public health Flashcards
what are the basic economic problems when thinking about health care?
- resources are finite (scarcity)
- the desire to do good and services that could be provided are infinite
- no country treats all of the ill people in the country because they don’t have the capacity to do so
- therefore the choice on where to provide health care cannot be avoided
what is the opportunity cost?
the opportunity cost of an activity is the sacrifice of benefits of other activities not chosen in order to choose the activity you fund
what is efficiency? (in terms of health economics)
efficiency is achieved when resources are allocated to activities to maximise benefit
what is an economic evaluation?
- the method used to asses whether resources have been used efficiently
- are the incremental costs worth the incremental benefits?
what are the three types of economic evaluatoin? describe what they are.
- cost-effectiveness analysis (incremental cost per life year gained)
- cost-utility analysis (incremental cost per quality life year gained)
- cost benefit analysis (net monetary benefit)
what is equity in terms of health economics?
the fairness or justice of the distribution of costs and benefits
opposing views on what fair is so difficult to quantify
what is health?
a state of complete physical, mental and social well being; not the absence of disease
what is the relationship between life expectancy and social class?
- as social class increases, life expectancy increases
- this gap is getting wider (thanks tory pigs)
what is the relationship between type of disease and social class?
- when a country reaches a certain threshold of income epidemic diseases of poverty are replaced by degenerative disease
- further increase income has no effect on the health of the nation
- unequal societies have worse health
what is social class?
- measure of occupation, social position, stratification and access to power and resources
- quantified using - registrar general (occupation focused) - NS-SEC model
what is the inverse care laws?
-those that require good medical care are often those that are most unable to access it
define incidence and state how it can be increased or decreased.
- the number of new cases per unit time
- increased - use screening to identify new cases and risk factors
- decreased - reducing risk factors (primary prevention)
define prevalence and state how it can be increased and decreased.
- number of existing cases at a point in time
- increased - screening, if risk factors increase, increased life expectancy due to better treatment
- decreased - cures for conditions and reducing risk factors
define sociology .
- the study of social relations and social processes
- it is a measure of social inter dependencies
- social structures - religion, family, medical profession etc. etc.
what is the role of the sick? (characteristics of someone who is adopting this role)
- they are exempt from normal social roles
- they are not responsible for their condition
- they should try to get well
- they should seek help from/cooperate with the medical profession
what is the medicalisation hypothesis?
-doctors see everything medically - this may be a problem when a condition is actually a product of the patients social environment ie depression
define iatrogenesis.
unintended effects of a therapeutic intervention.
what is the health belief model?
- a psychological model that attempts to explain and predict changes in health behaviours
- perceived susceptibility, barriers, benefits and self efficacy are all influences in changing behaviours
what is the stages of change model? (6 stages)
1) not thinking/pre-contemplation model
2) thinking about changing/ contemplation
3) preparing to change
4) action
5) maintenance
6) stable changed lifestyle or relapse
what are some other factors that change behaviour?
- motivational interviewing
- social marketing
- nudge theory (changing environment to make healthier option the easies)
- mindspace
- financial incentives
define public health.
- concerned with health protection, promotion and improving and organising health sciences
- can be local, regional, national, international or make you want to commit suicide
what is happening to world’s populations?
- population size is increasing
- infertility is increasing
- the elderly population is increasing
what is the definition of CAM (complementary and alternative medicine)?
- a broad domain of healing resources that encompasses all health systems, modalities, practices and their beliefs
- healing resources that aren’t part of the domminant health system of a particular society or culture in a given time
what are some names for CAM?
- complementary
- alternative
- folk
- non allopathic
- unorthodox
- traditional
- energy medicine
what are the NHS perspective ‘BIG 5’ in regard to CAM?
- acupuncture
- chiropractice
- homeopathy
- herbal medicine
- osteopathy
what are the major concerns with CAM?
- unrealistic expectations
- delayed conventional treatment and care
- general safety - unregulated practitioners and treatments - unknown drugs interactions
What would cause a person to seek CAM?
- lack of effectiveness of conventional treatment
- concern about unpleasant
- experience of poor communication with doctors therefore rejecting science
- disease isn’t serious enough
- high patient satisfaction rates
- gullibility and naivety
who mainly uses CAM?
- 35-60 mainly women
- higher income and education
- poor health status - 60% have a chronic disease
- geographical variation - southerners do it more - southern twats
- autism spectrum disorders
what is the point of screening?
- it’s a form of secondary intervention
- indentifies individuals that are more likely (not certain) to have a disease
what are true and false positives?
true +ves = positive test results when the person has the disease
false +ve = positive test result but the person doesn’t have the disease (also known as type 1 effor)
what are true and false negatives?
true negative = negative test result and person doesn’t have the disease
false negative = negative test result and person does have the disease
what is sensitivity? (of a test)
- number of true positive results/total number of results
- measures how well a test picks up those with a disease
what is specificity? (of a test)
- number of true negative results/total number of results
- measures how well a test recognises those without a disease
what is prioritised when designing a test, sensitivity or specificity?
sensitivity - the effect of missing the disease is worse than the trauma caused of a false positive result
this increases the number of false positives
define positive and negative predictive values.
PPV - the proportion of people with a +ve test result who have the disease
NPV - the proportion of people who are correctly excluded by the screening test
what is the relationship between PPV + NPV and prevalence + incidence?
- if prevalence is high = false positives fall, PPV increases and NPV decreases
- if prevalence is low = false positives rise, PPV decreases and NPV increases
give three examples of screening tests.
- Gothrie test - new borns heal prick test. tests for phenylketononia, CF, sickle cell.
- PAP test - cervical smear test for cervical cancer
- PSA test - prostate specific antigen test for prostate cancer
what are the principles of screening?
- condition tested for should be important
- should be acceptable treatment
- there should be a recognised early or latent stage
- there should be a suitable test that should be acceptable to the whole population
- the cost of case finding should be economical should be balanced in relation to the possible expenditure as a whole
what are the arguments for and against screening?
for - prevent suffering, early intervention improves outcomes of treatment, early treatment is cheaper
against - damage and distress that may be caused by false +ves and -ves, personal choice is compromised
define primary intervention and give examples.
- aims to prevent disease becoming established
- to reduce/eliminate exposures or behaviours that are known to increase a patients risk of developing a disease
-smoking cessation, vaccinations, proper dental hygiene and hospital decontamination
define secondary intervention and give examples.
- aims to detect a disease early and slow down/halt it’s progress
- screening - mammography, blood sugars, PSA, PAP etc
- low Na+ diet and daily exercise to prevent further MI or stroke
define tertiary intervention and give examples.
- aims to reduce complications and severity of disease softening the impact of chronic illness or injury that has long lasting damage
- cardiac rehab post MI, HIV medication, chronic disease management plans diabetes, arthritis, depression etc.
what is the difference between eustress and distress?
eustress = positive beneficial and motivating stress
distress = negative, damaging and harmful
what are the 5 types of stress?
- biochemical
- physiological
- behavioral
- cognitive
- emotional
what is biochemical stress?
endorphins and cortisol levels are altered
what is physiological stress?
shallow breathing, increased BP, increased acid production in stomach
what is behavioral stress?
absenteeism, smoking, alcohol, stress eating, sleep disturbance
what is cognitive stress?
negative thoughts, loss of concentration, stress headaches
what is emotional stress?
mood swings, irritability, aggression, boredom, tearful
what are the two types of stress in terms of duration?
- acute - dangerous situation, noise, hunger, infection
- chronic - financial, work, relationship, children and friends
what are the 2 types of data?
- qualitative
- quantitative
what type of graph shows continuous data?
- stem and leaf diagrams
- histogram
- box and whisker
what types of graph show discrete data?
- bar charts
- pie charts
what are the three measures of spread?
- range
- interquartile range
- standard deviation
what is the standard deviation?
- The Standard Deviation is a measure of how spread out numbers are
- the average distance each piece of data is from the mean
what is normal distribution?
- bell shaped curve
- 2/3 of date lies within one standard deviation of the mean
- 95% lies within 2 standard deviations of the mean
- mean and median are the same in normal distribution
what is the prevention paradox?
- more people with a disease have a low risk of getting a disease
- less people with high risk of disease actually present with a disease
what is the high risk approach to prevention?
- target high risk individuals
- aims to reduce risk below a set limit
- accepted by society as we treat those ‘outside’ normal levels
what is the population approach to prevention?
- target all individuals
- aims to reduce risk for each individual
- recognises that low risk people contribute to most cases (prevention paradox)
- not as accepted by society (concerns with treating the well unnecessarily - nanny state)
what approach to prevention is best for what people?
high risk approach - best for rich and educated as they’re more likely to interact with the healthcare systems, comply with treatment, have the means to change their lifestyles
population approach - best for all individuals this approach reduces social inequality
what are some methods of primary intervention for CHD?
SNAP
Smoking - taxation, cessation, control areas and packaging
Nutrition - recommendations (low salt, 5 fruit and veg etc), food standards, sugar taxation
Alcohol - taxation and awareness campaigns
Physical activity - 5x per week and PE in schools
what are methods of secondary and tertiary preventions in CHD?
medical management - antihypertensives, statins, metformin, asprin
Cardiac rehabilitation
phase 1 - hospital
phase 2 - 1-4 weeks post discharge
phase 3 - 4-16 weeks post discharge
phase 4 - long term of maintenance and lifestyle changes
what are some unmodifiable risk factors?
- age
- sex
- ethnicity
- family history
- early life circumstances
what are some (potentially) modifiable risk factors?
physiological
- high cholesterol
- hypertension
- T2 diabetes
lifestyle
- SNAP
- weight and BMI
what are some psychological influences on health?
- personality - Type A = neurotic, hostile, impatient (all increase CHD risk)
- depression and anxiety
- work - high demand and low control = stress = poorer health
- social support - quantity and quality of relationships