Module 2: Deciding on Interventions to Improve PopHlth Flashcards

Question

Causal phenomena - complexity

Answer 1

Causal phenomena are usually complex - and exposure - outcome relationships usually not 1:1 Causality is multi-factored

Answer 2

An event, condition and/or characteristic which play an essential role in producing the disease

Answer 3

Sufficient cause (causal mechanism): - the whole pie - a minimum set of conditions without any one of which the disease wouldn't occur - not usually a single factor; often several - a disease may have several sufficient causes Component cause: - a factor that contributes towards dis-ease causation, but is not sufficient to cause dis-ease on its own Necessary cause: - a factor/component cause that must be present if a specific dis-ease is to occur

Answer 4

Every causal mechanism always has some environmental component cause(s)

Answer 5

Blocking/removing any component cause would result in prevention of some cases of disease

Answer 6

Don't need to identify every component cause to prevent some cases of disease Knowledge of the complete pathway is not a pre-requisite for introducing preventative measures

Answer 7

Use association and other factors to infer causation and intervene to prevent disease Can intervene at any number of points in the pie

Answer 8

The need for prevention is growing as the limitations in curing disease become apparent and as the costs of medical care escalate

Answer 9

Health promotion Disease prevention Health protection All of which are split into population based (mass) strategies or high risk (individual) strategies

Answer 10

Focuses on whole pop Aims to reduce health risks/improve outcome of all individuals in pop Useful for a common disease or widespread cause

Answer 11

Focuses on individuals perceived to be a high risk Intervention is well matched to individuals and their concerns e.g. NZ needle exchange program --> helps prevent spread of HIV

Answer 12

Radical - addresses underlying causes Large potential benefit for whole pop Behaviourally appropriate Small benefit to individuals Poor motivation of individuals Whole pop is exposed to downside of strategy (less favourable benefit - risk ratio)

Answer 13

Appropriate to individuals Individual (subject and physician) motivation Cost-effective use of rss Favourable benefit : risk ratio Cost of screening; need to identify individuals Temporary effect Limited potential Behaviourally inappropriate

Answer 14

``` Acts on determinants of well-being Health / well-being focus Empowers people to increase control over and improve their health Involves whole pop in every day contexts Pre-disease ```

Answer 15

Primary - patient's regular source of healthcare Secondary - Specialist care Tertiary - hospital based care, rehabilitation

Answer 16

Protect and promote health of all Advocated a health promotion approach to primary care 1st time social determinants in health was recognised as key to achieving good health in populations Pre-req for health: - peace and safety from violence - shelter - education - food - income and economic support - stable ecosystem and sustainable rss - social justice and equity

Answer 17

'Mobilise action for community development' First time human rights was brought to health Charter acknowledges that health is: - a fundamental right for everyone - requires both individual and collective responsibility - opportunity to have good health should be equally available - good health is an essential element of social and economic development

Answer 18

Enable - provide opportunities for all individuals to make health choices through access to info, life skills, and supportive environments (individual level strategy) Advocate - create favourable political, economic, social, cultural and physical environments by advocating for health and focusing on achieving equity in health (system level strategy) Mediate - bring together individuals, groups, and parties with opposing interests to work together and come to a compromise for promotion of health (strategy that joins up individuals, groups and systems)

Answer 19

``` Develop personal skills Strengthen community action Create supportive environments Reorient health services towards primary health care Build healthy public policy ```

Answer 20

Disease focus | Looks at particular diseases and ways of preventing them, e.g. incidence, prevalence, risk factors, or impacts

Answer 21

Biological onset --> Clinical diagnosis --> Recovery, death or disability Primary (pre-disease) - limit occurrence of disease by controlling specific causes and risk factors Secondary (post-disease) - reduce more serious consequences of disease Tertiary (post-disease) - reduce progress of complications of established disease

Answer 22

Predominantly environmental hazard focused Risk/hazard assessment - environmental epidemiology, safe air and water Occupational health and monitoring Risk communication

Answer 23

A larger number of people at a small risk may give rise to more cases of disease than the small number who are at a high risk

Answer 24

A preventative measure which brings much benefit to the population offers little to each participating individual

Answer 25

Maori health status/inequalities Rights as indigenous peoples and treaty partners 'Mainstream' health promotion interventions generally less effective for Maori Maori health is everyone's responsibility

Answer 26

Systemic inequalities in... - health outcomes - exposure to determinants of health - health system responsiveness - representation in health workforce Ethnic inequalities in health can be reduced, eliminated, and prevented

Answer 27

Ethnic inequalities in health are fundamentally driven by the unequal distribution of health risks and opportunities (social determinants)

Answer 28

Dominant cultural populations benefit most; pakeha Although there is an overall benefit, it only predominantly improves groups already with good health outcomes --> gap widens

Answer 29

Very little or inequalities have been widened

Answer 30

Based on Western models Universal formula Often simply adapted for Maori Doesn't incorporate Maori values and realities Superficial vs structural approach - ads focus on an educational approach, but misses the fundamental structural approaches, e.g. low income / less privileged communities Tended to benefit non-Maori to a greater extent

Answer 31

Has pre-requisites, e.g. peace, shelter, education, food | For Maori pop, must address the pre-reqs (access to basic determinants of health)

Answer 32

A Maori model of health promotion Based on Southern Cross as a navigational aid 4 central stars (key tasks) and 2 pointers (pre-reqs) Fundamental components of health promotion from a Maori world view, but might also apply to other NZers Must address underlying determinants or won't achieve sustainable change

Answer 33

Pre-requisities: Te Mana Whakahaere (autonomy) Ngā Manukura (leadership) ``` Key tasks: Mauriora (cultural identity) Waiora (physical environment) Toiora (healthy lifestyle) Te Oranga (participation in society) ```

Answer 34

Mauriora: access to Te Ao Maori - e.g. access to Te Reo, Maori language and customs, working together to revitalise traditional Maori practices Waiora: environmental protection - physical environments are a key determinant of health - e.g. pollution, smoke free (indoor) environments like houses and maraes Toiora: healthy lifestyles - e.g. diets, smoking, exercise, culturally appropriate ways to help people stop smoking? Te Oranga: participation in society - social determinants, ensure we have rss to put above into action - participation of Maori individually and collectively in political processes - e.g. education, income, employment

Answer 35

Te Mana whakahaere: - enabling capacity for self governance (make decisions for themselves) - community control and enabling political environment Ngā Manukura: - health professional and community leadership - e.g. collaboration with leaders in communities

Answer 36

Remove barriers --> benefits everyone

Answer 37

Maori are over-represented in lower socio-economic groups (decile 8, 9, 10) in terms of socio-economic deprivation, e.g. child poverty

Answer 38

``` By Maori for Maori/everyone Self determination and control Valid models, frameworks, concepts Maori people, values, collectives Contemporary tools/methods Allows for diverse realities Focus on determinants of health Evidence-based ```

Answer 39

Involves identifying risk factors for disease or unrecognised disease by applying tests on a large scale to a population

Answer 40

Primary: screening women for alcohol intake to prevent breast cancer (screening for risk factors) Secondary: screening for breast cancer Tertiary: screening for bone density following chemotherapy for breast cancer

Answer 41

Suitable disease Suitable test Suitable treatment Suitable screening programme

Answer 42

To improve health outcome (morbidity, mortality and/or disability)

Answer 43

1. An important health problem: - Relatively common - Relatively uncommon: early detection and intervention --> better outcome 2. Knowledge of natural history of disease (or relationship of risk factors to the condition): - Detectable early (detectable risk factor / disease marker) - Increased duration of pre-clinical phase

Answer 44

Period between early features of disease and clinical diagnosis

Answer 45

``` Reliable - provides consistent results Safe Simple Affordable Acceptable Accuracy - the ability of a test to indicate which individuals have the disease and which do not - (sensitivity, specificity) ```

Answer 46

The Gold standard (diagnostic test): - in effect the ideal test - requires clinician, preparation by patient, and must be monitored --> test can't be applied to large pop groups - e.g. Colon cancer (Colonoscopy) Screening test: - less expensive diagnostic test - e.g. faecal occult blood test (colon cancer)

Answer 47

The likeliness of a positive test in those with the disease | The ability of the test to identify those who have the disease (a) from all individuals within the disease (a + c)

Answer 48

true positives/ all with disease x 100 (expressed as %)

Answer 49

The likeliness of a negative test in those without the disease The ability of the test to identify correctly those who don't have the disease (d) from all individuals free from the disease (b+d)

Answer 50

true negatives/ all without disease x 100 (expressed as %)

Answer 51

The sensitivity of a screening test is high if the proportion of true positives is high The specificity is high if the proportion of true negatives is high Sensitivity and specificity are a fixed characteristic of the test

Answer 52

a + b (all people with +ve results) c + d (all people with -ve results) Positive predictive value (PPV) Negative predictive value (NPV) PPV and NPV are not fixed charactersistics of the test Reflect both the test accuracy and prevalence of the disease

Answer 53

The proportion who really have the disease of all people who test positive The probability of having disease if the test is positive true positives/ all who test positive x 100 (expressed as %)

Answer 54

The proportion who are actually free of the disease of all people who test negative The probability of not having the disease if the test is negative true negatives/ all who test negative x 100 (expressed as %)

Answer 55

Evidence of early treatment leading to better outcomes Effective, acceptable and accessible treatment Evidence-based policies covering who should be offered treatment and the appropriate treatment to be offered

Answer 56

Benefits must outweigh harm Adequate resourcing and agreed policy for testing, diagnosis, treatment and program management Cost-effective Health care system must be able to support all elements of screening pathway Needs to reach all those who are likely to benefit from it

Answer 57

If screening program is evaluated in terms of survival time, it may give a false impression of success

Answer 58

Screening identifies 2 patients with rapidly progressive disease and 5 patients with slowly progressive disease Calculating mean survival from screened patients give an impression of longer average survival than occurs in population

Answer 59

RCT evidence that screening program will result in: - reduced mortality - increased survival time - -- lead time bias - --length time bias

Answer 60

Those who are likely to have the disease, but don't have symptoms Identified by observational studies, RR, and RD Enter a screening test Those who test positive --> Gold Standard test Those who test positive in GS --> intervention/treatment Those who test negative in GS --> re-screen (after specified time period)

Answer 61

If prevalence is moderate/low --> higher false positive test results If prevalence is high --> higher false negative test results

Answer 62

Fast progressing may have already died, or may not have started at the time of screening

Answer 63

Not enough money to fund all health problems

Answer 64

Most goes to services of curative and rehabilitative care - rss intensive Prevention and public health services 7%

Answer 65

Evidence-based measures: - descriptive - explanatory - evaluative Community expectations and values Human rights and social justice

Answer 66

Where are we now? Who is most/least affected?

Answer 67

``` High body mass index Tobacco use High blood pressure High blood glucose Physical inactivity Alcohol ```

Answer 68

What are the trends over time? Where have we come from? Where are we going? Are interventions that are already in place effective or not? - if current intervention for disease x is effective, will continue with intervention --> money used to fund new intervention for disease y

Answer 69

What are the determinants? Risks? Why are we getting worse/better? Why are pop's different?

Answer 70

Does the problem/risk factor disproportionately affect pop sub groups? Why? Treaty of Waitangi

Answer 71

Age of death and premature mortality (Years of potential Life Lost to death - YLL) Time lived with disability (Years Lived with a Disability - YLD) Population Attributable Risk (PAR)

Answer 72

RD = AR = EGO - CGO i. e. the amount of 'extra' disease attributable to a particular risk factor in the exposed group - incidence in exposed pop (EGO)

Answer 73

The amount of 'extra' disease attributable to a particular risk factor in a particular pop If association is causal: this is the amount of disease (theoretically) we could prevent if we remove that particular risk factor from the pop

Answer 74

Incidence in total pop (PGO) - incidence in unexposed pop (CGO) PGO = (a + b) / total pop

Answer 75

What can improve health outcomes (and in whom?) How well can the problem be solved? - target pop - expected number in pop who will be reached - evidence of effectiveness (based on known success rates) - cost

Answer 76

Does it make economic sense to address the problem? | Are there economic consequences if not carried out?

Answer 77

The health benefits that could have been achieved had the money been spent on the next best alternative intervention or healthcare programme

Answer 78

``` Public attitudes Human rights and social justice Acceptability: - will the community and/or target pop accept the problem being addressed - competing interests What do communities want (expectations): - confidence in health system - access to necessary care - fair treatment - culturally appropriate - good information about their options ```

Answer 79

Access to necessary care

Answer 80

RD looks at exposed group --> higher risk prevention strategy PAR looks at whole pop --> pop based prevention strategy

Answer 81

Higher prevalence --> higher PAR