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Phase 3a > Public Health > Flashcards

Public Health Flashcards

1
Q

What are the founding principles of the NHS?

A
  • Meets the needs of everyone
  • Free at point of delivery
  • Based on clinical need, not ability to pay
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2
Q

What is the Wilson Jungner criteria for screening?

A
  • Important problem
  • Natural history of untreated disease known
  • Recognisable latent/early symptomatic stage
  • Obvious Dx test
  • Accepted treatment (and more effective if started early)
  • Policy on who should be treated
  • Diagnosis and treatment should be cost-effective
  • Case-finding should be continuous
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3
Q

What is health psychology?

A

Emphasises the role of psychological factors in the cause, progression and consequences of health and illness

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4
Q

What is the aim of health psychology?

A

Put theory into practice by promoting healthy behaviours and preventing illness

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5
Q

What is health behaviour?

A

A behaviour aimed to prevent disease e.g. eating healthily

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6
Q

What is illness behaviour?

A

A behaviour aimed to seek remedy e.g. going to the doctor

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7
Q

What is sick role behaviour?

A

Any activity aimed at getting well e.g. taking prescribed medications/resting

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8
Q

What are health damaging/impairing behaviours?

A
  • Smoking
  • Alcohol/substance abuse
  • Risky sexual behaviour
  • Sun exposure
  • Driving without a seatbelt
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9
Q

What are health promoting behaviours?

A
  • Exercising
  • Healthy eating
  • Attending health checks
  • Medication compliance
  • Vaccinations
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10
Q

What is the leading causes of death in men and women in England?

A

Men = IHD
Women = Dementia and Alzheimer’s

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11
Q

What did Weinstein (1983) say about health damaging behaviour?

A

Individuals continue to practice health damaging behaviour due to inaccurate perceptions of risk and susceptibility

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12
Q

What are perceptions of risk influenced by?

A
  • Lack of personal experience with problem
  • Belief that preventable by personal action
  • Belief that if it has not happened by now, it’s not likely to
  • Belief that problem is infrequent
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13
Q

What is public health (Winslow 1920)?

A

The science and art of preventing disease, prolonging life, and promoting health through the organised efforts and informed choices of society, organisations, public and private communities, and individuals

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14
Q

Classify the determinants of health

A
  • Environment (physical/social/economic)
  • Genetics
  • Lifestyle
  • Healthcare access
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15
Q

What is the inverse care law?

A

The availability of medical or social care tends to vary inversely with the need of the popular served

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16
Q

What is the difference between equity and equality?

A

Equity = what is fair and just (giving everyone what they need)

Equality = equal shares (giving everyone equal shares)

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17
Q

What is the difference between horizontal and vertical equity?

A

Horizontal = equal treatment for equal need e.g. individuals with pneumonia (with all other things being equal) should be treated equally

Vertical = unequal treatment for unequal need e.g. areas with poorer health may need higher expenditure on health services

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18
Q

What are the different forms of health equity?

A
  • Equal expenditure for equal need
  • Equal access for equal need
  • Equal utilisation for equal need
  • Equal health care outcome for equal need
  • Equal health
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19
Q

What are the dimensions of health equity?

A
  • Spatial (geographical)
  • Social = age/gender/socioeconomic/ethnicity
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20
Q

What are the three domains of public health practice?

A
  • Health improvement = social interventions aimed at preventing disease/promoting health/reducing inequalities (education/housing/employment)
  • Health protection = measures to control infectious disease risks and environmental hazards (infectious diseases/radiation/chemicals and poisons)
  • Health care/improving services = organisation and delivery of safe, high-quality services for prevention/treatment/care (clinical effectiveness/efficiency/service planning/audit evaluation)
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21
Q

What are health inequalities?

A

Avoidable and unfair differences between groups of people or communities that cause marked differences in health outcomes

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22
Q

What are the three main levels of interventions?

A
  • Ecological e.g. clean air act
  • Community e.g. playground set up
  • Individual e.g. childhood immunisation
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23
Q

What are the categories of public health prevention?

A
  • Primordial = healthy/not at risk and want to prevent risk developing
  • Primary = at risk of condition/disease and want to prevent problem when risk(s) exist(s)
  • Secondary = has condition/disease and want to prevent progression
  • Tertiary = has condition/disease and want to prevent worst outcome/complications
  • Quaternary = has condition/disease and want to prevent over treatment
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24
Q

What is the needs assessment and planning cycle?

A

Needs assessment –> planning –> implementation –> evaluation

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25
Q

What is Maslow’s hierarchy of needs?

A
  • Basic needs = physiological needs (food/water/warmth/rest)
  • Basic needs = safety needs (security/safety)
  • Psychological needs = belongingness and love needs (intimate relationships/friends)
  • Psychological needs = esteem needs (prestige and feeling of accomplishment)
  • Self-fulfilment needs = self-actualisation (achieving one’s full potential including creative activities)
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26
Q

What is Bradshaw’s taxonomy of social need?

A
  • Felt (wants) = individual perceptions of variation from normal health
  • Expressed (demands) = individual seeks help to overcome variation in normal health (demand)
  • Normative (needs) = professional defines intervention appropriate for the expressed need
  • Comparative = comparison between severity, range of interventions and cost
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27
Q

What is a need, demand and supply?

A

Need = the ability to benefit from an intervention

Demand/want = what people ask for

Supply = what we actually provide

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28
Q

Give 2 health-related examples of things that are needed but not demanded or supplied (1)

A
  • Asymptomatic hypertension (unperceived)
  • Patient with cancer nearing end-of-life opting to not undergo further treatment (chosen)
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29
Q

Give 3 health-related examples of things that are needed and demanded but not supplied (2)

A
  • Patient doesn’t receive treatment because of external factors outside of their control e.g. lack of clinical staff (unchosen)
  • Patient perceives a need and demands health care but doesn’t receive care that a clinician would deem appropriate e.g. alternative medicine (clinician validated)
  • Clinician doesn’t convey need on behalf of patient e.g. refusing to refer patient for procedure they need/request
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30
Q

Give a health-related example of something that is demanded but not needed or supplied (3)

A

Patient requesting a GP appointment motivated by need for social interaction rather than health need

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31
Q

Give 2 health-related example of something that is supplied but not needed or demanded (4)

A
  • Overstocking of vaccinations (deliberate safety margins as demand cannot be precisely predicted)
  • Unattended appointment (has potential to address need and demand)
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32
Q

Give 3 health-related examples of things that are demanded and supplied but not needed (6)

A
  • Unnecessary follow up appointment/avoidable A&E attendance
  • Delayed discharge from hospital
  • Clinically unnecessary investigations/treatments
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33
Q

Give a health-related example of something that is supplied but not needed or demanded (7)

A
  • Proactive preventative care
  • Screening ?
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34
Q

What is a health needs assessment?

A

A process of identifying the unmet health and healthcare needs of a population, and what changes are required to meet those unmet needs

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35
Q

What are Bradshaw’s needs?

A

Sociological perception of need:
- Felt need = individual perceptions of variation from normal health

  • Expressed need = individual seeks help to overcome variation in normal health (demand)
  • Normative need = professional defines intervention approach for expressed need
  • Comparative need = comparison between severity, range of interventions and cost
36
Q

What are the stages of the planning cycle for health services?

A
  • Needs assessment
  • Planning
  • Implementation
  • Evaluation
37
Q

What are the three main approaches to health needs assessments?

A
  • Epidemiological
  • Corporate
  • Comparative
38
Q

Describe the epidemiological approach to health needs assessments

A
  • Person (who) = who are the affected people e.g. age/gender/occupation
  • Place (where) = where are they when they get diseases e.g. does prevalence/incidence vary (local/national/international)?
  • Time (when) = when do they get diseases e.g. does it vary by seasons/cycles?
39
Q

What are critiques of the epidemiological approach to health needs assessments?

A
  • Re-enforces biomedical model (measurable)
  • Reliant on quality and availability of data
  • Requires suitably trained staff to analyse data
40
Q

Describe the corporate approach to health needs assessments

A
  • Structured collection of knowledge and views of stakeholders (focus groups/interviews)
  • Based on demands/wishes/perspectives of interested parties (professional/political/public)
  • Recognition of importance of knowledge available from those who have been involved in local service
41
Q

What are critiques of the corporate approach to health needs assessments?

A
  • Blurs difference between need and demand and between science and vested interest
  • If used in isolation, may reflect demand and supply rather than ‘need’
  • Stakeholders concerns may be influenced by political agendas
42
Q

Describe the comparative approach to health needs assessments

A
  • Compares health performance across or between communities, disease groups, service providers
  • Measure variation in cost and service use
  • Fairly quick and inexpensive to achieve
43
Q

What are some drawbacks to the comparative approach to health needs assessments?

A
  • Hard to find similar comparator
  • Often knowledge of optimum service not known
  • Usage rates may vary markedly for unexplained reasons
  • Link between usage rates and health outcomes may be hard to demonstrate
44
Q

What are 2 frameworks of how to do a health needs assessment?

A
  • Two stage (Harvey and Taylor 2013)
  • Five stage (Cavanagh and Chadwick 2005)
45
Q

Describe the two stage HNA framework (Harvey and Taylor 2013)

A

Epidemiological

Stage 1 = health profiling and identifying priorities

Stage 2 = in-depth assessment of a health priority
- Component 1 = size of problem (incidence/prevalence/need for intervention)
- Component 2 = effectiveness/cost effectiveness of intervention
- Component 3 = provision of current services

46
Q

Describe the five stage HNA framework (Cavanagh and Chadwick 2005)

A

Epidemiological/corporate/comparative

Step 1 = getting started (who/why/goals/resources/barriers)

Step 2 = identifying health priorities

Step 3 = assessing a health priority for action

Step 4 = planning for change

Step 5 = moving on/review

47
Q

What are 2 examples of HNA-related activities?

A
  • Health equity audits (DOH 2004)
  • Health impact assessment (Scott-Samuel et al 2013)
48
Q

Describe health equity audit (DOH 2004)

A
  • Aims to help services narrow health inequalities by using evidence to inform decisions on investment/service planning/commissioning/delivery and to review the impact of action on inequalities
  • Identifies how fairly services/resources are distributed in relation to health needs
  • Prioritises actions to provide services relative to need
49
Q

Describe health impact assessment (Scott-Samuel et al 2013)

A
  • Aims to systematically assess potential health impacts, positive and negative, intended and unintended of projects/programmes/policies
  • Aims to improve quality of public policy decisions by making recommendations that are likely to enhance predicted positive health impacts and minimize negative ones
  • Screening
  • Setting up a steering group
  • Implementation/monitoring/evaluation
50
Q

What are some models and theories of behaviour change?

A
  • Health belief model (HBM)
  • Theory of planned behaviour (TPB)
  • Stages of change (a.k.a transtheoretical model - TTM)
  • Social norms theory
  • Motivational interviewing
  • Social marketing
  • Nudging (choice architecture)
  • Financial incentives
51
Q

What is the health belief model (HBM)?

A

Individual will change if they:
- Believe they are susceptible to the condition in question
- Believe that it has serious consequences
- Believe that taking actions reduces susceptibility
- Believe that the benefits of taking action outweigh the costs

  • Internal/external cues to action = factors that trigger a person’s decision to change their behaviour e.g. symptoms (internal)/advice and campaigns (external)
  • Critique = alternative factors e.g. outcome expectancy and self-efficacy
52
Q

What is the theory of planned behaviour (TPB)?

A
  • Best predictor of behaviour is intention

Intention is determined by:
- A person’s attitude to the behaviour
- The perceived social pressure to undertake the behaviour (subjective norm)
- A person’s appraisal of their ability to perform the behaviour (perceived behavioural control)

  • Critique = rational choice model so doesn’t take into account emotions/fear/threat/positive affect
  • Critique = doesn’t take into account habits and routines
  • Critique = relies on self-reported behaviour
  • Critique = assumes that attitudes/subjective norms/PBC can be measured
53
Q

What is the transtheoretical model (TTM a.k.a stages of change model)?

A
  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Advantage = acknowledges individual stages of readiness
  • Advantage = accounts for relapse
  • Advantage = temporal element
  • Critique = people don’t always move through every stage
  • Critique = change might operate on a continuum rather than in discrete stages
  • Critique = doesn’t take in account values/habits/emotions/culture/social and economic factors
  • Critique = people often change their behaviour in the absence of planning (intentions can change over short time period)
54
Q

What is the social norms theory?

A
  • Behaviour is influenced by misperceptions of how our peers think and act
  • Overestimations/underestimates of problem behaviour in peers will cause increased/decreased engagement in problematic behaviour
55
Q

What is motivational interviewing?

A

Counselling approach for initiating behaviour change by resolving ambivalence

56
Q

What is the nudge theory?

A

Nudge the environment to make the best option the easiest e.g. opt-out schemes/placing fruit next to checkouts

57
Q

What is malnutrition?

A

Deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients

  • Undernutrition
  • Overweight, obesity and diet-related noncommunicable diseases (e.g. stroke/diabetes/heart disease)
58
Q

What is undernutrition?

A

Stunting, wasting, underweight and micronutrient deficiencies or insufficiencies

59
Q

What is the triple burden of malnutrition?

A

Malnutrition including micronutrient deficiencies (hidden hunger)

60
Q

What does evaluation of health services mean?

A
  • The assessment of whether a service achieves its objectives
  • A process that attempts to determine as systematically and objectively as possible the relevance, effectiveness and impact of activities in the light of their objectives
61
Q

How might evaluation be used in health care?

A
  • Single intervention e.g. RCT evaluating effectiveness of new drug
  • Public health interventions e.g. evaluation of impact of smoking ban on health using epidemiological studies
  • Health economics e.g. evaluating cost-effectiveness of a medical intervention
  • Health technology assessment (incorporates systematic review, economic evaluation and mathmatical modelling)
62
Q

What is the general framework for health service evaluation?

A
  • Define what the service is
  • What are the aims/objectives of the service
  • Framework
  • Methodology to be used
  • Results, conclusions and recommendations
63
Q

What is the widely used framework for health service evaluation?

A

Donabedian’s 3 stage model
- Structure (e.g. buildings/staff/equipment)
- Process (e.g. tests/examination/counselling/prescribing)
- Outcome (e.g. mortality/morbidity (QoL)/satisfaction)

64
Q

What are some issues with health outcomes (in health service evaluation)?

A
  • Link (cause and effect) may be difficult to establish due to other confounding factors
  • Time lag between service provided and outcome may be long
  • Large sample sizes may be needed to detect statistically significant effects
  • Data may not be available
  • May be issues with data quality
65
Q

How is quality of health care commonly assessed?

A

Maxwell’s dimensions of quality (3 As and 3Es)

  • Acceptability
  • Accessibility
  • Appropriateness
  • Effectiveness
  • Efficiency
  • Equity
66
Q

What are qualitative methods of health service evaluation?

A

Consult relevant stakeholders e.g. staff/patients/carers

  • Observation
  • Interviews
  • Focus groups
  • Review of documents
67
Q

What are quantitative methods of health service evaluation?

A
  • Routinely collected data e.g. hospital admissions/mortality
  • Review of records
  • Surveys
  • Special studies e.g. using epidemiological methods
68
Q

What is the definition of epidemiology?

A

The study of frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease

69
Q

What are the two main measures of disease frequency?

A
  • Prevalence = point prevalence/period prevalence
  • Incidence = cumulative incidence or risk or incidence proportion/incidence odds/incidence rate
70
Q

What is point prevalence?

A

Measure of existing cases

No. of cases of disease at a point in time / total number of people in the defined population at the same point in time

71
Q

What is period prevalence?

A

Essentially a combination of prevalence and incidence

No. of cases of disease at any time during a specific period / total no. of people in that defined population

72
Q

What is incidence?

A

Measure of new cases/events/outcomes of disease

  • In a specified time period
  • In a defined population

3 measures of incidence = risk/rate/odds

73
Q

What is cumulative incidence (risk)?

A

No. of new cases of disease in a specified time period / no. of disease-free people at start of time period

74
Q

What is incidence odds (odd of disease)?

A

No. of new cases of disease in a specified time period / no. of people who were still disease-free at the end of the time period

a.k.a

Probability of getting disease by end of time period / probability of not getting disease by end of time period

75
Q

What is incidence rate?

A

Takes into account time in study - allows for open and closed cohorts

No. of new cases of disease in a given time period / total person-time at risk during that time period

76
Q

What is risk ratio?

A

Risk (cumulative incidence) in exposed group / risk (cumulative incidence) in unexposed group

77
Q

What is rate ratio?

A

Incidence rate in exposed group / incidence rate in unexposed group

78
Q

What is odds ratio?

A

Odds of disease in exposed group / odds of disease in unexposed group

79
Q

What factors affect association and causation?

A
  • Bias
  • Chance
  • Confounding
  • Reverse causation
80
Q

What are 2 approaches to prevention?

A
  • Population approach = preventative measure delivered on a population wide basis seeking to shift the risk factor distribution curve e.g. dietary salt reduction through legislation
  • High risk approach = seeks to identify individuals above a chosen cut-off and treat them e.g. screening for people with high BP and treating them
81
Q

What is prevention paradox (Rose 1981)?

A

A preventative measure which brings much benefit to the population often offers little to each participating individuals

e.g. statins and CVD (on average need to prescribe statins to 40 patients to be taken every day for 10 years, in order to prevent 1 from developing CVD)

82
Q

What are the 5 main epidemiological study designs?

A
  • Cohort
  • Case-control
  • Intervention (RCT)
  • Ecological
  • Cross-sectional study
83
Q

Describe the design of a cohort study

A
  • People without disease
  • Exposed/not exposed
  • Outcome of disease/no disease
84
Q

Describe the design of a case-control study

A
  • Cases (people with disease) = retrospectively look at exposed/not exposed
  • Controls (people without disease) = retrospectively look at exposed/not exposed
85
Q

Describe the design of a randomised controlled trial

A
  • Selection by defined criteria
  • Participants
  • Randomization = treatment/control
86
Q

Describe the design of a cross-sectional study

A

Point prevalence = people with disease/population (sample) surveyed

87
Q

Describe the design of an ecological study

A
  • Exposure level against prevalence of disease
  • Geographical (ecological correlation)
  • Time against prevalence of disease (time trends)

Phase 3a (21 decks)

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