Exam Review Flashcards
What is the WHO definition of health?
After World War II, WHO created a definition for health that emphasized the aspects of health which are not only related to disease status. The definition is:
Health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
What is the functional definition of health?
The functional approach to defining health looks at what our health state allows us to do or not to do. The definition is:
Health is the capacity of people to adapt to, respond to, or control life’s challenges and changes.
Define disease, illness, and sickness. Discuss the relationship between these terms.
Disease -  refers to a biological or physical malady affecting the body.
Illness - Refers to the perception of dysfunction by the afflicted individual.
Sickness - refers to the social acknowledgement of impairment or affliction.
Similar to the relationship between health and disease, the relationships between disease, illness, and sickness or not unidirectional. There can be disease without illness where increased blood pressure causes a heart attack or stroke when the person does not feel ill (hypertension). There can be illness without disease when the person feels ill but doctors cannot find anything wrong despite extensive testing (hypochondriac). Lastly there can be illness without sickness where the person feels ill but that feeling is not acknowledged by others (headache).
Discuss the relationships between disease and health.
It is important to understand that there is a relationship between disease and health that must be properly considered. This is because someone can have a disease and be healthy (well-managed diabetic), have a disease and be unhealthy (late stage cancer), have no disease but be unhealthy (cannot sleep or eat well due to stress), or have no disease and be healthy.
What is the main idea of the germ theory and who are the three key individuals involved in it?
The main idea of germ theory is that infections can come from germs so there must be sterilization methods for preventative measures.
Koch - Believed germs are present in those with disease and are absent in those without, germs can be isolated and cultured from those with disease, germs cause disease when introduced into a healthy host, and germs can be re-isolated from the newly diseased host.
Ignored the social context and potential genetic origins of many diseases.
Lister - Believed sepsis (infection) may be caused by pollen-like dust contaminating surgical wounds, anti-septic conditions like the application of carbolic acid should be used to prevent wound infections.
Caused surgical mortality to fall from 45% to 15% after intervention.
Pasteur - first postulated the germ theory of disease, discovered principles of microbial fermentation and sterilization, and described heat treatment methods for milk and wine (pasteurization).
What are the genetic and lifestyle theories of disease?
Genetic - Linked to advantages in biology, shifting responsibility for disease to interplay between genetics and the environment. Genetic theories emphasize hereditary vulnerability and focus on the individual, rather than society.
Lifestyle- Behaviourally-driven by things like smoking, consuming alcohol, and eating fatty foods. Lifestyle theories emphasize individual behaviour change as the route to good health.
What is multifactorial disease causation?
Multifactorial disease causation includes epigenetic‘s and environmental triggers. Epigenetics cover the idea of having a specific gene that raises your risk for disease. It is not completely deterministic. Environmental triggers are what cause the epigenetics but sometimes are not necessarily sufficient enough to cause disease.
Explain wellness and well-being.
Wellness - The state of feeling well, not ill or sick.
Well-being - A broad concept that encompasses other areas of our lived experience. Examples include learning, financial security, social participation, work, leisure, housing, health, security, environment, and family life.
What is a population? What is population health?
Populations are groups of individuals with a shared characteristic. They can be geographically or politically defined, but do not need to be.
Population health considers the health outcome of a group of individuals, including the distribution of such outcomes within the group. The field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two. The public health agency of Canada defines population health as an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups. They believe that the population health approach recognizes that health is a capacity or resource rather than a state. It is being able to pursue one’s goals, to acquire skills and education, and to grow.
What is epidemiology?
Epidemiology provides important information to develop, implement, and evaluate approaches to prevent disease and improve quality of life in populations by studying distribution and determinants of disease in those populations.
Distribution - The focus of descriptive epidemiology that looks at how specific health outcomes are dispersed or patterned across a population. This is essential for developing hypotheses about the etiology of disease or other health problems and for planning health services.
Determinants - The focus of analytical epidemiology that looks at anything that influences the state of health in an individual or the distribution of health states in a population.
What are the fundamental assumptions of disease?
1) Diseases do not distribute randomly in populations, but rather distribute in relation to the factors that determine health for the individuals in that population.
2) Factors that determine health status can be identified by studying distributions of health outcomes in populations.
What are determinants of health?
Determinants of health are the range of personal, social, economic, and environmental factors which determine the health status of individuals or populations.
Explain the Dahlgren and Whitehead model of determinants.
The Dahlgren and Whitehead model of the main determinants group factors to reveal over arching layers of influences on health.
Age, sex, and constitutional factors:
The factors closest to an individual are related to personal and biological features. These include age, sex, or genetic make up which can contribute directly to our susceptibility to diseases.
Individual lifestyle factors:
Factors associated with an individuals health practices and behaviours which are important but may not always be associated with an individuals freedom to choose, and can be influenced by larger factors at family, community, or more broad levels. These can include dietary and movement practices.
Social and community networks:
The extent to which people receive social support from peers, family, or other people in their community. Stronger levels of support are associated with better health outcomes. Being able to express one’s culture is also extremely important.
Living and working conditions:
Critical determinants of health which include education systems, work environment, housing, healthcare services, food, water, and sanitation services.
General socieconomic, cultural, and environmental conditions:
More broad conditions that influence health in direct and indirect ways. These include climate change, poverty, or affluence and how that supports it’s larger social and government system.
What are social determinants of health?
Social determinants of health refer to social and economic factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. The social determinants of health refer to specific features of social and societal conditions that affect health, and how these can be altered by informed action. These circumstances are shaped by money, power, and resources.
What are physical determinants of health?
Physical determinants of health refer to those factors in the physical environment which affect health risk and outcomes. These include air quality, water quality, soil contamination, occupational hazards, motor vehicle usage, and housing.
What are examples of social and physical determinants of health?
Psychosocial factors - Knowledge, attitudes, belief, and ideas.
Biological factors - Genetic changes.
Environmental factors - Violence and genocide.
Health policy effects - Depending on the policies in place, there may be different accesses to healthcare.
Individual behaviours - Smoking and alcohol usage.
Define root, underlying, and proximal determinants of health.
Root - broad factors in our natural environment, macro environment, and population level inequalities which seem distant to the diseased individuals themselves.
Underlying - factors in the middle of route and proximal causes which are aspects of our built environment and social context which influences health from a medium range.
Proximal - factors that are closer to an individual such as personal health behaviors, or whether a person is exposed to proximal factors like chemicals.
Discuss risk factors of health.
The term risk factor is used when referring to health determinants that have been linked, by evidence, to specific health outcomes such that we can make a statement about level of risk they are associated with.
Intrinsic - Non-modifiable and biological characteristics
Disease-related - existing diseases that act as a risk for other diseases
Behavioural - Personal behaviours or lifestyle choices
Physical environment- exposure to contaminants or a lack of access to services
Social environment - interpersonal relationships and community networks
Some risk factors are more common than others and are associated with a more increased risk of mortality. These include high blood pressure, smoking, air pollution, high blood sugar, and obesity.
As populations experience economic growth, health risks transition from traditional to modern groupings which can be shown on a risk transition graph.
What are health statics indicators?
Health status indicators are a specific way to measure and understand Health status in order to address key global health issues. The use of health status indicators are critical for three distinct reasons:
1) to determine the causes of illness, disability and death
2) to carry out disease surveillance
3) to make comparisons about health within and across countries
These typically include life expectancy at birth, neonatal mortality rate, infant mortality rate, under five mortality rate, and maternal mortality rate.
How is population health measured?
Population health is often measured with vital statistics that collect data about mortality. The most common population health indicator is under five mortality. Although a blunt measure of health, death is an important aspect to consider but does not recognize suffering, disease burden, disability, or morbidity.
Define health disparities/inequalities.
Health disparities refers to a type of difference in health that is closely linked with social or economic disadvantage. Common patterns of health disparities typically emerge within and across populations due to income and variation in health indicators.
Health inequalities involve how resources are shared equally amongst individuals, considering the differences in health that are not only unnecessary and avoidable but are also unfair and unjust.
Define health inequity.
Health inequities are a form of inequality which can be understood as distinct according to the WHO definition which states that health and equities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work, and age.
What is the difference between health equity and equality?
Equity: fair shares
Equality: equal shares
What is a critical scholar?
A person who challenges aspects of existing structures that others accept without question.
What should a critical scholar question when reading information?
Any Information:
1) How do we know this to be true?
2) Are there other ways to understand this?
3) Whose knowledge is this?
4) How do I judge the quality of the evidence in support of this knowledge?
Health Information:
1) What definition are the authors using for health?
2) Are they considering a broad or narrow definition of health?
3) Is their definition grounded in a particular cultural understanding?
Health Data:
1) What health indicators* are the authors using?
Define the different health indicators.
Infant Mortality: The number of deaths of infants under the age of 1 per 1000 live births in a given year.
Life Expectancy: The average number of years a newborn baby would be expected to live if the current mortality trends remained.
Maternal Mortality: The number of women who die as a result of complications due to pregnancy and childbirth per 100,000 live births.
Neonatal Mortality: The number of deaths of infants under 28 days of age in a given year per 1000 live births in that same year.
Under-5 Mortality: The probability that a newborn infant will die before reaching the age of 5, expressed as a number per 1000 live births.
Discuss life expectancy as a health indicator.
Life expectancy at birth is a narrow health indicator at a population level as it is only about the length of a person’s life and not the quality.
However, it is a comparable statistic across geographies and this is why it is used. Life expectancy at birth across various regions as varies and is largely linked to levels of health development.
Discuss under-5 mortality as a health indicator.
Under-5 mortality rate is another example of a key health indicator where the “per 1000 live births” is about comparability rather than specificity. This allows you to compare values across different regions with vastly different overall numbers of deaths by bringing values to a similar scale.
Why can mortality statistics be flawed?
Health data is based on the assumption that vital statistics, the records of births and deaths, are taken everywhere. However, this is not always the case.
What are the two categories of methodologies of collecting health evidence?
Quantitative: the process of collecting and analyzing data that is mainly expressed as
numbers. This type of research consists of close-ended questions and allows you to test hypotheses.
Qualitative: the process of collecting and analyzing data that is mainly expressed as words or images. This type of research consists of open-ended questions and enables you to explore ideas in-depth.
What is critical appraisal?
Critical appraisal is the process of carefully and systematically assessing the outcome of scientific research to judge its trustworthiness, value, and relevance in a particular context.
There are structured approaches to critically appraising all different types of studies as it is important to assess the quality of any evidence and knowledge base.
What are environmental determinants of health?
Geography: include global location, country, region within a country, and urban/rural location.
Natural Environment: encompasses air, water, soil, trees, and green space. It includes both biotic factors and abiotic factors.
Built Environment: refers to housing, community structures, and things like roadways and other transportation structures you might be exposed to in your lives.
Food Systems: include factors related to food sources, food distribution, levels of food security or insecurity, as well as concepts such as food deserts.
Macro-Environmental Factors: political, economic, and national factors. This includes governance structures, climate change, war and conflict zones, and natural disasters.
What is environmental health?
The natural environment is life’s foundational support system. Environment can be best understood as the space, objects, people, and nature that surround any living organism.
Environmental Health: comprises those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychosocial factors in the environment.
What are environmental health burdens?
- Poor sanitation and lack of clean water
- Air pollution
- Inadequate housing/shelter
- Changing land use and climate
- Pollution and exposure to toxics
There is a significant burden of disease associated with environmental factors. Environmental-associated diseases make up 8.4% of total burden of disease in low and middle income countries
- Indoor Smoke: 3.7%
- Unsafe Water/Sanitation: 3.2%
- Urban Air Pollution: 1.5%
What are the consequences of environmental health problems?
Unfortunately, there are consequences of physical environmental health problems that are not shared equally across a population.
- A disproportionate burden lower SES status
- A negative effect on economic productivity
- A higher risk for young children
What are air pollutants?
Ultra fine airborne pollutants in the atmosphere are a result of the smoke and fumes emitted through human activities. Due to their small size, these particles can easily enter and irritate children’s lungs, cross the blood-brain barrier to affect cognitive development, and cross the placenta affecting fetal development.
Outdoor Air Pollution: worse in lower income urban communities. Outdoor air pollution includes environmental pollutants and industrial waste.
Indoor Air Pollution: worse in lower income rural communities. Indoor air pollutants include solid biomass fuels used for heating and cooking
What are the major urban air pollutants?
The air quality in urban centres and cities is indicated by certain air pollutants.
Particulate Matter: block and inflame nasal and
bronchial passages (<PM10), or penetrate lungs and enter the bloodstream (<PM2.5).
Other Pollutants:
* Ozone (O3)
* Nitrogen oxides (NOx)
* Sulfur dioxide (SO2)
* Carbon monoxide (CO)
* Ammonia (NH3)
* Lead (Pb)
* Polycyclic Aromatic Hydrocarbons (PAHs)
* Volatile Organic Compounds (VOCs)
What are the health risks of burning solid fuels indoors?
Burning solid fuels indoors creates many health risks the disproportionately impact women and children.
- Incomplete combustion, leaving breathable particles, gases, and chemicals.
- Smoke that can result in conjunctivitis, upper respiratory irritation, and acute respiratory
infections. - Carbon monoxide, which can cause acute poisoning
- Cardiovascular disease, pulmonary disease, cancer, and adverse reproductive outcomes.
Issues in Birth: miscarriages, early delivery, and low birth weight.
Child Mortality: 10% of mortality of children under 5 years old.
Brain Development: harms development of healthy children’s brains.
Discuss air pollution exposure and health inequities.
Certain populations remain at higher risk of air pollution than other populations.
Urban Populations: increased exposure to industrial sites, smoldering dumps, and electrical generators.
Rural Populations: increased exposure to unventilated homes and smoke-producing cook stoves.
Refugees and Migrant Families: increased exposure to tents filled with wood smoke and lack of adequate housing, heating systems, and healthcare while in migration or resettlement.
What factor exacerbate air pollution health inequities?
Lack of Access to Healthcare: makes children from low SES at even greater risk for adverse health effects caused by exposure to air pollution.
Climate Change: air pollution contributes to greenhouse gas production and threatens economic livelihoods.
What are the causes and consequences of unsafe water?
Causes:
* Pollution, contamination, and toxic exposure
* Inadequate sanitation and waste disposal
* Poor hygiene practices
Consequences:
* Diarrheal illnesses such as gastroenteritis and cholera
* Vector-borne diseases such as malaria, dengue and schistosomiasis
What are water-related infections?
Water- Borne: transmitted through the ingestion of water (cholera).
Water- Washed: result from poor personal hygiene due to an inadequate supply of clean
water (HepA).
Water-Based: transmitted through an aquatic intermediate host (Guinea worm).
Water-Related Insect Vector: transmitted by insects that depend on water to reproduce (malaria or dengue).
What was the plan for First Nations groups to get clean water?
The government will ensure that First Nation leaders have access to the tools and resources they need to deliver clean water to their residents.
Discuss the water crisis in Kitigan Zibi Anishinabeg.
Kitigan Zibi Anishinabeg is situated about 130 kilometres north of Gatineau/Ottawa, adjacent to the town of Maniwaki. The municipal system of this community draws water from surface water, and has had issues with treating water to acceptable drinking water standards. The remaining residents are on individual wells and have been on a drinking water advisory since 1999 because of an unacceptable level of uranium in the groundwater.
Kitigan Zibi Anishinabeg is one of 32 First Nation communities across Canada with drinking water advisories in September 2021.
What global region has the most individuals lacking access to clean water?
East Asia and the Pacific
What is the built environment?
The built environment refers to the infrastructure that makes up and includes housing, community structures, and transportation structures. Even within a single city or town, people’s exposures in this area can vary greatly.
What aspects of housing can impact health?
Internal Housing Conditions: include biological, chemical, and physical hazards (physical design).
Area Characteristics: include social benefits and location.
Housing Tenure: includes psychological benefits and financial dimensions.
How do living spaces impact health?
Pollutants: outdoor air pollutants can have an impact on an individual’s health in both urban and rural settings.
Building Materials: modern building and furnishing materials contain chemicals that can lead to short-term or long-term health outcomes.
Mold/Bacteria: humidity can create mold and bacteria in bathrooms, leading to respiratory ailments such as asthma and allergic reactions.
Cleaning Products: chemicals from cleaning products used in the kitchen release VOCs that can irritate the eyes, nose, and throat, causing difficulty breathing or nausea.
Fumes: carbon monoxide fumes from attached garages can cause confusion, vomiting dizziness, weakness, headaches, and in concentrated doses can be lethal.
Gases: radon seeping through foundation and cracks in the home can lead to lung cancer.
Cigarettes: primary, secondary, and even tertiary smoke can lead to lung cancer and other respiratory illness, especially when smoked inside.
Solvents: chemical fumes from paints and solvents release VOCs.
Irritants: animal hair and dander can cause asthma attacks and allergic reactions.
Fireplaces: combustion gases from fireplaces and wood burning stoves can trigger respiratory illnesses.
What is residential segregation?
Residential segregation refers to the spatial separation of two or more social groups within a specified geographic area, such as a municipality, a county, or a metropolitan area.
It shows the extent to which groups defined by racial, ethnic, or national origin live in different neighbourhoods and has been associated with many human health outcomes.
Discuss homelessness.
Unsheltered Homelessness: individuals who, at some point in their life, have lived in a homeless shelter, on the street or in parks, in a makeshift shelter, or in an abandoned building. (2.6% male and 2.3% female)
Hidden Homelessness: individuals who had to temporarily live with family or friends, or anywhere else, because they had nowhere else to live. (15% population)
What factors contribute to core housing need?
Lack of Affordability: occurs when tenants pay more than 30% of their income on housing (76.1%).
Lack of Suitability: occurs when tenants live in overcrowding conditions (4.3%).
Lack of Adequacy: occurs when a tenant’s home lacks a full bathroom or requires significant repair (4.5%).
How is life course perspective important when considering housing?
A life course perspective provides a reminder to consider determinants of health as they differ by different ages in a person’s life.
Young children spend large proportion of their time at home, and housing plays an important role in child development. Children are more vulnerable to exposure to physical, chemical, and biological harms because of their specific behaviours, and the impacts might be more severe because of the lack of maturity.
What aspects of a neighbourhood impact a person’s health?
Physical Features: include air, water, and grocery stores.
Availability of Healthy Environments: decent and secure housing, non-hazardous work, and safe play areas.
Services Provided: education, transport, and health.
Socio-Cultural Features: political, economic, ethnic, history, norms, values, crime, and support networks.
Reputation of an Area: how neighbourhoods are perceived by insiders and outsiders and
can affect investment, self-esteem & morale, and who moves in and out.
Discuss food deserts.
Certain neighbourhoods are structured in a way that there is no easy access to healthy food sources, and in which unhealthy foods exist as the closest and easiest options for residents. This is often a very intentional tactic used by businesses.
What is the macro-environment?
The macro-environment considers things such as a country’s governance structures, whether there is war or conflict, whether people have experienced natural disasters, and the ever
present impacts of climate change.
Discuss natural disasters and complex humanitarian emergencies.
Global health is significantly impacted by natural disasters and complex humanitarian emergencies.
Natural Disasters: any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area.
CHEs: characterized by extensive violence and loss of life, displacements of populations, widespread damage to societies and economies, and the need for large-scale, multi faceted humanitarian assistance.
What affects the management of complex humanitarian emergencies?
- Population Migration
- Corruption
- Disruption of Supply Chains
- Collapse of State or National Level Institutions
- Breakdown of Law and Order
Discuss climate change.
Climate change is the single biggest health threat facing humanity. Some of the most significant impacts of climate change include rising temperatures, more extreme weather, rising sea levels, and increasing CO2 levels.
Though the extent of the impact is unknown, climate change will have a significant impact on global health as it affects food, air, water, vector-borne diseases, and drought. Whether people live in rural villages, big cities, or islands and coastal towns, their health is threatened by climate change.
Which health issues are becoming more prevalent due to climate change?
- Lyme disease
- Eco-anxiety
- Symptoms of environmental allergies
- Asthma exacerbation/respiratory issues
How can you reduce environmental health risks?
Outdoor Air Pollution: minimizing automobile usage, adopting cleaner transportation options, using less energy and material goods, and avoiding the burning of garbage.
Indoor air pollution: use of indoor stoves with efficient fuels and a reduction of chemical use in household products.
Water: implementation of appropriate water systems and promotion of proper hand washing practices.
Sanitation: implementing low-cost sanitation systems and encouraging lifestyle modifications to improve sanitation on an individual level.
Housing: encouraging the construction of homes that are well suited to the climate of an area. This includes ensuring appropriate construction approaches and components,
and avoiding the use of harmful chemicals in material goods or cleaning products.
Climate: encouraging major reductions in greenhouse gas emissions through transition to clean energy sources and supporting changes in social norms towards a reduction in overconsumption of resources.
How does governance impact health?
A country’s political system has a direct relationship to the availability, number, and type of services that are available. The health system, resource allocation, taxation, benefits, and pensions are all examples.
People’s physical, mental, and emotional health can be affected in countries where freedom of
movement or expression are limited, or where specific members of the population are not given equal freedoms or opportunities.
In regards to the connection between governance and health, democracy plays a very pertinent role. Overall it is more likely for health rates to be more negative if a country does not have a free democracy
How does war impact health?
War can be defined as a state of armed conflict between different nations or states. Living in a place that is undergoing war directly impacts physical health as well as mental and emotional health. Security of a person is at the base of Maslow’s hierarchy of needs and is a basic human right.
People who experience trauma associated with war, can have immediate, medium-term, and long-term health impacts. PTSD is one type of negative health impact. In addition, people can also face increased risks of conditions such as heart disease, heart attack, high blood pressure and stroke, sleep problems, weight gain, and memory and concentration impairment due to the long-term impact of stress.
What are social determinants of health?
Broadly, the SDOH are social factors that influence health outcomes. SDOH are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. SDOH account for between 30-55 per cent of health outcomes.
- Social relationships and supports
- Social norms
- Social policies
- Societal features
- Political and economic systems
- Income and social protection
- Early childhood development
- Education
- Working life conditions
- Access to health services
What are lifestyle factors?
Lifestyle factors are the changeable ways of life and habits that have a serious impact on human health. They refer to the behaviours, actions, and lifestyle choices that individuals make that affect their health. It is true that lifestyle factors are connected to individual
choice but it is imperative to understand that SDOH can have immense influence on the choices that people have and make.
From a lifestyle perspective:
* Don’t smoke
* Follow a balanced diet
* Keep physically active
* Manage stress by making time to relax
* Drink alcohol in moderation
* Cover up in the sun
* Practice safer sex
* Take up cancer screening opportunities
* Be safe on the roads
* Learn the First Aid ABCs (Airway, Breathing, Circulation/Compression)
What is culture?
Culture is a shared set of beliefs, ideas, values, and behaviours. Culture forms the basis of a group’s identity, as members of a cultural group will typically share a common ideology and cosmology. Culture can also be described as an ideology linked to behaviour. It is transmitted across generations and through cohorts. It is
malleable, dynamic, and responsive to external stimuli.
