Lesson 6

Question 1

What are the 5 A’s of Access

Answer 1

Acceptability 
Availability 
Accomodation 
Affordability 
Accessibility

Question 2

What do the 5 A’s of access constitute?

Answer 2

A set of 5 dimensions of fit between the patient and the health care system.

Question 3

What is availability?

Answer 3

Availability = Existence of service barriers

The relationship of the volume and type of existing services (and resources) to the clients’ volume and type of needs.

Question 4

What are some examples of availability?

Answer 4

How much confidence do you have in being able to get good medical care for yourself and family when needed?

How satisfied are you with your ability to find one good doctor to treat your whole family?

How satisfied are you with your knowledge on where to get good health care, in normal & emergency scenario.

Question 5

What is accomodation?

Answer 5

Accomodation = organisational barriers

The relationship between the manner in which supply resources are organised, and the expectation of clients.

Question 6

What are some examples of availability?

Answer 6

All things considered, how much confidence do you have in being able to get good medical care for you and your family when you need it?

How satisfied are you with your ability to find one good doctor to treat the whole family?

How satisfied are you with your knowledge of where to get healthcare?

How satisfied are you with your ability to get medical care in an emergency?

Question 7

What is acceptability?

Answer 7

Acceptability = Psychosocial Barriers

The relationship between client’ and providers’ attitudes to what constitutes appropriate care.

Question 8

What are some examples of acceptability?

Answer 8

Appearance of the doctor’s office?

Neighbourhood of the doctor’s office?

Other patients you usually see at the doctor’s office?

Question 9

What is accessibility?

Answer 9

Accessibility = Geographic Barriers

The relationship between the location of supply and the location of clients, taking account of client transportation resources and travel time, distance & cost.

Question 10

What are some examples of accessibility?

Answer 10

How satisfied are you with how convenient your physician’s offices are to your home?

How difficult is it for you to get to your physician’s office?

Question 11

What is affordability?

Answer 11

Affordability = Financial Barriers

The cost of provider services in relation to the client’s ability and willingness to pay for these services.

Question 12

What are some examples of affordability?

Answer 12

How satisfied are you with your health insurance?

How satisfied are you the doctor’s prices?

How satisfied are you with how soon you need to pay the bill?

Question 13

What is DALY’s?

Answer 13

The previous GBD plan only took into account mortality and NOT disability.

Summary measure of population health that combines data on premature mortality and non-fatal health outcomes (disabilities) to represent the health of a particular population as a single number.

Question 14

How is DALY’s calculated?

Answer 14

YLD ( years lived with disability) + years of life lost ( YLL)

Question 15

Why use DALY’s?

Answer 15

Provides a comparable measure of outcomes
Enables comparison between diseases to:

• prioritise health interventions
• monitor health interventions
• assess changes of these burdens over time

Question 16

What is YLL (Years of life lost)?

Answer 16

Represents MORTALITY - by counting years lost due to PREMATURE DEATH caused by a disease.

i.e. the years lost if a person dies before reaching the average life expectancy of that country.

Can be counted in the form of:
Number of deaths from the disease in a year.
Years lost per death relative to an ideal age.

Question 17

What is YLD (Years lived with disability)?

Answer 17

Represents MORBIDITY - by counting years lived with the disease.

Number of cases with non-fatal outcome with the disease.
Average duration of non-fatal outcome until recovery/death.
Disability weight.

Question 18

What is a key feature of DALY’s (a strength)

Answer 18

Enables comparisons between diseases by using one measurement unit that compares premature death AND disability.

Question 19

What is the epidemiological transition?

Answer 19

Characteristic shift in common causes of death and disability from perinatal and communicable (infectious) diseases to non-communicable ( chronic diseases)

Question 20

What is the risk transition?

Answer 20

Changes in risk factor categories as countries shift from low to higher income countries, where common risks for perinatal and communicable diseases ( e.g. unhygienic water ) are overtaken by non-communicable disease risk factors e.g. tobacco.

Question 21

What is the trend of the leading global risk factors contributing to the GBD from 1990 to 2015?

Answer 21

Increasing risk for NCDs

Decreasing risks for perinatal and communicable diseases

Question 22

What is the double burden of disease?

Answer 22

In many lower-middle income countries previous risk for peri-natal and communicable diseases are common with increasing risks for NCD.

Question 23

What are the 5 myths about NCD’s or chronic diseases? (Rich, poor, old, chronic, rich ie the rich sandwich)

Answer 23

Affects mostly the rich 
L or M.C countries should control infectious diseases first 
Primarily affect old people 
Chronic diseases can't be prevented
Affects mostly high-income countries

Question 24

What are the realities of the 5 Myths regarding NCD’s or Chronic diseases?

Answer 24

NCD’s mostly affect the poor

Double burden requires an intervention in both countries

Almost 50% of young people are affected by NCD’s, not the elderly

Significant proportions of premature heart disease strokes, cancer and diabetes can be prevented

> 80% of NCDs in low-and middle-income countries

Question 25

What role does the commercial sector play in unequal NCD epidemic?

Answer 25

The commercial sector ( distal/ upstream determinant) is driving the NCD epidemic

By creating the uneven distribution of risks ( smoking, harmful drinking and obesity)

Unequal distribution of disease, health inequities

Question 26

How does the commercial sector drive these NCD inequities?

Answer 26

Marketing to vulnerable target ( poor, women, children) , shaping preferences and changing social norms.

Changing physical and social environment
. Influence public policy development
. Concentrate outlets in low SES areas (ie more bottle shops in those areas)

Actively exploit difficulties with behaviour change

Offer choice and pleasure
Emphasize moderation.

Promote unhealthy consumption among vulnerable groups—- create uneven distribution of risks—- NCDs in poor > rich

Question 27

What are industrial epidemics?

Answer 27

Diseases arising from over consumption of unhealthy commercial products (e.g tobacco, alcohol, processed food, beverages)

Question 28

How can industrial epidemics be reduced?

Answer 28

Shift the focus from individual behaviours ( determinants) to more level 3 environmental and upstream drivers of unhealthy product consumption. I.e policies and SES.

Question 29

What do each of the 6 letters in MPOWER stand for?

Answer 29

The 6 MPOWER measures are: Monitor - tobacco use and prevention policies

Protect - people from tobacco use (smoke free legislations)

Offer- help to quit tobacco use (downstream option) – targeted programmes

Warn - about the dangers of tobacco

Enforce bans - on tobacco advertising, promotion and sponsorship

Raise taxes - taxes on tobacco

Question 30

What is the medical model of disability?

Answer 30

• Disabled people are defined by -> their illness or medical condition.
• Regards disability as -> individual problem.
• Promotes the view of a disabled person as dependent and needing to be cured or cared for (and justifies the way in which disabled people have been systematically excluded from society).
• The disabled person is the problem, not society.
• Control resides with -> professionals.
• Choices for the individual are limited to the options provided and approved by the ‘helping’ expert.

Question 31

What is the GBD’s take on the medical model of disability?

Answer 31

“Disability” is no longer seen as an individual problem but as a social issue caused by policies, practices, attitudes &/or the environment.
i.e. wheelchair user

Question 32

What does the social model focus on?

Answer 32

Social model focuses on ridding society of barriers, rather than relying on “curing” those who have impairments.