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Phase 3a > Public Health > Flashcards

Public Health Flashcards

1
Q

Explain the 3 domains of public health

A
  • Health improvement: societal interventions to prevent disease, promote health, and reduce inequalities
  • Health protection: measure to control infectious disease risks and environmental hazards
  • Health care: organisation and delivery or safe, high quality services for prevention, treatment, and care
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2
Q

What are the 3 main levels that public health interventions can be considered?

A
  • Ecological (population): changes in organisations, policies, laws, to impact population health (e.g. banning smoking in public places)
  • Community: changes in community awareness, attitudes, behaviours (e.g. outdoor gym equipment for local community)
  • Individual: changes knowledge, beliefs, behaviours of one person or family (e.g. childhood immunisations)
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3
Q

What is primordial prevention?

A
  • Preventing risk developing
  • e.g. laws to penalise substance misuse, affects those with no substance misuse who are healthy and not at risk
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4
Q

What is primary prevention?

A
  • Preventing a problem developing when a risk exists
  • e.g. targeted education and health promotion to those engaging in recreational drug use and at risk of substance misuse disorders
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5
Q

What is secondary prevention?

A
  • Early identification and preventing the problem progressing
  • e.g. drug treatment service (e.g. needle exchange, safe injecting sites, overdose naloxone) to those with clinical effects substance misuse disorders
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6
Q

What is tertiary prevention?

A
  • preventing the worst outcome or complications
  • e.g. drug treatment services or hospital care to prevent organ damage, death, or suicide
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7
Q

What are determinants of health?

A
  • rainbow by Whitehead, 1991
  • Constitutional factors (age, sex)
  • Individual lifestyle factors (diet, exercise, smoking/alcohol)
  • Social and community networks (social support, activities, community projects)
  • Living and working conditions (housing, care services, water and food, work environment, education)
  • General socio-economic, cultural and environmental conditions
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8
Q

Define horizontal equity

A
  • Equal treatment for equal need
  • e.g. individuals with pneumonia (with all other things being equal) should be treated equally
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9
Q

Define vertical equity

A
  • 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
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10
Q

How can health care equity be examined?

A
  • Supply of health care
  • Access to health care
  • Utilisation of health care
  • Health care outcomes
  • Health status
  • Resource allocation of health and other services (e.g. housing, education)
  • Wider determinants of health
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11
Q

What are the 4 stages of the planning cycle in a needs assessment?

A

Needs Assessment
Planning
Implementation
Evaluation

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12
Q

Define need, supply, and demand

A
  • Need: the ability to benefit from an intervention
  • Supply: what we actually provide
  • Demand: what people ask for
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13
Q

Explain Bradshaw’s taxonomy of social need (4 types of need)

A
  • Felt: individual perceptions of variation from normal health (want)
  • Expressed: individual seeks help to overcome the felt need (demand)
  • Normative: professional defines intervention appropriate for the expressed need (need)
  • Comparative: comparison between severity, range of interventions, and cost
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14
Q

What are the 3 approaches to health need assessments?

A

Epidemiological
Corporate
Comparative

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15
Q

Explain the epidemiological approach to health needs assessments

A

Uses disease incidence and prevalence in terms of:
- People: age, gender, occupation etc.
- Place: varying geographically
- Time: varying in seasons/cycles

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16
Q

What are the advantages and disadvantages of epidemiological approach to HNAs?

A
  • Advantages: uses existing data, evaluates service by trends over time
  • Disadvantages: quality of data is variable, does not consider felt needs or opinions of people affected
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17
Q

What sources of data are used in an epidemiological health needs assessment?

A

Population and census data
Birth/death registries
Primary care data
Hospital activity data
Survey data

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18
Q

Explain the corporate approach to health needs assessments

A
  • A structured collection of knowledge/views of ‘stakeholders’
  • Based on demands/wishes/perspectives of interested parties (professional, political, public)
  • Uses focus groups, interviews, public meetings, etc
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19
Q

What are the advantages and disadvantages of corporate approach to HNAs?

A
  • Advantages: based on felt and expressed needs, recognises knowledge/experience of those working with population
  • Disadvantages: difficult to distinguish need from demand, may be influenced by political agendas
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20
Q

Explain the comparative approach to health needs assessments

A
  • Compares health performance across communities, disease groups, service providers
  • Can be spatial (e.g. different towns) or social (e.g. different ages, social class)
  • Measures variation in cost and service use
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21
Q

What are the advantages and disadvantages of comparative approach to HNAs?

A
  • Advantages: quick and cheap, indicates whether health provision is better/worse than comparable areas
  • Disadvantages: may be difficult to find comparable population, may not yield what appropriate level should be
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22
Q

What are the benefits to health needs assessments?

A
  • Strengthens community involvement in decision making
  • Improved public participation
  • Improved team working and partnership
  • Improved patient care and use of resources
  • Improved communication with other agencies and public
  • Professional development of skills
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23
Q

What are the challenges to health needs assessments?

A
  • Professional boundaries prevent information sharing
  • Lack of commitment from top-down
  • Problems accessing local data or target population
  • Difficulty maintaining momentum and commitment
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24
Q

What is the 5 stage approach for a health needs assessment?

A
  • by Cavanagh and Chadwick
    1. Getting started (choose population, resources, aims)
    2. Identify health priorities (gather data, assess health conditions, determining factors, and perceptions of needs)
    3. Assessing a health priority for action (choose condition/factor with biggest influence, determine interventions)
    4. Planning for change (action planning, monitoring, and evaluation)
    5. Moving on/review (learning from project, measure impact)
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25
Q

What are the three approaches to resource allocation?

A

Egalitarian:
- provide all care that is necessary and require for everyone
- good because it’s equal
- bad because it’s too expensive

Maximising:
- act is evaluated solely in terms of it’s consequences
- good because resources allocated to those most likely to benefit
- bad because those who don’t make the cut receive nothing

Libertarian:
- each is responsible for their own health
- good because it promotes positive engagement
- bad because most diseases are not self inflicted

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26
Q

Define health psychology

A

The role of psychological factors in the cause, progression, and consequences of health and illness, by promoting healthy behaviours and preventing illness

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27
Q

Explain the 3 main categories of health behaviours

A
  • Health behaviour: aimed to prevent disease (e.g. eating healthily)
  • Illness behaviour: aimed to seek remedy (e.g. going to doctor)
  • Sick role behaviour: aimed at getting well (e.g. taking prescribed medication)
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28
Q

What are some solutions to health impairing behaviours?

A

Population level intervention:
- health promotion (e.g. change 4 life campaign)
- enables people to exert control over the determinants of health, so improves health

Individual level intervention:
- patient centre approach
- care responsive to individual needs
- e.g. 1 to 1 wellbeing coaching

Mixed level intervention:
- e.g. brief primary care intervention to reduce alcohol consumption could impact individuals (individual health outcomes), community (lower alcohol-related crime levels), or population (demographic patterns of liver disease)

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29
Q

Explain the theory of unrealistic optimism

A
  • Weinstein, 1983
    When individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility, influenced by:
  • lack of personal experience with the problem
  • belief that the problem is preventable by personal action
  • belief that if its not happened by now, its not likely to
  • belief that the problem is infrequent
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30
Q

List some reasons why people engage in health impairing behaviours

A

Health beliefs
Situational rationality
Culture variability
Stress
Age
Socioeconomic factors

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31
Q

What health outcomes are associated with lower risk perception?

A

Reduced attendance to health services
Reduced adherence to their medical regimen

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32
Q

Describe the health belief model

A
  • Becker, 1974
    Individuals will change if they believe:
  • they are susceptible to the condition
  • it has serious consequences
  • taking action reduces susceptibility
  • the benefits of taking cation outweigh the costs
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33
Q

What are the advantages and disadvantages to the health belief model?

A

Advantages:
- longest standing model of behaviour change
- successful for a range of health beliefs (e.g. breast self-examination, vaccinations, diabetes management)
Disadvantages:
- alternative factors may influence health behaviour (e.g. outcome expectancy, self-efficacy)
- does not differentiate between first time and repeat behaviour
- cues to action (internal/external) are often missing

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34
Q

Describe the theory of planned behaviour

A

*Ajzen, 1988
The best predictor of behaviour is ‘intention’, determined by:
- a persons attitude to the behaviour
- subjective norm (the perceived social pressure to undertake the behaviour)
- perceived behavioural control: a personal appraisal of the ability to perform the behaviour

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35
Q

What are the advantages and disadvantages of the theory of planned behaviour?

A

Advantages:
- takes into account social pressures and perceived control
- useful for predicting people’s intention
Disadvantages:
- lack of temporal element, direction, or causality
- does not consider emotions such as fear which may disrupt rational decision making
- does not explain how attitudes, intentions, and perceived behavioural control interact

36
Q

Describe the transtheoretical model of behaviour change

A
  • Prochaska & DiClemente, 1984
    1. Pre-contemplation (not ready yet, no intention of change)
    2. Contemplation (thinking about it, considering change)
    3. Preparation (getting ready to change)
    4. Action (doing it, engaging with change)
    5. Maintenance (sticking with it, consistently making change)
37
Q

What are the advantages and disadvantages of the transtheoretical model?

A

Advantages:
- acknowledges individual stages (tailored interventions
- accounts for relapses
- has a temporal element
Disadvantages:
- not all people move through every stage
- change may be continuous rather than in discrete stages
- does not account for emotions, habit, social factors

38
Q

Describe the social norms theory of behaviour change

A

*Perkins and Berkowitz, 1886
- Based on a set of assumptions that individuals incorrectly perceive that attitudes/behaviours of other are different from their own, when in reality that are similar
- Individuals may adjust their behaviour to that of the perceived majority, and are more likely to engage in problem behaviours
- Social norms approach interventions aims to correct misconceptions by exposing actual norms, to reduce problem behaviours and increase participation in healthy behaviours

39
Q

What are the advantages and disadvantages of the social norms theory

A

Advantages:
- takes into account social norms and perceptions
- can be targeted to certain populations or behaviours
Disadvantages:
- not all agree on its assumptions, and say that misperceptions are unrelated to behaviour
- interventions are easily undermined due to the misperceptions, and this may reinforce the misperceptions

40
Q

Define malnutrition

A

Deficiencies, excess, or imbalances in a person’s intake of energy and/or nutrients, covering:
- undernutrition (underweight, nutrient deficiencies, wasting)
- obesity/overweight (increased risk of diet-related noncommunicable disease)

41
Q

What are the early influences on feeding/eating behaviour?

A
  • Maternal diet and taste preference development
  • Role of breastfeeding for taste preference and body weight
  • Parenting practices and other factors (e.g. age of introduction to solids)
42
Q

How does the in utero environment impact food and behaviour?

A
  • Infants can demonstrate preference to certain tastes/odours
  • Amniotic fluid is influenced by the maternal diet
  • In utero environment influences taste exposure
43
Q

How does breastfeeding impact food and behaviour?

A
  • Composition/tastes varies between women across the day (foremilk = watery, hindmilk = energy dense)
  • This constitutes repeated exposure to different tastes, giving an advantage to accepting novel foods during weaning and being less picky eaters in childhood
44
Q

How does early taste exposure impact later preferences?

A
  • Greater preference for flavours they have been exposed to through amniotic fluid, breast milk, or formula
  • Effects of early experience on taste and flavour preferences last at least 10 years
  • Lower incidence of obesity in children who have been breast-fed
45
Q

How do parental practices influence infant feeding behaviours?

A
  • They can foster or prevent “healthful” eating
    behaviour in young and older children (and through to adulthood)
  • Maladaptive parental feeding practices include pressure to eat, authoritarian parenting style, restriction, using food as a reward, indulgent/neglectful feeding practices, and can lead to non-organic feeding disorders
46
Q

What are the challenges with weight loss?

A
  • Body weight regulation is highly complex due to developmental, social, and psychological influences
  • Long term weight loss is challenging as interventions demonstrate periods of plateau
  • Dieting results in loss of lean body mass not just fat mass
  • Chronic dieting may disrupt normal appetite responses and increase sensations of hunger
  • Risk factors for developing eating disorders
  • Biological mechanisms causing weight to ‘overshoot’ after in a diet-relapse cycle (metabolic set point)
47
Q

Define food/nutrition insecurity/poverty

A

Experiencing one or more of the following, due to not being able to afford or get access to food:
- Having smaller meals than usual or skipping meals
- Being hungry but not eating
- Not eating for a whole day

48
Q

What are the 4 dimensions of food insecurity?

A
  • Availability/affordability
  • Access (economic and physical)
  • Utilisation (opportunity to prepare food)
  • Stability (dimensions change over time)
49
Q

What are the 3 core principles of the NHS?

A
  • that it meets the needs of everyone
  • that it is free at the point of delivery
  • that it is based on clinical need not ability to pay
50
Q

Define health inequalities

A
  • Preventable, unfair, and unjust differences in health status between groups of people or communities
  • Arise from unequal distribution of social, environmental, and economic conditions
  • Causes marked differences in health outcomes
51
Q

Define the inverse care law

A
  • The availability of good medical or social care tends to vary inversely with the need of the population served
  • The more you need health care, the less there is available
52
Q

What are the vulnerable groups affected by health inequalities?

A
  • Homeless
  • Gypsies and Travellers
  • Asylum Seekers
  • LGBTQ +
  • Prisoners/Ex prisoners
  • Care leavers
  • Those with learning disabilities
  • Those with mental health problems
  • Those with physical disabilities
  • Elderly/Care home residents
53
Q

Describe Maslow’s hierarchy of need?

A
  • Physiological: breathing, food, water, sleep, excretion
  • Safety: security of body, employment, property, resources, family, health
  • Love/belonging: friendship, family, sexual intimacy
  • Esteem: self-esteem, confidence, respect of/by others
  • Self actualization: morality, creativity, spontaneity, lack of prejudice
54
Q

Define evaluation of health services

A
  • The assessment of whether a service achieves its objectives
  • A process to determine the relevance, effectiveness and impact of activities in light of their objectives
55
Q

What is the 3 stage framework for health service evalutaion?

A
  • Donabedian, 1960s
    Structure:
  • buildings, staff, equipment
  • e.g. number of ICU beds or vascular surgeons per 1000 population
    Process:
  • tests, examination, counselling, prescribing
  • e.g. number of admissions or operations performed
    Outcome: (5 Ds)
  • death (mortality)
  • disease/disability (morbidity)
  • discomfort
  • dissatisfaction
56
Q

What are Maxwell’s dimensions of quality of health services?

A
  • Acceptability
  • Accessibility
  • Appropriateness
  • Effectiveness
  • Efficiency
  • Equity
57
Q

What are the qualitative methods to health care evaluation?

A
  • Observations
  • Interviews
  • Focus groups
  • Review of documents
58
Q

What are the quantitative methods to health care evaluation?

A
  • Routinely collected data (e.g. hospital admissions, mortality)
  • Review of records (e.g. medical, administrative)
  • Surveys (e.g. satisfaction, symptoms)
59
Q

What are the limitations of using health outcomes to evaluate health services?

A
  • The link between health service provides and health outcomes may be difficult to establish, as many other factors may be involved
  • The time lag between service provided and outcome may be long (e.g. childhood healthy eating intervention and type 2 diabetes in middle age)
  • Large sample sizes may be needed to detect statistically significant effects
  • There may be issues with data availability or quality
60
Q

What is a case-control study, and what are the advantages/disadvantages?

A
  • Retrospective observational study which compares 2 existing groups which differ in outcome, to look back at different exposures
  • Advantages: good for rare outcomes, quick, can investigate multiple exposures
  • Disadvantages: difficult to find controls to match with cases, prone to selection and information bias
61
Q

What is a cohort study, and what are the advantages/disadvantages?

A
  • Prospective observational study which follows individuals with a common characteristic (exposure) overtime to compare their outcome
  • Advantages: can follow-up a group with a rare exposure, good for multiple outcomes, less risk of selection bias
  • Disadvantages: takes a long time, loss to follow up (drop outs), needs a large sample size, impractical for rare diseases
62
Q

What is a cross-sectional study, and what are the advantages/disadvantages?

A
  • Observational study which looks at data from a single point in time to examine outcomes and exposures
  • Advantages: relatively quick and cheap for a large sample size, provides prevalence data, good for surveillance and public health planning
  • Disadvantages: risk of reverse causality (don’t know whether outcome or exposure came first), cannot measure incidence, recall bias
63
Q

What is a randomised control trial, and what are the advantages/disadvantages?

A
  • An experimental study in which participants are randomly assigned to a control or intervention group to compare outcomes
  • Advantages: low risk of bias and confounding factors, can infer causality
  • Disadvantages: time consuming, expensive, specific inclusion/exclusion criteria mean population may differ from typical patients, ethical issues
64
Q

What are the causes of an association between exposure and outcome?

A
  • Chance
  • Bias
  • Confounding
  • Reverse causality
  • True causal association
65
Q

Define sensitivity, specificity, and positive/negative predictive values

A
  • Sensitivity: proportion of those with the disease who are correctly identified (true positive/all present)
  • Specificity: proportion of those without the disease who are correctly excluded by the screening test (true negative/all absent)
  • Positive predictive value: proportion of people with a positive test who actually have the disease (true positive/all positive)
  • Negative predictive value: proportion of people with a negative test who do not have the disease (true negative/all negative)
66
Q

Define incidence and prevalence?

A
  • Incidence: a measure of the number of new cases of a characteristic that develop in a population at a specific point or period in time
  • Prevalence: the number or proportion of a population who have a specific characteristic at a specific point or period in time
67
Q

What is person-time and incidence rate?

A
  • Person-time is a measure of the time at risk (e.g. time from entry to a study to disease onset or end of study)
  • This is used to calculate incidence rate (no. of people who become cases/total person-time at risk)
68
Q

What are the two main groups of bias?

A
  • Selection bias: systematic error in selection of study participants, or allocation of participants to different study groups
  • Information bias: systematic error in the measurement/classification of the exposure/outcome, from the observer, participant, or equipment
69
Q

What factors affect causality (Bradford-Hill criteria)?

A
  • Strength (stronger association between exposure and outcome)
  • Dose-response (higher exposure = higher risk)
  • Consistency (similar results from various studies)
  • Temporality (exposure preceding outcome)
  • Plausibility (reasonable biological mechanism)
  • Reversibility (removal of exposure reduces risk)
  • Coherence (logical consistency with other information)
  • Analogy (similarity with other established cause-effect relationships)
  • Specificity (relationships specific to outcome of interest)
70
Q

Define population and high risk approaches to prevention

A
  • Population approach: preventative measure delivered on a population wide basis and seeks to shit the risk factor distribution curve
  • High risk approach: identifies individuals above a chosen cut-off and treats them
71
Q

What is the prevention paradox?

A

A preventive measure which brings much benefit to the population often offers little to each participating individual

72
Q

What are the criteria for screening?

A
  • The condition: important problem, latent/preclinical phase, natural history known
  • The screening test: suitable (sensitive, specific, inexpensive), accepted by the public
  • The treatment: effective, agreed policy on whom to treat
  • The organisation and costs: facilities, costs and benefits, ongoing process
73
Q

What are some disadvantages of screening?

A
  • Exposure of well individuals to distressing or harmful diagnostic tests (e.g. colonoscopies for those with positive FIT tests)
  • Detection and treatment of sub-clinical disease that would never have caused any problems (e.g. non-aggressive prostate cancer)
  • Preventative interventions that my cause harm to the individual or population (e.g. increased antibiotic resistance if all were screened for group B strep in pregnancy
74
Q

What are the UK screening programmes?

A

3 in pregnancy:
- infections (hep B, syphilis, HIV)
- sickle cell and thalassaemia
- fetal anomaly (trisomy 21, 18, 13)

3 in newborn babies:
- NIPE (heart, eyes, hips, testes)
- hearing screen
- blood spot (sickle cell, congenital hypothyroid, CF, 6 metabolic diseases)

5 in young people and adults:
- cervical screening
- bowel cancer
- breast cancer
- AAA screening
- diabetic eye checks

75
Q

What is lead-time bias?

A
  • When screening identifies an outcome earlier that it would have otherwise been identified
  • Results in an apparent increase in survival time, but only because they knew about it for longer (same outcome still occurs)
76
Q

What is length time bias?

A
  • When screening is more likely to detect slow-growing disease that has a long phase without symptoms
  • This results in an apparent survival benefit to screening, but early detection didn’t improve the outcome
  • e.g. less aggressive cancer are more likely to be detected by screening rounds (because these patient are alive longer than those with more aggressive cancers)
77
Q

Define odds and odds ration

A
  • Odds is the probability of an event (i.e. a disease) occurring, calculated by probability event occurs divided by probability event doesn’t occur
  • Odds ratio compares the odds of an outcome occurring between two groups, calculated by odds of the event in treatment/exposure group divided by odds of the event in the control group
78
Q

Define absolute risk, absolute risk reduction, and relative risk

A
  • Absolute risk: number of events in the treatment or control group divided by total number of people in that group
  • Absolute risk reduction: absolute risk of events in control group - absolute risk of events in treatment group
  • Relative risk: absolute risk of treatment group divided by absolute risk of control group
79
Q

Define the number needed to treat

A
  • The number of patients needed to treat for one to benefit
  • Calculation: 1 divided by absolute risk reduction
80
Q

What is the interpretation of risk reduction or odds ratio?

A
  • If RR or OR is 1: no statistical difference between control and intervention
  • If RR or OR >1: control better than intervention
  • If RR or OR <1: intervention better than control
81
Q

Define asylum seeker and refugee

A
  • Asylum seeker: someone who is applying for refugee status
  • Refugee: someone who has been granted asylum status (usually 5 years)
82
Q

What health care is available to asylum seekers?

A
  • While application is being considered, free primary and secondary care
  • If application is refused, only free primary or emergency care
83
Q

What are the barriers for asylum seekers and refugees to accessing health care?

A
  • Language barriers or illiteracy
  • Reluctance of GPs to register them
  • Lack of permanent address
  • Mistrust in professionals
84
Q

What are some possible health problems for refugees and asylum seekers?

A
  • Injuries from war/travelling
  • Communicable disease
  • Lack of health screening and immunisations
  • Malnutrition
  • Untreated chronic diseases
  • Mental illness and psychological trauma
  • Sexual health problems
85
Q

What are the 4 aspects to negligence?

A
  • Was there a duty of care?
  • Was there a breach in that duty?
  • Was the patient harmed?
  • Was the harm due to the breach in care?
86
Q

What are some type of error in practice?

A
  • Negligence
  • Poor performance/ lack of skill
  • Misconduct
  • Failure of judgement
  • Human factors (e.g. bravado, timidity)
  • System failure (e.g. machine stops working)
  • Communication breakdown (e.g. unclear instructions)
  • Sloth error (being lazy, not checking results or accuracy)
87
Q

Define a never event

A

Serious, largely preventable patient safety incidents, that should not occur if the available preventative measures had been implemented

Phase 3a (10 decks)

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