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Population Health 111 > MODULE 2 Explore why disparities exist and why we reduce them > Flashcards

MODULE 2 Explore why disparities exist and why we reduce them Flashcards

1
Q

What are the key drivers of Population change?

A

Fertility, mortality and migration

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2
Q

Age Specific Fertility Rate

A

Number of births to women in a 5-year age group/Number of females in a 5-year age group, per 1 000

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3
Q

Total fertility rate (TFR)

A

a population measure of family size

(measure of fertility)

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4
Q

Replacement level

(TFR)

A

TFR level required for the population to replace itself without migration

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5
Q

How is fertility measured?

A

through birth statistics

(Dept of Internal Affairs register; Information Directorate at the Ministry of Health maintains register and Statistics NZ generate the reports)

birth rates, age-specific fertility rates, total fertility rates

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6
Q

How is mortality measured?

A

Death statistics

(Department of Internal Affairs register; Health Information Directorate at the Ministry of Health maintain and report)

number of deaths, death rates, life expectancy

Death rates measured: Infant mortality rate, crude death rate, standardised death rate

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7
Q

How is migration measured?

A

origin and destination statistics

(visitor information sheets when we leave the country; statistics NZ maintain and report)

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8
Q

Key trends in Births since 1970s

A

Number of live births in 1971 and 2008 are similar (around 64 000) BUT fertility rate is NOT the same (because the denominator, total number of women/denominator has increased).

The crude birth rate has decreased from around 22 per 1 000 in 1971 to under 15/1000 in 2013.

Age-specific fertility rate trend:

1984: first IVF baby born

30-34 age group: massive increase in ASFR since (Also in 35-39)

Decrease in ASFR in 20-24; 25-29 (a little in 15-19)

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9
Q

Key trends in Deaths since 1970s

A

All deaths in NZ from 1971-2013: increasing trend from just above 24 000 to just over 30 000

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10
Q

Key Trends in Migration since the 1970s

A

No key trend in permanent and long-term migration patterns bet 1971 and 2013 (arrivals and departures)

Migration trends consist of in-migration AND out-migration.

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11
Q

Crude birth rate calculation

A

=live births/total population per 1 000

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12
Q

Age-specific fertility rate

A

The number of births to women in a 5-year age group/Number of females in a 5-year age group per 1 000

Study setting: NZ, 1973-2013

Eligible population and Participants: Females aged 15-44, living in NZ between 1971 and 2013 who gave birth to at least one child

(NB: assumes that ASFR remains constant throughout woman’s lifetime)

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13
Q

Life expectancy in NZ 1970-2013

A

Difference in LE between sexes decreased from 6.1-3.7 years.

Males: from under 70 to just under 80 yo

Females: from around 75 to around 83 yo

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14
Q

Infant mortality rate

A

number of deaths aged <1 yo / live births per 1 000.

decreasing trend from 16.0/ 1000 to just over 4.0/1000.

Around 1989, An intervention:

NZ Cot Death Study commenced: recommendations:

Baby sleeps in prone position; mum doesn’t smoke during pregnancy

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15
Q

Crude death rate and Standardised Death rate

A

Crude:number of deaths/total pop per 1 000

Standardised: total of (expected deaths/standard population) per 1 000

From 8/1000 to under 4/1000 (std) and just over 6/1000 (crude)

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16
Q

Demographic measures of migration

A

internal migration

external migration

net migration = arrivals - departures

net migration rate= (immigrants/emigrants)/total population per 1 000

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17
Q

Migration

A

Permanent or semi-permanent change of residence by an individual or group of people

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18
Q

Internal migration

A

impacts on REGIONAL population growth

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19
Q

External migration

A

impacts on NATIONAL population growth

PLT= permanent and/or long-term migrants

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20
Q

Recent migration trends

A

Jan 2014 net migration gain: 25 666

Net loss of 15 000 people to Australia in Feb 2014 was well down from the loss of 36 700 in Feb 2013.

Net gains of migrants from most other countries in Feb 2014 year:

China (6 100)

India (5 800)

UK (5 800)

Philippines (2 500)

Germany (2 300)

France (1 700)

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21
Q

Population Ageing

A

occurs when the median age of a country’s population increases due to improved life expectancy and/or declining birth rates

happening in most high-income countries now, or will be within 25-50 years.

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22
Q

Types of Ageing

A

Numerical and stuctural

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23
Q

Numerical Ageing

A

the absolute increase in the population that is elderly

  • reflects previous demographic patterns
  • improvements in life expectancy
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24
Q

Structural ageing

A

the increase in the **proportion **of the population that is elderly

  • driven by decreases in fertility rates
  • began occurring in the 1800s
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25
Q

New Zealand’s Population from 1971-2031

A

Year

1971

1991

2011

2031

Population (mil)

  1. 9
  2. 5
  3. 41
  4. 19

Median Age

26

31

37

40

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26
Q

Population impacts of ageing

A

Natural decline and absolute decline

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27
Q

Natural decline

A

occurs when there are more deaths than births in a population

  • a combination of absolute and structural ageing
  • more elderly = more deaths
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28
Q

Absolute decline

A

occurs when there is insufficient migration to replace the ‘lost’ births and increased deaths

  • not expected to happen in NZ for 70+ years
  • Happening in some European/Asian countries
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29
Q

Dependency ratios

A

measure the pressure on the (economically) productive population

Elderly: pop 65+ years/ 15-64 years x 100

Youth pop aged 0-14/ 15-64 years x 100

The dependents per 100 working age population value is increasing for the elderly over the years; For youth, fairly stable, very slightly decreasing.

Elderly: from 20-42 per 100 working age pop

Youth: 30 to under 30

2026 overlap at about 30

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30
Q

New Zealand’s population is ageing rapidly

A
  • ethnic and regional variations
  • dependency ratios cross in 2026
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31
Q

Ageing population will have significant impact on health

A

e.g. prevalence of hearing loss expected to double by 2015

Population change in NZ will impact on the health needs of many populations, especially the elderly.

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32
Q

Implications for workforce

A
  • potentially similar to rural doctor problem?
  • ethnic-specific needs
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33
Q

Interpreting the dependency ratios

A

In 2011: Every 100 people of working age are ‘supporting’ 50 dependents

in 2061: there will be 70 dependents per 100 working age people.

(supporting= paying taxes, buying goods/services)

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34
Q

Consequence of increasing dependency ratio:

A

as the number of dependents increases, the amount of money for the government to spend on other resources (health, education, roads) will decrease

(the govt would have to find other ways to obtain revenue)

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35
Q

Determinant of health (individuals)

A

any event, characteristic or other definable entity, that brings about change for better or worse in health

often not due to one factor or exposure

usually multi-factorial (multiple factors)

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36
Q

Examples of determinants

A

water, shelter, sanitation (VIP)

income, employment, education

housing and neighbourhoods

societal characteristics (e.g. racism, attitudes to alcohol or violence, value on children) - broader level

autonomy & empowerment- social cohesion (trust and reciprocity etc)- broader level

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37
Q

The determinants of health framework: rainbow model

A

Components:

Non-modifiable factor:

  • age, sex & hereditary factors

Modifiable factors:

  • personal behaviour
  • family and community influences
  • rural and urban living and working conditions
  • national socioeconomic, cultural and environmental conditions (policies to regulate behaviours)
  • global, financial and ecological conditions.
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38
Q

Determinants of health (populations)

A

concepts are similar as for individuals, but nature of determinants is often different.

(not just application of individual perspective to whole population, but including characteristics of the population itself)

  • determinants of health in populations are also related to the context in which the population exists.
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39
Q

Structure and agency in Rainbow model

A

Agency= empowerment:

personal behaviour

family and community influences

Structure= social determinants:

family and community influences

rural and urban living and working conditions

national socioeconomic, cultural and environmental conditions

global, financial and ecological conditions.

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40
Q

Rainbow model framework properties

A
  • helps identify risk factors and consider levels of intervention
  • age, sex & hereditary factors (non-modifiable risk factors)
  • dashed lines= premeability between factors (no arch operates in isolation from the others; events at one level may impact on factors at another (higher or lower) level
  • recognises that determinants operate at different scales (micro (individual), meso (family, living, work), macro (national/global))
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41
Q

Example of Health Determinant Framework: Asthma

A

Age, Sex and Hereditary Factors:

Age < 10 years; Parents have asthma

Personal behaviour:

Being active (swimming, football) or not; using inhaler

Family and community influences:

parents etc smoke in the car/house

Rural and urban living and working conditions:

rural areas- ‘cleaner’ air; urban areas- pollution? opportunities for child to be active

**National socioeconomic, cultural and environmental **conditions:

socioeconomic conditions may dictate the area of residence quality of housing etc.

global financial and ecological conditions:

international trade agreements may impact on the cost of medications for asthma patients

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42
Q

Structure

A

social and physical environmental conditions/patterns (social determinants) that influence choices and opportunities available e.g. eating choices.

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43
Q

Agency

A

capacity of an individual to act independently and make free choices e.g. eating choices

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44
Q

Levels of action to improve population health

A

Downstream and upstream interventions

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45
Q

Downstream Interventions

A

operate at the micro (proximal) level, including treatement systems, and disease management

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46
Q

Upstream Interventions

A

operate at the macro (distal) level, such as government policies and international trade agreements

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47
Q

Identifying upstream determinants

A
  • provides effective intervention points without victim blaming
  • potentially more efficient economically and more successful than focusing on individuals
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48
Q

Indicators of Socio-economic position

A
  • income
  • education
  • occupation
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49
Q

Measuring income in Surveys

A

- Personal income

  • can be sensitive issue- reporting bias?
  • absolute measures
  • categorial measures

- household income

  • useful indicator for women, who may not be the main income earner
  • should be ‘equivalised’ for comparisons between populations (requires information on family size, dependents etc)
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50
Q

Socio-economic position

A

“The social and economic factors that influence what
positions individuals or groups hold within the structure
of a society”
Galobardes B et al. 2006 Indicators of socioeconomic position (part 1) JECH;60:7-12

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51
Q

Socio-economic determinants

A

These must be:

objective

measurable

meaningful

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52
Q

Socio-economic position

A

socio-economic status

social class

social stratification

socio-economic background (used at UoA)

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53
Q

Why measure SEP (Socio-economic position)?

A
  1. used to quantify the level of inequality within or between societies
  2. may highlight changes to population structures overtime, between Census periods or even between generations
  3. Needed to help understand relationship between health and other social variables (age, sex, ethnicity)
  4. have been associated with health and life chances for as long as social groups have existed.
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54
Q

Measures of income

A
  1. most directly measure the material resources aspect of SEP
  2. have a dose-response association with health (the more the better etc)
  3. have a cumulative effect over the life course
  4. have the greatest potential to change over a short duration
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55
Q

Measuring Education

A
  • Attempts to measure knowledge-related assets of an individual
  • can be measured as a continuous variable (years to complete educ; time in educ considered more impt than achievements)
  • can be measured as a categorical variable (educational attainment/milestones; specific achievements are important in determining SEP)
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56
Q

Measures of Education

A
  1. capture transitions from parent’s SEP to personal SEP
  2. believed to be associated with our ability to respond to health promotion messages
  3. easy to obtain, often good response rate, relevant to all age groups
  4. Problems/complications: cohort effects, e.g. different standards of education in different countries
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57
Q

Measuring occupation

A
  1. jobs grouped by potential income or SEP
  2. can be measured as:
  3. occupation is transferable
  4. widely available
  5. difficult to include individuals not currently employed
  6. cohort effects: different meanings of different cohorts
  7. closely associated with income
  8. reflects social standing
  9. individuals experience occupational or ‘social’ mobility over the life-course
  10. occupation influences/impacts on:
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58
Q

Jobs grouped by potential income or SEP

A
  • The NZ Socioeconomic Index of Occupational Status (NZSEI)
  • Social class in the UK
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59
Q

Occupation can be measured as:

A
  • current of longest held occupation
  • parental occupation in studies of younger populations
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60
Q

Occupation is transferable

A

occupation of “Head of household” for spouse and dependents

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61
Q

Occupation statistics are widely available

A
  • census data, vital events, surveys
  • sources of bias (recall, numerator: denominator)
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62
Q

Occupation reflects social standing

A

possibly certain privileges resulting from SEP (lawyers, doctors etc)

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63
Q

Occupations impacts on:

A
  • social networks
  • work-related stress
  • occupational exposure to environmental risks
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64
Q

Other measures of SEP in NZ

A

Housing

Culture

Population-based services and facilities

Social Capital

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65
Q

Other measures of SEP: Housing

A
  • tenure- private or social rented? owner occupier? (problematic as many houses are now owned by family trusts)
  • conditions- overcrowding, insulaiton, damp, mould etc.
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66
Q

Other measures of SEP: Culture

A
  • accepted patterns and norms of behaviour within identifiable groups in society
  • e.g. ethnicity, religion, gender
67
Q

Other measures of SEP: Population based services and facilities

A

-access to, and utilisation of, services

68
Q

Other measures of SEP: Social capital

A
  • connection with other people
  • trust, fear and reciprocity
69
Q

Deprivation

A

townsend 1990: A state of observable and demonstrable disadvantage relative to the local community or the wider society or nation to which an individual, family or group belongs

70
Q

Measuring Area-Level Deprivation

A

another way of measuring people’s relative position in society (another way is SEP)

  • measures focus on material deprivaiton
71
Q

Variables included in NZDep

A
  1. communication (no access to telephone)
  2. income (people (18-59) on means-tested benefit)
  3. employment (people (18-59) unemployed)
  4. income (households with equivalised income below current threshold)
  5. transport (no access to a car)
  6. support (under 60 yo living in a single parent family)
  7. qualifications (18-59 yo w/o qualifications)
  8. owned home (not living in own home)
  9. living space (people living in households below equivalised bedroom occupancy threshold)
72
Q

Area-level measures and the individual

ECOLOGICAL FALLACY

A

* A common mistake that occurs when information for groups of people or areas is used by researchers to describe characteristics of individual participants in a study– ECOLOGICAL FALLACY

73
Q

Appropriate uses of NZDep 2006

A
  • planning and resource allocation
  • research
  • advocacy
74
Q

Inequalities

A
  • Measureable differences or variations in health
  • differences in health experience and outcomes between different population groups- according to socio-economic position, geographical area, age, disability, gender, ethnic group
  • i.e. ‘the social gradient’
75
Q

Inequities

A
  • those inequalities that are deemed to be unfair or stemming from some form of injustice
  • health inequities are differences in the distribution of resources/services across populations which do not reflect health needs
  • relations of equal and unequal power (political, social and economic) as well as justice and injustice
76
Q

Why reduce inequities?

A

if average health status is improving, why does the gradient matter?

  1. unfair when they are the result ofo underlying structural factors
  2. affect everyone
  3. largely avoidable
  4. reducing it can be cost-effective
77
Q
A
78
Q

Calculating a Lorenz Curve and Gini coefficient

A

Gini= the ratio of the area between the Lorenz Curve and the line of absolute equality (numerator) and the whole area under the line of absolute equality (denominator)

79
Q

Measures of association/effect

A

rate difference (absolute measure of inequalities/inequities)

rate ratio (relative measure or inequalities/inequities)

80
Q

Measuring inequalities in health

A

a gradient exists for almost all indicators of health, illness or health service utilisation, risk factors and behaviours, regardless of which SEP measure we use

  • no threshold effect
81
Q

Inequalities affect everybody

A

NZ study of healthy homes (retrofitting insulation RCT)

Wider implications:

more health society- greater productivity, improve wealth of country, more money in economy

82
Q

Maori health is exemplified by systematic disparities

A
  1. in health outcomes
  2. in exposure to the determinants of health
  3. in health system responsiveness
  4. in representation in health workforce

disparities in:

cardiovascular diseases

cancer

injury

diabetes

mantal health (incl self-hearm and suicide)

infectious diseases

disability (among others)

participation in the health workforce

83
Q

disparity

A

differences

84
Q

inequality

A

unequal

85
Q

inequity

A

unjust

86
Q

Determinants of Ethnic inequities in health

A
  1. differential access to health determinants of exposures leading to differences in disease incidence
  2. differential acces to healthcare
  3. differences in quality of care received
87
Q

Factors in Maori Health inequality

A

Structural contribution and societal contribution

88
Q

Societal contribution

A

that there are values and assumptions widely held in NZ society about the deservedness of different groups of people.

both of these powerful drivers have historical (and contemporary) underpinnings. (Societal and structural contributions)

89
Q

Structural contribution

A

that the power, resources and opportunities of NZ society are organised by ethnicity (as well as clall (deprivation)) in NZ

(both Structural and societal contribution are powerful drivers that have historical (and contemporary) underpinnings.

90
Q

Interventions: levelling or privileging?

A

Titanic: remember that an escalator that allows only third class passenger to get to the lifeboats is a leveling intervention, not privileging as prior to this, third class passengers were at a disadvantage in acessing lifeboats as they are farther.

91
Q

Lessons from titanic:

interventions…

that are good

A
  1. structural interventions (more lifeboats, no barriers)
  2. social interventions (rights based approach, commitment to review and ‘level playing field’)
  3. not aimed at individual behaviour (not swimming lessons)
92
Q

When dealing with illnesses/issues

A

Always take into account the history of the problem.

e.g. Maori and Pakeha relationship

  • know early contact (initiallly flourished-economically, socially; the beginning of complex changes)
  • know official engagement (colonisation; declaration of independence; treaty of Waitangi, NZ; heralding an era of depopulation, disease and dispossession)
93
Q

For Maori Health development

A

we need to address the structural barriers to equitable access to the determinants of health and to address attitudes in society that stigmatises one group or assigns them differing value

94
Q

Relationship to health

A
  • land alienation
  • policy alienation (treaty implication)
  • unequal (inferior) citizenship
95
Q

Land alienation relationship to health

A

social disruption of community

breakdown of political power and alliances

economic resource depletion and poverty

resentment by indigenous people

96
Q

Treaty complications with regard to Maori Health

A

Treaty Implications (also of colonisation)
Different or denied citizenship – Art III
– Pensions – Old Age Pensions – 1898
• Equal provisions for Māori and pākehā
• [Asians particularly excluded]
• Māori access difficult – thru Māori Land Court
• Māori regularly removed from rolls
• Reduced amount paid to Māori
– Social Security Act 1938
• Underpayment continued until after WWII

97
Q

Unequal (inferior) citizenship

A

– entrenchment of poverty & dependency
– increased barriers to development
– acceptance of inequity by non-indigenous groups
– resentment, frustration and anger
– social breakdown, crime, high risk behaviours

98
Q

Dimensions of “Access”

A
  1. availability
  2. accessibility
  3. accommodation
  4. affordability
  5. acceptability
99
Q

Availability (existence of service barriers)

A
  • the relationship of the volume and type of existing services (and resources) to the clients’ volume and types of needs.
  • (provider’s side)
100
Q

Accommodation (organisational barriers)

A
  • the relationship between the manner in the manner in which supply resources are organised and the expectations of clients
  • (provider’s side)
101
Q

Acceptability (psychosocial barriers)

A
  • the relationship between clients and providers’ attitudes to what constitutes appropriate care
  • (patient’s side)
102
Q

Accessibility (geographic barriers)

A
  • The relationship between the location of supply and the location of clients, takinga ccount of clients transportation resources, and travel time, distance and cost
  • (patient’s side)
103
Q

Affordability (financial barriers)

A
  • The cost of provider services in relation to the client’s ability and willingness to pay for these services.
  • (patient’s side)
104
Q

Availability

A

Existence of service barriers

Existence, supply, personnel, equipment, materials, facilities

related to the provision of resources on both volume and distribution, but NOT the organisation of those resources (that’s accommodation)

105
Q

Accommodation

A

Organisational Barriers

organisation, design, delivery, skill mix

increasing the efficiency of existing services through reorganising the service delivery so that a greater output is achieved for each unit of input.

May sometimes overlap with “acceptability” (organisational barriers and facilitators (accommodation) e.g. opening hours; pschosocial aspects relating to improved understanding and communication between clients and sevice providers (acceptability))

106
Q

Acceptability

A

Psychosocial barriers

psychosocial, health beliefs, cultural, linquistic, racial, ethnic, indigenous, minority status, clients’ attitude

health beliefs are attitudes, values and knowledge that people have about health and health services that might influence subsequent perceptions of need and use of health services

107
Q

Accessibility

A

Geographic barriers

Geographic, spatioal, location, transport, distance, remoteness, travel time

also considers geographical barriers to services (time, cost, distance)

108
Q

Affordability

A

Financial barriers

economic, socioeconomic, cost, financial poverty, disadvantaged, ability to pay

financial barrier to access

direct cost vs indirect cost

(e.g. time taken off work; travel time; petrol etc)

109
Q

Examples of barriers to using ACC (Accident Compensation Corporation)

A

cluture and health beliefs

cost

language

knowledge and awareness

service quality

etc

110
Q

ACC: Availability

A

types of health services available

not all services are recognised and subsidised by ACC

lack of knowledge of the services and eligibility of ACC (Potential and Realized Access)

111
Q

ACC: Accessibility

A

transportation for the elderly

112
Q

ACC: Affordability

A

direct cost vs indirect cost

GP surcharge (esp for after hours)

value of cost

113
Q

ACC: Accommodation

A

Opening hours of the srvices (costm ore for after hours services)

interpretation services (quality of the interpreter)

114
Q

ACC: Acceptability

A

Health beliefs (what is a serious injury?)

Cultural appropriate services vs guidelines

115
Q

What is a healthy environment?

A

The physical, social or political setting(s) that prevent dispease while enhancing human health and well-being

chronic diseases such as CVD and obesity are associated with environments that favours more sedentary lifestyles and/or poor nutrition

(see de chalain and stephenson reading)

116
Q

Elements of healthy environments

A
  • Clean air and water
  • appropriate housing
  • access to wholesome food
  • safe community spaces
  • access to transport
  • opportunities to incorporate excercise as part of daily life

these are required to keep people healthy

117
Q

Neighbourhood outcomes

A

Physical activity

obesity

cardiovascular disease

mental illness

traffic calming measures

access to resources

money spent on food

days off work

118
Q

Built Environment

A

“all the buildings, spaces and products that are created, or at least significantly modified by people”

119
Q

Build environment types:

A

Structures

Urban Design

120
Q

Structures

A

homes

schools

workplaces

121
Q

Urban Design

A

Parks

business areas

roads

  1. Above ground: parks, business areas and roads
  2. below ground: waste disposal, subway trains
  3. across land: motorways/transportation network
122
Q

Urban form characteristics

A
  1. street network characteristics and design
  2. land-use mix
  3. housing density
  4. site design
  5. transport planning
123
Q

Street network characteristics and design

(concept, key features, health-related benefits)

A

interconnectivity of roads

grid-like pattern

reduces distance between destination, encouraging the use of ‘active transport’

**

traffic calming and other street design features

street width, cycle lanes, traffic management, pedestrian crossings

facilities that encourage walking and cycling and discourage driving

124
Q

Land-use mix

(concept, key features, health-related benefits)

A

food retail

accessible supermarkets and local food stores

provides a range of nutritious foods at competitive prices

**

mix of residential, commercial and business uses

different uses of land within a given zone

increases opportunities for active transport

**

public open spaces and physical activity spaces

open spaces in close proximity to residents; pools, parks, playgrounds

increase opportunities for physical activity

125
Q

Housing density

(concept, key features, health-related benefits)

A

density (private dwellings/m2)

increasing the number of residential and commercial premises in an area

increases active transport

126
Q

Site design

(concept, key features, health-related benefits)

A

food production

home/community gardens

cheap, fresh produce may also provide educational and mental-health benefits

**

street aesthetics

adequate lighting, clean parks, provision of public transport and facilities

improved safety, creates and environment that promotes active transport and well-being

127
Q

Transport planning

(concept, key features, health-related benefits)

A

improve/develop public transport systems

bus stops, cycling facilities, access to public transport stops

increases active transport

128
Q

Community resource accessibility index

A

36 facilities representing 6 domains:

  1. recreational
  2. public transport
  3. educational
  4. shopping facilities
  5. health
  6. social
129
Q

recreational

A

parks

beaches

130
Q

public transport

A

bus

ferry stops

131
Q

educational

A

childcare

primary

intermediate

132
Q

shopping facilities

A

dairy

supermarket

banks

133
Q

health

A

plunket

GP

pharmacy

A and E

134
Q

social

A

marae

churches

community halls

etc

135
Q

how is built environment measured?

A
  • measures are often context-specific
  • urban density
  • land use mix
  • street connectivity
  • community resources
136
Q

Measures are often context-specific

A

depending on the research question/health outcome of interest

137
Q

urban density

A

population and/or employment density

138
Q

land-use mix

A

residential, commercial, industrial, wasteland

139
Q

street connectivity

A

‘lollipop’ neighbourhoods vs well connected streets

140
Q

community resources

A

access to recreational facilities or healthy foods

141
Q

SHA

A

special housing areas

142
Q

Special conditions attached to SHA

A
  • fast-tracked resource consents for developers
  • existing neighbours have no right to object
  • in each SHA, at least 10% of the places must be affordable–defined as about $500k–although officials are hoping for a higher count of cheap places
143
Q

Brownfield land

A
  1. Sites affected by previous uses of the site
  2. derelict, or underused
  3. mainly in fully or party developed urban areas
  4. often require intervention to bring them back to beneficial use
  5. may have real or perceived contamination problems
144
Q

Places with large areas of Redeveloped or Previously developed land (R-PDL) had higher levels of…

A
  1. ‘not good’ health
  2. limiting long-term illness
  3. mortality

than wards with no or relatively small amounts of brownfield land

145
Q

Mapping Variations in Population Health

A
146
Q

GIS

A

geographical information system

a combination of CAD and spreadsheet

features have added value

147
Q

Strengths of GIS

A

• ‘see’ patterns hidden in tables
• Useful for surveillance resource
allocation & emergency response
• Real‐time tracking and analysis
• Data exploration/hypothesis testing
• Integration of many data sources
easily

148
Q

Limitations of GIS

A

• The data
– Map is only as good as the raw
data
– Some users don’t know the
basics of map making!
– Spatial datasets can be large
and/or expensive
• GIS requires a steep learning curve
– But an increasingly important
skill in health!
• Not just a map but complex
processes and procedures to enable
the benefits

149
Q

“Hotspot” analysis

A

used in pop health to identify areas with an elevated ‘risk’ of a disease

150
Q

GIS components

A

transportation

land use

census tracts

structures

postal codes

raster imagery

151
Q

Measuring inequities:

Relative versus absolute measures

A

Relative measures

  • risk ratio
  • extremal quotient (highest rate/lowest rate)
  • no units

Absolute measures

  • risk difference​
  • range (highest rate-lowest rate)
  • have units
152
Q

Effects of Earthquake

A

social connectedness

access to primary care

urban design

psychosocial impacts on health

153
Q

psychosocial effects of the earthquakes

A

refers to individual psychological effects impacting on how people feel AND

social effects impacting on how they relate to each other

chronic stress, disturbed sleep, dislocation, feelings of insecurity, loss, uncertainty, anger

154
Q

Four phases following a disaster

A
  1. initial heroic phase
  2. honeymoon phase
  3. disillusionment (long-term recovery and rehabilitation) phase
  4. the new equilibrium phase
155
Q

Initial heroic phase

A

people help not taking into account the cost

156
Q

honeymoon phase

A

people see some help arriving and believe that things will change

157
Q

disillusionment phase

A

people begin to realise how long the recovery will take

158
Q

new equilibrium phase

A

in the long term, when things never return to previous state, people find a new “normal” state

159
Q

screening versus monitoring

A

screening–trying to see if someone has a specific condition

monitoring–seeing people who are already known to have a specific condition

160
Q

psycho-social recovery plan

A

needs to support majority of population (listening, community-led interventions)

and cater for the most severely affected (efficient referral systems, specialist care)

161
Q

social connectedness

A

relationships people have with others and the benefits these relationships can bring to the individual as well as to society

family, whanau, colleagues, neighbours

connections made through sport, school, work and vountary/community service

networks and skills that help society function effectively = social capital

162
Q

social connectedness after EQ

A

spontaneous volunteering

sharing resources with neighbours

response agencies to assess wellbeing of residents

heightened sense of community due to EQ

spending more time with family

163
Q

Urban design and planning= urban areas healthier environments

key design qualities…

A
  1. context
  2. character
  3. choice
  4. connections
  5. creativity
  6. custodianship
  7. collaboration
164
Q
A

Population Health 111 (4 decks)

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