Population and Public Health Flashcards
what is population health?
the health outcomes of a group of individuals, including the distributions of such outcomes within the group
what is public health?
the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society
why is it important to understand the relationship between exposure and risk and outcome?
to plan interventions to promote health - keep healthy people healthy by avoid certain things or changing behaviour and care and treatment for those that are sick - equitable, safe and effective
what is the population health approach?
it is when health of the majority takes precedent - it is understanding the distribution and causes of ill health and finding a way at policy level to break the disease cycle. Solutions are often outside of the health sector - it is complicated as the chance of the exposure actually leading to disease is rare - most causal factors are actually just contributory and there is variation at an individual level
what are the types of causes?
necessary cause - presence is required for the disease to occur - you cannot have the disease without it but it does not always lead to the disease.
sufficient cause - presence leads to an effect - outcome alone would induce it but other factors can lead to same outcome
why might causes only be observable at a population level?
causes are not always direct and immediate - they might be remote and indirect
what is the prevention paradox?
when the majority of cases of a disease come from a low to moderate risk population and a seemingly small amount come from the high risk population. It is because disease have many causes, and are complicated and overlapping.
what did the fair society healthy lives say in Feb 2010?
to improve population health and reduce inequality children must have the best start in life, have control over their lives, have fair employment and opportunities, have a healthy standard of living and sustainable communities and the role and impact of ill-health prevention must be increased
define population?
a body of persons or individuals that have a characteristic in common or the whole number of people or inhabitants making up a region or country
how do you chose a subset of people?
decide who to include and where they reside and when we consider - person, place and time
what are the drivers of population change?
natural change = births - deaths
direct contribution from migration = immigration - emigration
indirect contribution from migration = changes in fertility and mortality
life expectancy
what does a triangular shape show in a population pyramid?
lots of young people and not a lot of old - mortality as age
how is the impact of societal and economic changes reflected in a population pyramid?
higher life expectancy - ageing population
men and women respond differently to changes in their environment - what does this show?
that gender is a risk factor for health - there are also gendered differences in health behaviours
what does ageing populations cause?
increases in multi morbidities and increase in ill health and disability - the social care also moves from a formal to informal setting
what are important drivers in health? give 3 examples?
age, gender and ethnicity
what do health behaviours partly cause?
the socioeconomic gradient
why is it difficult to identify causes of illness in public health data?
we need experimental but we have observational e.g. cohort or case control - selection of people in exposed and unexposed groups is not random - different in exposure but also in characteristics
when is an association most likely to be causal?
when the exposure is both necessary and sufficient
why is this usually not the case in public health data? i.e. why are the causes often not sufficient or necessary?
the illness can happen without the risk factor of interest, the risk factor does not always cause the illness and the
why do observational studies fall lower in the hierarchy of evidence than experimental studies?
because of the potential for confounding bias
what are the issues for causation?
although exposure can cause outcome, the outcome we think could also be the exposure - reverse causation, they could cause each other - bidirectional causation, or they could both be caused by something else - confounding
when is a causal association more plausible?
when the potential causes of confounding have been taken into account and dealt with appropriately, when there is less potential for reverse causality and the association meets a wider set of criteria
how can we deal with confounding?
stratifying into groups - identify potential for confounding, and statistical adjustment in regression model - taken into account multiple confounders
how can we reduce the potential for reverse causality?
use longitudinal data, use the same data and swap it around - cannot see cause if use observational
what is the bradford hill criteria?
it is a set of criteria, that is a way of examining is causality in an association is reasonable
what are the components of the bradford hill criteria?
there are 9 components. These are temporality, specificity, analogy, coherence, biological gradient, plausibility, experiment and strength
why will equal care not help to reduce health inequality?
because some people have a a greater need for healthcare than others
what is equitable care?
it is striving for equal outcomes - those in most need would receive the highest levels of care
what is health inequality and what does this mean for healthcare?
health inequality is the differences in health state or the distribution of heath determinants in different populations. in relation to medicine it is giving everyone the same budget. Some inequalities are unavoidable - these include the differences in morbidity between the elderly and young.
what are health inequities and what does this mean for healthcare?
health inequity are the differences that are avoidable, unnecessary, unfair and unjust. They are beyond the control of those involved and would mean we allocate a budget to everyone that they need to be healthy so those who are in more need have a higher budget. Health equity is needed to reduce inequality.
what is overt racism?
it is speech or behaviour that demonstrates a conscious awareness of racist attitudes and beliefs
what are some barriers to healthcare?
language barriers, poor communication, inadequate recognition, implicit bias, cultural naivety, insensitivity, discrimination and imbalance of authority
