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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 are some social determinants of health?

A
  • Physical/mental health
  • Trauma
  • Perception of risk
  • Access to healthcare services
  • Family history
  • Social stigma
  • Structural racism
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16
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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17
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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18
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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19
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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20
Q

What are the dimensions of health equity?

A
  • Spatial (geographical)
  • Social = age/gender/socioeconomic/ethnicity
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21
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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22
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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23
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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24
Q

What are the categories of prevention?

A
  • Primary = prevent disease from occurring in the first place
  • Secondary = detection of early disease in order to alter course of disease and maximise chances of complete recovery (e.g. screening)
  • Tertiary = trying to slow down progression of disease
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25
Q

What is the needs assessment and planning cycle?

A

Needs assessment –> planning –> implementation –> evaluation

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26
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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27
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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28
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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29
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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30
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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31
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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32
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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33
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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34
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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35
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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36
Q

Which professionals can be involved in a health needs assessment?

A
  • Community nurse/worker
  • GP
  • Primary care staff
  • Mental health practitioner
  • Social services
  • Residents
  • Public health officials
  • Health visitors
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37
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
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38
Q

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

A
  • Needs assessment
  • Planning
  • Implementation
  • Evaluation
39
Q

What are the three main approaches to health needs assessments?

A
  • Epidemiological
  • Corporate
  • Comparative
40
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?
41
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
42
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
43
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
44
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
45
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
46
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)
47
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

48
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

49
Q

What are 2 examples of HNA-related activities?

A
  • Health equity audits (DOH 2004)
  • Health impact assessment (Scott-Samuel et al 2013)
50
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
51
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
52
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
53
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
54
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
55
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)
56
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
57
Q

What is motivational interviewing?

A

Counselling approach for initiating behaviour change by resolving ambivalence

58
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

59
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)
60
Q

What is undernutrition?

A

Stunting, wasting, underweight and micronutrient deficiencies or insufficiencies

61
Q

What is the triple burden of malnutrition?

A

Malnutrition including micronutrient deficiencies (hidden hunger)

62
Q

What are early influences on feeding/eating behaviour?

A
  • Maternal diet
  • Breastfeeding for taste preference
  • Parenting practices
  • Age of weaning/types of food exposed
63
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
64
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)

65
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
66
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
67
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
68
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
69
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

70
Q

What are the two main measures of disease frequency?

A
  • Prevalence = existing cases of a disease at a specific point in time
  • Incidence = number of new cases of disease during a specific time period
71
Q

What is relative risk?

A

Risk in one category relative to another e.g. comparison of disease in exposed group vs unexposed - strength of association between risk factors and disease

RR >1 suggests risk has increased due to factor exposure

Absolute risk or incidence in exposed group / absolute risk or incidence in unexposed group

72
Q

What is odds ratio?

A

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

73
Q

What factors affect association and causation?

A
  • Bias (selection/information/public)
  • Chance
  • Confounding
  • Reverse causation
74
Q

What considerations are used to investigate causal relationships?

A

Bradford Hill Criteria - DR BC ST

  • Dose response (more risk with more exposure)
  • Reversibility (risk decreases if exposure taken away)
  • Biological plausibility (reasonable mechanism for cause and effect)
  • Consistency (seen in different geographical areas/different study designs/different subjects)
  • Strength (very high relative risk)
  • ***Temporality (exposure occurs before outcome)
75
Q

What is lead time vs length time bias?

A
  • Lead time = early identification doesn’t alter outcomes but appears to increase survival e.g. patients know they have the disease for longer
  • Length time = disease that progresses more slowly is more likely to be picked up by screening which makes it appear that screening prolongs life
76
Q

Describe the types of bias

A
  • Selection = systematic errror in selection of participants or allocation of participants to different study groups
  • Information = systematic error in measurement/classification of exposure/outcome
  • Public = studies with negative results less likely to be published
77
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
78
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)

79
Q

What are the 5 main epidemiological study designs?

A
  • Cohort
  • Case-control
  • Intervention (RCT)
  • Ecological
  • Cross-sectional study
80
Q

Describe the design of a cohort study

A
  • People without disease
  • Exposed/not exposed
  • Outcome of disease/no disease
  • Can be prospective or retrospective
81
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
82
Q

Describe the design of a randomised controlled trial

A
  • Selection by defined criteria
  • Participants
  • Randomization = treatment/control
83
Q

Describe the design of a cross-sectional study

A
  • Point prevalence = people with disease/population (sample) surveyed
  • No follow up
84
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)
85
Q

Define sensitivity and specificity in relation to screening tests?

A
  • Sensitivity = proprtion of people with disease who are correctly identified by the screening test
  • Specificity = proprortion of people without the disease who are correctly excluded by the screening test
86
Q

Define positive and negative predictive values

A
  • Positive = the proportion of people with a positive test result who actually have the disease
  • Negative = the proprtion of people with a negative test result who do not have the disease
87
Q

What is the difference between an asylum seeker and an refugee?

A
  • Asylum seeker = someone applying for refugee status
  • Refugee = someone who has been granted asylum status
88
Q

What healthcare can asylum seekers access?

A

Access to NHS but if claim is refused, can only access emergency NHS services (have to pay after)

89
Q

What do asylum seekers receive?

A
  • Vouches to live off
  • NASS support package
  • Access to NHS
  • Not allowed to work initially (no control over location)
90
Q

How can error be classified?

A
  • Intention (failure of planned action to reach desired action)
  • Action
  • Outcome
  • Context (interruptions/team factors)
91
Q

What factors are considered when assessing negligence?

A
  1. Was there a duty of care?
  2. Was there a breach in that duty?
  3. Was the patient harmed?
  4. Was the harm due to a breach in care?
92
Q

Describe Bolam and Bolitho?

A
  • Bolam = would a group of reasonable doctors do the same?
  • Bolitho = would that be reasonable?
93
Q

What is a never event?

A

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

94
Q

Compare person approach and systems approach

A
  • Person = holds individual accountable
  • Systems = identifies latent errors in system
  • Systems approach eliminates blame culture

Phase 3a (21 decks)

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