Public Health Flashcards
What is the main determinant of public health?
NOT mean income but the extent of income division
What is the Gini-coefficient
A statistical method of measuring wealth of a nation divided amongst its residents
low co-efficient = greater equality amongst people
High = UK
Low = Scandanavian countries
Name 3 responses to health inequalities…
- The Black Report (1980’s)
- The Acheson Report (1998)
- Proportionate Universalism
What is the Black Report?
Material (environmental causes influenced by behaviour)
Artifact (apparent product of how inequality is measured)
Cultural (poorer people = unhealthy behaviours)
Selection (sick people sink socially and economically)
What is the Acheson Report?
Aim = decrease inequalities in wealth
Healthcare priority to those families with children
What is proportionate universalism?
- just targeting disadvantaged will not reduce inequality
- needs to be a universal approach
- fair distribution of wealth is important
Name 3 theories of causation of inequalities?
- Psychosocial
- Neo-material
- Life-course
What are the 5 structural determinants of illness?
- social class
- poverty
- unemployment
- racism
- gender and health
What is the psychosocial theory of causation of inequalities?
stress»_space; inability to respond efficiently to the bodies demands
- impact on BP, cortisol levels and inflammatory and endocrine responses
What is the neo-material theory of causation of inequalities?
more hierarchical societies are less willing to invest into the provision of public goods
- poorer people has less material goods, quality of which is generally lower
What is the life-course theory of causation of inequalities?
comb of both psychosocial and net-material explanations
critical periods: possess greater impact at certain points in the life course
accumulation- hazards and their impacts add up»_space; hard work leads to injuries»_space; resulting in disabilities that may lead to more injuries
What is the biomedical model?
- mind and body = separate
- body, like a machine, can be repaired
- this privileges the use of technological interventions
- it neglects social and psychological dimensions of disease
When are you allowed to break confidentiality?
- Patient consent
- Public interest e.g. rare disease, research, education
- You are required to do so by law e.g. notifiable disease, ordered by police)
What is the criteria for patient information disclosure?
- anonymous
- patients consent
- kept to a necessary minimum
- data protection
What happens to confidentiality after death?
Duty of confidentiality continues
What are the 3 main notifiable diseases that must be reported to WHO?
cholera, yellow fever and the plague
What is health behaviour?
aimed to prevent disease (e.g. healthy eating, exercising)
What is illness behaviour?
aimed to seek remedy (going to the doctors)
What is sick role behaviour?
aimed at getting well (compliance, resting)
5 factors that promote mortality?
- poor diet
- sedentary lifestyle
- obesity
- smoking
- excess alcohol
What are the 4 domains of public health?
Health protection
Health improvement
Improving services
Addressing the wider determinants of health
What is meta-ethics?
Exploring fundamental questions: right/wrong/defining good or bad
Name the 5 ethical theories…
Virtue Imperative Categorical Utilitarianism 4x principles
What is applied ethics?
a recent emergence of ethical investigation into specific areas (e.g. medical, public health etc)
Name the ethical arguments
DICE Deductive Inducive Considering what we believe in Ethical analogies
What is a deductive ethical argument?
That one ethical theory can be applied to all medical problems
What is an inductive ethical argument?
That settles medical cases generate theory or guidelines for future practice)
What are ethical analogies?
removing limb of a healthy patient vs. plastic breast surgery
What is an ethical fallacy?
The idea that ethical considerations help to solve the problem of free will.
The assumption but some philosophers that free decisions must be restricted to moral decisions
What is Ad hominem?
a claim or argument is rejected on the basis of some irrelevant fact about the persons character rather than focusing on the content of their argument
What is petito principii?
assuming the initial point of the argument (a premise is assumed to be true without warrant)
What is an authority claim?
saying a claim is correct because the authority has said so
What is motherhood with regards to ethical fallacies?
The insertion of a soft statement to disguise the disputable one e.g. all humans are equal (so we shouldn’t stop PVS patient treatment)
What is the Health Belief Model (Becker 1974)
- individuals must believe they are susceptible to the condition
- believe that it has serious consequences
- believe that taking action reduces their risks
- believe that the benefits of taking action outweigh the costs
What is the Transtheoretical model?
Pre-contemplation Contemplation Preparation Action Maintenance Relapse?
What are the key purposes of the NHS press releases?
- reactive- defend the NHS reputation (reporting achievements, improvements, justifications)
- proactive- improving and protecting public health
- social marketing messages (Five-a-day, change4life)
- early recognition and symptom awareness (FAST)
What are the GMC duties of a doctor?
- protect and promote the health of patients and the public
- provide a good standard of practice and care
- recognise and work within the limits of your competence
- work with colleagues in the ways that best serve patients interests
- treat all patients as individuals and respect their dignity
What is morality?
concerned with the distinction between good and bad or right and wrong
What is ethics?
the attempt to arrive at an understanding of the nature of human values, how we ought to live and what constitutes right conduct
What it consequentialism/utilitarianism?
- act is evaluated solely in terms of its consequences
- maximising good and minimising harm
- the greatest happiness for the greatest number of people
e. g. killing one innocent person to save the lives of 10 others
What are the different types of consequentialism?
- hedonistic
- rule
- act
- preference
What are the 5 virtues of virtue ethics?
- compassion
- discernment
- trustworthiness
- integrity
- conscientiousness
What is the definition of hedonistic utilitarianism?
The theory that the right action is the one that produces the greatest net happiness for ALL concerned
What is the definition of preference utilitarianism?
promotes actions that fulfil the preferences of those involved
What is deontology?
the right/wrong of action themselves (the worthiness of an act)
What are the limitations of virtue ethics?
- assessment of virtue is culture specific
- notion of virtue = too broad and non-specific to allow practical application
- ignores social and communal dimensions
What are some challenges associated with utilitarianism?
- is it okay to treat minorities fairly to promote the happiness of the majority?
- is it okay to carry out ethically questionable research to maximise the welfare of society
What are some rivals of ethics?
- law
- personal conscience
- religious of cultural beliefs
What are the 4 principles of ethics?
- Autonomy
- Beneficience
- Non-maleficence
- Justice
With regards to ethical arguments what is the top down incentive?
That one specific ethical theory is consistently applied to each problem
With regards to ethical arguments what is the bottom-up incentive?
Past problems are used to create guides to future practice
What is the definition of autonomy?
respect the decision of the patient
- the decision is rational and informed
- there are no major controlling influences over the decision
What is non-maleficence?
Do no harm, reduce or prevent harm
What is beneficence?
doing something with the aim to benefit others (providing benefits, balancing the benefits against the risks)
What is justice?
needs vs. benefit, fairness in the distribution of benefit s and risks
What can be used to assess functional limitations amongst older people?
Katz ADL scale
IADL (instrumental Activities of Daily Living)
The Barthel ADL
MMSE
What activities does the Katz ADL assess?
Getting out of bed, bathing, dressing, toilet use, eating
What activities does the Barthel ADL Index assess?
feeding, getting out of bed, walking along the flat, going ups and down stairs
What activities does the IADL assess?
use of telephone, going shopping, cooking food, driving, housework, medication use
What does the MMSE assess?
- orientation, immediate memory
- short term memory
- language functioning
What is an acute illness?
A disease of short duration, that starts suddenly, has severe symptoms (can often be cured)
What is a chronic illness?
a persistent or recurring condition, may or may not be severe, often starts gradually with slow changes (cannot be cured but can be treated.
What is polypharmacy?
the use of 4 or more medications by a patient, generally adults over 65 years
Name 5 key challenges of an ageing population…
- strain on pension and social security systems
- increasing demand for long-term care
- bigger need for trained health workforce
- increasing demand for healthcare
- pervasive ageism
What is pervasive ageism?
denying older people the rights and opportunities available for other adults
What are the causes of an ageing population?
- improvement in sanitation, housing
- decline in premature mortality
- falls in fertility
- life expectancy is increasing around the globe
- more people reaching older age whilst fewer children are born
Name 2 key facts about ageing population…
- In the UK there are as many people +65 as there are under 15
- By 2025 there will be more people aged 65+ than <20
What are the two types of ageing?
Instrinsic: inevitable, natural
Extrinsic: dependent on external factors (air pollution, UV rays, smoking)
What are some examples of physical changes in later life?
- decrease in skin elasticity
- decrease in height»_space; stoop
- hair goes grey
- decreased in weight
- loss of joint flexibility
- increased susceptibility to illness
- decline in learning ability
- less efficient memory
What visual declines does ageing cause?
- need 3x more light
- depth/colour perception
- narrowing of visual field
What hearing declines does ageing cause?
- high frequency loss
- speech comprehension 20%
What loss of taste and smell does ageing cause?
50% loss of taste buds