Lecture 2 (13/07/21) Flashcards
Define Epidemiology?
study of DISTRIBUTION of; and DETERMINANTS of HEALTH-RELATED EVENTS (HRE) in specified POPULATIONS
and
the APPLICATION of this study to the CONTROL of those HRE
Define Distribution?
frequency and pattern of disease
Define Determinants?
factors that improve health or cause disease
e.g. smoking, exercise, etc.
What 3 Greek words is the word ‘Epidemiology’ derived from?
Epi: population
Demos: upon
Logos: Knowledge
Epidemiology is a method of causal reasoning. What does this mean?
Causal reasoning: process of identifying the causality (relationship between a cause and its effect)
- looking at relationship between exposures and health outcomes
While the clinician usually focuses on treating and caring for the individual, what does the epidemiologist focus on?
Looking at the frequency and pattern of events (distribution)
While the clinician usually focuses on treating and caring for the individual, the epidemiologist focuses on looking at the frequency & pattern of events.
What does this include?
Hint: I am an epidemiologist who watches ESPN
I: INTERVENTION to prevent additional cases / recurrences
E / S: identifying the EXPOSURE / SOURCE that caused the illness
P: whether there is POTENTIAL for further spread in the community
N: NUMBER of people who have been exposed
What are the 3 Stages of Disease (natural progression)?
1) Pre-disease stage: Primary Intervention
2) Latent disease: Secondary Intervention
3) Symptomatic: Tertiary Intervention
What are the 4 factors that cause disease when interacting?
Hint: now i HAVE a disease
H: Host- vulnerabilities, resistance
A: Agent- biological, chemical, physical, social, psychological
V: Vector- mosquito, human, water, food, fomites, etc.
E: Environment- physical, social, political, economic
What is the BEINGS model?
- concept that suggests that when these 9 factors interplay, it causes human disease and consequences
- therefore, these 9 factors are known as preventable causes (can be used to aid in prevention in human disease and its consequences)
What are the 9 factors in the BEINGS model?
B: Biologic & Behavioural factors
E: Environmental factors
I: Immunologic factors
N: Nutritional factors
G: Genetic factors
S: Services, Social, Spiritual factors
What are Determinants of Health?
- factors that determine the health of individuals/populations
- these factors can be positive or negative
What are the types of determinants?
- genetic determinants
- social determinants
- physical & environmental determinants
- behavioural determinants
- health care determinants
What are Genetic Determinants?
- age
- biological sex
- inherited health conditions
What are Social Determinants?
- conditions in which people are born, grow, live, work and age
- shaped by the distribution of money, power and resources at local, national and global levels
What are Physical & Environmental determinants?
- natural environment (i.e. green spaces)
- built environments (i.e. housing quality, conditions and exposures)
What are Behavioural Determinants of health?
- behaviours of an individual / population that risks contracting/preventing the disease
i. e. smoking, exercise, nutrition, etc.
What are Health Care Determinants?
- availability of quality health care, access and health insurance
What is Health Equity?
Each individual has the potential to reach his/her full health potential
What is Health Inequity?
differences in health outcomes between groups of people that are considered preventable or unfair
What are some Health Factors?
- health behaviours
- clinical care
- social and economic factors
- physical environment
Examples of health behaviours
- tobacco use
- diet & exercise
- alcohol use
- unsafe sex
Examples of clinical care
- access to care (i.e. location, time, cost, types of services)
- quality of care (i.e. specialists, diagnostics, treatment options, etc.)
Examples of social and economic factors
- education
- employment
- income
- family & social support
- community safety
Examples of physical environment
- environmental quality
- built environment
What Interventions targeting Determinants can work to improve people’s health?
- education
- connection to family, community, culture and country
- employment and income
- housing
- interaction with government systems
- health behaviours
What are some leading causes of morbidity in Samoa?
- pneumonia
- other complications of pregnancy and delivery
- injuries, wounds, poisoning and certain other consequences of external causes
- infections of the skin and subcutaneous tissue
- diabetes mellitus
- acute bronchitis and bronchiolitis
- hypertension
- diarrhoea and gastroenteritis
- other maternal care related to foetus and amniotic cavity and possible delivery
- typhoid fever
What are some leading causes of mortality in Samoa?
- diabetes mellitus
- cancers (all sites)
- cerebrovascular diseases
- other heart diseases
- hypertensive disease
- pneumonia
- injuries, wounds, poisoning and certain other consequences of external causes
- chronic lower respiratory diseases
- ischaemic heart disease
- certain conditions originating in the perinatal period
- septicaemia
- liver diseases
Define Disease Burden
the impact of a health problem as measured by financial cost, mortality, morbidity and other indicators
How is Disease Burden often quantified?
- QALYs (quality-adjusted life years)
- DALYs (disability-adjusted life years)
Define Burden of Disease
measures the impact of living with illness and injury and dying prematurely
What is used to estimate Burden of Disease?
HALYs (health-adjusted life years)
: calculate the combined effects of mortality and morbidity in populations, allowing for comparison across illnesses or interventions between populations
How are HALYs measured?
DALYs and QALYs
What do DALYs measure?
the difference between the current state of population health and an ideal situation where everyone reaches the age of standard life expectancy in perfect health
Explain this: DALYs are based on an assumption that ‘time’ is the most appropriate gauge of burden of disease
the greater the time lived with a disability, or with the disabling results of an illness, OR
the more time lost due to premature death,
the greater the burden of disease is considered to be
What do QALYs measure?
- both the quantity and quality of life lived
- used to analyse the cost-effectiveness of clinical (or public health) interventions
Researchers using a biomedical understanding of burden of disease are interested in the the following:
- morbidity
- mortality
- trends
- risk attributions
Define Morbidity
number of people in a population living with a health problem, and the severity of that health problem
Define Mortality
number of people in a population who die as a result of a health problem, and whether or not their deaths are considered premature (before the expected duration of life)
Define Risk Attributions
links between illness, disability or death outcomes to recognised risk factors
What does Economic Burden of Disease focus on?
financial costs of illness for individuals, households, healthcare systems, and societies
How is economic burden of disease measured?
- direct costs
- indirect costs
Define Direct Costs as a measure of economic burden of disease
value of expenses on prevention, diagnosis, and treatment
i.e. immunization and screening programs, in-hospital and out-patient care, visits to physicians and medications
Define Indirect Costs as a measure of economic burden of disease
value of labour and productivity losses
i.e. lost income and economic output due to illness-related absences from work, reduced productivity at work due to illness, or premature death
7 Principles of Holistic Care
PIRITI L
- “Prevention is the best intervention” (Prevention & Treatment)
- “Integration of healing systems is effective” (Integration of Healing Systems)
- ” Holistic medicine is relationship-centered care” (Relationship-centred care)
- “Care should be individualized” (Individuality)
- “Teach by example”
- “Healing powers are innate” (Innate healing powers)
- “All experiences are learning opportunities” (Learning opportunities)
Define Primary Health Care
Model of care that aims at ensuring health services are available, accessible, acceptable & affordable
Key words to define Primary Health Care
- essential
- practical
- scientifically sound
- socially acceptable
- universally accessible
- full participation
- affordable cost
- sustainable
- self-reliance
- self-determination
What is the goal of Universal Health Coverage (UHC)?
- ensure that all people obtain the health services they need without suffering financial hardship
- equity of access to health care (regardless of financial background or geographical location)
What are the dimensions of universal health coverage?
- Who is covered
- Which services are covered
- What proportion of the cost is covered
What objectives do WHO incorporate to define universal health care?
- equity of access to health services
- quality and effective health services
- financial-risk protection
What are some strategies for universal health coverage?
- reduced out-of-pocket spending
- increased prepayment
- risk pooling (fund pooling)
What does out-of-pocket spending mean?
direct payments
What does prepayment propose?
funds to pay for health care services are collected in advance of care being accessed
What does risk pooling (fund pooling) refer to?
- the management of financial resources in such a way that financial risk is shared amongst the population
- requires a prepayment system and thus provides a service to all, free at the point of access
What are 3 fundamental, interconnected problems impeding progress of health system financing?
- availability of resources
- over-reliance on direct payments
- inefficient and inequitable use of resources
Define Biostatistics
refers to statistical methods used to analyse health data
What are 3 classes of measures used in Epidemiology?
Hint: FAP
F: frequency
A: association
P: potential impact
What are some measures of frequency of disease?
- incidence
- prevalence
- morbidity
- mortality
- ratio
- proportion
- rate
Define Incidence
occurrence of new cases of disease/injury in a population over a specified period of time
Define Prevalence
number of cases of a disease that are present in a particular population at a given time
Define Morbidity
state of being symptomatic or unhealthy for a disease of condition
Define Mortality
occurrence of death
Define Ratio
- descriptive measure
- relationship between two numbers
e.g. males : females
Define Proportion
- ratio where the numerator is included in the denominator
- comparison of a part as a whole
e.g. males born / total number of babies born
Define Rate
- proportion with a specification of time
- measure of the frequency with which an event occurs in a defined population over a specified period of time
e.g. (deaths in 1999 / population in 1999) x 1000
