Public Health Flashcards
What is horizontal equity?
Individuals with the same disease should all be treated the same
What is vertical equity?
People with different needs require different treatment for the same disease, i.e. unequal needs.
Describe the difference between equality and equity
Eqaulity is everyone having the same, equity is what is fair and just
What are the 3 domains of public health?
- Improving and delivering services
- Health protection
- Health promotion
List the stages of the health behaviour model (4)
Believe they are suspetible
Believe there are serious concequences
Believe the action will reduce the chances
Believe the benefits of the action outweight the costs
Relies on the self belief of the individual, doesnt take into account emotion.
Looks at a cue.
What does the transtheoretical model suggest as the process of behaviour change?
Pre contemplation Contemplation Preperation Action Maintenance
Define need
The ability to benefit from an intervention
Define demand
What people ask for
Define supply
What is provided
Name 4 at risk groups
- Migrants
- Asymlum seekers
- Drug users
- Children
- Homeless
What are Bradshaws four taxonomy of needs?
In order for a need to become a reality, i.e. make a real need possible.
- Felt
- Expressed
- Normative
- Comparitive
(all overlap)
What is the inverse care law?
Those with better health tend to access better health care services, when in fact, it is people in poorer health that should be having greater access to these services
What is donabedians framework and what is it used for?
Framework for quality of care
Structure (context in which the care is delivered, e.g. physical facility, equipment, human resources, organisational characteritsitcs such as staff training and pay)
Process (sum of all the actions that make up healthcare, e.g. diagnosis, treatment, preventative care, patient education)
Outcome (the effects of healthcare on patients and populations) - really hard to draw conclusions and links between interventions and outcomes.
framework that can be used for the evaluation of healthcare services, gives infr
What are Maxwells 6 dimensions?
Framework for quality of care
3ES and 3AS
access, acceptability, appropriateness
equity, effectiveness, efficacy
What is a confounding variable?
A variable that unfluences the dependent and independent variable
Give an example of something that is demanded, and supplied, but not needed
Antibitoics for viral illness
Give an example of something that is needed and demanded, but not supplied
Cure for cancer
Cure for chronic disease
Better mental health services
Give an example of something that is needed and supplied, but not demanded
Smoking cessation
Alcohol Cessation
What is tertiary prevention?
Reducing the impacts of a disease and preventing complications
What is donabedians framework and what is it used for?
Framework for quality of care
Structure (context in which the care is delivered, e.g. physical facility, equipment, human resources, organisational characteritsitcs such as staff training and pay)
Process (sum of all the actions that make up healthcare, e.g. diagnosis, treatment, preventative care, patient education)
Outcome (the effects of healthcare on patients and populations) - really hard to draw conclusions and links between interventions and outcomes.
What is the prevention paradox?
If something brings a lot of benefit to the population, then it provides little benefit to each individual
What is lead time bias?
Bias - overestimation of survival.
In the lead, head start.
I.e. Screening detects people earlier even though they have the same outcome.
Name 3 ways you can quantitatively assess a health service
m
What are the 3 main biases involved with screening?
- Lead time
- Length time
- Selection
What is a confounding variable?
An unaccounted for variable which also independently affects the outcome
Give an example of something that is supplied, demanded and needed
Free contraception
What is the population approach to intervention?
Treating the whole population in an attempt to reduce the risk of people developing the disease
What are the bradford hill criteria?
Provide the minimal conditons for establishing a causal relationship between 2 variables
Name 4 / 9 bradford hill criteria
- Strength
- Plausability
- Consistency
- Evidence
- Dose response
- Temporarility
- Study design
- Reversibility
- Specificty
What are the four stages of a health needs assessment?
Needs Assessment
Plan
Implement
Assess
Name 1 advantage and 1 disadvantage to the corporate approach
Adv: engaging the individuals using the service and running it
Disadv: blur between demands and needs, bias, staekholders opinions
Name 1 advantage and 1 disadvantage to the ecological approach
Adv: Large amount of data, can study a particular question, addresses a clear problem.
Disadv: Biomedical model, expensive
Name 1 advantage and 1 disadvantage to the comparitive approach
Adv: can see the evidence of benefit in a population.
Disadvantage: Hard to find completely matched groups
What is an ecological study?
Observational study, data analysed at population / group level rather than individual level.
What is a case control?
Two groups with differing outcomes are identified, compared on the basis of a supposed causal atrribute
Define incidence
The number of new cases of a condition that develop during a specific time period
Name the 4 non-causal associations
- Chance
- Bias
- Reverse causality
- Confounding
(True association)
Give an example and explanation of a service that is supplied, but not needed or demanded
C-section on women with previous history of C-section
Define epidemiological needs assessment
Deciding what a population needs based on the incidence and prevalence of
certain diseases
Define comparative needs assessment
Individuals with similar characteristics to those receiving help, examines
health status, utilization
Define corporate needs assessment
Getting input from a number of individuals or groups to decide what is needed most (press, patients, professionals, politicians)
Name 2 disadvantages of the theory of planned behaviour
- No account for emotions
- Relies of self-reported behaviour
What is the rule of rescue?
We help people regardless of the disproportionate investment that helping the person would result in
What is the libertarian principle for resource allocation?
Patients are in control of their own healthcare, wellbeing anfdfulfillment of life goals
Name 3 behavioural interventions for weight loss
- Motivational interviewing
- Self-help groups
- Commercial weight loss programme e.g. weight watchers
Give four qualitative methods of research for evaluating healthcare
- Interviews
- Focus groups
- Observation
- Case reports
What are the three health behaviours?
- Sick role behaviour - actions taken by people recovering from illness
- Illness behaviour - think you are ill so seek remidy
- Health behaviour - prevent disease
What is maximising resource allocation?
Give to those who are most likely to benefit
What is libertarian resource allocation?
Everyone is responsible for their own health and wellbeing
What is egalitarian resource allocation?
Provide equal care to everyone
In what 3 cases can you break confidentiality?
- Required by law
- Public interest
- Patient has consented
List some risk factors for health inequalities
Place of residence Race or ethnicity Occupation Gender Religion Education Socioeconomic status Social capita or resources
What are the four things involved in Peytons style of teaching?
Trainer runs through without commentary
Trainer talks through and trainer does
Learner talks through and trainer does
Learner talks through and learner does
List 2 disadvantages of screening
- Puts potentially well individuals at risk of invasive procedures
- Detection and treatment of diseases that wouldnt have caused any harm
List 3 transtion points / times when a person is more likely to make a behaviour change during their life
Any major life event really
- Leaving school
- Going to uni
- Becoming unemployed
- Retiring
- Having children
- Post divorce
- Significant health event
What is involved in teh acid test for dols?
Looking at whether someone is depirved of their liberty.
Are they free to leave?
Are tey under continous supervision and control
Do they have capacity to consent to this?
Describe the key parts of the health belief model
- suspeptible
- severe concencequences
- doing action reduces suspebtility
- benefits outeight the costs
- Motivation
- percieved barriers
What is bias?
A systematic deviation from the true estimation of an association between an exposure and an outcome
What is the difference between an eating disorder and disordered eating?
disordered eating - enaged in the same behaviour but to less of a degree.
What is the boundary model of eating?
Deliberate reduction in food intake to maintain or loose weight
Dieters . - takes them longer to feel full as they have a great range between hunger and satiety
They usually stay under a strict limit, however when they increase ther food intake they have to eat more than others to feel full, reasulting in overall weight gain.
Reasons to go over boundary (disinhibition, ‘what the hell’ mentality) include:
- Large portion size, stress, emotions, high energy preload
What is the goal conflict model?
a social cognitive theory that attributes the difficulty of chronic dieters to a conflict between two incompatible goals: eating enjoyment and weight control. Although chronic dieters are motivated to pursue their weight control goal, most fail in food-rich environments: Surrounded by palatable food cues that activate thoughts of eating enjoyment, incompatible weight control thoughts are inhibited and weight control intentions are “forgotten”. For successful dieters - probably due to past success in exerting self-control - tasty high-calorie food has become associated with weight control thoughts. For them, exposure to palatable food makes weight control thoughts more accessible, enabling them to control their body weight in food-rich environments
What is the externality theory?
Overweight individuals eat according to external cues, time of day, sensory cues, whereas leener individuals repsond to internal cues –> however this is a very general statement
Define malnutrition
Deficiences, excesses or imbalances in a persons intake of energy and/or nutrients.
Covers under and over nutrition.
