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prevention promotion > Prevention and promotion in global health > Flashcards

Prevention and promotion in global health Flashcards

1
Q

GDP (Gross domestic product

A

used to measure economic performances/development. Critics: it doesn’t measure the health, quality of education, or joy. Doesn’t include beauty or poetry.

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1
Q

Human Development Index (HDI)

A

long and healthy life (life expectancy index), knowledge (education index), a decent standard of living (GNI index).

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2
Q

WHO Definition of health

A

a state of complete physical mental and social wellbeing, not merely an absence of disease or infirmity.

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3
Q

Goal of society

A

it might be more important to focus on how well you can participate in society and handle life’s challenges rather than just counting the number of years you survive. Coping better with life might be more practical and significant than fully recovering from every problem.

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4
Q

Indicators and measurement of health

A
  • Morality: number of people who have died within a population in a time period.
  • Morbidity: info about disease type, gender, age within a specific population.
  • Disability: impairments in covering, activity limitations and participation restrictions.
  • Quality of life: general wellbeing of individuals. Negative and positive features of life.
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5
Q

DALY

A

disability-adjusted life year. DALY helps health experts understand not only how long people live but also the impact of health problems on their ability to lead a good, healthy life. It’s a way of looking at both the quantity and quality of life.

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6
Q

YLL

A

years lost due to premature mortality. Subtracting age of death from the longest possible life expectancy for a person at that age.

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7
Q

YLD

A

years lived with disability

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8
Q

DALYs formula

A

YLL + YLD = DALYs

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9
Q

Formula YLL

A

YLL = N x L

N = number of deaths
L = standard life expectancy at age of death in years

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10
Q

Formula YDL

A

YLD = I x DW x L

I = number of incident cases
DW = disability weight
L = average duration of the case until remission or death (years)

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11
Q

Recommendable interventions for health

A
  • Curbing tobacco smoking
  • Tackling alcohol related harms
  • Promoting physical activity
  • improving quality of nutrition
  • addressing environmental risks for child health
  • preventing road related injuries
  • protecting mental health, preventing depression
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12
Q

Types of economic evaluation:

A
  • Cost consequence
  • Cost effectiveness
  • Cost utility
  • Cost benefit
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13
Q

APEASE criteria

A

The APEASE criteria is an evaluation framework used to assess the effectiveness of public health interventions, particularly those related to behavior change. The acronym stands for:

Affordability: Is the intervention economically feasible for the target population?

Practicability: Is the intervention practical and easy to implement for both the intervention providers and the target population?

Effectiveness: Does the intervention have a significant impact on the desired behavior change or health outcome?

Acceptability: Is the intervention acceptable to the target population and other stakeholders?

Safety: Does the intervention have any adverse effects or unintended consequences?

Equity: Does the intervention avoid increasing health disparities or inequities among different population groups?

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14
Q

EQ-5D

A

is a standardised instrument for use as a measure of health outcome.

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15
Q

Neoclassical exogenous growth models

A

technological progress is the engine of growth technological improvements are automatic and unmodeled (exogenous)

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16
Q

Endogenous growth models

A

try to explain the engine of growth. It is important to understand the economic forces underlying technological progress.

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17
Q

Barro model

A

public spending goes for public investment (infrastructures, schools, sanitation, health, etc) when the government uses money from taxes for useful projects, it can help everyone’s investments (both private and public) work better, and this can either boost or slow down the growth of the whole economy.

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18
Q

HIAP: health in all policies

A

way of making decisions in the government that thinks about how those decisions might affect people’s health. It means looking at all the different areas of government work and making sure they help make people healthier and treat everyone fairly.

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19
Q

Health a priority? Recommended …

A

working on socio-economic determinants to improve health.

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20
Q

Economic development a priority? Recommended ..

A

to invest in health

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21
Q

International organizations for global health:

A
  • World Health Organization:
    Providing leadership on matters critical to health and engaging in partnerships where joint action is needed. Setting norms and standards, providing technical support, and monitoring the health situation.
  • World Bank: helps countries around the world by giving them money and advice. Its main goal is to reduce poverty and improve people’s lives. It lends money to developing countries so they can build things like schools, hospitals, and roads. The World Bank also provides advice on how countries can manage their economies and reduce poverty. Overall, it works to make the world a better place by supporting projects and programs that benefit people and their communities.
  • UNICEF: helps children all around the world, they make sure children are happy healthy and safe.
  • The Global Fund: gathers money from different places and uses it to fight against diseases that affect many people, making sure they get the treatment and help they need.
22
Q

economy

A

the organized system of human activity involved in the production, consumption, exchange, and distribution of goods and services. Economy also refers to the way in which resources, especially those in shortage, are managed in a competent and appropriate manner.

23
Q

Economics

A

is the academic study of the production, distribution, and consumption of goods and services. Economics can be broken down into two main disciplines:
* Macroeconomics deals with the behavior of economies on a large scale, usually the economies of countries or regions.
* Microeconomics, on the other hand, usually addresses individual agents.
* Health system: the combination of resources, organization, financing and management that culminate in the delivery of health services to the population.

24
Q

Expense

A

monetary payment to purchase a productive factor (financial logic)

25
Q

Cost

A

resource utilisation (physical or monetary) to produce an activity (economical logic)

26
Q

Cost-opportunity

A

the potential benefits an individual, investor or business misses out on when choosing one alternative over another.

27
Q

Derived demand for health care

A

means that health care is an input into the production of health, unlike other sectors of the economy in which individuals demand goods for their direct effect on utility.

Example: I want to be healthy, but I don’t like to go to the hospital or to the dentist.

28
Q

Market failures in the health insurances

A

Asymmetric information leading to adverse selection.

  • The insurer sets an insurance premium.
  • The insurance is convenient only for patients most at risk or with pre-existing diseases who value that premium lower than the cost of not buying the insurance.
  • The “best” customers leave the market.
  • The more “expensive” customers are insured, and the insurer must increase the premium.
  • Other “virtuous” customers leave the market.
  • The market is unsustainable, or it is necessary to exclude those most at risk (for example the elderly or the disabled)
29
Q

Moral hazard:
Ex ante

A

since I have an insurance company that pays the costs of my treatment, I am less careful and prevention is disincentivized.

30
Q

Moral hazard:
Ex post

A

since as I have insurance that pays the costs of my treatment, when I get sick I will not look for the cheaper diagnosis or treatment but I will over spend to get well.

31
Q

Agency problem

A

The health provider is also a patient’s agent and can generate supplier-induced demand (disease mongering).

32
Q

Externalities

A
  • Negative externality: when the production or consumption of a product results in a cost to a third party.
  • Increase in negative behaviour: smoking, unhealthy habits (with treatment paid with public money).
  • Positive externality: a positive externality (also called ‘’external benefit’’ or ‘’external economy’’ or ‘’beneficial externality’’) is the positive effect an activity imposes on an unrelated third party.
  • Decrease in positive behaviour: unsufficient vaccination, less prevention.
33
Q

Public health – public good

A
  • Health is private good, but we also have public health, a public good
  • All non-rival and non-excludable goods can be produced only by public bodies (like public lights)

When not public, at least health is a meritory good

34
Q

What is a cost?

A
  • Anything which we naturally measure in monetary units is a cost.
  • That includes costs involved in the delivery of the intervention (staff, consumables).
  • As well as all healthcare that might be impacted downstream by the intervention (savings for people stopping smoking).
  • Impacts on employment and leisure time of an intervention are also costs (productivity costs).
  • Finally, if we want to value informal care in monetary terms the resulting estimates are costs and should be included with other costs.
  • Basically, if the units are a currency (euro, dollars, etc) it’s a cost.
35
Q

Challenges with respondents

A
  • Respondents are not typically faced with the task of valuing health outcomes or processes and may find it cognitively challenging. (How easy did you find it to value a reduction in your own risk of dying in a road accident?)
  • Some respondents may deem the questions inappropriate and refuse to engage with them (these are generally called ‘protesters’).
  • Responses may be highly skewed, and it can be difficult to discern whether some high values are ‘true’ values or not; such values can have a disproportionate impact on the total and mean value.
  • Finally, the nature of placing a monetary valuation on health ensures that responses from wealthier respondents (who are likely to place a lower utility on a unit of money and hence value health of a given utility at higher monetary values) are given a greater weight.
36
Q

QALY – Quality Adjusted Life Years

A
  • The QALY is a composite measure of quality of life and longevity.
  • Quality of life in a particular state of health is multiplied by the duration of time (in years) in that health state to generate the QALYs associated with that health state.
  • Quality of life is rated on a scale, with a maximum value of one for full health. Death is given the value of zero.
37
Q

relation between QALY and DALY

A

DALYs are related to the quality-adjusted life year (QALY) measure; however QALYs only measure the benefit with and without medical intervention and therefore do not measure the total burden. Also, QALYs tend to be an individual measure, and not a societal measure.

38
Q

Burden of disease

A

a way of figuring out the impact of various health issues on a population. It looks at things like diseases, injuries, and factors that can harm health. The goal is to get a full picture by using all the information available about how many people are affected and how it affects their well-being. This helps health experts compare and understand the health challenges in different places and over time. The World Health Organization (WHO) uses this approach to make sure the estimates are reliable and can be compared across regions and countries.

39
Q

HALE (health adjusted life expectancy)

A

In essence, HALE gives a more realistic picture of the quality of life by factoring in not just how long people live but also how healthy and active they are during those years.

40
Q

Net benefit

A

incremental benefit, incremental cost

If the extra money you gain or save from a new treatment is more than the additional cost of that treatment compared to what you were doing before, then the new treatment is considered cost-effective.

41
Q

Cost-benefit ratio or ROI

A

Ratio of incremental benefits divided by incremental costs.

42
Q

ICER

A

We cannot subtract the costs from the benefits, but we can take a ratio. That ratio is the incremental cost-effectiveness ratio or ICER.

The ratio is a measure of the efficiency of the intervention in generating health gains.

43
Q

Selecting an intervention from multiple alternatives

A
  1. Arrange the programmes in order of increasing cost. Any programme with a higher cost and lower health outcome than another programme is dominated.
  2. Calculate ICERs.
  3. Exclude all extendedly dominated programmes.
  4. Recalculate the ICER for the programme below the extendedly dominated programme.
  5. Select a programme. Programme with the largest health outcome and ICER that falls below threshold.
  6. Consider the threshold. Cost-effective?
44
Q

Societal perspective

A

Includes all costs and outcomes regardless of where they fall.

  • Government desires a narrower perspective, only interested in costs falling on government budgets or only costs falling on a subset of government budgets.
  • Social health insurers are interested in costs falling on employers.
  • Economists consider it to be most appropriate.
45
Q

Types of costs

A
  • Healthcare and non-healthcare
  • Direct and future healthcare costs
  • Cost-related and unrelated to intervention (increased lifespan)
  • General costs and direct costs
46
Q

International comparisons – PPP rate

A

Exchange rate = Purchasing Power Parity (PPP) rate. It’s calculated by selecting a representative basket of goods and services and summing the costs to buy that basket in different countries.

47
Q

health inequities are ..

A

avoidable, they are created by structural and political processes and decisions that affect the everyday living conditions of individuals and populations.

48
Q

social inequities arise because …

A

of inequities in the conditions of daily life and fundamental drivers: inequities in power, money and resources.

49
Q

Social determinants of health..

A

shape health inequities. Conditions in which people are born, grown, work, live and age.

50
Q

Social gradient in health..

A

graded relationship between social position and health where health outcomes progressively improve with increasing social position.

51
Q

Proportionate universalism

A

to reduce the steepness of the social gradient in health, actions must be universal but with a scale and intensity that is proportionate to the level of disadvantage.

52
Q
A

prevention promotion (3 decks)

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