Module 2 Flashcards
What are the causes of the causes
What causes the risk factor e.g what causes smoking
Causes of Causes example
Income
Employment
Education
Housing
Autonomy
Social Values
Determinants for populations
similar concepts to individuals but apply to the context in which the pop exists
Upstream Determinants
Shape the downstream determinants, e.g policy.
Downstream determinants
Immediate determinants e.g choices. Near to the change in health status
Upstream interventions
operate at the marco level (distal) such as gov policy and focus on the pop
Downstream Interventions
operate on the micro (proximal level) including disease management
What is the social gradient
Those who are less deprived have fewer disease occurrences. This goes up in a gradual status
What are the levels of the D and W model from in to out
Age sex constitution (non modifiable)
individual lifestyle factors
Social and community networks
Living and working conditions
general socioeconomic, cultural and environmental conditions
Example of Living and working conditions
Education
Housing
Health care services
Employment
Example of induvidual lifestyle factors
The choices an individual makes, shaped by genes and determinants
Habitus
The lifestyle, values, dispositions and expectation of particular social groups ‘learned’ through everyday activities
social norms
The community (L2)
- role of friends and family
- normalised attitudes
- social capital
Social Capital
the value of social networks that facilitates bonds between people of similar groups
The Environment (L3)
- built environment
- ecosystem
- physical environments
- political environment
- cultural environment
The Current Living Standards framework
Individual and collective wellbeing
Our Institutions and Governance - role in health of pop
The Wealth of NZ (4 capitals)
The 4 capitals
Natural
Social
Human
Financial/ Physical
Structure
Social and physical environmental conditions and patterns that influence choices and opportunities available
Agency
The Capacity of an individual to make free choices
What is a key feature of D and W model
- permeability between factors
- each factor influences each other
What is SEP
Socioeconomic Position
- factors that influence a person place in society
- determinants must be objective, meaningful, measurable
Why Measure SEP
used to tell the level of inequality in society or between societies
highlight changes to pop structures
association with health
How to Measure SEP
Education
income
Occupation
Housing
Assets and Wealth
Measures of SEP for pop
Area - school Deciles NZDEP
pop - Income inequality, literacy rates, GDP per capita
SEP on D n W model
L1 - you and choices you make, your oppourunities
L2 - parents education ect (often used in youth health) intergenerational SEP
L3 - NZDEP, IMD, GCH
Inequities
differences in allocation of resources which are unjust, unfair and avoidable,
reducing could be cost-effective
do not reflect health needs
Inequalities
differences between groups e.g social gradient
NZDEP
communication - people with no access to internet at home
income - people 18-64 receiving a means tested benefit
income - people living in an equivilised household with income below an income threshold
employment - 18-64 unemployed
qualifications - people 18-64 without any qualifications
owned home - people not living in own home
support - people under 65 living in single parent family
living space - people living in equivalised household below a bedroom occupancy threshold
living conditions - people living in dwellings that are always damp and or have mould greater than A4
Preston curve
x axis - GDP per capital
y axis - life expectancy
trend - increase in income is increase in life expectancy
levelling off in life expectancy
PROGRESS
P - place of residence
R - Race/ethnicity/language
O - occupation
G - Gender/ Sex
R- religion
E - Education
S - SEP
S - Social Capital
Why reduce inequities
- unfair
- avoidable
- they affect everybody
- reducing could be cost-effective
inequities in health outcomes result from inequities in opportunities
Lorenz Curve
measures income inequities
against a line of absolute equality (45*)
work with Gini coefficinent
Gini Coefficient
A/A+B
0 = equal
1 = very unequal
area between line of equality and line of perfect inequality
implications of income inequities
unequal society
less trust
increased stress
reduced economic productivity
Potential vs Realized access
potential - the number of services present in the population
realised - how people use and access facilities and services
Avaliability
volume and type of services
- do you know where to healthcare
- can you find good healthcare
Acceptability
Psychosocial barriers
- look of doc
- look of other pt at doc
Accommodation
organizational barriers
- GP hours
- how easy to get in touch with GP
- wait times
Affordability
Financial
- direct and indirect costs
Accessibility
Geographic barriers
- travel time
- transport resources
Systemic / Institutional racisms
Lives in policy
What did the Polynesian panthers do
food bank
homework help
tenancy help
protest
newspaper
help in rest homes
Education to liberation
Education leads to better employment and thus better income - break cycle of poverty, help rise up in society
IMD
employment - degree working age people are excluded from employment
income - extent of income deprivation by measuring state funded assistance
crime - crime domain and material victimisations
housing - proportion of people in overcrowded or rented housing
health - high level of ill health or mortality
education - captures youth disengagement, and proportion of working age without a formal qualification
access - cost and inconvenience of travelling to basic services
IMD vs NZDEP
close correlation
Elements of a health enviroment
- clean air and water
- appropriate housing
- access to wholesome food
- safe community spaces
- access to transport
Ecological fallacy
the error that arises when info about groups of people is used to make inferences about individuals
Built environment
all the buildings spaces and products that are created or at least significantly modified by people
Ways to measure built environment
mixed use spaces - increases active transport and physical activity
street connectivity - grid-like pattern
urban sprawl
access to recreation facilities
level of traffic- encourages active transport
socio-economic position
the social and economic factors that influence what positions individuals or groups hold within the structure of a society
measuring SEP for individuals
education, income, occupation, housing, assets and wealth
why measure SEP?
- quantify the level in inequality within or between societies
- highlight changes in pop structure
- understand relationship between health and other social variables
measuring SEP for populations
area measures:
- deprivation
- access
population measures:
- income inequality
- literacy rates
- GDP per capita
levels of dahlgren and whitehead model (inside to outside)
- age, sex, constitutional factors
- individual lifestyle factors
- social and community networks
- living and working conditions
- general socioeconomic, cultural and environmental conditions
how SEP relates to health
education, occupation, income and assets/wealth all interact to affect health outcomes
deprivation
a state of observable and demonstrable disadvantage relative to the local community or wider society or nation to which individual, family or group belongs
preston curve
GDP per capita on X axis, life expectancy on Y axis
commercial determinants of health
the tension between commercial interests and public health objectives and the way this influences patterns of health and disease across populations
constituency building
- promoting or sponsoring efforts beyond their core business
- partnerships with charities or foundations
determinants of ethnic inequities in health: [3]
- differential access to health determinants or exposures leading to differences in disease incidence
- differential access to health care
- differences in quality of care received
land alienation
associated with social disruption of community, breakdown of political power and alliances, economic resource depletion and poverty, resentment by indigenous peoples
ERP
estimate resident population (not broken down into ethnic group)
HSU
health service utilisation and outcomes (objective)
IDI
integrated data infrastructure
IDI benefits
- link data from multiple sources to gain system-wide insights
- view longitudinal, life-course information
- identify risk factors and protective factors
- perform predictive risk modelling
- evaluate effectiveness of particular interventions
- identify characteristics of groups with positive and negative outcomes
- tailor interventions to people based on characteristics they share with groups studied
IDI risks
- follow individuals who are using services
- identify specific individuals who are at risk or would benefit from a specific intervention
- identify specific individuals who are abusing systems and take enforcement action
prioritised output advantages
- ensure that where some need exists to assign people to a single ethnic group, ethnic groups of policy importance or of small size are not swamped by the NZ european ethnic group
- produces data that is easy to work with as each individual appears only once
prioritised output disadvantages
- places people in a specific ethnic group which simplifies yet biases the resulting statistics as it over-represents some groups at the expense of other in ethnic group counts
- is an externally applied single ethnicity which is inconsistent with the concept of self-identification
total response output advantages
- has the potential to represent people who do not identify with any given ethnic group, depending on the level of detal reported
total response output disadvantages
- creates complexities in the distribution of funding based on population numbers or in monitoring changes in the ethnic composition of a population in health
- creates issues in interpretation of data reported by ethnic groupings, where comparisons between groups include overlapping data
numerical ageing
the absolute increase in the population that is elderly (reflects previous demographic patters and improvements in life expectancy)
structural ageing
the increase in the proportion of the population that is elderly (driven by decreases in fertility rates)
natural decline of the population
occurs when there are more deaths than births in a population (combination of absolute and structural ageing, more elderly = more deaths)
absolute decline of the population
occurs when there is insufficient migration to replace the ‘lost’ births and increased deaths
what are SDGs
a global call to action to end poverty, protect the planet and improve the lives and prospects of everyone, everywhere
the 17 SDGs
- no poverty
- zero hunger
- good health and wellbeing
- quality education
- gender equality
- clean water and sanitation
- affordable and clean energy
- decent work and economic growth
- industry, innovation, infrastructure
- reduced inequalities
- sustainable cities and communities
- responsible consumption and production
- climate action
- life below water
- life on land
- peace, justice and strong institudtions
- partnership for the goals
target 3.4 NCDs
by 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being
biosphere level SDGs
- clean water and sanitation
- climate action
- life below water
- life on land
society level SDGs
- no poverty
- sustainable cities
- peace, justice and strong institutions
- affordable and clean energy
- good health and well-being
- quality education
- gender equality
- zero hunger
economy level SDGs
- decent work and economic growth
- industry, innovation and infrastructure
- reduced inequalities
- responsible, consumption and production
natural capital
this refers to all aspects of the natural environment needed to support life and human activity. it includes land, soil, water, plants and animals as well as minerals and energy resources
social capital
this describes the norms and values that underpin society. it includes things like trust, the rule of law, the crown-māori relationship, cultral identity and the connections between people and communities
human capital
encompasses peoples skills, knowledge and physical and mental health.
these are the things which enable people to participate fully in work, study, recreation and in society more broadly
financial/physical capital
this includes things like houses, roads, buildings, hospitals, factories, equipment and vechiles. these are the things which make up the country’s physical and financial assets which have a direct role in supporting incomes and material living conditions
volume
the computing capacity required to store and analyse data
velocity
the speed at which that data are created and analysed
variety
the types of data sources available
veracity
the accuracy and credibility of data
variability
the internal consistency of your data
value
the costs required to undertake big data analysis should pay dividends for your organisation and their patients
visualisation
the use of novel techniques to communicate the patters that would otherwise be lost in massive tables of data
