LMAP year 1 Flashcards
What does The public health approach to health suggests:
- 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
What contributes to the Wider determinants of health:
- 60% contribution by wider determinants of health to populations overall health status
o Genetics contribution: 15%
o Health care contribution: 25%
Red part of Policy rainbow
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
individual life style factors - orange layer of Policy rainbow
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.
yellow layer of rainbow policy - social and community networks
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.
Green layer of policy rainbow - living and working conditions
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.
General economic, cultural and environmental conditions
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.
how does access to green space improve health
increased physical activity
how does coping with stress improve health
better quality and quantity of sleep
how does social connectivity improve health
improved mental wellbeing
how does access to affordable healthy foods improve health
- a varied and balanced diet
how does education improve health
- mantain stable income
3 domains of socio-economic status
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.
equity vs equality
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.
what is veil of ignorance
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
What is the inverse carew law
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.
key points in population health inequalities
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.
What is epidemiology
Epidemiology is closely related to a branch of maths called biostatistics
what are measures of disease frequency
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.
What are Measures of Association
Reviews people with exposures (e.g. working with asbestos, veganism) and how this affects their health outcomes
- absolute risk
- relative risk
what is absolute risk
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.
What is relative risk
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%/
What is an indicator?
measures describing behaviour of system. Can use incidence and prevalence as indicators.
- Help us measure impact of interventions on health
two main process driving sleep
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
How is sleep measured
- PolySomnoGraphy (for analysis of sleep and understanding sleep disorders)
EEG, EMG and EOG used to monitor sleep
4 stages of sleep
4 stages
- Wake to sleep. Sudden dreaming and easily woken up
- Brain suppresses outside stimuli so not woken up. If deprived of this stage, memory is impaired
- Deep sleep. Difficult to wake from this sleep. Night terrors and walking in this stage. Waking up at this time = annoyed
- 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.
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.
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
Factors affecting sleep
- Housing
- Stress
- Education
- lifestyle
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.
how many adults report at least one symptom of a common mental disorder
17%
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
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
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
9 Types of binge drinkers classified by department of health
- 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.
- 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.
- 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.
- 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’.
- 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.
- 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.
- 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.
- 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.
- 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.
Define Binge drinking:
Drinking more than 8 units in one sitting for males and 6 for females.
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.
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.
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
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
UK Guidance on Alcohol
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14 units per week for men and women
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Spread drinking over 3 or more days if you do drink up to the limit
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Cut down by having several drink free days per week
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There is no safe way to drink . Single binge drink can , in rare case, cause death
public health interventions for smoking
Public health intervention includes
- 2007 public smoking ban
- Stoptober campaign
- Images on cigarette packets
