Module 3 Flashcards
(85 cards)
1
Q
Define Deprivation
A
State of observable and demonstrable disadvantage relative to the local community, society or nation to which an individual or group belongs.
2
Q
NZDEP: Communication
A
People under 65 without internet access at home.
3
Q
NZDEP: Income
A
1) People 18-64 receiving a means tested benefit.
2) People living in equivalised households with income below a threshold.
4
Q
NZDEP: Employment
A
Number of people 18-64 who are unemployed
5
Q
NZDEP: Qualification
A
Number of people 18-64 without any qualifications.
6
Q
NZDEP: Owned Home
A
Number of people not living in owned home.
7
Q
NZDEP: Support
A
People under 65 living in a single parent family.
8
Q
NZDEP: Living space
A
People living in equivalised households below a bedroom occupancy threshold.
9
Q
NZDEP: Transport
A
People without access to a car.
10
Q
Ecological Fallacy
A
Errors arising from using information about a group to make assumptions about individuals in the group.
11
Q
IMD: Employment
A
Extent to which individuals in the working age population are excluded from the workforce.
12
Q
IMD: Income
A
Inability for individuals in a group to support themselves financially and needing state funded financial support.
13
Q
IMD: Crime
A
Risk of personal and material victimisation and property damage.
14
Q
IMD: Housing
A
The proportion of houses which are not owned by their occupants or overcrowded.
15
Q
IMD: Health
A
Identifies the level of ill-health, by measuring the incidence of the indicators of ill-health.
16
Q
IMD: Educaction
A
Investigates youth participation in society (ie: getting an education).
Investigates proportion of working age population below a mean level of education.
17
Q
IMD: Access
A
How easily basic services can be reached- measured in terms of convenience and cost.
18
Q
Why should inequities be reduced?
A
Inequities are unfair. People are not given freedom to determine their health outcome. Lack of freedom caused by determinants beyond their control.
Reducing inequities is cost effective. Ensures workforce remains healthy and effective, and reduces costs of treatment. Usually involves only reallocation of resources according to need which adds no additional cost.
Inequities are avoidable. If health outcomes are different at different locations, it means that there are ways to change it. They stem from environmental factors which can be amended at the policy level.
Inequities affect everyone. By affecting the health outcomes of the most at risk, it can have a flow on effect in the form of incohesive society.
19
Q
Immediate and Long Term solutions to Inequality
A
Immediate: Reducing the SE inequality. Get more deprived people into better paid jobs and improving benefit and taxation policies.
Long term: Work with other factors of deprivation such as education and housing. Requires further investment.
20
Q
The Preston Curve
A
Shows non-linear relationship between income and life expectancy.
At low GDP, small increases in income can cause significant increase in life expectancy.
At high GDP, increases in income will have a negligible effect.
21
Q
Level-Up Approach
A
Reallocation of resources from least at risk group to most at risk group.
22
Q
Lifting-Up Approach
A
Uses examples of best performance at a SEP and trying to get others in that SEP to imitate.
23
Q
Population Structure
A
Age and sex
24
Q
Population Composition
A
Everything not age and sex.
25
Demographic Transition Definition
Global process where birth rate and death rate both shifts from high to low.
26
Numerical Ageing
The absolute increase in the number of elderly. Reflects improvements in life expectancy. Unaffected by birth rates of the time.
27
Structural Aging
The relative increase in the proportion of the elderly. Caused by decreasing fertility rates. Can be affected by interventions (One Child Policy).
Can converge with numerical ageing.
28
Natural decline
When death rate> birth rate. Life expectancy increase does not prevent deaths but does reduce birth rate due to reduced youth deaths.
29
Absolute decline
When there is insufficient immigration to counteract the decreasing population size due to natural decline.
30
Advantages of NZDep
Weighted domains.
| Widespread and well known to policy makers.
31
Limitations of NZDep
Uses Census data which isn't completed by everyone.
| Cannot identify drivers of deprivation.
32
Advantages of IMD
Uses the more representative IDI.
Explores drivers of deprivation
Better small area population data.
Forms specific solutions for small populations.
Domains are weighed.
Health outcome measured as part of deprivation.
Not limited by age boundaries like in NZDep.
33
Limitations of IMD
Uses IDI, is a deficit data set, so only people who interact with the healthcare system will be recorded.
IMD isn't very well established.
34
Built Environments
All buildings, spaces and products created or significantly modified by people.
35
Why healthy built environments
Can act as environmental interventions to make healthy choices more conducive.
36
Transport Planning
Improve public transport systems, such as access to public transport stops. Increases active transport.
37
Land use mix
Combination of land being used for different purposes. Allows active transport since distance from point A to point B is small.
Accessible healthy food retail is improved.
38
Housing/urban density
Increases the number of commercial and residential premises in an area- increase walkability by reducing distance between points.
39
Street network design
Grid like pattern- reduces distance between points and encourages active transport.
Traffic calming features and other facilities which encourage walking and cycling.
40
Site design
Community food gardens to improve access to fresh produce.
Availability of breastfeeding facilities to enable breastfeeding for as long as required.
Improved street aesthetics to improve safety and creates environment which promotes health and wellbeing.
41
Health Environments must include:
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Clean air and water.
Good housing
Access to wholesome food.
Safe community spaces.
Ability to incorporate exercise into daily life.
Access to transport.
```
42
Findings of 7 Modes Study
| Hint: Distance and time
Average exposure to pollutants decrease with increased distance from the centre of the road.
Active transporters are more exposed to pollutants as they take longer on their commutes, and they are not protected from exhaust etc.
43
Ways to reduce exposure to pollutants.
Engineering interventiosnL Physical barrier between active transporters and vehicles.
Increase distance between active transporters and vehicles.
Policy level interventions: increase road calming measures in residential areas to reduce volume of traffic. Improve experience of active transporters. Ensure basic services are accessible by active transport.
Actively avoiding sources of pollution, such as walking on the less busy side of the road, or not stopping the bus where there is a lot of vehicle exhaust.
Behavioural changes: Walking in green spaces or further from sources of pollutants, such as on the opposite side of a busy road.
44
Definition of Access
The end result of a process flowing from predisposing characteristics and enabling resources, through need (perceived and evaluated) to an ultimate health outcome.
45
Potential Access
The amount of services available to clients.
46
Realised Access
The amount of resources actually being used due to factors of the 5 dimensions of access.
47
Availability
The knowledge/existence of service barrier.
| Relationship between the volume and type of services available to the volume and type of services demanded.
48
Questions regarding availability.
1. 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?
2. How satisfied are you with your ability to find one good doctor to treat the whole family?
3. How satisfied are you with your knowledge of where to get health care?
4. How satisfied are you with your ability to get medical care in an emergency?
49
Accomodation
Organisational barriers.
| The relationship between the manner in which supply of resources is managed in preparation for clients.
50
Questions regarding accommodation
1. How satisfied are you with how long you have to wait for an appointment?
2. How satisfied are you with how convenient physicians’ hours are?
3. How satisfied are you with how long you have to wait?
4. How satisfied are you with how easily it is to contact your physician?
51
Accessibility
Geographical Barriers. Relationship between location of supply and location of client. Must take into account time and cost of transport.
52
Questions regarding accessibility.
- How satisfied are you with how convenient your physician's offices are to your home?
- How difficult is it for you to get your physician's office?
53
Acceptability
Psychosocial barriers.
The relationship between clients' and providers' attitudes as to what constitutes appropriate care. Clients expect non-discriminatory behaviour and the respect for different social groups and cultures.
54
Questions regarding acceptability
- How satisfied are you with the appearance of the doctor’s offices?
- How satisfied are you with the neighbourhoods their offices are in?
- How satisfied are you with the other patients you usually see at the doctors’ offices?
55
Affordability
Financial barriers. The relationship between the cost of provided services and the clients' ability and willingness to pay. Links to other barriers- lower willingness to pay leads to accessibility issues as affordable gps are far away.
56
Questions regarding affordability
How satisfied are you with your health insurance?
How satisfied are you with the doctors’ prices?
How satisfied are you with how soon you need to pay the bill?
57
The Inverse Care Law
The availability of good healthcare varies inversely with need for it.
Due to tendency for paid healthcare to follow economic distributions, where willingness to pay increases availability.
58
Characteristics of Big Data
Volume: Computing power needed to store and compute big data.
Velocity: How quickly can the data be processed and analysed?
Variety: The diversity in the type (texts, image) and source (administration, social media) of data.
Veracity: Accuracy and reliability of data, which can affect the quality of results of inquiries using this data.
Variability: Internal consistency of the data.
Value: Will the cost of obtaining and analysing data be paid off by the benefit that the results of the inquiry will have (for providing better health care for patients, or generating more profit).
Visualisation: Adequate use of infographic techniques to convey key trends in data that would not be visible from seeing datasets as numbers.
59
Sources of Big Data
Medical records- HSU/ IDI.
Internet of Things
Data repositories containing data from past research.
Social media.
60
Deterministic data linkage
Based on the same identifying information appearing in all datasets to be linked.
61
Probabilistic data linkage
Using statistical weights assigned to data from different sets that do not match exactly to calculate how likely it is that they refer to the same individual.
62
Benefits of the IDI
Links data from across multiple data sets to establish system wide insights.
Life course information- investigates how factors early in life can affect lifestyle outcomes later on.
Identifies risk and protective factors.
Performs predictive risk modelling.
Evaluate the effectiveness of particular interventions.
Identifies characteristics of groups with positive and negative outcomes- determinants of health.
Tailor interventions for people based on their similarities with studied groups. If they share this risk factor, then that risk factor can be targeted in interventions.
63
What can't you use the IDI for?
Following individuals who are utilising services- case management.
Identifying at risk individuals who could use an intervention.
Identify individuals who are abusing systems.
Although all of these seem like legitimate reasons, they involve identification of the individual to some degree and this undermines the de-identification of the data.
64
Data Governance
Regulating practices and processes involved in data storage, transferring and use to ensure professional use of data assets.
65
Data Quality
Regulating how the data is collected and the accuracy of the data being added. Large quantities of data is only reliable if the data going in is correct.
66
Data output
Quality interpretation of results.
| Administrative difficulties with analysing large amounts of data.
67
Five Safes of Big Data
Safe people: Analysts of data must be trustworthy with confidential data, and competent with large amounts of data.
Safe projects: Data usage must be for public benefit, rather than victim blaming or stigmatisation.
Safe settings: Authorised and secure access to data, as well as safe transfer of data outside of this setting for use (ie: proper de-identification and encryption).
Safe data: Data is de-identified, so it is ‘safe’ to be seen by people who aren’t meant to see it because it doesn’t mean anything.
Safe output: See safe data, except in published results.
The gist is that safe use of data would involve protection of individual identity, and the knowledge and intent to do so.
68
Implications of Big Data
Ability to conduct and experiment with hypothetical ‘what if’ scenarios to determine impacts of policy.
Inadvertent discrimination of groups in the population that can be identified by non-hidden aspects of data.
Difficult to control the spread of data.
Requires revisitation of privacy policies.
69
Epidemiological Triangle
Agent: Microbe causing disease.
Host: Carrier of agent who may be suffering symptoms.
Environment: External factors enabling disease spread,
70
P in PROGRESS
Place of Residence: Environmental determinants of health such as availability of healthcare infrastructure at areas of different SEP/ urban or rural areas.
71
What is PROGRESS used for
Framework to guide analysis of inequities acting on groups which affect their health outcomes.
72
First R in PROGRESS
Race/Ethnicity/Language/ Culture: Differences in experience due to social experiences of specific ethnic groups due to prejudices. Differing access to healthcare due to barriers of cultural practice imposed by cultural community, or barriers of language preventing easy communication.
73
O in PROGRESS
Occupation: Encompasses negative determinants associated with work, such as poor working conditions or unemployment. Inequity in health outcomes between different careers due to inherent dangers.
74
G in PROGRESS
Gender and Sex
Biological differences in outcome due to differences between sexes is unavoidable and not unfair.
Different gender-specific roles (assigned by societal expectation) contribute to inequity in health outcome as they cause exposure to different determinants. Social convention also leads to unfair treatment of different gender, leading to differing degrees of exposure.
75
Second R in PROGRESS
Religion
Religion associated inequities exist when there is lower availability of healthcare to a group due to religious affiliations. Not unfair if treatment is rejected due to religious reasons.
76
E in PROGRESS
Education
More educated people are more aware of the determinants of poor health and will take steps to avoid them. The lack of access to education beyond personal choice is unfair, and so will be the consequential difference in health outcome.
77
First S of PROGRESS
Socioeconomic Position:
Higher SEP means improved living conditions and general quality of life. Enables individual to make healthy lifestyle choices. Inequitable as the absence of more accessible for the more deprived isn't inevitable.
78
Second S of PROGRESS
Social Capital: Refers to community and the social network around an individual. Improving connection means improved ability to access help. Linked to inequities leading to SEP as increased SEP inequality in a community reduces social cohesion.
79
HSU Dataset
Collects hospitalisation and prescription data for each individual. Deficit data set as individuals must get sick to be recorded.
Can be used alongside other health data to see how interaction with healthcare system can have an effect on health outcome.
Data isn't collected for epidemiological research.
80
NZ Health Survey
20000 individuals interviewed per year and self-reported data on health status is collected. Self-reporting can lead to errors in BOM.
81
Vital statistics
Nationwide dataset regarding births and deaths in the population. Useful as denominators and can be linked to healthcare data to investigate immunisation rate of newborn or causes of death (etc).
82
Census
Collection of relevant personal information from every individual in a population. Investigates composition and allows division of population into cohorts. Cohorts can be used in epidemiology.
83
Integrated Data Infrastructure
Combines data routinely collected by the government due to interaction with government agency. Deficit data set as such interaction usually stems from deficit.
Very representative. Allows linking of data between datasets.
84
Prioritised Output Pros/Cons
PROS: Ensures all individuals are counted only once across all ethnic groups.
Allows less prevalent groups of policy importance to be represented.
CONS: Does not respect the right for individuals to identify as their chosen ethnicity.
Oversimplification of data.
85
Stages of the Demographic Transition Model
Stage 1: High stable birth. High fluctuating death.
Stage 2: High stable birth. High decreasing death.
Stage 3: high decreasing birth. Low stable death.
Stage 4: Low stable birth and death.
