HSPH REVISION 1 Flashcards
What are the 3 main types of knowledge production and 3 assumptions underlying each?
Define the following:
a) ontology
b) epistemology
What are some advantages and disadvantages of the scientific method?
Positivism (natural history, assumes regularities and patterns independant of the observer), critical realist (real world ‘out there’ independant of our experience), constructivism/constructionism (how we construct reality internally and between one another)
a) our assumptions about the nature of reality
b) branch of philosophy concerned with the theory of knowledge, studies the nature of knowledge, justification, and the rationality of belief.
Advantages: replicable, reliable, objective, evidence-based medicine, RCT gold standard of medical interventions
Disadvantages: doesn’t accomodate inconsistencies, confounding and outliers
Describe the two main ontological positions with their assumptions.
Describe positivism and interpretivism and the difference between these 2 basic research methods in sociology.
Why is adherence important and what is it?
1. Objectivism/realism (quantitative): the social world is objective, independent of us who perceive it
2. Subjectivism/idealism/constructionism (qualitative - words): the social world is constructed by us - built from perceptions and actions
Positivism: prefer scientific quantitative methods e.g. social surveys
Interpretivists: prefer humanistic qualitative methods e.g. unstructured interviews
The extent to which a pt’s behaviour, WRT taking medicine, corresponds with agreed recommendations from a healthcare provider. Imp b/c chronic disease burden growing, and compromises treatment effectiveness.
What is the average rate of adherence to long-term therapy for chronic illnesses in developed countries according to the WHO?
Describe three practical/moral steps that should be taken to improve adherence.
Understand the different points of view in relation to patients paying for their own healthcare or being denied treatment due to their lifestyle behaviours.
50% (lower in developing countries)
De-emphasize biomedical information, give more consideration to patient lay beliefs about clinical management, oppertunities for learning about their condition within and outside healthcare environment
E.g. should fat pts be refused routine operations across the NHS? Yes - it will help NHS save money; No - the NHS is meant to be for everyone.
What is meant by sociological perspectives?
Name two different types of sociological perspectives and the assumptions underlying them
Define ‘habitus’
Explain the term ‘biopower’ in relation to health
Ability to move between personal perspective and bigger social perspectives; explore the relationship between the 2 levels of responsibility
Biomedical (biological reality, dying trajectories etc.) vs phenomenological existentialist (meaning and significance of embodied experiences etc.)
Anthropological cultural (how body is interpreted, body rituals, suicide, cultural institutions of health related locations e.g. GPs, gyms, hospitals etc.) vs social constructionist (shared understanding or construct of death formed via values, norms etc.)
Social norms, tendancies, habits, resources that are taken for granted and so guide behaviour. Structured determining ways to think, feel and act that become interalised -> part of character. Patterns can be changed.
Having power over bodies; it is “an explosion of numerous and diverse techniques for achieving the subjugation of bodies and the control of populations”
Describe what is meant by ‘medicine as a social ideology’
Describe what is meant by the term ‘cultural norms’
Describe three different binaries and how these relate to medical practice
Presents an image of health that fits with the culture of industrial capitalist societies
Behavioral standards that a society adopts as a whole and follows when interacting with one another (different according to each culture).
Impact of changing age and gender roles
Disease of poverty to those of affluence
Social change and pattern of a disaese
Define the social determinants of health
Describe what is meant by health inequities
Define the health inequity loop
Define the Inverse Care Law
Complex, integrated and overlapping social structures and economic systems that are responsible for most health inequities. Include social env., physical env., health services and structual and societal factors. Shaped by distribution of money, power and resources.
The unfair, unjust and avoidable causes of ill-health
A loop of multiplicative effects that increase inequalities that someone may experience
The principle that the availability of good medical or social care tends to vary inversely with the need of the population served.
Provide three reasons why knowing and understanding the social determinants of health is important for doctors
Provide the names of three policy documents relating to the social determinants of health
Name the three most deprived areas in London
What is the child poverty rate in Tower Hamlets as compared with the London average?
Name three policy documents related to health and wellbeing in Tower Hamlets
Context of people’s lives determine their health, include education, health literacy, physical environment and income and social status
Policies on subsidised housing for disadvantaged people. Policies to address exposures for specific disadvantaged groups at risk (cooking fuels, heating etc.) Child welfar measures inc. provision of nutritional supplements.
Hackney, Newham and Tower Hamlets
49% compared to 37%
TH long term conditions pack. TH Health and Wellbeing Strategy. TH MH Strategy.
How does the Black Report 1980 use class descriptors?
What is the difference between absolute poverty and relative poverty?
Social classes are segments of the population sharing broadly similar types and levels of resources, with broadly similar styles of living and some shared perception of their collective condition e.g. professional, intermediate, skilled non-manual, skilled manual, partly skilled, unskilled.
Absolute poverty: set standard which is the same in all countries and doesn’t change over time e.g. living on less than £X per day
Relative poverty: standard defined in terms of society in which an individual lives and which therefore differs between countries and over time e.g living on less than X% of average UK income
What is childhood poverty?
Describe the meaning of social exclusion?
Define subjectivity.
Describe how the sociological term ‘field’ relates to subjectivity.
UK: lives in household with income <60% of UK’s average
Alienation of certain people in society
Exlplains identity - individual’s experience of the social and what they turn ito as a result of the social experience
What is a discourse?
What is the Life course perspective?
What is Social Action for Health?
Type of language associated with an institution - policies, procedures, standard operating procedures.
Examines an individual’s life history and investigates, for example, how early events influenced future decisions and events such as marriage and divorce,engagement in crime, or disease incidence.
A community development charity, which works alongside marginalised local people and their communities towards justice, equality, better health and wellbeing.
Describe the Department of Health’s Business Plan 2014-15 for the NHS and what this involves.
Describe the NHS Outcomes Framework 2016-17.
The DH corporate plan 2014 to 2015 contains information about: the goals and priorities for the department, including milestones for the year ahead, the department’s arm’s length bodies, health and care system facts, sustainable development and climate change, equality and human rights objectives, 2013 to 2014 achievements, the department’s ministers, non-executive directors and leadership team.
NHS OF: Sets out the framework and indicators that will be used to hold NHS England to account for improvements in health outcomes.
Define health literacy
Define patient education
Outline the following policy from the DOH “Liberating the NHS: No decision about me, without me. 2012”.
Outline the proposed junior doctors’ contract
Describes the individual’s cognitive and social skills that determine the ability to access, understand and use health information in a way that will promote their own health.
Any set of planned educational activities that improve patient’s health behaviours and/or health status.
Sets out how the government will put patients at the heart of everything the NHS does. It promises to focus on the thing that really matters to patients – the outcome of their healthcare. It also commits to empowering and liberating clinicians to innovate, with the freedom to focus on improving services.
Junior drs paid standard time for working normal working hours (7am - 7pm M-F), contract = extend the standard time from 60hrs/week to 90hrs/week and increase to 10pm every night of the week apart from sunday. Junior drs say that by not being paid extra in future for working at antisocial hours they will lose up to 30% of their salary.
Describe the impact of health beliefs
Describe factors that influence beliefs
Mechanic’s 10 variables that influence illness behaviour (symptom recognition, perceived seriousness, disruption, frequency, tolerance, information, culture, denial, competing interpretations, treatment availability). Health belief model.
Medical establishment (good?), family/friends, culture, social world (celebrities/internet/media)
How do health beliefs influence behaviour
What are some common health belief models?
Medical establishments, familty and friends, culture, social world etc.
Health belief model, theory of planned behaviour (intention, attitude, subjective norm, perceived behavioural control), transtheoretical meodel (stages of change), social cognitive theory, Leventhal’s sel-regulatory theory. These models have helped health promotion strategies.
What is self-management?
What issues need to be managed for a chronic illness?
What might make self-management difficult?
Taking charge of one’s health, dealing with symptoms that change over time, working more effectively with healthcare professionals, improving one’s quality of life.
Symptoms + response, medications, making behavioural changes/role adjustments, managing emotional impact, negotiating with the medical team, decision making, acceptance
Understanding/remembering, complex regimes, long-term habit changes, unwillingless to self-manage, no motivation, >1 condition, lack of social support, environment affects attemps to maintain changes e.g. diet
What are some practical barriers to adherance?
What is the Expert Patient Programme?
What is social support?
Cost of prescriptions and travel, childcare, time off work, mobility limitations, inconvenient health care hours.
Increases confidence by setting and achieving goals, improves quality of life by helping pt feel more in control of their condition. Teaches pts how to communicate better about their condition.
Perceived comfort, caring, esteem or help received from others. Social relationships. Assistance. Not always positive.
What are some negative effects of social support?
What is the ‘buffering’ effect of social support?
Give some examples of self-help?
Encouraged to cope with depression by drinking alcohol. Underestimate stress and are unhelpful. Set bad examples. Not helpful.
SS leads to better health by protecting people from the negative effects of high stress.
Joining a group with similar health issues (peer led/managed or professional), books, DVDs, courses etc.
Describe the prevalence of domestic violence in the UK.
What are the major risk factors for DVA?
Outline evidence based healthcare strategies for addressing domestic violence.
1/4 women and 1/6 men in their lifetime. Most women don’t present with obvious trauma in health care settings.
Gender, age (younger), relative poverty, separation
IRIS model: Training and support, referral pathways (incl. safeguarding for children and adults) - health education material, clinical enquiry, validation, documentation, in pts records in own words with details and body map, immediate risk check and safety assessment, medical record prompts, recording and flagging system, advocate educator, practice champion
What is the biggest physical health difference between abused and non-abused women?
How many more times are women who have experienced DVA likely to abuse alcohol than those who have not?
More gynaecological problems
2-6 more times
Describe the components of information provision.
Define health literacy and patient education.
Explain the process of gaining consent.
Health literacy, patient education
Health literacy: degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions
Patient education: a strategy to increase knowledge and understanding so as to enhance self-managmenet skills.
For consent to be valid, it must be voluntary and informed, and the person consenting must have the capacity to make the decision. Consent can be given verbally or in writing.
When may an intervention occur regardless of patient decision?
Define stigma, deviance, and labelling.
Pt. requires emergency treatment to save their life, but they’re incapacitated (for example, they’re unconscious), pt. immediately requires an additional emergency proceduredure following an operation, pt. with a severe mental health condition – such as schizophrenia, bipolar disorder or dementia – lacks the capacity to consent to the treatment of their mental health (under the Mental Health Act 1983), pt. requires hospital treatment for a severe mental health condition, but self-harmed or attempted suicide while competent and is refusing treatment (under the Mental Health Act 1983), pt. is severely ill and living in unhygienic conditions (under the National Assistance Act 1948)
Labelling: individual characteristics are identified by others and given a negative label. (A form of social control)
Deviance: illness is a form of deviance - it disrupts social systems as the sick person can’t contribute.
Stigma: powerful discrediting and tainting label that radically changes the way people view themselves and are viewed as persons. Associated wtih blemishes of body or character, or belonging to a “bad/inferior” group.
What is enacted stigma?
What is felt/anticipated stigma?
Why do doctors need to think about stigma?
How can stigma be limited?
What is externalising?
Discrimination due to a condition.
Fear that discrimination might occur e.g. person feels fear, guilt, shame
Stigma affects: pt expectations, life quality, treatment adhernace, medically unexplained symptoms
Consider people’s fears and anxieties, educate public, see person as individual not illness
It isn’t the person that’s the problem, but the problem that is the problem.
Describe framework to critically evaluate evidence based decision making.
Define health economics.
Case reports/series, observational studies (cohort, case-control, cross-sectional), clinical trials (randomised, masked), systematic reviews. RCT can demonstrateeffect size and control for confounding factors. Economic evaluation measures cost effectiveness. Trials are replicated to produce stronger evidence. Limitiations: methodological (e.g. design - bias), economic (cost of RCT), unethical, rare disease, emergency conditions, if can’t measure something quickly, political (vested interest groups, who pays for research). Real evidence based medicine is in the centre of individual clinical expertise, best external evidence and patient values and expectations.
Banch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare
Describe two health improvements and promotion in practice.
Define communicable disease control.
Define screening.
Describe environmental and occupational hazards.
Change food environment that people live in e.g tax unhealthy foods. Housing improvements. Also things to e.g. reduce HIV by preventing tansmission in adults, prevent pregnancy in HIV positive women, reduce viral load during and after pregnancy via antiretroviral, promote elective c-sections, avoid breastfeeding.
An illness that arises from transmission of an infectious agent or its toxic product from an infected person, animal or reservoir to a susceptible host, either directly or indirectly through an intermediate plant or animal host, vector, or environment. Controlling this.
Screening: evaluation or investigation of something as part of a methodical survey, to assess suitability for a particular role or purpose.
Fracking? Hazardous materials and pollutants, noise/light/odour/traffic, social and economic change, seismic events, GHG emissions.
What is positivism?
What is interpretivism?
The world exists independantly of us.
All reality is viewed, described and understood by a socially constructed mind.
