Module 2 Flashcards
Individual healthcare
- Clinicians generally deal with individuals
- Aim to treat disease and restore health
- Reactive form of treatment
Population healthcare
- Health of a group of individuals in the context of their environment
- The social and physical environment of people
- Comprehensive & proactive approach to clinical practice
PHF - defintion
structure - DPIRPFDTPSAWAME
Public Health Framework: provide mass benefit for the largest number of people at the same time to reduce inequities in the distribution of health & wellbeing.
Define the problem -> Identify risk and protective factors -> Develop and test preventative strategies -> Assure widespread adoption -> Monitor and evaluate
Bradford Hill Criteria
TaBS CRaBS
Temporality Biological gradient Strength of association Consistency of association Reversibility Biological plausibility Specificity of association
Temporality
timeline will be given
- Sequence of events: Cause must precede disease.
- Essential to establish a causal relationship
e. g. Smoking -> lung cancer deaths
- Strength of association -
will mention strength
- The stronger an association, the more likely to be causal in absence of known biases (selection, information & confounding)
e. g. British doc study: RR>10
Consistency of association
- diff groups
- Replicating findings w/ different investigators, times, places, methods
e. g. Multiple studies showing similar results
Biological gradient
- Incremental change in disease rates in conjunction with corresponding changes in exposure
Biological plausibility of association
- Association making biological sense
e. g Chemicals in tobacco are known to promote cancers (carcinogens)
Specificity of association
(weakest criteria)
A cause -> single effect or effect has a single cause. But, health issues have multiple/interacting causes & many outcomes share causes.
E.g. smoking -> multiple outcomes. Multiple causes -> lung cancer
Reversibility
The demonstration that under controlled conditions changing the exposure causes a change in the outcome => likely causal relationship. e.g. reduced risk after quitting smoking
Definition of the cause of disease
event/condition/characteristic (or combination) which play an essential role in producing the disease
Causal pie - KJ Rothman
Sufficient cause, component cause and necessary cause
- Use the association and other factors to infer causation and intervene to prevent disease
- Can intervene at any number of points in the pie
- No prerequisite knowledge of the complete pathway needed to introduce preventive measures.
Sufficient cause
- The whole pie
- A minimum set of conditions without any one of which the disease would not occur
- Often several
- The disease may have several sufficient causes (several pies => same disease)
Component cause
- A factor that contributes towards dis-ease causation, but not sufficient to cause dis-ease by itself
- Component causes “interact” to produce disease
Necessary cause
- A factor that must be present if a specific dis-ease is to occur
Pop based (mass) strategy purpose
- Focuses on the whole pop & aims to reduce health risks/ improve outcomes of pop. useful for a common disease or widespread cause
- e.g.: Immunisation programmes, legislation of seatbelts, low salt foods at supermarkets
Pop based (mass) strategy advantages
- Radical - addresses underlying causes
- Large potential benefit for whole population
- Behaviourally appropriate (change societal norms)
Pop based (mass) strategy disadvantages
- Small benefit to individuals
- Poor motivation of individuals
- Whole population is exposed to downside of strategy (less favourable benefit-to-risk ratio)
High-risk individual strategy purpose
- Focuses on high risk individuals
- Well matched to individuals and their concerns
- e.g.: Intervention targeting obese adults, intravenous drug users
High-risk individual strategy advantages
- Appropriate to individuals
- Individual motivation
- Cost effective use of resources - Favourable benefit-to-risk ratio
High-risk individual strategy disadvantages
- Cost of screening, need to identify individuals
- Temporary effect
- Limited potential
- Behaviourally inappropriate (Unchanged societal norms)
Health promotion
Acts on determinants of wellbeing in pop. & enables/empowers people to increase control over/improve, their health. Usually pre-disease
Primary healthcare declaration- Alma Ata 1978
- Protect and promote health of all
- Advocated a health promotion approach to primary care
- 1st time social determinants were recognised as being key to good health for individuals in a pop
Prerequisites for health
Peace and safety from violence, Shelter, Education, Food, Income and economic support, Stable ecosystem and sustainable resources, Social justice and equity
Ottawa charter aim
Aim to mobilise action for community development.
Ottawa charter acknowledgement
health is:
- A fundamental right for everybody (human rights in health)
- Requires both individual and collective responsibility (includes government)
- Opportunity to have good health should be equally available (equity lens). Government has to focus on the prerequisites of health. Incorporate health into the policies.
- Good health is an essential element of social and economic development
Ottawa charter basic strategies
Enable, Advocate, Mediate
Ottawa charter Enable
(Individual level strategy) To provide opportunities for all individuals to make healthy choices through access to information, life skills and supportive environments
Ottawa charter Advocate
(System-level strategy) To create favourable political/economic/social/cultural/ physical environments by promoting/advocating for health & focusing on achieving equity
Ottawa charter Mediate
(Individual, group & system strategy) To facilitate/ bring together individuals/groups/ parties with opposing interests to work together/come to a compromise for the promotion of health
