Final Flashcards
Why is the AIDS epidemic so large in South Africa?
Accessibility of preventative measures
Apartheid
Describe Nelson mandelas role in the aids epidemic
Criticized for failing to identify the threats posed by HIV during his presidency - never made priority
Delegated to thabo mbeki
Descibe thabo mbeki’S role in the aids epidemic
Criticized the scientific idea that HIV causes AIDS
Organized presidential advisory panel regarding HIV/AIDS including several scientists who denied the causality
Appointed health minister who promoted herbal remedies
Blames for 343000 to 365000 preventable deaths and not prescribing ART
Describe Jacob zuma’s role in the HIV epidemic
In 2006, charged with raping hiv positive women and minimized by taking hot shower
Four years later had baby with daughter of another family friend
In 2010, released hiv test results to launch scaled up government programme of couselling and testing
Major overhaul of aids policy in December 2010 that resulted in increase of ART
What is the problem with the current healthcare in South Africa?
Many hospitals are in a state of crisis
Not enough doctors
84% of the population is uninsured
Rely on nurses and community health workers to improve access to health care in rural areas
What are the reasons that there is a disproportionate burden of HIV in young women?
Several factors including biological, social, behavioural, cultural, economic, and structural
Great mucousal surface, STIs, hormones/birth control/pregnancy
Dominant patriarchal cultural society
Lower SES
Behavioural vaulnerabilities
Structural vaulnerabilities
Define income
Financial or material resources earned from work
Define wealth
The value of what is owned, minus any debts
A better indicator of long term health outcomes
Define social status
The social and economic positions of individuals or groups within society
How is SES a social determinant of health
Difficulty accessing health care and experience poorest health outcomes
Income provides prerequisites for health such as shelter, food, warmth, and ability to participate in society
Can increase stress and anxiety
Explain poverty in a global context
Acts like a disease
Puts sufferer at risk of high morbidity and mortality
Can cause direct harm at extremes
Children have increased health risks as adults
Findings are consistant across time, geography, and different populations
How does income inequality effect a society?
The healthiest populations are those in societies which are prosperous and have equitable distribution of wealth
Studies show that may be more important determinants than total amount of income earned by society members
What do large gaps in income distribution lead to?
Lead to increases in social problems and poorer health among the population as a whole
How are poverty, inequality and health related?
Poverty directly harms the health of those with low incomes; income inequality affects the health of everyone
What are the three arguments for addressing poverty in health care?
- This is required by the fundamentals of family medicine (health advocated, communicator, resource to a defined community)
- Poverty is a major risk factor for disease so required intervention
- Poverty is a disease and warrants treatment like any other
How was colonialism a unique determinant of health?
Inconvenient allies of the 18th century became the Indian problem that needed to be done away with
- the Indian act
- dispossession of land, relocation, violated treaty rights
- the Indian residential schools
Descibe the Indian residential schools
1863-1996: 150000 children from across Canada were forced to attend IRSs
130 schools operated
Run in partnership between churches and federal government with the explicit goal to kill the Indian in the child
What were the steps used by the IRSs?
- Isolate children from normal socialization processes
- Create punitive and deprived living conditions
- Foster peer to peer agression and abuse
- Maintain segregation and marginalized status
How did IRS create punitive and deprived living conditions?
Administer arbitrary and unpredictable sexual, emotional, and physical abuse
Humiliated and genufrate cultural features and practices
Deprive of food, clothing, basics, health care (over 4000 died)
How did IRS maintain segregation and marginalized status?
Return children to their original community with neither traditional skills nor access dominant group resources
What were some issues with IRSs?
Survivors are more likely to suffer from physical and mental problems compared to those who did not attend
What were some intergenerational impacts of IRSs?
Epigentic impacts in subsequent generations emanating from survivor trauma, prenatal conditions
What are the effects of IRS on parenting practices?
parenting skills diminished empathy mental health problems child abusers and domestic violence substance abuse mistrust of education
What are the effects of IRS on social relationships?
Mistrust of one another
Internalized racism
Shame, guilt, anger, sadness
Disconnection between youth and elders
What are the effects of IRS on community traditions?
Loss of language
Lack of skills to achieve effective governance
Lateral violence
Diminished connection to healing traditions and spirituality
What are some government policies going forward from IRS?
Truth and reconciliation calls to action
Addressing jurisdictional issues regarding health and delivery
Address gaps in determinants, including funding for child welfare, education, community infrastructure, and health resources
Why is housing important?
Fulfills physical needs by providing security and shelter from weather and climate
Fulfills psychological needs by providing a sense of personal space, safety, and privacy
Fulfills social needs by proving a gathering area and communal space for the family, the basic unit of society
Fulfills economic needs
What are some basic needs that are compromised when you are homeless?
Bathing Holding down a job Using your skills Feeding yourself Staying warm/dry/cool Hosting friends Socializing Feeling safe
What attitudes might individuals encounter as a result of being homeless?
Negative perceptions from society, police, other homeless people, stigma abuse
What is the impact of homelessness?
Are at greater risk of premature death compared to the general population
What are some potential solutions to ending homelessness?
Housing is health care: approach to taking homelessness in Vermont has lowered chronic homelessness rates, health care costs, and saved money on lay enforcement and social services
Housing first: provinding housing before a job
What are housing firsts core 5 principles?
Immediate access to permanent housing with no housing readiness requirements
Consumer choice and self-determination
Recovery orientation
Individualized and client-driven supports
Social and community integration
What are the neighbourhood mechanisms?
Community services
Social environment
Psychical environment
Describe community services
Grocery stores
Recreational opportunities
Health care facilities
Retail stores
Describe social environment
Social relationships - transmit information Neighbourhood cohesion - social capital Shared cultural norms and values Civic participation - demand services Access to education and employment
Describe the physical environment
Toxicants
Noise
Poor housing
What are some examples of education in the global context?
Poverty reduction HIV/AIDS Maternal mortality Child health Hunger
Describe the effect of education on poverty reduction
No country has ever achieved continuous and rapid growth without achieving an adult literacy rate of at least 40%
The higher productivity income gains reflect can contribute to national economic growth
Describe the effects of education on HIV AND AIDS?
Women are now the principle victims of HIV/AIDS in poor countries
Education helps women protect themselves
Young people who have completed education are less that half as likely to contract hiv as those with little or no schooling
Describe the effect of education of maternal mortality
Women with six or more years of education are more likely to seek prenatal care, assisted childbirth, and postnatal care, reducing the risk of maternal and child mortality and illness
Describe the effects of education on child health
Educated mothers are 50% more likely to immunize their children than mothers with no school
Describe the effects of education on hunger
Most farmers in the developing world are women
Educating girls and women leads to more productive farming and accounted for more than 40% of the decline in malnutrition achieved between 1970 and 1995
Define literacy
More than knowing how to read, write, or calculate
Involves understanding and being able to use the information required to function effectively
Define multiple literacies
Ways of reading the works in specific contexts: technological, Health, information, media, visual, scientific and so on
What are Canadians with low literacy more likely to be?
Unemployed and poor
Suffer poorer
Die earlier
What do people with higher levels of literacy and education have?
Have better access to health physical environments
Are better able to prepare their kids for school
Tend to smoke less
Tend to be more physically active
Tend to have access to healthier foods
How is employment associated to health?
Employment provides income, a sense of identity and helps structure day-to-day life
Unemployment frequently leads to material and social deprivation, psychological stress, and the adoption of health threatening coping behaviours
What work dimensions shape health outcomes?
Employment security Physical conditions at work Work pace and stress Working hours Opportunities for self expression and individual development at work
What did the Whitehall studies find?
The higher the quality of job, whether measured by job status, income, or degree of control over work, the better the persons mental and physical health
What is attributed job insecurity?
Study population is deemed to be at risk by researchers
What is perceived job insecurity?
Workers own perceptions of discrepancy or experienced and desired job security
Considered the more potent stressor
What are some less obvious health effects of working conditions?
High stress jobs: predispose individuals to high BP, CVD, and development of physical and psychological difficulties
Shift work: associated with CHD, sleep disorders, anxiety and depression, substance abuse, and family breakdown
Commuting: contribuez to a sedementary lifestyle and higher stress
Forced inactivity in the workplace
Demand - control imbalance
Effort - reward imbalances
Define under-5 mortality rate and infant mortality rate
Under-5: probability of dying by age of 5 years
Infant: probability of dying by age of 1 year
What are the 6 major causes of child mortality?
Diarrhea Malaria Neonatal infection Pneumonia Preterm delivery Lack of oxygen at birth Malnutrition and lack of safe water and sanitation contribute to half of all these deaths
What are some cost effective measures that would reduce the number of deaths by half?
Vaccines Antibiotics Micronutrient supplementation Insecticide treated bed nets Improved family care Breastfeeding practices
What are the three proposed models of early childhood experiences?
Cumulative effects
Latency effects
Pathway effects
What are cumulative effects?
Analogous to the life course hypothesis emphasizing the accumulation of dis/advantage over the entire lifecourse
Eg. Chronic poverty
Define latency effects
Exposures early in life, including in utero, have later effects on health (regardless of later life experiences)
Eg. Low birth weight
Define pathway effects
No direct effects but early life circumstances determine later life circumstances
Eg. SES, education
Define biological embedding
The process by which human experience alters biological processes in stable and long term ways that influence health over the life course
Define epigentic regulation
Environmental signals may cause long term changes in gene expression through modifying DNA or associated proteins but not DNA sequence variation
Define gene-by-environment interaction
Contrasting with genetic of environmental main effects, specific génotypes my produce systematically different human characteristics depending upon the individuals environment
What was the Quebec ice storm a natural experiment for?
Effects it prenatal maternal stress in critical windows of pregnancy on physical, cognitive and behavioural development in offspring
>150 pregnant women and children followed from birth uni adolescence
What did the Quebec ice storm study find?
Negative cognitive and language development from age 2
Shorter gestation length and lower birth weights in infants exposed
Brain sparing in boys but not in girls in early pregnancy
Severity of stress increased insulting secretion at age 13
What is the impact of experiences from conception to age 5?
Have the most important influence of anytime in the life cycle in the connecting and sculpting of the brains neuroma
Critical window
What is the impact of positive stimulation early in life?
Improves learning and memory, behaviour, and health into adulthood
What are the impacts of a loving, secure attachment between parents and caregivers?
Especially in the first 18 months of life, helps develop trust, self-esteem, emotional control, and the ability to have positive relationships with others in later life
What are neglected and abused infants and children at a higher risk for?
Injuries
A number of behavioural, social, and cognitive problems later in life
Death
Define food security
Exists when individuals have complete physical and economic access to an adequate amount of good which meets their dietary needs to support and health lifestyle
What is the FAO’s mandate?
To ensure people have regular access to enough high quality good to lead active, healthy lives
To raise levels of nutrition, improve agricultural productivity, better the lives of rural populations and contribute to the growth of the world economy
What does food security depend on?
Supply of food
Reliability of supply
Access
What is food utilization?
Whether micronutrient intake is sufficient in quantity and balance to allow adaquate absorption of available macronutrients
What factors can influence food security?
Distrabution Corruption Commodity prices Climate change Natural disaster Gender Power differentials
What are the three pillars of food security?
Food availability: sufficient quantities of food available on a consistant basis
Food access: having sufficient resources to obtain appropriate foods for a nutritious diet
Food use: appropriate use based on knowledge of basic nutrition and care, as well as adequate water and sanitation
How is obesity related to food insecurity?
Obesity is not always due to food insecurity but can be a manifestation of an inability to access nutritious food or inadequate health literacy
What are the arguments for educating our children about food choices?
Children will not eat what they don’t know about
Obesity related diseases are preventable
Why do older people make up more of the population?
Rapid increase in life expectancy coupled with declining fertility rates
Led to policy concerns about impact on health and social services
What are some barriers to successful aging?
Inequalities in health at older age
A life-course perspective on health in older age
Risk factors in the social environment
What are some social risk factors of aging?
Retirement: period of key identity transition
Perceived control: social identity allows control with allows health and well being
Perceived social status: loss of occupation status and/or income may affect health of older adults
Why is caregiving a social risk factor for aging?
Majority of individuals who assume caregiving roles most likely do so in mid-to later life
More likely women
Stess and time of caregiving often result in compromised immune, neuroendocrine, cardiovascular functioning and social engament
How is social support a social risk factor for aging?
Morbidity and declines in functioning often precedent with age and also acts as a buffer for stressors
Direct effect: blood pressure response to a challenge and maintaining cognitive function
Indirect effect: higher income and education associated with larger social networks
What is an age friendly community?
Encourages active ageing by optimizing opportunities for health participation and security in order to enhance quality of life as people age
What are the 8 age-friendly indicators?
- Outdoor spaces and buildings
- Transportation
- Housing
- Social participation
- Respect and social inclusion (ageism)
- Civic participation and employment (volunteering)
- Communication and information
- Community supports and health services
What is cultural competence?
Refers to the skills, knowledge, and attitudes of a health care provider that are required to provide care with consideration for various cultural differences
Ongoing process whereby the health professional respects, accepts, and applies knowledge and skill appropriate to client interactions without allowing personal beliefs to influence clients differing views
What are the 6 attributes of cultural competence?
Cultural awareness Cultural knowledge Cultural understanding Cultural interaction Cultural sensitivity Cultural skill
What is cultural awareness?
In depth self exploration of own cultural beliefs/values as they influence your behaviour and the delivery of competent care
Receptive to learning about the cultural dimensions of the patient
Recognizing that health is expressed differently across cultures and that cultural influences responses to health, illness, disease, and death
What is cultural knowledge?
Information about organizational elements of diverse cultures
Emphasis placed on learning about clients worldwide
Knowing about cultures other that your own
Recognizing differences in communication styles and etiquette between and within cultures
What is cultural interaction?
Verbale and non verbal communication between people of different cultures
Engaging in effective communication
Learning from clients about life experience and their health significance
Appropriate language and literacy level
What is cultural understanding?
Continuous reflections on the effects of culture for diverse clients
Understand what western medicine does not have all the answers
Know that marginalization influences patterns of seeking care
What is cultural sensitivity?
Being able to appreciate, respect and value cultural diversity
Recognizing how ones own cultural background may influence professional practice
What is cultural skill?
Effective integration of cultural awareness knowledge to obtain relevant info to meet the needs of culturally diverse clients
Cultural assessments that consider beliefs, values, family roles, health practices, and the meanings of health and illness
What is the desired outcome of cultural competence?
A set of congruent behaviours, attitudes, and policies that come together in a system, agency, or among professionals to enable them to work effectively in a cross cultural situation
What does cultural competence do?
Moves beyond cultural awareness and cultural sensitivity
Acknowledge and respond to the unique world views
Recognizes cultural patterns of behaviour but also acknowledge social inequities faced by others
What are the three steps to cultural competence?
1) self awareness
2) self analysis
3) community partnership
What is social justice?
Fair and proper administration of laws conforming to the natural law that all persons irrespective of ethnic origin, gender, possessions, race, religion, etc, are to be treated equally without prejudice
What are the different layers of social justice?
Local: homelessness and youth crime
National: indigenous injustice, unemployment
International: World poverty, slavery
What are the types of social change agents?
Ultra-committed change makers Faith inspired givers Socially conscious consumers Purposeful participants Casual contributors Social change spectators
What are ultra commited change makers?
the most active agents of change, dedicate lives to social justice
What are faith inspired givers?
inspired by religion and are typically active within any given faith
What are socially conscious consumers?
those who are drawn to green and social justice issues, and tend to support environmentally conscious businesses
What are purposeful participants?
More pragmatic in natural
Driven by professional motivations like work and school
What are casual contributors?
Typically of an older demographic
Inspired by local communities and want to instigate change in their immediate environment
What are social change spectators?
Not an ongoing commitment
How could we improve daily living conditions?
Equity from the start Healthy places health peoples Fair employment and decent work Social protection across the lifespan Universal health care
