PUBLIC HEALTH Flashcards
What are the three domains of public health?
Health improvement
Health protection
health services
What is horizontal equity?
Equal treatment for equal need
What is vertical equity?
Unequal treatment for unequal need
What is a health need?
Ability to benefit from an intervention
What are Bradshaw’s needs?
Felt
Expressed
Normative
Comparative
FENC
What are the three ways to assess health needs?
Epidemiological
Comparative
Corporate
What are the advantages/disadvantages of using an epidemiological approach to health needs assessment?
‘Top-down’ approach.
Uses existing data.
Quality of data can be variable.
Doesn’t consider felt needs.
What are the advantages/disadvantages of using a comparative approach to health needs assessment?
Compare health provision of one population to another.
Can be spacial (town/city) or social (class).
Cheap, indicates where comparative need is greatest.
Doesn’t identify level of ‘good’ provision.
What is a corporate approach to health needs assessment?
Ask the local population what their health needs are.
Focus groups, public meetings and interviews.
Wide variety of stake-holders e.g. politicians, teachers, charities.
What are the two approaches to health needs evaluation?
Maxwell’s
Donabedian
What is Maxwell’s approach to health needs evaluation?
3 E’s:
Equity
Effectiveness
Efficiency
3 A’s:
Appropriateness
Accessibility
Acceptability
Describe the donabedian approach to health needs evaluation
Structure
Process
Outcome
What are the Wilson and Juggler criteria for a good screening test?
Is the condition important?
Is there an accepted treatment?
Facilities for diagnosis and treatment should be available.
There is should be a recognizable latent or early phase.
There should be a suitable test or examination.
The test should be acceptable to the population.
The natural history of the condition should be adequately understood.
What is sensitivity?
Sensitivity: percentage of those with the disease who have positive tests.
What is specificity?
Specificity: percentage of those without the disease who have negative tests.
What is the positive predicted value?
Positive predicted value (PPV): the percentage of correct positive results.
What is the negative predicted value?
Negative predicted value (NPV): the percentage of correct negative results.
Describe two types of bias that can be seen in screening
Lead time bias
Length time bias
What is lead time bias?
When screening identifies an outcome earlier than it would otherwise have been identified this results in an apparent increase in survival time, even if screening has no effect on outcome.
What is length time bias?
Type of bias resulting from differences in the length of time taken for a condition to progress to severe effects, that may affect the apparent efficacy of a screening method.
What is incidence?
Incidence: rate at which new cases appear (must give time frame).
What is the prevalence?
Prevalence: number of cases at any given time (%).