Health and Society (orange)

Question 1

1. what is the basis of economics?
2. what is opportunity cost?
3. who are the “buyers” in the NHS market?
4. who are the “sellers” in the NHS market?
5. why us the demand for healthcare increasing? (4)

Answer 1

1. how to allocate scarce resources amongst competing activities
2. the value of what you give up when you make a treatment decision
3. CCGs
4. acute hospital trusts, private hospitals and primary care
5. • ageing population
     - multiple morbidities/chronic conditions (as people are living longer)
     - technological change
     - increases in size and composition of the population

Question 2

1. how is the NHS funded?
2. what is the “flat curve of medicine?”
3. what 2 types of effectiveness must be considered when choosing a treatment?

Answer 2

1. General Taxation, national insurance, and payments for prescriptions and dentistry etc
2. new treatments are expensive but produce a relatively small yield in terms of health improvement

3. clinical effectiveness (does the patient have necessary condition for the treatment?)
cost effectiveness (greatest health gain for the lowest cost?)

Question 3

1. How can we examine trends of a particular disease/how do trends differ in terms of:
   a) time
   b) place
   c) person
2. what is often ascertained from population data
3. Name 2 examples of how changes at the level of the population have helped the individual
4. name 2 examples of how changes at the level of the population have harmed the individual

Answer 3

a) relating to events (such as war) or other particular circumstances (e.g. economic hardship) during that time.

b) different genetics and environmental factors.
Age distribution, socioeconomic factors, societal factors ect

c) age and gender
2. associations/risk factors (based on circumstances of similar individuals), rather than cause and effect

3. vaccination policy. seatbelt legilsation
4. global warming. negative changes in dietary trends

Question 4

What makes a good healthcare system? (7)

Answer 4

1. safe care
2. effective care processes
3. equity
4. preventative care provision
5. well co-ordinated care
6. healthcare outcomes

Question 5

1. How does society have an impact on science? (3)
2. What is social darwinsim
3. What is eugenics
4. What did people involved in the eugencis movement believe?
5. Name 5 examples of eugenic practices

Answer 5

1. scientific debate takes place in the public arena.
   media is not always impartial when presenting scientific news
   medical science has to work within social prejudice and myth
2. survival of the strongest/closest to pefection
   Intellectual, moral and behavioural traits are hereditary
3. when a specific intervention is considered which seeks to improve the genetic heritage of a child, community or humanity in general.
4. that it is possible to explain social status by reference to biological capacity and that social groups or administrative categories represented biologically separate breeding groups.
5. genetic screening; birth control, forced abortion, sterilisation, forced pregnancies; marriage restrictions; segregations; genocide.

Question 6

How can genetics/genetic testing impact on people’s lives? (5)

Answer 6

1. obligation of other family members who may also be at risk, to know
2. uncertainty before and after results
3. decisions around selection/elimination of characteristics pre and post conception
4. prophylactic action
5. impact on health insurance and employment

Question 7

1. what are health inequalities?
2. What form do social inequalities take?
3. What is the WHO definition of social determinants of health
4. According to the registrar general, define the 5 social classes

Answer 7

1. health differences linked to inequalities on people’s everyday circumstances
2. social gradient
3. conditions in which people are born, grow, work, live and age, and the wider set of forces shaping conditions of daily life (social norms, social and economic policies etc)

4. I professional occupations
II managerial and technical occupations
III skilled occupations
IV partly skilled occupations
V non-skilled occupations

Question 8

According to the black report. what are the 4 explanations for health inequalities

Answer 8

1. statistical artefact
2. health determines social class - health-related social mobility; ill health can push people down the social ladder
3. differences in health behaviour - social gradient is seen in health damaging behaviour
4. broader, material and structural inequalities - social structure determines material conditions which influence health directly or indirectly.

Question 9

1. what is life course theory?
2. describe how early life can influence health inequalities
3. describe how social processes can influence health inequalities
4. Draw the current accepted model for health inequalities

Answer 9

1. examines an individual’s life history and investigates how early events influence future decisions and health outcomes
2. maternal risks before and during pregnancy (infection, nutrition, diet, alcohol, smoking etc) > risk of poor infant growth and dev > increased lifetime vulnerability
3. poor social family circumstances > raised risk of poor physical development and educational attainment in childhood > raised risk of poor socioeconomic circumstances in adulthood
4. position in society from birth throughout life (STRUCTURAL) > MATERIAL conditions and BEHAVIOURAL risk > health

Question 10

How can social Inequalities be measured? (5)

Answer 10

1. household income
2. educational attainment
3. employment status
4. housing tenure
5. area of residence

Question 11

1. What is the epidemiological transition that occured in the past?
2. Name the 5 determinants of health and health outcomes

Answer 11

1. decline and control of infectious diseases and the rise of chronic, non-infectious degenerative disease
2. biological, socioeconomic, environmental, lifestyle and health services

Question 12

1. What is health promotion?
2. What are WHOs 5 aspects of health promotion (HARPS)
3. What is health education?
4. What is health protection?

Answer 12

1. the process of enabling people to increase control over and improve their health
2. Healthy public policy
   Action in the community
   Re-orienting health sercixes
   Personal Skills
   Supportive Environment
3. Learning experiences designed to facilitate voluntary actions conductive to health
   aims to give people knowledge and skills to change potentially health damaging behaviour
4. legislation to protect public health

Question 13

1. What is primary disease prevention?
2. What is secondary disease prevention?
3. What is tertiary disease prevention?

Answer 13

1. aims to prevent onset of disease. e.g. vaccinations, supportive environments (school meals etc), health education and protection, screening for risk factors
2. aims to detect and cure disease at early stage. e.g. screening programmes
3. aims to minimise the effects or reduce the progression of irreversible disease

Question 14

1. What is health persuasion?
2. What is legistative action?
3. What is personal counselling?
4. What is community development?
5. Describe 2 dilemmas that all of these approaches to health promotion have
   6 Describe the 5 needs for opportunistic prevention

Answer 14

1. informing individuals what to do, e.g. by mass screening campaigns. Cheap but limited effectiveness
2. laws to protect health, such as smoking ban. Raises questions about autonomy
3. opportunistic prevention in consultation. Also increasing use of online resources
4. locally based initiatives such as food banks
5. if resources are limited, why should they be diverted away from curative medicine?
   how do we balance individual freedom and social control?
6. caring not scaring. awareness of patient’s receptiveness, respectful, avoid preaching, part of long term relationship

Question 15

Should those who take risks be shunted to the back of the queue? (e.g. smokers)

1. Arguments for
2. Arguments against

Answer 15

1. smoking lead to the disease in the first place
   limits effectiveness of surgery
   poor outcome will lead to further surgery with a higher fail rate
   we should target limited resources where they are most effective
2. we have an ethical obligation to treat on the basis of need
   discrimination against people who smoke, which is more often poor
   doctors should not make value judgements

Question 16

1. Describe 3 arguments against a market for blood

2. describe how donor rates can be increased without use of payment mechanisms (2)

Answer 16

1. • represses altruism
     - erodes sense of community
     - increases blood supply from poor, unskilled and unemployed ( take from poor, give to rich; increased infection risk)
2. opt out schemes
   use of transplant co-ordinators to increase supply

Question 17

1. What is ethnicity?
2. why is ethnicity important in medicine? (4)
3. What is ethnocentricity?
4. What questions about ethnicity are asked when introducing health policy/screening programmes? (4)

Answer 17

1. socially determined. Linked to country of origin, residence, religion and social networks. (Race is linked to biology/genetics)
2. • disease prevalence varies with ethnicity
     - approach/response to treatment may vary with ethnicity
     - perception to treatment may vary with ethnicity
     - affects how people behave towards othets
3. the tendency to evaluate other groups according to the values and standards of one’s own ethnic group (especially the conviction that one’s own group is superior)
4. • who should be screened?
     - should the policy be based on ethnicity?
     - cost effectiveness of policy?
     - should screening be targeted, or introduced in all areas?

Question 18

1. what is stigma?
2. why do we often categorise people as other?
3. what is social constructionism?

Answer 18

1. a mark of disgrace associated with a particular circumstance, quality or person
2. as a way to categorise ourselves as normal and therefore feel better about ourselves
3. the meaning of social action not inherent in behaviour but conferred by an audience. e.g. a change in the concept of madness over time and between cultures/in different contexts

Question 19

Describe the process of producing stigma

Answer 19

1. Labelling - distinguishing and labelling human difference
2. stereotyping - development of cultural attributes that categorise a group
3. Othering - using labels to separate oneself from social groups. people tend to become their label
4. Stigmatisation - devaluing people based on an attribute or behaviour considered different or undesirable
5. Discrimination - acting differently towards people based on an attribute/behaviour

Question 20

1. Define the following:
   a) discreditable stigma
   b) discrediting stigma
   c) felt stigma
   d) enacted stigma
   e) courtesy stigma
2. what is internalising?
3. What is Passing?
4. What is covering?
5. What is resisting?

Answer 20

1a. keeping potentially stigmatising conditions hidden
1b. stigma that can’t be hidden
1c. a sense of feel and shame due to one’s condition, even if no stigmatising behaviour has been shown towards you
1d. discrimination towards others
1e. stigma felt by someone with a person who is stigmatised

2. absorbing the social views of being of lower status and the impact on personal beliefs and behaviours
3. passing oneself off without acknowledging symptoms (e.g. an alcoholic concealing drinking behaviour)
4. not disclosing condition. E.g. a blind person wearing sunglasses
5. contesting stigma related outcomes

Question 21

Name 6 implications of stigma for medicine

Answer 21

1. fear of stigma may act as a barrier to hekp seeking
2. concern about confidentiality
3. to diagnose defines a need for treatment (medical model)
4. in some cultures, stigma contributes to a lack of care
5. in some cultures, stigma is strongly associated with mental and sexual health
6. doctor has a role to reduce the stigmatising process

Question 22

1. What type of mental health issues are a) women and b) men more likely to be diagnosed with?
2. Why is this?
3. Describe the experiences of women with mental health issues
4. describe the experiences of men with mental health issues. What are the explanations for this?

Answer 22

1a) neuroses
1b) psychosis
2. some aspects associated with biological issues; some aspects associated with the roles and behaviours of being masculine and feminine

3. women are more likely to be admitted to psychiatric hospitals, receive a prescription for psychotropic medication, and receive a diagnosis of depression
4. men successfully commit suicide more than women.
   men are more likely to be diagnosed as siffering from psychosis, alcohol or drug abuse
   constructions of masculinity leave men unwilling to express their emotions, leading to them suppressing their feelings.

Question 23

1. Which ethnic minority group have the lowest rates of mental illness?
2. which ethnic minority group have the highest rate of hospital admissions for depression and alcohol problems?
3. What is the experience of Black and Caribbean people with mental health issues?
4. Describe the minority stress model

Answer 23

1. chinese
2. irish
3. more likely to be diagnosed with psychosis
   recieve more “physical” treatments in care
   recieve more tranquilisers and less counselling/psychotherapy
   regarded as violent and located in locked wards
   hospitalised by police or compulsory admissions
   have poorer outcomes after care
4. exposure to distal stress coming from social attitudes (e.g. racism)
   increased exposure to proximal/internal stress which is a byproduct of distal stress - internalisation of stigma, vigilence, negative feelings
   * lack of social support and low SES, prejudice and discrimination create a stressful environment that causes mental health problems