Module 3 and 3+ Flashcards
population based intervention/strategy (mass)
whole pop.
aims to reduce health risks in all
useful for common or widespread
addresses underlying causes,
large potential benefit for whole pop.
behaviourally approprate
small individual benefit
more individual motivation
whole pop. exposed to downsides
high risk prevention strategy/intervention (individual)
high risks groups targeted
appropriate to individuals and high motivation
cost effective
favourable benefit to risk ratio
high cost of screening
temporary effect
limited potential, behaviourally inappropriate
5 priority action areas of ottawa charter
– Develop personal skills - indv. hlth. responsibilit
– Strengthen community action - community autonomy and self prioritisation
– Create supportive environments - natural resources and physical social environments, enable healthier choices, economic support
– Reorient health services towards primary health care
– Build healthy public policy
3 levels of disease prevention strategy
Primary - work before biological onset - reduces incidence/prevalence by controlling causes and risk factors, e.g vaccination
Secondary - early detection to prevent more serious consequences of disease, reduces prevalence, e.g screening
Tertiary - after clinical diagnosis, reduce complications of established disease, e.g rehabilitation
health promotion
act on wellbeing determinants; health/wellbeing focus; enables/ empowers people to increase control over and improve their health; whole pop. in everyday contexts; mostly primary and public health settings
health protection
environmental hazard focus, risk/hazard assessment, occupational health and monitoring (work safety regulations), communication of risk to public
disease prevention
disease focus; looks at particular diseases (or injuries) and ways of preventing them (incidence, prevalence, risk factors impacts, interventions)
te pae mahutonga
4 central stars (key tasks) and 2 pointers (pre-requisites)
Mauriora - access to te ao maori (the maori world - cultural values/identity),
Waiora - environmental protection
Toiora - healthy lifestyles
Te oranga - participation in society (social determinants of health, [education, employment, good housing])
- Nga manukura (leadership) health professional and community leadership (partnership), health professionals not telling, but working with community
- Te mana whakahaere - autonomy, self governance, community control and enabling a political environment
sensitivity
likelihood of a positive test in those with the disease (can test identify correctly those who have disease from all individuals with it): true positives/all with disease x 100
specificity
likelihood of a negative test in those without disease (can test identify correctly those who do not have the disease from all individuals without it) true negatives/all without disease x 100
Positive predictive value (PPV)
proportion who really have the disease of al people who test positive (probability of having disease if test positive) true positives/all who test positive x 100
Negative predictive value
probability of not having disease if test is negative (proportion of who are actually disease free of all people who test negative) true negatives/all who test negative x 100
NPV and PPV
NPV and PPV change to reflect prevalence, if prevalence is high = higher false negative, if prevalence is low = higher false positive
criteria for health prioritisation
- evidence based measures
- descriptive evidence - what problem
- explanatoy evidence - why (determinants, risks, why trend?)
- evaluative - what improves outcomes and in whole (intervention - community expectation - acceptability and what they want
- Te tiriti, human rights, social justice
population attributable risk
the amount of extra disease attributable to a risk factor in a particular population (when association is causal, this si the amount we could prevent if we removed the risk factor from this pop.) occurance in tot. Pop. (PGO) - CGO. directly related to the prevalence of risk factor within population
reasons for Global burden of disease project
- Data on disease burdern was incomplete
- Largely mortality based
- Lobby groups give distorted image of what problems are most important
- Unless the same approach is used to estimate burden of diseases, it is difficult to priorities what conditions are most important
Aims of GBD
- Use a systematic approach to summarise the burden of diseases at the pop. level, based on epidemiological principles and best evidence
- Take account of deaths and non-fatal outcomes when estimating burden
Gains of daly
- Has been able to identify risk due to non-fatal diseases like mental health and injuries
- Recognises non-communicable diseases as a major and increasing problem in low and middle income countries - not just rich ones
challenges with GBD
- Who gets to decide on disability weights? Is it biased
- Is it reasonable to apply one set of disability weights globally
- do all people with a particular level of disability have the same opportunities in society
- Physical and social environment influence disability experiences
- Represents people with disabilities as a burden
- Disability weights do not very with the context that a person with a disability exits in
It takes a medical model to disability
medical model of disability
- The disabled are a burden and need to be cured
- They are the problem, not society
- Control rest with professionals so choices and options provided rest with the expert
Social model of disability
- Problem is with the policies and environment
- Focus on ridding society of barriers rather than relying on curing
why policy interventions are difficult to implement
- industry opposition
- Government reluctance to regulate/tax/fund
- Lack of sufficient public demand for policies
epidemiological transition
Characteristic shift in common causes of death and disability from perinatal and communicable (infectious) diseases to non-communicable (chronic) diseases
Risk transition
changes in risks factor profiles as countries shift from low-to higher income countries where common risks for perinatal and communicable diseases are replaced by non-communicable disease risks (e.g unclean water becomes tobacco)
double burden of disease
in many middle income countries previously common risks for perinatal and communicable diseases coexist with increasing risks for non-communicable diseases
industrial epidemics
Diseases arising from over- consumption of unhealthy commercial products (e.g. tobacco, alcohol, processed food, sugar-sweetened beverages)
To address the commercial determinants of NCDs and health inequalities:
- Shift focus from individual behaviours to broader environment and upstream drivers of unhealthy product consumption
- Tackle the broader determinants of health(i.e.,upstream determinants)
- Develop effective health policy recognising the tension between commercial and health objectives
surveilance
continuous systematic collection, analysis and interpretation of health-related data
three essential channels for effective communications
- Channels - relevant, accessible, trustworthy
- Message - appropriate, co-designed, tested
- Messenger - trusted credible
feminisation of HIV epidemic
refers to the observation that increasing proportions of new infections are among women, primarily due to heterosexual transmission of the infection
right to health
- States obliged to respect (e.g. no discrimination), protect (e.g. no interference from 3rd parties) and fulfil (e.g. adopt measures to achieve equity)
- enshrined in international law
snowflake hypothesis
overprotection from parents and therefore low resilience leading to mental distress
igen hypothesis
mediating factors from social media leading to mental health issues. Perfectionism, racism+discrimination
doomer hypothesis
impact of job insecurities, housing affordability, climate, political polarisation, disinformation
