General

Question 1

What is a paradigm?

Answer 1

Scientific practice founded on beliefs, standards and norms that are the consensus of a group of researchers, this determines the choice, the what of the object to study and the methods to find solutions

Kuhn; Willett G, 1996; Klee, 1997

Question 2

What is a theory

Answer 2

Statement with an chain of propositions from deductive reasoning that form hypotheses that are verifiable by observations

They are always partial. They focus on a specific aspect of reality to ignore the rest.

“It is more fruitful to ask whether a theory is useful than to ask whether it is true.”

Willet 1996

Question 3

The elemets that consitute human health according to Lalonde

Answer 3

Human Biology
Environment (external factors beyond our control)
Lifestyle
Health Care System

Lalonde, 1974

Question 4

Three different approaches in public health

Answer 4

Lalonde, 1974; Rose, 1985; Frohlich et Potvin, 2008

Question 5

Criteria of vulnerable population

Answer 5

• Population at risk- those with highest risk because of biological factors
• Vulnerable population- those at risk because of socioeconomic conditions, oppression such as racism, sexism, stigmatization

Les populations vulnérables - critères
1. Distinctes des groupes à risques : elles sont à risques des risques
2. Associées avec la position dans la hiérarchie sociale et pas à l’étiologie de la maladie
3. Concentrent de nombreux risques
4. Risques accumulent à travers le parcours de vie
5. Capacité moins grande de profiter des interventions populationnelles

Lalonde, 1974; Rose, 1985; Frohlich et Potvin, 2008

Question 6

High-risk population

Defintion

Answer 6

Proportion of population contributing most to average risk

Question 7

What governs action?

Answer 7

Action can be utilitarian (based on individual interest) or normative (based on values and values)

Social also includes hierchies, capital (trust), and networks (support)

• « Il n’est pas juste une question de déterminants sociaux, c’est aussi quels sont les parachutes institutionnels et culturels, quelles sont les structures de protection auxquels les gens ont accès »

“Policy is social resource (ie. social network, capital, hierarchy and values) creation” Hall &Lamont, 2009

Lamont 2011; Hall &Lamont, 2009

Question 8

Solidarity

Answer 8

Mechanical solidarity: community imposes values and norms based on consensus / small group sharing the same values and norms

vs.

Organic solidarity: increasingly specialized functions enabling us to evolve as a society, solidarity based on the complementarity of individuals).

Individualism as a threat as people develop their own norms/values

Durkhein

Question 9

Social network vs social capital

Answer 9

• Social networks – logistical support, emotional support
• Social capital – associations and trust in others

Social resources include: social networks, capital, hierarchies and narratives

Hall et Lamont 2009

Question 10

What is the main problem of current societies?

Answer 10

How to maintain social connections

Question 11

Public health functions

Answer 11

• Surveillance
• Protection
• Promotion
• Prevention

Other
* Santé au travail
* Emergency intervention (DiRuggeiro)
* Environment protection
* Develop Policy (Turnock)
* Services planning and management (systems and politiques publiques)

Turnock BJ, 2016
3 core functions: Assess, Policy development, Assure – linked to 10 essential services

Kindig 2007;Pommier 2007;Martin-Moreno, 2016

Variety of definitions depending on context, from 5 to 12 (Martin-Moreno JM et al. 2016)

Question 12

Ethical challenges of core public health functions

Answer 12

Surveillance – autonomy, confidentiality

Protection – benevolence, responsibility, common good

Prevention – non-malfaisance (do not harm), solidarity

Promotion – auto-determination, usefulness

Massé R, 2003

Question 13

Types of evidence

Answer 13

• Type 1 – disease relationship (setting, example, quantity?, action) – suggests something should be done
• Type 2 – Effectiveness of public health intervention – intervention should be implemented
• Type 3 – Adaptation and translation of an effective information - concerns How an intervention should be implemented

Evidence-based public health: Choices based on evidence, but the use of participation is key to make a decision. This is followed by HIA before implementation, then evaluation

Brownson 2009, 2022

Question 14

Public health in Quebec

Answer 14

• Institute societal en santé publique: decisions and institutions
• Politiques publiques
• Système de service en santé publique: delivery
• DRSP
• INSPQ
• INESS
• La Loi sur la santé publique de 2001 établit le cadre législatif des fonctions de santé publique. L’orientation législative au Québec cadre avec une approche de type « Santé dans toutes les politiques ».

Question 15

What is HiAP?

Answer 15

Systematically consider health implications of decisions

De Leeuw E et al. 2017; Smith et al. 2013; Baum F et al. 2013

Question 16

Synomyms of HiAP

Answer 16

Intersectorial approach and whole government approach

De Leeuw E et al. 2017; Smith et al. 2013; Baum F et al. 2013

Question 17

Adelaide statement

Answer 17

“Health is a political choice” –> Health sector should understand policies and health implications of such policies

De Leeuw E et al. 2017; Smith et al. 2013; Baum F et al. 2013

Question 18

Window of oportunity

Answer 18

Goverment agenda decided by:
1. Political stream (public and politicians)
2. Problem stream

3. Policiy stream (experts) –> Policy entrepreneurs–> alternatives

When the 3 convert –> window of opportunity and then decision

Kingdom, 1984

Question 19

Health impact assessment

Answer 19

• Procedures, methos, tools to judge policies and decisions regarding their impact on health
• Done before the implementation
• Allows intersectorial action and influence policies to increase health

Question 20

Health is created largely outside the health sector.

Answer 20

de Leeuw E 2017

Question 21

Causal description vs Causal explanation

Answer 21

Causal description – describing the consequences that we can attribute to varying a treatment – this is a unique strength of experiments

Causal explanation – clarify the mechanisms and conditions where the causal relationship works, eg. Lightbulbs and switches, sources of electricity

Shadish WR et al. 2002

Question 22

Conditions for causality

Answer 22

• Echangegability: is people interchangeable (confounders)
• Positivity: Each individual has the same chances to benefit from the intervention (this redefines the target population)
• Coherence: The intervention is well defined and specific. The same for everyone

Sourial 2022

Question 23

Propensity score

Answer 23

Allows the creation of a sample in which individuals are interchangeables and have the same chances of being exposed to the intervention (positivity).

We need to include in the model all known confounders.

Reproduces randominzation

Sourial 2022

Question 24

Causal question

Answer 24

Would the result be the same in intervention group had they not been exposed?

Intervention - counterfactual ≠ 0 –> causality

Sourial 2022

Question 25

Risk analysis steps

Answer 25

1. Hazard identification: is is a risk? –> in vitro, in vivo and epidemiological data
2. Dose-response evaluation: what is the threshold? –> modeling and experimental studies
3. Exposure evaluation: what is the source? –> water, aire, food, soil
4. Harm characterisation: what is the risk population? Literature review, biological sample

Recommendations done based on these steps

Vener 2022; Faustmann 2015

Question 26

Precaution/uncerainty principle

Answer 26

• Proportionality: of risks and benefits
• Justice: risks and benefits are distributed equally in the population
• Autonomy: capacity of individuals to make decisions and respect their values
• Feasibility: resources
• Adapatability: to new info for risks, benefits and other considerations

Ricci et al, 2003; Weed DL, 2004

“Precaution at its core is prevention” (Weed DL, 2004)

Question 27

What is one health?

Answer 27

Non antropocentric apporach to understand the relationship between human health, animal health and evironmental health

Kelly A et al. 2014; Rabinowitz P and Conti L, 2013

Question 28

Bases of the one health apprach

Answer 28

• Interdependence of all health: not anthropocentric – humans, animals, environment
• Intersectoral approach: collective needs, eg. Drinking water, climate change
• Process of collaboration: reduce professional segregation between human and animal health (Rabinowitz, 2013), importance of veterinary medicine (Kelly, 2014)

Question 29

Examples of health issues that benefit from one health approach

Answer 29

Eg. Fires – climate change impact weather patterns, drier, impacts animal health, human health (people leaving homes, people chronic conditions esp. respiratory)

Eg. Lyme disease and ticks – dogs are sentinels, getting ticks more often, climate change extending the fall season, earlier spring

Eg. Antibiotics in agriculture – antibiotic resistance to Ceftiofur which combats salmonella, ban in 2004, reduced antibiotic resistance in chickens and then subsequently in humans, demonstrated the interdependence of animal and human health (2005-2008) (Dutil et al., 2018)

Question 30

Logical Positivism

Ontology, epistemology, methodology

Answer 30

Ontology: Realism
* 1 reality outside of mind

Epistemology: Objectivist/dualist
* Researcher can be separated to produce objective knowledge
* Matter exist independent to mind and has laws

Methodology:
* Scientific method to experiement on a external reality
* Observation and verification to test hypothesis

Teology (purpose): Determine the laws of the world to predict phenomena

Axiology (values): Objectivity

“Exterior looking”

Vienna circle

Question 31

Post-positivism

Ontology, epistemology, methodology

Answer 31

Ontology: Critical vision on realism
* 1 reality outside of mind which we can partially understand through observation and experimentation.

Epistemology: Objectivist/dualist
* Researcher can be separated to produce objective knowledge that is highly probable, but in the future can be falsified
* Matter exist independent to mind and has laws

Methodology: Falsification
* Just because something happens many times doesn’t mean ti will always happen (ex. humans not eating turkey from Jan to Sept)
* Science is deductive: hypothesis –> deductions –> falsification –> Provisionaly true (until further falsification)
* cimetière des idées

Teology (purpose): Determine the laws of the world to predict phenomena

Axiology (values): Objectivity

“Exterior looking” (Poupart J et al. 1997)

Popper

Question 32

(Social) Constructivism/Interpretivism

Ontology, epistemology, methodology

Answer 32

Ontology: Relativist
* There are many relative context-specific reailities
* Reality is socially created (Berger and Luckmann, 1966): Role of history, language and culture
* Object have existance outside but not meaning outside of human world

Epistemology: Relativist (but not 100%)
* There is no on right or objective meaning but there are criteria to get to the truth
* Nuance understandings from people enrich our understandings of the world

Methodology: Qualitative to study the dialectical process of social construction of reality

“Interior looking” (Poupart J et al. 1997)

Agonism between realist and antirealist perspectives have brought a more mature view of science where both perspectives of science are needed (Lehoux P, 2001)

Question 33

Steps

Dialectical process of reality

Answer 33

1. Externalization – express subjective reality with language
2. Objectivation – subjective reality becomes part of institutions, norms, values (external to individual)
3. Internalization – incorporate into individual consciousness, entrenched values

Berger and Luckmann, 1966

Question 34

Pragmatism

Ontology, epistemology, methodology

Answer 34

Ontology of action
* rather than representations of conceptualizations, it’s our experiences the most important touch point with reality
* Values action and impact on that reality rather than theory or philosophy
* agonism between realism and relativism

Epistemology of action
* Kwoledge is built and modified through actions and interactions with people
* There is a bidirectional relationship between knowledge and practice
* Critical perspective on the usefulness: Knowledge is created by choosing the best tools to solve the problem
* Explicit recognition of the limits of inquiry within time and context

Methodology: mixed methods
* Scientific inquiry and experimentation but recognizing its limitations and the influence of social structures
* What is helpful and useful at the time
* How to come up with better tools, less about understanding or describing the problem

Teology (purpose): autonomy, skills, relationships

Axiology (Values): usefulness, change, action

“As scientists, we should not seek to mold the world to knowledge we have, but question ourselves if our understanding is helpful to the context” (Poupart J et al. 1997)

Dewey; Willis JW et al. 2007; Creswell, 2007

Question 35

Critical realism/critical theory

Answer 35

Ontology: realism

Epistemology: Feminist
* The knower is always influenced by her/his situation–> knowledge is situated
* Looking up, view from oppressed

Methodology: mixed methods

Teology (purpose): Undercover and disengtangle power relationships and empower the oppressed

Axiology (values): justice, equity

The view from the bottom (those who are oppressed) (Poupart J et al. 1997

Willis JW et al. 2007; Poupart, 1997; Freire, 1972

Question 36

Precision public health

Answer 36

“emerging practice to more granularly predict and understand public health risks and customize treatments for more specific and homogenous sub-populations, often using new data, technologies and methods”

• big data driven and epidemiology – roots in infectious disease
• Outstanding issues – how to account for community values and resources

Dobbins M & Buckeridge D, 2020

Question 37

What is the new public health?

Answer 37

Concerned with SDoH, relationship with environment, political drivers of health, need to return to Indigenous perspectives

Baum F, 2008

Question 38

Agency vs structure

Answer 38

Agency
* Social basis: Individualism
* Principle: Autonomy
* Ethics: Human rights approach
* Consequence in public health: Victim blaming
* Interventions in public health: Individual behaviour change

Structure
* Social basis: Collectivism
* Principle: Paternalism
* Ethics: The greatest good for the greatest number
* Consequence in public health: Oversocialize, collective good – may accrue more benefits to those with more agency
* Interventions in public health: Socio-structural influence on development of health or illness

Baum F, 2008

From dualism to duality, Agonism –> Easier to conceptualize the integrated, multi-level, multi-strategy approach (Carroll, 2017)

Question 39

Domains for recommendations Healthy lives (Marmot M et al. 2010)

Answer 39

• Lifecourse perspective: Give children a good start
• Everyone can maximise capabilities and have control of their lives (Ottawa Charter, 1986)
• Fair employment and good work
• Healthy standard of living
• Sustainable communities: active travel, public transport
• Ill health prevention

Question 40

Inequality vs inequity

Answer 40

Inequalities in health describe the differences in health between groups independent of any assessment of their fairness.

Inequities refer to a subset of inequalities that are deemed unfair (avoidable, justice).

Evans T et al. 2001

Question 41

Dimensions of empowerment

Answer 41

• Material (to live a decent life)
• Psychosocial (have control of their lives)
• Political (they need to be able to participate in decision making processes)

Marmot 2007

Question 42

Proportionate universalism

Answer 42

Refers to the concept that people across the whole population gradient are entitled to social benefits proportionate to their needs.

Blends whole population, at-risk, vulnerable – rooted in equity

Marmot M, 2020

Question 43

Example of a policy with unintended consequences

Answer 43

Ban the box – to restrict criminal records being available to employers, and favor social insertion after prison.

Unintended consequence: this created an inequity in that employers used race as a proxy for criminality and were 6 times less likely to call people of color back for job opportunies

Wiseman et al., 2021

Question 44

Validity vs causality

Answer 44

Causality is about mechanism, the explanation
* causal explanation Shadish, 2002 (causality - which answers the why and why not with a counter factual)
* Causality authors - Pearl J, 2018; Sourial N et al., 2018

Validity is about the reproducibility
* causal description (experiments and logical inference, where validity and reproducibility is key)
* Validity - Rothman, 2014; Campbell, 1965

Tubulchinsky, 2013; Rothman, 2008; Klee, 1997; Shadish, 2002

Question 45

Public health principles

Answer 45

• Social justice:develop the ability of people to realize their potential in the society in which they live
• Health equity: the absence of avoidable differences in health among groups
• Social determinants of health: the conditions in which people are born, grow, live, work and age
• Ecological determinants of health: natural resources, ozone layer, fertile soil, stable climate
• Evidence-based public health: surveillance, types of evidence (Brownson 2009), participation and consultations, health impact assessment
• Intersectorial action

Canadian Public Helath Association, 2017