Healthy and unhealthy communities - Public Health Flashcards
Describe the socioecological modeel of health
- Maps relationship between the individual, their environment, and the disease
- Individual lifestyle factors looks at personal behaviour and way of living that can promote or damage health e.g., smoking, whether or not we are physically active, the foods we choose to eat, alcohol consumption
- Social and community networks influence our individual actions e.g., driking culture
- The third layer is structural factors e.g., housing, working conditions
What are health inequalties?
They are unjust and avoidable differences, in people’s health across the population and between specific population groups
Describe how health inequalities affect different populations
- Age-standardises mortality is higher in Scotland, Wales, and Northern Ireland than in England
- Within England, age-standardised mortality is higher in the North
- High levels of area deprivation produce higher levels of mortality in relation to: Ischaemic heart disease, lung cancer, stroke, infants death and stillbirths
- High levels of area deprivation produce increased incidence of: lung cancer, teenage pregnancy
- Social class differences make a larger contribution to male mortality variation than region of residence
- London has the highest rate of moratility from infectious and respiratory diseases
- Children aged 5 who are of lower income have a less developed vocabulary and more behaviour problems than those of higher income
a) Describe the role of the WHO Commission on Social Determinants of Health (CSDH)
b) What are their overarching recommendations?
a) The CSDH was established to support countries and global health partners to address the social factors leading to ill health and inequalities
b)
- Improve living conditions
- Tackle the inequitable distribution of power, money, and resources
- Measure and understand the problem and assess the impact of action
a) What is the marmot review?
b) What are the 6 marmot review policy objectives?
a) The marmot review is an evidence based study to address the social determinants of health
b)
- Give every child the best start of life
- Enable all children, young people, and adults to maximise their capabilities and have control over their lives
- Create fair employment and good work for all
- Ensure healthy standard of living for all
- Create and develop healthy ad sustainable places and communities
- Strengthen the role and impact of health prevention
What did the ‘marmot review: 10 years on’ reveal?
Although there has been progress in some areas since 2010 there is a widening of health inequalties and life expectancy decreasing
Outline national, regional and local measures to reduce health inequalties
National
- Stoptober (Stop smoking for 28 days and you’re more likely to quit for good)
Regional
- University college London hospitals (UCLH) pathway programme for homeless patients admitted to hospital
- Involves hospital GP’s and nurses working with others to address the social determinant’s of housing, finncial and social issues of patients
- After it’s introduction, A&E attendance by supported individuals fell by 38% with a 78% reduction in bed days
Local
- Public Health England support local areas on risk factors such as smoking with targeted effective interventions on reducing rates in deprived areas especially in pregnancy and mental health settings
- Published ‘Smoking Cessation: A briefing for midwifery staff’ launched an online training module ‘Very brief advice on smoking for pregnant women’
What is screening?
Screening is testing people who do not suspect they have a health problem (without symptoms)
What are the purposes of screening?
- Reduce risk of ill healh by earlier detection and treatment
- Provide information to help doctors and patients make choices in managmement and conditions
Describe the principles of screening
- The condition should be an important health problem
- The natural history of the disease should be adequately understood
- There should be recognisable latent or early symptomatic stage
- There should be a suitable test or examination i.e., simple to perform and interpret, acceptable to those taking party, accurate and repeatable, and sensitive and specific
- Treatment started at an early stage should be of more benefit than treatment started at a later stage
- There should be accepted treatment for patients with recognised disease
- There should be an agreed policy on who should recieve treatment
- Diagnosis and treatment should be cost-effective
- Case finding should be a continuing process
What are the components of a screeing program?
- Register of eligible people
- System of invitation and recall
- Screening tests
- Confirmation of differential diagnosis
- Treatments of other interventions
- Information and support for patients
- Staff training
- Standars and quality assurance
What are the drawbacks of screening?
- Over diagnosis
- False positive tests - further testing can lead to more false positive tests
- False negative tests - false sense of security and may lead to the maintenance of unhealthy behavius
- Unnecessary treatment - might naveer have progressed to severe disease/death
- Costs of screening, further testing, and treatment
Describe the components of test accuracy
Sensitivity = % of people with disease who test postive
Specificty = % of people without disease who test negative
Reliability = the probability that the test result will be the same if it is repeated
a) Which component of test accuracy is most important for screening tests and why?
b) What is the problem of this?
a) Screening tests should be highly sensitive to detect as many true postivies as possible so that people with the disease are not missed out.
b) It will include people who do not have the disease (false positives)
a) Which component of test accuracy is most important for diagnostic tests and why?
b) What is the problem of this?
a) Diagnostic tests should be highly specific to dectect as many true negatives as possible so that only people with disease are treated.
b) It will exclude people who have the disease (false negatives)
