Population Health 3 Flashcards
What is the definition of protection?
Protection seeks to protect the population from hazards, such as food-borne diseases, water contamination and hazardous waste.
- Health protection is accomplished through infrastructure and regulation, with inspectors ensuring smooth operation and compliance and Medical Officers of Health overseeing the system and investigation and intervening in emergencies or outbreaks
What is the definition of Health Promotion?
Health promotion seeks to enable the population to live as healthy a life as possible using both individual-level interventions and community level programmes and design.
- Health Education and the 5 key strategies of the Ottawa Charter are core components of Health Promotion
5 Key Strategies of the Ottawa Charter:
- Building healthy public policy
- Creating supportive environments
- Strengthening community action
- Developing personal skills
- Reorienting health services
What is the defintion of prevention?
Prevention is the attempt to intervene in the development or progression of a specific disease and subsequent ill-health.
Describe the three stages of prevention: Primary, Secondary, and Tertiary.
The three stages of prevention:
- Primary prevention: preventing the occurrence of a disease
- Halting or slowing the progression of a disease
- Preventing deterioration and maximizing quality of life
What is the goal of prevention?
The goal of prevention is to improve function and delay death (square the curve). Ideally, prevention would keep individuals cruising along the top green dashed line, in the prime of their lives despite diseases, until they’re knocked off quite suddenly from something else entirely.
- Prevention programs should focus on diseases that cause disability (measured in DALYs)
- A perfectly squared disability curve would reflect a state where DALY = 0
What 3 concepts are important in the guidance of prevention programs?
Prevention
- Measures of Risk - consider both the relative risk and absolute risk ex. breast cancer screening 15% vs. 0.05%
- Risk Curves - dose response curves can be complicated, physicians often rely on simplistic but physiologically unrealistic concepts of cut-points and thresholds
- Distribution of Risk - frequency distribution or bell-curve of the risk factor must be understood in order to consider the underlying drivers of it in the population and can identify opportunities to intervene
What is the prevention paradox?
The Prevention Paradox
- A large number of people exposed to a small risk may generate more cases than a small number of people exposed to a large risk
- A preventive measure that brings large benefits to the community offers little to each participating individual
Compare the high risk vs. population approach.
Disease prevention
- Focusing interventions on those that are highest risk
- Trying to shift the population distribution of risk to the left
ex. blood alcohol levels and traffic crashes
What characteristics make for a good candidate for disease screening?
Disease screening
- Important condition - a disease has to be common and it has to cause significant impairment on quality or length of life; it has to have a reasonably high incidence and it has to be associated with a high burden of disease (measured in DALYs)
- Natural history known - finding preclinical disease is not particularly helpful if you have no idea what happens next
- Recognizable preclinical or latent stage - without a latent phase there is no windwo in which to screen and we could more effectively just wait for individuals to present with symptoms
- Early treatment helps - in many cases the treatment of early stage disease has no impact on the long-term prognosis
- Suitable screening test - in order to recruit healthy individuals to participate in a screening program that by definition is unlikely to provide them much benefit (most people will screen negative) the test has to be palatable
- Diagnosis and treatment is cost-effective
- Screening reduced mortality - the inevitable false positives that come with screening carry a burden of disease, as does the treatment that will be offered to those found to have early disease
What is sensitivity?
Sensitivity is the true positive rate, the percentage of people with the disease that test positive.
What is specificity?
Specificity is the true negative rate; it is the percentage of people that do not have the disease and test negative.
What is the positive predictive value?
The positive predictive value is the probability that a positive test reflects the presence of disease.
What is the negative predictive value?
The negative predictive value is the probability that subjects with a negative screening test truly do not have the disease.
What is tertiary prevention?
The two most classic examples of tertiary prevention are probably 1) palliative care, where the focus is not on curing the un-curable or avoiding the inevitable, but on maximizing quality of life in face of terminal disease; and 2) harm reduction, where some risks are tolerated in order to focus on reducing the harms and ill-health that stem from them
- Much of the work of tertiary prevention will fall to allied health professionals; OT, PT, nurses, social workers, mental health professionals, pharmacists
What strategies are included in the Public Health Act?
Public Health Act
- Food regulation
- Housing regulation
- Nuisance and general sanitation regulation
- Personal services regulation
- Swimming pool, wading pool and spray park regulations
- Communicable disease regulation
