Public Health

Question 1

What is public heath?

Answer 1

The science and art of preventing disease, prolonging life and promoting health through organised efforts and informed choices of society, organisations, public and private, communities and individuals-Wanless 2007

Question 2

Health improvement influences?

Answer 2

Promote health by influencing:

• Lifestyle
• Socioeconomic determinants of health
• Physical environment
• Cultural Factors

Question 3

What is the Nuffield Council of Bioethics?

Answer 3

Independent body that examines and reports on ethical issues in biology and medicine. They provide information to the public e.g. campaign for 5 a day

Question 4

In what way could the Nuffield Council of Bioethics provide this information?

Answer 4

• Enable choice- stop smoking programmes, cycle lanes, free fruit etc.
• Guide choice through changing default policy- restaurant making health option norm and chips and optional extra
• Guide choice through incentives
• Guide choice through disincentives
• Restrict choice- removing unhealthy ingredients from food in shops or restaurants
• Eliminate choice

Question 5

What was the Marmot Review?

Answer 5

Addressed health inequalities in England 11/02/10.
Social determinants of health lead to health inequalities.
Social gradient in health inequalities: The lower one’s social and economic status, the poorer ones health is likely to be. Poorest die 7 years earlier than richest, and spend more of their lives with disability.
Factors such as housing, income, education, social isolation and disability strongly affect health inequalities and socioeconomic status.

Question 6

What are the 6 policy objectives for proportional universalism?

Answer 6

1. Giving every child the best start in life
2. Enabling all children, young people and adults to maximise their capabilities and have control over their lives
3. Creating fair employment and good work for all
4. Ensuring a healthy standard of living for all
5. Creating and developing suitable places and communities
6. Strengthen the role and impact of ill-health prevention

Question 7

The Commission on Social Determinants of health has three principles of action- what are they?

Answer 7

1. Improve the conditions of daily life
2. Tackle the inequitable distribution of power, money and resources
3. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about it

Question 8

Society- what are the three social identities?

Answer 8

Biological: Sex, age, ability, genealogy, ph/genotype
Cultural: Language, diet, customs, beliefs, more…
Structural: Where we dwell- status, occupation, wealth, education

Question 9

What are Ferdinand Mount’s five inequalities?

Answer 9

Political: equal rights to healthcare
Life outcomes: equal quality of health
Opportunity: equal access to health and healthcare
Treatment and responsibility: equal quality of healthcare
Participation: equal consideration in healthcare decisions

Question 10

What is IMD?

Answer 10

Incidence of Multiple Deprivation: Takes into account income, employment, health and disability, educations, skills and training, barriers to housing and services, living environment, crime. Lower score = more deprived

Question 11

Child survival: What are the main causes of child mortality?

Answer 11

Pneumonia, preterm complications, diarrhoeal diseases, intrapartum related complications and malaria

Question 12

What are the social determinants of health?

Answer 12

Conditions in which people are born, grow, live, work and age. Shaped by money, power and resources. Mostly responsible for health inequalities- the unfair and avoidable differences in health status seen within and between countries. Sometimes called ‘upstream factors’

Question 13

Child survival: What is IMCI and its 3 components?

Answer 13

Integrated Management of Childhood Illness- strategy to reduced childhood mortality and morbidity and contribute to improved growth in developing countries.

1. Improve case management skills of health providers through training
2. Improve health system by strengthening district health planning and management. Make available essential drugs and supplies, provide quality support and supervision at health facilities, improving referral, improving referral and health information systems and organising work efficiently at health centre
3. Improving family and community practices by promoting those practices with the greatest potential for improving child survival, growth and development.

Question 14

Evidence for Disease Prevention: What is its purpose?

Answer 14

To know how much disease a region or group has, and to formulate a worthy hypothesis

Question 15

Evidence for Disease Prevention:

Method 0: Anecdote and case series pros and cons

Answer 15

Descriptive study- least effective

Pros: Quick, easy to perform in clinic, provides new previously unobserved conditions, provides new potential risk factors

Cons: Not scientific, not able to test a hypothesis, seriously affected by observer bias, difficult to make inference about disease cause

Question 16

Evidence for Disease Prevention:

Method 1: Cross-sectional survey pros and cons

Answer 16

Descriptive study- PREVALENCE Good at estimating disease burden. Surgery variables are measured on an individual basis in a defined population at a particular point in time. Incidence register, observe and record the occurrence of disease.

Pros: Quick, good at estimating prevalence or burden

Cons: Only represents that point in time, cannot estimate incidence, sampling frame may lead to bias (missing workers)

Question 17

Evidence for Disease Prevention:

Method 2: Measuring incidence when new cases arrive

Answer 17

INCIDENCE- Rate of new cases of disease (over a set period of time, as a proportion of population normally)

Question 18

Evidence for Disease Prevention:

Method 3: Ecological studies pros and cons

Answer 18

Descriptive study- The unit of analysis is a group defined by time, geography and socio demographics. Comparing one group of people to another.

Pros: Less expensive, less prone to bias due to participation, easy to perform using routinely collected data, provides new hypotheses about the cause of a disease condition, provides new potential risk factors

Cons: Ecological fallacy- do population level measure hold for the individual?, assume average value of the risk the factor applies to all individuals, assume average incidence applies to all individuals of the population, data collection may vary e.g. coding systems

Question 19

Evidence for Disease Prevention:

Method 4: Case control studies pros and cons

Answer 19

Analytical study- Patients with a diseases (case) are compared with people who do not have the disease (controls). Compared for an exposure (potential cause). This is retrospective. You KNOW THE DISEASE FIRST then have to measure the cause and exposure.

Often used to identify factors that may contribute to a medical condition by comparing subjects with the disease to similar SUBJECTS WITHOUT THE DISEASE (CONTROLS)

Pros: Good for rare disease/rare exposures, fairly quick

Cons: Prone to selection bias, especially prone to participation bias, finding a suitable control group can be difficult, difference in recall leading to bias

Question 20

Evidence for Disease Prevention:

Method 5: Cohort study pros and cons

Answer 20

Analytical Study: Compares disease between an exposed study cohort and a non-exposed study cohort. Nobody has disease, then measure exposure of the cause interested in. Follow cohort through time and then count the number who do and don’t have the disease.

Cohort = people who share a common experience or condition

Pros: God for rare exposures, can look at multiple outcomes, reduces information bias, direct measurement of incidence

Cons: In efficient fir rare diseases, expensive, retrospective is quicker, loss to follow-up

Question 21

Randomised control trial pros and cons

Answer 21

RCT tests how well an intervention works (rather than just observing the exposure of interest)

Controlled variable: One group given the treatment under test
Placebo: Non-active treatment- CONTROL GROUP
Treatment group, intervention, rate of outcome
Control group, intervention, rate of outcome
Randomised: Assigning patients to a treatment group, avoiding bias by the investigator, creating similar comparison groups. Randomness is useful to eliminate confounding bias.
Blinding:
Single blind: Patient does not know which treatment they’re getting
Double blind: Patient and Clinician and Scientists do not know which treatment

Pros: GOLD STANDARD- properly randomised controlled trial offers the best test of causality. Section bias and confounding removed (if randomised). If blinded; less observer bias.

Cons: Not real life, high cost, inappropriate and unethical for many research questions