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NEW XIA POPLHLTH > Mod4 > Flashcards

Mod4 Flashcards

1
Q

Prior to the GBD project

A

There was a large individual healthcare focus

We only considered mortality data and hospitalization

There was very limited global, regional information on behaviours/exposures that are important risk factors for death/disability

Many countrie’s data on non-fatal disease and injury was incomplete

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2
Q

What are the aims of the GBD project

A

Use a systematic approach to summarise the burden of disease and injury at the population level, using epidemiological principles and evidence, and aid in setting health service and research priorities

Aid in identifying disadvantaged groups and targeting interventions

Develop projection scenarios of mortality and disability

Take into account non-fatal outcomes as well as deaths

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3
Q

What are the 3 groups of diseases in the GBD project

A

1) communicable diseases
2) Non-communicable diseases
3) Injuries

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4
Q

Definition of DALYs

A

disability adjusted life years- this is a summary measure that combines data on premature mortality and non-fatal outcomes to represent a population’s health as a single number

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5
Q

Why do we use DALYs

A

It enables comparisons between outcomes and diseases by giving a common ground
It enables assessment of changes in disease burden over time

It can be used to test interventions

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6
Q

YLD

A

Years of life lived with disability

Number of cases of non fatal outcome

average duration of non fatal outcome until death/recovery

A disability weight

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7
Q

YLL( recheck this definition with teacher slide)

A

Years of life lost due to premature death

Number of deaths from a disease per year

Number of years lost per death relative to the idea age in that population

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8
Q

What are the biggest gains of the DALYs approach

A

Drew attention to the previously hidden burden of mental health problems and injuries as major public health problems

Recognised that NCDs are a major and increasing problems in low /middle income countries

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9
Q

What are the limitations of DALYs apprach

A

Who decides on disability weights-need a fair panel

A global set of disability weights is unreasonable as there is different impact on societal opportunities, and the burden of disease may be different in different countries

Considers only biological disability and not how physical/social environments influence disability expereince

May represent the disabled as a burden

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10
Q

Policy complications from GBD findings

A

eVIDENCE BASED HEALTH POLICY FORMATION REQUIRES REGULAR update of global, regional, national and subnational information

Since the epidemiological transition is underway in developing regions, the focus of policy debate/research must shift to adult health agenda

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11
Q

What is the medical model of disability

A

Defines disabled people by their condition

Regards disability as the individual’s problem

Views the disabled people as dependent

Control resides with professionals

Choices for individuals are limited to options provided by experts

Deficit model

Systematic exclusion

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12
Q

Social model of disability

A

Sees disability as a social issue(policies, practices, attitudes, environment)

Focuses on ridding society of barriers (not curing)

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13
Q

What are the 3 recommendations by the WHO Commision on the social determinants of health

A

Improve daily living conditions
tackle the inequitable distribution of power, money and resources

Measure and understand the problem and assess the impact of action

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14
Q

Epidemiologic transition

A

The characteristic shift in common causes of death/disability from perinatal and communicable to non-communicable diseases

Influenced by the strength of causal association between the risk factor and health condition

Prevalence of risk factor in a population

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15
Q

Risk transition

A

As countries shift from low to high income, risk factor profiles change from communicable to nocommunicable risks,

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16
Q

Double burden of disease

A

Middle income countries are in the middle of the risk transition, so are struggling with both G1 and G2 riks factors and diseases. This places enormous pressure on the health care systems

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17
Q

Industrial epidemic

A

Diseases arising from overconumption of unhealthy commercial products

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18
Q

What is WHO’s MPOWER strategy for tobacco

A

Monitor tobacco use and preventative policies
Protect non smokers from tobacco

Offer help to quit programs
Warn about dangers of tobacco
Enforce bans on tobacco promotion
Raise taxes on tobacco

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19
Q

hOW DOES THE COMMERICAL SECTOR DRIVE ncd inequalities

A 
Marketing unhealthy commodities
Marketing to vulnerable targets
Changing environments
Reinforcing power inequalities
Targeting young children
Higher outlet density in poor areas
Exposure in films

Exploiting behavioural change difficulties

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20
Q

What is the right to health

A

The right to the enjoyment of the highest attainable standard of physical and mental health available in a community

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21
Q

What are the 5 key aspects of the right to health

A

An inclusive right-includes underlying determinants of health
Contains freedoms- from torture, cruel treatment, non consensual medical treatment

Contains entitlements- to equal opportunity, to access, to health information to participation in health decision making

Non discrimination- health services/ goods without discrimination

Services, facilities must be available, accessible, acceptable and of good quality

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22
Q

What are the 3 obligations of the state

A

Respect- the state cannot infringe on/interfere with the right to health

Protect- the state must prevent 3rd parties from interfering with the right to health

Fulfil- the state must proactively adopt active measures to achieve equity

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23
Q

What is meant by discrimination

A

Any distinction/restriction/exclusion made on the basis of various grounds which impairs/nullifies the recognition or exercise of huma rights and fundamental freedoms

i.e, linked to marginalisation of specific groups

Marginalised/discriminated groups bear a disproportionate share of health problems

Impacts many layers of determinants

Root of fundamental structural inequalities
Even unintention, it is still a violation if it impairs the enjoyment of rights

A right to health implementation is under political/legislative judicial action at a national or global level. Right to health framework goes beyond medical, ethical quality issues to focus on accountability

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24
Q

A human rights approach

A

Human rights are interdependent, indivisible and interrelated

A point of leverage to promote action

Internationally agreed upon standards that governments sign up to and are held accounatble for

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25
Q

What are the 3 different determinants of health inequalities of Maori health

A

differential access to health determinants, exposures leading to different disease incidence
Differential access to health care

Differences in quality of care received

26
Q

Disparities minorities feel

A

Minorities feel less listened to,
spend less time with the healthcare provider

less likely to receive adequate explanations
More likely to have unanswered questions

More dissatisfied with health service and system

27
Q

What are some structural issues of inequality

A

Some people find it easier to access services than others. The power, resources and opportunities of NZ are organised by ethnicity and deprivation

28
Q

What are some social issues of health inequalities

A

Social values play a role in equities

There are values, or assumptions widely held in NZ about deservedness of different groups of people

29
Q

What are some trends with Maori

A

Maori have a higher mortality rate for all non-elderly ages

A gap in life expectancies has persisted over decades between Maori and non Maori

Maori are overrepresented in more deprived quintiles deciles

They have lower participation in the health workforce
Worse rates of survival

Less interaction with health services

30
Q

Historical processes that drove Maori inequalities

A

Colonisation
Land seize
Effect of inferior citizenship

31
Q

How did colonisation have an effect on Maori

A

Colonists harboured assumptions
No respect for indigenous people

There are notions of superiority and civilisation

Notions of deserving and undeserving

Many of these beliefs persist today, creating social barriers

32
Q

Maori land

A

confiscation- basis of settler wealth

Maori were land based people, it caused social disruption, poverty, economic depletion, resentment, breakdown of political powers and alliances

Child women ratios fell

33
Q

Effects of inferior citizenship

A

entrenchment of poverty, dependency

Increased barriers to development

acceptance of inequity by the colonists

Resentment and anger among Maori
Social breakdown, crime, high risk behaviors

34
Q

What are some stats about adolescents

A

1 They are one sixth of the world’s population
2) There is a larger cohort of adolescents today than ever before
86% of them live in low income and middle income countries

3)Many adolescent disease and injury burdens are preventable or treatable but are often neglected

35
Q

What is the global trend of DALYs

A

Mental health and substance abuse has been the leading cause of DALYs
some communicable diseases going down, and some non-communicable diseases going up

36
Q

Youth is defined as

A

10 to 24 year olds

37
Q

Trends of deaths for global

A

Injuries are the leading cause of deaths in 2016
Some communicable diseases- diarrhoea and lower respiratory infections going down
HIV going down

38
Q

Where you live matters for youth causes of DALYs

A

high income countries are a lot about mental health+ road injuries

Like in africa, you see a lot of communicable diseases and HIV

asia gives a mixxed picture,
injury typically at the bottom except for africans

though patterns variable

39
Q

Leading global risk factors trends

A

alcohol use always no.1 cause for deaths for 15-19 year olds

Unsafe sex exploded from 11 to 2.
Communicable disease risk factors tend to go down the board but still quite damn high.

40
Q

Youth NZ facts

A

It was a cross-sectional survey that included a random sample of students attending NZ secondary schools

Each student in secondary schools had an equal probability of being invited to complete the survey if they were at school

41
Q

Recruitment error of Youth2000

A

Survey response rate was about 70% so it was reasonably representative of young people in secondary schools in NZ

However, there is recruitment bias as it did not interview people not at school- those who dropped out or have significant disability that cannot complete the survey

These people’s interests are likely to be under-represented

42
Q

Youth 2000

blind and objective measurements

A

It employed M-CASI technology, which hopefully promoted a sense of privacy of information among students

Strengths-
This may more likely cause young people to provide honest answers, hence less measurement bias

Students are more likely to respond and complete the survey because they enjoyed the experience of a novel technology- maybe better response rates

This again may have some errors- We can’t get back to youth whose responses may indicate they are vulnerable or at risk because the survey is anonymous

Students with some disabilities or language difficulties may not complete the survey

43
Q

Measurement bias of youth2000

A

It was anonymous and confidential which would increase the likelihood of honesty

But it was self reported: youth may feel more inclined to provide socially desirable rather than completely honest answers

44
Q

What is the inverse care law

A

The availability of good medical or social care tends to vary inversely with the need for it in the population served

45
Q

Causal relation error

Youth 2000

A

cross sectional studies

bradford hill criterion of temporality unlikely to be fulfilled

46
Q

Resilience

A

refers to the ability to spring back despite adversity

People with various protective or resiliency factors may be less vulnerable to harm despite exposure to risk

The presence of resiliency factors is associated with a reduction in health risk behaviours

47
Q

What the youth 2000 has found about neighborhood caracteristics and wellbeing

A

Family connections
School connections
Community connections all play a role

Family members care, time with family, feel safe, feel part of school, friendships, caring neighbours, workmates, volunteer roles, etc

48
Q

What are the 4 systematic disparities exemplified in Maori health

A

There are systematic disparities in health outcomes, in exposure to the determinants of health
In health system responsiveness and in representation in health workforce

49
Q

What are the determinants of ethnic inequities in health

A

1) Differential access to health determinants or exposures leading to differences in disease incidence
2) Differential access to health care
3) Differences in quality of care received

50
Q

Right to health

Universal declaration of human rights-1948

A

everyone has a right to the standard of living adequate for the health and wellbeing of himself including medical care and…

Didn’t define parameters of right to health but noted they both include and transcend medical care

51
Q

international covenant on economic, social and cultural rights 1966 UN

A

explicity right to health and steps states should take to realise progressively the maximum available resources to the highest attainable standard of health

gives examples of inclusions able to evolve etc and expectation of international co=operation

52
Q

Right to health is not right to be healthy

A

memorise

53
Q

What are some things icesr (international covenant on economic, social and cultural rights) clarifying

A

right to health is not the same as right to be healthy

R2H is related to other health rights and health equity

Itemises some freedoms from and entitlements to

obligations of the state

54
Q

5 basic facts about right to health

A

enshrined in international law

extends beyond health care to pre-conditions

Includes freedoms and entitlements

States oblighed to respect, protect and fulfil
social epidemiology links good health with social justice

55
Q

What does respect mean in r2h

A

no discrimination

56
Q

what does protect mean

A

no interference from 3rd parties

57
Q

what does fulfil mean

A

adopt measures to achieve equity

58
Q

Human rights framework to R2H

A

Health inequities are evidence of laws, policies and practices that distribute resources and opportunities in a discriminatory manner and limit full participation

Health is acknoledged as political and health policy decisions have a legal dimension rather than being purely political discretion

59
Q

Right to health in NZ

The code of health and disability service consumer’s rights

A

Outlines 10 rghts including freedom from discrimination and services of an appropriate standard

Aligns with human rights act

Code in part a response to ethical issues in health services research

60
Q

purpose of NZ Public health and disability act

A

reducing inequalities as one of it’s purposes
No explicit mention of R2H but main purpose a district health base based health system to foster community participation

to acknowledge a treaty of waitangi clause-that no one will have special privileges on basis of race

61
Q

Treaty of Waitangi and right to health

A

affirms indigenous rights as does 1835 declaration of independence
good governance
didn’t sign for a bad deal
Active protection taonga-te reo claim

NEW XIA POPLHLTH (14 decks)

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