FINAL POPHLTH CRAM Flashcards
What are the reasons for the GBD project
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
What are the aims of the GBD project
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
What were the key sources of data for DALYs
statistical models developed to get best estimates when data were incomplete
epidemiological studies and surveys
disease surveillance system
vital registration data
What were the major impacts of the GBD approach
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
Right to health
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
Respect
No discrimination against ethnicity, gender, etc
Protect
No interference from 3rd pparties
Fulfill
adopt measures to achieve equity
What are 2 aspects of right to health that makes it fit with the human rights framework
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
Difference of right to health compared with right to be healthy
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
Why should we eliminate discrimination
Because discrimination causes impairment of enjoyment of rights
Right to Health history
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
What are the 3 levels of influence
The person
The community
The environment
The person
Age, sex, biology, behaviour
The community
Includes local influences such as the home, workplace and neighbourhood
social capital and
The wider societal levels such as education and the healthcare system
What is in The environment
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
Alma ata1978
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
What does the ottawa charter acknowledge
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
What are the 5 priority action areas
Develop personal skills
Strengthen community action
create supportive environments
Reorient health services towards primary health care
Build healthy public policy
Develop personal skills
Life skills education in schools
Strengthen community action
self-help groups and community organised services, community initiatives that promote healthy schools, healthy cities
youth health
Create supportive environments
implementing air control measures, water and sanitation promgrammes, b
Reorient health services towards primary health care
Care process responsive to needs of patients and families
How is data collected to estimate HIV prevalence in populations
surveillance systems
epidemiological studies
surveys in health facilities, especially antenatal clinics
What are the 5 key things that happen in health protection
predominantly environmental hazard focused
Risk/hazard assessment
Monitoring
Risk communication
Occupational health
List 6 things that make a suitable screening program
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
What is a suitable test
reliable safe simple affordable acceptable accurate
Discrimination
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
Right to health in NZ
The code of health and disability service consumer rights
What’s in the code of health and disability service consumer’s rights
Outlines 10 rights including freedom from discrimination and services of an appropriate standard
alighns with human rights act
What are the 4 features of the NZ Public health and disability ACT
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
UN Declaration on Rights of Indigenous peoples
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
What are the 4 factors that shape HIV/AIDS
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
Feminisation of the HIV epidemic
refers to the observation that increasing proportions of new infections are among women, primarily due to heterosexual transmission of the infection
What are social determinants that influence the acquisition and treatment of HIV
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
Gender inequities in feminisation
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
Impact on young people
Children particularly vulnerable
done through mother to child transmission
Half of new HIV infections are among people under 25
Mother to child transmission is reduced
by screening pregnant mothers and treating those who are HIV+ with anti-retroviral drugs
What are the key sources of bias whe generalising antenatal clinic surveys
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
How is HIV prevented and controlled
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
What are the 3 major challenges for the future regarding HIV
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
obesity causes
genetic, metabolic, behavioral and environmental
How is obesity distributed
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
Stereotypic progression of the obesity pandemic
starts in women, middle age, high wealth
then it progresses to men, children low SES, rural
What are the 4 kinds of consequences of obesity
Metabolic disorders-Diabetes, cancers
Mechanical disorders-arthritis
Psychological problems-low self esteem
Social consequences-weight discrimination
Obesogenic environments
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
What are 3 global forces that drive the pandemic
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
Moderators
Factors which attenuate/accentuate the rise in obesity
Drivers
Changes in drivers over time drive changes in outcomes over time
Mediators
factors through which the drivers operate
What prevents implementation of WHO’s prevention strategies
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
What are the 3 determinants of health inequalities
Differential access to health determinants and exposures leading to different disease incidence
Differential access to health care
Differences in quality of care received
Globally minorities feel
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
Structural issues
Some people find it easier to access services than others. The power, resources and opportunities of NZ society are organised by ethnicity and deprivation
Social issues
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
Leveling interventions
Levels opportunity and risk and removes structural barriers
This is not privilegeing as it raises those in need
Treaty of Waitangi ARTICLES
1-Construction of a state sector-who gets to vote
Art2- Give Maori sovereignty over their own lands
Art3-Different/denied citizenship
The Maori text is increasingly recognised because
More hapu signed the Maori text
Those who signed it fully knew what they were agreeing to
International legal principle grants and preference
What are the disparities in health outcome for Maori
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
What are the 3 reasons why there are disparities in Maori health
1) Colonization
2) Maori land
3) Effects of inferior citizenship
colonization
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
Maori land
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
Effects of inferior citizenship
Entrenchment of poverty, dependency
increased barriers to development
Acceptance of inequity by the colonists
Social breakdown, crime, high risk behaviors
