LMAP year 1 Flashcards
1
Q
What does The public health approach to health suggests:
A
- that some of wider determinants of health (e.g. the physical environment or environmental conditions) are outside of our control but some (e.g. personal lifestyle) are and while can be influenced by external factors, these also have an element of individual responsibility.
- A range of factors affect our health
2
Q
What contributes to the Wider determinants of health:
A
- 60% contribution by wider determinants of health to populations overall health status
o Genetics contribution: 15%
o Health care contribution: 25%
3
Q
Red part of Policy rainbow
A
These factors are out of an individual’s control such as age, sex and genetics. Health outcomes related to these factors could for example be a genetically inherited condition, or a disease that only affects one gender
4
Q
individual life style factors - orange layer of Policy rainbow
A
The second layer of the rainbow in orange represents and individuals lifestyle, such as physical activity levels, diet, drug use or amount of sleep they get. As we go through this module you will learn in detail how each of these lifestyle factors can contribute to good health, but also importantly - how much these modifiable lifestyle factors contribute to common preventable disease.
5
Q
yellow layer of rainbow policy - social and community networks
A
You will see this in your future clinical practice for example with
elderly
patients that may be socially isolated in clinic or on the wards , or in the
context of working in an area in which redevelopment of the area has led to changes for locals to the existing community.
6
Q
Green layer of policy rainbow - living and working conditions
A
For example, when managing a child with poorly controlled asthma - could it be due to poor housing, with exposure to damp and mould? Or being able to understand and think more broadly about thinking about unemployment in mental and physical health outcomes for your patients and the wider population.
7
Q
General economic, cultural and environmental conditions
A
For example, certain
screening or vaccination programmes may be more or less successful in different groups depending on cultural beliefs.
S tigma within society can disuade certain individuals from seeking help for various physical and mental health problems. And s ocio economic
factors, for example the financial crisis in 2007 2008 can have a widespread and lasting impact on a populations heal th status. We will learn
about this in more detail as we move through the module.
8
Q
how does access to green space improve health
A
increased physical activity
9
Q
how does coping with stress improve health
A
better quality and quantity of sleep
10
Q
how does social connectivity improve health
A
improved mental wellbeing
11
Q
how does access to affordable healthy foods improve health
A
- a varied and balanced diet
12
Q
how does education improve health
A
- mantain stable income
13
Q
3 domains of socio-economic status
A
Encompasses 3 domains
- Education -> higher level of education = better health status
- Income -> marker of status and means of achieving health e.g. better quality food
- Occupation -> the job that we do, not necessarily what we are qualified to do.
14
Q
equity vs equality
A
Equality = situation where people have equal access to health services (there inequality is people not having access). Equity = proportionate measure based on need. E.g. offer more focused services to communities who need it most.
eg. Living in a more deprived area = lower life expectancy and more DFLE
- People from poorer neighbourhoods don’t reach retirement age before disability strikes.
15
Q
what is veil of ignorance
A
Veil of ignorance = a component of social contract theory, allows us to test ideas for fairness.
- Behind the Veil of Ignorance, no one knows who they are. They lack clues as to their class, their privileges, their disadvantages, or even their personality. - Example:, the veil of ignorance would lead people to refuse slavery, because even though slavery is very convenient for slave-owners, for slaves, not so much, and since behind the veil of ignorance one would not know whether they would be a slave or a slave-owner, they would refuse slavery
16
Q
What is the inverse carew law
A
Inverse Carew Law = most deprived areas have least access to healthcare services
- Fewer services which are lower quality.
- Attributable to affluent people choosing to not work in these areas
People form disadvantage backgrounds seeks healthcare services less. Unable to speak English, don’t know about services or too many other stresses to have remaining cognitive bandwidth to seek help.
17
Q
key points in population health inequalities
A
Key points
a. The wider determinants have a significant impact on the health and wellbeing of local
and wider communities.
b. Socioeconomic status is a key determinant of health that refers to the social status of
an individual or group.
c. Providing adequate healthcare to those most in need can improve health outcomes
by reducing inequalities and creating a fairer society.
Key points 2
a. Prevalence, incidence and risk are key epidemiological measures of disease and
association that enable measurement and intervention in population health.a fairer society.
18
Q
What is epidemiology
A
Epidemiology is closely related to a branch of maths called biostatistics
19
Q
what are measures of disease frequency
A
Incidence
o About how many cases of disease occur
o Generally better for acute conditions
o Measured as number of cases/time. E.g. 4 cases over 2 years = incidences of 2 cases per year. Therefore, incidence is a rate
- Prevalence
o Proportion population with a disease at a given point in time
o Better for chronic disease. E.g. studying 4 people and 1 has disease at start of study = prevalence 25%. By end of study 3 have disease so prevalence is 75%.
o Can use prevalence for acute disease.
20
Q
What are Measures of Association
A
Reviews people with exposures (e.g. working with asbestos, veganism) and how this affects their health outcomes
- absolute risk
- relative risk
21
Q
what is absolute risk
A
Absolute Risk
o Of the exposed group (4 people), 3 people have the disease)
o Therefore, absolute risk is ¾ or 75%
o Of unexposed group, 3/5 have the disease. Therefore absolute risk is 60%
o Absolute risk difference = difference between the absolute risks of exposed and unexposed. Therefore 15% for the above example.
▪ Having the exposure is associated with a 15% risk of getting the disease/outcome.
22
Q
What is relative risk
A
Relative Risk
o Absolute risk of difference compared to original risk
o In this case that is 15/60, which is 25%
Relative risk tends to overstate differences. E.g. lifetime risk of getting a disease is 0.1%, which increase to 0.2% if you eat a certain food, this is a 100% increase in relative risk, whereas absolute risk difference is 0.1%/
23
Q
What is an indicator?
A
measures describing behaviour of system. Can use incidence and prevalence as indicators.
- Help us measure impact of interventions on health
24
Q
two main process driving sleep
A
Sleep has roles to play in energy metabolism, neurodegeneration and immune function
Two main processes driving sleep:
- Sleep homeostat
o Idea that longer you’re awake the more you want to sleep
o Wakefulness leads to sleep pressure. Reaches critical point which causes us to fall asleep.
o Can’t be the only thing going on – think about how tired you get during the day before you get a cup of tea. (Caffeine prevents adenosine absorption to promote wakefulness.) - Circadian Process
- Pattern of physiological processes over a 24 hours period
o Ensures hunting at most advantageous times of day
o Light regulates this via photosensitive retinal ganglion cells
o Light is the main zeitgeber of sleep
25
How is sleep measured
- PolySomnoGraphy (for analysis of sleep and understanding sleep disorders)
EEG, EMG and EOG used to monitor sleep
26
4 stages of sleep
4 stages
1. Wake to sleep. Sudden dreaming and easily woken up
2. Brain suppresses outside stimuli so not woken up. If deprived of this stage, memory is impaired
3. Deep sleep. Difficult to wake from this sleep. Night terrors and walking in this stage. Waking up at this time = annoyed
4. REM. Brain looks like wake brain activity.
a. Eves move around in inactive way
b. Body is also paralysed. Prevents us acting out our dream. If awoken at this time then you can’t move and might feel emotional. Important for emotional input and control.
27
what is sleep architecture and what affects it
Proportion of time in stages = sleep architecture
- Changes to sleep architecture affects behaviour
- Better exercise = better sleep, and vice versa
- Not sleeping causes you to have rebound deep sleep
- Alcohol = fragmented sleep. REM in first half (REM is reduced) and little deep sleep
- Depression = REM disrupted. Earlier than usual.
28
western attitudes to sleep
Western attitudes to sleep
- Born out of capitalism and industrial evolution
- People don’t recognise that decrease in sleep causes decrease in productivity. Up for longer = false economy
- Orthosomnia: people interpret variations in sleep pattern as a sign of disease
29
Factors affecting sleep
- Housing
- Stress
- Education
- lifestyle
30
are sleep disorders more common in men or woman
Like most psych disorders, more common in women.
- Women more likely to report problems
- Sleep has bigger impact of divorce and health than in men
- Women’s sleep is more affected by caregiving goal
People social situation will alter how comfortable they are with changing.
31
how many adults report at least one symptom of a common mental disorder
17%
32
physical signs indicative of mental health struggle
```
Physical signs:
o Changes to period
o Having no energy
o Gaining/losing weight
o Sleep problems
o Unexplained aches and pains
```
33
Psychological signs indicative of mental health struggle
```
Psychological signs:
o Constantly feeling low or sad
o Feeling anxious/worried
o Felling hopeless/helpless
o Suicidal thoughts/ thoughts of self-harm
o Low self esteem
o No motivation/interest in things
```
34
social signs indicative of mental health struggle
```
Social signs
o Difficulty coping with mistake at work
o Avoiding hanging out with friends
o Disregardig hobbies and interests
o Having difficulties at home
```
35
9 Types of binge drinkers classified by department of health
1. Destress: Use alcohol to regain control of life and calm down. Pressurised job or stressful home life leads to feelings of being out of control and burdened with responsibility. They include middle-class women and men.
2. Re-bonding: Are driven by a need to keep in touch with people who are close to them. Alcohol is the ‘shared connector’ that unifies and gets them on the same level. They often forget the time and the amount they are consuming.
3. Macho drinkers: Often feeling under-valued, disempowered and frustrated in important areas in their life. They are mostly men of all ages who want to stand out from the crowd. Drinking is driven by a constant need to assert their masculinity and status.
4. Conformist: Are driven by the need to belong and seek a structure to their lives. They are typically men aged 45 to 59 in clerical or manual jobs and believe that going to the pub every night is what ‘men do’.
5. Border dependents: Men who effectively live in the pub which, for them, is a home from home. They visit it during the day and the evening, on weekdays and at weekends, drinking fast and often.
6. Depressed: May be of any age, gender or socioeconomic group. Their life is in a state of crisis e.g. recently bereaved or divorced and so crave comfort, safety, and security. Alcohol is a comforter and a form of self-medication used to help them cope.
7. Hedonistic: Crave stimulation and want to abandon control, use alcohol to release inhibitions. They are often divorced people with grown-up children, who want to stand out from the crowd.
8. Boredom: Consume alcohol to pass the time, seeking stimulation to relieve the monotony of life. Alcohol helps them to feel comforted and secure. Typically, single mums or recent divorcees with a restricted social life.
9. Community: Are motivated by the need to belong. Drinking provides a sense of safety and security but also gives their lives meaning. They are usually lower-middle-class men and women who drink in large friendship groups.
36
Define Binge drinking:
Drinking more than 8 units in one sitting for males and 6 for females.
37
Define Alcohol Abuse:
Habitual excessive use of alcohol such that drinking alcohol has caused problems in other areas of life e.g. social, personal, or legal problems.
38
Define Chronic alcohol dependence:
When somebody drinks excessively leading to growing problems in their life but continues to drink even after their alcohol consumption begins to affect them physically.
39
Risk factors for alcohol problems
o
Psychological : high stress, anxiety, depression
o
Social: Culture, religions, family, work influences, new college/job started, peer pressure
o
Environmental : income/financial pressure, proximity to alcohol stores
40
how to calculate units of alcohol
```
Calculating units using ABV
-
Turn volume of alcohol consumed into L
-
Multiply volume in lit res by percentage
e.g. drinking 7 50ml of prosecco and ABV 12 % = 9 units
```
41
UK Guidance on Alcohol
-
14 units per week for men and women
-
Spread drinking over 3 or more days if you do drink up to the limit
-
Cut down by having several drink free days per week
-
There is no safe way to drink . Single binge drink can , in rare case, cause death
42
public health interventions for smoking
Public health intervention includes
- 2007 public smoking ban
- Stoptober campaign
- Images on cigarette packets
43
When are you More likely to smoke
- Unemployed, have severe mental illness, work manual and routine jobs
44
short term consequences of smoking in England
Short term:
- Irritation and inflammation of the airway
- Catecholamines increased causing increased heart rate and blood pressure
45
long term consequences of smoking in England
Long term:
- Double risk of MI (coagulation process, hypertension and heart rate contribute to this)
- Risk of COPD and lung cancer
- GI tract more likely to have cancers, and increased risk of stomach ulcers
- Decreases fertility in both sexes
- Osteopenia, osteoporosis
- Premature skin ageing
46
Common causes of
| addiction
Psychological dependence: perceived need of substance/behaviour, linked to emotional/cognitive symptoms experiences
```
Physiological
: physical dependence on
substance/behaviour. Physical
withdrawal in absence of
susbtance/ behaviour
-
Use different criteria to assess
situation : ICD 10 use d to diagnose
dependence
```
47
Diagnostic criteria for alcohol dependence according to ICD-10
The diagnostic criteria for alcohol dependence,
according to the ICD-10 (F10.2) (e9)
Three or more of the following manifestations should have occurred together for at least 1 month or, if persisting for periods of less than 1 month, should have occurred together repeatedly within a 12-month period:
Three or more of the following manifestations should have occurred together for at least 1 month or, if persisting for periods of less than 1 month, should have occurred together repeatedly within a 12-month period:
Three or more of the following manifestations should have occurred together for at least 1 month or, if persisting for periods of less than 1 month, should have occurred together repeatedly within a 12-month period:
* A strong desire or sense of compulsion to take the substance;
* Impaired capacity to control substance-taking behaviour in terms of its onset, termination, or levels of use, as evidenced by the substance being often taken in larger amounts or over a longer period than intended, or by a persistent desire or unsuccessful efforts to reduce or control substance use;
* A physiological withdrawal state when substance use is reduced or ceased, as evidenced by the characteristic withdrawal syndrome for the substance, or by use of the same (or closely related) substance with the intention of relieving or avoiding withdrawal symptoms;
* Evidence of tolerance to the effects of the substance, such that there is a need for significantly increased amounts of the substance to achieve intoxication or the desired effect, or a markedly diminished effect with continued use of the same amount of the substance;
* Preoccupation with substance use, as manifested by important alternative pleasures or interests being given up or reduced because of substance use; or a great deal of time being spent in activities necessary to obtain, take or recover from the effects of the substance;
* Persistent substance use despite clear evidence of harmful consequences as evidenced by continued use when the individual is actually aware, or may be expected to be aware, of the nature and extent of harm.
48
what is the stress-diathesis model
The Stress-Diathesis Model describes how disorders arise as a combination of predisposition and life experiences
49
signs and symptoms of stress
Symptoms of stress
- Increased heart rate/palpitations
- Headache
- Short of breath
- Diarrhoea
- Fatigue
Signs of Stress
- Mood disturbance
- Nervousness
- Worry
- Focus-lessness
- Isolation
50
what is personality
Personality is what determine how people respond to a situation. Refers to patterns of thinking, feeling and behaving.
People have different parts of their personality, which comes together as a whole.
51
what is coping style
Coping Style is a set of tools or strategies that we deploy to manage stressful situations.
52
what improves sleep
intervention and sleep education models
- sleep hygiene
- stress management
- science of sleep
53
Define Absolute poverty:
not having enough resources to secure basic life necessities: food, water, shelter, clothing
54
what is the poverty line
The poverty line: when your resources are well below your minimum needs. Poverty line is £47 per month – 10% of
the worlds live below this. This value changes depending on country, e.g. in Kenya its $1.91, and in Canada it’s $21.70
55
poverty in UK definition
Poverty (in north west London): inability to meet basic needs, because food, clean drinking water, proper sanitation,
education, healthcare and social services aren’t accessible.
56
basic personal needs
Basic personal needs: food, shelter and clothing
57
impact of poverty on physical health
```
Physical
o Bowel problems
o High blood pressure
o Missing appointments
o Weight gain as improper nutrition
```
58
impact of poverty on psychological health
Psychological
o Chronic stress
o Stress about missing appointments
o Experiencing psychiatric illness may change appetite
59
impact of poverty socially
Social
o Betting
o Strains in relationship
60
what is the Gig economy
a labour market where organisations, such as Uber and Deliveroo, contract with independent workers for
temporary positions, instead of permanent jobs.
- Don’t work off of minimum wage but by number of tasks completed.
61
what is social protection. give examples
The government provides protection via benefits: this is called social protection. Examples include:
- Universal Credit
- Tax Credits, deduction from taxable income.
- Jobseeker’s Allowance and low-income benefits
- Carers and disability benefits
- Child Benefit
- Benefit for families, e.g. maternity grant, help with childcare and free school meals.
- Heating and housing benefit
- Death benefits, e.g. Bereavement payment.
62
eligibility of universal credit
Universal Credit -> combines multiple benefits into one means-tested payment.
Eligibility:
- Unemployed or on a low income
- 18 years or older, although in special circumstances you may be eligible if you are 16 years or older
- You or your partner is under State Pension age
- You and your partner have £16,000 or less in savings between you
- You live in the UK
63
how circumstances influence universal credit allowance
Your circumstances Standard monthly allowance
Single and under 25 £251.77
Single and 25 or over £317.82
In a couple and you're both under 25 £395.20 (for you both)
In a couple and either of you are 25 or over £498.89 (for you both)
64
what are the Benefits of Employment
- Better physical and mental wellbeing. People who are employed are healthier to begin with. (Reverse
causality – people are unable to work due to their disabilities.)
65
what is cognitive capacity
Cognitive Capacity: the total amount of information the brain is capable of retaining at any particular moment.
➔ Being anxious about finances for example makes you drop 13 IQ pints.
66
2 types of nutrient in food
Food is composed of 2 types of nutrients:
| - Macro + micro
67
types of macronutrients
Macro nutrients
3 types of fat
1. Unsaturated
a. Mono + poly unsaturated. Reduce inflammation + lower cholesterol.
2. Saturated
a. Meet + dairy products. Try replacing with unsaturated
3. Trans fats
a. Modified to increase shelf-life. Promote inflammation, insulin resistance and increased LDL
3 types or carbs
1. Simple (mono/disaccharides)
2. Complex – oligosaccharides or polysaccharides.
3. Fibres
a. Regulates hunger + blood glucose. Helps food move through the gut.
b. Reduce risk of colon cancer and heat disease
Protein -> there are 9 essential amino acids
68
what are micronutrients and why are they essential
Micronutrients
- Don’t need a lot, but absence can lead to death.
- 2 types: vitamins + minerals. Those which are essential are not made by the body and therefore should be
absorbed in the diet
69
recommended daily intake from eatwell guide
```
<3 Stay hydrated <3
- 5 portions of food daily
- Whole grain carbs
(more fibre +
micronutrients)
```
70
What is a food desert:
- An areas that has
limited access to
affordable and
nutritious food
71
where are greenhouse gases from
¼ of greenhouse gases is from
| the global food system
72
personal, socio-cultural and environmental factors that affect physical activity
```
Factors that affect levels of physical activity
- Personal (physical and psychological)
o Chronic illness
o Fear of judgment
o Lack of interest
o Lack of time
o Poor self-efficacy
- Socio-cultural factor
o Carer responsibilities
o Community perception of physical activity
o Cost
o Fear of crime
o Stigma
- Environmental
o High density traffic
o Lack of access to parks
o Pavements or sports/recreational facilities
Physical activity linked to poor walkability and lack of access to appropriate areas accounts for 3.3% of global deaths
```
73
benefits of green spaces
Benefits of green space relating to populations
- Options for safe routes for active travel
- Purpose build spaces to facilitate individual and group sport and physical activity
- Reducing inequalities in access to facilities
74
psychological benefits of green spaces
Psychological benefits
- Improved wellbeing
- Possible benefit in mild depression
- Providing spaces for relaxation
- Reducing physiological stress indicators
- Refuge from noise pollution
75
environmental benefits of green spaces
Environmental benefits
- Cooling cities _ regulating urban temperatures
- Plants creating oxygen + capturing pollutants
76
intensity of exercise and types
as intensity of exercise increases, heart rate, respiratory rate and energy consumption also increase further
```
sedentary (not moving, working at desk)
-->
light (cleaning, carrying out rubbish, yoga)
-->
moderate (walking, cycling, shopping)
-->
vigorous (football, dancing, swimming)
--->
very vigorous (sprinting up hills, weight exercise and press ups)
```
77
Benefits of physical activity over time
- Reduced resting + exercising HR
- Reduced blood pressure
- Increased coronary blood flow
- Increased myocardial capillary density
- Decreased blood coagulability
- Increased cardiac contractility, myocardial electrical stability and vascular endothelial function
78
which factors allow benefits of physical activity
This is achieved by affected these other factors
o Reducing inflammation
o Improving sleep
o Reducing stress
o May also improve insulin sensitivity, reduce inflammation, alter levels of NTs and contribute to
hormone regulation.
o Helps to maintain a healthy weight
79
impact of regular physical activity on mental health
Regular physical activity does the following (mental health)
- Imporve self-esteem
- Reduce stress
- Improve sleep, cocnentration, memory and learning ability
- Reduced risk of depression and anxiety
- Reduced brain atrophy
80
4 areas to tackle physical inactivity by PHE
PHE has identified 4 areas
1. Active society
2. Moving professionals
3. Moving at scale
4. Active environments
81
Some examples of population interventions to increase cycling in London include:
- Cycling super highways and cycle routes and paths creating safer routes
- Phased traffic lights at intersections
- Cycle to work schemes
- Availability of public bikes
- Cycle training
- Reducing air pollution
- Reducing speed limit of traffic in central areas
82
Molecule involved in skeletal muscle contraction
= adenosine triphosphate
83
Female Athlete Triad
The female athlete triad is defined as the combination of disordered eating, amenorrhea and osteoporosis.
84
Factors affecting Health Behaviours
Health literacy: Cognitive and social skills which determine the motivation and ability of individuals to gain
access to, understand and use information in ways which promote and maintain good health
Health education: Giving information; directly teaching individuals and communities how to achieve better
health; usually focused on individuals and raised awareness among those individuals.
Health improvement: Process of enabling people to increase control over, and to improve, their health. It
moves beyond a focus on individual behaviour towards a wide range of social and environmental
interventions.
85
describe a clinician tactic to promote behaviour change
Shared decision making
- SDM ensures that people are supported to be as involved in the decision making process as they would wish.
SDM means people are supported to:
o understand the care, treatment and support options available and the risks, benefits and
consequences of those options
o make a decision about a preferred course of action, based on evidence based, good quality
information and their personal preferences.
86
when and why should we use shared decision making
When to use?
- Any non-life threatening situation.
Why should we use?
- Individuals are supported to make decisions based on their personal preferences and are, therefore, more
likely to adhere to evidence-based treatment regimes, more likely to have improved outcomes and less likely
to regret the decisions that are made.
87
What does good shared decision making looks like – for people?
- SDM supports people to be as involved as they would wish in a decision about which course of action to take
when their health status changes.
- The process supports people to understand the diagnosis they have and the options they face (including doing
nothing) alongside what is known of the risks, benefits and consequences of pursuing those options. In a
process of deliberation, they are then supported to talk about ‘what matters to me’ in terms of their attitude
to risk, the trade-offs they are willing to make and the outcomes that are important to them. Finally, a
decision is made in partnership with their professional team.
- The process can be supported by the use of evidence-based decision support tools that are tailored to
support people (especially those with low levels of health literacy) to understand their options and what is
known of the benefits, harms, consequences and burdens of those options.
88
How should the system should ensure that people are prepared to have a shared decision-making conversation
- Putting in place a campaign that encourages people to ask questions
- Having access to relevant information and decision support materials before, during and after an appointment
with a healthcare professional.”
89
what is self efficacy? use smoking as an example to list level of self efficacy from lowest to highest
```
Self-efficacy is “people’s beliefs in their capabilities to produce desired effects by their own actions. Level of self efficacy
from lowest to highest is as follows:
1. I intend to reduce smoking
2. I will stop smoking whilst at work
3. I intend to quit smoking altogether
```
90
Examples of behaviours that have been influenced in UK
- hand hygiene protocol
- disposal of needles and sharps
- antimicrobial stewardship
- surgical safety checklist
91
Examples of behaviours that have been influenced in UK
- hand hygiene protocol
- disposal of needles and sharps
- antimicrobial stewardship
- surgical safety checklist
92
what is antibiotic stewardship
```
Antibiotic Stewardship
- One initiative is
TARGET (Treat
Antibiotics
Responsibly,
Guidance, Education
and Tools): it
provides a range of
resources to support
health professionals
and educate
patients in the
appropriate use of
antibiotics in humans.
- Alongside this, the UK has adopted the World
Health Organisation new categorisation of
antibiotics AWaRe (Access, Watch, Reserve).
```
```
ACCESS
- First and second choice
antibiotics for treating the most common Infections.
Includes. amoxicillin for
pneumonia and penicillin for
streptococcal sore throat
```
```
WATCH
- Antibiotics with higher
resistance potential, that
should only be prescribed
for specific indications.
Includes ciprofloxacin in the treatment of complicated UTI
```
RESERVE
- Antibiotics that are last resort options that should only be used In severe circumstances, when other options have failed.
Includes; colistin and fV
parenteral fosfomycin
93
COMB model
3 factors influence behaviour
Capability
- Physical (equipment). Psychological (knowledge of how to access cigarette supplies from retail
Motivation
- Reflective (not any for smoking), Automatic (addicted to nicotine)
Opportunity
- Social (smoking is a part of work culture), Physical (areas where smoking is allowed), Psychological
94
Which COMB domain do these interventions belong to?
- Incentives for individuals and organisation that complete hand-washing to the
recommended standard
- Observations and presentation of feedback on how often hands are washed
during working hours
- Attending a course on hand washing technique and importance of hand
hygiene
Capability Psychological
| domain
95
Which COMB domain:
Incentives for individuals and organisation that complete hand-washing to the
recommended standard
Motivation-Automatic domain
96
Which COMB domain:
- Providing each healthcare worker with a personal bottle of hand sanitiser
- Increasing the number of hand basins on the ward.
Opportunity-Physical
97
Which COMB domain:
Healthcare teams build 'stop points' into their ward round when everyone
washes hands
Opportunity-Social
98
what is central to public policy
Influencing behaviour is central to public policy: MINDSPACE is a pneumonic of behavioural insight methods and a
checklist for use when developing policy
99
What factors influences our behavioural insight when developing policy
```
M - messenger
I - Incentives
N - Norms
D - Defaults
S - Sallience
P - Priming
A - Affect
C - Commitments
E - Ego
```
100
sleep, stress, dependance key points
Key points
a. Sleep is a dynamic process that responds to, but also impacts, our waking lives. The
impact of chronic sleep deprivation can be seen in every aspect of functioning and
across the spectrum of health complaints: both mental and physical.
b. Symptoms of mental ill-health are common across the population. These can manifest
as changes in mood or worry, but also as physical symptoms.
c. Stress is a normal response to challenge, but chronic stress can become a risk factor
for health complaints and poor health behaviours. It can also lead to burnout.
d. Alcohol and tobacco consumption are a considerable burden on the public’s health
and create pressures for the NHS.
e. Different factors put people at greater risk of engaging in these behaviours and being
harmed by these behaviours. For example, stress is a common pathway into problem
drinking, as people employ and develop unhealthy coping mechanism such as
excessive drinking to cope with stress.
Key points
a. There are no ‘symptoms’ of stress. Stress is a normal physiological response that can
be helpful in some situations
b. An increase in stress can precipitate health problems, particularly in those who have
an underlying predisposition.
c. How we cope with stress is a key modifiable factor in how effected we are by stress.
Faulty coping mechanisms often lead to damaging health behaviours and poor mental
health outcomes.
d. Sleep, stress and addiction are all bidirectionally related to each other. Improving one
area one will often improve another.
101
Financial Security and Social Protection key points
Key points
a. Poverty exists across the globe and adversely affects physical, psychological and
social functioning.
b. The impacts of poverty on health can be direct (access to resources; increased stressresponse
due to lack of resources) and indirect (choosing behaviours which help in
the immediate at the sacrifice of long-term health and wellbeing).
c. Social Protection works to help the most at risk from poverty, but the systems are
cumbersome, difficult to navigate and susceptible to fraud / gaming.
102
relationships and finance key points
Key Points
a. Humans are social creatures whose evolutionary past has developed around networks
and social connection. A key hormone in this is oxytocin.
b. Social Isolation is different from Loneliness, with the former being an objective
measure of connectedness and the latter being the level of satisfaction with your
connections
c. Loneliness is connected with many health outcomes, both physical and psychological
d. Different groups are more vulnerable to isolation, particularly the elderly, and middleaged
men.
103
nutrition key points
Key points
a. Food comprises macro and micronutrients, which are further sub-categorised into
various nutrient groups that enable a multitude of vital bodily functions.
b. Trans-fats can have negative health impacts through inflammation, insulin resistance
and LDLs.
c. The Eatwell Guide provides an objective, evidence-based recommendations to
maintain a balanced, healthy diet.
d. Food deserts present a physical barrier to healthy eating and are concrete example of
the physical environment influencing health behaviour and outcomes.
6.3 Physical Activity & Nutrition (Part 2 of 3; LOL)
Key points
a. Nutrition is the main driver of energy balance and excess energy storage can lead to
early cell death through inflammatory processes.
b. Obesity is a complex, multi-factorial issue that requires individual and population-level
intervention.
c. The Eatwell Guide provides an objective, evidence-based recommendations to
maintain a balanced, healthy diet.
d. The gut microbiome plays a key role in digestion and metabolism
e. Food insecurity is a global issue and can be categorised according to severity.
104
physical activity key points
Key points
a. Physical activity confers a multitude of physical and psychological health benefits
across the life course.
b. The UK Chief Medical Officers’ guidelines for adults and older adults provides key
recommendations on the amount, frequency and type of regular physical activity.
c. Inequality in the levels of physical activity between individuals and populations can be
due to a combination of individual, socio-cultural and environmental factors.
d. An active society, moving professionals, moving at scale and active environments are
the key areas of action defined by public health leaders to increase physical activity
on a local and national scale
6.4 Physical Activity & Nutrition (Part 3 of 3; LOL)
Key points
a. The evolutionary mismatch theory can be used to explain the possible adaptive lag
between human evolution and the rapid change of our environment in relation to
physical activity levels.
b. The general effects of a sedentary lifestyle promote a pro-inflammatory state through
a variety of processes. Conversely, an active lifestyle can promote an antiinflammatory
state.
c. Visceral fat is a key promoter of systemic inflammation.
d. The UK Chief Medical Officers’ physical activity guidelines for adults provides
evidence-based recommendations for the amount and type of physical activity advised
by age group.
105
behaviour and health key points
Key points:
a) Health-related behaviours describe the range of both positive and negative drivers of
health outcomes. Behavioural risk factors are those that contribute to disease, and in
particular non-communicable diseases (NCDs). Behaviours are influenced by many
factors, the majority of which are outside the health care system.
b) One model for analysing and changing behaviour is the COM-B model. The model
breaks down behaviour being the result of capability (physical and psychological),
motivation (reflective and automatic) and opportunity (physical and social).
c) Behavioural insights, such as those set out in MINDSPACE, can be used by policy
makers to design interventions that facilitate population and individual level
behavioural change. To achieve successful and sustained change a multifaceted
approach that integrates cultural, regulatory and individual modifications may be
necessary.
d) Shared decision making (SDM) can aid health behaviour because it supports
individuals to make health decisions based on their preferences and evidence-based
decision support tools to assist explanations of risks, benefits and consequences of
pursuing an action. Self-efficacy is intrinsically linked to success and failure of health
behaviours and behavioural change.
106
7.2 Behaviour, Risks and Consequences key points
Key points:
• The seven pillars of self-care are a coherent and holistic approach to self-care.
Synergistically they enable individuals to maintain health and decrease use of health
care services.
• Cardiovascular disease, Type II diabetes mellitus and certain cancers (especially lung,
bowel, breast, melanoma) are the major disease groups affected by behaviour and
lifestyle. Behaviour change prior to and after diagnosis can have advantageous health
effects.
• The COM-B model can aid initiation of behaviour change. Application of the COM-B
model can enable design of interventions and help identify barriers / challenges to
changing behaviour of an individual or a population.
