Public Health Flashcards
Define equity versus equality?
equity: what is fair and just
equality: having fair shares, may not always be equitable
What is horizontal versus vertical equity?
horizontal = equal treatment for equal need
vertical = unequal tx for unequal need eg poor area needs more services
Define the inverse care law
Availability of health care tends to vary inversely with need
What are the key determinants of health?
PROGRESS:
Place of residence
Race
Occupation
Gender
Religion
Education
Socio economic
Social capital
What are the 3 domains of public health practise?
- health improvement: societal interventions aimed at preventing disease, promoting health + reducing inequality
- health protection: measures to control infectious disease and environmental hazards
- improving services: delivery of safe, high quality services
What are Maxwell’s dimensions of the quality of health care?
3As, 3Es
Acceptability
Accessibility
Appropriateness
Effectiveness
Efficiency
Equity
What are the 3 steps of health care evaluation?
structure - what is there eg number of hospitals
process - what goes on eg how many patients seen
outcome eg number of deaths
Define health needs assessment
a systematic approach for reviewing health issues affecting a population
in order to enable agreed priorities and resource allocation
to improve health and reduce inequalities
What is need vs demand vs supply?
need = ability to benefit from an intervention
demand = what people ask for
supply = what is provided
What is health need vs health care need?
health need = ability to benefit from an intervention measured using mortality/morbidity
health care need = ability to benefit from health care
Define felt need
individual perceptions of variation from normal health
Define expressed need
individual seeks help to overcome variation in normal health (demand)
Define normative need
professional defines intervention for the expressed need
Define comparative need
comparison of severity, range of interventions and cost between two groups with similar characteristics
A health needs assessment is based on what 3 perspectives?
- epidemiological
- comparative
- corporate
What is considered in the epidemiological perspective of a health needs assessment?
size of problem
services available - prevention or tx
evidence base
What are the pros + cons of using the epidemiological perspective in a health needs assessment?
+ uses existing data
+ provides data on disease incidence/mortality/morbidity
- quality of data variable
- data collected may not be data required
- does not consider felt needs or opinions/experiences of people affected
What is the comparative perspective of a health needs assessment inform health need?
compares services/outcomes received by a population with others
eg spatial, social - age, gender, ethnicity, class
What may the comparative perspective of a health needs assessment include?
health status
service provision and utilisation
heath outcomes - mortality, morbidity, QoL, patient satisfaction
What are the pros + cons of the comparative perspective in a health needs assessment?
+ quick + cheap
+ indicates relative performance of health provision
- difficult to find comparable population
- data may not be available/high quality
What is the corporate perspective of a health needs assessment?
ask local population what their health needs are using focus groups/interviews etc
What are the pros + cons of the corporate perspective in a health needs assessment?
+ based on felt + expressed needs
+ recognises detailed knowledge/experience of those working within the populations
+ wide range of views
- difficult to distinguish need from demand
- groups may have vested interests
- may be influenced by political agendas
What 3 principles is resource allocation based on?
- egalitarian - provide all care that is necessary and required for everyone
- maximising - evaluate entirely in terms of consequences, is it beneficial?
- libertarian - each is responsible for their own health
What are the pros and cons of egalitarian resource allocation?
+ equal for everyone
- economically restricted
What are the pros and cons of maximising resource allocation?
+ allocated to those who it is most likely to benefit the most
- those with less need receive nothing
What are the pros and cons of libertarian resource allocation?
+ promotes patient engagement
- most disease not self inflicted
What is primary vs secondary vs tertiary prevention?
primary = preventing disease occurring g vaccine
secondary = early identification to alter disease course eg screening
tertiary = limit consequence of established disease
What is the population versus high risk approach to prevention?
population = delivered to everyone to lower the number of people at risk eg dietary salt reduction through legislation
high risk = identify individuals above chosen cut-off and treat eg screening for high BP and treat
Define the prevention paradox
A preventive measure which brings much benefit to the population often offers little to each participating individual eg seatbelts
Define screening
A process that sorts out apparently well people who probably have a disease from those who probably don’t
What is the Wilson Jungner criteria for screening?
INASEP
Important disease
Natural history of disease understood - known marker, recognisable early/latent stage
Acceptable to population - not too invasive
Simple, safe, precise test
Effective treatment - early vs late detection has better outcomes, accepted by population
Policy agreed on who to tx + facilities to treat them
Cost
Screening must be ongoing
What are the disadvantages of screening?
over detection of subclinical disease
harmful/distressing diagnostic tests following screening
preventive interventions may be harmful eg SEs of meds
Define sensitivity
ability to detect people with disease
= TP/total disease population (TP + FN)
What can a highly sensitive test indicate?
high SeNsitivity = SNout = rule out
disease has a trait which is almost always present + the test looks for this trait > if the trait isn’t present > disease unlikely > rule out
Define specificity
excluding those without disease correctly
= TN/TN + FP
What can a highly specific test indicate? But what is the caveat to this?
highly SPecific = SPin = rule in
helps rule a disease in when positive as the trait is rare in other diseases
HOWEVER a positive doesn’t = diseases because it doesn’t factor in prevalence of the disease
What is the consequence of low specificity?
high number of FP follow ups
Define positive predictive value
proportion of people who test +ve who actually have the disease
= TP/TP + FP
Define negative predictive value
proportion of people who test negative who don’t have the disease
= TN/FN + TN
What factor impacts predictive values but not sensitivity and specificity?
underlying prevalence
Define lead time bias
early identification doesn’t alter outcome but APPEARS to increases survival eg pt knows they have the disease for longer
Define length bias
slowly progressing diseases more likely to be caught in screening > makes it look like screening prolongs life when it is only catching slow growing types eg cancer
What are the 2 types of observational study?
descriptive > ecological, case reports
analytical > cohort, case control
both > cross sectional
What is an ecological study?
type of cross sectional study
carried out on the population, not individual
eg income, pollution, climate, diet
shows prevalence + association, not causation
What is a cross sectional study?
data collection from a population at a single point in time = prevalence study eg census
shows snapshot of populations current health data
not emerging new data
What are the pros and cons of a cross sectional study?
+ large sample size
+ data on prevalence of RF/disease
+ useful for PH planning
+ cheap, quick
- no time reference > risk of reverse causality (outcome caused the exposure) > cannot assume causality
- cannot distinguish between causal factors and factors that cause the disease to persist
- not useful for rare conditions
What is a cohort study?
longitudinal study on a group of individuals who share a common characteristic
RFs/tx eg one has intervention, one doesn’t
follows up over time to measure who gets disease
can be retro/prospective
What are the pros and cons of a cohort study?
+ can follow up rare/dangerous exposure that would be unethical in RCT
+ identification of RFs
+ accurate + detailed exposure assessment in a prospective study incl dose response
+ identify potential confounders prospectively
+ meet temporality criteria for causality
- long time, can be impractical
- large sample size required
- people dropout
- cost - active follow-up costly
What is a case control study?
looks for people with a disease, then looks back at exposure, to establish cause
What are the pros and cons of a case control study?
+ quick, cheap
+ good for looking at rare DISEASE
+ can study effect of multiple exposures on risk for a single disease
- difficulty finding similarly matched control participants
- prone to selection, information, observer and response bias
- not suitable for rare exposures
- not suitable for studying multiple outcomes for a single exposure
What are the 2 types of study?
- observational
- experimental
Name an experimental study type
RCT - participants randomised, one group receives tx, other acts as a control
What are the pros and cons of an RCT?
+ low risk of bias/confounding due to randomisation
+ can infer causality
- time consuming
- expensive
- still can be unreliable if sample not representative eg volunteer bias
What are the 5 stages of grief?
denial
anger
bargaining
depression
acceptance
What is adjustment disorder? Provide examples.
reaction to an event is maladaptive/not expected
- recovery too long - acceptance in grief pathway should be by 6m
- coping mechanisms extreme/harmful
-continuing impact on relationships/school/work - self-harm/suicide
What is the toxic triangle for child abuse?
parents MH
alcohol + drug abuse
domestic abuse