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POPLHLTH 111 > Module 2 > Flashcards

Module 2 Flashcards

1
Q

Epidemiology

A

Study of distribution and determinants of health-related states or events in specified populations and application of this study to control of health problems

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2
Q

Importance of pop. Health

A

Lifestyle, environment and public health improvements play significant roles in health + mortality

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3
Q

Aim of public/population health framework

A

Provide max. Benefit for largest no. People at same time reducing inequities in distribution of health and wellbeing

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4
Q

“Define problem” study

A

Cross-sectional

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5
Q

“Identify risk and protective factors” study

A

Cohort and case-control

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6
Q

“Develop and test prevention strategies” study

A

RCT and diagnostic test accuracy

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7
Q

“Assure widespread adoption” study

A

Evaluative studies

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8
Q

Preventative action can be

A

Put in place before identifying causative factor

  • knowledge of complete pathway is not a pre-requisite for introducing preventative measures”
  • can help reduce disease occurrence in pop.
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9
Q

James Lind’s experiment

A

One of earliest controlled trial although patient no. Were very low
- example of prevention before identifying cause (vitamin C deficiency)

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10
Q

Causal relationships

A

Epidemiology examines relationships/association between exposures and outcomes for this purpose but remember correlation/association doesn’t always = causation

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11
Q

Determining causality

A
  • can NOT be proven in human studies (practical and ethical reasons)
  • most non-experimental in ‘noisy’ environments thus must beware of errors
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12
Q

Bradford Hill framework - aid to thought

A

1) temporality
2) strength of association
3) consistency of association
4) biological gradient/dose-response
5) biological plausibility of association
6) specificity of association
7) reversibility

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13
Q

Temporality

A

Cause THEN outcome

- easier in cohort than cross-sectional/case-control studies

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14
Q

Strength of association

A

Measured by size of relative risk

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15
Q

Dose-response

A

Incremental change in exposure = change in disease rates

- linear dose-response relationship

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16
Q

Specificity

A

Cause = single effect or single cause = effect

- weakest feature as health issues have multiple interacting causes and many outcomes share causes

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17
Q

Reversibility

A

Under controlled conditions (RCT), exposure change = outcome change
(Cause deleted = outcome deleted)
- strongest evidence but not always possible

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18
Q

Rothman’s causal pie components

A

Recognises multicausality

  • sufficient cause
  • component cause
  • necessary cause
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19
Q

Sufficient cause (causal mechanism)

A

Whole pie

  • min. Set of conditions
  • often several factors
  • 1 disease may have several sufficient causes
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20
Q

Component cause

A

Slice

  • contributes towards disease causation
  • insufficient alone
  • interact to produce disease
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21
Q

Necessary cause

A

A component cause that MUST be present for specific disease to occur
- some diseases may not have one so a component cause will be a necessary cause

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22
Q

Prevention using causal pie

A

Blocking/removing any component cause = prevention of some cases of disease
(No need to identify every component cause)
- can intervene at any number of points in pie

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23
Q

Causal pie limitations

A
  • fails to capture dose-response relations as a continuum (just series of discrete sufficient causes)
  • assumes all causes are deterministic (occurrence completely determined by combo of causes without randomness)
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24
Q

Probabilistic concept of causation

A
  • cause increases probability/chance that its effects will occur
  • sufficient cause raises prob to 1
  • necessary cause raises prob from 0
  • each component cause contributes towards prob from 0 to 1
  • considers environmental factors, group level effects
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25
Q

Counterfactual definition of causation

A
  • presence/absence of cause ‘makes a difference’ in outcome or prob of outcome (doesn’t clarify what kind of difference like probabilistic)
  • consistent with both deterministic and probabilistic phenomena
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26
Q

State of Māori health

A

1) systematic inequalities
- health outcomes
- exposure to determinants
- health system responsiveness
- representation in health workforce
2) ethnic inequalities
- can be reduced, eliminated, prevented

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27
Q

Causes of health inequalities

A

Ethnic inequalities in health fundamentally driven by unequal distribution of health risks and opportunities (social determinants)

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28
Q

Conventional health promotion

A
  • based on western models
  • universal formula
  • simply adapted for Māori
  • not grounded in Māori values and realities (land, access to traditional Kai, te reo)
  • superficial vs. structural approach
  • tended to benefit non-Māori to greater extent than maori
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29
Q

Te pae mahutonga

A

Fundamental components of health promotion from a Māori world view

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30
Q

Te pae mahutonga components

A 
4 central stars
- mauriora
- Waiora
- toiora
- te oranga
2 pointers
- nga manukura
- te mana whakahaere
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31
Q

Mauriora

A

Access to te ao maori (maori world - cultural resources - indigenous dimension)
- working with communities to incorporate/revitalise traditional practices

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32
Q

Waiora

A

Environmental protection; native and social environ.

- innovative group/community programs aligning with cultural values

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33
Q

Whanaungatanga

A

Close connection between people

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34
Q

Toiora

A

Healthy lifestyle

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35
Q

Te oranga

A

Participation in society; social determinants of health

  • addressing underlying issues
  • not just in communities but action at political level
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36
Q

Nga manukura

A

Health professional and community leadership
- fostering, supporting, collaborating with existing leadership/knowledge in communities rather than telling people what they should do

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37
Q

Te mana whakahaere

A
  • capacity for self governance (self-determination, identifying own priorities/needs, solution, sharing, putting in practice, breaking barriers)
  • community control and enabling political environ.
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38
Q

Principles of maori health promotion

A
  • by Māori for Māori (for everyone - not excluding)
  • self determination and control
  • valid models, framework, concepts - not just translated from western context but coming from Māori world view
  • Māori people, values, collectives
  • contemporary tools and methods
  • allows for diverse realities
  • focus on determinant of health - not just surface level
  • evidence-based
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39
Q

Importance of preventing disease

A

Need for prevention growing as the limitations in curing disease become apparent and as the costs of medical care escalate

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40
Q

How epidemiology prevents disease

A
  • unravelling causal pathway
  • directing preventative action
  • evaluation of effectiveness
41
Q

Population based (mass) strategy

A
  • focuses on WHOLE POP.
  • control determinants of incidence in pop. As a whole
  • useful for common disease or widespread cause
  • characteristics of pop.
  • shifts whole risk distribution
42
Q

Population based (mass) strategy advantages

A
  • radical: addresses underlying causes
  • large potential benefit for whole pop.
  • behaviourally appropriate
43
Q

Population based (mass) strategy disadvantages

A
  • small benefit to indiv.
  • poor motivation of indiv.
  • whole pop. Exposed to downside of strategy
44
Q

High risk (individual) strategy

A
  • focuses on individuals perceived to be at high risk
  • indiv. Protection
  • intervention well matched to indiv. And concerns
  • shift distribution of high risk to more favourable direction (truncation of risk distribution)
45
Q

High risk (individual) strategy advantages

A
  • appropriate to indiv.
  • indiv. Motivation
  • cost effective use of resource: concentrate limited medical services and resources where needed most
46
Q

High risk (individual) strategy disadvantages

A
  • cost of screening: need to identify individuals, may be unable to identify borderlines
  • palliative and temporary effect - not radical: not seek to alter underlying causes
  • limited potential: weak power to predict future disease
  • behaviourally inappropriate: constrained by social norms
47
Q

Need for population based AND high risk strategies

A
  • many diseases need both approaches
  • competition usually unnecessary
    Priority of concern should always be the discover and control of causes of incidence though
48
Q

Health promotion

A
  • address risk factors and determinants of well-being
  • cover wide range of social and environmental interventions designed to benefit/protect indiv’s health and QOL
  • health/wellbeing focus
  • enables/empowers people to increase control over and improve health
  • involves whole pop. In every day context
49
Q

Alma ata 1978

A

Declaration for primary health care

  • protect and promote health of all
  • advocated health promotion approach to primary care
50
Q

Prerequisites for health

A

Peace and safety from violence, shelter, education, food, income and economic support, stable ecosystem and sustainable resources, social justice and equity
- all don’t have to be met before health promotion program but success depends on fulfilment

51
Q

Ottawa charter for health promotion

A

‘Mobilise action for community development’
Acknowledges health is
- fundamental right for everybody
- requires both individual and collective responsibility
- opportunity to have good health should be equally available
- good health is an essential element of social and economic development

52
Q

Building healthy public policy

A
  • Protect health, individuals, communities to enable them to make easier choices regarding health
  • Giving opportunity to make easier healthy choices
  • Often done through regulations and legislations
  • Making health as an important aspect of all policies (not limited to health sector/health laws)
53
Q

Reorient health services

A
  • Focussed more on support on need of people for healthy life
  • Strengthening protective factors and reducing other risk factors
  • Diversify
54
Q

Creating supportive environ.

A

Natural, physical, social setting - WHERE you are, live, work etc.

55
Q

Develop personal skills

A
  • individual empowerment

- training

56
Q

Strengthen community action

A

Community empowerment

57
Q

Ottawa charter 3 basic strategies

A

Enable, advocate, mediate

58
Q

Enable

A
  • To provide equal opportunities/resources for all individuals to make healthy choices through access to information, life skills and supportive environments
  • individual level strategy
  • Cannot achieve fullest health potential unless able to take control of things that determine health
59
Q

Advocate

A
  • To create favourable political, economic, social, cultural and physical environments by promoting/ advocating for health and focusing on achieving equity in health
  • system level strategy
60
Q

Mediate

A
  • To facilitate/bring together individuals, groups and parties (governments, health and other social/economic sectors, nongovernmental and voluntary organisations, local authorities, industries, media) with opposing interests to work together/ come to a compromise for the promotion of health
  • strategy that joins individuals, groups and systems
61
Q

Disease prevention

A
  • disease focus

- looks at particular disease/injuries + ways of preventing them

62
Q

Natural history of disease and prevention strategies

A

Primary: between exposure and biological onset
- control specific causes and risk factors
- vacc
Secondary: between biological onset and clinical diagnosis
- reduce more serious consequences
- screening
Tertiary: between clinical diagnosis and outcome
- reduce progress of complications
- rehab

63
Q

Health protection

A
  • Predominantly environmental hazard focused
  • Risk/Hazard assessment
  • Occupational health & Monitoring
  • Risk communication
64
Q

Screening

A

Involves identifying risk factors for disease, unrecognised disease or complication of disease by applying tests in a large scale to a pop.
- can be prim. Sec. Tert. As prevention strategy depending on what is screened for

65
Q

Objective screening initiative

A

Improve health outcome (morbidity, mortality and/or disability)

66
Q

Screening criteria

A

Suitable disease, test, treatment, screening programme

67
Q

Suitable disease

A

A. Important public health problem
- relatively common
- relatively uncommon esp. if known that early detection/intervention = better outcome
B. Knowledge of natural history of disease/relationship between risk factors and condition
- detectable early
- increase duration of pre-clinical phase

68
Q

Suitable test

A

Reliable, safe, simple, affordable, acceptable, accurate

69
Q

Test accuracy measured through

A

Diagnostic test accuracy studies - tests screening against gold standard

70
Q

Sensitivity

A
  • Likelihood of +ve test in those with disease
  • Test’s ability to correctly identify disease from all with disease
    = true positives/all with disease = a/(a+c)
71
Q

Specificity

A
  • likelihood of -ve test in those without disease
  • test’s ability to correctly identify no disease from all free from disease
    = true negatives/all without disease = d/b+d
72
Q

Sensitivity and specificity are

A

Fixed characteristics of test

73
Q

Positive predictive value (PPV)

A

Probability of disease if positive test

= true positives/all who test positive = a/a+b

74
Q

Negative predictive value (NPV)

A

Probability of no disease if negative test

= true negatives/all who test negative = d/c+d

75
Q

PPV and NPV are

A

Not fixed characteristics of test

- reflects both accuracy AND disease prevalence

76
Q

Prevalence and false values

A
  • high prevalence = higher false negative

- low prevalence = higher false positive

77
Q

Suitable treatment

A
  • Evidence of early treatment = better outcomes
  • Effective, acceptable and accessible treatment
  • Evidence-based policies covering who should be offered treatment and what appropriate treatment to be offered
78
Q

Suitable screening programme

A
  • Benefits must outweigh harm
  • RCT evidence that screening programme will result in:
    reduced mortality
    increased survival time
  • Adequate resourcing and agreed policy for testing, diagnosis, treatment and programme management
  • Cost effective
  • Health care system must be able to support all elements of the screening pathway
  • Needs to reach all those who are likely to benefit from it (might require specific initiatives for particular population groups)
79
Q

Biases when using increased survival time as measure of success of screening programmes

A

Lead time bias: early detection by screening may give false impression of increased life expectancy

Length time bias: calculating mean survival from screened patients (more likely to identify slow progressing diseases) gives impression of longer average survival

80
Q

Requirement for prioritisation

A

Limited resources/funds so must distribute/spend wisely

- is distribution such that all groups have equal opportunity in achieving best health outcomes?

81
Q

Distribution of healthcare funds in NZ

A

1) Services of curative and rehabilitative care
2) Services of long-term nursing care
3) Medical goods dispensed to outpatients
4) Prevention and public health services
5) Ancillary services to health care
6) Health administration and health insurance

82
Q

Info used to establish PopHlth priorities

A

1) evidence-based measures
2) community expectations
3) public attitudes
4) human rights and social justice

83
Q

Types of evidence-based measures

A
  • descriptive evidence
  • explanatory evidence
  • evaluative evidence
84
Q

descriptive evidence

A 
Define problem
- who is most/least affected?
- where are we now?
- where have we come from?
- where are we going?
Death rates/trends used
85
Q

Explanatory evidence

A
  • What are the determinants? Risks?
  • Why are we getting worse/better?
  • Why are pop.s different?
    Equity
  • Does the problem/risk factor disproportionately affect pop sub groups? Why?
  • Treaty of waitangi - maori
86
Q

Epidemiological measures used in prioritisation

A
  • age at death/premature mortality
  • time lived with disability
  • population attributable risk (PAR)
87
Q

Age at death

A

Years of potential life lost to death (YLL)

88
Q

Time lived with disability

A

Years lived with a disability (YLD)

89
Q

Attributable risk (AR)

A

Risk difference

  • Amount of “extra” disease attributable to a particular risk factor in the exposed group
  • Used if wanting to prioritise interventions to those who are exposed to risk factor (high risk group)
90
Q

Population attributable risk (PAR)

A
  • Amount of “extra” disease attributable to a particular risk factor in a particular population
  • if association causal: Amount of disease (theoretically) we could prevent if we removed the particular risk factor from the pop
  • Used if wanting to prioritise intervention to whole pop
91
Q

PAR equation

A

PAR = PGO - CGO

= a+b/P - b/CG

92
Q

PAR and prevalence

A

Directly related

- increasing prevalence = increasing PAR

93
Q

Evaluative evidence

A
  • What can improve health outcomes and in whom?
  • Is the intervention improving health outcomes?
  • how well can problem be solved?
    (target population, expected number in population who will be reached, evidence of effectiveness (based on known success rates), cost)
94
Q

Evaluative evidence: economic feasibility

A
  • make economic sense to address problem?

- economic consequences if not carried out?

95
Q

Community expectations and values

A

What do communities want?

  • Confidence in health system
  • Access to necessary care
  • Fair treatment
  • Culturally appropriate
  • Good info about options
    • people able to make their own choices
96
Q

Public attitudes

A

Acceptability

  • Will the community and/or target pop accept the problem being addressed?
  • Competing interests
    • do the people have other more important matters
97
Q

Human rights and social justice

A

Treaty of Waitangi

98
Q

Caution with evidence-based considerations

A

Often too focussed

- while valuable, need to be mindful of communities to achieve desired outcomes despite best evidence

POPLHLTH 111 (5 decks)

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