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NEW XIA POPLHLTH > FINAL POPHLTH CRAM > Flashcards

FINAL POPHLTH CRAM Flashcards

1
Q

What are the reasons for the GBD project

A

Data on the burden of disease and injury from many countries were incomplete

Available data largely focused on deaths and there is little information on non-fatal outcomes

Lobby groups can give a distorted image of which problems are most important

Unless the same approach is used to estimate the burden of different conditions, it is difficult to decide which conditions are most important and which strategies may be the best buys

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2
Q

What are the aims of the GBD project

A

To use a systematic approach to summarize the burden of diseases and injury at the population-level based on epidemiological principles and best available evidence

To take account of deaths as well as non-fatal outcomes when estimating burden of disease

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3
Q

What were the key sources of data for DALYs

A

statistical models developed to get best estimates when data were incomplete

epidemiological studies and surveys
disease surveillance system

vital registration data

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4
Q

What were the major impacts of the GBD approach

A

informed priority setting based on premature death as well as disability

avoided biases due to incomplete data

Methods used could be applied to any population

Non-communicable diseases recognised as a major and increasing problem in low and middle income countries

Drew attention to previously hidden burden of mental health problems and injuries as major health prolems

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5
Q

Right to health

A

1) enshrined in international law
2) extends beyond health care to pre-conditions
3) States obliged to respect
protect and
fulfil
Socal epidemiology links health with social justice and thus links to good government

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6
Q

Respect

A

No discrimination against ethnicity, gender, etc

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7
Q

Protect

A

No interference from 3rd pparties

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8
Q

Fulfill

A

adopt measures to achieve equity

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9
Q

What are 2 aspects of right to health that makes it fit with the human rights framework

A

1) Health inequities are evidence of laws, policies and practices that distribute resources and opportunities in a discriminatory manner and limit full participation

Health is acknowledged as political( power, social context and politics_ and health policy decisions have a legal dimension rather than being purely at political discretion

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10
Q

Difference of right to health compared with right to be healthy

A

Right to health is the responsibility of governments or political power to equalise health outcomes whereas right to being healthy is an individual responsibility

Right to being healthy cannot be guaranteed as it is a function of an individual’s family history and other risks

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11
Q

Why should we eliminate discrimination

A

Because discrimination causes impairment of enjoyment of rights

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12
Q

Right to Health history

A

Universal declaration of Human rights-1948
-didn’t define the parameters of right to health but noted they both include and transcend medical care

The determinants of health contextualised

ICESCR-international covenant on economic, social and cultural rights, that explicitly states rights of health needed

Then in 2000, ICESCR clarified in article 14
that the right to health is not equal to the right to be healthy
related to other human rights and health equity

And gives examples of what the obligations of the states should be

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13
Q

What are the 3 levels of influence

A

The person
The community
The environment

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14
Q

The person

A

Age, sex, biology, behaviour

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15
Q

The community

A

Includes local influences such as the home, workplace and neighbourhood

social capital and

The wider societal levels such as education and the healthcare system

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16
Q

What is in The environment

A

Refers to the cultural, social, political, physical and the built environments

Water quality, clean air
Design of communities, buildings roads, light rail

Knowledge, beliefs, values accepted by a group of people

Emerging or re-emerging toxins affecting populations

Biodiversity, climate change, ecological footprint

Approaches to improving population health

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17
Q

Alma ata1978

A

Protect and promote health of all
advocated a health promotion approach to primary care

gives us the pre-requisites for health

  • peace and safety from violence
  • shelter
  • education
  • food
  • income and economic support
  • stable ecosystem and sustainable resources
  • social justice and equity
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18
Q

What does the ottawa charter acknowledge

A

That health is a fundamental right for everybody
It requires both individual and collective responsibility

The opportunity to have good health should be equally availabele
And that good health is an essential element of social and economic development

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19
Q

What are the 5 priority action areas

A

Develop personal skills
Strengthen community action
create supportive environments
Reorient health services towards primary health care

Build healthy public policy

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20
Q

Develop personal skills

A

Life skills education in schools

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21
Q

Strengthen community action

A

self-help groups and community organised services, community initiatives that promote healthy schools, healthy cities
youth health

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22
Q

Create supportive environments

A

implementing air control measures, water and sanitation promgrammes, b

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23
Q

Reorient health services towards primary health care

A

Care process responsive to needs of patients and families

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24
Q

How is data collected to estimate HIV prevalence in populations

A

surveillance systems
epidemiological studies
surveys in health facilities, especially antenatal clinics

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25
Q

What are the 5 key things that happen in health protection

A

predominantly environmental hazard focused

Risk/hazard assessment

Monitoring
Risk communication

Occupational health

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26
Q

List 6 things that make a suitable screening program

A

Benefits must outweigh harm
RCT evidence that screening program will result in reduced mortality and increase survival

cost effective

health care system must be able to support all the elements of the screening pathway

Needs to reach all those who are likely to benefit from it

27
Q

What is a suitable test

A 
reliable
safe
simple
affordable
acceptable
accurate
28
Q

Discrimination

A

Discrimination travels on various axes of identity-isms
Acts on access to and thru’ care and quality of care

Even if not intentiional, discrimination causes impairment of enjoying rights

29
Q

Right to health in NZ

A

The code of health and disability service consumer rights

30
Q

What’s in the code of health and disability service consumer’s rights

A

Outlines 10 rights including freedom from discrimination and services of an appropriate standard

alighns with human rights act

31
Q

What are the 4 features of the NZ Public health and disability ACT

A

Reducing inequalities one of its purposes
main purpose a DHB based health system to foster community participation

Treaty of Waitangi clause that notes that no-one will have special privileges on basis of race

reducing inequalities focus re-iterated in overarching policy documents

32
Q

UN Declaration on Rights of Indigenous peoples

A

Preamble states everyone has human rights

Indigenous peoples have rights not fully realised

Declaration seeks to facilitate full realisation of rights and stronger relationships between indigenous peoples and states

33
Q

What are the 4 factors that shape HIV/AIDS

A

AIDS related deaths are decreasing and people are living longer with HIV due to improved treatment and expanded access to treatment and care

But globally, a high proportion of people with HIV do not know their HIV status, and most people living with, or at risk for HIV do not have access to HIV prevention, treatment and care

HIV/AIDs is really multiple epidemics-not all communities regions and populations are affected in the same way

In order to reduce the burden of HIV/AIDs-it is essential to tailor the response and interventions to local circumstances and prevalent risk factors

34
Q

Feminisation of the HIV epidemic

A

refers to the observation that increasing proportions of new infections are among women, primarily due to heterosexual transmission of the infection

35
Q

What are social determinants that influence the acquisition and treatment of HIV

A

Gender inequalities in rules governing sexual relationships, negotiating condom use, sexual abuse

Poverty and low social status, and consequent limited access to education and reproductive health services( less likely that women can access the opportunity for prevention and treatment)

Social norms, stigma and discrimination that prevent access to prevention efforts and treatment

Problems with disclosure of HIV status, partner notification and confidentiality

36
Q

Gender inequities in feminisation

A

Women rights to safe sexuality and to autonomy in all decisions relating to sexuality is intimately related to economic independence. This right is most violated in those places where women exchange sex for survival as a way of life

Basic social and economic arrangement between the sexes which results both women and men means that often male control increases over women’s lives in a context of poverty

Unless and until the scope of human rights is fully extended to economic security, women’s right to safe sexuality is not going to be achieved

37
Q

Impact on young people

A

Children particularly vulnerable
done through mother to child transmission
Half of new HIV infections are among people under 25

38
Q

Mother to child transmission is reduced

A

by screening pregnant mothers and treating those who are HIV+ with anti-retroviral drugs

39
Q

What are the key sources of bias whe generalising antenatal clinic surveys

A

Prevalence among pregnant women may not be similar to prevalence among men, children, women-can’t extrapolate directly

Data from urban antenatal clinics will not represent the prevalence in remote or rural populations

Estimates among people attending clinics can defer from those who do not attend clinics

40
Q

How is HIV prevented and controlled

A

Safer sex: Media, education condoms

Safer products: screen blood products for HIV
Needle and syring exchange programmes for IV drug users

Protect against needle stick injuries

INCREASE ACCESS TO HEALTHCARE-voluntary testing, counselling, support

REDUCE DISCRIMINATION OF THOSE DISABLED

41
Q

What are the 3 major challenges for the future regarding HIV

A

Global resources for prevention and care for HIV fall well short of the needs

Successful efforts for prevention need to combat stigma and discrimination

Inequities in resources and access to health care, make it essential to address the social determinants of health and human rights

42
Q

obesity causes

A

genetic, metabolic, behavioral and environmental

43
Q

How is obesity distributed

A

In high income countries, both ages are affected, but disproportionately more in the more disadvantaged groups

In low middle income countries, the most affected are middle aged people in urban environments, especially women

Underdeveloped countries face a dual burden, as they are still dealing with undernutrition, yet some areas hit with obesity

44
Q

Stereotypic progression of the obesity pandemic

A

starts in women, middle age, high wealth

then it progresses to men, children low SES, rural

45
Q

What are the 4 kinds of consequences of obesity

A

Metabolic disorders-Diabetes, cancers
Mechanical disorders-arthritis

Psychological problems-low self esteem
Social consequences-weight discrimination

46
Q

Obesogenic environments

A

The sum of influences that the surroundings/opportunities/conditions have on promoting obesity in individuals and populations

Obesity is the result of people responding to the obesogenic environments they find themselves in

The obesogenic environment has physical, exonomic, policy and sociocultural aspects

47
Q

What are 3 global forces that drive the pandemic

A

Food systems- globalised food supply and technological changes creating cheaper and more available food calories

Changes to lifestyle-levels of occupational physical activity, sedentary lifestyles, increased mechanisation, fewer active transport and recreation opportunities

Political and economic drivers-drive us to consume in an attempt to improve the economy via market based growth

48
Q

Moderators

A

Factors which attenuate/accentuate the rise in obesity

49
Q

Drivers

A

Changes in drivers over time drive changes in outcomes over time

50
Q

Mediators

A

factors through which the drivers operate

51
Q

What prevents implementation of WHO’s prevention strategies

A

policy resistance-strong opposition by powerful food companies

Political timidity and susceptibility to lobbying

Muzzling of civil society organisations

Weak accountability services

Lack of public pressure

Inadequate present systems for monitoring population nutrition and weight

52
Q

What are the 3 determinants of health inequalities

A

Differential access to health determinants and exposures leading to different disease incidence

Differential access to health care

Differences in quality of care received

53
Q

Globally minorities feel

A

less listened to
spend less time with the healthcare provider

Less likely to receive adequate explanations

More likely to have unanswered questions

More dissatisfied with health service and system

54
Q

Structural issues

A

Some people find it easier to access services than others. The power, resources and opportunities of NZ society are organised by ethnicity and deprivation

55
Q

Social issues

A

Social values and moves play a role in inequities

There are values and assumptions widely held in NZ about deservedness of different groups of people

56
Q

Leveling interventions

A

Levels opportunity and risk and removes structural barriers

This is not privilegeing as it raises those in need

57
Q

Treaty of Waitangi ARTICLES

A

1-Construction of a state sector-who gets to vote

Art2- Give Maori sovereignty over their own lands

Art3-Different/denied citizenship

58
Q

The Maori text is increasingly recognised because

A

More hapu signed the Maori text

Those who signed it fully knew what they were agreeing to

International legal principle grants and preference

59
Q

What are the disparities in health outcome for Maori

A

Maori have higher mortality rates for all non-elderly ages

A gap in life expectancies has persisted over decades between Maori and non-Maori

Maori are over-represented in more deprived quintiles

60
Q

What are the 3 reasons why there are disparities in Maori health

A

1) Colonization
2) Maori land
3) Effects of inferior citizenship

61
Q

colonization

A

Colonist harboured assumptions
No respect for indigenous

Notions of superiority and civilisation

Notions of deserving and undeserving

Many of these beliefs persist today creating social barriers

62
Q

Maori land

A

confiscation: basis of settler wealth

Land alienation: directly impacted health

Social disruption: poverty, economic depletion, resentment, breakdown of political power and alliances

Child-women ratios fell

63
Q

Effects of inferior citizenship

A

Entrenchment of poverty, dependency
increased barriers to development

Acceptance of inequity by the colonists

Social breakdown, crime, high risk behaviors

NEW XIA POPLHLTH (14 decks)

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