Module 3 Flashcards
1
Q
What is socioeconomic position?
A
It is a relative measure
“The structural and economic factors that influence what positions individuals or groups hold within the structure of society”
2
Q
In order for socioeconomic position to be a use full measure what determinants must be used?
A
Objective
Measurable
Meaningful
3
Q
Why measure socioeconomic position?
A
- Used to quantify the level of inequality within or between societies
- needed to help understand the relationship between health and other social variables
4
Q
What elements are measured for measuring socioeconomic position for individuals?
A
- education
- Income
- Occupation
- Housing
- Assets/wealth
5
Q
Measuring socioeconomic position for populations?
A
- Area measures ( area deprivation, access deprivation)
- income inequality
- Literacy rates
- Gross domestic product (GDP)
6
Q
Socioeconomic individual lifestyle factors?
A
- Focuses on YOU
- Your education, income, occupation
- you make the decisions to influence your opportunities
7
Q
How does your economic position relate to health?
A
Education related to health - more educated less likely to smoke etc
8
Q
Social and community influences socioeconomic position?
A
- Your parents education, income, occupation
- your own influences are influenced by your parents education, occupation, income & assets
9
Q
Living & working conditions influences o socioeconomic position?
A
- Use area based measures (most common in NZ is NZ index deprivation
- other measures include social fragmentation & accessibility index’s
10
Q
Variables included in the NZ deprivation?
A
- Communication - people aged < 65 with no access to internet
- Income = 18-65 receiving a benefit
- Income = income below threshold
- Employment = unemployed
- Qualifications = no qualifications
- Owned home = not living in own home
- Support = single parent families
- Living space = below bedroom occupancy thresholds
- Transport = no access to a car
11
Q
General socioeconomic, cultural, environmental conditions?
A
- Groups populations with similar socioeconomic position levels together
- cross-sectional or longitudinal
- The NZ census mortality study
- Using the integrated data infrastructure
12
Q
Global socioeconomic position?
A
- Income inequality
- National income
- Literacy rates
- Free trade agreements
13
Q
Why do we need population data for ?
A
Measuring trends - births, mortality, morbidity, migrations
More applied work
14
Q
The population data sources?
A
The census Estimated resident populations Vital effects Health service utilisation and outcomes (HSU) Integrated data infrastructure (IDI) Nationally representative surveys Ad how surveys
15
Q
Why denominators and age structure matters?
A
HSU
IDI
16
Q
When collecting data we have to be mindful of?
A
Ethics & data privacy Purpose of data collection Population Vs Population samples Are they representative sample? Objective vs subjective measurements
17
Q
Population structure measures?
A
Ages & sex
18
Q
Population composition?
A
By other attributes
19
Q
Ethnicity coding protocol used?
A
Total response output
Prioritised response output
Sole combination
20
Q
Population structure effects?
A
Fertility
Mortality
Migration
21
Q
Types of aging?
A
Numerical & structural aging
22
Q
Numerical aging?
A
Absolute increase I the population that is elderly
Improvements in life expectancy
23
Q
Structural aging?
A
- The increase in the proportion of the population that is elderly
- driven by decrease in fertility rates
24
Q
Natural decline of the population occurs?
A
- When there is more deaths then births In a population
- combination of absolute and structural aging
25
Absolute decline of the population?
Occurs when there is insufficient migration to replace the lost births & increased death rates
26
Main causes of death in NZ are?
Cancer
Ischaemic heart disease
Stroke
Chronic lower respiratory disease
27
What are viral effects?
Births, deaths, marriages
28
Health service utilisation & outcomes is recorded by who?
Ministry of health record and report
29
What are important pieces of information that you need to know about a pandemic?
- How transmissible it is
- How severe & unequal
- How controllable
- How certain is the info and how stable is the threat
30
What are the main strategic options for responding to a pandemic?
Control (reduce incidence)
Eliminate (reduce to zero In country)
Or do nothing
31
What is the reproductive number?
Mean number of infections directly generated by 1 case in the population where all individuals are susceptible to infections
32
Effective reproductive number?
The number of additional infections caused by an initial infection at a specific time
33
Intervention for elimination strategy?
Exclusion of cases
Case & outbreak management
Preventing community transmission
Social safety net
34
How would you measure the success of your pandemic response?
Rapid decline
End of community transmission
Deaths
Recovered
35
How do you calculate herd immunity?
1-(1/Ro)
36
How do you calculate population immunity?
Vaccine effectiveness X vaccine coverage
37
What is misinformation?
False information that is spread regardless of intent to mislead
38
What is Disinformation?
Deliberately misleading or biased information; manipulated narrative or facts; propaganda
39
What lessons are there from the pandemic in terms of future threats?
- Improving evidence based informed decision making
- adapting response to future threats
- building effective public health infrastructure
- supporting effective global health institutions
- seizing public health opportunities provided by the COVID 19 reset
40
Maori health assumptions?
- Demographic differences between Maori & non Maori populations and implications
41
Ethnicity is what?
A social construct
42
Maori health is exemplified by systematic disparities In what?
Health outcomes
Exposure to determinants of health
Health system responsiveness
Representatives in the health work force
43
Disparities in Maori health?
- Unequal access to SDH
- CVD
- Cancer
- Injury
- Diabetes
- Mental health inc self harm
- Infectious diseases
- Disability
- Participation in the health workforce
44
What does disparities mean?
Differences
45
What does inequalities mean?
Unequal, no judgement
46
What does inequities mean?
Social justice/ fairness
47
Structural issues for the titanic example?
```
Lack of Life boats
Barriers to the boats for 3rd class passengers
```
48
Social interventions for the titanic ?
Right based approach
| Commitment to reviews and level playing field
49
What lessons can we learn from the titanic example?
We can have a levelling interventions which are not privileging - such as the escalator example which levels the death rate but not privileging
50
As deprivation increases so does what?
Death rate increase
51
Why do disparities exist?
```
Internal = Within Maori
External = how the external environment treat Maori - this is the important one
```
52
What are the determinants of ethnic inequalities in health ?
1. Differential access to health determinants or exposures leading to differences in disease incidence
2. Differential access to health care
3. Differences in quality of care received
53
Differential access to health determinants or exposures leading to differences in disease incidence
Differences to exposure of determinants of health leads to differences in health outcomes
- Such as poor housing leading to respiratory problems
54
Differential access to health care
No vehicles to get to quality health care, costs, deprivation
- Maori suffer more deaths by IHD, however, receive less angioplasties
55
Differences in quality of care received means?
Once in the healthcare system - the treatment received by the Maori is normally poorer than if you were non-Maori
56
Structural contributions to Maori health?
The power, resources and opportunities of NZ society are organised by ethnicity
57
Societal contributions to Maori health?
That there are values & assumptions widely held I NZ society about the deservedness of different groups of people
58
Variables in the NZ dep?
| Communication
People aged <65 with no access to internet
59
Variables in the NZdep?
| Income (1)
People aged 18-65 receiving a means tested benefit
60
Variables in the NZdep?
| Income (2)
People living in equivalence household with income below an income threshold
61
Variables in the NZdep?
| Employment
People aged 18-65 unemployed
62
Variables in the NZdep?
| Qualifications
People aged 18-64 without any qualifications
63
Variables in the NZdep?
| Owned home
People not living In their own home
64
Variables in the NZdep?
| Support
People aged <65 living in a single parent family
65
Variables in the NZdep?
| Living space
People living in equivalised households below a bedroom occupancy threshold
66
Variables in the NZdep?
| Transport
People with no access to a car
67
Ensuring area level deprivation?
It is another way of measuring people “relative” position In society
68
What does mitigate mean?
Avoid overwhelming health services
69
What does suppress mean in relation to COVID ?
Reduce to low level to minimise health effects eg HIV, AIDS
70
What does eradicate mean in relation to COVID?
Reduce to zero at global level
71
What does eliminate in relation to COVID mean?
Reduce to zero in a country or region
72
What does control mean in COVID ?
Reduce incidence/prevalence
73
Taking a history is critical otherwise you are what?
Treating the symptoms and not the underlying causes
74
Maori health early contact?
Initially flourished economically & socially
75
Maori health official engagement ?
Colonisation
Treaty of waitangi
Heralding an era of depopulation
Disease & dispossession
76
Maori health colonisation?
Was not value free
Assumptions heals by colonisers
Notions of superior & inferior
Notions of deserving & undeserving
77
Treaty implications - Creation of governments?
Art I & Art II
78
Art I?
- Construction of state sector - justice system, education, health, welfare
- Constitution act 1852
79
Art II?
Laws & policies
| Disregard for Maori voice/ authority despite ART II
80
Maori land alienatioN relationship to health?
Social disruption
Breakdown of political power and alliances
Economic resource depletion & poverty
81
Different or denied citizenship - ART II?
| Pensions
Old age pensions ART II
equal provisions for Maori & pakeha, however!
- Maori access difficult - through Maori land court
- Maori regUlarly removed from rolls
- reduced amount paid to Maori
82
Land alienation, policy alienation & unequal (inferior citizenship)
Contributed to what?
The poor health of the Maori
83
Relative inequality? What is it, how do you Calculate it?
It is the same as relative risk
| Ego/CGO
84
What is absolute inequality and how do you calculate it?
It is the same as risk difference
| Calculated by EGO-CGO
85
Structural interventions for the titanic example?
- equal access to the lifeboats
- no barriers to the boats
- enough boats
86
Interventions are not aimed at changing individual behaviour but more so ?
Changing the access for individuals
87
Maori health has a colonial and contemporary history ?
Yes
88
Early contact Maori health ?
Initially flourished - economically & socially
89
After the official engagement what happened?
```
Colonisation
ToW
Depopulation
Disease
Dispossession
```
90
Colonisation and the treaty created a government
Construction of state sector such as justice system, education, health, welfare - These are all remnants of the Treaty of Waitangi
91
Maori land meant what?
Historical basis of settler wealth
Pre-exemption pause of ToW
Maori land court
92
How does land alienation result or associate with health?
- Through social disruption of community
- Breakdown of political power & alliances
- Economic resource depletion & poverty
- Resentment by indigenous peoples
93
Art III - Pensions?
1898
- Equal provision for Maori & pakeha - however didn’t turn out like that
- Asians particularly excluded
- Maori access difficult - thru Maori land court
- Reduced amounts paid to Maori
- regularly removed off rolls
94
Addressing inequities in political ?
Yes
95
What is equality?
Giving everyone the same
96
What is equity ?
Giving everyone what they need to become equal
97
Inequalities ?
Measurable differences or variations in health
98
Inequities?
Those inequalities that are deemed to be unfair or stemming from some form of injustice
99
Progress stands fro?
```
P- Place of residence
R - rave/ethnicity
O - occupational differences
G - Gender/sex
R - Religion
E - Education
S - Socioeconomic status
S - Social capital
```
100
Absolute inequality ?
Risk difference EGO -CGO
101
Relative inequality ?
Relative risk
EGO/CGO
Always out of 1
102
CGO?
Always the most advantaged group
103
Why reduce inequalities ?
They are unfair
Avoidable
They effect everybody
Reducing inequities can be cost effective
104
Intra-generational mobility?
Refers to the movement up or down the social ladder in an individuals lifetime
105
Inter-generational mobility?
Refers to the change in socioeconomic position between a parent and their children
106
Equality of opportunity?
Everyone has the same chance of moving up the social ladder
107
The Lorenz curve?
Describes the well-being of society
| Draw absolute and measure income inequality - the more concave the more income inequality
108
The prevalence of mental illness is higher in what?
Countries with high levels of income inequality
109
The best/lowest levels of mental health in countries is a result from?
Countries with low levels of income inequality
110
Implications of income inequalities?
```
An unequal society
Less social cohesion
Less trust between groups
Increased stress
Reduced economic productivity
Poorer health outcomes
```
111
Define deprivation?
A state of observable and demonstrable disadvantage relative to the local community, wider society or nation to which an individual, family or group belongs
112
What are the 7vs of big data ?
Volume, velocity, variety, veracity, variability, value, visualisation
113
Where does big data come from?
Electronic medical and health records
Internet of things (IoT)
Research data repositories
Social media
114
What is volume?
The computing capacity required to store & analyse data
115
What is velocity ?
The speed at which that data is created analysed
116
What is variety ?
The types of data sources available (text, images, social media)
117
What is veracity ?
The accuracy and credibility
118
What is variability?
The internal consistency of your data (reproducible research)
119
What is value
The cost required to undertake big data analysis should pay dividends for your organisation & their patients
120
What is Visualisation ?
The use of novel techniques to communicate the patterns that would otherwise be lost in massive tables of data
121
What is data linkage?
Is the linkage of data between different sources based on key info - such as sex, age, AUID, NHI
122
Benefits of linking data?
It provides a more complete picture
123
What does deterministic mean?
The exact matches based on personal information appearing in all of the datasets that are to be linked
124
What is Probabilistic ?
Statistical weights are used to calculate the probability that data from different sources refer to the same individual
125
What is the NHI No.?
National health index
Tracks your interactions with the health system
Allows gps, pharmacists, DHBs to be reimbursed
126
External quotient?
Like relative risk however calculated by:
| Highest value / lowest value
127
Range?
Like risk difference however calculated:
| Highest value - lowest value
128
What is the integrated data infrastructure?
- A large research data base containing micro data about people & households
- Deidentified data from a range of government agencies, statistics NZ
- holds 166billion facts
129
Benefits of IDI?
De-identified
Linkable
Accessed in a data safe haven
130
Potential risks of IDI?
- Resident population definitions can vary from study to study
- The source is only as good as the data it contains
- selection biases? What are the concerns about data quality ?
131
3 key areas in which big data presents challenges ?
1. Data governance
2. Data generation
3. Data output
132
Data governance challenges ?
Collection of practices and processes which help to ensure formal management of data assets within an organisation
133
Data generation challenges ?
Data quality is even more important
Larger numbers results in more accurate picture
Includes - capturing, curating, updating & accuracy
134
Data output challenges ?
Including analysis, wiring large datasets and generating meaningful and reliable outputs
135
IDI privacy means?
Refers to the ability of a person to control the availability of information about themselves
136
IDI security means?
Refers to how the agency stores & controls access to the data it holds
137
IDI confidentiality means?
Refers to the protection of information from & about individuals & organisations and ensuring that the information is not made available or disclosed to unauthorised individuals or entities
138
Implications of using big data?
Data in = data out
Inadvertent discrimination of sub populations
Anonymity is not guaranteed
Control over your data
139
What actually is big data?
- Large or complex datasets which often need terabytes or petabytes of storage
- Large amounts of information at a population, regional or local level or span different geographical areas
140
Why is IDI referred to as a “deficit” data set?
To be counted you have had to have interactions with acc, police, education, health etc which means you’ve even gotten into trouble or fallen ill or something like that
141
Deprivation definition?
Is an observable or demonstrable disadvantage relative to the local community, wider society, or nation to which an individual belongs to
142
NZ IMD components?
```
Education
Income
Employment
Housing
Health
Access
Crime
```
143
What does employment mean in the IMD?
Measures the degree to which working age people are excluded from employment
144
What does IMD income mean?
Captures the extent of income deprivation in a data zone by measuring state-funded financial assistance to those with insufficient income
145
What does crime mean in IDM?
Measures risk of people and material victimisation
146
What does housing mean in IDM?
Prop of people living in overcrowded housing & prop living in rented accommodation
147
What does Health mean in IDM?
Identifies areas with a high level of ill health or mortality.
148
What does Education mean in IDM?
Youth disengagement
| & proportion of working age without a formal qualification
149
What does access mean IDM?
Cost & inconvenience of travelling to access basic services - supermarkets, GPS, service stations, ECE, primary & secondary schools
150
Comparing IDM to NZDep 2013 ?
- Things that you include in the IDM don’t just cover things in the census
- In the graph some places have low IDM but high NZDep and vice versa
151
Appropriate uses for the NZ dep?
Planning & resource allocation
Research
Advocacy
152
Appropriate interpretation of NZDep 2013?
“People living I the most deprived neighbourhoods”
NOT - the most deprived people
153
What is the ecological fallacy?
The error that arises when information about groups of people use used to make inferences about individuals
NB// - just because you are from a deprived areas doesn’t mean you as an individual is deprived
154
Addressing variations in health.
| Upstream interventions tend to be at what level of the Dahlgreen and whitehead model?
Outermost arch on the Dahlgren & whitehead model
However interventions can target the individual and community level - taxation schemes, green prescriptions
155
What is a healthy environment?
The physical, social or political setting that prevent disease why enhancing human health & well-being
156
Elements of a healthy environment ?
```
Clean air & water
Appropriate housing
Access to wholesome food
Safe community spaces
Access to transport
Opportunities to incorporate exercise
```
157
What is the built environment?
All the buildings, spaces, products that are created, or at least significantly modified by humans
158
Built environment structures?
Homes, schools, workplaces
159
Built environment urban design?
Roads, parks, business areas
Above ground - electric transmission lines
Below ground - waste disposal, subway trains
Across land - roads, highways
160
How can a built environment be measured?
Urban density
Land use mix
Street connectivity
Community resources
161
Community resource accessibility index components ?
36 facilities representing 6 domains
1. Recreational - parks, beaches
2. Public transport
3. Education
4. Shopping facilities
5. Health
6. Social - Marae, churches, halls
162
Definition of access?
- Proof of access is use of services not simply the presence of a facility
- access can be measured in relation to need
163
What are the 5 As?
- Availability
- Accessibility
- Accomodation
- Affordability
- Acceptability
164
What does availability mean?
The relationship BETWEEN volume & types of existing services.
- How satisfied are you with your ability to find a good doctor?
- Knowledge of where to get good health advice?
- Ability to get medical care in an emergency ?
165
What is accommodation?
The relationship BETWEEN how supply resources are organised & expectation of clients
- how satisfied are you with how long you have to wait to get an appointment ?
- how convenient a physicians office hours are?
- how long you have to wait In the waiting room?
- how easy it is to get in touch with your physician?
166
What is acceptability ?
The relationship BETWEEN Clients & providers attitudes to what constitutes appropriate care ?
- how satisfied are you with the appearance of a doctors office?
- the neighbourhoods in which the offices are In?
- the patients you usually see in the office?
167
What is accessibility?
The relationship between LOCATION OF SUPPLY & location of clients
- how satisfied are you with how convenient your physicians office is to your home?
- how difficult is it to get to your physicians office?
168
What is Affordability
The relationship BETWEEN the doctors prices & the willingness and clients ability to pay for these services
- how satisfied are you with your health insurance?
- how satisfied are you with your physician prices?
- how satisfied are you with how soon your have to pay the bill?
169
What’s the difference between potential & realised in availability?
Potential - The services which are available
Realised - The actual use of these services by individuals or yourself
170
What is affordability direct cost?
The surcharge you pay directly to your GP for their service
171
What is the indirect cost of affordability?
The fuel you use to get to the appointment
| The time taken off to go to the appointment
172
The costs of the providers services in relation to the clients ability & willingness to pay is what 5A?
Affordability
173
The relationship between location of supply & location of clients is what 5A?
Accessibility
174
The relationship between the clients & providers attitudes to what constitutes appropriate care ?
How satisfied are you with the appearance of the office?
Neighbourhood in which the offices are in?
Acceptability
175
The relationship between the manner in which supply resources are organised & expectation of clients?
How satisfied are you with how long you have to wait?
Get in touch with your physician?
Accomodation
176
The relationship between the volume & type of existing services?
How satisfied are you with your ability to find a good doctor?
Availability
177
Two measures of deprivation ?
NZDep 2013
| IMD
178
All things considered how much confidence do you have in being able to get good medical care for you and your family when you need it ?
How satisfied are you with your knowledge of where to get health care?
How satisfied are you with your ability to get medical care in an emergency ?
Availability
179
How satisfied are you with how long you have to wait?
How satisfied are you with how convenient physician office hours are?
How satisfied are you with how long you have to wait I; the waiting room?
How satisfied are you with how easy it is to get in touch with your physician?
Accommodation
180
How satisfied are you with how convenient your physicians office is to you home?
How difficult is it to get to your physicians office?
Accessibility
181
How satisfied are you with the appearance of your physicians office?
How satisfied are you with the neighbourhood their office is it?
How satisfied are you with the other patients you usually see in the waiting room?
Acceptability
182
How satisfied are you with your health insurance?
How satisfied are you with your doctors prices?
How satisfied are you with how soon you need to pay the bill?
Affordability
183
(A+b/pop) - (b/CG)
= PAR
184
Gini coefficient?
The ratio of the area between the line of perfect equality and the observed Lorenz curve
185
What are the SDGS?
A global call to action to end poverty, protect the planet and improve the lives of everyone
186
Goals of the SDGS?
```
No poverty
Zero hunger
Good health and well-being
Quality education
Gender equality
Clean water & sanitation
Affordable & clean energy
Decent work & economic growth
Industry, innovation and infrastructure
Climate action
Life on land
Peace, justice & strong institutions
Sustainable cities & communities
```
187
SDG and the determinants of mental health ?
Neighbourhood
Environmental
Social & cultural Economic
Demographic
188
Neighbourhood for SDG & mental health consists of ?
- clean water & sanitation
- sustainable cities & communities
- affordable & clean energy
- responsible consumption & production
189
Environmental for SDG & mental health consists of ?
- Climate action
| - Peace, justice, strong constitutions
190
Social & cultural for SDG & mental health consists of ?
Quality education
191
Economic for SDG & mental health consists of ?
- No poverty
- Industry innovation & infrastructure
- Reduced inequalities
- Decent work & economic growth
- Zero hunger
192
Demographic for SDG & mental health consists of ?
Gender equality
193
Poverty in relation to NZ SDG?
Prioritising the health of the poor
194
No hunger in relation to NZ SDG?
Addressing the causes and consequences to improve health
195
Good health & wellbeing in relation to NZ SDG?
Ensuring healthy lives & promoting well-being for all at all ages
196
Education in relation to NZ SDG?
Supporting high quality education for all to improve health
197
Clean water in relation to NZ SDG?
Preventing disease through safe water and sanitation for all
198
Decent work in relation to NZ SDG?
Promoting health employment as a driver for an inclusive society
199
Equity in relation to NZ SDG?
Ensuring equitable access to health services
200
Sustainable communities in relation to NZ SDG?
Fostering health communities through better planning, safer & more active living
201
Responsible consumption in relation to NZ SDG?
Promoting sustainable procurement & responsible consumption
202
Climate change in relation to NZ SDG?
Protecting health from climate risks & promoting health through low carbon activities & development
203
Partnerships in relation to NZ SDG?
Mobilising partners to monitor & attain the health related SDG
204
Haddin matrix interventions could lead too?
1. Pre-event - could prevent injuries in the first place
2. Event - could reduce the severity of injury at the time of the accident
3. Post-event - could reduce the consequences of the injury after the event
205
Interventions on humans focus on ?
Educational orientation - trainings, skills etc
206
Interventions focusing on inanimate objects (vehicle/agent) often have a ?
Engineering orientation
207
Interventions focusing on the environment often have a ?
1. Physical - Could include street design
2. Social - could include legislation, set up & financing
3. Health system - Could include availability of trauma & rehab services
