Public Health Flashcards
1
Q
Definition of health
A
A state of complete physical, mental and social wellbeing
Not merely the absence of disease
2
Q
Three domains of public health
A
Health protection
Health improvement
Improving services
3
Q
What is Health protection in public health
A
Measures to control infectious disease risk and environmental hazards
e.g. notifiable diseases, contact tracing for STIs, immunisations
4
Q
Health improvement in public health
A
Social interventions aimed at preventing disease, promoting health + reducing inequality
e.g. 5-a-day, screening
5
Q
Improving services in public health
A
Organisation and delivery of safe, high quality services
e.g. auditing and implementing recommendations
6
Q
Domains of determinants of health
A
Genetic
Environmental
Lifestyle
Healthcare
7
Q
PROGRESS in determinants of health
A
Place of residence
Race/ethnicity
Occupation
Gender
Religion
Education
Socioeconomic status
Social capital/resources
8
Q
Inverse care law
A
Availability of medical or social care tends to vary inversely with the needs of the population served
9
Q
Equality
A
Equal shares
Equality does not always mean equitable
10
Q
Equity
A
What is fair and just
11
Q
Horizontal equity
A
Equal treatment for equal need e.g. individuals with pneumonia should be treated equally
12
Q
Vertical equity
A
Unequal treatment for unequal need e.g. individuals with pneumonia require more care than those with common cold
13
Q
Forms of health equity
A
Equal expenditure for equal need
Equal access for equal need
Equal utilisation for equal need
Equal healthcare outcome for equal need
Equal health
14
Q
Dimensions of health equity
A
Spatial e.g. geographical
Social:
- Age
- Gender
- Socioeconomic status
- Ethnicity
15
Q
How can health equity be examined
A
Supply of healthcare
Access to healthcare
Utilisation of healthcare
Healthcare outcomes
Health status
16
Q
Levels for improving public health
A
Individual e.g. childhood immunisation
Community e.g. playground set up for local community
Ecological/population level e.g. banning smoking in public places
17
Q
Difference between secondary + tertiary prevention
A
Secondary: detecting disease early and preventing it worsening e.g. screening
Tertiary: once disease already well-established, improving quality of life + reducing symptoms
18
Q
Cycle of health needs assessment
A
Needs Assessment –> Planning –> Implementation –> Evaluation –> Assessment etc.
19
Q
What is health needs assessment
A
A systematic approach for reviewing health issues affecting a population which leads to agreed priorities and resource allocation, to improve health and decrease inequalities
20
Q
Elements to consider in health needs assessment
A
Need - ability to benefit from an intervention
Demand - what is asked for
Supply - what is provided
21
Q
Felt need
A
Individual perceptions of variation from normal health
22
Q
Expressed need
A
Individual seeks help to overcome variation in normal health (demand)
23
Q
Normative need
A
Professional defines intervention appropriate for the expressed need
24
Q
Comparative need
A
Comparison between severity, range of interventions and cost
25
Sociological (Bradshaw) perspective on health needs elements
Felt need
Expressed need
Normative need
Comparative need
26
Epidemiological approach to health needs
Defines problem and size of problem
Looks at current services
Recommends improvements
27
Limitations of epidemiological approach to health needs
Data available may be poor
May be inadequate evidence base
Doesn't consider felt need
28
Comparative approach to health needs
Compares services received by one population to another
29
Limitations of comparative approach to health needs
Data available may vary in quality
May be hard to find comparable population
Comparison may not be perfect
30
Coroporate approach to health needs
Takes into account views of any groups that may have an interest e.g. patients, health professionals, media, politicians
31
Limitations of corporate approach to health needs
May be hard to distinguish need from demand
Groups have vested interest --> bias
Dominant individuals may have undue influence
32
Egalitarian resource allocation
Provide all care that is necessary and required to everyone
Equal for everyone
Economically restricted
33
Maximising resource allocation
Based solely on consequence
Resources allocated to those likely to receive most benefit
Those with 'less need' receive nothing
34
Libertarian resource allocation
Each individual responsible for own health
Onus on patient so may be more engaged
However, not all diseases are self-inflicted
35
Donabedian framework for health service evaluation
Structure - what is there e.g. number of hospitals
Process (+ output) - what goes on?
Outcome - e.g. number of deaths
36
Maxwell's dimensions of assessing quality of health service
3As and 3Es
Access
Appropriateness (relevant to need)
Acceptability
Equity
Efficient
Effective
37
Limitations of using health outcomes for assessment of health services
Link between health service provided + health outcome difficult to establish as other factors involved
Delay between service + outcome may be long
Large sample sizes required
Data may not available/may be poor
38
What is health psychology
Emphasises the role of psychological factors in the cause, progression and consequences of health and illness
Aims to promote healthy behaviours + prevent illness
39
Three behaviours related to health
Health behaviour
Illness behaviour
Sick role behaviour
40
Health behaviour
A behaviour aimed to prevent disease e.g. eating healthily
41
Illness behaviour
A behaviour aimed to seek remedy e.g. going to the doctor
42
Sick role behaviour
Any activity aimed at getting well e.g. taking prescribed medication, resting
43
Examples of health damaging/impairing behaviours
Smoking
Alcohol + substance abuse
Risky sexual behaviour
Sun exposure
Driving without a seatbelt
44
Examples of health promoting behaviours
Exercising
Healthy eating
Attending health checks
Medication compliance
Vaccinations
45
Stages in transtheoretical model of behaviour change
Precontemplation
Contemplation
Preparation
Action
Maintenance
<-- relapse
46
Advantages of transtheoretical model of behaviour change
Acknowledges individual stages of readiness
Accounts for relapse
Temporal element
47
Disadvantages of transtheoretical model of behaviour change
Some individuals skip stages
Change may be continuous, not discrete
Doesn't consider values e.g. cultural + social factors
48
Examples of models and theories of behaviour change
Health belief model
Theory of planned behaviour
Stages of change/transtheoretical model
Social norms theory
Motivational interviewing
Social marketing
Nudging
Financial incentives
49
Health belief model (Becker, 1974)
Individuals will change if they:
- Believe they are susceptible to the condition (perceived susceptibility)
- Believe that it has serious consequences (perceived severity)
- Believe taking action reduces susceptibility (perceived benefit)
- Believe benefits of taking action outweigh costs (health motivation)
Takes into account demographics + psychological characteristics + cues to action (internal or external), as well as perceived barriers
50
Advantages of health belief model
Can be applied to wide variety of health behaviours
Cues to action are unique
Longest standing model
51
Disadvantages of health belief model
Other factors may influence outcome
Doesn't consider emotions
Doesn't differentiate between first time and repeated behaviours
52
Elements of health belief model
Demoographic variables + psychological characteristics
-->
Perceived susceptibility
Perceived severity
Health motivation
Perceived benefits
Perceived barriers
-->
Likelihood of action
+ cues to action
--> Action
53
Theory of planned behaviour (Ajzen, 1988)
Proposes best predictor of behaviour is intention, determined by:
- Attitude to behaviour
- Perceived social pressure to undertake behaviour (subjective norm)
- Perceived behavioural control
--> Intention
--> Behaviour
54
Bridging the gap between intention and behaviour in theory of planned behaviours
P PAIR
Prepatory actions
Perceived control
Anticipated regret
Implementation intentions
Relevance to self
55
Advantages of theory of planned behaviours
Can be applied to wide variety of health behaviours
Useful for predicting intention
Takes into account importance of social pressures
56
Disadvantages of theory of planned behaviours
No temporal element, direction or causality
Doesn't consider emotions
Assumes attitudes can be measured
57
Transitional points where health behaviour interventions are likely to be more effective
Leaving school
Entering workforce
Becoming a parent
Becoming unemployed
Retirement
Bereavement
58
Static risk factors
Features of a patient's history that someone cannot deliberately intervene in and change e.g. race, childhood trauma
59
Dynamic risk factors
Potentially changeable risk factors that may fluctuate over time and that have the possibility of intervention e.g. substance misuse, financial problems
60
Error of inherting thinking
Working diagnosis handed over and accepted with consideration and determination of whether this has been substantially proven/whether it matches the overall clinical picture
61
Error due to failure to consider alternatives
Typically when one abnormality is found that fits a particular diagnosis and no further searching is done for other clues that may change the differential
62
Error of overatachment
Conducting tests to confirm what we expect or want to see, instead of ruling out other causes
Confirmation bias
Premature closure
63
Error of bravado
Typically working above competence in a show of over-confidence that is not safe
64
Error of ignorance
Unconscious incompetence
65
Examples of ethical frameworks
Four quadrants approach
Seedhouse's ethical grid
66
Factors in four quadrants approach to ethical dilemmaa
Medical indications (beneficence + non-maleficence): encounters include a review of diagnosis + treatment options
Quality of life (beneficence + non-maleficence): aim of encounters is to improve, or at least address, quality of life for a patient
Patient preferences (respect for autonomy): encounters occur as patient presents --> patients values are integral
Contextual features (loyalty + fairness): encounters occur in wider context beyond patient + physician e.g. family, law, policy, insurance etc.
67
Layer 1 in Seedhouse's ethical grid
Core rationale
Is the intervention going to create autonomy, respect autonomy, treat all persons equally and serve needs first?
68
Layer 2 in Seedhouse's ethical grid
Deontological layer
Is the intervention consistent with moral duties - keeping promises, telling the truth, minimising harm and generating benefit?
69
Layer 3 in Seedhouse's ethical grid
Consequentialism layer
Is the intervention going to provide the greatest benefit for the greatest number? Furthermore, who will be the benefactors: society, an individual, a group or onself
70
Layer 4 in Seedhouse's ethical grid
External considerations
Is the intervention likely to be affected by resources, the law, risks, disputed evidence or facts and degree of certainty of the evidence on which the action is taken?
71
Toxic triangle for child abuse
Parents mental health issues
Alcohol + drug abuse
Domestic abuse
72
Domestic abuse
Any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between current or former partners or family members in a person over 16
73
Role of doctor in dealing with domestic abuse
Display helpline posters, give contact cards
Ensure records are kept
Vocally acknowledge it is not acceptable, be non-judgemental
Refer when appropriate
Break confidentiality if health is in danger
Don't speak about abuse when family members are present
74
DASH risk asessment
Low = serious harm unlikely
Medium = serious harm likely without change in circumstances --> give domestic abuse helpline contact details
High = risk of imminent harm
- Refer for multi-agency risk assessment conference (Marac) or independent domestic violence advocacy service (IDVAS)
75
Wilson Jungner criteria for screening
INASEP
Important disease
Natural history of disease understood e.g. known disease marker
Acceptable to population e.g. not too invasive
Simple, safe, precise test
Effective treatment (early detection --> better outcomes)
Policy agreed on who to treat + screen
Cost should be economically balanced
Continuous process
Facilities for diagnosis + treatment available
76
Screening disadvantages
Over-detection of subclinical disease
Harmful/distressing diagnostic tests e.g. colonoscopy after faecal occult blood test
Preventive interventions may be harmful e.g. side effects of medication
77
Sensitivity =
Ability to detect people with disease
Number of true positive results/total disease population
78
Specificity =
Ability to correctly exclude those without disease
Number of true negatives/total population without disease
Low specificity --> high number of false positives requiring follow-up
79
Positive predictive value =
Proportion of people who test positive who actually have the diseae
True positive/total positive
80
Negative predictive value =
Proportion of people who test negatively who do not have the disease
True negative/total negatives
81
Lead-time bias
Early identification doesn't alter outcome, but appears to increase survival
e.g. patient knows they have the disease for longer
82
Length-time bias
Slowly progressive diseases are more likey to be caught in screening, so screening appears to prolong life (whereas it is only catching slow growing disease)
83
Ecological studies
Descriptive
Observational
Looks at prevalence of disease over time
Population data, not individual
Can show prevalence and association, but not causation
84
Cross-sectional studies
Descriptive + analytical
Observational
Collects data from a population at a specific point in time e.g. census or patient survey
85
Advantages and disadvantages of cross-sectional studies
+ve:
- Large sample size
- provides data on prevalence
-ve:
- No time reference --> risk of reverse causality i.e. outcome may have caused exposure
86
Cohort studies
Analytical
Observational
Longitudinal study in similar groups, but with different risk factors/interventions
Follow-up over time to measure disease incidence
+ve:
- Can follow up rare exposure
- Can follow up naturally occuring-exposure that means RCT would not be ethical
- Allows identification of risk factors
-ve:
- Takes long time
- Expensive
- Drop out
87
Case-control study
Analytical
Observational
Looks at cause of disease by comparing similar participants with disease, and controls without
Retrospective assessment of exposure/cause
+ve:
- Quick
- Good for looking at exposures of rare outcomes
-ve:
- Difficutly finding similarly matched control participants
- Prone to selection + information bias
88
Advantages + disadvantages of RCTs
+ve
- Low risk of bias or confounding
- Can infer causality
-ve
- Time-consuming
- Expensive
- Can still be unrealiable if population sample not representative e.g. volunteer bias
- Not ethical in many scenarios
89
Odds
Probability/1-probability
90
Odds ratio
Odds that an outcome will occur given a particular exposure, compared to odds of outcome occurring in absence of the exposure
Odds of exposure in cases/odds of exposure in controls
Can be interpreted as relative risk when event is rare
91
Selection bias
Bias in selection of study participants
e.g. loss to follow up, difference between intervention + control group
Systematic difference between characteristics of individuals sampled and the population from which the sample is taken, OR
A systematic difference between the comparison groups within the study
Most important in case-control studies
92
Information bias
Systematic error in measurement or classification of exposure or outcome
Occurs when there is a systematic difference between comparison groups in the way that the data was collected
93
Sources of information bias
MORRP
Measurement bias e.g. different equipment
Observer bias i.e. observer's expectations influencing reporting
Recall bias - past events not remembered or recalled correctly
Reporting bias - respondent doesn't report truth as they feel ashamed/judged
Publication bias - trials with negative results less likely to be published
94
Bradford Hill criteria for causality
STD R Crap
Strength of association - magnitude of RR
Temporality - does exposure precede outcome
Dose response - higher risk of exposure --> higher risk of disease
Reversibility - removal of exposure reduces risk of disease
Consistency - similar results from different researchers using various study designs
Biological plausability
95
Epidemiology
Study of frequency, determinants + distribution of diseases and health realted states in populations
In order to prevent and control diease
96
Absolute risk vs relative risk
Absolute = actual numbers involved, has UNITS
Relative = ratio of risk of disease in exposed to risk in unexposed ie.g. incidence in exposed/incidence in non-exposed, NO units
97
Absolute risk reduction
Absolute difference in the rate of events between the 2 groups
Gives an indication of baseline risk + intervention effect
Incidence in non-exposed - incidence in exposed
98
Attributable risk, number needed to save:
Attributable = incidence in exposed - incidence in unexposed
Number needed to save = 1/attributable risk of exposure
99
Number needed to treat
1/absolute risk reduction (as decimal)
100
Addiction
Craving
Tolerance
Compulsive drug-seeking behaviour
Physiological withdrawal state
101
Positive conditioning in addiction
Addiction increases desire to use drug
102
Positive conditioning in addiction
Addiction increases desire to use drug
103
Positive conditioning in addiction
Addiction increases desire to use drug
104
Negative conditioning in addiction
People do not quit due to unpleasant withdrawal e.g. nausea
105
Negative conditioning in addiction
People do not quit due to unpleasant withdrawal e.g. nausea
106
Motivational interviewing
Attempts initiating behaviour change by resolving ambivalence
107
Motivational interviewing
Attempts initiating behaviour change by resolving ambivalence
108
Nudge theory in behaviour change
'Nudge' the environment to make the best option the easiest e.g. placing fruit next to checkouts
109
Unrealistic optimism theory
People engage in health-risky behaviours due to inaccurate perception of risk and susceptibility
110
Reasons for unrealistic optimism
Lack of personal experience
Hasn't happened now --> isn't going to happen
Believes problem is infrequent
Cultural variability
Socioeconomic factors
More common in younger age
Health belief e.g. believes healthy in other ways
111
Social exclusion
Dynamic process of being shut out fully/partially from social, economic, cultural or political systems
112
Social exclusion
Dynamic process of being shut out fully/partially from social, economic, cultural or political systems
113
5 domains of exclusion in older people
Material resources
Civic activities
Basic services
Neighbourhood
Social relationships
114
What does the NCSCT do?
- Delivers training + assessment programmes
- Provides support services for local + national providers
- Conducts research into behavioural support for smokign cessation
Overall: delivers tobacco control and smoking cessation interventions
115
Why notify about communicable diseases
So health protection agency can take urgent control measures
May be the only one who can tell Health protection agency
Duty of registered medical practitioners
116
What is included in Maslow's hierarchy of needs
- Self-fulfillment needs -->
Self-actualisation: desire to become the most that one can be, including creativity
- Psychological needs -->
Esteem: respect, self-esteem etc
Love + belonging: friendship, intimacy, family, connection
- Basic needs -->
Safety needs: personal security, employment, resources, health, property
Physiological needs: air, water, food, shelter, sleep, clothing, reproduction
117
Common causes of homelessness
Relationship breakdown
Domestic abuse
Fight with parents
Bereavement
118
Common causes of homelessness
Relationship breakdown
Domestic abuse
Fight with parents
Bereavement
119
Health problems faced by homeless
Mental illness
Infectious disease
Nutrition
Drug addiction
Dental + feet hygiene
Violence
120
Barriers to healthcare for homeless
Location
Discrimination
Don't prioritise health
May not know where to find help
121
Rules about asylum seekers
Someone applying for refugee status
They recieve:
- Vouchers to live off
- NASS support package
- Access to NHS
Not allowed to work, and have no choice where they go
122
Rules about asylum seekers
Someone applying for refugee status
They recieve:
- Vouchers to live off
- NASS support package
- Access to NHS
Not allowed to work, and have no choice where they go
123
Refugee
Someone who has been granted asylum status
Usually lasts 5 years
124
Humanitarian protection
Failed to get asylum, but serious threat of returning means they can stay for 3 years
125
Health problems for refugees
Injury/illness from war or travelling
Communicable disease
Lack of health screening + immunisation
Malnutrition
Untreated chronic disease
Mental illness: PTSD, depression, anxiety, post-migratory stress
126
Barriers to healthcare for travellers/migrants
Reluctance of GPs to register them
Illiteracy
Communication difficulties
Lack of permanent site
Mistrust of professionals
127
Article 2 of Human Rights Act 1998
Right to life
128
Article 2 of Human Rights Act 1998
Right to life
129
Article 3 of Human Rights Act 1998
Right to freedom from inhuman + degrading treatment
130
Article 8 of Human Rights Act 1998
Right to respect for privacy and family life
131
Article 8 of Human Rights Act 1998
Right to respect for privacy and family life
132
Article 12 of Human Rights Act 1998
Right to marry + find a family
133
Article 12 of Human Rights Act 1998
Right to marry + find a family
134
Article 14 of Human Rights Act 1998
Right to freedom from discrimination
135
4 elements of negligence
1. Was there a duty of care?
2. Was there are a breach in that duty?
3. Was the patient harmed?
4. Was the harm due to the breach in care?
136
Never events
Serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented
137
GMC duties of a doctor
Make the care of your patient your first concern
Protect + promote the health of the public
Provide a good standard of practice + care
Treat patients as individuals and respect their dignity
Work in partnership with patients
138
Intuitive thinking
Ability to understand something instantly without concious reasoning, recognition primed + heuristic (cognitive shortcuts), pattern recognition
+ve: fast + frugal
-ve: prone to biases
139
Intuitive thinking
Ability to understand something instantly without concious reasoning, recognition primed + heuristic (cognitive shortcuts), pattern recognition
+ve: fast + frugal
-ve: prone to biases
140
Analytical thinking
Not good at estimating odds or values, but very good at measuring + calculatig them
Premise of medical research + evidence-based medicine
+ve: accurate + reliable
-ve: slow, resource intensive + expensive, cognitively demanding
141
Analytical thinking
Not good at estimating odds or values, but very good at measuring + calculatig them
Premise of medical research + evidence-based medicine
+ve: accurate + reliable
-ve: slow, resource intensive + expensive, cognitively demanding
142
Dual process theory
Intuitive thinking with its irresistible combination of heuristics + biases AND analytical thinking -->
Not always just either/or --> BOTH in unison
143
Bias
A systematic errior which leads to an incorrect measure of association
144
Confounding
Occurs when an apparent association between an exposure and an outcome is actually the result of another outcome
145
Methods for reducing confounders
Randomisation - assumes confounders are then distributed equally
Restriction - limit study to people who are similar in relation to the confounders
Matching - select two comparative groups with the same distribution of the potential confounder (case-control)
146
Ecological fallacy
Mismatch that arises when making assumptions about an individual on the basis of a group study e.g. assuming everyone in the class has a high IQ, just because the average IQ is high
147
Prevention paradox
SEATBELTS
Intervention that brings benefit on a population level, but little to no benefit on the individual
