Module 2: History and Frameworks

Question 1

_____ diseases are responsible for most deaths in the Western world, formerly _____ diseases were the biggest threat. This transition is called the _____ _____.

Answer 1

Non-communicable. Communicable. Epidemiologic transition.

Question 2

What does the term “compression of mortality” mean? What do graphs visualize?

Answer 2

People are living longer. Graphs visualize the survival probability to different ages.

Question 3

A “fire triangle” is considered the simplest way to consider a communicable disease framework. What is it?

Answer 3

For fire to exist, need FUEL to burn, OXYGEN to power it, and HEAT to set it off.

Question 4

What are the components of the epidemiologic triad of disease?

Answer 4

Host: characteristics that determine susceptibility (e.g., age, sex, genetic profile, medical history, culture, occupation, income)

Agent: element that causes disease (e.g., biologic, chemical, physical, nutritional, etc.)

Environment: circumstances host and agent find themselves in (e.g., temperature, humidity, housing, water, air pollution, etc.)

Question 5

What are the three modes of transmission?

Answer 5

Person-to-person, through a common vehicle (e.g., water or food), or through a vector (e.g., mosquitoes).

Question 6

Diseases are not instantly acquired. How is COVID-19 an example of this?

Answer 6

You have a pre-symptomatic phase where you do not hold enough virus to make you notably sick. As viral load increases, you generate mild-moderate illness symptoms. We are not referring to simply whether a person has the disease or not.

Question 7

A disease is not evident until it is. This is why some people freak out about having something before they obviously do, they worry about _____ _____.

Answer 7

Preclinical symptoms.

Question 8

What is the difference between subclinical, preclinical, and clinical disease?

Answer 8

Subclinical: NOT destined to become clinically apparent. Often diagnosed by serologic (antibody) response.

Preclinical: Destined to progress to clinical disease.

Clinical: Characterized by signs and symptoms.

Question 8

What is a carrier?

Answer 8

Harbours the organism; no evidence of an antibody response; can infect others.

Question 9

One common example of preclinical disease concern applies to people aged 50 or over. What is it and why?

Answer 9

Dementia/Alzheimer’s. May be concerned about forgetting something - as preclinical, would fail an Alzheimer’s test, but would they in a couple years?

Question 10

What is the difference between induction and latency phases?

Answer 10

Induction: The time between an exposure of importance and developing the disease.

Latency: Individual has the disease but it is not clinically evident.

Question 11

What phase is commonly associated with screening? Provide an example.

Answer 11

Latency phase.

E.g., breast cancer screening - will determine whether disease starting and intervention warranted.

Question 12

What is the difference between persistent (chronic) disease and latent disease?

Answer 12

Persistent: when a person permanently changes (e.g., postpolio syndrome).

Latent: Infection with no active multiplication of the agent, only the genetic message is present, not viable organism.

Question 13

What is the difference between endemic, epidemic, and pandemic?

Answer 13

Endemic: Usual occurrence, background rate of disease.

Epidemic: In excess of normal, important enough to act upon.

Pandemic: Worldwide epidemic.

Question 14

What are two elements that make up an outbreak?

Answer 14

Local sudden rise in cases. Infections in population affected by susceptibility or immunity to the disease.

Question 15

What is the definition of herd immunity?

Answer 15

The resistance of a group of people to an attack by a disease to which a large proportion of the members of the group are immune.

Question 16

What are the four things that must be true for herd immunity?

Answer 16

Single host species within which transmission occurs (“herd” must be the same).

Relatively direct transmission from one member of host species to another.

No reservoir other than host (e.g., humans).

Infections must induce solid immunity.

Question 17

What is an incubation period? For what is this term most used?

Answer 17

Interval from receipt of infection to the time of onset of clinical illness (the onset of recognizable symptoms). Mostly used in infectious disease.

Question 18

What is the difference between quarantine and isolation?

Answer 18

Quarantine: separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick (appropriate duration depends on incubation period).

Isolation: separates sick people with a contagious disease from people who are not sick.

Question 19

What are the three types of prevention? Provide examples.

Answer 19

Primary: Preventing initial development of a disease (e.g., immunization).

Secondary: Early detection of existing disease to reduce severity and complications (e.g., cancer screening).

Tertiary: Reducing impact of the disease (e.g., stroke rehabilitation).

Question 20

The most effective/efficient way to improve health is sometimes framed as what?

Answer 20

Medical care (treatment) versus public health efforts (prevention).

Question 21

The McKeown thesis suggested what? What are the implications?

Answer 21

Medical interventions like vaccines and curative medicine were not the causes of the decline in mortality in England/Wales from 1860-1950.

We do not need a strict understanding of a disease in order to get to the bottom of a useful intervention for treating disease.

Question 22

There are treatments that act as prevention, like for Alzheimer’s or HIV. How does this impact prevention?

Answer 22

This is a medical intervention that can prevent cases in a population, but does not alter the data-generating process (i.e., will still see new batches of cases).

Question 23

In the 1970s, universal health care insurance had been established in many countries,
including Canada. However, this did not have what anticipated effect?

Answer 23

Equalizing health outcomes across dimensions of concern.

Question 24

When universal health care was established, what conception of health was prominent?

Answer 24

The biomedical conception (“health is the absence of disease”).

Question 25

Shifted attention from health care to the determinants of health status resulted in what three major reports in Canada?

Answer 25

1974: A New Perspective on the Health of Canadians: A Working Document. (“The Lalonde Report”)

1986: Ottawa Charter for Health Promotion and Achieving Health for All: A Framework for Health Promotion.(“The Epp Report”)

1987: Canadian Institute for Advanced Research (CIFAR/CIAR) Program in Population Health (closed in 2003)

Question 26

What were Lalonde’s Big Four?

Answer 26

Human Biology
Environment
Lifestyle
Health Care Organization

Question 27

The Lalonde report spawned what two fields?

Answer 27

Health Promotion
Population Health

Question 28

Health promotion is what, essentially?

Answer 28

Enabling people to choose healthy options, trying to get them to do so.

Question 29

Population health grew from what initiative and what book?

Answer 29

CIAR Population Health Initiative.

“Why Are Some People Healthy and Others Not?” (1994)

Question 30

What are the differences between health promotion and population health?

Answer 30

Health promotion: Stories, experience; embracement of activism; value-committed position.

Population health: Evidence, science; no claim to activism; value-ambiguous position.

Question 31

What is arguably one of the most widely used frameworks for the health of a population?

Answer 31

Solar & Irwin (2010).