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)
Describe the evidence for effectiveness of screening
- RCTs provide best evidence
- Time trends in disease incidence and outocmes - compared to countries/regions without screening
- Case control studies
- Systemic reviews of evidence
- Modelling (combining a variety of evidence)
Describe the common sources of bias in screening evaluation
- Healthy screening effect - people who take part tend to be healthier than those who don’t
- Length time bias - disease is more likely to be detected in people with longer lasting and slowly progressive types of disease compared to people whose more aggressive disease progressed too fast to be detected by screening
- Lead time bias - earlier detection makes duration of survival after diagnosis longer, even if treatment is ineffective so the time after diagnosis is biased upwards beacuse diagnosis was artifically made earlier
List the screening programs that exist in the UK
- Cervical cancer
- Breast cancer
- Bowel cancer
- Abdominal aortic aneurysms
- Antenal and neonatal testing
- Diabetic eye disease
What are some screenining within other NHS programmes?
- Health check - screen adults 40-74 for early signs of stroke, kidney disease, type 2 diabetes or dementia
- National diabetes prevention programme
Describe how the environment and human health interact at different levels
Physical level
- Climate - efefcts of cold, heat and sunlight
- Natural radiation - causing lung cancer, leukaemia
- Geology - soil and water which is related to diet
Biological level e.g., malaria
Social evel e.g., housing
What are the 10 most common workplace hazards?
- Slips, trips and falls
- Electrical
- Fire
- Confined spaces
- Physical hazards
- Ergonomic hazards
- Chemical hazards
- Biological hazards
- Asbestos
- Noise
Describe the hazards in healthcare and provide examples
- Risk of exposure to nedles and other sharp instruments
- Many strong chemicals used e.g., anaesthetic agents, disinfectants
- Biological hazards e.g., blood and other bodily fluids, bacteria, and viruses
- Physical hazards e.g., poor posture, repetitive motions, moving patients with equipment, prolonged preriods of sitting/standing
- Stress e.g., long hours, rotating shifts, delivering bad news
- May experience aggression and violence
What are the public health approaches to address occupatonal hazards to health?
- Signs put up to want people of dangers
- Introduction of mandatory safety equipment e.g., helmets, goggles, and boots
- Training on manual handling and the provision of equipmenet to make the transportation of goods easier
- Some countries e.g., Denmark have laws to provide all workers with a standing desk to reduce the risk of sedentary jobs including MSK problems and general inactivity
Describe transport hazards on health
- Speeding
- Vehicle collisons
- Vehicles hitting pedestrians or cyclists
- Carbon emissions which are negatively affecting us as individuals and our planet
- Car problems e.g., brake failure and burst tires
