I and P Flashcards
What is public health?
the science and art of the following:
- preventing disease
- prolonging life
- promoting health
This is through organised efforts and informed choices of society, organisations, public and private, communities and individuals.
What is health improvement?
promoting the health of populations by influencing:
- lifestyle
- socio-economic determinants of health
- physical environment
- cultural factors
What is the Nuffield council of bioethics?
Independent body that examines and reports on ethical issues in biology and medicine.
They then provide information
e.g. campaign for 5 a day
What is the Marmot review?
proposes an evidence based strategy to address the following:
- social determinants of health,
- the conditions in which people are born,
- grow,
- live,
- work
- age
which can lead to health inequalities.
The conclusion is that premature death and illness effects everyone below the top.
What does the Marmot review call for?
Proptional universalism
For universal action - not just focussing on the bottom 10%.
What are the 6 policy objectives for proportional universalism which is part of Marmots review?
- giving every child the best start in life
- enabling all children, young people and adults to maximise their capabilities and have control over their lives
- creating fair employment and good work for all
- ensuring a healthy standard of living for all
- creating and developing sustainable places and communities
- strengthening the role and impact of ill-health prevention
What does the commission say about the social determinants of health?
it is important to close the gap in generation by:
- improving the conditions of daily life - the circumstances people are born, grown, live, work and age in
- tackle the inequitable distribution of power, money and resources - the structural drivers of those conditions of daily life (globally, nationally and locally)
- measure the problem, evaluate action, expand knowledge base, develop workforce that is trained in the social determinants of health and raise public awareness about social determinants of health.
What is income inequality inversely proportional to?
health and social problems of a country
What is society?
the aggregate of people living together in a more or less ordered community
As part of society what does it mean by biological?
who we are
- sex
- age
- disability
- genealogy
- ph/genotype
As part of society what does it mean by cultural?
language, diet, customs and beliefs
As part of society what does it mean by structural?
status
occupation
wealth
education
What 5 types of inequalities does Ferdinand Mount talk about?
- polictical
- life outcomes - equal quality of health
- opportunity - equal access to health care
- treatment and responsibility
- participation - equal consideration in healthcare decisions
Where is health information available from?
- statutory surveys
- statutory notifications
- health service records
- health services research
What is the index of multiple deprivation? (IMD)
Based on the idea of distinct dimensions of deprivation which can be recognised and measured separately.
These are then combined into a single overall measure for each small area.
the index is made up of 7 distinct dimensions of deprivation called domain indices.
What are 7 domain indices which is part of the index of multiple deprivation (IMD)?
- income
- employment
- health and disability
- education, skills and training
- barriers to housing and services
- living environment
- crime
What does it mean if the area is ranked 1 by the ImD 2004?
it is the most deprived
each patients is assigned to an area and iMD rank by postcode
What are the main causes of child mortality?
- pneumonia
- preterm complications
- diarrhoeal
- intrapartum related complications
- malaria
What are the social determinants of health also known as?
upstream factors
What is the integrated management of childhood illness (IMCI) designed to do?
to reduce childhood mortality, morbidity and disability in developing countries.
to contribute to improved growth and development of children under 5 years.
What is the community integrated management of childhood illness? (IMCI) - what components are involved?
Component 1
- improving case management skills of health providers through training using locally adapted materials
Component 2
- improving the health system by strengthening district health planning and management,
- making available essential drugs and supplies required for effective case management,
- providing quality support and supervision at health facilities,
- improving referral and heath information systems and organising work efficiently at the health centre.
Component 3
- improving family and community practices by promoting those practices with the greatest potential for improving child survival, growth and development.
What studies can be used for evidence for disease prevention?
descriptive studies:
- Anecdote and case series
- Cross-sectional survey
- measuring of incidence
- ecological studies
- case control studies
- cohort studies
What are descriptive studies?
- describe cases - those with the disease
- describe population - persons in whom cases arise
Purpose
- to know how much disease a region or group has
- to formulate worthy hypotheses
What are the pros and cons of anecdote and case series?
Pros
- quick
- easy to perform in a clinic
- provides new previulsy unobserved conditions
- provides new potential risk factors
Cons
- not scientific hence not able to test a hypothesis
- seriously affected by observer bias
- difficult to make inference about disease cause
What is cross-sectional survey and what are the pros and cons?
is a type of observational study that involves the analysis of data collected from a population, or a representative subset, at one specific point in time—that is, cross-sectional data.
Pros
- quick
- good at estimating prevalence or burden
Cons
- only represents that point in time
- cannot estimate incidence
- sampling frame may lead to bias
What is an ecological study and what are the pros and cons?
is an observational study defined by the level at which data are analysed, namely at the population or group level, rather than individual level. Ecological studies are often used to measure prevalence and incidence of disease, particularly when disease is rare.
Pros
- less expensive
- less prone to bias due to participation
- easy to perform using routinely collected data
- provides news hypotheses about the causes of a disease or condition
- provides new potential risk factors
Cons
- ecological fallacy
- assumption of average value
- assumption of average incidence
- data collections may vary
What are case control studies and what are the pros and cons?
A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls).
Often used to identify factors that may contribute to a medical condition by comparing subjects who have that condition/ disease with patients who don’t.
Pros
- good for rare diseases and/or rare exposures
- fairly quick - no need to follow up
Cons
- prone to selection bias
- prone to participation bias
- finding a suitable control can be difficult
- difference in recall can lead to bias
What is cohort study and what are the pros and cons?
Cohort studies are a type of medical research used to investigate the causes of disease, establishing links between risk factors and health outcomes. Cohort studies are usually forward-looking - that is, they are “prospective” studies, or planned in advance and carried out over a future period of time.
Cohort - people who share a common experience or condition
Followed through time for the outcome
Pros
- good for rare exposures
- can look at multiple outcomes
- reduce information bias, survivor bias
- direct measurement of incidence
Cons
- inefficient for rare diseases
- expensive
- retrospective is quicker
4, loss of follow up
What is health promotion?
the process of enabling people to increase control over and to improve their health
What 3 basic strategies does the Ottawa Charter identify?
- advocating for health
- enabling people to achieve their full health potential
- mediating between the different interests in society in pursuit of health
Obesity
individual choice or subject to our environment
What are the 4 health promotion disciplines?
- fiscal
- tax or subsidy
e. g. making healthy things cheaper and non-healthy things more expensive - Legislate
- making particpation in some unhealthy or risky activities illegal - Service provsion
- how the routine activities of services can modify risk exposure - Education
- increasing consciousness, awareness and knowledge
What is libertarian paternalism?
Guiding choice by architecture rather than by coercion (by tax, law or other)
What is micro/individually focussed changes?
lifestyles at individual/ GP level
such as diabetes prevention trials
What are macro changes?
subsidies/ taxes to effect behaviour change
- not likely to be popular
What makes difference to population health?
Randomised controlled trials
What are the pros and cons of randomised controlled trials?
Pros
- strongest evidence for causality if randomised selection bias and confounding is removed.
- If blinded less observer bias
Cons
- Not real life
- costly
- can inappropriate or unethical for many question
What are randomised controlled trials (RCT)?
A study in which people are allocated at random (by chance alone) to receive one of several clinical interventions. One of these interventions is the standard of comparison or control. The control may be a standard practice, a placebo (“sugar pill”), or no intervention at all.
What is error?
the difference between estimated/ measured value and true value
What is bias?
systematic, non-random deviation of results and inferences from the the truth or processes leading to such deviations.
What is diagnostic bias?
when a diagnosis is made based on exposure
e.g. mesothelioma in asbestos workers
Self-selection bias
Participants contact study
- through adverts or word of mouth
- more likely to participate in it runs in family history
- HEALTHY WORKER EFFECT - workers self-selecting are more likely to be healthier
What are the types of information bias (3)?
- recall bias
- interview bias
- surrogate bias
What do the types of information bias lead to?
misclassification bias.
When data is placed into categories (discrete variables) the ignored should be sampled.
What are the main measures of childhood obesity?
- BMI
- Skinfold thickness
- Waist circumference
- Bio-impedence - a form of body composition analysis
What does the national child measurement programme measure?
height and weight measurements go over 1 million kids aged 4-5 yrs and 10-11 yrs each year.
What is the national obesity observatory?
a single point of contact for wide-ranging authoritative information on data, evaluation and evidence related to weight status and it’s determinants.
Centiles
less than 2nd = underweight
What did the foresight report in 2007 state influences obesity?
- obseogenic envrioment
- obesity as normal response to an abnormal environment
- locked into lifestyles
- passive obesity