Module 2 Flashcards
Lecture 12
Can you take preventative action before the cause is identified?
yes
List the stages of the public health framework & each stage’s study type
Defining the problem-cross sectional
Identifying risk and protective factors- cohort / case control studies
Develop/ test prevention strategies - RCT/ diagnostic accuracy test
Assure widespread adoption - cross sectional
–> Monitor and evaluate
What is the goal of population health
give the maximum benefit to the most people while reducing inequities in the distribution of health and well being
Instead of seeking the cause of the disease in the individual, epidemiology seeks
the relationship between the exposure and the disease in populations (outcome)
What is the Bradford Hill criteria
An ‘aid to thought’ used to confirm that an exposure is the cause of a disease.
Do all the BHcriteria have to be met?
no
What is Temporality?
The exposure must precede the disease
Which criteria is a requirement
temporality
What is strength of association
If associations are stronger due to a larger RR or RD, this can infer a casual relationship –> however, small RR / RD shouldn’t be dismissed
What is consistency of Association
The association is found in similar studies done by different investigators at different times using different samples
What is the thing to watch out for in Consistency of Association
lack of consistency may be caused by poor study design so causal effect may still be there
What is Dose Response
Dose response is when you observe that increasing the level of exposure produces a proportional effect in the risk of disease
What is the thing to watch out for in Dose response
Some relationships although causal don’t have a proportional relationship but rather have max effect if it reaches a threshold.
What is Biological plausibility
If there can be a biological explanation linking the exposure to the disease then it could support it being causal
What is Specificity
The idea that one cause has lead to one effect- however this isn’t so necessary because it is common to have multiple exposures cause a disease or multiple diseases being caused by an exposure
What is reversibility
The principal that if the exposure is indeed causing the disease, then changing the exposure will change the outcome
List all the headings of the BH criteria
Temporality, Strength of Association, Consistency of Association, Dose response, Biological plausibility, Specificity and Reversibility.
Define Cause
An event, condition, characteristic or COMBINATION of these factors that play an essential role in producing the disease
What is a ‘necessary cause’
individual factor that must be present in the causal pie for the disease to be present
What is a ‘sufficient cause’
a causal pie made of component causes and these are all factors that will all contribute to the inevitable production of the disease.
What is a ‘ component cause’
this is a cause that contributes towards the disease causation but is not sufficient to cause the disease by itself
Where can intervention take place
at any of the points of the causal pie.
Do you need to know the whole disease pathway to intervene ?
no
How are the determinants of social health found
First they look at the whole population to see who is at risk, then they use the Dahlgren and Whitehead model to identify the effects of different determinants on different populations health, then finding the inequities and inequalities and how/why to reduce them.
Finding the ‘causes of the causes’ fits under what part of the Public health framework?
Risk factors and protective factors (2nd step), although sometimes risk factors are itself a new problem
Determinants are like drivers that
lead people to take unhealthy behaviours/ exposure themselves to risk factors that lead to disease
define Determinants (for individuals)
any event, characteristic or other definable entity that brings about a change for worse or better in health
At different life stages, determinants can
change
define Determinants (for population)
These are the same factors that can determine health for individuals but it refers strongly to the context of the population itself and its own characteristics- addressing them directly.
At what level do the Upstream determinants operate
This happens at the distal level
At what level do the Downstream determinants operate
This happens at the proximal level
What are characteristics of the downstream determinants
This is on an individual (micro) scale, that are easily changed in a short amount of time. These include treatment systems and disease management
What are the characteristics of upstream determinants
This is on a societal (macro) scale that are not easily changed in a short amount of time. These include government policy, trade agreements
Define proximal determinants and give an example
These are determinants that are readily and directly associated with a change in health status. Eg lifestyle behaviours
Define distal determinants and give an example
These are distant determinants that indirectly influence changes in health by their effect on proximal factors. Eg. Cultural factors,
What are the 5 headings of the Dahlgren Whitehead model
Age, sex and constitutional factors, Individual lifestyle factors, Social and community networks, Living and Working conditions, General social economic, cultural and environmental conditions.
What is the social gradient
the trends of health as you go across different socioeconomic groups
What three groups is the D&W model split into
The person , community (in the home, workplace and the neighbourhood) and environment (refers to cultural, how politics drives the social, the built environments)
What are Age sex and constitutional factors?
Non modifiable traits- hereditary factors. these are genes that affect populations more so than rare individuals. Genes + environment = phenotype
What are lifestyle factors
Choices made by the individual including behavioural risk factors. These may be part of ‘habitus’
define habitus
The values, behaviours and expectations learned through everday activities being part of a social group which can influence your lifestyle factors.
The person level of the D& W model includes
age,sex, biology factors, lifestyle and behaviour risk
factors
The community level of the D& W model includes
local influences such as home, workplace, neighbourhood, Social capital and the wider societal levels such as education and health care system
The environment level of the D& W model includes
cultural (beliefs), political (approaches to healthcare), ecosystem (climate change), biological (toxins), physical (water quality), built environments (rail system)
The ability to change behaviours from habitus depends on
the social group
What is social and community networks
The role of families, friends and people working and living in the same community influences what is thought of as normal and acceptable behaviours. Another part of this is the social capital of an community
What is social capital
This is the level of trust between a community and the value of socially uplifting behaviours in that community that forge bonds between diverse people - eg civic participation, volunteerism
What are some outputs of social capital
sense of unity, pro social behaviour, institutional trust, social connection, pro social norms
What are the four different types of interlinked ‘capital’
human, natural, financial, and social capital
What does the outputs of social capital lead to
wellbeing and social outcomes
Define structure (in pophlth)
Social and physical environmental conditions/ patterns (determinants) that influence choices and make opportunities available.
Define Agency (in pophlth)
The capacity of an individual to act independently and make free choices.
Where does structure and agency lie on the DW model
Structure is in the three outermost levels (2/3) , Agency is in the two innermost (1)
The determinants of health are a framework to help you
identify risk and protective factors
Protective factors should not be
‘not’ something
By identifying risk and protective factors, this helps us to think of interventions. what 2 things must you consider when thinking about tackling these factors ?
Different factors can affect others, so distal factors may affect proximal factors. Factors operate at different scales= person- micro, community/ family- meso and society = macro
Inequities in health outcomes result from
inequities in health opportunities
Opportunities could be thought of as
chance of exposure
Define inequalities
measurable difference/ inequalities in health
Differences in health experiences and outcomes between different populations according to ethnicity, gender, area is an example of
inequalities
Inequalities help us to see the
social gradient
Define inequities
Inequalities that are unfair/ based from injustice/ imbalance of power resulting in health outcomes
Define health inequities
Differences in the distribution of health resources and services across populations that do not reflect the needs of that population
What is the rationale for Maori health promotion / interventions (what hasn’t been happening)
Maori as an indigenous people have not had their rights fulfilled. Evidence of persistent inequalities. Mainstream health interventions have not been effective with for Maori than for non-Maori. Maori health is everyone’s responsibility.
What is the state of Maori health at the moment
There have been systemic inequities in health outcomes, exposure to determinants of health, access to quality healthcare, and representation in the health workforce at all levels created by historical and contempory factors.
Ethnic inequalities have been created and perpetuated therefore they can be
reduced, eliminated and prevented
What causes health inequalities
the unequal distribution of health risks and opportunities (social determinants)
What is health promotion?
set of strategies/ approaches to addressing health inequities
What are the main failings of conventional health promotion
Based on western models, it has a one size fits all mentality, that focuses on the superficial, rather than structural approach. This isn’t rooted in Maori values and is poorly adapted for the Maori realities.
What are the prerequisites of the Ottawa charter
Peace, shelter, education, food, income, stable eco-system, sustainable resources, social justice and equity
What is a Maori health promotion model
Te Pae Mahutonga- the Southern cross
What are the 6 parts of Te Pae Mahutonga
4 Key tasks (Mauriora, Waiora, Toiora, Te Oranga) and 2 prerequisites (Nga Manukura and Te Mana Whakahaere)
What is Mauriora
The security of cultural identity and means access to Te Ao Maori (the Maori world). Including Te Reo, Tikanga Maori (customs) , Marae, Maori environments and ecological resources.
What is Waiora
Environmental protection and a recognition of some of the physical determinants of health, including clean water, clean air, vegetation and wildlife, less noise pollution. (keeping people in harmony with the environment)
Can Te Pae Mahutonga be applied to other whole population approaches
yes
What is Toiora
Healthy lifestyles - depending on personal behaviour and as Maori experience more risk factor, a shift from harmful lifestyle takes targeted interventions, risk minimisation, cultural relevance, risk management and positive development
What is Te Oranga
Participation in society - the participation of Maori individually and collectively in decision making at all levels. The ability to have ownership and access to the resources to fulfill the other three stars
What is Nga Manukura
Leadership - Leadership from health professionals in partnership with community leadership to enable and empower them to do things for themselves.
What is Te Mana Whakahaere
Autonomy - having the political structures and processes in place to give communities ownership and control over health promotion finding community based solutions. Self governance
What are the principles of Maori Health Promotion
Focusing on the underlying determinants to achieve sustainable change
Maori decision making at all levels
Allows for diverse realities
Using contemporary methods, valid approaches. Knowing the dynamics of the community to have leverage
Give leadership to communities
What is the liberation
Removing barriers to good health outcomes for everyone by empowering them rather than putting bandaids
Epidemiology can play a central role in preventing disease by
unraveling the causal pathway, directing preventative action, evaluating effectiveness
Why is preventing disease becoming more needed?
The cost of treating disease (to healthcare system and consumers) and the limitations of curing disease causes disparities between different populations utilisation/ access to technological solutions therefore creating inequalities
What is the goal of health professionals try to reduce risk factors, identify early stages of disease so that it can be treated early?
Its so the number of people presenting to curative health services can be reduced and they can then provide equitable care to all population groups
What are the three types of population health approaches and what are the two ways they can be delivered ?
Health promotion, disease prevention and health protection– delivered either by population based (mass) strategies or High risk (individual) strategies
What is the population based strategy? (focus, aims, useful)
Its focus is to address WHOLE POPULATIONS. Aims to reduce the health risks/ improve the outcomes of all individuals in the population. Useful for widespread diseases with a common cause eg immunisation
What is the High Risk individual strategy (focus, aim, useful)
Focus on individuals who are perceived to be high risk. Aim to improve their health/ reduce their risk to bring them back to the normal population level. Useful for matching individuals and their concerns. eg needle exchange programme
What are the advantages of a high risk strategy?
Targeted towards individuals-> appropriate
High individual and Clinician motivation -> strong justification of treatment
Cost effective use of resources -> the people who need it
Favourable benefit to risk ratio-> Benefits outweigh the risks
What are the disadvantages of high risk strategy?
It has limited potential -> not radical and even if some individuals are high risk, its only beneficial if they make up the majority of the cases of disease
Screening for high risk individuals is costly, needs to be done at different stages of life
Its effects are temporary-> need to keep screening
Behaviourally inappropriate-> requires people to step out of social norms
What are the advantages of a population based strategy?
Radical-> addressing the underlying causes
Large potential benefit for the whole population-> eliminating risk factors
Behaviourally appropriate-> changes the societal norm
What are the disadvantages of a population based strategy?
Small benefit to individuals-> not all of them are at risk, no immediate reward
Low motivation of individuals
Whole population is exposed to the downside of the strategy
Low benefit to risk ratio-> not everyone is reaping the reward but everyone has the downsides
What is Health Promotion (acts on, purpose, involves)
This acts on the determinants of Well being. Its purpose is to empower people to make healthy choices. It involves whole populations in everyday contexts.
What is primary health care
Healthcare services that are the first point of contact, a regular source of healthcare . Eg GP
What is secondary health care
The specialist you are referred to by your GP
What is tertiary health care
Institutionalised health care services such as rehabilitation, hospital based care.
When/where was the Alma Ata declaration for primary health care made
1978 International conference for primary healthcare in Kazakhstan
What was so special about the Alma Ata
Focused on a health promotion approach to healthcare, looking to protect & promote health of all, primary healthcare was important. It also addressed the social determinants - the idea that prerequisites are required for people to be healthy- no war, food, water, income etc
When/where was the first international conference on health promotion made?
21/11/1986 , Ottawa
What is so special about the Ottawa Charter for health promotion
Recognises the human rights of health, assigns responsibility to the individual and collective, advocates an equity in good health opportunities, and pushes the idea of health for all will increase the social and economic development of all
What are the three basic strategies of the Ottawa Charter
Enable -> provide opportunity for people to make informed choices (individual)
Advocate -> create favourable societal environments to get equity in health (systems)
Mediate -> bring together opposing groups/ individuals to work for the greater good of healthcare
What are the 5 priority action areas of the Ottawa charter
Develop personal skills, strengthen community action, create supportive environments (physical), Reorient health services towards primary healthcare, build health policy
What is disease prevention strategies (focus, goal)
Focuses on the disease. Identifies features about the disease prevalence and risk and works to reduce the occurrence of disease in the population
What is the primary, disease prevention strategy and when is it implemented
Primary occurs before the biological onset and limits the occurrence of the disease by controlling specific risk factors and causes - eg vaccine
What is the secondary disease prevention strategy and when is it implemented
Secondary occurs just after symptoms are occurring and reduces serious consequences of the disease eg- screening for early diagnosis
What is the tertiary disease prevention strategy and when is it implemented
Tertiary occurs just before the outcome of the disease (recovery,death or disability) and helps to reduce the progress of complications of the established disease. eg. rehabilitation
What is health protection (focus, goal)
These focus on environmental hazards. Its goals are to manage environmental risk by assessing and monitoring hazards, communicating this to the public and starting regulations on occupational health
Can there be overlap between Health protection, health promotion and disease prevention?
yes
It is before the disease is occurring-> what population health approaches am I expecting to be occurring?
The whole of health promotion, and the primary part of disease prevention, some parts of health protection
