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POPLHLTH111 > Module 2 (interventions) > Flashcards

Module 2 (interventions) Flashcards

1
Q

Socioeconomic position

A

The social and economic factors that influence what positions individuals hold in a society; measured to quantify the level of inequality within/between societies and look for patterns associated with social variables and health

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2
Q

Socioeconomic factors

A

All must be measurable, objective and meaningful

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3
Q

Determinants for individual socioeconomic position

A

Any event, characteristic or other entity that brings about a change for the better or worse in health; vary at different life stages; income, employment, education, housing and neighbourhoods (conditions), societal characteristics and autonomy and empowerment (social cohesion)

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4
Q

Income determinant

A

Strongly related to wellbeing and the ability to purchase health-improving goods and services and take time off work for health appointments; modifiable and can change rapidly

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5
Q

Employment determinant

A

Main factor determining adequate income; enhances social status, improves self-esteem, provides social contact and enhances opportunities for regular activity (important fro physical and mental health)

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6
Q

Education determinant

A

Critical in determining SEP, as it is a pathway to income opportunities and gives people the ability to stand up for what they believe in health; allows people to have literacy

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7
Q

Literacy

A

A person’s ability to take on health messages, pick up on signs of illness themselves and understand the health information/services available to them in order to make appropriate health decisions; stems from education

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8
Q

Housing and neighbourhoods (conditions) determinant

A

Many families now spend a greater proportion of their income on housing costs, leaving less money for other items essential to good health; leads to the sharing of accommodation, causing overcrowding, which impacts physical and mental health

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9
Q

Societal characteristics determinant

A

Racism, attitudes to alcohol or violence, value on children (how they are treated)

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10
Q

Autonomy and empowerment (social cohesion) determinant

A

People with strong family/cultural/community ties tend to have a better health than those who are socially isolated; unemployment and high mobility also reduce social connectedness

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11
Q

Determinants for population socioeconomic position

A

Concepts similar to individuals, but nature of them (how they are measured) are different; not just application of the individual perspective to whole population, but includes characteristics of the population itself; related to the context in which the population exists

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12
Q

Proximal determinants

A

A determinant of health that is proximal/near to the change in health status; downstream factors

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13
Q

Proximal determinants examples

A

Lifestyles and behavioural factors related to nutrition, smoking or other factors

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14
Q

Downstream interventions

A

Operate at the micro (proximal) level; include treatment systems and specific disease management; things we can change easily

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15
Q

Distal determinants

A

A determinant of health that is either distant in time and/or place from the change in health status; upstream factors

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16
Q

Distal determinants examples

A

National, political, legal and cultural fcators that indirectly influence health by acting on the proximal factors

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17
Q

Upstream interventions

A

Operate at the macro (distal) level, such as government policies and international trade agreements; things we can’t change easily

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18
Q

Social gradient

A

Inequalities in social status due to any determinants related to inequalities in health status; links socioeconomic position and population health; for nearly every health outcome and in nearly every society, there is an association between better health outcomes and tertiary education, good jobs and wealth

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19
Q

Social mobility

A

The ability of individuals/groups to move within or between social strata or climb the social ladder; lower in more unequal countries; upward, downward, intergenerational and intragenerational

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20
Q

Upward mobility

A

Moving up the social ladder

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21
Q

Downward mobility

A

Moving down the social ladder

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22
Q

Intragenerational mobility

A

Movement on the social laddeer within an individual’s lifetime

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23
Q

Intergenerational mobility

A

A link in change in SEP or social ladder/position between parent and child

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24
Q

Dahlgren and Whitehead model

A

Model to show upstream and downstream determninants on health status; three levels of influence; agency and structure

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25
Q

D&W model level 1

A

The person; includes age, sex and constitutional factors and individual lifestyle factors; individual choices impact the likelihood of good/bad health

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26
Q

Habitus

A

Level 1 D&W; lifestyle, values and dispositions and expectation of particular social groups ‘learned’ through everyday activities (ability to change behaviour may vary by social groups); learning behaviours may change due to social exposure

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27
Q

D&W model level 2

A

The community; includes social and community networks and living and working conditions; families/friends have a significant role in developing ‘normative’ behaviour

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28
Q

Social capital

A

Level 2 D&W; the value of social networks that facilitates bonds between similar groups of people; levels of trust (shown to be higher in countries in more equal countries); provides inclusive environment for people with diverse backgrounds

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29
Q

D&W model level 3

A

The environment; includes general socioeconomic, cultural and environmental conditions; physical, built, cultural, biological and political environments, and the ecosystem

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30
Q

Agency

A

The capacity of an individual to act independently and make free choices (empowerment, level of autonomy); level 1 and some level 2 of D&W (downstream)

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31
Q

Structure

A

Social and environmental conditions (social determinants) that influence choices and opportunities available; level 2 and 3 of D&W (upstream)

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32
Q

The four capitals

A

Intragenerational wellbeing relies on growth, distribution and sustainability of these four capitals; neural, human, social and financial/physical; make up the patchwork art

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33
Q

Neural capital

A

All aspects of the natural environment needed to support life and human activity; includes land, water, soil, plants and animals, minerals and energy resources

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34
Q

Human capital

A

People’s skills, knowledge and physical and mental health; enable people to participate fully in work, study, recreation and society more broadly

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35
Q

Social capital

A

The norms and values that underpin society; includes trust, the rule of law, the Crown-Māori relationship, cultural identity and people-community connections

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36
Q

Financial/physical capital

A

Includes things like houses, roads, buildings, hospitals, factories, equipment and vehicles, which make up the country’s physical and financial assets (direct role in supporting incomes and material living conditions)

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37
Q

Determinants (inputs) of the four capitals

A

Institutional equality; social and collaborative skills; education; family/whanau wellbeing; reconcilliation of injustices and historical damage to trust; population density; built environment; home ownership and residential stability; material wellbeing; income inequality

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38
Q

Social capital (outputs)

A

The more of these put in, the more positive wellbeing outcomes (safer communities and more demographic function); pro-social behaviour, pro-social norms, sense of equity, social connections, institutional trust

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39
Q

Wellbeing outcomes

A

Better physical health; better mental health; better educational outcomes; better labour market outcomes; better housing outcomes

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40
Q

Societal outcomes

A

Stronger economic performance; better democratic functioning; safer communities; more inclusive society

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41
Q

Inequality

A

Measurable differences or variations in health experiences/outcomes between different population groups

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42
Q

Measures of association for inequality

A

Absolute inequality = risk difference; relative inequality = relative risk

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43
Q

Why health inequalities should be reduced

A

Equitable thing to do; they are avoidable; they affect everyone; has economic benefits

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44
Q

Population health

A

Concerned with the health of groups of individuals in the context of their social and physical environment

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45
Q

Causal relationships

A

Causality cannot be proved in human studies (for practical and ethical reasons)

46
Q

Bradford hill criteria

A

Framework where not all criteria need to be fulfilled and judgement should be used due to the usually complex causal phenomena; temporality, strength of association, consistency of association, biological gradient, biological plausibility of association, specificity of association and reversibility

47
Q

BHC temporality

A

First the cause and then the dis-ease; essential to distinguish a causal relation

48
Q

BHC strength of association

A

The stronger an association, the more likely to be causal in absence of known biases (selection, information and confounding)

49
Q

BHC consistency of association

A

Replication of the findings by different investigators at different times in different places with different methods (multiple studies show similar results)

50
Q

BHC biological gradient

A

Incremental change in dis-ease rates in conjunction with corresponding changes in exposure; as exposure rates increase, disease rate increases

51
Q

BHC biological plausibility of association

A

Does the association make sense biologically?; biologically makes sense

52
Q

BHC specificity of association

A

A cause leads to a single effect or an effect has a single cause; however, health issues have multiple, interacting causes and many outcomes shares causes

53
Q

BHC reversibility

A

The demonstration that under controlled conditions, changing the exposure causes a change in outcome

54
Q

Causal pies

A

Several causal components act together to produce an effect; a given disease can be caused by more than one causal mechanism; blocking/removing any component (sufficient, necessary, component) cause would prevent some cases of disease

55
Q

Sufficient cause

A

The whole pie; a minimum set of conditions without any of which the disease would not occur; not usually a single factor, often several; a disease may have several sufficient causes

56
Q

Component cause

A

A factor that contributes towards dis-ease causation, but it is not sufficient to cause the dis-ease on its own; interact to produce a disease

57
Q

Necessary cause

A

A factor or component cause that must be present if a specific dis-ease is to occur

58
Q

Population based strategy

A

Mass strategy; attempts to shift distribution of health outcomes to a more favourable position in the whole population

59
Q

Population based strategy advantages

A

Radical and addresses underlying causes; large population benefit for whole population; behaviourally appropriate

60
Q

Population based strategy disadvantages

A

Small benefit to individuals; poor motivation of individuals; whole population is exposed to downside of strategy (less favourable benefit-to-risk ratio)

61
Q

High risk strategy

A

Individual strategy; tries to move outcome for high risk group toward normal distribution

62
Q

High risk strategy advantages

A

Appropriate to individuals; individual motivation; cost effective use of resources; favourable benefit-to-risk ratio

63
Q

High risk strategy disadvantages

A

Cost of screening needed to identify individuals; temporary effect; limited potential; behaviourally inappropriate

64
Q

Population health actions

A

Come under both population based and/or high-risk strategies; health promotion, health protection and disease prevention

65
Q

Health promotion

A

Health/wellbeing focus; acts on determinants of wellbeing; enables/empowers people to increase control over and improve their health; involves whole population in everyday contexts

66
Q

Disease prevention

A

Disease focus; looks at particular diseases (or injuries) and ways of preventing them

67
Q

Health protection

A

Predominantly environmental hazard focussed; risk/hazard assessment; occupational health and monitoring; risk communication

68
Q

Healthcare services

A

Primary care (patients’ regular source of healthcare); secondary care (specialist care) and tertiary care (hospital-based care; rehabilitation)

69
Q

Alma Ata 1978

A

Declaration for primary healthcare; first time that social determinants of health (and primary healthcare) was recognised as key to achieving good health for individuals within a population

70
Q

Ottawa charter

A

First international conference on health promotion and asked that governments consider health in all its polices (not just health); has three basic strategies and five strands/priority action areas

71
Q

Basic strategies of ottawa charter

A

Enable, advocate and mediate

72
Q

Enable OC

A

Provide opportunities for all individuals to make health choices through access to information, life skills and supportive environments (individual level strategy)

73
Q

Advocate OC

A

Create favourable political, economic, social, cultural and physical environments by promoting/advocating for health and focusing on achieving equity in health (systems level strategy)

74
Q

Mediate OC

A

Facilitate/bring together individuals, groups and parties with opposing interests to work together/compromise for the promotion of health (strategy that joins up individuals, groups and systems)

75
Q

Priority action areas of ottawa charter

A

Develop personal skills; strengthen community action; create supportive environments; reorient health services toward primary healthcare; build healthy public policy

76
Q
  1. Develop personal skills; examples
A

Priority action of OC; life skills, education in schools, awareness campaigns

77
Q
  1. Strengthen community action
A

Priority action of OC; self-help groups and community-organised services, community initiatives that promote healthy schools, healthy cities, youth health projects

78
Q
  1. Create supportive environments
A

Priority action of OC; implementing air control measures, water and sanitation programmes, building speed bumps, requirement of workplace safety measures

79
Q
  1. Reorient health services toward primary healthcare
A

Priority action of OC; care process responsive to needs of patients and families, health education services, amenities to enhance hospital experience

80
Q
  1. Build healthy public policy
A

Priority action of OC; taxation on alcohol and cigarettes, mandatory seat belt use; banning of smoking in public places, food and drug control, mandatory sports in schools

81
Q

Primary disease and prevention strategies

A

Between the exposure and the biological onset; limit the occurrence of disease (focus on preventing onset) by controlling certain risk factors

82
Q

Secondary disease and prevention strategies

A

Between the biological onset and clinical diagnosis; reduce the more serious consequences of the disease by identifying the disease early so simple measures can help patient before it is too late

83
Q

Tertiary disease and prevention strategies

A

Between the clinical diagnosis and outcome; reduce the progress of complications of established disease (improve outcome)

84
Q

Challenges for health promotion in Māori health

A

Pakeha population usually benefits; sometimes widened the health inequalities between the two ethnicities; due to the models being Western and universal

85
Q

Te Pae Mahutonga

A

4 central stars/key stars (Mauriora, Waiora, Toiora, Te Oranga) and 2 pointers/pre-requisites (Ngā Manukura, Te Mana Whakahaere)

86
Q

Mauriora

A

Access to the Māori world; cultural identity; e.g. working with communities to incorporate/revitalise traditional practices for SIDS)

87
Q

Waiora

A

Physical environments are a key determinant to health; e.g. smokefree, safe bed-sharing for SIDS

88
Q

Toiora

A

Diet, smoking, exercise, safe sex, alcohol; e.g. smoking cessation and breastfeeding promotion for SIDS

89
Q

Te Oranga

A

Social determinants of health, ensuring we have resources to put other key tasks into practice; education, income, employment, housing, political participation, decision-making in society at all levels; e.g. improving education and income support

90
Q

Ngā Manukura

A

Leadership; partnering and enabling community leadership (health professional and community); e.g. Māori professional and academic leadership, collaboration with leaders in communities

91
Q

Te Mana Whakahaere

A

Autonomy; communities need to be enabled to do stuff for themselves; enabling control and having structures in place to be able to make decisions; e.g. communities enabled to identify their own aspirations and priorities and to share in the design of their own solutions

92
Q

Screening in health

A

Involves identifying risk factors for a disease or unrecognised disease by applying the test on a large scale to a population; screening test less expensive diagnostic test, people who test positive subject to a diagnostic test;

93
Q

Screening criteria

A

Suitable disease, suitable test, suitable treatment and suitable screening programme

94
Q

Suitable disease

A

Needs to be an important public health problem; need to have knowledge of the natural history of the disease (or relationship of risk factors to the condition)

95
Q

Suitable test

A

Reliable, safe, simple, affordable, acceptable and accurate

96
Q

Suitable treatment

A

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

97
Q

Suitable screening programme

A

Benefits must outweigh cost; RCT evidence that screening programme will result in reduced mortality and/or increased survival time; adequate resourcing and agreed policy for testing, diagnostic, treatment and programme management; cost affective; able to reach people who need it

98
Q

Lead time bias

A

Survival time from clinical diagnosis to outcome/death; screening before clinical diagnosis may show an apparent increase in life expectancy; may give a false impression of success

99
Q

Length time bias

A

Some diseases will have shorter/longer progress times, patients may have a longer/shorter period between disease onset and death/outcome; likely to pick up more people with slow progressing disease; gives impression of longer average survival

100
Q

GATE frame for study findings in screening

A

Triangle: whole population
Circle: cases diagnosed with (EG)/without (CG) using gold standard
Square: cases diagnosed with/without new test; a (true +) and c (false -) in EG, b (false +) and d (true -) in CG

101
Q

Specificity

A

Likelihood of a negative test in those without the disease; high if the proportion of true negatives is high
= true negatives / all without disease

102
Q

Sensitivity

A

Likelihood of a positive test in those with the disease; high if the proportion of true positives is high
= true positives / all with disease

103
Q

PPV

A

Positive predictive value; proportion who really have the disease of who people who test positive (probability of having the disease if test is positive)
= true positives / all who test positive

104
Q

NPV

A

Negative predictive value; proportion who are actually free of the disease of all people who test negative (probability of not having the disease if test is negative)
= true negatives / all who test negative

105
Q

Population health priorities

A

Evidence-based measures, community expectations and values, human rights and social justice

106
Q

Evidence-based measures (health priority)

A

Finding what conditions are most important in a population; descriptive evidence (square in GATE; trends, most/least affected); explanatory (circle in GATE; determinants, why?); evaluative (how can in be solved, economic feasibility and opportunity cost)

107
Q

Community expectations and values (health priority)

A

Acceptability (will the community/target population accept the problem being addressed?); what do communities want? (culturally appropriate, good information, fair treatment, access)

108
Q

Human rights and social justice (health priority)

A

Obligation to Treaty of Waitangi

109
Q

YLL

A

Years of Life Lost (due to death); age at death and premature mortality

110
Q

YLD

A

Years Lived with a Disability ; time lived with disability

111
Q

PAR formula

A

Population attributable risk = PGO (incidence in total population) - CGO (incidence in unexposed population)

112
Q

Population attributable risk

A

Amount of ‘extra’ disease attributable to a particular risk factor in a particular population; if the association is causal, PAR is the amount of disease we could prevent if we removed that particular risk factor from the population

POPLHLTH111 (3 decks)

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