Public health Flashcards
What are the determinants of health
o Genes
o Environment – physical and social
o Lifestyle
o Health care
What is the difference between equity and equality?
o Equity = About what is fair & just
Depends on the need
o Equality = Concerned with equal shares
Describe the three domains of Public Health practice
- Health improvement
- Concerned with societal interventions (not primarily delivered through health services) aimed at preventing disease, promoting
health, and reducing inequalities - Health protection
- Concerned with measures to control infectious disease risks and
environmental hazards - Improving services (Health care)
- Concerned with the organisation and delivery of safe, high quality
services for prevention, treatment, and care
Difference between horizontal equity and vertical equity?
Horizontal equity
- Equal treatment for equal need
e. g. Individuals with pneumonia (with all other things being equal) should be treated equally
Vertical equity
- Unequal treatment for unequal need
e. g. Individuals with common cold vs pneumonia need unequal treatment
e. g. Areas with poorer health may need higher expenditure on health services
What are different forms of health equity?
Equal expenditure for equal need Equal access for equal need Equal utilisation for equal need Equal health care outcome for equal need Equal health
What are the dimensions of equity?
- Spatial - geographical
- Social:
- Age
- Gender
- Class
- Ethnicities
What are the domains in examining health equity?
- Supply of health care
- Access to health care
- Utilisation of health care
- Health care outcomes
- Health status
- Resource allocation -health services and other services such as education and housing
- Wider determinants of heath - diet, smoking, socioeconomic, physical environment
Steps in accessing health inequalities?
1) Assess inequality
2) Then decide if inequitable
Inequalities need to be explained
But equality (Eg: Equal utilization) may NOT be equitable
Different levels of public health interventions? with example
o Individual lvl: Eg: Vaccinations
o Community lvl: Eg: Education in schools
o Ecological (Population) lvl: Laws to make smoking or alcohol harder
Different levels of risks in Domestic abuse?
STANDARD – current evidence does NOT indicate likelihood of causing serious harm
MEDIUM – there are identifiable indicators of risk of serious harm. Offender has potential to cause serious harm but unlikely unless change in circumstances
HIGH – there are identifiable indicators of imminent risk of serious harm. Dynamic – could happen at any time and impact would be serious
Use DASH risk checklist
Where do you refer high risk domestic abuse cases to?
Multi-Agency Risk Assessment Conference (MARAC)
IDVAS - Independent domestic violence advisor service
What is incidence?
New cases/ number of disease free people at
the start of the study
Number of new cases per unit time
What is prevelance?
Number of existing cases at a given time
What is absolute risk?
Measurement of likelihood of a certain event would happen
gives a feel for actual
numbers involved i.e. has units
e.g. 50 deaths / 1000 population
What is relative risk?
Measurement of risk of a certain event happening as compared to other
Tells us about the strength of association between a risk factor and a disease
Absolute risk of expoure / abosulte risk in the unexposed
What is attributable risk?
Rate of disease that can be attributed to exposure
o Incidence in exposed – Incidence in unexposed
Is about the size of effect in absolute terms i.e. gives a feel for the public health impact (if causality is assumed)
What is number needed to treat?
Number of patients you need to treat to prevent 1 additional bad outcome
o Formula = 1/Absolute risk increase
Two main types of bias?
- Selection bias - selection of participant (sampling bias), and Allocation of participants into different study groups
- Information measurement bias:
- Observer - Observer bias - (Different observers may assess subjective criteria differently; Eg: Being aware of a subject’s disease status may introduce a bias in how the outcome is assessed)
- Participant - Recall bias - Due to differences in accuracy or completeness of the recollections retrieved by study participants regarding events or experiences from the past
- Instrument (wrongly caliberated)
3. Publication bias - negative results are not published
If association is not causal what else do you need to consider?
o Bias
o Chance
o Confounding
o Reverse causality
What is the bradford hill criteria for causality?
- Temporality: does exposure precede the outcome?
- Dose-response: the higher the exposure, the higher the risk of disease
- Strength of association: the magnitude of the relative risk
- Reversibility (experiment): removal of exposure reduces risk of disease
- Consistency- similar results from different researchers using various study designs
- Biological plausibility - biological mechanisms explaining the link
What are the different types of prevention?
- Primary = Intervention to prevent onset of disease
- Secondary = Intervention to pick up asymptomatic individuals with disease & treat
- Tertiary = Intervention to reduce -ve effects of disease from symptomatic individuals
What is the prevention paradox?
A preventive measure which brings much benefit to the population often offers little to each participating individual
What is the wilson and jugner criteria?
- The condition:
- needs to be an important health problem
- needs to have a latent phase
- known disease progression - A screening test:
- acceptable
- suitable - Treatment:
- Effective
- Agreed policy on whom to treat - organisation and cost:
- Cost effective
- Facilities
- On-going process
What is sensitivity?
Proportion of people with the disease to be correctly identified by the test
Memory: How sensitive is the test in picking out those with the disease accurately (True positives)
Formula: true positive / (true positive + false negative)