- predominantly environmental hazard focused - risk/hazard assessment - occupational health & monitoring - risk communication

Module 3 Flashcards by Abigail Campbell

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.

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Population based (mass) strategy

Attempts to move the whole distribution of disease exposure and outcomes in a more favourable direction

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High risk (individual) strategy

Only affects individuals over a certain threshold of the distribution

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Population-based strategy advantages

radical (addresses underlying causes)
large potential benefit for whole population
behaviourally appropriate

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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)

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High-risk strategy advantages

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

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High-risk strategy disadvantages

cost of screening
temporary effect
limited potential
behaviourally inappropriate

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Health promotion

acts on determinants of wellbeing of the whole population in everyday contexts

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Ottawa charter

health promotion: ‘mobilise action for community development’

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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

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Ottawa charter basic strategies: [3]

Enable
Advocate
Mediate

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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

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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

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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

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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

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Primary prevention strategy

limit the occurrence of disease by controlling specific causes and risk factors
reduces disease incidence

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Secondary prevention strategy

early detection to reduce the more serious consequences of disease
reduces prevalence

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Tertiary prevention strategy

reduce the complications of established disease

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Health protection

predominantly environmental hazard focused
risk/hazard assessment
occupational health & monitoring
risk communication

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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

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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

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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

1. suitable disease 2. suitable screening test 3. suitable treatment 4. 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

1. drew attention to previously hidden burdens such as mental health 2. 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