Population and Public Health

Question 1

what is population health?

Answer 1

the health outcomes of a group of individuals, including the distributions of such outcomes within the group

Question 2

what is public health?

Answer 2

the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society

Question 3

why is it important to understand the relationship between exposure and risk and outcome?

Answer 3

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

Question 4

what is the population health approach?

Answer 4

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

Question 5

what are the types of causes?

Answer 5

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

Question 6

why might causes only be observable at a population level?

Answer 6

causes are not always direct and immediate - they might be remote and indirect

Question 7

what is the prevention paradox?

Answer 7

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.

Question 8

what did the fair society healthy lives say in Feb 2010?

Answer 8

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

Question 9

define population?

Answer 9

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

Question 10

how do you chose a subset of people?

Answer 10

decide who to include and where they reside and when we consider - person, place and time

Question 11

what are the drivers of population change?

Answer 11

natural change = births - deaths
direct contribution from migration = immigration - emigration
indirect contribution from migration = changes in fertility and mortality
life expectancy

Question 12

what does a triangular shape show in a population pyramid?

Answer 12

lots of young people and not a lot of old - mortality as age

Question 13

how is the impact of societal and economic changes reflected in a population pyramid?

Answer 13

higher life expectancy - ageing population

Question 14

men and women respond differently to changes in their environment - what does this show?

Answer 14

that gender is a risk factor for health - there are also gendered differences in health behaviours

Question 15

what does ageing populations cause?

Answer 15

increases in multi morbidities and increase in ill health and disability - the social care also moves from a formal to informal setting

Question 16

what are important drivers in health? give 3 examples?

Answer 16

age, gender and ethnicity

Question 17

what do health behaviours partly cause?

Answer 17

the socioeconomic gradient

Question 18

why is it difficult to identify causes of illness in public health data?

Answer 18

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

Question 19

when is an association most likely to be causal?

Answer 19

when the exposure is both necessary and sufficient

Question 20

why is this usually not the case in public health data? i.e. why are the causes often not sufficient or necessary?

Answer 20

the illness can happen without the risk factor of interest, the risk factor does not always cause the illness and the

Question 21

why do observational studies fall lower in the hierarchy of evidence than experimental studies?

Answer 21

because of the potential for confounding bias

Question 22

what are the issues for causation?

Answer 22

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

Question 23

when is a causal association more plausible?

Answer 23

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

Question 24

how can we deal with confounding?

Answer 24

stratifying into groups - identify potential for confounding, and statistical adjustment in regression model - taken into account multiple confounders

Question 25

how can we reduce the potential for reverse causality?

Answer 25

use longitudinal data, use the same data and swap it around - cannot see cause if use observational

Question 26

what is the bradford hill criteria?

Answer 26

it is a set of criteria, that is a way of examining is causality in an association is reasonable

Question 27

what are the components of the bradford hill criteria?

Answer 27

there are 9 components. These are temporality, specificity, analogy, coherence, biological gradient, plausibility, experiment and strength

Question 28

why will equal care not help to reduce health inequality?

Answer 28

because some people have a a greater need for healthcare than others

Question 29

what is equitable care?

Answer 29

it is striving for equal outcomes - those in most need would receive the highest levels of care

Question 30

what is health inequality and what does this mean for healthcare?

Answer 30

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.

Question 31

what are health inequities and what does this mean for healthcare?

Answer 31

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.

Question 32

what is overt racism?

Answer 32

it is speech or behaviour that demonstrates a conscious awareness of racist attitudes and beliefs

Question 33

what are some barriers to healthcare?

Answer 33

language barriers, poor communication, inadequate recognition, implicit bias, cultural naivety, insensitivity, discrimination and imbalance of authority