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Block A - Molecules to Global Health > Global Health > Flashcards

Global Health Flashcards

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1
Q

What are the 3 recognized indeginous communities in QC?

A
  1. FIRST NATION (60%): +65 different first nations in Canada, only ones living on a reserve, largest group
  2. INUIT (4%) : Artic regions, 4 regions in Canada (Nunavik, Nunatsiavut, Inuvialuit Settlement Region and Nunavut)
  3. METIS (36%): Mixed race (primarily first nations and European), new culture and new language . Definition changes
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2
Q

What are the health issues of indeginous communities in QC ?

A
  • Death age
  • TB
  • Type 2diabetes
  • Infections disease
  • Lung cancer, COPD, Bronchiolitis
  • Renal disease
  • Iron/Vitamin D deficiency
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3
Q

Explain 2 preventive strategies and their advantages/disadvantages (in the continuum of strategies required to improve the population health)

A
  1. High-risk strategy: focus on the individual, traditional medical approach
    ⇨ Advantages: intervention appropriate to individual, subject motivation, physician motivation, cost-effective, benefit:risk ratio favourable.
    ⇨ Disadvantages: difficulties and cost of screening, palliative and temporary, limited potential for population and behaviourally inappropriate
  2. Population strategy: seeking to control the determinants of incidence
    ⇨ Advantages: radical, large potential, behaviourally appropriate
    ⇨ Disadvantages: small benefit for individuals, poor motivation subject, poor motivation of physician, benefit:risk ratio worrisome
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4
Q

Distinguish between primary, secondary and tertiary prevention

A
  1. Primary: before disease (vaccination, physical activity) DECREASE INCIDENCE
  2. Secondary: screening (early stage disease) DECREASE PREVALENCE
  3. Tertiary: symptomatic disease (treatment, rehabilitation) DECREASE IMPACT
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5
Q

List the 5 action areas of the Ottawa Charter for Health Promotion

A
  1. Build healthy public policy
  2. Create supportive environments
  3. Strengthen community action
  4. Develop personal skills
  5. Reorient health services
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6
Q

List the 4 core functions of public health

A
  1. Surveillance (collection of data to determine what’s happening)
  2. Health protection (emergency, infectious diseases)
  3. Disease (and injury) prevention
  4. Health promotion (OTTAWA CHARTER)
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7
Q

Describe population versus individual level strategies to address oral health problems

A
  1. Individual level
    Provide person-centred care
    Advocate for your patient / liaise with external resources (social prescription)
  2. Community level
    Adapt your clinic’s organisation and equipment to the needs and characteristics of your community
    Partner with community and advocating to improve local policies
  3. Societal level
    Advocate for healthy public policies and for inclusion
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8
Q

Describe who are the homeless in Canada (how much, where, who)

A

•HOW MUCH ? 3016 in Montreal. (2016)
•WHERE? Outdoor, uninhabitable places, restaurants, shelters, transitional housing, hospitals, detox, jails, hidden homelessness (couch).
•WHO ? Men (76%), combination of substance misuse and mental health issues
violence or abuse frequent among women
41% over 50 years old, 16% immigrants, 10% indigenous people.
61% have a psychiatric diagnostic. 78% have a history of substance misuse.

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9
Q

Describe the different kinds of actions that frontline health workers can use in the clinic and in the community to address the social causes underlying poor health

A
  1. Treating the immediate health problem
  2. Asking about underlying social problems
  3. Referring to local social support resources
  4. Advocating for more supportive environments
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10
Q

Describe fundamental measures (elaborated by WHO) for a successful public health approach to the development of palliative care (drug availability)

A 

Drug availability's strategies relies on : 
−	Identifying national opinion leaders 
–	Estimating opioid need

–	Ensuring affordable supply

–	Facilitating appropriate prescribing
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11
Q

Describe the 5 priorities for action in Canada concerning palliative care

A
  1. Ensure all Canadians have access to high quality hospice palliative end-of-life care 

  2. Provide more support for the family caregivers 

  3. Improve the quality and consistency of hospice palliative/end-of-life care in Canada 
 (integrative care)
  4. Encourage Canadians to discuss and plan for end of life 

  5. Actively promote Palliative Care and Pain Relief as an International Human Right
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12
Q

The objective of the course is that you ask yourself 3 questions when you see a patient. Name the 3 questions.

A
  1. Why does the patient have this problem?
  2. How could this have been prevented?
  3. What can I do to improve his health and health of the population?
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13
Q

What are the different definitions possible of a disease (bio, psycho and social)?

A

BIO : DISEASE = physiological dysfunction
PSYCHO : ILLNESS = subjective to perception
SOCIAL : SICKNESS = unable to fulfill social role

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14
Q

List the 2 main goals of the population health approach

A
  1. ↑ global health

2. ↓ health inequities

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15
Q

Describe the different levels of violence (3 main)

A
  1. COLLECTIVE: Link between past and ongoing collective violence and “lateral or interpersonal violence
  2. INTERPERSONNAL (between individuals)
    - Community violence (acquaintance, stranger)
    - Family violence:
    A. Child maltreatment,
    B. Intimate partner violence
    C. Elder abuse
    3.SELF-DIRECTED (self-directed) : Symptom of a bigger picture
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16
Q

List the different kinds of evaluations in public health

A
  • FORMATIVE (is this the best way to tackle this problem? Pre-testing strategies)
  • PROCESS (how well is the program implemented)
  • OUTCOME (where the objectives met in the short to medium-term)
  • IMPACT (long-term; what difference did the program or policy make in the long term)
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17
Q

Name some of the aspects of public health that raise special ethical dilemmas

A

Dilemmas:
•Balancing individual rights/liberties and the public good
•Balancing duty to the individual and the duty to population
•Balancing respect for autonomy and paternalism

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18
Q

Name 2 ethical frameworks to assess the public health special dilemmas

A
  1. Consequentialism
    Actions based on outcome, utilitarian
    •Minimize deaths/serous illness
    •Maximize life-years
    •Maximize expected utility, maintenance of social order
    Ex. Mass vaccination, screening programs, goal maximizing
  2. Liberalism (2 versions)
    Actions based on rights/freedoms/liberties/equality
    •EGALITARIAN : making sure everyone has the same opportunities
    •LIBERTARIAN : the state should get out of the way as much as possible
    Ex. Target vulnerable populations, equalize outcome, social determinants
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19
Q

what is cultural competency ? What are the different levels?

A 
It's the capacity to skills to work with patients from diverse backgrounds.
LEVELS : 
1. ORGANIZATIONAL
2. INDIVIDUAL 
    a) general skills 
    b) specific cultural expertise 
    c) ethnic match
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20
Q

List the PH legislations and mandates (regional PH action plan : 4 orientations)

A

Axis 1: Global development of infants and young children
Axis 2: Adoption of healthy lifestyles and creation of healthy and secure environments
Axis 3: Prevention of infectious diseases
Axis 4: Managing risks and emergencies
Transversal axis: Continued surveillance of health status of the population and their determinants

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21
Q

In Canada, remaining life expectancy isn’t equal. List from less years lost to more those factors :
lower education
lower income
aboriginal identity

A 
lower income (5,2 years less) 
lower education (5,4 years less) 
aboriginal identity (7 years less)
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22
Q

what’s the negative definition of health ?

what’s the positive definition of health ?

A

NEGATIVE : health is the absence of disease or disability
POSITIVE : health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmitys

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23
Q

what are the different definitions possible of a disability (bio, psycho and social)

A

BIO : IMPAIRMENT = loss off body function
PSYCHO : DISABILITY = restricted activity
SOCIAL : HANDICAP = disadvantage in social role

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24
Q

what are preventable health gaps ?

A

the difference (in deaths for example) of people living in rich countries vs poor countries

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25
Q

Describe the health planning cycle

A
  1. need assessment
  2. priority setting
  3. understand causes
  4. select & implement interventions
  5. evaluates outcomes
    START AGAIN
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26
Q

place these health strategies from the more to the less upstream

  • primary, secondary and tertiary prevention
  • health promotion (Ottawa charter)
  • Diagnosis, treatment & rehabilitation
  • Acton on the social determinants of health
A
  1. Action on the social determinants of health
  2. Health promotion (Ottawa charter)
  3. Primary, secondary and tertiary prevention
  4. diagnosis, treatment & rehabilitation
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27
Q

Who are the only indigenous nation who live on a reserve in QC?

A

First Nations

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28
Q

Differentiate Inuit, Innu and Inuk

A
  • Inuit is the name of the indigenous community
  • Inuk is a singular inuit
  • Innu is a First Nation for Qc
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29
Q

Is there a federal registery for all the indigenous communities ?

A

No, not for the Métis (but yes for Inuit and First Nations)

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30
Q

What is the total # of aboriginal population in Canada ?

A

1.7 million

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31
Q

Is the indigenous pop growing quickly ? Is it old ?

A

The pop is really growing quickly and young

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32
Q

Royal Proclamation (1763)

A

The first documented recognition of indigenous nations by the British Crown

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33
Q

British North America Act (1867)

A

Establish that «Indians» are under FEDERAL authority

34
Q

Treaty 6

A

Basis for Health Canada’s non-insured health benefits program (same as the plan d’assurance maladie, but includes mental/dental/travel plans). Everything has to be approve by the federal government = leads to longer time for treatments

35
Q

Indian Act (1876)

A

Defines who is an «Indian» and also outlines several rights inherent to registered «Indians». A lot of indian women lost their rights because of marriage (to a non-aboriginal men).

36
Q

Social determinants of health for indigenous populations (4 main)

A
  1. Housing
  2. Drinking water
  3. Education
  4. Childhood poverty
37
Q

Main challenges for new immigrants ?

A
  1. Trouble finding decent work

2. Difficulty accessing quality housing, language training, health care services…

38
Q

What are the many entry points to improve health ?

A
  • demographics groups
  • diseases or causes of death
  • hazards to health
  • settings
  • behaviours/lifestyle
  • determinants of health
39
Q

what are the different approche of action on the social determinants of health ?

A
  • Intersectoral action
  • whole-of-governement
  • health in all policies
40
Q

what’s the population health approach ?

A
  1. Focus on the health of the population
  2. Address the determinants of health
  3. Base decision on evidence
  4. Increase upstream investments
  5. Apply multiple strategies (action on social det., health promo, etc.)
  6. Collaborate across sectors and levels
  7. Mechanisms for public involvement
  8. Accountability for health outcomes (result-based focus, evaluations)
41
Q

What are the determinants of our health according to Lalonde (1974)?

A

Determinant: the range of social, economic and environmental factors, which determine the health status of individuals or populations. Include:
1. Human biology
2. Lifestyle
3. Environment
- Physical
- Social:
o Income and social status
o Social support networks
o Education and literacy
- Employment
4. Health care organization (is only one of many determinants of health)

42
Q

how does homelessness evolve ?

A
  1. TRANSITIONAL : single episode of homelessness for a short duration (normally following a psychosocial crisis)
  2. EPISODIC : multiple episodes (linked often to substance misuse) = 2 or more episodes in a 3 year period
  3. Chronic: long duration, linked with mental health issue (around 20% of shelter populations)
43
Q

what’s the At Home Project purpose (2009)

A

To evaluate 2 service models :

  1. Housing First
  2. ACT
44
Q

What is the Housing First ?

A
  • Offer a subsidized, furnished apartment without any conditions regarding treatment or substance use
  • support services are provided by a single organization working out in the community
  • Housing subsidies are attached to clients
  • Favored approach is RECOVERY (client have a high level of power over the type and intensity of the services receive)
45
Q

Does the subsidized housing + ACT cost less or more that a bed in a shelter ?

A

Less.

46
Q

What are the social accountability levels ?

A
  1. Micro levels : clinician-patient/family relationship
  2. Meso levels: organizational level, community level
  3. Macro levels : societal level, global level
47
Q

the indian act and the residential school is what level of violence ?

A

Collective violence

48
Q

what interventions work to prevent violence ?

A
  • home/family-based
  • school/centre-based
  • community-based
49
Q

What are the 7 stratefies for preventing violence (elaborated by WHO)

A
  1. laws
  2. norms
  3. environment
  4. parental support
  5. economic strenghtening
  6. response services
  7. education and life skills
50
Q

is it more $$ to die in hospitals or at home ?

A

in hospital (36 000$ vs 16 000$)

51
Q

when does formative evaluation occurs ?

A

Part of the development stage, occurs before the large-scale implementation

52
Q

what are the SMART objectives ? (mesuring progress)

A 
Specific
Mesurable
Achievable
Relevant
Time bound
53
Q

the kind of healthcare system you get is going to be a reflection of what ?

A

your values in society

54
Q

What is a «good hospital», 3 broad areas of quality

A
  1. process of care mesures (do the steps that needs to be done are done and go as planned ?)
  2. outcome of care mesures (how is the system producing?)
  3. Patient satisfaction measures
55
Q

what is latent error ?

A

defects in the design and organization of processes and systems that can lead to failures and errors

56
Q

What ethical framework is assumed by public health ? Can it be a blanket justification for every decision ?

A

PH - which assumed a CONSEQUENTIALIST framework - cannot be a blanker justification for coercive/paternalistic/burdensome measures

57
Q

what do we mean by organizational level of cultural competency ?

A

Talking about the infrastructures and ethos of services and institutions of society (what are our hospitals like. What are some of the problem the refugee are facing going there?)

58
Q

what are the main general skills of the individual level of cultural competency ?

A
  1. scientific mindedness (testing hypothesis rather than forming premature conclusions)
  2. dynamic sizing (judging whether a cultural characterization accurately reflects an individual or functions as a stereotype)
59
Q

what is religious competency ?

A

skills practices and orientations that recognize, explore, and harness patient religiosity to facilitate diagnosis, recovery, and healing

60
Q

what is cultural safety ?

A

acknowledging the power imbalances inherent to clinician-client relationship

61
Q

what is cultural humility ?

A

a lifelong commitment to self-evaluation and self-critique to address the power imbalances in patient-physician dynamic and develop partnerships with communities (realizing that medicine doesn’t always has all the answer)

62
Q

what’s the prioritization scheme of a consequentialist in regards to, let’s say, vaccination ?

A
  • minimize deaths/serious illness
    -maximize life-years
    -maximize expected utility through maintenance of social order
    IN CONCLUSION
  • AGREEMENT ON MAXIMIZATION
    -DISAGREEMENT ON UTILITY MESURE
63
Q

what’s the prioritization scheme of a libertarian in regards to, let’s say, vaccination ?

A
  • equity
    -equalize access (not outcomes)
    -let the market decide
    IN CONCLUSION
    -EGALITARIANS PRIORITIZE EQUALITY OF OPPORTUNITY/OUTCOMES
    -LIBERTARIANS PRIORITIZE INDIVIDUAL FREEDOM OF CHOICE
64
Q

what’s the shadow of Desert ?

A

the fact to prioritize the worthy (should not be a formal guide, but still haunts popular responses/ to resource allocation)

65
Q

what is occupational health ?

A

public health for the population known as public workers

66
Q

what does occupational health deals with ?

A

HIRARC

  • Hazard Identification in the workplace
  • Risk Assessment to workers and the public from the hazards
  • Risk Control recognition, diagnosis, treatment, and prevention and control of diseases injuries, and other adverse health conditions resulting from work
67
Q

what’s the difference between a work related injury and a work-related illness ? (quebec law)

A
  • INJURY : an injury that happens at the workplace while the worker is at work is presumed to be an employment injury
  • ILLNESS : work-related diseases are listed in law in Schedules (listed diseases that are characteristic of the work)
68
Q

Are almost all the work-related injuries preventables ?

A

YES

69
Q

what are the 2 major work related conditions ?

A
  • Musculoskeletal problems

- mental health problems

70
Q

The public health director shall be responsible, in the region, for

A
  1. informing the population on its general state of health
  2. identifying situations which could pose a threat to the population (surveillance)
  3. ensuring expertise in preventive health and health promotion
  4. identifying situations where intersectoral action is necessary to prevent diseases, trauma or social problems
71
Q

According to the Canadian Act (1984), what are the 5 criterias in order to receive federal funding?

A

Acronym: PUCAP (hehe)

  1. Portable
  2. Universal
  3. Comprehensive
  4. Accessible
  5. Publicly administered
72
Q

What is the percentage of health care funds that go to public funding?

A

70%

73
Q

What percentage of gross domestic income goes to health care?

A

12%

74
Q

True or false: Fee-for-service payment has to inflationary potential.

A

Yes, c’est ça l’esti de problème.

75
Q

What is the inverse care law?

A

The people who need the more care have less acess to care. In other words, The availability of good medical care tends to vary inverstly with the need for it in the population served.

76
Q

What is the 3 main objectives of any health care system ?

A
  1. Improve the health of the population hey serve
  2. Respond to people’s expectations
  3. Provide financial support for ill-health
77
Q

True or false: Witnessing violence is just as bad as being the victime of violence.

A

True. Stress of witnessing violence damages health: cortisol, maladaptive coping strategies, cycle of violence, and negative impacts on early brain development.

78
Q

What are DALYs and GBD?

A

DALY
Disability Adjusted Life Years = the burden of a disease (physical or mental), years lost due to premature mortality (YLL) + years lost due to disability (YLD)

GBD
Global Burden of Diseases = collective disease burden

79
Q

What are the causes of treatment gaps?

A
  1. Perceived need
  2. Structural barriers for those perceived need
  3. Attitudinal barriers for those with perceived need
80
Q

Give examples of key public health challenges in the 21st century

A
  • Climate change
  • Lyme disease
  • Forest fires
  • Opioid crisis
  • Child exploitation
  • Global conflicts
  • Human trafficking
  • Global poverty
81
Q

What are the 5 key messages of the Lancet Commission’s Global Surgery 2030

A
  1. 5B people do not have access to safe, affordable surgical and anaesthesia care
  2. 143M additional procedures are needed in LMICs each year
  3. 33M individuals face catastrophic health expenditure due to payment for surgery
  4. Investing in surgical services in LMICs is affordable, saves lives and promotes economic growth
  5. Surgery is an indivisible, indispensable part of health care
82
Q

What is the elephant in the global health care room?

A

Paternalism.

Block A - Molecules to Global Health (8 decks)

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