Module 3 Flashcards
What is the Public Health Model?
Define the problem
Identify risk and protective factors
Test and develop intervention strategies
Ensure widespread adoption
Monitor mediate and evaluate
What are the Bradford Hill criteria?
- Temporality
- Strength of Association
- Consistency of Association
- Biological gradient (dose-response)
- Biological plausibility of the association
- Specificity of association
- Reversibility
What is temporality?
Determine causal relationship, TIMELINE
Cause/exposure factor –> disease after exposure
Smoking leads to lung cancer to deaths
The strength of association?
Stronger association, more likely its causal in absence of known biases like confounding, selection.
British Doctors study : RR>10
Consistency of association?
Replication of the findings by different
investigators, at different times, in
different places, with different methods
Are you getting consistent results?
Bio gradeint?
Incremental change in disease rates in conjunction with corresponding changes in exposure
Chemicals in tobacco that are know to promote cancers. Increasing smoking per day has more deaths
Dose response
Bio plausibility of association?
Biological speaking, does it make sense? Person can have cancer if he smoked due to the chemicals in the cig?
Specificity?
A cause leads to a single effect
However, a single cause often leads
to multiple effect
Smoking leads to –> MULTIPLE OUTCOMES
Reversibility?
The demonstration that under
controlled conditions changing the
exposure causes a change in the
outcome
Smoke a lot higher chances but if I stopped smoking, change exposure, change outcome
British Drs study:
Reduced risk
after quitting
What are the 3 different types of causes?
Sufficient
Component
Necessary
Sufficient cause?
A Sufficient cause is a factor/s that will inevitably
produce the specific dis-ease
Necessary cause?
A Necessary cause is a factor (or component
cause) that must be present if a specific dis-ease is
to occur
Component cause?
Component cause is a factor that contributes
towards dis-ease causation, but is not sufficient to
cause dis-ease on it’s own
Example of different causes if the event is car crash?
Necessary cause: Car on car impact.
Sufficient cause: Faulty brakes (if you don’t stop, you will eventually hit)
Component: Sleepy driver, dim lights (by itself will not cause the crash)
Can you only have sufficient cause to cause an event?
yea
Can a necessary cause be in the sufficient cause?
yes
What is like the Ottawa charter but in Maori version?
Te Pae Mahutonga - 4 key tasks
What are the 4 key tasks of the Te Pae Mahutonga?
Mauriora
Waiora
Toiora
Te Oranga
Mauriora?
Access to Te Ao Maori
To the Maori world, cultural identity language and cultural spaces
Waiora
Environmental protections
How we modify/improve physical environment to improve health
Toiora
Healthy lifestyle
Te Oranga
Participation in society
WHat are the 2 prerequisites of Te Pae Mahutonga?
Nga Manukura (leadership - health pro and community leadership)
Te Mana Whakahaere (autonomy - capacity for self governance, community control and enabling political environment)
What is the objective of screening>
to improve health outcome, morbidity, mortality, disability
What class can screening be out under?
All it can be primary, secondary, and tertiary
Which target intervention does screening normally apply to?
High risk individuals
What is it called if the screening is applied to everyone?
Population based
What is an example of primary screening?
Screening for risk factor
Eg 2 screening?
Breast cancer, they already have the biological onset, they need diagnosis by detecting early stages of the disease
Eg 3 screening?
Screening for bone density following chemo for breast cancer, they have undergone treatment and already diagnosed, emergence of a complication is what is screened we want to treat and reduce complication of the disease already diagnosed
What question is with screening?
Do we spend our money on screening or not?
WHat is the criteria for screening?
Suitable: disease test screening programme treatment
Suitable disease?
a. An important public health problem
i. Relatively common
ii. Relatively uncommon
1) Early detection and intervention - better outcome
b. Knowledge of them natural history of the disease )or relationship of risk factors to the condition)
i. Detectable early (detectable risk factor/disease marker)
ii. Increase duration of pre-clinical phase
Suitable test?
Reliable consistent results safe simple affordable acceptable accurate
Suitable screening programme?
If lose an arm benefits do not outweigh the harm.
Decrease mortality increase survival time thru early detection, diagnosis treatment
Suitable treatment?
Terminal illness “you have disease.. but we have no treatment..”
Should get early treatment early detection
effective, accessible, acceptable
How does screening work?
Less expensive than diagnostic test, identify the groups that are test +ve and -ve so cheap for all population .
The +ve people move to diagnostic test.
What is diagnostic test?
Invasive more specific and best test for the persons to determine if they have disease. Expensive so that is why not WHOLE POP
Do the flowchart of screening of disease
ok
When talking about accuracy under the suitable test what is involved?
Sensitivity and Specificity
Sensitivity?
Ability of the test to identify correctly those who HAVE the disease from all individuals with the disease
TRUE POSITIVE= a/a+c
Specificity
Ability of the test to identify those who DO NOT have the disease from all the individuals free from the disease.
TRUE NEGATIVES = d/d+b
What does it mean when the sensitivity of screening test is high?
The proportion of true positives is high
What does it mean when screening specificity is high?
The proportion of true negatives is high
Leading time bias vs length time bias
RECHECK LEC
Social model of disability?
Disability is seen as a social issue caused by policies, practices, attitudes and or environment NOT individual issue
Ridding society of barriers rather than relying on curing people who have impairments
Medical model of disability
Disabled people are labeled by their illness of issue
Disability is an individual problem
Promotes the view that disabled people as dependent and needing to be cured or cared for (justifying the way in which disabled people have been systematically excluded from society)
Disabled people are the problem, not the society
Control resides with professionals
Choices for the individual are limited to the options provided and approved by the helping expert
What does the GDB look at disability/ what view?
Medical model of Disability
What is the difference between NZDep and IMD?
NZDep gets their info from the Census which is a once every 5 years getting info about NZ and its structural (age-sex) population, GOLD STANDARD, but this is prevalence, a SNAPSHOT
IMD get information from IDI, a longitudinal study where data is collected from public gov organisations. This, however can over and under rep certain populations as only people who have been to hospital for example is included which means we are excluding all the healthy people. This is however, longitudinal so it keeps being updated.
What is the aim of GDB project?
Systematic approach to summarises the burden of disease and injury at population level based on epidemiological principles and evidence
Take account deaths and disability when estimating burden of disease
WHat is DALY
SUmmary measure of pop health with premature death and disability rep the health of the population as a single number
What is the DALY equation?
YLD + YLL
YLL?
Years life lost
- Number of deaths from the disease in a year
- Years of life lost relative to ideal age
YLD?
Years Lived w Disability
- No. cases with disability with disease
- Average duration of disability till death
- Weight of disability
Gains of DALY
Attention to previously hidden burden of mental health issues and injures as major public health problems
Recognise non communicable diseases as a major and increasing problem in low and middle income countries (not just rich countries
Challenges of DALY
Disability weights are considered the same as severity of impairment relating to a disease, DO NOT VARY W A PERSON’S SES
Criticised fro its potential to represent people with disabilities as burden
What is the 2030 agenda?
Benefits for adolescents now
For their future adulthood
And their children
What are the 3rd dimensions of Haddon Matrix
- Effectiveness
- Freedom
- Equity
- Feasibility
- Stigmatisation
- Unforeseen circumstances
- Preference/accessibility
What are the 7 domains of IMD
Crime Education Housing Access Health Employment Income
Another comparison of NZDEP and IMD is… map wise…
In NZDEP we can see that the whole ‘neighborhood’ is deprived but IMD gives us the lens to see the underlying issues of why it is deprived. What are the factors? WHich that means allows us to specifically target what we can do to fix.
What is your visualisation fo NZdep vs IMD
That NZDEP indicators are one sentence (not much) but IMD is extensive af
What makes Big Data BIG
Velocity - speed at which data create and analysed
Variety - types of data available
Veracity - accuracy and credibility of data
Volume - computing capacity required to store and analyse data
Value - costs required to undertake big data should pay dividends to patent and organisation
Variability - internal consistency of your data
Visualisation - use of novel techniques to communicate the pattern that would otherwise be lost in massive tables of data
What is the Right to Health?
The gov doing the bare minimum to provide the opportunity for the public to be healthy like Human Rights
What is the Right to be Healthy?
More than doing the bare minimum like personal lifestyle policies, endorsing organisations which promote healthy wellbeing.
Feminisation of HIV epidemic
Refers to the observation that increasing proportion of new infections are among women, primarily due to heterosexual transmission of the infection
Tobacco control acronym
Monitor tobacco use and prevention policies
Protect people from tobacco use (upstream, law)
Offer help to quit (downstream)
Warn about the dangers
Enforce bans on tobacco adverts
Raise taxes on tobacco
Epidemiological transition
characteristic shift in the
composition of causes of death and disability from
communicable to non-communicable diseases
Demographic transition
decline in fertility and mortality rates observed in most developed and several developing countrie
Risk transition
Changes in risk factor profiles as countries shift from low to higher income countries where common risks for prenatal and communicable disease (unhygienic water) are replaced by non communicable diseases like tobacco
Double burden of disease
Many middle income countries previously common risks for prenatal and communicable disease co exist with increasing factor of non communicable diseases.
Industrial epidemics
Disease arising from overconsumption of unhealthy commerical products
Horizontal equity?
yreferstoaninterventionthattreatsallpeople
equallyorinauniversalway
Vertical equity?
referstoastrategythat
resultsinunequaltreatmentofpeoplebasedontheirunequalriskof
injury
Effectiveness
Is there goof evidence that the intervention would work?
Cost
What are the costs of implementing and or enforcing the program of policy may be also relevant to consider who beas this cost as there may be inequity issues (low income fam may not be able to afford)
Freedom
Extent to which the freedom of a particular group is compromised can result in resistance to the intervention
Stigmatisation
Concept that intervention should NOT stigmatise people whenever possible (like low income fam to qualify for a product)
Preferences/acceptability
Proposed strategy to the affected community or individuals - importance of perceptions and involved socioeconomic cultural context norms and values
Feasibility
Is ti effective is it likely to be applicable in the setting
Unforseen adverse consequences
Thisrelatestosituationslikefencingapropertyresultinginlimitedaccess
tohousefromroadandsecurityconcernsforvehicleorpersonalsafety.
