HSPH Revision Guide Flashcards
What is health?
State of complete physical, mental and social well being, and not merely the absence of disease or infirmity
How do we measure health?
Health status Person's body structure or function Person's symptoms and what they can or can't do extent Extent to which condition affects person's normal life research Health outcomes Physiological indicators
What contributes to increased health costs
Population growth (0.8%)
Ageing populations
Medical Technology
Increase prevalence of chronic conditions
Staffing costs
Failure of productivity in NHS to match other sectors
NHS Long Term Plan 2019
Making sure everyone gets best start
Delivering world-class care for major health problems
Supporting people to age well
Health meaning
Dynamic condition resulting from a body’s constant adjustment and adaptation in response to stress, and changes in the environment for maintaining an inner equilibrium called homeostasis
Interplay between individual and environment
Epigenetics
Study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself
Human Genome Project
Eudaimonic
Highest human good and realisation of one’s potential
Social determinants of health
Any social factor that can potentially impact on health and wellbeing
e.g. poverty, education, employment
Any cultural influences
Poverty distress
Dahlgren + Whitehead 1991
Layers of influence on health
Map of the relationship between the individual, their environment and the disease
Health Inequalities
Unjust and avoidable differences in people’s health (outcomes) across the population and between specific population groups
Go against principles of social justice because they are avoidable
Don’t occur randomly or by chance
Limit chance to live longer, healthier lives
Causes of health inequalities
Politics, poverty, physical, economics, social, cultural
Public health surveillance
Continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice
Public health surveillance impact
Serve as early warning system for impending public health emergencies
Document impact of an intervention
Monitor and clarify epidemiology of health problems
Evidence Based medicine
Integration of best research evidence with clinical expertise and patient values
Social Determinants of health
Conditions in which people are born, grow, live, work and age
Shaped by distribution of money, power + resources at global, national and local levels
Responsible for health inequalities
Health inequality
Differences in the health outcomes of individuals or groups
Equality Act 2010 Protected characteristics
Age, gender, disability, gender reassignment, pregnancy, maternity, race, religion or belief, sex and sexual orientation
Social Class
Segments of population sharing broadly similar types and level of resources, with broadly similar style of living + some shared perception of their collective condition
Social Class levels
I. Professional (doctor, accountant, lawyer)
II. Intermediate (manager, schoolteacher)
IIIn. Skilled non-manual (secretary, shop assistant)
IIIm. Skilled manual (bus driver, butcher)
IT. Partly skilled (postman, bus conductor)
V. Unskilled (cleaner, dock worker)
Social class and health Whitehall I + II
Inverse gradient of CVD risk with social class Women had greater angina + morbidity than men Obesity, shorter height + family history of HD were found to be more prevalent in lower level job ppl
Shit Life Syndrome
Poor working aged people locked in cycle of poverty and neglect
Poverty
Weakens social structure
Decreases access to care
Increase pressure on NHS
Absolute poverty
A set standard- the same in all countries and does not change over time
Extreme Poverty
Living on less than 1.25 dollars per day
Relative poverty
A standard defined in terms of the society in which an individual lives, differs between countries and over time
Poverty Across London
London has higher than 21% England poverty rate average
High poverty West London
Tower Hamlets, Hackney + Newham have poverty above 45%
Social exclusion
alienation or disenfranchisement of certain people within society
Social gradient in health
Inverse relationship between grade of employment + risk of death
Lower the grade of employment, the higher the risk of death
Brunner + Marmot 1999
Stress as a mediator
GCPH 2016
Deaths of despair in middle aged white ment- de-industrialisation, de-stabilisation, poverty, deprivation
Warraich 2017
Medical success- better at treating conditions + prolonging life so now more people are living with chronic conditions
White, Adams and Heywood 2019
Health Inequality Loop
Chronic Illness
Long term condition where there is no cure, and which are managed with drugs and other treatment
Noncommunicable Diseases
Including HD, stroke, cancer, diabetes and chronic lung disease
Collectively responsible for almost 70% of deaths worldwide
Prevalence of Long Term Conditions
Older people (58% of people over 60 compared to 14% under 40) More deprived groups (people in poorest social class have 60% more prevalence than those in richest social class, and 30% more severity of disease)
Long term conditions impact
50% all GP apps
64% all outpatient apps
Over 70% of all inpatient bed days
Men death rates from conditions
HD and stroke reduced by 50%
Lung cancer reduced 1/3rd
Dementia + alzheimers increase 60%
Liver disease increase 12%
Female death rates
HD and stroke halves
Alzheimer + dementia doubled
Female vs Male life expectancy 2016
3.6 years greater for F
Impairment
An injury, illness or congenital condition that causes or is likely to cause a loss or difference of physiological or psychological function
Disability
Restriction of ability caused by the condition
Handicap
Disadvantage that results when a disability or impairment limits or prevents the fulfilment of a role
International classification of Functioning, Disability and Health (WHO 2001)
Integrates medical and social models
Recognises the significance of environment
Focus on components of health
International classification of Functioning, Disability and Health (WHO 2001)
KEY COMPONENTS
Body structures and functions
Activities
Participation
Stigma
A mark of shame, disgrace or disapproval that results in an individual being rejected, discriminated against and excluded from participating in a number of different areas of society
Bury
Biographical distribution
Charmaz
Loss of self
Serious chronic illness may lead to restricted lives, social isolation, being discredited, burdening others
NHS Ten Year Plan
New service model, more NHS action on precent + health inequalities, progress of care quality + outcomes, better care for major health conditions, support NHS staff
Tower Hamlets Wellbeing strategy 2012
Stop increase in obesity and overweight children Reduce tobacco prevalence Higher physical activity Reduce STIs Reduce drinking + drugs
Trauma informed public health approaches for adults & children
Prevent (toxic stress)
Protect
Prepare
Promote
Gender identity
Refers to a person’s innate felt sense of being male or female
Gender variance/gender non-conformity
Behaviours and interests that fit outside what is considered ‘normal’ for a child or adult’s assigned biological sex e.g. tom boy
Gender dysphoria
A condition where a person experiences discomfort or distress because there’s a mismatch between their biological sex and gender identity.
Gender fluidity
Wider, more flexible range of gender expressions, with interests and behaviours that may even change from day to day
Genderqueer- nonbinary
Fluidity of gender expression that is not limiting
May not identify as male or female, but as both/neither/blend
Health expectancy
A measure of morbidity (used to describe how often a disease occurs in a specific area or a term used to describe a focus on death)
Women vs men mortality + morbidity
Women have lower mortality but higher morbidity
Women can expect to live longer in poor health than men- 10.7years
Whitehall II
Mortality lower in women
Queer theory
All sexualities are pluralistic, fragmented and frequently constructed
Biographical time
The processes, experiences and events that occur during an individual persons lifetime
Historical time
The impact of cohort effects upon the individual experience of ageing
Erikson’s Stages of Development
Stage 7= 40-65, generativity vs. stagnation
Stage 8= 65+, late adulthood
Ageism
Discrimination or unfair treatment based on a person’s age
Equality Act 2010
prevent discrimination
Ethnicity
A group of individuals who identify themselves or are identified by others as belonging to a social grouping which is distinct (in language, lifestyle, religion etc.)
Race
Classification of physical characteristics such as skin colour + hair texture, which reflect ancestry and or geographical origins
Socially constructed category that changes over time and place
Culture
Its own distinctive ways of classifying the world
Gives us means by which to make sense of the world and to construct meaning
Institutionalised racism
The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people
Institutionalised racism 2
Patients from ethnic minorities who are identified as those falling outside of these constructed norms of patient behaviour
Racism
A belief that some races are superior to others
Used to justify a position that racial inequalities are ‘natural’
Prejudice
A positive or negative evaluation of another person based on their perceived group membership e.g. race, class or gender
Discrimination
The prejudicial treatment of an individual based on his or her membership, or perceived membership, in a certain group or category
Stereotype
A conventional, formulaic, and oversimplified conception, opinion, or image of a group of people or things
Epidemiology
The study of patterns of disease and the factors that influence the emergence, propagation and frequency of a disease in a population
Employs the research strategy of measuring differential exposure variables of populations. The key assumption being that a change in exposure can alter disease incidence
Ethnicity
One of several variables that are used to subdivide the population for purposes of health research and for planning service provision
Social construction
The understanding that every day knowledge is creatively produced by individuals and is directed towards practical problems
Ethnic group
Based on an individual conception of social group membership and personal identity
Ethnic origin
An allocated definition based on common ancestry or place of origin
CVD + Framingham Risk Score
Combined risk of CVD highest in south Asians, then white ppl, then people of African origin
Intersectionality
The inseparable effect of holding multiple identifiers of disadvantage
Diabetes in Tower Hamlets
43% children in yr 6 overweight/obese- in London average 39%
Lowest no. of adults eating fruit and veg
23% physically inactive
Diversity
Any dimension or factor that is used to differentiate groups and people from one another
Adherence
The extent to which a person’s behaviour – taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider
40%
Compliance
Assumes passive patient
Concordance
Focuses on decision making process
hard to measure quantitively
Measuring adherence
Clinical/direct observation, indirect observation, self report method
Highest primary adherence by drug class
Antimicrobial
Highest primary adherence by patient age
under 18
Prescription non-adherence
28%
Intentional vs. Non-intentional adherence
Intentional- socially condemned, complex to understand and change
Non-intentional- socially less blame, easier to understand and change
Chronic medication adherence
50% not taken
New medication adherence
30% don’t after 10 days
Kidney transplant adherence
22% don’t adhere
HIV antiretroviral adherence
37-83% adherence
Necessity-Concerns Framework
Horne et Al
Whether someone adheres to treatment is guided by weighing up necessity beliefs against concerns
Necessity Beliefs
Belief in treatment efficacy, belief that illness requires treatment
Concern beliefs
Worries about side effects
Unsure of self-efficacy
Health Literacy
The cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand and use information in ways that promote and maintain good health
Doctor as a professional
ethical and legal guidelines • reflect, learn & teach others • multi-professional team • protect patients and improve care • deal effectively with uncertainty & change • methods of improvement • recognise own personal health needs
Professionalism
Moral contract that exists between a professional and the public
attitudes, values and behaviours required of the modern doctor and how those can be taught, nurtured and learned. • role and evolution of professional regulation and standards • changing forces of society and their impact on professionalism • importance of professionalism and it’s practice within the context of modern medicine.
GP Professionalism
How to address low patient engagement in healthcare and increase health literacy. 2. How to promote and maintain therapeutic optimism when working in areas of high deprivation. 3. How to effectively use evidence-based medicine (EBM) when working with patients with high levels of multi-morbidity and social complexity. 4. How to meet effectively the health needs of migrants including people seeking asylum and refugees.
Biopsychosocial model
Behaviours, thoughts and feelings may influence a physical state. • Disputed the long-held assumption that only the biological factors of health and disease are worthy of study and practice. • Argued that psychological and social factors influence biological functioning and play a role in health and illness also. • More realistic model in light of the role lifestyles play in a society having entered the new millennium. • This new theoretical model therefore has been developed in an attempt to improve on the disease approach and narrow view with respect to health and illness held by the medical model so that psychological and social factors of the individual can also be considered
When given treatment, need to make sure works biologically but also improves way the person lives
Obesity England ranking
40th in world
Obesity in adults england
28.1%
Men vs women obese
2/3 men
6/10 women
Bullying
Offensive, malicious and insulting behaviour
Harassment
Unwanted conduct affecting dignity
Resilience
Ability to bounce back after adverse effects
