Module 4

Question 1

Epidemic Transition

Answer 1

Global increase in the burden of NCDs over CDs, due to the increasing burden of the risk factors of NCDs.

Question 2

What are risk factors prioritised on?

Answer 2

Strength of association.
Consistency
Population Attributable Risk.

Question 3

Risk Transition

Answer 3

As a country becomes more economically developed, the risk factors shift due to decreasing prevalence of the determinants of CDs but increasing determinant of NCDs.

Question 4

Double Burden of Dis-ease

Answer 4

Determinants of NCDs are introduced to developing countries due to their economic advancements, but determinants of CDs have not been completely eradicated.
Requires double response, but the NCD intervention tend to be cost effective.

Question 5

Inequities in the Distribution of Burden of NCDs

Answer 5

80% of NCD burden is in LMICs.

Nearly 50% of the burden of NCDs is on 30-69 y/os.

Question 6

DALY/ Disability Adjusts Life Years

Answer 6

Summary measure of population health that combines mortality and morbidity (fatal and nonfatal health outcomes).

Question 7

Years of Life Lost

Answer 7

YLL= number of deaths/annum to dis-ease x years lost per death (relative to ideal age- ie: life expectancy of country).

Question 8

Years Lost to Disability

Answer 8

YLD= Number of cases with nonfatal outcomes/annum x duration of each case x weighting of each case.

Question 9

Reasons for the Global Burden of Dis-ease Project

Answer 9

Incomplete DALYs data from many countries.
Health data focusses on mortality and not morbidity- non fatal dis-eases underprioritised.
Lobby groups can provide a distorted image of dis-ease burden. Burden also hard to compare as they are measured with different methods.

Question 10

Aims of the Global Burden of Dis-ease Project

Answer 10

To use a systematic approach to summarise dis-ease burden in populations based on EPIDEMIOLOGICAL PRINCIPLES and BEST AVAILABLE EVIDENCE.
Measures and takes in consideration both death and disability.

Question 11

Gains from the Global Burden of Dis-ease Project

Answer 11

1) Drew attention to hidden burden of high morbidity dis-eases such as mental health disorders.
2) Recognition of the burden of NCDs in LMICs.

Question 12

Issues with quantifying disability with DALYS

Answer 12

1) Disability weights are constant for every individual- but social position and other circumstances will vary the effect of the disability from one person to the next.
2) GBD presents disabled as burden to society.

Question 13

Medical Model of Disability

Answer 13

Defines disability as a personal problem, and the disabled require medical aid to overcome the limitations brought about by it.
Disabled people are the problem and lack autonomy. Must adhere to the advice of ‘helping’ medical professionals to partake in society.

Question 14

Social Model of Disability

Answer 14

Defines disability as a problem with the environment, policies and social attitudes.
Focusses on removing barriers in society which prevent disabled from fully participating in it.

Question 15

Inequities in Distribution of Smoking and How They are Brought About

Answer 15

Increased prevalence in more deprived areas, following the social gradient and increased marketing to vulnerable groups.
Changing physical, political and commercial environment to increase access to tobacco.
Targeted marketing approach.
Exploits addiction and difficulty of moderation and behaviour change.

Question 16

MPOWER

Answer 16

Monitor tobacco use and prevention
Protect people from tobacco use by providing tobacco free areas.
Offer help to quit smoking-high risk dis-ease prevention.
Warn about the risk of tobacco.
Enforce bans on tobacco promotion and sponsorship to reduce influence.
Raise taxes on tobacco.

Question 17

Inequities in burden of road traffic injuries

Answer 17

90% burden in LMICs and increasing, while decreasing in HICs.
In LMICs most deaths occur in 15-29 and 30-41 y/os, but in HICs the burden is only on youths.
In LMICs vulnerable road users contribute to most of DALYs, but in HICs they do not.
Socioeconomically more deprived groups are more likely to contribute more to DALYs- they live closer to roads and the agents of injury.
Other socioeconomic determinants also have effect.
Children are more likely to be injured than adults.
Vulnerable road users are more likely to be injured BUT NO PROTECTIVE POLICIES IN MOST COUNTRIES.

Question 18

5 Preventative Measures for RTIs

Answer 18

ENVIRONMENTAL changes so that behaviour does not lead to changes to risk.
1)Safer Transport and Land Use Policies. Adhering to and implementing United Nations legislation regarding road safety.
2) Safer Roads. Improving quality and safety of road for all users by incorporating protective features
3) Measuring and understanding the problem, and assessing the impact of intervention.
- ie: Prioritisation of the dis-eases with the highest burden, and monitoring the effect of interventions.
4) Safer road users
Altering downstream determinants instead of environment, but using upstream means. Using legislation and policies- compliance strategies- to force road users to change their high-risk behaviour. Eg: Legislation against drink-driving, requiring the use of seatbelts…
5) Post crash response
Improve responsiveness- tertiary prevention strategies.
Ability for healthcare systems to provide immediate treatment and long term rehabilitation.

Question 19

Inequities of the burden of HIV

Answer 19

> 70% of infected live in SS Africa.
90% of pregnant HIV mothers in requiring treatment live in SSA.
78% of infected in W.Europe and NA get treatment while only 38% in SSA do.
95% of new infections were in LMICs and mostly in 15-24 age group.

Question 20

High Risk Groups- HIV

Answer 20

Homosexual and heterosexuals. 
Sex workers. 
Injecting drug users/ People receiving unhygienic injections. 
Mother-infant transmission. 
Receivers of unscreened blood.

Question 21

Factors contributing to HIV epidemic

Answer 21

Most are not aware of exposure status so they can unknowingly spread the dis-ease. Also they do not report their infection status so are not counted.
Heterosexual transmission is dominant.
FEMINISATION.

Question 22

Feminisation of the HIV Epidemic and Determinants

Answer 22

Observation that increasing proportions of new infections of HIV are in females.
Gender inequitalities- inequal access to education and different socioeconomic status. POVERTY IS A DETERMINANT.
Putting up with male control over female health, or foregoing health protection as a part of ensuring socioeconomic stability.
Increased risk of sexual violence.
Fear of stigmatisation and judgement, especially in certain cultures.

Question 23

3 Ways of Controlling and Preventing HIV

Answer 23

Education campaigns to encourage safer sexual practices.
Safer blood products and practices (using needle exchange programs).
Increasing access to primary health care, rehabilitation and screening.

Question 24

Lessons from the HIV epidemic

Answer 24

Surveillance and management of risk factors is crucial-especially when the disease has no cure.
Highlights importance of prevention as treatment can be inhibited by stigmatisation etc.
Poor, inequitable distribution of health resources as shown by inequitable distribution of HIV.
Social determinants leading to violation of rights responsible for high prevalence in vulnerable groups.

Question 25

Trends in obesity

Answer 25

Initiated in a country due to influx of cheap processed food due to socioeconomic development.
Social gradient for obesity is more pronounced for children- more of the deprived children are more likely to be obese (instead of overweight). Due to increased consumption of obesogenic foods as they are more affordable and accessible.
Women become obese before men.
Adults become obese before children.
Higher SEP become obese before low SEP WHEN THE COUNTRY IS LOW/MIDDLE INCOME.
Urban becomes obese before rural.

Question 26

Causes of Obesity

Answer 26

Increased passive overconsumption of energy due to increased availability of palatable, affordable and effectively marketed food.
Natural response to an obesogenic environment.
Reduction in occupational physical activity despite increasing recreational physical activity.

Question 27

Model of the Determinants of Obesity

Answer 27

DRIVERS create MEDIATORS which are affected by MODERATORS to give and OUTCOME.
Drivers: Affect the environment, resulting in upstream determinants of poor health.
Mediators: Tangible changes to downstream determinants caused by upstream determinants.
Moderators: Factors (such as those due to the environment) which affect the effect of mediators.
Outcomes: yup.

Question 28

Obesogenic Environment Definition

Answer 28

Sum of influences that the surroundings, opportunities or conditions have on promoting obesity in individuals and populations.

Question 29

Effect of the Local Environment of Obesity (Physical, Economical, Sociocultural and Political)

Answer 29

Economical: Improved SEP means more dispensible income to spend on more wholesome food.
Physical: Physical accessibility of green spaces for exercise/opportunities for active transport.
Policy: The extent of governmental control over what’s marketable and the supply of obesogenic foods to the consumers. Controls if an obesogenic environment is created.
Sociocultural environment: Cultures have different emphases on physical activity or expectations of body sizes. Can affect amount of PA or the willingness to avoid obesogenic behaviour.

Question 30

Consequences of the Obesity Epidemic

Answer 30

Metabolic Disorders
Mechanical disorders due to overburdening of body.
Mental disorders due to poor body image and self esteem. Furthered by reduced opportunities in society and bias.

Question 31

5 Ways to Prevent Obesity

Answer 31

Using epidemiology to identify risk factors and predict future trends. Can explain inequities.
Policies exist but poorly implemented:
Reduced marketing to children.
Tax on unhealthy food.
Health food policies in schools and childhood centres.
Front of packet labelling of health effects.

Question 32

Why are interventions for obesity poorly implemented?

Answer 32

Policy inertia.
Direct opposition and lobbying from food corporations.
Reluctance to commit to regulation and belief in the ability for health education to reduce demand in unhealthy food. Does not want to partake in conflicting interests.
Insufficient public demand for change.

Question 33

Trends in adolescent health

Answer 33

Globally DALYs mainly due to NCDs (such as poor mental health). Deaths mainly due to injuries and CDs.
Globally, leading fatal risk factors are mostly related to CDs and injury.

Question 34

Results from the Youth Survey

Answer 34

High prevalence of good health, but that may not be representative of the population of interest.
Shows that Inverse Care Law exists. Youth with disability are more likely to report that their health needs are not met.

Question 35

Types of Error in the Youth Survey

Answer 35

Recruitment error: Only surveyed youth in normal high schools. More deprived youth/ youth in alternate education not considered while they are more likely to have different health outcomes.
Outcome measurement: Although anonymity is more likely to encourage honest reporting, the subjective nature of the measurements and the fear of social judgement can lead to inaccuracies.

Question 36

What does Right of Health entail? (5 areas)

Answer 36

1) Inclusive right to determinants of health beyond medical care, such as :
Safe drinking water/food/sanitation
Healthy working and living environments.
Health related education and information.
Gender equality.
2) Freedom from degrading, inhumane and nonconsensual medical treatment.
3) System of health protection which provides equitable opportunity to all to obtain the maximum level of health.
4) Equitable and timely access by all to essential medicines and care.
5) Opportunity for all to partake in health-system decisionmaking.

Question 37

According to R2H, states are obliged to:

Answer 37

RESPECT their citizens’ right to health.
Non discriminatory provision of healthcare and services.
PROTECT their citizens’ right to health.
Act against any third party intervention that would harm health outcomes of the population.
FULFIL their citizens’ right to health.
If the health framework does not provide equitable health outcomes, then the state must act to provide opportunities to those groups to enable them to reach the same health outcome.

Question 38

4 R2H instruments used in NZ.

Answer 38

NZ Health and Disability Strategy/ He Korowai Oranga are involved in reducing inequity- fulfills clause in ToW and DoI which promises equal citizenship.
Article I promised good governance, which entails the points outlined by RPF.
Article II promised protection of Taonga which can entail health.
UN declaration of the Rights of Indigenous People acknowledges that everyone has human rights, but the rights of the indigenous are not fully realised.

Question 39

Resilience

Answer 39

Promoted by ‘strength based measures’. Resilience refers to the ability for youth to return to a good state of wellbeing despite adversity, as well as decreased vulnerability to harm. Increase of factors contributing to resilience leads to reduction in health risk behaviours.