Module 4

Question 1

What is the GBD?

Answer 1

Global Burden of Disease Project

Question 2

What were the reasons for conducting the GBD?

Answer 2

Data on the burden of disease (and injury) from many
countries were incomplete

Available data largely focused on deaths; little information
on non-fatal outcomes (disability)

  Lobby groups can give a distorted image of which
problems are most important

Unless the same approach is used to estimate the burden
of different conditions, it is difficult to decide which conditions are most important and which strategies may be the “best buys”

Question 3

What are the aims of the GBD?

Answer 3

1.  To use a systematic approach to summarize the
burden of diseases and injury at the population-level based on epidemiological principles and best available evidence

2.  To take account of deaths as well as non-fatal
outcomes (i.e., disability) when estimating the burden of disease

Question 4

What were the key sources of datas for this project?

Answer 4

  ‘Vital registration data’ (eg, NZ’s national
mortality and hospital discharge databases)

Disease surveillance system

  Epidemiologic studies & surveys n  Statistical models developed to get bestestimates when data were incomplete

Question 5

What is a DALY?

Answer 5

DALY = Years of life lost to mortality (YLL) + Years lived with disability (YLD)

Stands for Disability-Adjusted Life Year

Question 6

Give the DALY for a year of perfect health

Answer 6

0

Question 7

Give the DALY for a year of life lost due to death

Answer 7

1

Question 8

Give the DALY for a year with disability

Answer 8

between 0 and 1

Question 9

What is a communicable disease?

Answer 9

infectious diseases and (The GBD project includes problems during pregnancy, childbirth, or very early life in this group)

Question 10

What is a non communicable disease?

Answer 10

chronic diseases (e.g, heart disease, strokes, cancer, diabetes)

Question 11

Explain Demographic transition

Answer 11

decline in fertility and mortality rates

observed in most developed and several developing countries

Question 12

Explain epidemiological transition

Answer 12

characteristic shift in the composition of

causes of death and disability from communicable to non-communicable diseases

Question 13

Explain risk transition

Answer 13

Changes in risks factor profiles as countries shift
from low- to higher income countries, where common risks for perinatal and communicable diseases (e.g., unhygienic water) are replaced by risks for non-communicable diseases (e.g., tobacco)

Question 14

Explain double burden of disease

Answer 14

  In many middle-income countries, previously common risks for
perinatal and communicable diseases co-exist with increasing risks for non-communicable diseases.

Question 15

What are the key factors influencing the risk burden?

Answer 15

• How strong is the ‘causal’ association between the risk factor and health condition(s) (eg, relative risk)
• How common is the exposure to this risk in the population of interest? (eg, the prevalence of the risk factor in the population)

Question 16

Where are most chronic diseases? high or low income countries

Answer 16

low and middle income countries MOSTLY among poor

Question 17

What role does the commercial sector play in (unequal) NCD epidemics?

Answer 17

(1) Social norms changed as smoking became popular among other social groups
(2) A greater emphasis on downstream (compared with upstream) strategies has put equity in public health at risk
(3) Difficulties with behaviour change are actively exploited by industries

Question 18

Explain the development of right to health

Answer 18

1. Universal Declaration of Human Rights – 1948

2. International Covenant on Economic, Social & Cultural Rights (ICESCR) – 1966

Question 19

Explain the rights to health

Answer 19

1. Enshrined in International Law
2. Extends beyond health care to pre-conditions
3. 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)

4.Social epidemiology links health with social justice & thus links to good government

Question 20

What are the two rights to health acts in NZ?

Answer 20

The Code of Health & Disability Service Consumer’s Rights

NZ Public Health & Disability Act

Te Tiriti o Waitangi

Question 21

What are the Rights to Health?

Answer 21

1. Universal Declaration of Human Rights
2. ICESCR
3. Other international rights conventions
4. Indigenous Rights
5. NZ legislation & policies

Question 22

What are two relatively common situations in which YOU may be screened for HIV, even if you do not belong to a known high-risk group or have any clinical signs or symptoms of HIV/AIDS?

Answer 22

If you are pregnant or are giving blood

Question 23

What are the high risk groups for HIV + people?

Answer 23

homosexual sex partners
heterosexual sex partners
sex workers 
injecting drug users
infants born to or breast fed by HIV + mothers 
Anyone receiving unscreened blood

Question 24

Explain Feminisation of the HIV epidemic

Answer 24

refers to the observation that increasing proportions of new infections are among women, primarily due to heterosexual transmission of the infection. In Sub-Saharan Africa, about 60% of people living with HIV are women.

Question 25

What specific social determinants cause Feminisation of the HIV epidemic? or the HIV epidemic in general?

Answer 25

Gender inequalities in who suggests condom use
low social status and therefore lack of education and health services
 Problems with disclosure of HIV status, partner notification and confidentiality

Question 26

Two major challenges to the DALY approach to Disability

Answer 26

• The GBD project criticised for its potential to represent people with disabilities as a ‘burden’
• Disability weights are considered to be the same as the severity of an impairment relating to a disease/health condition, and do not vary with a person’s social position, where they live, their access to healthcare or any other life circumstance

Question 27

Explain the “Medical Model” of Disability

Answer 27

The disabled person is the problem, not society.

Question 28

Explain the “Social Model” of Disability

Answer 28

The social model focuses on ridding society of barriers, rather than relying on ‘curing’ people who have impairments.

Question 29

Explain Youth2000 surveys

Answer 29

Cross‐sectional surveys using random samples ofsecondary school students in 2001, 2007 and 2012

• Anonymous, confidential, self‐report

Question 30

Define Resilience

Answer 30

‘Resilience’ refers to the ability to spring back despite adversity. This means people with various protective (or resiliency) factors may be less vulnerable to harm despite exposure to risk.

Question 31

Explain the Haddon matrix

Answer 31

There are 4 columns: 
Host
Agent/Vehicle
Physical environment 
Social environment 
And three rows:
Pre-Event
Event 
Post-Event

Question 32

x% of global energy obtained

from fossil fuels

Answer 32

85% of global energy obtained

from fossil fuels

Question 33

What are the gases that make up most of the global warming effect?

Answer 33

carbon dioxide, methane and other gases

Question 34

What is an example of an indirect effect of global warming?

Answer 34

The zika virus spreads faster as countries become warmer and mosquitos carrying this virus migrate towards these countries

Question 35

What is an example of a direct effect of global warming on health?

Answer 35

Heat waves can decrease food yields, thus we may not be able to feed ourselves as food prices rise.

Question 36

How can global warming effect the work capacity of humans?

Answer 36

At higher temps, we work less (labour) thus may be more inefficient on economy.