HSPH REVISION 2 Flashcards
Define ethnicity, culture and racism.
What is institutional racism?
Describe the tension between reification of ethnicity and the need to provide a socially accountable healthcare service.
Culture: sets of beliefs and ideas that a defined social group draws upon in order to identify and manage the practical problems of their everyday lives
Ethnicity: some form of distinctive set of cultural characteristics
Racism: prejudice, discrimination, or antagonism directed against someone of a different race
Racial discrimination that has become established as normal behaviour within a society or organization
Ethnicity - used to divide people into relatively advantaged and disadvanted groups in health matters. May lead to artefactual data. Problematic for subsequent use in geerating research findings and planning for health needs/policies.
Define social capital.
What are the key explanations for ethnic health differences?
Describe the principles of culturally competent healthcare practice
What is social construction?
Quantity and quality of social interactions in the community.
Patterns of ethnic inequalities in health vary from one health condition to the next.
Health professionals sensitive to cultural differences and complexities of ethnicity.
Everyday knowledge is creatively produced by individuals and is directed towards practical problems.
Describe medical culture.
Explain how medical culture influences the accumulation of knowledge about health
Explain the impact of the medical model on patient care and professional identity of doctors
Culture: all that in society which is socially rather than biologically transmitted. MC: Learning of medical role: separation of the student from the lay medical world.
To understand their patients, physicians must recognize how culture affects health, health beliefs, and health disparities. In this regard, physicians must be aware both of the cultures of their patients and of the culture of medicine.
Medical Model: abnormal behavior is the result of physical problems and should be treated medically. Sometimes, that is clearly true, as with traumatic brain injury. In other cases, there has always been doubt about the medical model e.g with mental illnesses.
Define chronic illness, impairment and disability.
Describe the prevalence of chronic illness and the impact it has on the person.
Give examples of chronic illnesses.
Chronic illness: condition/disease that is persistent/long-lasting in its effects or a disease that comes with time.
Impairment: any loss or abnormality of psychological, physiological or anatomical structure or function
Disability: any restriction/lack (resulting from an impairment) of ability to perform an activity in the manner/within the range considered normal
Prevalence: 15 million, 50% GP consultations
Diabetes, asthma, arthritis, stroke, CVD, depression
Describe the ‘hard work’ of chronic illness
Understand responses to being diagnosed with chronic illness including biographical disruption
Outline current health policy regarding chronic illness
Describe how the patient’s experience of illness relates to medical diagnosis and care
Challenge for doctors: non-adherance, lifestyle change, treatment burden for patient, communication, co-morbidities, coordination of health care
Affects identity and disrupts the map they have of their lives (biographical distribution). Restricted lives, social isolation, being discredited, burderning others.
National framewordk for NHS continuing healthcare and NHS-funded nursing care. NHS outcomes framework. 2010-15 Government policy on long term conditions. 2013-15 Equality analysis.
Doctor interested in explaining aetiology of disease. Pt trying to make sense of disruption caused by disease.
Outline the impact of chronic illness on the healthcare system
Outline the biopsychosocial model
Often poorly served by the current health care system that is primarily symptom oriented and focused on acute illness. Additionally, payment is heavily weighted toward medical procedures or treatment of late complications of disease, rather than toward the cognitive and time-consuming efforts required for successful primary or secondary disease prevention. Current payment policies need modification to support team care for effective chronic disease management.
A broad view that attributes disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical, etc), psychological factors (mood, personality, behavior, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.).
What is the Declaration of Helsinki?
Describe ethical guidelines for the treatment of patients and for conducting research
A set of ethical principles regarding human experimentation developed for the medical community by the World Medical Association. It is widely regarded as the cornerstone document on human research ethics.
Patient treatment: respect for the individual, their right to self-determination and to make informed decisions regarding participation - initially and during the research. The investigator’s duty is solely to the patient, and the subject’s welfare must always take precedence over the interests of science and society. Ethical considerations must always take precedence over laws and regulations. Consent should always be obtained.
Conducting research: Research should be based on a thorough knowledge of the scientific background, a careful assessment of risks and benefits, have a reasonable likelihood of benefit to the population studied and be conducted by suitably trained investigators using approved protocols, subject to independent ethical review and oversight by a properly convened committee. Studies should be discontinued if the available information indicates that the original considerations are no longer satisfied. Information regarding the study should be publicly available.
Define gender from a sociological perspective.
Describe the influence of social factors on gender.
Gender: an institution embedded in all the social processes of everyday life and social organisations.
Use of the categories ‘male’ and ‘female’ often involves the identification of social characteristics. Social interactions and roles communicate our gender to others. Gendered social practices shape women’s and men’s bodies in ways that reinforce particular cultural images of feminity and masculinity. Socially constructed conceptualisms of masculinity/feminity can become self-fulfilling prophecies as they’re embodied in social practices.
Describe the patterns of morbidity and mortality related to gender and understand the probable causes suggested.
Describe key health concerns for men and women.
UK: women - lower levels of mortality (death) than men, but higher levels of morbidity (unhealthy). Women can expect to live longer in poor health than men. Probable causes: gender paradox mechanism (more women use health services, greater stoicism amongst men)
Gender influences way women and men relate to their health through differences in power, oppertunities and personal and social expectations. E.g. paid and unpaid work (more women work parttime and men fulltime), male work roles can be more risky, women have less positive inpatient experience than men, men consult GP less, men more likely to assess their own health.
What are the multifaceted responses of stress?
Describe the interaction between environment and genes.
Describe the contribution of psychological factors to specific disease groups e.g. cardiovascular disease.
Define psychoneuroimmunology.
Cognitive, emotional, behavioural, physiological
Environment e.g. babies of stressed mothers during pregnancy show more anxiety, fearfulness, cognitive and attentional problems. Also certain level of genetic predisposition.
Depression, anxiety, stress, social isolation, lack of social support, type A behaviour etc. contribute to CDV.
The interaction of behavioural, neural and endocrine factors and the functioning of the immune system.
Consider psychological perspectives of clinical reasoning and decsion making.
How does expert decision making differ from novice decision making?
What is the role of cognitive bias in decision making, and the concept of debiasing?
Model of inductive clinical reasoning: initial collection of info from history + examination -> series of logical problem solving steps -> diagnosis. Pattern recognition: based on experience of lots of cases. Heuristics: educated guess.
Novices tend to over-diagnose rare but memorable conditions. Recent experience of dramatic case influences subsequent cases even in experienced doctors.
Systematic and predictable errors in judgement, resulting from reliance on heuristics. Debiasing: develop insight/awareness, consider alturnatives, reflection, decrease reliance on memory, simulation, specific training, make task easier, minimise time pressures, feedback
Describe the role and practice of shared decision making and patient centered decision making.
SDM: Dr and pt both involved, and discuss possible treatment options, dr gives expert opinion, dr and pt decided on treatment and management together. Vs. informed decision making where responsibility lies with pt. PCDM: pt expresses own agenda. dr understands pt’s POV, agree together on diagnosis and managment.
Should improve adherence as pt has been heard and can follow/understand regime better. But may go on too long.
Understand the size of the problem of non-adherence.
Differentiate between intentional and non-intentional non-adherence.
Describe beliefs related to non-adherence.
Describe ways in which clinicians can improve adherence.
Over 50% of all adults in England have literacy skills below level 2.
Accessability issues e.g. language barrier. Exluded via lack of basic skills (literacy and numeracy). Social exclusion. Terminology can be a barrier. Learning difficulties e.g. dyslexia.
Cultural issues can create different expectaion e.g. pretend to understand to save face, or impolite to question someone of higher social status.
Use specialist terminology only when needed. Use visual resources. Allow time for pt to process questions and formulate own questions. Consider health education materials design.
Understand the definition of: a refugee, asylum seeker, undocumented migrant and a victim of trafficking.
Refugee: successful asylum application, Government recognises they are unable to return to country of origin owing to well-founded fear of being persecuted.
Asylum seeker: left country of origin and applied for asylum in another country but application not yet concluded
Refused asylum seeker: application refused
Undocumented migrant: enters/stay in UK without documents required under immigration regulations
What is the entitlement to NHS primary healthcare?
What are the barriers to accessing primary NHS healthcare?
How are victims of trafficking identified?
Why is access to healthcare for refugees and vulnerable migrants important?
Everyone in England is entitled to free primary care regardless of nationality or immigration status. Inability to provide proof of address/ID would not be considered reasonable grounds to refuse to register a pt/withhold appointments.
Primary healthcare barriers: perceived barriers (most), admin difficulties, lack of access understanding, language barrier, feared arrest, refused, asked to pay in advance
