POPH progress test - Lecture 14 and 15

Question 1

Epidemiology

Answer 1

The study of the occurrence and distribution of health-related events, states or processes in specified populations

Question 2

Population health

Answer 2

The health outcomes of a group of individuals including the distribution of such outcomes within the group

Population can be large such as a country or a small geographic area like Dunedin or a particular group of people like students
Group perspective rather than an individual perspective of health
Average at population level, does not take into account the individual’s circumstances

Question 3

Distribution of health by socioeconomic status

Answer 3

People with low socioeconomic status have poorer health

As deprivation increases, the percentage of affected individuals increases

Question 4

Two important patterns of health distribution in NZ

Answer 4

Two important patterns of health distribution in NZ - ethnicity and socioeconomic status

Question 5

Ways to assess socioeconomic status?

Answer 5

Socioeconomic status (SES) - social and economic position in society

Ways that we assess SES? 
Occupation 
workplace environment?
Non-workers? 
People changing occupations?

Income - household, individual
Gross or net income?
Individual or household?

Education - qualification
Highest qualification? - likely to be a stable measure as it doesn’t change that often
Easy to remember?

Living standards measures
economic living standard index (survey)
Survey, range of aspects

By deprivation
NZi Dep (individual) and NZDep (area based)
NZDep is an area based measure of deprivation - looking at factors like access to internet, qualifications, employment, income, access to a car etc. This measure is applicable to everyone. Areas of approximately 100 people characterised into deciles. It is a measure that considers a rand of aspects.
Decile 1 is an area with the least deprived score (highest SES)
Decile 10 is an area with the most deprived score (lowest SES)
NZDep is a neighbourhood measure, not an individual measure
Incorporates a range of aspects but not everything. It is not a label
Measures relative socioeconomic deprivation and there is great complexity behind the measure

Question 6

NZDep

Answer 6

NZi Dep (individual) and NZDep (area based)

NZDep is an area based measure of deprivation - looking at factors like access to internet, qualifications, employment, income, access to a car etc. This measure is applicable to everyone. Areas of approximately 100 people characterised into deciles. It is a measure that considers a rand of aspects.

Decile 1 is an area with the least deprived score (highest SES)
Decile 10 is an area with the most deprived score (lowest SES)

NZDep is a neighbourhood measure, not an individual measure
Incorporates a range of aspects but not everything. It is not a label
Measures relative socioeconomic deprivation and there is great complexity behind the measure

Question 7

Absolute poverty

Answer 7

“Income level below which a minimum nutritionally adequate diet plus essential non-food requirements is not affordable. The amount of income a person, family or group needs to purchase an absolute amount of the basic necessities of life.”

This is extreme poverty as the individual is unable to access the bare minimum of society’s resources

Question 8

Relative poverty

Answer 8

“The amount of income a person, family, or group needs to purchase a relative amount of basic necessities of life; these basic necessities are identified relative to each society and economy.”

Question 9

Social gradient of health

Answer 9

In NZ and around the world, the poorest of the poor have the worst health
The Social Gradient of Health shows that with increasing levels of deprivation, poorer health outcomes increase
This is because of low SES
Low SES leads to poor quality housing (cold? mouldy? overcrowding?) which leads to health conditions ( e.g. respiratory conditions, rheumatic heart disease)

Question 10

Social determinants of health

Answer 10

The social determinants of health are the conditions in which people are born, grow, live, work and age, and the wider set of forces and systems shaping the conditions of daily life

Individual lifestyle factors → smoker? alcohol intake? diet? physical activity?
Social and community influences → what do others in the community do? neighbourhood?
Living and working conditions → housing? employed? type of work (physical hazards/physically demanding?)
General socioeconomic, cultural and environmental conditions → socio-economic factors at a national level? air quality levels?

Question 11

Global burden of disease

Answer 11

Burden of Disease - the impact of a health problem as measured by financial cost, mortality, morbidity or other indicators (DALY, YLL, YLD)

Two types of disease that can contribute to this burden …
Communicable disease - infectious diseases that can spread from person to person (HIV, Influenza, the plague)
Non-communicable disease - internal diseases suffered by an individual - they cannot be transmitted from person to person (e.g. cancer, heart disease)
Injury is another type of condition that contributes to burden but it is not important for POPH192

Low income countries have higher levels of communicable diseases

High income countries have higher levels of noncommunicable diseases
Non-communicable diseases as a cause of death in high income countries is often related to ageing

Question 12

Communicable disease

Answer 12

Communicable disease - infectious diseases that can spread from person to person (HIV, Influenza, the plague)

Question 13

Noncommunicable disease

Answer 13

Non-communicable disease - internal diseases suffered by an individual - they cannot be transmitted from person to person (e.g. cancer, heart disease)

Question 14

Mortality

Answer 14

Death

Question 15

Morbidity

Answer 15

Away from physiological and psychological wellbeing

Question 16

DALYs

Answer 16

DALYs - Disability Adjusted Life Years
Integrated measure of health loss
It is the sum of year of life lost (YLLs) and years lived with disability adjusted for severity (YLDs).
One DALY represents the loss of one year of life lived in full health

The sum of DALYs across the population can be thought of as a measurement of the gap between current health status and an ideal health situation (where the entire population lives to an advanced age, free of disease and disability.)

Question 17

YLLs

Answer 17

YLLs - Years of Life Lost
Years of life lost due to premature mortality
Measure of fatal health loss
It takes into account the number of deaths and the age at death

Question 18

YLDs

Answer 18

YLDs - Years lived with Disability
Years of life lost due to premature disability/health condition
Measure of non-fatal health loss

Question 19

Two transition theories that occur when a population is developing

Answer 19

Demographic transition and epidemiological transition

Question 20

Demographic transition

Answer 20

Demographic transition

Explains changes in population death and birth rates over time
Explains growth and change in populations over time
Pattern of a demographic transition
Initially there is high birth and death rates and a low total population
Death rate decreases, followed by birth rate
Total population increases, and both death and birth rates stabilise

Question 21

Epidemiological transition

Answer 21

Explains changes in population disease patterns over time - non communicable and communicable diseases
Pattern of epidemiological transition
As a country becomes more developed there is a decrease in communicable diseases and a corresponding increase in non-communicable diseases
This typically occurs as countries undergo development and upgrade sanitation/public health practices (also vaccines, development of infrastructure)
In the least developed countries e.g. Sub-Saharan Africa, there is high levels of communicable diseases
In developing countries e.g. India, we see a double burden of both communicable and non-communicable disease
In the developed countries e.g. US, NZ, there are high levels of non-communicable disease

Question 22

Ageing population

Answer 22

As a country becomes more developed, people generally live longer

It also linked in with both transitions - in a more developed country people have a longer life expectancy but also lower fertility (seen in the demographic transition), and older people also contribute more to non-communicable diseases (epidemiological transition)

Question 23

Compression of morbidity

Answer 23

Compression of morbidity aims to slow the progression from chronic disease to morbidity
This means that people can have a good quality of life and contribute to society for longer

Morbidity occurs later in life
Slows the progression from chronic illness to disability. Will create an increase in milder chronic disease but a decrease in the period of time a person experiences severe disability
Prolonging life to elderly ages by suppressing communicable diseases has its disadvantages - unpleasant non-communicable diseases such as diabetes