Module 3 Flashcards
Epidemiology definition
The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.
Population based (mass) strategy
Attempts to move the whole distribution of disease exposure and outcomes in a more favourable direction
High risk (individual) strategy
Only affects individuals over a certain threshold of the distribution
Population-based strategy advantages
- radical (addresses underlying causes)
- large potential benefit for whole population
- behaviourally appropriate
Population-based strategy disadvantages
- small benefit to individuals
- poor motivation of individuals
- whole population is exposed to downside of strategy (less favourable benefit-to-risk ratio)
High-risk strategy advantages
- appropriate to individuals
- individual motivation
- cost effective use of resources
- favourable benefit-to-risk ratio
High-risk strategy disadvantages
- cost of screening
- temporary effect
- limited potential
- behaviourally inappropriate
Health promotion
acts on determinants of wellbeing of the whole population in everyday contexts
Ottawa charter
health promotion: ‘mobilise action for community development’
Ottawa charter acknowledges that health is: [4]
- a fundamental right for everybody
- that it requires both individual and collective responsibility
- the opportunity to have good health should be equally available
- good health is an essential element of social and economic development
Ottawa charter basic strategies: [3]
- Enable
- Advocate
- Mediate
Enable (OC)
To provide opportunities for all individuals to make healthy choices through access to information, life skills and supportive environments
- An individual level strategy
Advocate (OC)
to create favourable political, economic, social, cultural and physical environments by promoting/advocating for health and focusing on achieving equity in health
- A systems level strategy
Mediate (OC)
To facilitate/bring together individuals, groups and parties with opposing interests to work together/come to a compromise for the promotion of health
- A strategy that joins up individuals, groups and systems
Ottawa charter priority action areas: [5]
- develop personal skills
- strengthen community action
- create supportive environments
- reorient health services towards primary health care
- build healthy public policy
Primary prevention strategy
- limit the occurrence of disease by controlling specific causes and risk factors
- reduces disease incidence
Secondary prevention strategy
- early detection to reduce the more serious consequences of disease
- reduces prevalence
Tertiary prevention strategy
- reduce the complications of established disease
Health protection
- predominantly environmental hazard focused
- risk/hazard assessment
- occupational health & monitoring
- risk communication
systematic inequities for Māori: [4]
- in health outcomes
- in exposure to the determinants of health
- in health system responsiveness
- in representation in the health workforce
Māori health promotion
the process of enabling Māori to increase control over the determinants of health and strengthen their identity, thus improving their health and position in society
cultural identity
Mauriora
participation in society
Te Oranga
healthy lifestyles
Toiora
environmental protection
Waiora
community leadership
Ngā Manukura
autonomy
Te Mana Whakahaere
estabilishing population health priorities: evidence based measures: [3]
- descriptive
- explanatory
- evaluative
descriptive evidence (prioritisation)
who is most least affected?
- historical trends
- future trends
explanatory evidence (priorisation)
what are the determinants/risks? why are we getting worse/better? why are populations different (equity)?
PAR
if the association is causal then this is the amount of disease (theoretically) we could prevent if we removed the risk factor from the particular population
evaluative evidence (prioritisation)
what can improve health outcomes (and in whom)? is the intervention improving health outcomes? economic feasibility?
Screening
This can apply to all levels of disease prevention.
Pop gets screened –> those who test pos go to gold standard test—> if pos then treatment. All neg will get rescreened at a time interval of choice
Screening Criteria
- suitable disease
- suitable screening test
- suitable treatment
- suitable screening programme
Suitable disease (screening)
needs to be an important health problem
can be common or uncommon
so detection leads to better health outcome
Suitable test (screening)
reliable
safe
affordable
accurate
go against the gold standard
Specificity
d/cg x 100
is high if the proportion of true negatives is high
fixed measure
Sensitivty
a/eg x 100
high if proportion of true pos is high
fixed measure
PPV
a/a+b
proportion who really have the disease of all who tested positive
changes with prevalence
if higher prev then a higher so higher PPV
NPV
d/c+d x 100
probability of not having the disease if test is negative
not fixed
Suitable treatment Screening
evidence of early treatment leading to better outcomes
Suitable screening programme
benefits must outweigh harm
RCT evidence screening result is less deaths or increased survival time
reach all of community
cost effective
Lead time Bias
survival time = time of death - time of diagnosis
if diagnosed earlier then appearance of more survival time even though disease progression is the same
Length time bias
slower cases of disease progression more likley to be diagnosed than rapid cases
Reasons for GBD Project
wanted info for policy on both death and disability
burden of disease
take account of fatal and non fatal outcomes
DALY
Disability Adjusted Life Years
DALY = YLL + YLD
says burden of disability is the same in very country
YLL
years of life lost
- number of deaths per year
- years lost per death relative to ideal age
YLD
years lived with disability
- disability weight
- number of cases
- average duration until recovery or death
Communicable Diseases
infectious diseases which can be transmitted e.g HIV
Non Communicable Diseases
not able to spread
e.g CVD
Low income country DALY
mostly CD
few NCD
lower age of death
High Income country DALY
mostly NCD
few CD
higher age of death
Better healthcare
Gains of the DALY approach
- drew attention to previously hidden burdens such as mental health
- NCD as an issue in both LIC and MIC and HIC
Medical vs Social model of disability
Medical - thinks of those with a disability as a burden, individual problem, seen as dependent
Social - not the problem of the person but caused by social and environmental barriers
