Global Health Flashcards
What is the goal of population health?
- Improve the health of the overall population
- Reduce health inequities
what is equality vs equity?
Equality means that everyone gets the same thing
Equity is when that thing is adjusted according to other factors (i.e., the smallest person gets the largest block)
what is mortality vs morbidity?
Mortality is the nb of deaths caused by a specific illness
Morbidity refers to having that specific illness
what are some inequities around the world? (2)
- Infant and maternal mortality
- Life expectancy
what are some inequities in Canada? (3)
- Lower education
- Lower income
- Aboriginal identity
what are the elements of the continuum of strategies (from downstream/proximal to upstream/distal)?
- patient level: diagnosis, treatment, rehabilitation
- high risk groups: primary, secondary, tertiary prevention
- general population: health promotion (Ottawa Charter)
- general population: actions on the social determinants of health
interventions act on __ to better the ___
causes; outcomes
what is a risk factor? is it downstream/upstream? give examples
- something that is associated with health-related condition(s)
- downstream and proximal
- behaviour, lifestyle, environmental exposure or inherited characteristic
- i.e., smoking
what is a determinant? is it downstream/upstream? give examples
- range of social, economic and environmental factors which determine the health status of individuals or populations
- upstream and distal
- income, social status, social support, education, etc.
social causes of determinants of health are often ____ problems. give examples
structural
i.e., poverty, lack of education, housing, etc.
The primary determinants of disease are ___ and ___, so remedies must also be ___ and ___
economic; social; economic; social
Creating ______ is needed to make the healthy choices easy
supportive environments
why do we want to create supportive environments? (2)
- Want to move away from blaming the victim for their unhealthy choices (proximal/downstream)
- Unhealthy choices are a product of an unhealthy living environment (distal/upstream)
(distal/upstream / proximal/downstream):
By changing the environment (______), we enable individuals to make healthier choices (______)
distal/upstream; proximal/downstream
what is the who definition of health (positive)?
state of complete physical, mental and social well-being and not merely the absence of disease and infirmity
what is the negative definition of health?
absence of disease
what are the terms for “disease” and what do they mean at the bio, psycho, and social levels?
- BIO: “disease”, physiological dysfunction
- PSYCHO: “illness”, subjective perception
- SOCIAL: “sickness”, unable to fulfill social role
what are the terms for “disability” and what do they mean at the bio, psycho, and social levels?
- BIO: “impairment”, loss of body function
- PSYCHO: “disability”, restricted activity
- SOCIAL: “handicap”, disadvantage in social role
how does the medicine wheel depict health’s multidimensionality?
includes physical, mental, emotional, spiritual health
what is public health?
prevention of disease, prolonging of life and promoting health through the organized efforts of society
how do we ensure good public health? (5 steps)
- evaluate outcomes
- needs assessment
- priority setting
- understanding causes
- select and implement interventions
what are the 3 indigenous groups in Canada?
- first nations
- inuit
- métis
describe First Nations (2)
- “North American Indian”, “Indian”, “Native American”
- Biggest portion of our indigenous population
describe Inuit (3)
- “The People”
- Live in Nunavik, Nunatsiavut (Labrador), Inuvialuit Settlement Region (NWT) and Nunavut
- One person of Inuit descent = “Inuk”
describe Métis (3)
- Person who self-identifies as Métis
- Rupert’s Land (fur trade routes)
- Mixed offspring of Indian women and European fur traders
what is the doctrine of discovery? (3)
- Provides legal justification of Papal Bulls
- Acquire legal title, sovereignty and jurisdiction over indigenous nations and lands
- Underpinned colonialism
what are treaties? (3)
- Sacred covenants establishing a relationship
- Designed to prevent war –> facilitate trade
- No monetary or land transfer provisions
what is the Medicine Chest Clause?
§ Basis for Health Canada’s non-Insured Health Benefits Program (NIHB)
what is manifest destiny? (2)
- Idea that white Americans are divinely ordained to settle the entire continent of North America
- Remove or destroy the native population
what is the Indian Act? (2)
- Federal government administers Indian status, local first nations governments and management of reserve land/monies
- Removing Indian status
what is Jordan’s principle?
all first nations children living in Canada can access the products, services, and supports they need, when they need them
what is Joyce’s principle? (2)
- Guarantee the right of equitable access, without any discrimination, to all social health services
- Right to enjoy the best possible physical, mental, emotional and spiritual health
what is the CanMeds Competency Framework? (7)
medical expert is:
1. Scholar
2. Collaborator
3. Communicator
4. Professional
5. Advocate
6. Expert
7. Leader
what is the common definition of “indigenous”?
descendants of those who inhabited a country/geographical region at the time when people of different cultures or ethnic origins arrived
what are the health disparities in indigenous people? (5)
- Lower life expectancy
- Higher rates of infant mortality
- diabetes
- chronic diseases
- TB
what are social determinants of health of indigenous communities? (6)
- Income and social protection
- Food insecurity
- Housing
- Political empowerment
- ELS
- Education
explain colonization as a social determinant of health (4)
- distal factors of wellbeing - colonization (i.e., racism, Indian Act, residential schools)
- Intermediate factors of wellbeing (i.e., cultural supports, social network, access)
- proximal factors of wellbeing (i.e., income, housing, education)
- wellbeing
what is unintentional racism?
manifests in the form of erroneous assumptions based on negative stereotypes regarding patient health behaviours/diagnoses
what is the the doctor’s responsibility in ensuring cultural safety? (4)
- Patients’ way of knowing and being is understood and valid
- Patients’ are active partner in health care decision-making processes
- Patients’ determine whether the care received is culturally safe
- Obtain patient feedback
what is medical colonialism? give an example
a culture/ideology rooted in systemic anti-indigenous racism that uses medical practices/policies to establish, maintain and/or advance a genocidal colonial project
i.e., forced sterilization
what is the truth and reconciliation commission? (2)
- Component of IRS settlement agreement
- provided those directly or indirectly affected by the legacy of the Indian Residential Schools system with an opportunity to share their stories and experiences
what is an asylum seeker? (2)
- Person who requests protection from Canada upon arrival in the country or during a temporary stay
- Need to be able to prove that there are dangers in your home country
what are the 3 types of refugees?
- Receives protection from Canada
- Refugees selected abroad (admitted to Canada after being in refugee camp/persecuted in their own country)
- Refugees recognized in Canada (asylum seeker who received refugee status)
what are the 3 types of people without legal status?
- Tourist or temporary resident who has no visa and has not left Canada
- Person whose asylum application was refused and did not leave Canada
- Person who illegally crossed the border and has not reported to the authorities
what is the process involved in claiming asylum in Canada?
- Asylum claim made in Canada port of entry or inland with IRCC
- IRCC determines if person is eligible (i.e., cannot have criminal record)
- If eligible, hearing (i.e., prove the dangers)
- If eligible, access to social assistance, education, emergency housing and legal aid WHILE a decision is pending
T/F: a person seeking asylum has no healthcare
FALSE: they have the federal interim health program
what happens if a person’s asylum claim is accepted vs rejected?
Accepted:
- Person receives protected person status and can apply for permanent residency, RAMQ
Rejected:
- Can appeal
- If appeals are exhausted, person must leave voluntarily or is deported
- Can apply on Humanitarian and Compassionate grounds
describe the health screening of asylum seekers (2)
- Canada Border Services Agency: designed to assess limited number of public health risks (not preventative screening)
- Done within 12m prior arrival or within 60d of asylum claim (Physical exam, chest xray, syphilis, urine analysis, HIV)
T/F: the government owns the results of asylum seekers’ health screening
TRUE
what is the refugee health assessment? (4)
- Must be referred for this
- Voluntary and covered by interim federal health program
- Well-being assessment by social worker
- Health assessment by nurse (thorough)
what are the guidelines for the healthcare of immigrants/refugees to Canada? (4)
- Clinical preventive care should be informed by home country and migration history
- Forced migration, low income, language barriers = considered in the assessment and delivery of preventive care
- Routinely offer vaccination and screening for HepB, HepC, TB, HIV, etc.
- Detecting and addressing the following is on a case by case (NOT ROUTINELY) malaria, depression, PTSD, etc.
what are the 4 recommendations for mental health screening of refugees/immigrants?
- Maintain high index of suspicion for mental health disorder (somatic complaints)
- Depression should be assessed by validated questionnaire (PHQ9)
- PTSD should be screened only if symptoms arise and are detrimental to health
- Vigilance for child maltreatment and intimate partner violence
what are the 3 recommendations for women’s health in refugees and immigrants?
- Contraception (provide culturally sensitive counselling)
- Vaccinate against HPV (ages 9-26)
- Screen for cervical cancer
describe the Clinique pour Demandeurs D’asile et Réfugiés (6)
- By referral ONLY –> COMPLEX CASES
- Screening refugee health assessment
- Medium term care for must vulnerable asylum seekers
- Attestation letters describing scars and female genital mutilation
- Referral to specialists
- Registration on waitlist for family doctor
what is the approach for improving health of individuals? what does it include? (3)
- Biomedical approach (patient-practitioner relationship):
- Diagnosis, treatment, rehabilitation
- Clinical prevention practices
what are the two approaches to improving population health?
public health approach and population health approach
what is the population health approach
conceptual framework for thinking about why some people are healthier than others (the determinants of health at individual and population levels)
what are the differences in population vs public health? (2)
- Public health has its 4 main functions –> surveillance, protection, prevention, promotion
- Population health tries to improve population health while reducing health inequities
what 5 steps are required for controlling health problems?
- Awareness that it exists (measurement)
- Understanding the cause (logic model)
- Capacity to control cause (preventability)
- Sense that problem worth solving (priority)
- Political will
what re the 2 strategies in the “diagnosis, treatment and rehabilitation” section of the continuum of strategies? what are they?
high-risk strategy (traditional medical approach and focused on the individual)
population strategy (control determinants of incidence)
why can we say that the high risk strategy focuses on the individual? (2)
- screening (identify those at risk)
- protection (behavioural change)
describe primary prevention (3)
- Before the person gets the disease
- Reduce risk factors to avoid ever getting the disease
- i.e., smoking cessation
describe secondary prevention (3)
- Preclinical/presymptomatic stage of the disease (the person does not know they have it)
- Detect the disease early to cure/slow progression with greater success than if diagnosed clinically
- i.e., Pap tests
describe tertiary prevention (3)
- The person has symptomatic disease
- To care for those with disease, slow progression, prevent complications, reintegrate into social role
- i.e., treatment/rehabilitation
(primary, secondary, tertiary prevention):
- decrease impact
- decrease incidence
- decrease prevalence
- tertiary
- primary
- secondary
what are the 5 areas of the Ottawa Charter for health promotion?
- Build healthy public policy
- Create supportive environments
- Strengthen community actions
- Develop personal skills (health literacy)
- Reorient health services
is an intersectional action upstream or downstream?
upstream
what are the 4 core functions of public health?
- surveillance
- health protection
- disease prevention
- health promotion
what is the CLEAR Toolkit? (4)
- Treating the immediate problem
- Asking about underlying social problems
- Referring to local social support resources
- Advocating for more supportive environments
what are the 3 levels of social accountability ?
- micro
- meso
- macro
what are the barriers to frontline health workers becoming more engaged in addressing health inequities? (3)
- Low perceived self-efficacy of healthcare workers
- Lack of training/role modelling
- Absence of communities of practice to bring together professionals
what are the facilitators for frontline health workers to tackle health inequities? (4)
- Treating patients with dignity and respect and creating safe spaces for disclosure
- Extra time per consultation to address complex health and social needs
- Knowing about local referral resources for specific social challenges
- Resources, training and ongoing support of healthcare workers
what are the 5 principles of community-oriented primary care?
- Responsibility for the health of a defined population
- Care based on the identified health needs at the population level
- Prioritization
- Program intervention covering all stages of health illness continuum of the selected condition
- Community involvement
what is trauma-informed care? (5)
- Trauma awareness and acknowledgment
- Safety and trustworthiness
- Choice, control, and collaboration
- Strengths-based and skills-building care
- Cultural, historical and gender issues
what is whole person care?
looks at physical, mental and social health
what can we do at the patient level? (6)
- Use trauma informed care
- Take social history
- Learn about local referral resources
- Help patients access benefits
- Advocate for your patients’ needs
- Create shared management plan
what can we do at the community level? (5)
- Educated on SDOH
- Get involved in community partnerships
- Advocacy for more supportive environments
- Participatory action research
- COPC and population health planning
what can we do at the practice level? (5)
- Integrated services
- Culturally adapted
- Accessible to those most in need
- Outreach/patient navigation services
- Extra time available
who are the people experiencing homelessness in Canada?
situation of an individual/family/community without stable, safe, permanent, appropriate housing, or the immediate prospect, means and ability of acquiring it
what is hidden homelessness?
includes couch-surfing, hotel/motel, single-room occupancies
what is the 2-dimensional classification of homelessness?
- location
- duration
what is the cause of homelessness?
interaction between:
1. individual and relational factors
2. structural factors (i.e., inability to afford housing)
3. system failures
what were the results of the USA study that looked at the effect of sleeping outside on health? (2)
- Sleeping on the street has 3x higher mortality than in shelters
- Sleeping on the street has 10x higher mortality than the general population
how do we stop homelessness? (2)
- Prevent homelessness
- Help people experiencing homelessness to regain permanent housing (housing + support)
what is housing first? (3)
- Scattered and immediate access
- Higher % of positive trajectories
- Reduction in cost per person
what are the different levels at which homelessness can be prevented? (5)
- structural (i.e., legislation)
- systems (i.e., access to healthcare)
- early intervention (support)
- eviction prevention (crisis support)
- housing stability
describe dental carries (3)
- Dental decay is the most common non-communicable disease in the world
- Peak period is in young kids –> dental decay is a marker of poverty (social determinant)
- No change in incidence/prevalence
describe tooth loss (edentulism) (3)
- Used to be very common in rich countries
- peak in older adults
- less prevalent today
describe severe periodontitis (gum disease) (2)
- Occurs more often with age
- Linked to inflammatory response –> overreactive inflammation
what 3 examples were given to show how dental and global health are related?
- diabetes
- pneumonia
- oropharyngeal cancer
what are the 2 established biological links between dental health and general health?
- dental carries: behavioural problems (pain), lower minerals and growth hormone
- tooth loss: nutritional intake, vitamins
what 4 associations were given for dental and general health?
- Periodontal disease and cardiovascular disease
- Periodontal disease and poor birth outcomes
- Carries and diabetes
- Caries and obesity
what are the 4 social determinants of oral health?
- income (poorer use less dental services)
- education
- household status (can’t afford to use dental services)
- being a woman
what social determinants are common to oral and general health? (3)
- Individual lifestyle factors
- Social and community networks
- General socio-economic, cultural and environmental conditions
what are the population strategies to address oral health problems? (3)
- smoking
- fluoride
- diet
what are the individual strategies to address oral health problems? (3)
- smoking
- fluoride
what is palliative care? what is its goal?
- focused on providing relief from the symptoms and stress of the illness
- The goal is to improve the quality of life for both the patient and the family
what does palliative care deliver? (7)
- Assessment/management of symptoms
- Coping support
- Therapeutic relationship
- Patient education
- Decision-making
- Caregiver support
- End-of life issues
what are the key barriers to the global implementation of palliative care? (6)
- Poor access to essential medicines (i.e., opioids)
- Climate change, conflict and inequitable distribution of wealth/resources
- Insufficient palliative care workforce
- Inequitable access to high-quality non-palliative care
- Palliative care beliefs
- Policy driven/absent problem
what is the old vs new model of palliative care?
- Old model had palliative care as a separate care –> people went there to die
- New model includes palliative care from the start of the diagnosis and adds bereavement for family members
T/F: Research shows that palliative care has a survival benefit
TRUE
what can we do the implement palliative care globally? (5)
- Affordable essential package of palliative care and pain relief interventions
- Balanced global system to prevent non-medical use and misus of medicines and ensure effective access to essential medicines
- Better evidence and priority setting tools to adequately measure global need for palliative care
- Bring palliative care from the hospital to the community
- Want to create a virtuous cycle of palliative care beliefs
how are the consequences of the Tuskegee study still present today?
led to vaccine hesitancy in black communities
how are the consequences of the Sick Kids study still present today?
leads to food-insecurity in first nation populations
what influences health at the individual and community levels? how?
- poverty
- individual: higher incidence/prevalence/severity of illness
- community: effect on household wellbeing
what are the 3 forms of violence?
- collective violence
- interpersonal violence (family and community)
- self-directed violence
what are the forms of family violence? (3)
- child maltreatment
- intimate partner violence
- elder abuse
what are the forms of community violence? (2)
- acquaintance (bullying)
- stranger (gang violence)
what are the links between past and ongoing collective and interpersonal violence? (2)
- mass production of adverse childhood experiences
- adverse community environments
T/F: children who witness family violence suffer the same consequences as those directly abused
TRUE
T/F: we should be routinely screening for violence
FALSE
what are the 3 types of interventions for violence?
- home/family based
- school/center based
- community based
what are the 7 things for preventing violence according to WHO?
- Laws
- Norms
- Environments
- Parental support
- Economic strengthening
- Response services
- Education
