- Health inequities are differences
in the distribution of resources/services across populations that do not reflect health needs

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52
Q

PROGRESS (equity for whom)

A

Place of residence, race, occupation, gender, religion, education, socioeconomic status, social capital + disability

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53
Q

Why reduce inequalities

A
  • They are unfair
  • They are avoidable
  • They affect everyone
  • They are cost-effective to avoid
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54
Q

Implications of income inequalities

A
  • Unequal society
  • Less trust
  • Increased stress
  • Less social cohesion
  • Reduced economic productivity
  • Poorer health outcomes
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55
Q

5 As

A
  • Availability
  • Accomodation
  • Accessibility
  • Acceptability
  • Affordability
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56
Q

Accessibility

A

Relationship between location of supply and location of clients, taking into account transportation time, distance and cost

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57
Q

Availability

A

Volume and type of existing services and resources available in relation to the volume and type of clients needs (e.g knowledge of where to get health care)

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58
Q

Accommodation

A

Relationship between manner in which services and resources are organised and the expectations of the clients

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59
Q

Affordability

A

Cost of services in relation to clients’ ability and willingness to pay

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60
Q

Acceptability

A

Relationship between providers and clients’ attitudes to what constitutes appropriate care

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61
Q

4 Vs

A

Volume, veracity, velocity, variability

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62
Q

3Vs

A

Variability, visualisation, value

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63
Q

Events that determine population structure

A
  • Fertility rates
  • Death rates
  • Birth rates
  • Migration
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64
Q

Dependency ratio

A

(youth+elderly (0-14, 65+)/working age population) x 100

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65
Q

Numerical Ageing

A

Absolute increase in the population that is elderly

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66
Q

Structural Ageing

A

Increase in the proportion of the population that is elderly

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67
Q

Natural decline

A

More deaths than births

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68
Q

Absolute decline

A

Insufficient migration to replace lost births and increased deaths

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69
Q

Prioritised output advantages

A
  • Ensures ethnic groups are not swamped by NZ European ethnic groups
  • Produces data that’s easy to work with, as everyone is only counted once
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70
Q

Prioritised output disadvantages

A
  • Places people in specific ethnic groups which simplifies yet biases the stats as it overrepresents some groups at the expense of others
  • Externally applied single ethnicity may be inconsistent with personal identification
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71
Q

Total response output advantages

A
  • Has potential to represent people who do not identify with any given ethnic group
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72
Q

Total response output disadvantages

A
  • Creates complexities in the distribution of funding based on population numbers or in monitoring changes in the ethnic composition of population health
  • Creates issues in data interpretation by ethnic grouping where comparisons between groups include overlapping data
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73
Q

What is a healthy environment?

A

Physical, social or political settings that prevent disease while enhancing human health and wellbeing

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74
Q

Elements of a healthy environment

A
  • Access to wholesome food
  • Safe community spaces
  • Appropriate housing
  • Clean air and water
  • Opportunities to incorporate exercise as part of daily life
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75
Q

Measures or built environment

A
  • Urban density
  • Land use mix
  • Street connectivity
  • Community resources (e.g. facilities and healthy food)
76
Q

4 Urban design concepts that improve active travel (including features and benefits)

A
  1. Street connectivity - grid-like design - reduces the distance between destinations increasing use of active travel
  2. Land use mix - mix of commercial, residential and business uses of land within a given area - increase active travel
  3. Traffic calming - crossings, cycle lanes, footpaths, street width - encourages active travel and discourages driving
  4. Public open spaces - open spaces close to residents e.g. pools, parks, playgrounds - increases physical activity
77
Q

Ecological fallacy

A

Bias that arises when information about a group of people is used to make inferences about an individual

78
Q

SDGs goal

A

A global call to action to end poverty, protect the planet and improve the lives and prospects of everyone everywhere.

79
Q

SDGs Economy acronyms

A

DIRR

80
Q

SDGs environment acronym

A

CCLL

81
Q

What 2 SDGs do not map onto NZ LSF

A
  • Gender equality
  • Reduced inequalities
82
Q

What NZ LSF do not map onto SDGs

A
  • Cultural identity
  • Recreation and leisure
  • Subjective wellbeing
  • Social connectiveness
83
Q

Population health actions

A
  • Health promotion
  • Health protection
  • Disease prevention
84
Q

Population-based (mass) strategy aim

A

Improve health outcomes for all individuals in a population

85
Q

Population-based (mass) strategy advantages

A
  • Behaviourally appropriate
  • Large potential benefit
  • Addresses underlying causes
86
Q

Population-based (mass) strategy disadvantages

A
  • Small individual benefit
  • Poor motivation of individuals
  • Whole population exposed to downside
87
Q

High-risk (individual) strategy:

A

Focuses on individuals perceived to be at high risk

88
Q

High-risk (individual) strategy advantages

A
  • Cost-effective
  • Favourable benefit-to-risk ratio
  • Individual motivation
  • Appropriate to individuals
89
Q

High-risk (individual) strategy disadvantages

A
  • Cost of screening/need to identify individuals
  • Behaviourally inappropriate
  • Temporary effect
  • Limited potential
90
Q

Primary prevention

A

Aims to reduce occurrence of disease by addressing known risk factors

91
Q

Secondary prevention

A

Early detection of disease to reduce more serious consequences

92
Q

Tertiary prevention

A

Reduce complications of already established disease

93
Q

Prerequisites for health

A

Peace, income and economic support, education, social justice and equity, shelter, safety, stable ecosystem, sustainable resources, food

94
Q

Te Pae Mahutoga tasks and pre-requisites

A

Te oranga - participation in society
Mauriora - cultural identity
Toiora - healthy lifestyle
Waiora - healthy environment
Te mana whakahaere - autonomy
Nga manukura - leadership

95
Q

Reasons for Maori health promotion

A
  • Mainstream health promotions are often less effective in Maori
  • Maori health outcomes/inequities
  • Rights as Indigenous people and treaty partners
96
Q

Ottowa Charter basic strategies and action areas

A

Enable, advocate, mediate
- Develop personal skills
- Strengthen community action
- Create supportive communities
- Build healthy public policy
- Reorientate health services towards primary care

97
Q

Screening criteria

A
  • Suitable disease
  • Screening test
  • Screening programe
98
Q

A suitable screening test is:

A
  • Reliable
  • Safe
  • Simple
  • Affordable
  • Acceptable
  • Accurate
99
Q

Sensitivity

A

Likelihood of a positive test in those with disease (true positive/all with disease) x 100

100
Q

Specificity

A

Likelihood of negative test in those without disease (true negatives/all without disease) x 100

101
Q

PPV

A

Positive predictive value, (true positives/all who test positive) x 100, increases with increase in prevalence

102
Q

NPV

A

Negative predictive value, (true negatives/all who test negative) x 100, decreases with increase in prevalence

103
Q

Lead time bias

A

An apparent increase in life expectancy due to the time of diagnosis

104
Q

Length time bias

A

Mean survival time from screened patients gives impression of longer average survival time due to different rates of disease progression in each patient

105
Q

PAR

A

Population attributable risk, PGO-PGO, occurrence in total population - occurrence in unexposed population

106
Q

3 point panther platform

A
  • Peaceful resistance against racism
  • Create mana Pasifika (own ethnic identity)
  • Educate to liberate
107
Q

Actions of PPP

A
  • T.A.B
  • P.I.G
  • Homework centres
  • Legal aid booklet and human rights
  • Protests (dawn raids, 1986 springbok tour)
108
Q

Racism

A

Any individual action or institutionalized practice backed by institutionalized power than negatively affects people because of their ethnicity

109
Q

Institutionalised racism

A

Differential access to good, services and opportunities of society by race

110
Q

Material conditions influenced by institutionalized racism

A
  • Clean environment
  • Sound housing
  • Gainful employment
  • Quality education
  • Appropriate medical facilities
111
Q

Access to power influenced by instituionalized racism

A
  • Less Maori in government
  • Differential access to information, resources, voice
112
Q

Personally mediated racism

A

Prejudice and discrimination towards someone because of their race - where prejudice means differential assumptions about the abilities, intentions and motive of someone and discrimination means differential action towards them.

113
Q

Internalized racism

A

Acceptance by members of stigmatized races of the negative messages said about their own intrinsic worth and abilities.

114
Q

HIV Social determinants

A
  • Harmful social norms that promote harmful power dynamics (rules governing sexual relationships: negotiating condom use, gender-based violence/sexual abuse - associated with 3x risk of HIV, problems with disclosure of HIV status, stigma & discrimination
  • Early school dropout (lack of education leads to lack of safe/well paid jobs, lack of resources)
  • Lower access to health services
115
Q

Prevention for HIV

A
  • Address social determinants (empower women & educate men, enable opportunities for education & financial independence, change social norms around power dynamics, gender-based violence, stigma and discrimination, improve health literacy, improve access to sexual health services
  • Safer sex (media campaigns, education, condoms)
  • Safer products (screen blood products, needle exchanges)
  • Increase access to health care (voluntary testing, treatment, care and support for HIV+, antenatal screening & treatment)
116
Q

Control

A

Reduce to an acceptable endemic level using feasible means

117
Q

Elimination

A

Reduce to zero in a country for prolonged periods

118
Q

Eradication

A

Reduce to zero globally, permanently

119
Q

Mitigation

A

Reduce to avoid overwhelming the health care system

120
Q

Suppresion

A

Reduce to minimise negative health impacts

121
Q

R.eff

A

Mean number of additional infections from an initial infection at one point in time

122
Q

Herd immunity

A

When enough of a population has been immunised against a disease to stop its spread and further infections

123
Q

Message

A

Appropriate, co-designed, tested, clear and simple

124
Q

Messenger

A

Trustworthy, credible

125
Q

Channel

A

Relevant, accessible, trustworthy

126
Q

Who influences food environments?

A
  • Food industry
  • Government
  • Society
127
Q

Local environments that shape obesity

A
  • Physical
  • Economic
  • Policy
  • Socio-cultural
128
Q

Drivers of obesity

A

Underlying global impacts e.g. national wealth

129
Q

Mediator definition

A

Factors through which drivers operate, lies on the causal pathway between a risk factor and the associated outcome.

130
Q

Mediators of obesity

A

Food availability, food composition, prices, e-bikes, PA, screen environments

131
Q

Moderators definition

A

Factors which accentuate the trends (e.g. sociocultural and built environment)

132
Q

Moderators of obesity

A

Culture, built environment, food culture, local climate, religion

133
Q

Policy inertia is caused by:

A
  • Food industry opposition
  • Government reluctance to tax/fund
  • Lack of public demand
134
Q

Industry influence in NZ

A
  • Big money behind harmful products
  • Dirty PR operator
  • Attack blogger
  • Character assassination of public health advocates
135
Q

Industrial epidemic

A

Diseases arising from over consumption of unhealthy commercial products

136
Q

To address commercial determinants:

A
  • Shift focus from individual behaviours to the broader environment and upstream drivers of unhealthy product consumption
  • Tackle upstream determinants
  • Develop effective health policy recognising the tension between commercial and health objectives
137
Q

How commercially driven epidemics came to be:

A
  • Social norms changed
  • Market to vulnerable targets
  • Changing physical and social environments (concentrated outlets and influence policy)
138
Q

Passive overconsumption of energy is due to

A

Hyperpalatable, heavily promoted, readily available, cheaply priced, highly profitable ultraprocessed foods

139
Q

Cost

A

The cost associated with implementing the policy to people, and the overall cost of the prevention strategy

140
Q

Stigmatization

A

Concept that a program or policy should not stigmatize people wherever possible

141
Q

Freedom

A

Extent to which the freedom of a particular group is compromised

142
Q

Vertical equity

A

Refers to unequal treatment of unequally situated individuals to make them more equal in regard to a particular attribute

143
Q

Horizontal equity

A

Involves treating everyone equally, applied universally

144
Q

Appropriate uses of NZDep & IMD

A
  • Resource allocation and planning
  • Research
  • Community advocacy
  • Policy development
145
Q

NZDep 2018

A
  • Area based measure which has variables that determine area deprivation
  • Divides small census areas into deciles/quintiles based on deprivation
  • Based on data from census
146
Q

NZDep 2018 Domains

A
  • Income
  • Income
  • Qualifications
  • Support
  • Communication
  • Owned home
  • Living space
  • Living conditions
  • Unemployment
147
Q

IMD

A
  • Looks at overall deprivation to understand the drivers
  • Based on data from IDI
148
Q

IMD domains

A
  • Employment
  • Income
  • Crime
  • Health
  • Access
  • Education
  • Housing
149
Q

IMD strengths

A
  • Measures data more comprehensively than existing area based measures
  • 7 domains can be used individually or together
  • Weights different domains differently, resulting in different identified areas of deprivation
  • Uses data from multiple data sources
  • Data is more recent as it is continuously updated
  • Includes health and crime, which are good indicators of area deprivation
150
Q

Data sources other than census

A
  • ERP (estimated resident population)
  • Vital events
  • HSU (health service utilisation)
  • IDI (integrated data infrastructure)
  • Nationally representative survey
  • Ad Hoc survey
151
Q

IDI benefits

A
  • De-identified
  • Can compare different denominators
152
Q

IDI disadvantages

A
  • Resource is only as good as the data it contains
  • Cannot follow or identify individuals
  • Deficit approach - describes population in relation to what they don’t have.
153
Q

Component cause

A

Individual factor that contributes to disease causation but is not sufficient to cause disease on its own

154
Q

Sufficient cause

A

Minimum set of conditions for disease to occur

155
Q

Necessary cause

A

A factor (or component cause) that must be present for disease to occur

156
Q

Temporality

A

First the cause, then the disease (e.g. cohort studies have shown an association between maternal Zika virus in early pregnancy and microcephaly in new-born babies)

157
Q

Strength of association

A

The stronger the association, the more likely to be causal in the absence of known biases

158
Q

Specificity of association

A

A cause leads to a single effect, an effect has a single cause

159
Q

Consistency of association

A

Replication of the findings by different investigators, at different times, in different places, with similar methods (similar studies have shown similar results)

160
Q

Biological plausibility of association

A

Does the association make sense biologically? (e.g. virus infections are known to affect brain growth in new-born babies)

161
Q

Biological gradient

A

Incremental change in disease rates in conjunction with corresponding changes in exposure

162
Q

Reversibility

A

The demonstration that under controlled conditions, a change in exposure results in a change in outcome

163
Q

Level 1 of rainbow model

A

The individual: age, sex, constitutional and life-style factors - non modifiable

164
Q

Level 2 of rainbow model

A

The community: social & community networks and living & working conditions

165
Q

Level 3 of rainbow model

A

The environment: general socioeconomic, cultural and environmental conditions

166
Q

Living and working conditions

A
  • Ag & food production
  • Housing
  • Unemployment
  • Working conditions
  • Water and sanitation
  • Access to health services
  • Education
167
Q

Built environment

A

Design of communities/all the buildings, spaces and products that are created or significantly modified by people

168
Q

Causes of causes for individuals

A
  • Income
  • Education
  • Employment
  • Housing
  • Neighbourhood
  • Societal characteristics
  • Autonomy and empowerment
169
Q

Downstream/proximal

A

Health determinant that is near the change in health status

170
Q

Upstream/distal

A

Health determinant that is distant in time and/or place from change in health status

171
Q

Structure

A

Social and physical environmental conditions that influence the choices and opportunities available

172
Q

Agency

A

The capacity of an individual to act independently and make free choices

173
Q

RCT main design features

A
  • Longitudinal
  • Experimental
  • Random allocation
  • Measured over follow up
174
Q

RCT strengths

A
  • Random allocation minimises confounding
  • Can measure incidence and prevalence
175
Q

RCT weaknesses

A
  • Ethical limitations
  • Difficult to recruit representative populations
  • Maintenance error
  • Expensive
  • Small
176
Q

Cohort main design features

A
  • Longitudinal
  • Observational
  • Participants allocated by measurement and followed up
177
Q

Cohort strengths

A
  • Easier to recruit
  • Ethical to study harmful exposures
  • Cheaper than RCT
  • Often large
178
Q

Cohort weaknesses

A
  • Confounding common
  • Maintenance error
179
Q

Cross-sectional main design features

A
  • Observational
  • Participants allocated by measurement and outcomes measured at same time
180
Q

Cross-sectional strengths

A
  • Easier to recruit people
  • Ethical to study harmful exposures
  • Maintenance error not an issue
  • Cheap
  • Fast to undertake
  • Large
181
Q

Cross-sectional weaknesses

A
  • Confounding common
  • Reverse causality
  • Can only measure prevalence
  • Crucial for sample to be representative
182
Q

Ecological main design features

A
  • Groups/countries
  • Can be RCT, cohort or cross-sectional
183
Q

Ecological strengths

A
  • Large, so low random error
  • Cheap
  • Quick
184
Q

Ecological weaknesses

A
  • Confounding common
  • Measurement error very common
185
Q

Equity

A

Equity recognises different people with different
levels of advantage require different approaches
and resources to get equitable health outcomes

186
Q

4 steps in preventing disease

A
  1. Define the problem
  2. Identify risk and protective factors
  3. Develop and test prevention strategies
  4. Assure widespread adoption
187
Q

Commercial determinants 2

A

Structures, rules, norms and practices by which business activities designed to generate profit influence patterns of health and disease across populations

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