Public Health Flashcards
What is ASPHER’s core competences for Public Health Professionals?
ASPHER is the Association of Schools of Public Health in the European Region. The core competencies include:
-Methods in public health
-Population health and its social and economic determinants
-Population health and its material and environmental determinants
-Health policy
-Health promotion, protection and disease prevention
-Ethics
What is Health?
A state of complete physical, mental and social wellbeing (not just the absence of disease).
The ability to adapt and manage physical, mental and social challenges throughout life.
What is public health?
Public Health is the discipline that addresses health at a population level.
What is the difference between clinical medicine and public health?
Clinical Health/Medicine deals with patients at an individual level.
Public Health looks at groups of people, both well and unwell: groups are communities, nations, the globe.
What are the two scopes of public health?
1- Understanding (Epidemiology & Surveillance)
2- Acting (Interventions, Health Promotion, Disease Prevention, Healthcare and Treatment)
Public health closes the gap between these two: the data, information, best practice, knowledge AND decision and actions.
What are some public health disciplines?
(Knowledge)
Epidemiology, Biostatistics, Study designs, qualitative research, demography, Ethics, Human Rights, Health Economics, Anthropology, Policy Science, Law and more.
What are some of the skills needed for public health practice? (3)
Management (all about the efficiency and effectiveness)
Leadership (all about the vision and direction)
Governance (all about value & accountability)
What is the public health approach? What are the 7 steps of operation?
- Identification of problems/challenges
- Scoping
- Conceive a clear question
- Research methods
- Inform Action
- Translate into practice
- Scale up, evaluate impact
What does the philosophy of science have to do with public health?
This relates to the 3rd step of the public health approach: evidence. The philosophy of science starts with conceiving a clear question.
What is evidence?
Evidence is based on foreground questions, which provide specific knowledge needed to inform actions or decisions.
When collecting evidence, what are multi-component questions?
Evidence (the specific knowledge needed to inform actions or decisions), is collected by asking multi-component questions: the most popular acronym is PICO:
P - Population or Problem
I - Intervention
C - Comporator
O - Outcomes
It helps you set boundaries, and the questions will help you to:
- define the population
- the phenomena
- measures (variables) needed to capture the phenomena (what we measure and how)
What is the difference between creating and using evidence?
You have a relationship with the evidence, in order to make decisions:
1 - Generating New Evidence: Creating/generating evidence is based on real world data that can be measured as data, numbers, in scales. We generate data with science, the scientific method (research methods, study design).
2 - Use Existing Evidence:
Using evidence is the information, facts and evidence that already exists. The question then becomes, is is readily accessible and usable? Is the quality good?
Good questions are: FINER -
Feasible
Interesting
Novel (contribute to advance knowledge)
Ethical
Relevant (likely to have an impact)
What is the scope of qualitative and quantitative methods?
(Part of generating evidence)
Qualitative Methods aim to understand the nature of the phenomenon: questions are Who, What, How, When, Why. The study designs are observations, interviews, fcus groups and surveys.
Quantitative Methods aim to understand the how much of a phenomenon: questions are Prevalence, Incidence, Impact and Associations. The study designs are ecological, case-control, cross-sectional, cohort, before & after and RCTs.
What are the main study designs in PH?
Public Health is looking at the population level, therefore working with groups of people: so we need control groups to compare. W/o a control group, we can’t come to any conclusions.
RCTs are see as the optimal design.
What is the evidence-to-action-cycle?
The evidence to action cycle, is going through what studies, information, facts and evidence that already exists - appraise the quality of the evidence, apply it and then act (with the complex intervention).
What are the 2 ways that we can get evidence/ acquire knowledge?
There are 2 ways that we get evidence/acquire knowledge:
1- research question –> study plans –> results
2 - (backwards): study results –> inference look at study plan –> second part of inference to look if this is accurate more largely or was this study (sample) unique
You use the evidence to make decisions
What is epidemiology? How does it relate to public health?
Epidemiology is the science that studies the patterns and determinants (causes) of health characteristics and their impact/burden on defined populations.
It is a cornerstone of public health because the better we understand the distribution, impact and casual relationships of health exposures and outcomes, the better we can plan interventions to improve health.
Remember: population perspective, comprehensive view of GROUP comparisons.
What are the main measures of descriptive epidemiology?
Descriptive epidemiology is:
community diagnosis, charting temporal trends, completion of the clinical picture, delineation of new syndromes.
Key measures here are prevalence (frequency of existing cases) and incidence (occurrence of new cases).
Prevalence Formula = Incidence x Duration
Low prevalence if there are few new cases or a short duration
Long durations are usually mental disorders
What is surveillance?
Surveillance is the ongoing, systematic collection, analysis and interpretation of health data. Disease surveillance data is used to determine the need for public health action.
Objectives include case management, outbreak detection, program management.
What is the difference between epidemics and pandemics?
Epidemic is the spread of disease in excess of the norm.
Pandemics are the spread of disease on a global scale.
What is the difference between eradication and elimination?
Eradication is the global reduction of the prevalence of a disease to zero. Only small pox has been eradicated.
Elimination is not complete.
Who is John Snow?
John Snow is the father of modern epidemiology.
1854 London cholera outbreak. He used a public health approach, by:
1- defining the problem
2 - exploring the cause (not just digging deep into the disease itself, but looking at the broader context)
3 - searching for solutions (interventions)
4 - intervention (informed action)
What are the uses of epidemiology?
The uses/approaches of epidemiology are
Descriptive, Analytic, Interventional and Translational (filling the gap with what we know/we do).
What is analytical epidemiology?
Analytical epidemiology is used to describe associations between factors (internal and external) and health.
Risk Factor –> Disease
Connections aren’t always causal, it could be chance (sampling error), bias (systematic, selection error), confounders (factors providing an alternative explanation for observed association ex of grey hair) or reverse causality (disease causes exposure).
There are different types of risk, measures of risk: absolute risk, relative risk, absolute risk reduction and so on.
What are the uses of epidemiology in public health?
Interventional: to design interventions based on evidence. To assess the interventions.
Translational: Evidence synthesis, evidence based medicine. Filling the gap with what we know and what we do: making the knowledge practice, creating the programs.
What is exponential growth in disease spreading?
This is a dynamic of the epidemic. Exponential growth is how quickly somethings spreads beyond our brain’s capacity to grasp.
What is R0? What does the number mean?
R0, is the basic reproductive number (thinking about disease spread). It is the average number of secondary cases that are caused by a single infectious individual in a totally susceptible population. It is the key parameter to express the epidemic spreading.
If R0 is more than 1; there will be an epidemic.
If R0 is less than 1; the number of cases will decline.
If R0 = 1; the disease will be endemic.
How do you calculate R0?
R0 = Duration x Contact x Probability of Transmission
This formula helps us to create preventive measures, for example:
Duration (vaccines may reduce infectiousness, better immunity)
Contact (vaccines may reduce the number of susceptible individuals) + (quarantines/lockdowns to reduce contact)
Probability of Transmission (Masks to reduce likelihood)
What is flattening the curve?
Flattening the curve is part of the dynamics of epidemics. It is reacting on the speed so that health care services can respond more effectively. This also gives us the opportunity to learn more about the disease as time goes on.
What are the 3 public health strategies? What are the goals, aims, key and timing for each?
Containment, Mitigation and Supression
What are measurements for determinants of health?
Determinants of health are how we measure a population’s health. They include:
- Disability (physical or mental impairment)
- Mortality (# of deaths from all causes/something specific in 1 year)
-Disease indicators (prevalence of cases + incidence of new cases) - Life expectancy
- DALYs (disability adjusted life years, commonly used for looking at burden of disease)
What are the 3 determinants of health?
1- Material and Environmental (external elements & conditions, like air pollution, climate, pesticides, occupational exposures, natural and man-made disasters).
2- Individual Characteristics
3 - Social, Economic, political (income, social status, access to health services)
What are measures that assess socioeconomic status?
Socioeconomic status is a determinant of health. It is the relative position of a family or individual in a hierarchical structure, based on access to/control over wealth, prestige and power.
Can be assessed by access to:
1 - resources (income, wealth, education)
2 - prestige (social status)
Can be assessed a the individual, household or community level.
Common indicators include: income, assets, occupation, education. There is not a single “best” indicator.
Others, maybe more useful, include: family wealth, subjective social status, economic mobility and assets.
What did we learn from the Turin Longitudinal Study?
The Turin Longitudinal Study, is a example we looked at for the determinants of health.
They were able to collect data around several trends, how characteristics affect health and created an interpretative model to find the root causes of inequalities.
In the map of Torino, every KM towards the less wealthy areas, saw 1 year less of life expectancy, as well as more pollution.
Mindmap cities aimed to identify local stakeholders across cities in Europe, for health promotion and equity-oriented policies formulation. Collected evidence to reduce health inequalities and create work plans and best practices.
What are the 4 types of health prevention?
Health prevention is all measures taken to prevent disease at individual and population levels. The 4 types include:
- Primordial: targets multiple diseases via risk factors. This could be changes to the environment, to put ppl in the position for healthy habits. For example, trails for ppl to hike on.
- Primary: targets multiple diseases via removing/reducing exposure to causes. Once you have a good understanding of the the cause, you can remove the risk factor for generally healthy individuals.
- Secondary: early/timely treatment/care targeting one disease. Must have a system in place for timely care: the goal is to prevent the consequences of disease, lessen the signs/symptoms, improve quality of life. This is closely linked to screening.
- Tertiary: Targeting one and co-morbid disease, it isn’t necessarily a treatment, but the goal is to reduce consequences and co-morbidities of poor health: give best level of health despite illness.
What are some ways to prevent NCDs?
What are some criteria for screenings?
Non-communicable diseases are prevented with:
-screenings (very important); example, new born blood test, primary prevention.
Wilson & Junger’s criteria for a screening: must be an important health problem, should be an accepted treatment, available facilities for diagnosis and treatment, recognizable early on, acceptable and suitable test, natural history of condition understood, agreed policy on who to treat, cost-effectiveness and continous.
-risk assessments
- prevention
What is a complex intervention?
A complex intervention of health has:
- separate elements (many things are important)
-interactions between elements - several actors/targets play part
- an “active” ingredient that is hard to define.
Components ( the elements); in order to establish clear relationships between components, you can draw relationships.
Behaviors = complexity: many factors lead to a behavior
Actors/Targets: there are groups and levels; for example, in a school could be parents, administrators, teachers, students – how do they relate to each other? You will have more than one target.
What is the MRC framework?
The MRC framework was designed to develop and evaluate complex interventions. We need to know if interventions work (effectiveness) and how they work (what are the “active ingredients”).
There are 4 main parts: Development, Feasibility & Piloting, Evaluation and Implementation. It is a cycle, not step by step guide.
What is iSupport an example of?
iSupport is an example of a complex intervention that we looked at in class. We looked at how it was designed as part of the MRC framework.
The team that implemented iSupport in Ticino did continuous interviews to adapt the program to the local context. Note, sometimes you are constrained by external factors. They also involved stakeholders at multiple levels.
What are some Global Burden of Disease (GBD) metrics?
