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
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
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
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
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
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)
7
Q
Medical model
A
- Views disability as an individual problem,
- Individuals are defined by their disability
8
Q
Social model
A
- Views disability as a social issue
- Focuses on ridding social barriers
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)
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
11
Q
Epidemiological transition
A
Characteristic shift in common causes of death and disability from perinatal and CDs to NCDs
12
Q
Perceived ethnicity
A
The ethnicity others perceive you to be based on skin, dress, accent etc
13
Q
Foregone healthcare
A
Inability to access healthcare when needed
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
15
Q
Snowflake hypothesis
A
Overprotection and low resilience affecting early development (parental monitoring, parental stress)
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)
17
Q
Doomer hypothesis
A
Impact of job insecurities, housing affordability, climate crisis, political polarisation, disinformation and misinformation on youth mental health
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
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
20
Q
Triple dividend
A
- Benefits for adolescents now
- Benefits for their future adult lives
- Benifits in outcomes for their future children
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
22
Q
Key indicators of Maori health
A
- Major causes of death
- Patterns of morbidity and mortality
- Life expectancy
23
Q
Maori health is exemplified by disparities in:
A
- Health outcomes
- Health system responsiveness
- Health system representation
- Exposure to determinants of health
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
25
Structural intervention
Physical approach/intervention - more lifeboats, no barriers, ensure equal access to safety/healthcare
26
Social intervention
Rights-based approach - equal rights to lifeboat
27
R2H: state is obligated to...
Respect (no discrimination)
Protect (no 3rd party interference)
Fulfil (adopt measures to achieve equity)
28
Instruments relevant to Maori health
- TToW
- Indigenous rights act
- Human Rights Act
- Te Pae Ora act
- Code of patient rights
29
NZ Living standards frame work captures:
- 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
30
Wealth of Aotearoa
Natural, Human, Financial/physical, Social
31
Natural
All aspects of the living environment needed to support human life and activity
32
Human
Peoples skills, knowledge, physical and mental wellbeing
33
Financial/physical
Things that have a direct role in supporting incomes and material living conditions
34
Social
Norms and values that underpin society
35
Commercial determinants of health
Inherent tensions between public and commercial objectives in the consumption, affordability and availability of goods and services
36
Industry strategies
- Shaping the evidence
- Constituency building
- Employing narratives/framing techniques
- Policy substitution, development & implementation
37
Shaping the evidence techniques
- Lobbying
- Shaping research and funding priorities
- Financing university chairs and programmes (2012-2018 Fonterra chair in human nutrition UoA)
38
Constituency building techniques
- Partnerships with charities or health/education related foundations
- Promoting/sponsoring efforts beyond core business (ANZ + cricket)
39
Employing narratives/framing techniques
- 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
40
Policy substitution, development and implementation techniques
- Contributing to health policy consultations
- Partnerships or voluntary agreements with the government (health star rating)
41
SEP definition
Social and economic factors which influence the position an individual or group holds within the structure of society
42
Why measure SEP
- 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
43
Measure of SEP for individuals
- Housing
- Education
- Occupation
- Income
- Assets + wealth
44
Measures of SEP for populations
Area: Deprivation & access
Population: GDP, literacy rates, income inequalities
45
Area level deprivation
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
46
Global determinants of SEP
GDP, literacy rates, income inequalities, free trade agreements
47
Preston curve
Life expectancy (y), GDP per capita (x)
48
Lorenz curve
Measures level of income inequalities in a country (more concave = more unequal)
49
Gini coefficient
Measures relationship between Lorenz curve and line of perfect equality, A/(A+B), 0 = equal, 1 = unequal
50
Inequalities
Differences in health experience or outcomes between population groups (according to
SEP, area, age, disability, gender,ethnic group
i.e. ‘the social gradient’)
51
Inequities
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
52
PROGRESS (equity for whom)
Place of residence, race, occupation, gender, religion, education, socioeconomic status, social capital + disability
53
Why reduce inequalities
- They are unfair
- They are avoidable
- They affect everyone
- They are cost-effective to avoid
54
Implications of income inequalities
- Unequal society
- Less trust
- Increased stress
- Less social cohesion
- Reduced economic productivity
- Poorer health outcomes
55
5 As
- Availability
- Accomodation
- Accessibility
- Acceptability
- Affordability
56
Accessibility
Relationship between location of supply and location of clients, taking into account transportation time, distance and cost
57
Availability
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)
58
Accommodation
Relationship between manner in which services and resources are organised and the expectations of the clients
59
Affordability
Cost of services in relation to clients' ability and willingness to pay
60
Acceptability
Relationship between providers and clients' attitudes to what constitutes appropriate care
61
4 Vs
Volume, veracity, velocity, variability
62
3Vs
Variability, visualisation, value
63
Events that determine population structure
- Fertility rates
- Death rates
- Birth rates
- Migration
64
Dependency ratio
(youth+elderly (0-14, 65+)/working age population) x 100
65
Numerical Ageing
Absolute increase in the population that is elderly
66
Structural Ageing
Increase in the proportion of the population that is elderly
67
Natural decline
More deaths than births
68
Absolute decline
Insufficient migration to replace lost births and increased deaths
69
Prioritised output advantages
- 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
70
Prioritised output disadvantages
- 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
71
Total response output advantages
- Has potential to represent people who do not identify with any given ethnic group
72
Total response output disadvantages
- 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
73
What is a healthy environment?
Physical, social or political settings that prevent disease while enhancing human health and wellbeing
74
Elements of a healthy environment
- Access to wholesome food
- Safe community spaces
- Appropriate housing
- Clean air and water
- Opportunities to incorporate exercise as part of daily life
75
Measures or built environment
- Urban density
- Land use mix
- Street connectivity
- Community resources (e.g. facilities and healthy food)
76
4 Urban design concepts that improve active travel (including features and benefits)
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
Ecological fallacy
Bias that arises when information about a group of people is used to make inferences about an individual
78
SDGs goal
A global call to action to end poverty, protect the planet and improve the lives and prospects of everyone everywhere.
79
SDGs Economy acronyms
DIRR
80
SDGs environment acronym
CCLL
81
What 2 SDGs do not map onto NZ LSF
- Gender equality
- Reduced inequalities
82
What NZ LSF do not map onto SDGs
- Cultural identity
- Recreation and leisure
- Subjective wellbeing
- Social connectiveness
83
Population health actions
- Health promotion
- Health protection
- Disease prevention
84
Population-based (mass) strategy aim
Improve health outcomes for all individuals in a population
85
Population-based (mass) strategy advantages
- Behaviourally appropriate
- Large potential benefit
- Addresses underlying causes
86
Population-based (mass) strategy disadvantages
- Small individual benefit
- Poor motivation of individuals
- Whole population exposed to downside
87
High-risk (individual) strategy:
Focuses on individuals perceived to be at high risk
88
High-risk (individual) strategy advantages
- Cost-effective
- Favourable benefit-to-risk ratio
- Individual motivation
- Appropriate to individuals
89
High-risk (individual) strategy disadvantages
- Cost of screening/need to identify individuals
- Behaviourally inappropriate
- Temporary effect
- Limited potential
90
Primary prevention
Aims to reduce occurrence of disease by addressing known risk factors
91
Secondary prevention
Early detection of disease to reduce more serious consequences
92
Tertiary prevention
Reduce complications of already established disease
93
Prerequisites for health
Peace, income and economic support, education, social justice and equity, shelter, safety, stable ecosystem, sustainable resources, food
94
Te Pae Mahutoga tasks and pre-requisites
Te oranga - participation in society
Mauriora - cultural identity
Toiora - healthy lifestyle
Waiora - healthy environment
Te mana whakahaere - autonomy
Nga manukura - leadership
95
Reasons for Maori health promotion
- Mainstream health promotions are often less effective in Maori
- Maori health outcomes/inequities
- Rights as Indigenous people and treaty partners
96
Ottowa Charter basic strategies and action areas
Enable, advocate, mediate
- Develop personal skills
- Strengthen community action
- Create supportive communities
- Build healthy public policy
- Reorientate health services towards primary care
97
Screening criteria
- Suitable disease
- Screening test
- Screening programe
98
A suitable screening test is:
- Reliable
- Safe
- Simple
- Affordable
- Acceptable
- Accurate
99
Sensitivity
Likelihood of a positive test in those with disease (true positive/all with disease) x 100
100
Specificity
Likelihood of negative test in those without disease (true negatives/all without disease) x 100
101
PPV
Positive predictive value, (true positives/all who test positive) x 100, increases with increase in prevalence
102
NPV
Negative predictive value, (true negatives/all who test negative) x 100, decreases with increase in prevalence
103
Lead time bias
An apparent increase in life expectancy due to the time of diagnosis
104
Length time bias
Mean survival time from screened patients gives impression of longer average survival time due to different rates of disease progression in each patient
105
PAR
Population attributable risk, PGO-PGO, occurrence in total population - occurrence in unexposed population
106
3 point panther platform
- Peaceful resistance against racism
- Create mana Pasifika (own ethnic identity)
- Educate to liberate
107
Actions of PPP
- T.A.B
- P.I.G
- Homework centres
- Legal aid booklet and human rights
- Protests (dawn raids, 1986 springbok tour)
108
Racism
Any individual action or institutionalized practice backed by institutionalized power than negatively affects people because of their ethnicity
109
Institutionalised racism
Differential access to good, services and opportunities of society by race
110
Material conditions influenced by institutionalized racism
- Clean environment
- Sound housing
- Gainful employment
- Quality education
- Appropriate medical facilities
111
Access to power influenced by instituionalized racism
- Less Maori in government
- Differential access to information, resources, voice
112
Personally mediated racism
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
Internalized racism
Acceptance by members of stigmatized races of the negative messages said about their own intrinsic worth and abilities.
114
HIV Social determinants
- 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
Prevention for HIV
- 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
Control
Reduce to an acceptable endemic level using feasible means
117
Elimination
Reduce to zero in a country for prolonged periods
118
Eradication
Reduce to zero globally, permanently
119
Mitigation
Reduce to avoid overwhelming the health care system
120
Suppresion
Reduce to minimise negative health impacts
121
R.eff
Mean number of additional infections from an initial infection at one point in time
122
Herd immunity
When enough of a population has been immunised against a disease to stop its spread and further infections
123
Message
Appropriate, co-designed, tested, clear and simple
124
Messenger
Trustworthy, credible
125
Channel
Relevant, accessible, trustworthy
126
Who influences food environments?
- Food industry
- Government
- Society
127
Local environments that shape obesity
- Physical
- Economic
- Policy
- Socio-cultural
128
Drivers of obesity
Underlying global impacts e.g. national wealth
129
Mediator definition
Factors through which drivers operate, lies on the causal pathway between a risk factor and the associated outcome.
130
Mediators of obesity
Food availability, food composition, prices, e-bikes, PA, screen environments
131
Moderators definition
Factors which accentuate the trends (e.g. sociocultural and built environment)
132
Moderators of obesity
Culture, built environment, food culture, local climate, religion
133
Policy inertia is caused by:
- Food industry opposition
- Government reluctance to tax/fund
- Lack of public demand
134
Industry influence in NZ
- Big money behind harmful products
- Dirty PR operator
- Attack blogger
- Character assassination of public health advocates
135
Industrial epidemic
Diseases arising from over consumption of unhealthy commercial products
136
To address commercial determinants:
- 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
How commercially driven epidemics came to be:
- Social norms changed
- Market to vulnerable targets
- Changing physical and social environments (concentrated outlets and influence policy)
138
Passive overconsumption of energy is due to
Hyperpalatable, heavily promoted, readily available, cheaply priced, highly profitable ultraprocessed foods
139
Cost
The cost associated with implementing the policy to people, and the overall cost of the prevention strategy
140
Stigmatization
Concept that a program or policy should not stigmatize people wherever possible
141
Freedom
Extent to which the freedom of a particular group is compromised
142
Vertical equity
Refers to unequal treatment of unequally situated individuals to make them more equal in regard to a particular attribute
143
Horizontal equity
Involves treating everyone equally, applied universally
144
Appropriate uses of NZDep & IMD
- Resource allocation and planning
- Research
- Community advocacy
- Policy development
145
NZDep 2018
- 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
NZDep 2018 Domains
- Income
- Income
- Qualifications
- Support
- Communication
- Owned home
- Living space
- Living conditions
- Unemployment
147
IMD
- Looks at overall deprivation to understand the drivers
- Based on data from IDI
148
IMD domains
- Employment
- Income
- Crime
- Health
- Access
- Education
- Housing
149
IMD strengths
- 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
Data sources other than census
- ERP (estimated resident population)
- Vital events
- HSU (health service utilisation)
- IDI (integrated data infrastructure)
- Nationally representative survey
- Ad Hoc survey
151
IDI benefits
- De-identified
- Can compare different denominators
152
IDI disadvantages
- 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
Component cause
Individual factor that contributes to disease causation but is not sufficient to cause disease on its own
154
Sufficient cause
Minimum set of conditions for disease to occur
155
Necessary cause
A factor (or component cause) that must be present for disease to occur
156
Temporality
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
Strength of association
The stronger the association, the more likely to be causal in the absence of known biases
158
Specificity of association
A cause leads to a single effect, an effect has a single cause
159
Consistency of association
Replication of the findings by different investigators, at different times, in different places, with similar methods (similar studies have shown similar results)
160
Biological plausibility of association
Does the association make sense biologically? (e.g. virus infections are known to affect brain growth in new-born babies)
161
Biological gradient
Incremental change in disease rates in conjunction with corresponding changes in exposure
162
Reversibility
The demonstration that under controlled conditions, a change in exposure results in a change in outcome
163
Level 1 of rainbow model
The individual: age, sex, constitutional and life-style factors - non modifiable
164
Level 2 of rainbow model
The community: social & community networks and living & working conditions
165
Level 3 of rainbow model
The environment: general socioeconomic, cultural and environmental conditions
166
Living and working conditions
- Ag & food production
- Housing
- Unemployment
- Working conditions
- Water and sanitation
- Access to health services
- Education
167
Built environment
Design of communities/all the buildings, spaces and products that are created or significantly modified by people
168
Causes of causes for individuals
- Income
- Education
- Employment
- Housing
- Neighbourhood
- Societal characteristics
- Autonomy and empowerment
169
Downstream/proximal
Health determinant that is near the change in health status
170
Upstream/distal
Health determinant that is distant in time and/or place from change in health status
171
Structure
Social and physical environmental conditions that influence the choices and opportunities available
172
Agency
The capacity of an individual to act independently and make free choices
173
RCT main design features
- Longitudinal
- Experimental
- Random allocation
- Measured over follow up
174
RCT strengths
- Random allocation minimises confounding
- Can measure incidence and prevalence
175
RCT weaknesses
- Ethical limitations
- Difficult to recruit representative populations
- Maintenance error
- Expensive
- Small
176
Cohort main design features
- Longitudinal
- Observational
- Participants allocated by measurement and followed up
177
Cohort strengths
- Easier to recruit
- Ethical to study harmful exposures
- Cheaper than RCT
- Often large
178
Cohort weaknesses
- Confounding common
- Maintenance error
179
Cross-sectional main design features
- Observational
- Participants allocated by measurement and outcomes measured at same time
180
Cross-sectional strengths
- Easier to recruit people
- Ethical to study harmful exposures
- Maintenance error not an issue
- Cheap
- Fast to undertake
- Large
181
Cross-sectional weaknesses
- Confounding common
- Reverse causality
- Can only measure prevalence
- Crucial for sample to be representative
182
Ecological main design features
- Groups/countries
- Can be RCT, cohort or cross-sectional
183
Ecological strengths
- Large, so low random error
- Cheap
- Quick
184
Ecological weaknesses
- Confounding common
- Measurement error very common
185
Equity
Equity recognises different people with different
levels of advantage require different approaches
and resources to get equitable health outcomes
186
4 steps in preventing disease
1. Define the problem
2. Identify risk and protective factors
3. Develop and test prevention strategies
4. Assure widespread adoption
187
Commercial determinants 2
Structures, rules, norms and practices by which business activities designed to generate profit influence patterns of health and disease across populations
