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POPLHLTH111 > Module 3 (determinants of determinants) > Flashcards

Module 3 (determinants of determinants) Flashcards

1
Q

Socioeconomic position

A

The social and economic factors that influence what positions individuals hold within the structure of society; based on occupation and the purchasing power different occupational groups have

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2
Q

Determinants of SEP

A

Must be objective, measurable and meaningful

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3
Q

Measures of SEP

A

Used to quantify the level of inequality within or between societies; may highlight changes to population structures; needed to help understand the relationship between health and other social variables; associated with health and life changes

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4
Q

Why health inequalities should be reduced

A

They are unfair; they are avoidable; they affect everybody; reducing them can be cost effective

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5
Q

Measuring SEP for individuals

A

Education (increases opportunities for occupations and income opportunities); income; occupation; housing; assets and wealth

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6
Q

Measuring SEP for populations

A

Can see the different gradients in health/social outcomes based on the different levels of these measures; area measures (deprivation and access) and population measures (income inequality, literacy rates and GDP per capita)

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7
Q

Inequality

A

Measurable differences in health experiences or outcomes occurring between different population groups (the social gradient)

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8
Q

Inequity

A

An inequality that stems from injustice (unjust distribution of the social determinants of health and resources/services/opportunities in a way that doesn’t reflect health needs) and involves power relations

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9
Q

Habitus

A

The lifestyle, values, dispositions and expectations of a particular social group

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10
Q

Social capital

A

The norms and values that underpin society, and the social networks that provide an inclusive environment and sense of unity

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11
Q

SEP on D&W model

A

Individual lifestyle factors (your education, occupation and income; decisions you make; social and community influences; living and working conditions; general socioeconomic, cultural and environmental conditions; global determinants

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12
Q

Individual lifestyle factors

A

Education –> knowledge (able to pick up health measures); income –> material goods (ability to purchase health and essential materials); occupation –> status and power

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13
Q

Social and community influences

A

Your parents influence on education, occupation and income; commonly used to measure SEP for children and adolescents

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14
Q

Living and working conditions

A

Use area-based measures of SEP (NZDep most common); other measures include social fragmentation and accessibility indices (who has the opportunity to use particular services; health promoting and demoting)

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15
Q

Measuring area-level deprivation

A

Another way of measuring people’s relative position in society, but reports this based on where they live, not on them; focus on material deprivation; should be applied to conditions and quality of life that are of a lower standard that is ordinary in a particular society

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16
Q

Deprivation

A

State of observable and demonstrable disadvantage relative to the local community or the wider society or nation to which an individual, family or group belongs

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17
Q

Ways of describing changes in population

A

Population structure and population composition

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18
Q

Population structure

A

The age and sex distribution (affected by changes in fertility rates, mortality rates and migration); affects the rates at which fertility/mortality/migration occur in the population

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19
Q

Population composition

A

All attributes of the population other than the age and sex distribution (changes in fertility/mortality rates and migration)

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20
Q

Numerical ageing

A

Absolute increase in the population that is elderly; reflects previous demographic patterns and improvements in life expectancy

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21
Q

Structural ageing

A

Increase in the proportion of the population that is elderly; driven by decreases in fertility rates; began occurring in the 1800s

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22
Q

Natural decline

A

When deaths>births; combination of numerical/absolute and structural ageing; more elderly = more deaths

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23
Q

Absolute decline

A

When there is insufficient migration to replace the decreased births and increased deaths; not likely to happen in NZ for another 70 years; happening in some European/Asian countries

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24
Q

Demographic transition

A

4 stages; a pattern of changes in birth and death rates which causes a change in total population; all countries have gone through this or are going through; NZ and other developed countries are in stage 4

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25
Q

Measures of deprivation

A

NZDep and IMD

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26
Q

NZDep variables (9)

A

Communication; income; income; employment; qualifications; owned home; support; living space; transport

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27
Q

Communication NZDep

A

People under 65 with no access to the internet at home

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28
Q

Income NZDep

A

People between 18-64 receiving a means-tested benefit; people in equalised households with income below a threshold

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29
Q

Employment NZDep

A

People aged 18-64 who are unemployed

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30
Q

Qualification NZDep

A

People aged 18-64 with no qualification

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31
Q

Owned home NZDep

A

People not living in their own home

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32
Q

Support NZDep

A

People under age 65 living in a single parent family

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33
Q

Living space NZDep

A

People in equalised households below a bedroom occupancy threshold

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34
Q

Transport NZDep

A

People with no access to a car

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35
Q

General socioeconomic, cultural and environmental conditions

A

Macro scale; group populations with similar SEP levels together; cross-sectional or longitudinal analysis

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36
Q

Global determinants

A

Comparison of our country to global; income inequality, national income (GDP), literacy rates and free trade agreements

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37
Q

Stage 1 of demographic transition

A

High birth and death rate; low total population; pre-transition (pre-industrial)

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38
Q

Stage 2 of demographic transition

A

High birth rate and moderate death rate; low total population; declining mortality, birth rates remain high

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39
Q

Stage 3 of demographic transition

A

Moderate birth rate and low death rate; moderate total population; fertility rates begin to decline

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40
Q

Stage 4 of demographic transition

A

Low birth and death rates; high total population; low fertility and mortality

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41
Q

Crude birth rate

A

CBR; number of births/total population (including males)

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42
Q

General fertility rate

A

GFR; number of births/number of women of reproductive age (15-45)

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43
Q

Age-Specific fertility rate

A

ASFR; number of births to women in 5 year age bands

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44
Q

Total fertility rate

A

Sum of ASFR x 5; shows the likelihood that we remain above the replacement level

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45
Q

Data considerations

A

Ethics and privacy/confidentiality; purpose of data collection vs use in analysis; population vs population samples; representative sample of NZ population; objective vs subjective measures of health

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46
Q

Dependency ratio

A

Child: 0-14yrs / working age
Elderly: >64yrs / working age
Total: (child + elderly) / working age

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47
Q

Limitation with dependency ratio

A

Assumption that the working age group represents all people who are working; some in working age group may not be working, some elderly may still be working

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48
Q

Types of ageing

A

Numerical and structural ageing

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49
Q

Population impacts of ageing

A

Natural and absolute decline of the population

50
Q

Important aspect of data

A

Quality of data is an important aspect of epidemiology; if we don’t have good data, it will be unreliable information

51
Q

Implications for the workforce in the future

A

More elderly needing to be taken care of when they retire; less youth population to do so and fill in jobs; raising retirement will mean more tax is paid and more pension contributions but fewer jobs available to younger workers

52
Q

New equity definition

A

Equity recognises that different people with different levels of advantage require different approaches and resources to get equitable health outcomes

53
Q

Inequities affect everybody

A

e.g. our warm housing intervention resulted in a 50% reduction in reported days off school

54
Q

Inequities are avoidable

A

e.g. our analysis indicates that the four DHBs in our study should prioritise Māori and Pacific patients for cancer and cardiovascular disease related surgery following NZ’s move to Level 1

55
Q

Inequities are unfair

A

Our survey reported that on average, female employees earned 35% less than male employees. However, the difference in earnings were as high as 50% among senior leadership roles

56
Q

Reducing inequities can be cost effective

A

Our results indicate that our intervention means that a female would have half the current number of tests AND a statistically significant reduction in cervical cancer cases

57
Q

Denominators

A

Census population; HSU population; IDI population; choice of denominator influences who is incorporated in the analysis and who we end up targeting/allocating resources to

58
Q

Census population

A

Everyone who answered the census and is a usual resident

59
Q

HSU population

A

All health service users in the last 12 months prior to census night

60
Q

IDI population

A

People who have used health, education, tax and other services prior to census night

61
Q

Lorenz curve

A

Cumulative frequency graph of the proportion of wealth shared by different proportions of a population; the more concave the line, the greater the income inequality in that population; includes a line of absolute inequality and equality

62
Q

Line of absolute inequality

A

Y-axis of Lorenz curve graph which shows the perfectly unequal income distribution

63
Q

Line of absolute equality

A

45degree line on the Lorenz curve graph which shows the perfectly equal income distribution

64
Q

Gini coefficient

A

The ratio of the area between the line of perfect equality and the observed Lorenz curve to the area between the line of perfect equality and the line of perfect inequality
Gini = (A) / (A+B)
0 = very equal society
1= very unequal society

65
Q

The implications of income inequities

A

An unequal society (between higher and lower paid groups); less social cohesion and therefore less trust between groups; increased stress ( impacts mental and physical health); reduced economic productivity; poorer health outcomes

66
Q

Commuter environment on transport mode and route choice

A

Air pollution, safety, travel time, cycleways; reasons why people choose to travel a particular way

67
Q

Travel mode and route choice on health and well-being

A

Implications for separation of the road; breathing rate; travel time; positives with exercise

68
Q

Air pollution exposure

A

Larger dosage for people closer to the centreline of the road (higher for runners, cyclists and walkers); can be reduced with cycle and walk ways further away from the road, and with noise barriers

69
Q

Influences on more people cycling

A

Low traffic volume with low vehicle speed on residential streets; seperate cycleways on high-traffic roads; mixed land use (residences, commercial entities and civic facilities all co-located) so that destinations are walkable/cycleable from home

70
Q

Individually minimising adverse health impacts while travelling

A

Route choice; side of the road; build infrastructure to encourage people to make good decisions

71
Q

Urban planning features which are health promoting

A

Cycleways, bus lanes, developments to encourage active mode and public transport uptake

72
Q

NZ IMD variables (7)

A

Employment; income; health; education; housing; crime; access

73
Q

Employment IMD

A

Degree to which the working age people are excluded from employment

74
Q

Income IMD

A

Extent of income deprivation (state funded financial assistance)

75
Q

Health IMD

A

Areas with high levels of ill health or mortality

76
Q

Education IMD

A

Youth disengagement; proportion of working age people lacking formal qualifications

77
Q

Housing IMD

A

Proportion of people in: overcrowded housing and rented accomodation

78
Q

Crime IMD

A

Victims per 1000, over 30 days

79
Q

Access IMD

A

People with no access to a car

80
Q

Pros of NZDep

A

Weights the domains; widespread and well known to analysts and policy makers

81
Q

Cons of NZDep

A

Not everyone completes the census; can’t explore drivers of deprivation seperately

82
Q

Pros of IMD

A

IMD uses information from the IDI, which includes more people than the census; can explore the drivers of deprivation (domains); better small area information; forms more specific solutions; weights domains

83
Q

Cons of the IMD

A

IDI is a transactional dataset (deficit); new method, not used much yet

84
Q

Deficit dataset

A

In order to be ‘counted’ you have had to have had an interaction with a government agency (WINZ, Corrections/Police, or the health system); it counts people that have had outcomes that are ‘bad’, what people don’t have (experienced economic hardship, been sick and needed hospitalisation, etc).

85
Q

The ecological fallacy

A

The error that arises when information about groups of people is used to make inferences about individuals; cannot make assumptions about an individual only from where they live

86
Q

Elements of a healthy environment

A

Clean air and water; appropriate housing; access to wholesome food; safe community spaces; access to transport; opportunities to incorporate exercise as part of daily life

87
Q

The built environment

A

All buildings, spaces and products created or modified by people; structures (homes, schools, workplaces) and urban design (parks, business areas and roads)

88
Q

Urban design improving active travel and physical activity

A

Street connectivity; traffic calming and other street design features; mix of residential, commercial and business uses; public open spaces and physical activity spaces

89
Q

7 V’s of big data

A

Volume; velocity; variety; veracity; variability; value; visualisation

90
Q

Volume (big data)

A

A larger computer capacity is required for processing and analysing

91
Q

Velocity (big data)

A

Data is created/analysed instantly

92
Q

Variety (big data)

A

A huge range of sources of data

93
Q

Veracity (big data)

A

A lot of accuracy, creditability of truth, enabling objective decisions to be reached

94
Q

Variability (big data)

A

High reproducible internal consistency of results

95
Q

Value (big data)

A

The cost of storage/analysis/analysts pays off

96
Q

Visualisation (big data)

A

Use of novel techniques to communicate patterns to the public

97
Q

5 A’s of access

A

Access is viewed as a set of more specific areas (dimensions of access) of fit between the patient and the health care system; availability, accessibility, accomodation, affordability and acceptability

98
Q

Availability

A

Existence of services barriers; the relationship of the volume and type of existing services (and resources) to the clients’ volume and type of needs

99
Q

Accomodation

A

Organisational barriers; the relationship between the manner in which supply resources are organised and the expectation of clients

100
Q

Acceptability

A

Psychosocial barrier; the relationship between client’s and provider’s attitudes to what constitutes appropriate care

101
Q

Accessibility

A

Geographic barriers; the relationship between the location of supply and the location of clients, taking account of client transportation resources and travel time, distance and cost

102
Q

Affordability

A

Financial barriers; the cost of provider services in relation to the client’s ability and willingness to pay fro these services

103
Q

Māori disparities in health exemplified

A

Exemplified in health outcomes, exposure to the determinants of health, health system responsiveness and representation in health workforce

104
Q

Māori health disparities in health examples

A

Unequal access to SDH; cardiovascular disease; cancer; injury; diabetes; mental health including self-harm; infectious diseases; disability; participation in the health workforce

105
Q

Lessons from the Titanic relating to Māori health

A

Structural contribution (power, resources and opportunities of NZ society are organised by ethnicity and class deprivation) - more lifeboats and less barriers; societal contribution (values and assumptions widely held in NZ society about the deservedness of different groups of people) - level playing field

106
Q

Determinants of ethnic inequalities in health

A

Differential access to health determinants or exposures leading to differences in disease incidence; differential access to health care; differences in quality of care received

107
Q

5 domains

A

Demographic; economic; neighbourhood; environmental; social and cultural cultural

108
Q

Demographic domain; risk and protective factors

A

Gender and sex, age, ethnicity; social norms, discrimination, gene-environment interactions in sensitive developmental windows

109
Q

Demographic domain relevant SDGs

A

Gender equality

110
Q

Economic domain; risk and protective factors

A

Debt, assets, employment, food security, housing; social causation (stress, helplessness, antisocial coping behaviours) and social drift (disability and stigma)

111
Q

Economic domain relevant SDGs

A

No poverty; zero hunger; decent work and economic growth; industry, innovation and infrastructure; reduced inequalities

112
Q

Neighbourhood domain; risk and protective factors

A

Structural characteristics of neighbourhood; urban migration, exposure to violence

113
Q

Neighbourhood domain relevant SDGs

A

Clean water and sanitation; affordable and clean energy; sustainable cities and communities; responsible consumption and production

114
Q

Environmental events domain; risk and protective factors

A

Natural hazards, industrial hazards; trauma, severe stress and insecurity

115
Q

Environmental events domain relevant SDGs

A

Climate action, peace, justice and strong institutions

116
Q

Social and cultural domain; risk and protective factors

A

Education and social cohesion; cognitive reserve and social skills and support

117
Q

Social and cultural domain relevant SDGs

A

Quality education

118
Q

Sustainable developmental goals not met by wellbeing domains

A

Gender equality and reduced inequalities

119
Q

What is big data

A

Large or complex data sets; large amounts of information at a population, regional or local level or span different geographical areas; combining data from multiple sources to explore health outcomes

120
Q

3 pros of the IDI

A

Identify characteristics of groups with positive/negative outcomes; identify risk/protective factors; de-identified

121
Q

3 cons of the IDI

A

Only as good as the data in it; inherent selection biases from the choice of sources of data; can’t identify specific individuals at risk or for a specific intervention

POPLHLTH111 (3 decks)

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