Midterm - Pop. Perspectives Flashcards

Question

What is global health?

Answer 1

Global health considers policies and issues that cross borders. The scope of a public health specialist is limited to a particular community. Global health goes beyond those limits, and even transcends political boundaries. Global health is not to be confused with international health, which is defined as the branch of public health focusing largely on foreign aid efforts by industrialized countries.

Answer 2

Differences in the health status of individuals and groups E.g. Sickle cell anemia more common in those from African and Middle Eastern descent

Answer 3

Health inequalities that are unfair, unjust and modifiable - Health inequity is a type of health inequality – element of injustice in it - Health inequities are systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies. E.g. those who live in remote parts of Canada, low income Canadians

Answer 4

Ethical reasons - Inequities are the result of a toxic combination of poor social policies and programmes, unfair economic arrangements, and bad politics Legal reasons- Charter of Rights and Freedoms (section 15 - right to equal protection) - The preamble of the Ontario Excellent Care for All Act (2010) defines equity as a critical component of quality health care. Economic Reasons: Income disparity alone is associated with about 20% increased health care spending

Answer 5

- A population health approach focuses on improving the health of an entire population and improving equity between subpopulations. - The approach includes understanding that some population groups are healthier than others, not because of personal choice, but because of social, economic and environmental circumstances over the course of people’s lives.

Answer 6

Equality: “the quality or state of being equal: the quality or state of having the same rights, social status, etc.” Equity: “fairness or justice in the way people are treated”

Answer 7

_ Intersectionality is a metaphor for understanding the ways that multiple forms of inequality or disadvantage sometimes compound themselves and create obstacles that often are not understood among conventional ways of thinking - Intersectionality is a lens through which you can see where power comes and collides, where it locks and intersects. It is the acknowledgement that everyone has their own unique experiences of discrimination and priviledge

Answer 8

- most widely known and widely used of all models on the determinants of health - illustrates the influence of various factors on individual health and well-being, beginning with the most foundational (socioeconomic, cultural and environmental conditions) and extending to the most malleable (individual lifestyle factors) - useful for explaining the concept of health equity to a broad intersectoral audience - use of a holistic and intersectoral approach, importance of upstream action

Answer 9

Determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health. The main determinants of health include: -Income and social status -Employment and working conditions -Education and literacy -Childhood experiences -Physical environments -Social supports and coping skills -Healthy behaviours - Access to health services (gets the most attention) -Biology/genetic endowment -Gender -Culture -Race / Racism

Answer 10

Social determinants of health -Relate to an individual's place in society -E.g. income, education or employment. Experiences of discrimination, racism and historical trauma are important social determinants of health for certain groups -E.g. Indigenous Peoples, LGBTQ2S+, Black Canadians

Answer 11

Studies have shown that -About 10% of health outcomes are attributed to access to health care -About 20% to genetic predispositions - Remaining 70% are due to social, environmental, behavioural variables

Answer 12

Income Compared to those in highest income group, lower income Canadians have: Worse self rated health Shorter life expectancies Suffer more illnesses (regardless of age, sex, race and place of residence). Distribution of income in a society may be a more important determinant of health than the total income earned Large gaps in income distribution lead to poorer health among the population

Answer 13

How income is distributed in a country 0= perfect equality 1= perfect inequality

Answer 14

- Linked with intersectionality - Overlaps with other determinants of health - Girls and women don’t have same education opportunities - People of different genders could have different health behaviors (i.e. risky behaviors or seeking care) - Eating habits between genders (assumption women are eating healthy and for men less of a focus) - Health system response can be different depending on gender (i.e. research only done using men now shift to including women in research)

Answer 15

“Causes of the causes” diagramming An analysis tool that can be used to determine the “upstream” contributing factors in any problem Helps analyze issues beyond their most obvious, immediate causes. Assists in identifying causes that extend beyond individual behaviors.

Answer 16

Ecological determinants of health: include air, water, food; other ecological processes and natural resources (biodiversity, nutrient cycles, pollinators, marine systems)

Answer 17

the benefits that natural ecosystems generate for society

Answer 18

-A field of research, education, and practice that adopts systems approaches to promote the health of people, animals, and ecosystems in the context of social and ecological interactions -Approach that recognizes health effects within complex environmental and social interactions - Transdisciplinarity, participative research geared towards finding solutions to wicked problems - Ecosystem approaches to human health

Answer 19

a solutions-oriented, transdisciplinary field and social movement focused on analyzing and addressing the impacts of human disruptions to Earth’s natural systems on human health and all life on Earth

Answer 20

the present geological epoch that we are living in, reflective of humanity’s power over nature

Answer 21

- a global initiative that recognizes that the health of humans, animals and ecosystems are interconnected - a multidisciplinary and cross-sectoral approach to address risks that originate at the animal-human-ecosystems interface

Answer 22

Ecological Footprint (EF): measures the amount of biologically productive land and water required to produce all the resources consumed, and absorb the waste produced, by a given population. Living Planet Index (LPI): tracks the state of the world’s biological diversity based on average changes in vertebrate species from terrestrial, freshwater and marine habitats.

Answer 23

-occurs when long-term weather patterns are altered; Global warming is one measure of climate change, and is a rise in the average global temperature. -Rising global surface temperatures during last century -Dramatic increase in recent decades associated with human activity -Climate change is one component of global change -Climate change is directly associated with the increasing concentrations of heat-trapping "greenhouse gases” in our atmosphere, from the burning of fossil fuels such as coal and oil, deforestation, land-use changes, and other sources

Answer 24

-Small amounts of persistent chemicals, and some heavy metals, are already spread widely in the environment. -These can have enormous biological effects as they become bio-concentrated up the food chain, reaching levels in top predators (including humans) millions of times higher than in the source. -this means that everyone born or living since World War II carries a lifelong body burden of multiple and persistent organic pollutants with health consequences that are unknown

Answer 25

impact of human activity on the key processes that govern the functioning of the biosphere; includes climate change, ecotoxicity, resource depletion, species extinction, etc

Answer 26

a social movement to address the unfair exposure of poor and marginalized communities to harms associated with resource extraction, hazardous waste, and other land uses

Answer 27

population growth, urbanization, economic growth and development, technological change, social values

Answer 28

Direct - heatwaves, extreme weather events, drought Indirectly mediated through the effects of climate change on: - Ecosystems (agricultural losses and changing patterns of disease) - Economies/social structure (migration and conflict)

Answer 29

Civil conflict Storms and flooding Disease transmission Heat Air pollutants Food Supply

Answer 30

Populations most at risk -Older adults -Children -Pregnant women -People with disabilities -Immunocompromised people -Low income households

Answer 31

-Leading weather-related cause of death -Urban heat islands -Worsens air pollution -Cardiovascular disease, asthma -Loss of labour productivity, especially in low HDI countries

Answer 32

-damage crops and disrupt farming -Sea level rise and flooding of coastal lands will lead to salination or contamination of fresh water and agricultural lands, and the loss of nursery areas for fishing -Drought, and changing patterns of plant and livestock diseases and pest infestations, reduction of income from animal production, decreased crop yields, lessened forest productivity, and changes in aquatic populations will all affect food production and security

Answer 33

Climate change effectively amplifies the underlying causes of undernutrition – -food access (physical and market), child care - feeding practices (less women’s time for child care b/c more time spent on getting food and water), -increasing disease (malaria and intestinal infections reduce iron and cause micronutrient deficiencies).

Answer 34

-Thousands of others flee their homes in the context of slow-onset hazards, such as droughts or coastal erosion linked to sea level rise. -Climate change is also a “threat multiplier” in many of today’s conflicts, from Darfur to Somalia to Iraq and Syria. Climate change sows seeds for conflict, but it also makes displacement much worse when it happens.

Answer 35

Infections that have newly appeared in a population or have existed previously but are rapidly increasing in incidence, impact or geographic range Newly emerging (novel pathogen to humans) Re-emerging (geographical or human host range expansion) Deliberately emerging (bioterrorism) 60% are zoonotic (pathogens originating in animals) 29% are vector-borne (transmitted from host to host by an arthropod vector)

Answer 36

Novel pathogens (‘true’ emergence) - Drivers: Deforestation and agricultural practices that promote spill-over from animals to humans or evolution of viral and microbial variants Emergence in new regions (introduction) -Drivers: Pathogen movement due to trade and travel (to where and when conditions are suitable) Local emergence (spread) -Drivers: Environmental, climatic, social and demographic changes that affect human exposure to pathogens/vectors

Answer 37

Social factors: lack of adequate health care; increases in international travel; breakdown in control; agricultural practices that favour host range shifts Demographic factors: aging population in developed countries; urbanization; population growth Environmental factors: global climate change; land use practices that result in human contact with previously remote habitats

Answer 38

1. Expand the guiding principles of public health 2. Public health professionals and organizations must improve their capacity to understand and address the ecological determinants of health and how they interact with the social determinants of health 3. Walk the talk: Environmentally responsible health care 4. Change social norms and values 5. Change the focus of development and the way it is measured 6. Strengthen ethical purchasing and investment policies 7. Protect people and communities from harm and health inequity 8. Protect people and communities from the adverse impacts of ecological change 9.Work with others to establish policies and practices that create more ecologically sustainable and healthy societies and communities.

Answer 39

Projected increases in temperature with climate change are expected to permit and accelerate the expansion of vector-borne diseases More regions becoming more climatically suitable

Answer 40

Strategies and approaches used by the private sector to promote products and choices that are detrimental to health CDOH as the systems, practices and pathways though which commercial actors drive health and equity. Includes all commercial entities Links between health and commercial entities are complex Neutral definition: Positive and negative contributions Outcomes: - Health (includes both human and planetary health) - Equity

Answer 41

corporations are described as ‘vectors of diseases’ unhealthy commodities are the agents of these diseases individuals are the hosts

Answer 42

Pornography Guns and firearms Gambling Chemicals i.e. pesticides Pharmaceutical products Other drugs - cannabis Alcohol Car/automobile Tobacoo/vaping Ultra processed foods

Answer 43

Popular brands owned by so few companies Since companies so large can watch regulations around the world Exist in countries all over the world Power is very concentrated in very few companies

Answer 44

Practices to secure preferential treatment or prevent, shape, circumvent, or undermine public policies in a way that furthers corporate interests Lobbying -In house and external Government Relations (GR) companies -Frame issues in self-serving way -Promote self-serving policies (Self-regulation, Free-trade, Promote individual liberties) Threaten to take jobs away Campaign donations Funding front groups Litigation Bribery

Answer 45

- looked at frequency of interactions between HC and industry stakeholders - what strategies and practices were being used by industry Industry had more interactions with HC than non-governmental organizations Met most about front of pack labelling –industry doesn’t like Most interactions used information and messaging as strategy PRACTICES Framing debate Promoting de-regulation Shaping evidence base Most used no policy substitution strategy Policy Substitution - Developing and promoting alternatives to proposed policies including revised policies, voluntary codes, self-regulation and non-regulatory initiatives

Answer 46

Practices involving the production and use of science to alter products or otherwise secure favourable outcomes for the industry Funding research (Foster doubt about harm) Discrediting independent research Falsifying data Ghost writing reports Deliberately suppressing/hiding data

Answer 47

Practices to promote sales of products or services 4 P’s of marketing Product (what it looks like) Price (of what you're selling) Promotion (In a variety of media/settings, Rise of digital media) (advertising) Place (where it is sold)

Answer 48

To examine the frequency, healthfulness and power of food marketing viewed by children & adolescents across all digital platforms in Canada 83% of ads overall were viewed on social media: YouTube: 29% Pinterest: 23% TikTok: 20% 13% of ads viewed on mobile gaming Overall child exposure: 11.2 ads/child/day or 4067 ads/child/year Overall adolescent exposure: 22.7 ads/adolescent/day or 8301 ads/adolescent/year Children: Fast food restaurants – 22% Chocolate & candy – 11% Regular soft drinks – 9% Adolescents: Fast food restaurants – 21% Savoury snacks - 13% Chocolate & candy – 10%

Answer 49

Efforts to shape legitimacy and credibility, reduce risk and enhance corporate brand image Corporate Social Responsibility activities engaged in most heavily by corporations with harmful core products (Philanthropy, Education, Research) Hire public relations (PR) companies

Answer 50

Emerged from a realization among transnational corporations of the need to account for and redress their adverse impact on society: specifically, on human rights, labour practices, and the environment.

Answer 51

Public Health: This focuses on protecting and improving the health of communities through organized efforts. It includes activities like disease prevention, health education, and health policy. Public health looks at the health of the population as a whole and works to address health issues at the community or societal level. Population Health: This is more about understanding health outcomes in specific groups of people, often considering factors like social determinants, behaviors, and access to healthcare. It aims to improve the health of these groups by looking at data and identifying what influences their health. In short, public health is about the collective efforts to improve health for everyone, while population health focuses on specific groups and the factors affecting their health.

Answer 52

certain amount reflected by causes of death but a lot of problems hidden (people not feeling well but not captured – don’t have primary care doctor) Visible Part (Above Water): This represents the obvious cases of disease, like people who are sick and seeking treatment. Hidden Part (Below Water): This includes many more people who are affected by the same disease but might not show symptoms or seek help. These could be individuals with mild cases, those who are undiagnosed, or those who have risk factors but aren’t yet ill. The idea highlights that the actual burden of disease in a population is often much larger than what is seen on the surface.

Answer 53

Health = a state of complete physical, mental and social wellbeing - the ability to adapt to one's environment -the ability to adapt and self-manage in the face of social, physical, and emotional challenges -Do we need a new definition of health to incorporate ageing populations into its basic tenets? Strong relationship between definitions of health/disease and sources of information used to measure health -Definition can inform choice of data source -But often data source implicitly creates definition

Answer 54

Existing sources of data - Whole population, high accuracy but limited health information (Census, vital statistics (birth and death records)) -Tip of the iceberg for many questions but reasonably accurate and high population coverage (Hospital discharge abstracts, Physician records & billing databases, Communicable disease and other surveillance systems, Disease registries) -Health surveys (capture more of the iceberg) Tradeoffs - Population coverage, accuracy of information, coverage of the “iceberg”, availability of information Existing data sources vs. primary data collection

Answer 55

Consider availability of information needed to answer research question (including exposure data too) Consider also: -Accuracy of information -Population coverage -Coverage of the “iceberg” -Accessibility (privacy concerns often place significant limitations on ability to access record-level data) -Timeliness Different aspects may be important in different studies

Answer 56

Provincial and territorial Vital Statistics Acts Registration of all live births, stillbirths, deaths and marriages compulsory These Acts follow a Model Vital Statistics Act that was developed to promote uniformity of legislation and reporting practices among the provinces and territories Compiled by Statistics Canada into the Birth Database and Death Database

Answer 57

Data items recorded: -Age, sex, marital status, place of residence and birthplace of the deceased -Date of death -Underlying cause of death classified based on International Classification of Diseases and Related Health Problems (ICD) -Province or territory of occurrence of death -Autopsy (whether one held; if so, whether results were taken into account in establishing the cause of death) -Coverage of Death Database extremely high -Accuracy: believed high for most fields -Cause of death: several sections eliciting direct cause of death information on certificate --underlying and antecedent causes --other significant conditions --manner of death, e.g., natural, accidental, suicide, homicide --further information on injuries -Errors relatively common in cause of death assignment, often due to non-specific terminology

Answer 58

Surveillance / notifiable diseases Disease registries Administrative health care use data: -Canada: Canadian Institute for Health Information (CIHI) -Ontario: IC/ES Surveys (general population or targeted)

Answer 59

Surveillance is the collection of data relevant to public health, which can then be analysed to guide prevention and treatment programmes Surveillance systems differ in purpose, population coverage, data elements, timeliness etc. Chronic or infectious disease, often through healthcare administrative data or laboratory data Can be active or passive

Answer 60

special case of surveillance system where physician reporting is mandated Usually infectious disease that require control Over 50 notifiable diseases in Canada (infectious diseases)

Answer 61

List or database of people with a pre-defined condition Population-based vs. clinic/hospital/etc. based -‘Population-based’ defines a target population and registers all cases arising from that population -Clinic based: register all cases treated at a hospital/clinic Data sources and elements differ depending on registry (e.g., data from hospitals, laboratories, vital statistics) Uses of Registries -Descriptive epidemiology of disease -Incidence/mortality rates by age, sex, etc. -Trends in incidence/mortality -Generate etiological hypotheses -Prognosis -Source of subjects for studies of etiology and prognosis (Ethical/privacy issues)

Answer 62

Data on discharges from all Canadian hospitals except those in Quebec (Quebec data appended to DAD to create the Hospital Morbidity Database) Data element examples: length of stay, patient demographics, admission/discharge/transfer details, provider information, diagnoses, interventions

Answer 63

An independent non-profit organization that receives funding from the Ontario government Focused on research to inform health care and health services In Ontario Multiple data holdings (health services, demographics, registries, surveys, providers), including several CIHI datasets, with information about Ontario residents

Answer 64

Information collected from a sample of the population, often by self-report (interviews and/or questionnaires); also sometimes includes physical measures General population or special populations Opportunity to study “positive” aspects of health, factors that cannot be directly observed or captured in administrative records Examples: Canadian Community Health Survey: an on-going cross-sectional survey of the Canadian household population -Collects information related to health status, health care utilization and health determinants National Population Health Survey - Similar data to CCHS -Longitudinal -Started in 1994 -Participants contacted every two years -Smaller sample size -Started with 17,000 but many have dropped out -Rare diseases or events difficult to study

Answer 65

-Identify health concerns (Frequency, Outbreaks/clusters, Investigation of associations) -Compare health of different regions -Examine inequalities in health -Prioritize health services & policies -Evaluate health and service policies -Capture balance of length and quality of life

Answer 66

Health behaviors of the individual (inner oval) are influenced by interpersonal, organizational, community, and public policy domains represented by the progressively larger ovals. Many influencers span more than one domain.

Answer 67

specific data (amounts, rates) across people -e.g. smoking rate specific data (amounts, rates) outside a person -e.g. air quality or water quality data about systems and structures -e.g. policies against smoking

Answer 68

Mortality rate: incidence of death in the population Annual mortality rate: number of deaths in one year, divided by “population at risk” (typically mid-year population) May be general (all cause) or cause-specific Reflects incidence and severity of disease When comparing populations with differing age distributions, can report age-specific mortality rates, or age-standardized rates

Answer 69

Incidence measures events: new cases (incident cases) of disease (or death) arising during a defined time Often used in etiological research (since prevalence is complicated by association with both incidence and duration) Two types of incidence -Cumulative incidence or incidence proportion -Incidence rate or incidence density

Answer 70

-Prevalence is not a rate, but a cross-sectional proportion (e.g., cases per thousand people) -Useful for estimating burden of disease, or planning needs for health services (use incidence to study etiology)

Answer 71

Incidence -Factors associated with incidence – e.g., age distribution Duration -Increased survival without cure leads to increased prevalence (e.g., insulin for diabetes, HAART for HIV/AIDS) Both increased case fatality and increased cure lead to decreased prevalence Differential migration of people with or without disease Changes in diagnosis/definition of the disease (apparent prevalence) Changes in reporting or case-finding (apparent prevalence)

Answer 72

An exposure that contributed to the onset of a disease. Without it, the disease would not have occurred.

Answer 73

Quality-Adjusted Life Years: Metric describing quantity and quality of years lived. Potential years of life lost (PYLL): Potential of years lost due to a condition (disease, events). Premature mortality Disability-adjusted life years (DALYs): single measure to quantify the burden of diseases, injuries and risk factors. -The DALY is based on years of life lost from premature death and years of life lived in less than full health. Health Expectancy Metrics: Life Expectancy Disabilty-Free Life Expectancy Healthy Life Expectancy Health Adjusted Life Expectancy

Answer 74

Bias Confounding Chance Statistical significance versus impact/clinical significance

Answer 75

Cumulative evidence: The proportion of individuals who experience an event from the start to the end of a specified time period (probability of experiencing event) -Requires counting events over a specified period of time (influenced by length of time considered) -No units (but time period must be specified) -The denominator must include at-risk persons only Incidence rate: Measures the rate at which people develop a new case of a disease or condition -“person-time at risk” = # people * time spent at risk (allows for different follow-up periods for different people) -Not a probability (takes on any value from 0 to +∞) -Units: time-1 or cases/person-time Can be computed from: -Individual data (knowledge of person-time at risk for each person in study cohort) -Aggregate population data:

Midterm - Pop. Perspectives Flashcards

(99 cards)