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Poplhlth111 > Module 2 > Flashcards

Module 2 Flashcards

1
Q

Linds experiment:

A

an early RCT with low participants. sailors given different acidic foods to see if people would recover from scurvy

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2
Q

Why is establishing causal relationships important

A
  • provides support for evidence -based practice
  • epidemiology does not determine the cause of disease in individuals rather populations
  • enables preventative measures to be put in place even if the cause of a disease isn’t fully understood
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3
Q

Bradford Hill Criteria

A

7 criteria to help determine if there is a causal relationship (not a checklist)
- temporality
- strength of association
- reversibility
- biological gradient
- biological plausibility of association
- consistency of association
- specificity of association

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4
Q

temporality - bradford hill

A

did cause come before disease?

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5
Q

Strength of association - bradford hill

A

RR and RD high? absence of biases (selection, confounding, information)

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6
Q

reversibility - Bradford hill criteria

A

does change in exposure change the outcome under controlled circumstances?

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7
Q

Biological gradient - bradford hill

A

does incremental increase of dose response (exposure) result in corresponding increases in outcomes?

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8
Q

biological plausibility - bradford hill

A

does it make sense biologically (ie chemicals in tobacco are carcinogenic)

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9
Q

Consistency of association bradford hill criteria

A

replication of findings. multiple studies with similar results in different environments, times, places, methods

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10
Q

specificity of association

A

a cause leads to a single effect or effect has a single cause

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11
Q

Epidemiological triad:

A

host: persons in P
Environment: physical, social, policy
Agent: biological, chemical, physical, nutritional

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12
Q

Causal pie - whole pie

A

sufficient cause- several components, minimum set of conditions for a disease to occur - without any slice, disease unlikely to occur. not a single factor. a disease can have several pies.

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13
Q

causal pie - component cause

A

a slice of the pie - a factor that contribute sot disease but not sufficient to cause disease on it’s own. includes necessary cause

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14
Q

necessary cause - causal pie

A

a component cause that must be present in the pie for a disease to occur

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15
Q

counterfactual causation

A

cause makes a difference in outcome, includes deterministic and probabilistic

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16
Q

probabilistic causation

A

cause increases the chance that effect will occur. Sufficient raise probability from 0 to 1; necessary raises from 0; each component contributes towards 0 to 1

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17
Q

Deterministic causation

A

whenever A occurs, B occurs

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18
Q

problems with causal pie model

A
  • assumes all causes are deterministic
  • fails to capture dose response as a continuum
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19
Q

Public health framework

A

Phase 1: define the problem
Phase 2: identify risk and protective factors
Phase 3 Develop and test prevention strategies
Phase 4: ensure widespread adoption

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20
Q

Causes of causes for individual:

A

any event, characteristic or definable entity that brings about a change for better or worse in health, like income, debt, employment, education, housing

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21
Q

Causes of the causes for population

A

similar for individuals, but nature and measurement of the determinants are slightly different. Determinants in populations are related to the context that the population exists in

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22
Q

Upstream

A

distal, a macro. government policies and trade agreements, cultural, legal, national. cause the need for proximal
distant in time or place from the change in health status

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23
Q

Downstream

A

proximal, micro. treatment and disease management
near to the change in health status

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24
Q

Levels of the Dahlgren and whitehead model

A
  1. individual: choices, and non-modifiable factors like age, sex, constitutional factors, and
  2. community and living conditions: social and community networks. Family and friends play a significant role in developing normative behaviours - what is normal and acceptable to d and experience. also the conditions you live and work in
  3. environment: general socioeconomic cultural and environmental conditions
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25
Q

habitus

A

lifestyle, values, dispositions, and expectations of particular social groups, learned through everyday activities

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26
Q

Social capital

A

Social capital - the value we place on our networks that facilitate bonds and change. who you know not what you know. the community environment and your role in it (ie volunteerism)

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27
Q

level 3 of dahlgren and whitehead - environment

A
  • Physical: water quality, clean air, living things
  • Built: design of communities, infrastructure
  • Cultural: knowledge, beliefs and values
  • Biological: emerging or re-emerging toxins in population
  • Ecosystem: climate change, biodiversity, ecological footprint
  • Political: policy and approaches to improving pophlth
    Properly Built Castles Benefit Every Peasant
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28
Q

3 High level component of living standards frame work

A
  • Individual and collective wellbeing: resources and life aspects important for individuals, families, communities
  • Institutions and governance: the role of institutions in safeguarding and building wealth and health
  • The wealth of NZ: literal wealth, but also the natural environments, and things not in an accounts
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29
Q

4 capitals

A
  • Natural: environment
  • Social: norms and social values, law and trust, crown-maori relationships
  • Human: skills and knowledge, mental and physical health
  • financial/physical: money, but also infrastructure, housing, etc.
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30
Q

Structure

A

social and physical environment conditions that influence choices and opportunities available - social factors and choices

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31
Q

Agency

A

the capacity of an individual to act independently to make free choices

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32
Q

SEP- socio economic position

A

the social and economic factors that influence what positions individuals or groups hold within a society’s structure.
objective, measurable, meaningful measurements

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33
Q

why measure SEP?

A

Quantify inequality;
highlight changes over time;
understand relationship between health and other variables;
associations between different chances in life

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34
Q

How measure SEP for individuals

A

education (quantity and quality);
income;
occupation;
housing;
assets and wealth

35
Q

How measure sep for populations

A

area:
- deprivation (i.e decile)
- access
populations:
- income inequality
- literacy rates
- GDP per capita

36
Q

SEP individual - dahlgren and whitehead

A

Individual education, occupation, income, decisions these influence your opportunities

37
Q

SEP community and social - dahgren and whitehead

A

PARENTS education, occupation, income. Used to measure SEP in children and adolescents. Your parent’s SEP can be associated with your own. This also applies to your friends

38
Q

SEP Living and working conditions - dahlgren and whitehead

A

measures like
- NZDep (NZ index of deprivation),
- index of multiple deprivation (IMD) which explores the drivers of area deprivation;
- geographic classification for health (GCH), that classifies based on pop size, and drive time to closest major, large, medium, and small urban areas; social fragmentation and accessibility

39
Q

Area deprivation

A

a state of observable and demonstrable disadvantages relative to the local community or the wider community , society, nation to which an individual, group or family belongs

40
Q

SEP general socio-economic, cultural, environment - dahlgren and whitehead

A

Global determinants: income inequality, gdp, literacy rates; free trade agreements
group populations with similar SEP together; cross section or longitudinal analyses; NZ census mortality study

41
Q

preston curve

A

describes relationship between increase in life expectancy according to decreasing deprivation measures

42
Q

NZdep 2018 variables

A
  • communication: no access to home internet
  • income: 16-64 receive benefit
  • income: living in equivalised homes with below threshold income
  • employment: 18-64 unemployed
  • qualifications: 18-24 without qualifications
  • owned home: not living in own home
  • support: <65 living in single parent family
  • living space: equivalised homes below bedroom occupancy threshold
  • living condition: people living in dwellings that are damp or mouldy
43
Q

Equality vs equity

A

equality - everyone gets the same
equity - every gets what they need

44
Q

Inequality

A

measurable differences in health outcomes and experiences according to groups like SEP, area, gender, ethnicity, race, class

45
Q

inequity

A

inequalities that are unfair or stemming from some form of injustice. Differences where the distribution of resources does not reflect health needs - equal and unequal power

46
Q

PROGRESS acronym

A

a framework to describe the factors that can contribute to health inequities:
* Place of residence
* race/ethnicity/culture/language
* occupation
* gender/sex
* Religion
* Education
* Socioeconomic status
* Social capital
Also disability is there

46
Q

MOH inequity definition

A

in aotearoa new zealand, people have differences in health that are not only avoidable but unfair and unjust

47
Q

measures of association for inequity

A

CGO is typically the most advantaged group
* No association: RD-0, RR-1
* Negative association: RD<0, RR-<1
* Positive association: RD->0, RR->1

48
Q

why reduce inequities?

A
  • they are unfair
  • they are avoidable
  • they affect everybody
  • reducing can be cost effective
49
Q

lorenz curve

A
  1. Order pop. from lowest to highest and ask what % of wealth is owned by poorest 10,20,30%,..etc.
  2. Draw 45˚ line of absolute equality
  3. Draw line based on available date = concave
  4. More concave = greater inequality
50
Q

Gini coefficient

A

ratio between the area between perfect equality line and observed lorenze curve to the area between line of perfect equality and line of perfect inequality. = a/a+b. 0 = every equal, 1 = very unequa

51
Q

implications of inequality

A

less social cohesion;
less trust;
increased stress;
reduced economic productivity;
poorer health outcomes

52
Q

commercial determinants of health

A

the Structures rules, norms, and practices that business activities designed to generate wealth and profits influence population health - the inherent tension between commercial and public health objectives around consumption, accessibility , and affordability
- outer layer of dahlgren and whitehead

53
Q

Strategies used by commercial industry to impact health

A
  • Shape evidence
  • employing narratives and framing techniques
  • constituency building
  • policy substitution
54
Q

commercial industry shaping evidence

A
  • lobbying
  • shaping research and funding priorities
  • financing university programmes, researcha nd chairs
55
Q

Employing narratives and framing techniques (commercial strats)

A
  • focus on youth (schools)
  • focus on individual behaviours
  • frame themselves as ‘being part of the solution’
  • focus on corporate social responsibility
56
Q

constituency building (commercial strats)

A

promoting or sponsoring efforts like charities or health/education related orgs./foundations beyond their core business

57
Q

policy substitution, development, implementation (commercial strats)

A

partnerships/voluntary agreements with governments or contributing to health policy consultations

58
Q

Access definition

A

the end result of a process flowing from predisposing characteristics and enabling resources (potential access) through need (perceived and evaluated) to ultimate health outcomes (health status and satisfaction)

59
Q

5 As

A

dimensions of access - a set of specific areas of fit between patient and healthcare system
availability
accessibility
accommodation
affordability
acceptability

60
Q

Availability

A

relationship between volume and type of existing services to the clients volume and type of needs
- ability to get care when need it or in emergency
- one good doctor to treat family
- knowledge of where to get care
- existence of services barriers

61
Q

accessibility

A

the relationship betweent he lcoation of supply and the location of clients (considering client transportaion - resources/services, time, distance, cost)
- geographic barriers
- how difficult to get to physicians offices

62
Q

accommodation

A

relationship between manner supply resources are organised and expectation of clients (organisation vs expectation)
- wait times
- office hours
- ability to get in touch
- organisational barriers

63
Q

acceptibility

A

relationship between clients’ and providers’ attitudes to what constitutes appropriate care
- office appeaance
- office neighbourhood
- other patients
- psychosocial barriers

64
Q

affordability

A

cost of provider services in relation to client’s ability and willingness to pay for these services
- satisfied with health insurence
- satisfied with doctors’ prices
- satisfied with when to pay bill
- financial barriers

65
Q

potential access

A

what services are available

66
Q

realised access

A

what services are actually used and why only those and not others?

67
Q

Key indicators of maori health status

A
  • life expectancy: gap between maori and non-maori that has not drastically changed since 1951
  • deprivation: maori under represented in least deprived and over represented in most deprived deciles
  • major causes of death: diabetes, cardiovascular disease higher in maori
  • general patterns of mortality and morbidity
68
Q

historical process that has influenced maori and wellbeing

A
  • colonisation (different values and assumptions colonists; only european view early on)
  • tiriti implications (who gets to vote, justice system, land confiscation, colonial values implanted, land ownership)
  • land alienation (social disruption, breakdown of political power, lace of capital, led to lower numbers of child survival)
  • policy alienation
  • unfair citizenship (poverty, dependency, barriers, victim blaming, resentment, social breakdown then high risk behaviour)
69
Q

how social and economic inequalities between maori and non-maori have arisen

A
  1. differential access to health determinants or exposures leading to differences in disease incidence
  2. differential access to care (access to vaccines)
  3. differences in quality care (maori not getting preventative inhalers as well as relievers)
70
Q

interventions

A

structural - (more life boats, no barriers)
social - (rights based approach - commitment review and level playing field
these aren’t aimed at individual behaviour (e.g swimming lessons)

71
Q

key sources of data for epidemiology

A

Census
ERP
Vital events - births, deaths marriages
Health service utilisation
Integrated data infrastructure
nationally represented surveys
ad hoc surveys

72
Q

estimated resident populations (ERP)

A

estimate of all people who usually live in NZ at a given date

73
Q

dependency rations

A

Dependency is those who are dependent on the working age population
Child = 0-14 years / working age x 100
Elderly = ≥65/working age x 100
Total = (youth+elderly)/working age x 100
Change in dependency ratio will need to be reflected in health system (more elderly = more deaths

74
Q

natural decline of pop.

A

occurs when more deaths than births in pop. (more elderly, more deaths)

75
Q

absolute decline of pop.

A

occurs when there is insufficient migration to replace lost births and increased deaths

76
Q

stages of demographic transition

A
  1. pre-transition/ industrial - low tot. Pop., vari. Dth rate. High bth rate
  2. Declining mortality and high bth rate
  3. Fertility rates decline as pop increase
  4. High tot. Pop., low fertility, low death rate
77
Q

ecological fallacy

A

The error that arises when information about groups of people is used to make inferences about individuals (we use individual data, but measure averages and make conclusion fro that, not the individual because we cannot make conclusions of the individual based on the group and the other way around

78
Q

Healthy environment

A

physical social or political setting(s) tat prevent disease wile enhancing human health and wellbeing
- Clean air and water
- Appropriate housing
- Access to wholesome food
- Safe community spaces
- Transport and opportunities to exercises

79
Q

Built environment

A

all the buildings, spaces and products that are created,
or at least significantly modified by people

80
Q

built environment measurements

A

must be context specific
1. urban density - population or employment
2. land use mix - increases opportunities for active transport
3. street connectivity - encourages active transport
4. community resources, spaces - healthier foods, more opportunities for physical activity

81
Q

Sustainable development goals

A

Layer 1 - environment
layer 2 - society
layer 3 - economy
topped by partnerships for the goals

82
Q

4 V’s of big data

A

volume - computing capacity for storage and analysis
velocity - data creation and analysis speed
variety - type of data sources available
veracity - accuracy and credibility
also:
variability - consistency, reproducibility
value - cost and value put in
visualisation - use of novel techniques in communication

Poplhlth111 (3 decks)

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