Public Health Flashcards
What are the 3 domains of public health?
- health improvement
- health protection
- health care
What is health improvement?
- social interventions aimed at preventing disease, promoting health, reducing inequalities
- encompasses education, housing and employment
- screening programmes
What is health protection?
- measures to control infectious disease and environmental hazards
- notifying diseases
- contact tracing
What is health care?
- organisation and delivery of safe, high-quality services for prevention, treatment and care
- auditing and improving recommendations
What is health behaviour?
- behaviour aimed to prevent disease
What is illness behaviour?
behaviour to seek remedy
What is sick role behaviour?
behaviour aimed at getting well e.g. resting
What is health promotion?
- process of enabling people to exert control over their health
Give examples of health promotion at a population level?
- awareness campaigns
- screening
- immunisations
Give an example of health promotion at an individual level
- patient centred approach
- care responsive to individual needs
What is unrealistic optimism?
- individuals continue to practice health damaging behaviours
- inaccurate perceptions of risk and susceptibility
What 4 factors influence perception of risk?
- lack of personal experience
- preventable by personal action
- if it hasn’t happened by now, it isn’t likely to
- infrequent problem
What is the health belief model?
- perceived barriers are the most important factor in addressing behaviour change
What are the 4 parts of the health belief model?
- Believe they are susceptible to the condition
- Believe that it has serious consequences
- Believe that taking action reduces susceptibility
- Believe that the costs of taking action outweigh the benefits
What are the pros and cons of the health belief model?
- can be applied to wide variety of behaviours
- other factors may influence outcome, doesn’t consider emotions, doesn’t differentiate between first time and repeated
What is the theory of planned behaviour?
Best predictor of behaviour
change is intention
What are the 3 determinants of the theory of planned behaviour?
- Personal attitude
- Social pressure to change (social norm)
- perceived behavioural control
What are the stages of the transtheoretical model of change?
- pre-contemplation
- contemplation
- preparation
- action
- maintenance
What is nudging?
- nudging the environment to make the best option easiest
- e.g. fruit at checkout
What is the social norms theory?
- behaviour influenced by social norms in their group
- leads to misperceptions
What is motivational interviewing? RULE
- enhance a patient’s motivation to change, resolve ambivalence
- Resist righting reflex
- understand their motivations
- listen with empathy
- empower patient
What are the determinants of health?
- genes
- environment
- lifestyle
- healthcare
What is horizontal equity?
- equal treatment for equal need
What is vertical equity?
- unequal treatment for unequal need
What is equity?
- resources shared based on need
- being fair and just
What is equality?
- providing everyone with the same amount of resources regardless of need
What is a health needs assessment?
- systematic method for reviewing health issues faced by a population
- agreed priorities and resource allocation
- to improve health and reduce inequalities
What are the 3 parts of a health need assessment?
- need
- demand
- supply
What are the 3 levels of interventions in public health?
- individual e.g. immunisations
- community e.g. playgrounds
- ecological (population) e.g. clean air act
What is felt need?
- individual perceptions of variation from normal health
e.g. person believes they need to lose weight even if they don’t
What is expressed need?
- individual seeks help to overcome variation in normal health
e.g. seeks help from doctor
What is normative need?
- professional defines intervention appropriate for the expressed need
e.g. doctor says go to rehab
What is comparative need?
- comparison between severity, range of interventions and cost
e.g. patient improves but then service is oversubscribed so no longer prioritised
What is Maslow’s hierarchy of needs?
- physiological
- safety
- love
- esteem
- self-actualisation
What is self-actualisation?
- a person’s motivation to reach his or her full potential
- must meet basic needs before this can be met
What is the inverse care law?
availability of medical care varies inversely with the need of the population served
What are the key determinants of health? PROGRESS
- place of residence
- race
- occupation
- gender
- religion
- education
- socioeconomic status
- social capital
What is the medical model of disability?
- sees the disabled person as the problem
- what they can’t do e.g. walk
What is the social model of disability?
- the problem is the disabled world
- e.g. no ramps or lifts
What is the bucket model of error?
- self: poor knowledge
- context: distraction, poor handover
- task: errors, process, complexity
What is an error of commission?
- making a wrong action/doing something incorrectly
- wrong Abx for UTi
What is an error of omission?
- forgetting to do something
- e.g. forgetting to give prescribed meds
What factors affect food behaviours?
- maternal diet
- breastfeeding
- parenting practices
- age of intro to solid foods and types given
What are non-organic feeding disorders?
- feeding aversion, food refusal, negative mealtimes
- <6 years old usually
What are the 4 stages of a planning cycle for a needs assessment?
- needs assessment
- planning
- implementation
- evaluation
What is an epidemiological approach to health needs assessment?
- define disease and incidence
- assess services available and match against existing evidence for cost effectiveness and quality
What are the problems with an epidemiological approach to a health needs assessment?
- doesn’t consider felt needs
- purely biomedical approach
- requires existing data
What is a corporate approach to health needs assessment?
- wide variety of stakeholders
- focus groups
- problems: difficult to distinguish need and demand
- certain groups have vested interest
What is a comparative approach to health needs assessment?
- compares services received by 2 diff subgroups e.g. diff locations or ages
- problems: difficulty finding comparison and comparing outcomes
What are Maxwell’s dimensions? 3 A’s and 3 E’s
- effectiveness
- efficiency - output maximised?
- equity
- acceptability e.g. operations at acceptable time of day
- accessibility
- appropriateness
What is ethnocentrism?
- tendency to evaluate other groups according to your own values and standards
- with conviction that your values are superior to theirs
What are the 3 resource allocation methods?
- egalitarian
- maximising
- libertarian
What is egalitarian allocation?
- provide all care that is necessary and required to everyone
- adv: equal
- dis: econonomically restricted
What is maximising allocation?
- based solely on consequence
- +: resources given to those likely to benefit most
- -: those with less need receive nothing
What is libertarian allocation?
- each individual responsible for own health
- +: onus on patient so more engaged
- -: not all diseases self inflicted
What is evaluation?
- process that attempts to systematically assess whether a service meets its objectives
What is the Donabedian approach to evaluation?
- structure: what there is
- process: what is done
- outcome
What are the 5 D’s for outcome of evaluation?
- death
- disease
- disability
- discomfort
- dissatisfaction
What is epidemiology?
- the study of the frequency, distribution and determinants of diseases and health affecting factors in populations in order to prevent and control disease
What is incidence?
- number of new cases in a specific time period divided by size of population
What is prevalence?
- number of existing cases in a population at a specific point in time
- divided by the total population
What is relative risk?
- risk in exposed vs unexposed group
- strength of association between RF and disease
- RR >1 indicates risks have increased
- doesn’t account for baseline risk
How do you calculate relative risk?
- absolute risk in exposed group/absolute risk in non-exposed group
how do you calculate absolute risk?
- new cases/total population at risk
What is attributable risk?
- amount of disease specifically due to exposure
- exposed risk - unexposed risk
What is the number need to treat?
- no of patients who need a specific treatment to prevent 1 having a bad outcome
e.g. no to give up smoking to prevent 1 person getting lung cancer - 1/attributable risk
- round up
What is bias?
- systematic error resulting in deviation from true effect of exposure on an outcome
What is selection bias?
- error in selection of study participants
- allocation of participants to different groups
What is information bias?
- error in collection of info
- recall, reporting, calibration of instrument
What is publication bias?
- studies with -ve results less likely to be published
What is confounding?
- when an apparent association between an exposure and outcome is actually the result of another factor
- independently associated with exposure and outcome but don’t lie on causal pathway between two
e.g. grey hair and back pain (age is the factor)
What are 3 ways to reduce confounding?
- randomisation
- restriction (limit people who are similar)
- matching (case control study - 2 comparison groups w/ same distribution of confounders
What is lead time bias?
early identification doesn’t alter the outcome but appears to increase survival as disease identified earlier
What is length time bias?
- disease that progresses slowly is more likely to be picked up by screening > screening appears to inc survival
What is allocation bias?
- individuals assigned to different treatment groups in a way that favours one leading to unequal comparisons
What are the bradford hill criteria for causation? DRBCST CAS
- dose response
- reversibility
- biological plausibility
- consistency
- strength
- temporality
- coherence
- analogy
- specificity
What is temporality?
- exposure occurs before outcome
e.g. people smoking before developing lung cancer
What are the 3 prevention types?
- primary: prevent the disease - vaccination
- secondary: detect a disease early and prevent it getting worse- screening
- tertiary: improve quality of life and reduce symptoms - rehab
What is a duty of candour?
- hcps must be open and honest when something has gone wrong or has the potential for harm or distress
What is a never event?
- largely preventable patient safety incident that shouldn’t occur if preventative measures have been implemented
e.g. wrong site of surgery
What are the 4 questions if negligence is suspected?
- was there a duty of care
- was there a breach in that duty
- did the patient come to harm
- did the breach cause that harm
What are the 2 questions to determine if negligence occurred?
- bolam test: would a group of reasonable doctors do the same
- bolitho test: would it have been reasonable for them to do so
What is the swiss cheese model of error?
- cheese: organisation’s defence against failure
- holes: weakness on individual parts of system
- system produces errors when holes align momentarily
What is sloth error?
- inaccurate documentation or not checking results for accuracy
What is fixation error?
- focus on one diagnosis
- confirmation bias
What is communication breakdown?
- unclear plan
- not listening and explaining well
What is poor team working?
- some individuals out of depth
- others underutilised
What is playing the odds?
- choosing the common and dismissing the rare
What is bravado/timidity?
- working beyond confidence or not having confidence to object
What is ignorance?
- lack of knowledge
- conscious or unconscious competence
What is lack of skill?
- not having appropriate skills/training/practice
What is system error?
environmental, technological, equipment failure
What are the two outcomes of error?
- adverse event: incident resulting in harm
- near miss: potential to cause harm but fails to develop
What is rationing?
- refusing resources based on lack of affordability rather than clinical ineffectiveness
What is ecological fallacy?
mismatch arising from trying to draw conclusions about individual level epidemiological associations from a group level study
e.g. assuming all med students have high IQs
What is the prevention paradox?
- a preventative measure which brings much benefit to the population often offers little to each participating individual e.g. seatbelts
What is the positive predictive value?
- proportion of people with positive test result who acc have disease
- (a/(a+b))
What is negative predictive value?
- proportion of people with a negative result who don’t actually have the disease
- (d/(c+d))
