Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Population Health 111 > MODULE 3 Strategies for Improving Population Health > Flashcards

MODULE 3 Strategies for Improving Population Health Flashcards

L1* Describe the place of individual health care in an overall framework of determinants and distribution of health of the population * Understand and apply guidelines/frameworks for assessing causation: Bradford Hill Criteria Rothman’s Causal Pies

1
Q

Individual vs Population Health Care

A

Clinicians: individuals. treat disease to restore health. Reactive. Treating patients who are present

Population Health: health of groups of individuals, in the context of their environment. Proactive and comprehensive approach to clinical practice. Identifying and treating all appropriate patients in a population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The Public/Population Health Model

A

Provide maximum benefit for the largest number of people, at the same time reducing inequities in the distribution of health and wellbeing.

Epidemiology:

  1. Define the problem

(CSS)

  1. Identify the risk and protective factors

(Cohort S, Case-C S)

  1. Develop and test prevention strategies

(RCTs; Diagnostic Test Accuracy Studies)

  1. Assure widespread adoption
  2. Monitor and evaluate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Role of Epidemiology

A

To seek the cause of dis-ease, so appropriate preventative measures can be introduced.

NOT determine the cause of a dis-ease in a given individual.

Determines the relationship/association between a given exposure and dis-ease populations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

James Lind’s Experiment

A

RCT

Prevention of Scurvy before the cause was identified

Study Participants:

12 British Sailors with Scurvy

Learned that citrus helped with treating Scurvy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Bradford Hill Criteria (1965)

“Aids to thought”

(means that not all have to be present. Judgement necessary!)

A
  1. Temporality
  2. Strength of Association
  3. Consistency of association
  4. Biological Gradient (dose-response)
  5. Biological Plausibility of association
  6. Specificity of association
  7. Reversibility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Temporality

A

First the cause, then the dis-ease

essential to establish a causal relation

e.g. Smoking as a cause of lung cancer: British Doctors’ Study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Strength of Association

A

the stronger an association, the more likely to be causal in absence of known biases (selection, information, and confounding)

BDS: RR>10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Consistency of Association

A

Replication of the findings by different investigators, at different times, in different places, with different methods

e.g. Multiple studies have shown similar results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Biological Gradient (dose-response)

A

Incremental change in disease rates in conjunction with corresponding changes in exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Biological plausibility of association

A

does this association make sense biologically?

e.g. Carcinogens in tobacco

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Specificity of association

A

A cause leads to a single effect

However, a single cause often leads to multiple effect

e.g. Smoking –> Multiple outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Reversibility

A

The demonstration that under controlled conditions that changing the exposure causes a change in the outcome

e.g Reduced risk after quitting in BDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Notes on Bradford Hill Criteria

A

USE YOUR JUDGEMENT

Causal phenomena are usually complex- and exposure -outcome relationships are not usually 1:1.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causal Pies Framework:

JK Rothman

A cause of disease:

A

An event, condition, characteristic (or combination of these factors) which play an essential role in producing the disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Causal Pies

A
  • sufficient cause
  • component cause
  • necessary cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sufficient cause

A

Factor/s that will inevitably produce the specific dis-ease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Component cause

A

Factor that contributes towards disease causation, but is not sufficient to cause disease on its own

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Necessary Cause

A

Factor (or component cause) that must be present if a specific dis-ease is to occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Difference between Sufficient and Component Cause

A

Component Causes are all the possible causes. Sufficient Causes are the causes that are enough to cause an event

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

A CAUSAL PIE FOR TB (example)

What are the Component Cause?

What is/are the Necessary Cause?

* We use the association and several other factors to infer causation and intervene to prevent disease

* we can intervene at any number of points in the pie

* knowledge of the complete pathway is not a pre-requisite for introducing preventive measures

A

Component Cause:

poverty

reduced immunity

poor sanitation

overcrowding

TB Bug

Necessary Cause:

TB Bug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why do we need to prioritise in health?

A
  1. currently not enough money to fund all health problems
  2. new technologies being developed everyday, incr in medical cost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where NZ’s health dollar goes (2008)

A

Total budget for 2013/2014

6% public health

4% administration

26% inpatient curative and rehab care

26% outpatient/home curative and rehab

20% long term nursing

12% medical goods

6% ancillary services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Estabilishing Public Health Priorities

A

Problem

Solution

Decision Criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The problem

A

who is affected?

how common is it?

size, groups, seriousness

(death rates: cancer (high priority area as first but may not be this list, depending on who you are/where you are looking at))

consider death rates in diff population groups

trends over time of major risk factors in NZ

how serious is it?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

The problem–how serious is it?

A
  • age at death and premature mortality (years of potential life lost to death (YLL))
  • time lived with disability (disability adjusted life years (DALY))
  • population attributable risk (PAR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

risk difference= attributable reisk (AR)

A

=
EGO-CGO
i.e.
The amount of “extra” disease attributable to a particular
risk factor in the
exposed group
~
incidence in exposed population (EGO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Population Attributable Risk (PAR)

A

The amount of “extra” disease attributable to a
particular risk factor in a
particular population
•
If the association is causal
– this is the amount of
disease (theoretically) we could prevent if we removed
that particular risk factor from the
population

(WHOLE POPULATION, NOT JUST THE WHOLE GROUP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Population Attributable
Risk (PAR)

A

=
Incidence in the total population –
Incidence in unexposed pop (CGO)

(PGO-CGO)

(total who got disease/total population - comparison group who got the disease/ comparison group total)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Population Attributable
Risk (PAR)

A

= RD x Prevalence of exposure
in the population

= risk difference (EG-CG) x (exposure group/ population)

30
Q

Population Attributable Risk (PAR)

A

The amount of “extra” disease attributable to a particular risk factor in a particular population

31
Q

Solution- effectiveness

(Second stage, after Problem)

A

Estimated effectiveness of the solution

How well can the problem be solved?

32
Q

How well can the problem be solved?

(in terms of a particular intervention)

A
  1. target population
    1. expected number in population who will be reached
    2. evidence of effectiveness (based on known success rates in literature)
    3. cost
33
Q

Possible ways to intervene to solve the problem

(e.g. obesity)

A

Brief GP intervention

National mass media campaign

school-based intervention

34
Q

Decision Criteria

(after Problem and Solution)

A

Economic feasibility

Acceptability

Equity

Others

35
Q

Economic feasibility

A

does it make economic sense to address the problem?

are there economic consequences if not carried out?

36
Q

Opportunity cost

A

the health benefits that could have been achieved had the money been spent on the next best alternative invervention or healthcare programme (Tobacco use versus Obesity)

37
Q

Acceptability

A

Will the community and/or target population accept the problem being addressed?

competing interests

38
Q

Equity

A

does the problem disproportionately affect population sub groups?

treaty of waitangi

39
Q

Legality

A

do current laws allow the problem to be addressed?

40
Q

After Problem, Solution, Decision Criteria have been addressed…

A

DESICION MAKING!

41
Q

Opportunity cost

A

foregone benefit to other patients if the same resources were invested in the best alternative way

42
Q

Promotion, Prevention, Protection: Approaches to Taking Action

A
  1. Discuss the advantages and disadvantages of the
    high
    risk and population approaches
    to prevention
  2. Gain familiarity with the strands of the
    Ottawa Charter
    - a
    framework for health promotion
  3. Describe and differentiate the three different
    levels of
    disease prevention
  4. Understand and be able to discuss the differences in approaches and the overlaps between:
    health promotion, disease prevention and health protection
  5. Describe the main components of the tobacco control programme in relation to health promotion, disease
    prevention and health protection
43
Q

Importance of preventing disease

A

Epidemiology can play a central role in preventing diseases by:

unravelling the causal pathway

directing preventive action

evaluation of effectiveness

the need for prevention is growing as the limitations in curing disease become apparent and as the cost of medical care escalate

44
Q

Population Health Actions

A
  1. Health promotion
  2. Disease prevention
  3. Health protection
45
Q

Strategies for Prevention

A

Population based (mass) strategy

High risk individual strategy

46
Q

Population based (mass) strategy

A

focuses on the whole population

aims to reduce health risks of the entire population

useful for a common disease or widespread cause

e.g. immunisation, programmes, water fluoridation, legislated use of seatbelts

47
Q

High Risk Strategy

A

Focuses on individuals perceived to be a high risk e.g. intravenous drug users, those with systolic BP > 160mmHg

intervention is well matched to individuals and their concerns e.g. screening for elevated BP then treating (e.g. intervention targeting obese adults)

(e.g. needle exchange programme–successful at preventing spread of HIV amongst IDUs)

48
Q

Advantages of Population (Mass) Strategy

A
  1. radical- addressses underlying causes
  2. large potential benefit for whole population
  3. behaviourally appropriate
49
Q

Disadvantages of Population (mass) strategy

A
  1. Small benefit to individuals
  2. poor motivation of individuals
  3. whole population is exposed to downside of strategy (less favourable benefit-to-risk ratio)
50
Q

Advantages of High-risk individual strategy

A
  1. Appropriate to individuals
  2. individual motivation
  3. cost effective use of resources
  4. favourable benefit-to-risk raito
51
Q

Disadvantages of high-risk individual strategy

A
  1. cost of screening, need to identify individuals
  2. temporary effect
  3. limited potential
  4. behaviourally inappropriate
52
Q

Health Promotion

A

acts on determinants of wellbeing

health/wellbeing focus

enables/empowers people to increase control over, and improve their health

involves whole population in every day contexts

53
Q

Alma Ata 1978

A

Declaration for primary health care (international conference on primary health care in Kazakhstan)

54
Q

Aims of Alma Ata

A

protect and promote health of all

advocated a health promotion approach to primary care

55
Q

prerequisites for health

A
  1. peace and safety from violence
  2. shelter
  3. education
  4. food
  5. income and economic support
  6. stable ecosystem and sutainable resources
  7. social justice
56
Q

Ottawa Charter for Health promotion

“Mobilise action for community development”

A

Charter acknowledges that health is:

  • a fundamental right for everybody
  • requires both individual and collective responsibility
  • opportunity to have a good health should be equally available
  • good health is an essential element of social and economic development
57
Q

Ottawa Charter 1986

Three basic strategies

A

Enable

Moderate

Advocate

58
Q

Ottawa Charter

5 priority action areas

A

develop personal skills

strengthen community action

create supportive environments

reorient health services towards primary health care

build healthy public policy

59
Q

Enable

A

to enable all people to achieve their fullest health potential through supportive environments, access to info, life skills, opportunities for healthy choices etc

60
Q

Moderate

A

to bring together all parties with opposing/other interests to work towards the promotion of health

61
Q

Advocate

A

to encourage/speak for positive changes by explaining the benefits of change

62
Q

Care Pyramid

A

Tertiary

Secondary

Tertiary

63
Q

Ottawa charter hung in the Rainbow Frame

A
64
Q

Ottawa Charter examples

A
65
Q

Disease prevention

A

disease focus

looks at particular diseases (or injuries) and ways of preventing them e.g. the incidence, the prevalence, risk factors, or impacts

66
Q

Natural history of diesease prevention and strategies

A
67
Q

Primary

A

limit the incidence of disease by controlling specific causes and factors

Examples :

  • Immunisation
  • Slip, slop, slap
  • Seat belt regulations
68
Q

Secondary

A

Reduce the more serious consequences of disease

Examples :
- Screening people 65+
for risk of hip fractures
- Rescue services for
prevention of drowning

69
Q

Tertiary

A

Reduce the progress of complications of established disease

Examples :
- Counselling services
for people with post
traumatic stress
disorder(PTSD)
- Rehab services for
stroke patients

70
Q

Health Protection

A

predominantly environmental hazard focus

risk/hazard assessment

(environmental epidemiology; safe water and air, bioscecurity)

monitoring

(biomarkers of exposure hazardous substances)

risk communication

(relating environmental risks to the public )

occupational health

(safety regulations on work sites)

71
Q

Summary for disease prevention, health promotion and disease protection

A
72
Q

Public Health Actions for Prevention

A

Population Health 111 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions