Module 2: Causality & Causes of Causes & SEP Flashcards
Causality in epidemiological studies
Identify associations between potential exposures with outcomes but not done via human experiments
Lind’s experiment
Proved that cures can be found before finding causes e.g. Cholera and scurry
Bradford Hill framework
Non strict criteria for causal relationship
Temporality - BHF
Key to causality - First cause then disease
Strength of association - BHF
Stronger association means causal association in absence of cofounding
Reveribilty - BHF
If you can show removal of causes removes outcome
Biological gradient - BHF
Change in disease rates has corresponding chnages in outcome
Biological plausability of association - BHF
Does the cause make biological sense
Consistency - BHF
Many similar repeated studies show similar results
Specfitiy - BHF
Cause has a single effect
Specficity - BHF
Cause has a single effect
Rothmans causal pie model
Recognises multiple factors can contirbute to being a cause
Rothmans pie model weakness
Assumes all causes are deterministic always
Sufficient cause - RPM
All factors are the minimum requirement of disease “whole pie”
Component cause - RPM
A factor contributing to a disease but isn’t sufficient to cause it alone “Slice of pie”
Necessary cause - RPM
A factor necessary for cause
Causation probability
A cause increases probabilty of outcome
Probability of outcome rises to 1
Sufficient cause
Probability of outcome rises from zero
Necessary cause
Contributws to moving probability from zero to 1
Component cause
Downstream determinants
Interventions at micro level - Easily changed in one day “Proximal causes”
Upstream determinants
Interventions at macro distant level thus requires formal change e.g. government, political
Dahlgren and whitehead model
Framwork identifying determinants of health and levels of intervention
Level 1 intervention: Individual (D&WH)
Non modifiable factors - Genes, inherited biology, lifestyle habits
Level 2 intervnetion: Community (D&WH)
Social and community influences, housing and work
Level 3 intervnetion: Enviromental (D&WH)
Socioeconomic, culutral and enviroment conditions e.g. buildings, religion, climate, political, city design
Four social capitals components
- Natural eniroment to support life and human activity
- Social norms and values in society
- Human involves peoples skills, knowlegde, wellbeing
- Financial/physical is countries financial and physical assets
Structure in Pop hlth
Social determinants influencing choice and opportunity
Agency in Pop hlth
Capactiy of individuals/community to make own choices
Socio economic position
Status, class, stratification of people in society is measured to quantify level of inequity in relationship between health and social variables
SEP for individuals
Education, income, occupation, housing, assets and wealth
SEP for populations
Area based - deprivation and access
Population based - Income inequality, literacy rates(life expectancy), Gross domestic product per capita (Health prioritisation)
SEP on Dahlgren & whitehead model
Education is key determinant for opporutnitiess, income, assets and wealth but everything is integrated
SEP - Social influence
Parents SEP influences childrens SEP
SEP - Housing/work
Employment, housing and sanitation
SEP - Intergenerated SEP
Generational influence of SEP from parent to grandchild
SEP - General socioeconomic, cultural and environmental conditions
Population groups with similar SEP levels
SEP - Global determinants
Income inequality, national income, literacy rates, free trade agreements
Causes of causes/social gradient
Individuals with lowest income have poorest health care due to a causal linkage
Education -> employment -> Income -> access
Education -> access -> Discrimination -> Being in a minority group
