Midterm - Pop. Perspectives Flashcards
What is the Lalonde Framework/Report?
- Was presented at Pan American Health Organization (PAHO) meeting - 1974
- Tool to describe the“health field”
- Challenged biomedical dominance
- Human biology, the environment and lifestyle were considered at least as significant to health as the health care system.
- A founding document of health promotion field
- Lalonde framework broadened things – bringing in the social and environment considerations
- Sound in theory, flawed in practice - Not linked to action
- didn’t have a large impact in Canada but did in other countries – they looked at their health systems with this framework
What is the Ottawa Charter for Health Promotion (1986)?
- First International Conference on Health Promotion organized by the WHO
- Broadened definition of health
- To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.
Beginning of the social determinants of health
Prerequisites for Health
The fundamental conditions and resources for health are:
peace
shelter
education
food
income
a stable eco-system
sustainable resources
social justice, and equity.
In the Ottawa Charter for Health Promotion what were the 5 key strategies?
Role of health promotion: to enable, mediate and advocate.
- Strengthening community action
- Developing personal skills
- Creating supportive environments
- Re-orienting health care services toward prevention of illness and promotion of health
- Building healthy public policy
What is the Population Health Promotion model?
- Work of Hamilton and Bhatti, 1996.
- Standard population health framework
- One PHAC uses
- Shows who are we trying to target when making public health approach (can target family, community, sector, etc)
- What are we targeting (all the social determinants of health)
- How are we targeting it – 5 different ways to target the social determinants (from the Ottawa Charter of Health Promotion)
What is Population Health?
1989: The Canadian Institute for Advanced Research launched the concept of population health
1999: Endorsed by F/P/T governments
Term increasingly used by academics, practitioners, policymakers, funders, professional organizations
DETERMINANTS OF HEALTH FOCUS: Broad definition of health focuses on determinants outside the health care system
explicitly acknowledged trade-offs between investing in health care and investing in other social goods
EQUITY FOCUS: Focus on health outcomes of a group of individuals, including the distribution of such outcomes within the group
UPSTREAM FOCUS: what can be done, should be done before illness prevention and treatment are necessary
What is Public Health?
PHAC: Public health is defined as the organized efforts of society to keep people healthy and prevent injury, illness and premature death. It is a combination of programs, services and policies that protect and promote the health of all Canadians.
What is a model of Indigenous conceptions of health: An example from BC?
- fluid concept of wellness: it can be adapted and customized freely and is not confined to remain the same.
Centre circle: individual
Second circle: facets of healthy life
Third circle: overarching values
Fourth circle: people around us and places we come from
Fifth circle: determinants
What is Public Health purpose and aims?
Purpose: to achieve optimal well-being and health for all people living in Canada
Aims: what is the public health system trying to achieve
- enhance the health status of populations
- protect against health emergencies and mitigate the impacts
- achieve equitable health outcomes
What are the functions of public health?
- health promotion
- health surveillance
- health protection
- population health assessment
- disease and injury prevention
- emergency preparedness and response
What is health promotion?
Working collaboratively with communities and other sectors to understand and improve health; this is done through healthy public policies, community-based interventions, public participation and advocacy or action on the underlying circumstances that shape health (e.g. determinants of health such as housing, income, systemic racism)
What is health surveillance?
Collecting health data to track diseases, the health status of populations, the determinants of health and differences among populations.
What is health protection?
Protecting populations from infectious disease, environmental threats and unsafe water, air and food.
What is population health assessment?
Assessing the changing strengths, vulnerabilities and needs of communities.
What is disease prevention?
Supporting safe and healthy lifestyles to prevent illness and injury, and reducing risk of infectious disease outbreaks through investigation and preventive measures.
What is emergency preparedness and response?
Planning for, and taking action on, natural or human-made disaster to minimize serious illness, injury or death.
What are the building blocks for public health? How the public health system carries out the functions?
- Policy and program interventions
- Evidence, knowledge and information
- Medical and digital health technology
- Workforce expertise and human resource capacity
- Financing
- Governance, leadership and engagement
What is the CPHA Public Health - Conceptual Framework?
Hazard identification: What health problems are caused by exposure to X?
Hazard characterization: What is the relationship between level of exposure (pathogen) and probability of developing an adverse effect or disease?
- Under what circumstances does adverse event occur?
Exposure Assessment: what is known about the frequency, timing, and level of contact with exposure?
-types of populations exposed?
- estimating future exposures?
Risk characterization- stage when hazard characterization and exposure assessment come together
- To assess how well the data support conclusions about the nature and extent of the risk from exposure
What is the precautionary principle?
- when an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically.
(1) taking preventive action in the face of uncertainty;
(2) shifting the burden of proof to the proponents of an activity;
(3) exploring a wide range of alternatives to possibly harmful actions; and
(4) increasing public participation in decision-making
What is social justice?
- Social justice is the view that everyone deserves equal rights and opportunities — this includes the right to good health
-To advance human well-being by improving health and to do so by focusing on the needs of the most disadvantaged
-Some groups in face systematic disadvantage
-Core value of public health
What are output measure and outcome measure?
Output measure – the product of the program (number of something) (have control)
Outcome measure – the impact of the program (don’t have control)
What the economic benefit of public health interventions?
- In Canada, we spend about 6% of total health expenditures on public health
-Public health interventions are highly cost-effective
-Meta-analysis examining industrialized countries with universal health care
-For every $1 invested in public health interventions = median return of over $14 saved in costs to health/economy
What are upstream, midstream and downstream appraoches?
Upstream – community impact
-trying to improve community conditions
- i.e. laws, policies and regulations that create community conditions supporting health for all people
Midstream – have more of an individual impact
– addressing individuals social needs
- include patient screening questions about social factors like housing and food access (use data to inform care and provide referrals)
- i.e. social workers, community health workers and/or community-based organizations providing direct support/assistance to meet patients social needs
Downstream - individual impact
- providing clinical care
- i.e. medical interventions
What are the types of prevention in public health?
Primordial prevention: Policies and laws that protect populations.
- targeting social and economic policies effecting health
- E.g. tobacco free policies in public buildings, safe drinking water, seatbelts., increase minimum wage
Primary prevention: Interventions that prevent disease from occurring.
- targets risk factors leading to injury/disease
- E.g. bike helmets, handwashing, vaccinations.
Secondary prevention: Interventions that involve screening and detection of asymptomatic disease to improve outcomes.
- prevents injury/disease once exposure to risk factors occurs but still in early, “preclinical” stage
- E.g. mammograms and HIV tests.
Tertiary prevention: Treatment or therapy that involves an intervention to reduce complications of established disease.
- rehabilitating persons with injury/disease to reduce complications
-E.g. cardiac rehabilitation following a heart attack
What is the Framework for public health action?
base: socioeconomic factors
2nd: changing the context to make individuals’ default decisions healthy
3rd: long-lasting protective interventions
4th: clinical interventions
5th: counseling and education
- model emphasizes the level of population impact that can be achieved, and the level of individual effort needed for a given type of intervention
What is global health?
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.
What are health inequalities?
Differences in the health status of individuals and groups
E.g. Sickle cell anemia more common in those from African and Middle Eastern descent
What is health inequity?
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
Why is health inequity important?
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
What is the goal of the population health approach?
- 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.
What is equality vs equity?
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”
What is intersectionality?
_ 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
What is the Dahlgreen & Whitehead (1991) wider determinants of health model?
- 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
What are the determinants of health (Canadian government definition)?
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
What are the social determinants of health?
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
What determines health outcomes?
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
What is the most impactful determinant of health?
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
What is the Gini Coefficient?
How income is distributed in a country
0= perfect equality
1= perfect inequality
What is gender and health?
- 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)
How can you identify the root causes of a problem?
“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.
