FINAL EXAM Flashcards
Stress
State of mental or emotional strain or tension from adverse or very demanding circumstances
Hans Selye
Hungarian born Canadian endocrinologist working out of McGill. He was a pioneer of biological effects of stressful stimuli
Selye definition of stress
The non-specific response of the body to any demand” & “That which produces stress”
General adaptation syndrome (GAS):
- Alarm: Body recognizes a stressor and is in state of alarm (activation of flight or fight)
- Resistance: Follows alarm reaction, it is a removal or disappearance of symptoms
- Exhaustion: As a result of chronic stress the body’s resources are depleted and unable to function properly
SAM system (3):
- Sympatho-adrenal-medullary pathway
- Perceived through the sympathetic nervous system of the autonomic nervous system
- Increases secretion of epinephrine and norepinephrine
Consequences of the SAM system (5):
- Suppression of cellular immune function
- Increased blood pressure and heart rate
- Variations in normal heart rhythm
- Sweating
- Neurochemical imbalances
HPA system (4):
- Hypothalamic-pituitary adrenal pathway
- Hypothalamus sends message to pituitary
- Anterior pituitary gland secretes ACTH
- This activates adrenal cortex to produce cortisol and glucocorticoids
Consequences of the HPA system (3):
- Cognitive decline
- Immuno-suppression
- Insulin resistance
Cortisol
Steroid hormone that the adrenal glands produce and release
Ways stress can be measured (5):
- Schedule of recent experiences - self report checklists
- Age specific checklists
- Life events and difficulties scale
- Interviews
- Difference in biographical circumstances
Problems with measuring stress via checklist (3):
- Memory and recall of life event
- What constitutes a life event; people interpret descriptors in very different ways
- Other factors influence how people respond (eg. Culture, gender, age)
Cognitive appraisal theory:
Originated in sociology/psychology. It was developed by Lazarus to describe and explain individual differences in adaptation
Theories of cognitive appraisal theory (3):
- Individuals constantly evaluate their relationship with the environment
- Behavioural and emotional responses determined by meaning attached to situation
- Psychological stress occurs when individuals appraise an interaction between themselves and the environment as greater than resource
3 types of stress appraisals:
- Harm or loss
- Threat
- Challenge
Life stress can lead to… (9):
- Asthma
- Rheumatoid Arthritis
- Anxiety
- Depression
- Cardiovascular disease
- Chronic pain
- HIV/AIDS
- Stroke
- Cancer
Animal research
Stress contributes to initiation, growth and metastasis of tumors
Human research
Stress contributes to antiviral defenses, DNA repair and cellular aging
According to Association of Dispositional Mindfulness with Stress article, what is the most common causes of stress among undergraduate students
Academic activities
Examples of academic stressors (5):
- Workload
- Too much information
- Studying
- Pressure to make friends when moving abroad
- Stress from living on residence
Psychological well-being (6):
- Autonomy
- Self-acceptance
- Environmental mastery
- Personal growth
- Purpose in life
- Positive relations with others
Cortisol levels at night vs morning
Low overnight and increase progressively during morning
Mindfulness
Awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment
Dispositional mindfulness would be associated with (4):
- Lower perceived stress
- Lower physiological stress
- Higher psychological well-being
- Greater perceived stress = disrupted cortisol secretion, lower well-being
Stress-elicited endocrine responses (2):
- Hypothalamic-pituitary-adrenocortical axis (HPA)
- Sympathetic-adrenal-medullary (SAM)
Cortisol
Primary effector of HPA activation. It regulates a broad range of physiological processes like anti-inflammatory, metabolism, and gluconeogenesis
Catecholamines
Effector of SAM activation. Exerts regulatory effects on cardiovascular, pulmonary, hepatic, skeletal muscle, and immune systems
Repeated activation of HPA and SAM interferes with..
Control of other physiological systems resulting in increased risk for physical and psychiatric disorders
Friedrich Engel’s study - The Condition of the Working Class in England:
- Examined and observed differences in mortality rates in suburbs of Manchester
- Observed death rates correlated with quality of housing and quality of streets
Rudolf Virchow*
Sent to Poland to investigate an epidemic of typhus in 1848. He found that feudalism, unfair tax policies and lack of democracy leads to poor living conditions, inadequate diet, and poor hygiene = typhus
Virchow recommendation
Preserving health and preventing disease requires full and unlimited democracy and radical measures rather than mere palliatives
What makes people healthy (traditional) (3):
- Biomedical model
- Pathogenesis-origins of disease
- Emphasis on personal factors/consciousness raising
What makes people healthy (alternative) (3):
- Upstream approach, emphasizes social determinants of health
- Salutogenesis-origins of positive health
- Emphasis on structural factors
What makes people healthy (individual) (4):
- Lay health beliefs
- Self health management - self care capacity/coping skills
- Biology and genetic endowment
- Health protective behavior - personal health practice/lifestyle
Public Health Agency of Canada - 12 determinants:
- Social status
- Support networks
- Education
- Employment
- Social environment
- Physical environment
- Personal health practices
- Skills
- Healthy child development
- Biology
- Health services
- Gender
- Culture
Statistics of Canadians sick from their life, health care, genetics, and environment
- 50%, 25%, 15% and 10%
Social inequality
Relatively stable differences between individuals and groups of people in the distribution of power and privilege
Social inequity
Unfair, avoidable differences arising from poor governance, corruption, social exclusion, discrimination
Social gradient
Graded association between the indicator of socioeconomic status and population health
Socio-economic position (SEP)
Social and economic factors that influence what position individuals and groups hold in the social structure of a society
SEP individual level measures (4):
- Occupation
- Income
- Education
- Wealth
Traditional tips for better health (5):
- Don’t smoke. If you can, quit. If you can’t quit, cut down
- Keep physically active
- Follow a balanced diet with fruit and vegetables
- If you drink alcohol, do so in moderation
- Manage stress by taking time to relax
Social determinants perspective tips for better health (4):
- Don’t be poor. If you can, stop
- Practice not losing your job
- Don’t live in a neighbourhood with high crime rates
- Don’t belong to a visible minority
Social determinants of health
The conditions in which people are born, grow, live, work and age. The circumstances are shaped by distribution of money, power, and resources at global levels
Salutogenic model:
Developed by Antonvosky that highlights importance of improving living and working conditions to provide a health-protective environment and the health and wellness of population
Pathogenesis
Origins of disease
Salutogenesis
Term used to encourage researchers to explore factors that protect and enhance good health (rather than what contributes to ill health)
Personal determinants
Individual level (eg. Genetics, beliefs, attidues, personal health practices)
Structural determinants
Societal level (eg. Rates of employment, living and work conditions, health care)
Lalonde major determinants of population health (4):
- Human biology: genetics that could lead to susceptibility of disease/hereditary disease
- Lifestyle: personal factors such as smoking, drinking, eating and physical activity
- Environment: immediate surroundings like air, water, soil, and food
- Use of formal health-care services: Focuses on individual health rather than population health so it is not well equipped to deal effectively with major health challenges like preventing occurence of disease and enhancing health
What is considered the leading cause of health problems
Life style problems - Tobbaco use, poor diet, physical inactivity
Types of environmental factors:
- Natural environment: Housing, workplace
- Built environment: Planning and design of our cities
Sprawl
Term that means that people must drive greater annual distances and navigate more complex roads which increases risk of traffic accidents
Education
Important health determinant because it improves people’s ability to access and understand complex health related information about effective selfcare
Health literacy
The ability to access, understand, evaluate and communicate information as a way to promote, maintain and improve health
WHO definition of population
Powerful and transforming demographic force. As the proportion of older people increase, there is a rise in prevalence of chronic diseases
3 types of support:
- Emotional support: Feelings of being cared for and valued
- Instrumental support: Vital practice assistance with activities of daily living
- Informational support: Knowledge about health related matters
Primary determinants*
Household income, education level, employment status
Secondary determinants*
Daily behavioural practices and psychosocial wellbeing
Horizontal structures*
Immediate factors that shape health and well-being (eg. Family, work, living conditions)
Vertical structures*
Distant factors that indirectly influence health (eg. Social, political and economic policies)
Life course perspective
Theory that suggests that each life stage influences the next. Thus, experiences from childhood impact how our life unfolds and so on
Pathogenic approach goal
Discover origin and nature of disease for treatment and has an illness-avoidance orientation. Focuses on biophysical aspects for risk factors in micro-organisms
Salutogenic approach goal
Discover origin and nature of good health to promote health protective behavior. Focuses on psychosocial aspects of health status to search for good health in social environment and lifestyle
Sex (3):
- Multidimensional biological construct
- Premised on biological characteristics enabling human reproduction
- Encompasses anatomy, physiology, genes, hormone
Gender
Structure of social relations that centres on the reproductive arena and the set of practices that bring reproductive distinctions between bodies into social processes
Things are gendered when:
- Characterized as masculine or feminine
- Prescribes or exhibits patterns of difference by gender
Individual level of gender (6):
- Sex category
- Identity
- Display
- Marital & procreative status
- Sexual orientation
- Personality
Structural level of gender (6):
- Gendered statuses
- Divisions of labour
- Kinships and family rights
- Personalities
- Social control
- Ideology
- Imagery
Differences in health due to gender (5):
- Women live longer than men
- Gender differs in major causes of death
- Women diagnosed as suffering from more ill health than men
- Women make more frequent use of formal health care than men
- Differences in the social determinants of health
Major causes of death (gender)
Unintentional injuries from motor vehicle accidents and suicide more common in men. Breast cancer and lung cancer from smoking more common in women
Health care differences (gender)
When women and men present the same complaints or medical diagnoses, women are given prescription more often
Role-accumulation hypothesis*
Suggests that women taking on multiple roles leads to positive health effects
Role-strain hypothesis*
States that women taking on multiple roles are harmful to health
Social acceptability hypothesis*
Suggests that women have been socialized into accepting the sick role
Risk taking hypothesis*
Suggests that men engage in risky behavior, because they are socialized to do so
Transgender/transsexual
Gender identity does not match their physical body (sex)
Trans people discrimination
They experience discrimination and violence. 73% in Ontario experience ridicule, half experience depression, and 43% attempted suicide
The international Classification of Diseases:
Developed by the WHO to classify the global population’s experience of disease and illness
What is the greatest cause of ill health according to WHO
Z59.5 (extreme poverty)
Structures of inequality (4):
- Class
- Gender
- Ethnicity
- Age
Social exclusion
Process of marginalization reflecting unequal power relationships between groups in society and involving unequal access to social, cultural, political, and economic resources
4 dimensions of social exclusion:
- Exclusion from civil society: limitations due to legal constraints or systemic discrimination
- Exclusion from social goods: limited access to resources or services like housing
- Exclusion from social production: Limited opportunities to contribute through employment or education
- Economic exclusion: Limited opportunities for acquiring adequate material conditions: living in high crime neighbourhood
Socioeconomic status
Refers to an individual’s relative social and economic position in society based on income, occupation and education
Life expectancy in Sierra Leone and Japan
47.5 years in Sierra Leone and 84.6 years in Japan
Demand control model:
- The psychological demands on the working person
- Degree of control the person has over work schedules and job conditions
Effort reward imbalance model
Emphasizes importance of social reciprocity in our work lives. Health is affected if the time and effort devoted to work are not matched by rewards, incomes, opportunities
Michael Marmot
- British epidemiologist and researcher of social gradient
- Investigator of Whitehall studies
Whitehall studies
Studies social gradient in mortality from CHD among British civil servants
Approaches that explain health inequality:
- Materialist and neo-materialist explanation
- Cultural behavioral explanation
- Psychosocial explanation
Materialist
Emphasizes the material conditions under which people live and characterizes aspects of the social structure such as differences in socioeconomic status
Differential exposure hypothesis
A materialist explanation. States that people exposed to positive and negative exposures over the life course and outcomes in adulthood are indicators of advantages, disadvantages and differences in exposure to stress influence biological factors that influence health outcomes
Cultural behavioural explanations
How we learn to behave in society
Differential vulnerability hypothesis
Argues that we all have stressors in our daily lives that our position on the social gradient can help to alleviate or make worse
Wilkinson’s income inequality hypothesis:
Suggest a greater inequality income distribution within proper population increases social problems
Income influences on children health (3):
- Low birth weight
- Injury related mortality (eg. fire and homicide deaths)
- Developmental problems (eg. Hyperactivity, psychosocial problems, delinquent behavior, delayed vocabulary
Neo-materialist
Health is affected not only by differential access to social and economic resources, but also by the level of funding invested in social infrastructure
Psychosocial explanation
People’s interpretation of their standing in the social hierarchy matters. Sense of relative deprivation can generate feelings of low self-esteem, shame, envy
Medical Care Act 1966
Implemented in 1968. Federal government share the costs 50-50 with the provinces for all medical services provided by a doctor outside of hospitals
When was medicare adopted in all Canadian provinces*
1971-1972
First province to implement medicare
Saskachewan
Canada Health Act
Principles and criteria for provinces to receive federal support; prohibitions of extra billing and user fees added to existing components
Five principles of Canada Health Act:
CUPPA
- Comprehensiveness: All medically necessary services should be provided by hospitals medical practitioners and dentists working in hospitals
- Universality: Providing service on uniform terms and conditions
- Portability: When people move between provinces, emergency healthcare is provided. Travel insurance not acquired
- Public administration: Has to be operated on a non-profit basis by a public authority who is accountable to the provincial government
- Accessibility: Reasonable access without financial or other barriers
Key features of the Canadian Health Care System (6):*
- Health care delivery is the responsibility of the provinces
- Privately delivered and publicly financed
- Private providers and public not for profit hospitals
- Fee for service funding and global budgets
- Choice of practitioner
- Universal coverage applies to less than 1/2 of total health care expenditures
How do we finance health care:
- Tax
- Health insurance premium
- Out of pocket expenditures
Total amount of money spent on health care in Canada*
$228.1 billion
3 main categories of health that funds go to
Hospitals, drugs, physicians (Physicians had a 4.5% growth in cost since 2007)
Year of establishment for Canada Health Act
1984
CIHI Report
Stated that the rate of growth in health spending has barely kept pace with the rates of inflation and population growth combined
WAHRS
Aboriginal organization who represent Aboriginal peoples who use illicit drugs and or illicit alcohol
Method for research in Determinants of Health: Discrimination and Social Exclusion
- Talking circles limited to ten participants
- Interviewed 30 individuals from 19-70 years and shared experiences about access to healthcare services
Most prevalent colonial discourse against Aboriginals
That they like narcotics
Egalitarianism
Particularly appealing, pervasive and powerful discourse in healthcare that perpetuates the assumption that people are treated the same regardless of social, ethnocultural or gendered locations
Ethnicity
A complex and multi-dimensional phenomenon that includes culture, ethnoculture, ethnic ancestry/origin, ethnic identity, language, religion, and race
Culture
General term that denotes a complex collection of values, beliefs, behaviors and material objects shared by a group and passed on from generations
How are health and ethnicity similar
They are both multi dimensional concepts that can be measured in several different ways
Two common measures of ethnicity in population health:
- Ethnic ancestry/origin
- Ethnic identity
Ethnic ancestry/origin
Refers to place where an individual or ancestors were born
Ethnic differences in health (5):
- Aboriginal people have poor health outcomes because of social exclusion and racism
- “Healthy immigrant effect” that deteriorates over time
- Ethnic differences in perception and understanding of symptoms
- Ethnic differences in health care behaviour
- Ethnic differences in the social determinants of health
Median income for aboriginal women and men vs non aboriginal in 2005
The median income for aboriginal women was $16,079 and $22,386 for aboriginal men, compared to $21,765 for non-aboriginal women and $33,214 for non-aboriginal men in Canada
2 most prominent sources of health inequity in Canada
- Aboriginal identity
- Socioeconomic status
Leading cause of death among aboriginal infants
Respiratory ailments, infectious/parasitic diseases and accidents which are indicators of inadequate housing, unsanitary conditions and poor access to medical facilities
Intergenerational trauma
Negative emotional effects stemming from an initial terrible experience felt throughout life course and reproduced through generations
Intercultural care
a one size fits all approach to health care that harms the safety and effectiveness of medical care offered to those with diverse backgrounds
Cultural sensitivity
Emphasizes awareness that doctors and nurses understanding patients who may come from different cultural backgrounds
Cultural safety
Allows patient to judge whether a particular health-care professional or treatment is, in fact, culturally safe
Medicine wheel
The indigenous way of understanding health and wellness. Seasons are associated with four elements of wellness ranging from physical, emotional, mental and spiritua
Explanations for the deterioration of the healthy immigrant effect (3):
- Converging lifestyles (eg. Smoking, alcohol abuse, bad diet)
- Resettlement stress (eg. Social exclusion, unemployment)
- Differential access to health care (eg. Language and cultural barriers, and lack of access to formal health-care services and family physicians)
Healthy immigrant effect
Term given to the phenomena of immigrants arriving to Canada with stronger health than Canadian borns. However, immigrant health experiences a steep decline over time since migration to reach the Canadian-born population’s health levels or lower.
Thrifty gene biological hypothesis
Unproven explanation for high rates of diabetes among aboriginals by putting focus on biological factors and minimizing the environmental and lifestyle factors like age, stress, lifestyle
Ethnic density effect
Refers to health benefits associated with living in a neighbourhood with a high concentration of others from one’s own ethnic group
Myth buster 1 summary (IMG’s are the solution to the doctor shortage in underserviced areas)
There is a greater demand for healthcare in rural and remote communities because they experience higher rates of chronic disease, traumatic accidents, and poor mental health than urban but there aren’t enough health workers especially doctors. Therefore, many international medical graduates were recruited for temporary placement but many ended up leaving these communities after receiving their full license due to personal and social problems, so the problem for underserviced communities still remained in place without a solution. To fix this, the best hope is to encourage people who are already from rural areas to apply for medical school which would hopefully want to make them stay at the job
Myth buster 2 summary (User fees ensure better use of health services)
Article that debates whether user fees ensure quality of health services, while minimizing unnecessary hospital visits, and the answer was no, they do not. In fact they affect those who are chronically ill very negatively. It basically just obstructs access to needed care especially for those who cannot afford it and was not necessarily effective unless you had a higher income. And they ran up an experiment by the RAND Health Insurance, and found that user fees cause people to forego necessary treatment. So for example an elderly started taking less medicine and the conditioned worsened, so there was increase in patients ending up in hospitals
Primary health care services
Provides direct provision of first-contact health care services and coordinates patients’ health care services. May include prevention and treatment of common diseases and injuries or referrals to other units
Secondary health care services
Services may be provided in the home or community (mostly long-term or chronic care)
Palliative care
Approach of service providing counselling and management on those nearing death and their families wanting emotional support. Delivered at hospitals, long-term care facilities, home
Supplementary health care services
Prescription drugs outside hospitals, dental care, vision care, medical equipment and appliances and services of other professionals like physiotherapists
Iatrogenesis
Term used to describe sickness and injury caused by the health-care system
3 types of iatrogenesis
- Clinical
- Social
- Cultural
Ivan Illich
Argued that modern medicine is the major threat to health in medical nemesis
Clinical iatrogenesis
Illness or injury caused directly by the health-care system
Social iatrogenesis
When people become dependant on medical interpretations of reality
Cultural iatrogenesis
Increasing medicalization would eventually compromise people’s abilities to look after their own health without professional health
Toward a Healthy Future (TAHF)
Produced by the federal/provincial/territorial advisory committee to address health inequalities
6 chapters of TAHF:
- Socio-economic environment
- Healthy child development
- Physical environment
- Personal health practices
- Health services
- Biology and genetic endowment
Results of research article: News media, health literacy and public policy in Canada
- Significant difference in focus between health influences identified in policy statements and newspaper coverage of health stories
- More people focused on traditional healthcare
- Newspaper failed to discuss issues like housing, child development, education, working hazards
Public health model
Approach that sees the causes of death and injury as preventable rather than inevitable
Framing theory
Cues learned from the media can also be used to make sense of our experiences and social situation
4 functions of frames:
- Define problems
- Diagnose causes
- Make moral judgements
- Suggest remedies
Episodic framing
Led people to attribute responsibility to individuals
Thematic framing
Led people to attribute responsibility more to societal causes
What was the research article: Testing the effect of framing and sourcing in health news sources about
Experiment to see whether public health framing and rich sourcing had a causal effect on peoples’ attitudes towards health problems
First factor of article
Framing (public health/traditional)
Second factor of article
Sourcing (rich/poor)
Repetition factor of article
Four health topics (obesity, diabetes, immigrant health, smoking)
43%
BC budget spent on health care
