Module 3 Flashcards
What is socioeconomic position?
It is a relative measure
“The structural and economic factors that influence what positions individuals or groups hold within the structure of society”
In order for socioeconomic position to be a use full measure what determinants must be used?
Objective
Measurable
Meaningful
Why measure socioeconomic position?
- Used to quantify the level of inequality within or between societies
- needed to help understand the relationship between health and other social variables
What elements are measured for measuring socioeconomic position for individuals?
- education
- Income
- Occupation
- Housing
- Assets/wealth
Measuring socioeconomic position for populations?
- Area measures ( area deprivation, access deprivation)
- income inequality
- Literacy rates
- Gross domestic product (GDP)
Socioeconomic individual lifestyle factors?
- Focuses on YOU
- Your education, income, occupation
- you make the decisions to influence your opportunities
How does your economic position relate to health?
Education related to health - more educated less likely to smoke etc
Social and community influences socioeconomic position?
- Your parents education, income, occupation
- your own influences are influenced by your parents education, occupation, income & assets
Living & working conditions influences o socioeconomic position?
- Use area based measures (most common in NZ is NZ index deprivation
- other measures include social fragmentation & accessibility index’s
Variables included in the NZ deprivation?
- 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
General socioeconomic, cultural, environmental conditions?
- Groups populations with similar socioeconomic position levels together
- cross-sectional or longitudinal
- The NZ census mortality study
- Using the integrated data infrastructure
Global socioeconomic position?
- Income inequality
- National income
- Literacy rates
- Free trade agreements
Why do we need population data for ?
Measuring trends - births, mortality, morbidity, migrations
More applied work
The population data sources?
The census Estimated resident populations Vital effects Health service utilisation and outcomes (HSU) Integrated data infrastructure (IDI) Nationally representative surveys Ad how surveys
Why denominators and age structure matters?
HSU
IDI
When collecting data we have to be mindful of?
Ethics & data privacy Purpose of data collection Population Vs Population samples Are they representative sample? Objective vs subjective measurements
Population structure measures?
Ages & sex
Population composition?
By other attributes
Ethnicity coding protocol used?
Total response output
Prioritised response output
Sole combination
Population structure effects?
Fertility
Mortality
Migration
Types of aging?
Numerical & structural aging
Numerical aging?
Absolute increase I the population that is elderly
Improvements in life expectancy
Structural aging?
- The increase in the proportion of the population that is elderly
- driven by decrease in fertility rates
Natural decline of the population occurs?
- When there is more deaths then births In a population
- combination of absolute and structural aging
Absolute decline of the population?
Occurs when there is insufficient migration to replace the lost births & increased death rates
Main causes of death in NZ are?
Cancer
Ischaemic heart disease
Stroke
Chronic lower respiratory disease
What are viral effects?
Births, deaths, marriages
Health service utilisation & outcomes is recorded by who?
Ministry of health record and report
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
What are the main strategic options for responding to a pandemic?
Control (reduce incidence)
Eliminate (reduce to zero In country)
Or do nothing
What is the reproductive number?
Mean number of infections directly generated by 1 case in the population where all individuals are susceptible to infections
Effective reproductive number?
The number of additional infections caused by an initial infection at a specific time
Intervention for elimination strategy?
Exclusion of cases
Case & outbreak management
Preventing community transmission
Social safety net
How would you measure the success of your pandemic response?
Rapid decline
End of community transmission
Deaths
Recovered
How do you calculate herd immunity?
1-(1/Ro)
How do you calculate population immunity?
Vaccine effectiveness X vaccine coverage
What is misinformation?
False information that is spread regardless of intent to mislead
What is Disinformation?
Deliberately misleading or biased information; manipulated narrative or facts; propaganda
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
Maori health assumptions?
- Demographic differences between Maori & non Maori populations and implications
Ethnicity is what?
A social construct
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
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
What does disparities mean?
Differences
What does inequalities mean?
Unequal, no judgement
What does inequities mean?
Social justice/ fairness
Structural issues for the titanic example?
Lack of Life boats Barriers to the boats for 3rd class passengers
Social interventions for the titanic ?
Right based approach
Commitment to reviews and level playing field
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
As deprivation increases so does what?
Death rate increase
Why do disparities exist?
Internal = Within Maori External = how the external environment treat Maori - this is the important one
What are the determinants of ethnic inequalities in health ?
- Differential access to health determinants or exposures leading to differences in disease incidence
- Differential access to health care
- Differences in quality of care received
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
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
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
Structural contributions to Maori health?
The power, resources and opportunities of NZ society are organised by ethnicity
Societal contributions to Maori health?
That there are values & assumptions widely held I NZ society about the deservedness of different groups of people
Variables in the NZ dep?
Communication
People aged <65 with no access to internet
Variables in the NZdep?
Income (1)
People aged 18-65 receiving a means tested benefit
Variables in the NZdep?
Income (2)
People living in equivalence household with income below an income threshold
Variables in the NZdep?
Employment
People aged 18-65 unemployed
Variables in the NZdep?
Qualifications
People aged 18-64 without any qualifications
Variables in the NZdep?
Owned home
People not living In their own home
Variables in the NZdep?
Support
People aged <65 living in a single parent family
Variables in the NZdep?
Living space
People living in equivalised households below a bedroom occupancy threshold
Variables in the NZdep?
Transport
People with no access to a car
Ensuring area level deprivation?
It is another way of measuring people “relative” position In society
What does mitigate mean?
Avoid overwhelming health services
What does suppress mean in relation to COVID ?
Reduce to low level to minimise health effects eg HIV, AIDS
What does eradicate mean in relation to COVID?
Reduce to zero at global level
What does eliminate in relation to COVID mean?
Reduce to zero in a country or region
What does control mean in COVID ?
Reduce incidence/prevalence
Taking a history is critical otherwise you are what?
Treating the symptoms and not the underlying causes
Maori health early contact?
Initially flourished economically & socially
Maori health official engagement ?
Colonisation
Treaty of waitangi
Heralding an era of depopulation
Disease & dispossession
Maori health colonisation?
Was not value free
Assumptions heals by colonisers
Notions of superior & inferior
Notions of deserving & undeserving
Treaty implications - Creation of governments?
Art I & Art II
Art I?
- Construction of state sector - justice system, education, health, welfare
- Constitution act 1852
Art II?
Laws & policies
Disregard for Maori voice/ authority despite ART II
Maori land alienatioN relationship to health?
Social disruption
Breakdown of political power and alliances
Economic resource depletion & poverty
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
Land alienation, policy alienation & unequal (inferior citizenship)
Contributed to what?
The poor health of the Maori
Relative inequality? What is it, how do you Calculate it?
It is the same as relative risk
Ego/CGO
What is absolute inequality and how do you calculate it?
It is the same as risk difference
Calculated by EGO-CGO
Structural interventions for the titanic example?
- equal access to the lifeboats
- no barriers to the boats
- enough boats
Interventions are not aimed at changing individual behaviour but more so ?
Changing the access for individuals
Maori health has a colonial and contemporary history ?
Yes
Early contact Maori health ?
Initially flourished - economically & socially
After the official engagement what happened?
Colonisation ToW Depopulation Disease Dispossession
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
Maori land meant what?
Historical basis of settler wealth
Pre-exemption pause of ToW
Maori land court
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
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
Addressing inequities in political ?
Yes
What is equality?
Giving everyone the same
What is equity ?
Giving everyone what they need to become equal
Inequalities ?
Measurable differences or variations in health
Inequities?
Those inequalities that are deemed to be unfair or stemming from some form of injustice
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
Absolute inequality ?
Risk difference EGO -CGO
Relative inequality ?
Relative risk
EGO/CGO
Always out of 1
CGO?
Always the most advantaged group
Why reduce inequalities ?
They are unfair
Avoidable
They effect everybody
Reducing inequities can be cost effective
Intra-generational mobility?
Refers to the movement up or down the social ladder in an individuals lifetime
Inter-generational mobility?
Refers to the change in socioeconomic position between a parent and their children
Equality of opportunity?
Everyone has the same chance of moving up the social ladder
The Lorenz curve?
Describes the well-being of society
Draw absolute and measure income inequality - the more concave the more income inequality
The prevalence of mental illness is higher in what?
Countries with high levels of income inequality
The best/lowest levels of mental health in countries is a result from?
Countries with low levels of income inequality
Implications of income inequalities?
An unequal society Less social cohesion Less trust between groups Increased stress Reduced economic productivity Poorer health outcomes
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
What are the 7vs of big data ?
Volume, velocity, variety, veracity, variability, value, visualisation
Where does big data come from?
Electronic medical and health records
Internet of things (IoT)
Research data repositories
Social media
What is volume?
The computing capacity required to store & analyse data
What is velocity ?
The speed at which that data is created analysed
What is variety ?
The types of data sources available (text, images, social media)
What is veracity ?
The accuracy and credibility
What is variability?
The internal consistency of your data (reproducible research)
What is value
The cost required to undertake big data analysis should pay dividends for your organisation & their patients
What is Visualisation ?
The use of novel techniques to communicate the patterns that would otherwise be lost in massive tables of data
What is data linkage?
Is the linkage of data between different sources based on key info - such as sex, age, AUID, NHI
Benefits of linking data?
It provides a more complete picture
What does deterministic mean?
The exact matches based on personal information appearing in all of the datasets that are to be linked
What is Probabilistic ?
Statistical weights are used to calculate the probability that data from different sources refer to the same individual
What is the NHI No.?
National health index
Tracks your interactions with the health system
Allows gps, pharmacists, DHBs to be reimbursed
External quotient?
Like relative risk however calculated by:
Highest value / lowest value
Range?
Like risk difference however calculated:
Highest value - lowest value
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
Benefits of IDI?
De-identified
Linkable
Accessed in a data safe haven
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 ?
3 key areas in which big data presents challenges ?
- Data governance
- Data generation
- Data output
Data governance challenges ?
Collection of practices and processes which help to ensure formal management of data assets within an organisation
Data generation challenges ?
Data quality is even more important
Larger numbers results in more accurate picture
Includes - capturing, curating, updating & accuracy
Data output challenges ?
Including analysis, wiring large datasets and generating meaningful and reliable outputs
IDI privacy means?
Refers to the ability of a person to control the availability of information about themselves
IDI security means?
Refers to how the agency stores & controls access to the data it holds
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
Implications of using big data?
Data in = data out
Inadvertent discrimination of sub populations
Anonymity is not guaranteed
Control over your data
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
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
Deprivation definition?
Is an observable or demonstrable disadvantage relative to the local community, wider society, or nation to which an individual belongs to
NZ IMD components?
Education Income Employment Housing Health Access Crime
What does employment mean in the IMD?
Measures the degree to which working age people are excluded from employment
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
What does crime mean in IDM?
Measures risk of people and material victimisation
What does housing mean in IDM?
Prop of people living in overcrowded housing & prop living in rented accommodation
What does Health mean in IDM?
Identifies areas with a high level of ill health or mortality.
What does Education mean in IDM?
Youth disengagement
& proportion of working age without a formal qualification
What does access mean IDM?
Cost & inconvenience of travelling to access basic services - supermarkets, GPS, service stations, ECE, primary & secondary schools
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
Appropriate uses for the NZ dep?
Planning & resource allocation
Research
Advocacy
Appropriate interpretation of NZDep 2013?
“People living I the most deprived neighbourhoods”
NOT - the most deprived people
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
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
What is a healthy environment?
The physical, social or political setting that prevent disease why enhancing human health & well-being
Elements of a healthy environment ?
Clean air & water Appropriate housing Access to wholesome food Safe community spaces Access to transport Opportunities to incorporate exercise
What is the built environment?
All the buildings, spaces, products that are created, or at least significantly modified by humans
Built environment structures?
Homes, schools, workplaces
Built environment urban design?
Roads, parks, business areas
Above ground - electric transmission lines
Below ground - waste disposal, subway trains
Across land - roads, highways
How can a built environment be measured?
Urban density
Land use mix
Street connectivity
Community resources
Community resource accessibility index components ?
36 facilities representing 6 domains
- Recreational - parks, beaches
- Public transport
- Education
- Shopping facilities
- Health
- Social - Marae, churches, halls
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
What are the 5 As?
- Availability
- Accessibility
- Accomodation
- Affordability
- Acceptability
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 ?
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?
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?
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?
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?
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
What is affordability direct cost?
The surcharge you pay directly to your GP for their service
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
The costs of the providers services in relation to the clients ability & willingness to pay is what 5A?
Affordability
The relationship between location of supply & location of clients is what 5A?
Accessibility
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
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
The relationship between the volume & type of existing services?
How satisfied are you with your ability to find a good doctor?
Availability
Two measures of deprivation ?
NZDep 2013
IMD
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
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
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
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
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
(A+b/pop) - (b/CG)
= PAR
Gini coefficient?
The ratio of the area between the line of perfect equality and the observed Lorenz curve
What are the SDGS?
A global call to action to end poverty, protect the planet and improve the lives of everyone
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
SDG and the determinants of mental health ?
Neighbourhood
Environmental
Social & cultural Economic
Demographic
Neighbourhood for SDG & mental health consists of ?
- clean water & sanitation
- sustainable cities & communities
- affordable & clean energy
- responsible consumption & production
Environmental for SDG & mental health consists of ?
- Climate action
- Peace, justice, strong constitutions
Social & cultural for SDG & mental health consists of ?
Quality education
Economic for SDG & mental health consists of ?
- No poverty
- Industry innovation & infrastructure
- Reduced inequalities
- Decent work & economic growth
- Zero hunger
Demographic for SDG & mental health consists of ?
Gender equality
Poverty in relation to NZ SDG?
Prioritising the health of the poor
No hunger in relation to NZ SDG?
Addressing the causes and consequences to improve health
Good health & wellbeing in relation to NZ SDG?
Ensuring healthy lives & promoting well-being for all at all ages
Education in relation to NZ SDG?
Supporting high quality education for all to improve health
Clean water in relation to NZ SDG?
Preventing disease through safe water and sanitation for all
Decent work in relation to NZ SDG?
Promoting health employment as a driver for an inclusive society
Equity in relation to NZ SDG?
Ensuring equitable access to health services
Sustainable communities in relation to NZ SDG?
Fostering health communities through better planning, safer & more active living
Responsible consumption in relation to NZ SDG?
Promoting sustainable procurement & responsible consumption
Climate change in relation to NZ SDG?
Protecting health from climate risks & promoting health through low carbon activities & development
Partnerships in relation to NZ SDG?
Mobilising partners to monitor & attain the health related SDG
Haddin matrix interventions could lead too?
- Pre-event - could prevent injuries in the first place
- Event - could reduce the severity of injury at the time of the accident
- Post-event - could reduce the consequences of the injury after the event
Interventions on humans focus on ?
Educational orientation - trainings, skills etc
Interventions focusing on inanimate objects (vehicle/agent) often have a ?
Engineering orientation
Interventions focusing on the environment often have a ?
- Physical - Could include street design
- Social - could include legislation, set up & financing
- Health system - Could include availability of trauma & rehab services
