Public Health Flashcards
3 domains of public health
Health improvement
health protection
improving services
What is health improvement?
social interventions aimed at preventing disease, promoting health + reducing inequalities
e.g. education, employment, housing
What is health protection?
measures to control infectious disease risks + environmental hazard
e.g. infectious disease, radiation, chemicals + poisons, environmental hazards
What is improving services?
organisation + delivery of safe, high quality services for prevention, treatment + care
e.g. clinical effectiveness, efficiency, service planning, audits, clinical governance
What are the determinants of health?
genetic, environmental, healthcare, lifestyle
inverse care law
availability of medical or social care tends to vary inversely with need of population served
equality
treating everyone the same, giving equal shares
equity
being fair, giving what they need to be successful
PROGRESS
place of residence
race or ethnicity
occupation
gender
religion
education
socio economic status
social capital or resources
horizontal equity
equal treatment for equal need
vertical equity
unequal treatment for unequal need
Bradford-Hill criteria
DR BC ST
dose-response
reversibility
biological plausibility
consistency
strength
temporality
bias
systematic error that results in deviation from true effect of exposure on outcome
confounding factors
factor is associated with exposure of interest + independently influences outcome
selection bias
systematic error in selection of study participants or allocation of participants to different study groups
information bias
systematic error in measurement or classification of exposure or outcome
public bias
studies with negative results less likely to be published
health definition
state of complete physical, mental + social wellbeing, not merely the absence of disease
3 types of health needs assessment
epidemiological, comparative, corporate
need definition
ability to benefit from an intervention
felt need
individual perceptions of deviation from normal health
expressed need
seeking help to overcome variation in normal health
normative
professional defines intervention for expressed need
comparative need
comparison between severity, range of interventions + cost
Maxwell’s dimensions
3 As + Es
access
appropriate, relevant to need
acceptability
equity
efficient
effective
health behaviour
aimed at preventing disease e.g. going for a run
illness behaviour
seeking remedy e.g. going to GP
sick role behaviour
activity aimed at getting better e.g. taking abx
transtheoretical model stages
PC PAM
pre contemplation
contemplation
preparation
action
maintenance
medical negligence
was there a duty of care?
was there a breach in that duty?
was patient harmed?
was harm due to breach in care?
Bolam rule
would reasonable doctor do the same?
Bolitho rule
would that be reasonable?
sloth error
lazy e.g. inadequate documentation
system error
inadequate built in safeguards
lack of skill
not having appropriate training
fixation
focus on 1 Dx only
bravado
working beyond competency
playing odds
deciding it’s common disease + turns out to be rare disease
poor team working
communication breakdown
ignorance
unconscious incompetence
screening
identifying apparently well individuals who have or are at risk of having particular disease
primary prevention
prevent disease from occurring
secondary prevention
detection of early disease to alter chances + improve outcomes (screening)
tertiary prevention
slow down progression of disease
Wilson-Junger criteria
condition should be important health problem
accepted Tx
facilities for Dx + Tx available
recognisable latent or early stage
suitable test or exam
test acceptable to population
natural Hx understood
agreed who to treat
cost-benefit balance
case finding continuous process
sensitivity
people with disease correctly identified
specificity
people without disease correctly excluded
PPV
people who test positive who have disease
NPV
people who test negative without disease
cross-sectional study
snapshot of those with + without disease to find associations at single point in time
+ cheap + quick
+ few ethical issues
- prone to bias
- no time reference
case-control
retrospective observational study looks at certain exposure + compares similar participants with + without disease
+ good for rare diseases
+ inexpensive
- only show association (not causation)
- unreliable due to recall bias
cohort
longitudinal prospective study which takes population of people recording their exposures + conditions they develop
+ can show causation
+ less chance of bias
- large amount lost to follow up
- expensive
RCT
similar participants randomly controlled to intervention or control groups to study effect of intervention
+ can infer causality
+ less risk of bias/confounders
- time consuming + expensive
- ethical issues can interfere
health needs assessment cycle
planning
implementation
evaluation
seedhouse ethical grid layers
4 layers
core rationale
deontological layer
consequential layer
external considerations
4 quadrants
medical indications
patient preferences
quality of life
contextual features
virtue ethics
virtuous habits, live life of moral character
consequentialism
whether action is right by judging consequences
utilitarianism
greatest good for greatest number
hedonism
it’s good if consequence produces pleasure or avoids pain
deontology
follow rules + do duty
satiation
bring eating occasion to end - control meal size
satiety
suppresses hunger after eating occasion - control snacking between meals
health equity
equal expenditure for equal need
equal access for equal need
equal utilisation for equal need
equal healthcare outcome for equal need
equal health
dimensions of health equity
spatial - geographical
social - age, gender, socioeconomic class, ethnicity
perceptions of risk
no personal experience with problem
belief that preventable by personal action
belief that if not happened by now, it won’t happen
belief that problem infrequent
health needs assessment - epidemiological approach
looks at evidence base, defines problem + size of problem, looks at current services, recommends improvements
+ provide info on incidence + prevalence of disease + existence + utilisation of services
- data available may be poor
- may be inadequate evidence base
- doesn’t consider felt need
health needs assessment - comparative approach
compares services received by 1 population to another (spatial/social)
- data available may vary in quality or unavailable
- may be hard to find comparable population
- comparison may not be perfect
health needs assessment - corporate approach
takes into account views of any group that may have an interest e.g. patients, doctors, media, politicians
interviews, focus groups, meetings
- may be hard to distinguish need from demand
- groups have vested interest - leads to bias
- dominant individuals may have undue influence
- may be influenced by political agendas
lead time bias
early identification appears to prolong survival time
length time bias
less aggressive cancers more likely to be identified by screening - makes it appear screening prolongs life
theory of planned behaviours - what determines intention?
ASP
attitudes to behaviour
subjective norms
perceived control over behaviour
theory of planned behaviours - what bridges the gap between intention + behaviour
P-PAIR
preparatory actions
perceived control
anticipated regret
implementation intentions
relevance to self
theory of planned behaviour advantages
can be applied to wide variety of health behaviours
useful for predicting intention
takes into account importance of social pressures
theory of planned behaviour disadvantages
no temporal element, direction or causality
doesn’t consider emotions
assumes attitudes can be measured
relies on self-reported behaviour
transtheoretical model advantages
acknowledges individual stages of readiness
accounts for relapse
temporal element
transtheoretical model disadvantages
some individuals skip stages or move backwards
change may be continuous or not discrete
doesn’t consider values e.g. cultural + social factors
health belief model - what determines likelihood of action?
perceived susceptibility
perceived severity
health motivation
perceived benefits
perceived barriers
health belief model advantages
can be applied to wide variety of health behaviours
cues to action unique component
longest standing model
health belief model disadvantages
other factors may influence outcome
doesn’t consider emotions
doesn’t differentiate between 1st time + repeated behaviours
cues to action often missing in HBM research
nudge theory
changing environment to make preferred option easiest
- weak evidence to support this
motivational interviewing
counselling approach for initiating behaviour change by resolving ambivalence
