Public Health Flashcards
What are some structural determinants of health?
- Genetic - Constitutional (age/sex) - Culture - Lifestyle - Social/community networks - Living + working conditions
Which lifestyle factors promote mortality?
- Smoking - Obesity - Sedentary lifestyle - Excess alcohol - Poor diet
What does health psychology emphasise the role of?
Emphasises the role of psychological factors in cause, progression + consequences of health and illness
What are the 3 types of health behaviours?
- Health behaviour = behaviour aimed to prevent disease
- Illness behaviour = behaviour aimed to seek remedy
- Sick role behaviour = any activity aimed at getting well
What are some examples of changing health behaviours?
- Health belief model: perceived susceptibility, perceived barriers, benefits and self efficacy are all influences on changing behaviours
- Stages of change model: not thinking (pre contemplation) → thinking about changing (contemplation) → preparing to change → action → maintenance → stable changed lifestyle/relapse
- Motivational interviewing
- Social marketing
- Nudge theory (changing the environment to make the healthy option the easiest option)
- Mindspace
- Financial incentives
What are modifiable and non-modifiable risk factors?
- Modifiable risk factors = things we can change, e.g. smoking
- Non-modifiable risk factors = things we can’t change, e.g. age
What are 3 models of behaviour change?
- Health Belief Model (HBM)
- Theory of Planned Behaviour
- Stages of change (transtheoretical) model
What is the Health Belief Model?
Individuals will change if they believe they are susceptible, that the disease has serious consequences, or that the benefits of taking action outweigh the costs
What is the Theory of Planned Behaviour?
Intention is determined by a person’s attitude to behaviour, perceived social pressure (subjective norm) + person’s appraisal of their ability to perform behaviour (perceived behavioural control)
What is the Transtheoretical model?
Precontemplation (no intention), contemplation (beginning to consider), preparation (getting ready), action + maintenance
What is morality? What is ethics? What are the two types of ethics?
Morality is the concern with the distinction between good + evil. Ethics is a system of moral principles which defines what is good for individuals and society. Meta ethics = nature of good and bad, normative ethics = focus on acts
What are some different forms of ethical arguments?
- Top down deductive, where one specific ethical theory is consistently applied to each problem
- Bottom up inductive, using past medical problems to create guides to practice
- An approach where theories are considered which best fit one’s own beliefs before applying.
- Analogies can also be used
What is the doctrine of double effect?
Sometimes it is permissible to cause a harm as a side effect (or “double effect”) of bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end
What are the 4 key ethical theories?
- Consequentialism
- Deontology
- Virtue ethics
- Four principles
What is consequentialism? What is utalitarianism? What is the doctrine of double effect?
- Consequentialism = act is evaluated in terms of consequences.
- Utalitarianism = consequentialist theory. Action is right if it leads to most happiness for greatest number of people
- Doctrine of double effect = doing something morally good with a morally bad side-effect, e.g. treatments with side effects
What is utalitarianism?
An act is evaluated solely in terms of its consequences. It acts to maximise good, e.g. killing one to save many
What is deontology?
Deontology = features of act themselves determine worthiness, not consequences. Actions are good or bad according to set of rules
What is virtue ethics? What are the five focal virtues?
- Virtue ethics = focus is on role of character, integrating reason and emotion
- The five focal virtues are:
- Compassion
- Discernment
- Trustworthiness
- Integrity
- Conscientiousness
What are the four principles?
- Autonomy = respecting patient’s choice
- Beneficience = doing what is in the best interests of your patient
- Non-malificence = do no harm
- Justice = doing what’s best for society as a whole
What is the definition of health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
What is the biomedical model of health?
Biomedical:
- Physical and biological factors of health - can be repaired
- Only health professionals can practice it
- Focus on diagnosis, cure + treatment of disease - solutions found in technologies
- Mind/body dualism (suggests can be treated separately)
- Knowledge is objective - neutral + distinct from social factors
What is the social model of health?
Contrasts biomedical model.
- Gives thought to a wide range of factors
- Wide range of people can practice it
- Focus on prevention
- Challenges mind/body dualism
- Knowledge is not objective - we are taught to see the body
What is the first theory of health, ‘Health as an Ideal State’? What are its problems?
- Goal of perfect well-being (WHO definition)
- Disease, illness + forms of handicap must be absent
Problems:
- Is anyone ever healthy?
- What is complete well-being?
- Can we ever attain this ideal state?
- Misleading?
What is the second theory of health, ‘Health as a state of social functioning’? What are its problems?
- Health is a means towards social functioning
- All forms of disease and social handicap need to be removed
- Can still be healthy (function socially) even when suffering with a chronic illness/disease
Problems:
- Very narrow definition seeing health as the opposite of disease
- Patient’s normal state may be unhealthy
- Refusal of treatment might be seen as healthy
What is the third theory of health, ‘Health as a personal strength or ability’? What are its problems?
- Approaches are typically humanist - focus on how people respond to challenges
- Health is a means to a greater end - responding positively to problems
- Attempts to recover holistic ideas about health
Problems:
- Vague
- How can we interfere?
- Basically no good definition for health - twisted to suit purposes
What are the definitions of disease and illness?
- Disease = technical malfunction or deviation from the norm which is scientifically diagnosed. It isn’t homogenous, doctors give different diagnoses
- Illness = the social, lived experience of symptoms and suffering
What is illness harmful to?
Has a double impact on the body and social functioning. Illness is harmful to social functioning thus it allows legitimate deviance from social obligation
What is the sick role? What are the 4 components?
- Sick role = concept that concerns the social aspects of becoming ill and the priviledges and obliagations that come with it:
- Patient exempt from normal social rules
- Is not responsible for their condition
- Should try to get well
- Should seek help and co-operate with medical professionals
What role does a doctor have in deciding if someone can enter the sick role?
- Sickness is either chosen or by force (by intolerable social expectation)
- Only a doctor can determine if someone is sick and can enter the sick role
- Official conformation that they are not malingering
What is the medicalisation hypothesis?
Professional’s tend to see problems in terms of their own profession. Doctors therefore see everything medically. Therefore some conditions that seem medical can be in fact products of social forces, e.g. ADHD/depression?
What are some criticisms of the sick role?
- Failure to account for conflict
- Cannot account for social change - patients are not as passive and more active in their care; patient-doctor relationship is not as symmetrical
- People with chronic illnesses remain in deviant state
What are the 4 criteria of good care?
- Co-participation in care and patient as decision maker
- Acceptance of an open agenda
- Holistic rather than biomedical
- Development of counselling skills
What is medicalisation (sociological model of health)?
- Explains problems in medical terms
- Professionals see problems in terms of their own profession, doctors see everything medically
- Problems that seem medical could be products of social forces
What are the criticisms of medicalisation?
- Historical naivety
- Over simplistic view of medicine
- Under estimate the degree to which modern medicine has been successful in eradicating disease
- The addiction of patients to modern medicine is considerably overstated
What is iatrogenisis (sociological model of health)? What are the different types?
- Unintended adverse effects of a therapeutic intervention
- Can be clinical (unintended side effects of modern medicine), social (leads to nothing other than the ‘expropriation of health’) + cultural (health professionals have an even deeper, health denying impact that removes people’s ability to deal with their weakness and vulnerability)
What is the social paradox (sociological model of health)?
- Diseases can be caused by social factors (e.g. lifestyle) but treated with biological interventions (need to be tackled socially as well)
What is global health defined as? How is global health bets addressed?
- Health provokes, issues, and concerns that transcend national boundaries
- Influenced by circumstances or experiences in other countries
- Best addressed by cooperative actions + solutions
What are some global issues?
- Population growth
- Low fertility in developed countries
- Digital divide - difference in access to information
- International migration
- Global environmental change
- International political crisis
- International agreements
What is happening to the world’s population? What is happening to the the number of children per women in developing and developed countries? What is happening to world fertility?
- The world’s population is increasing. The total number of children per woman is decreasing in less developed countries and remains stable in developed countries. World fertility is generally decreasing.
- The population is aging, especially in the middle class. There is also a high population of under 15s.
What percentages do developing countries make up?
- 84% of world’s population
- 93% of the burden of disease
- 18% of global income
- 11% of global health spending
- There is an unequal distributionof nurses and beds to population ratios globally
Which organisations are the key actors in Global Health?
- United Nations and their agencies, e.g. UNICEF, WHO
- Multilateral Developmental Banks, e.g. The World Bank
- Bilateral agencies, e.g. USAID
- Private foundations, e.g. Rockefeller Foundation
- Non-governmental organisations, e.g. Doctors Without Borders
- Global health partnerships
- Massive disease burden if poorer countries is a threat to global wealth + security
- Millions of people die from preventable diseases due to lack of resources
- Potential to save millions of lives but depends on richer nations for support
What is the impact of smoking?
- Single greatest cause of illness + premature death in UK
- 100,000 deaths per year
- Huge economic cost
- Associated health problems: cancers, COPD, stomach ulcers, impotence, oral health, cataracts
What are the reasons for smoking? What can quitting smoking be modelled by?
Nicotine addiction
- Coping with stress
- Habit
- Socialising
- Fear of weight gain
- Quitting smoking can be modelled by the stages of change model: pre contemplation(smoking) → contemplation(smoker thinking about quitting) → preparing to change → action (ex-smoker less than 6 months) → maintenance (greater than 6 months no smoking)→ stable changed lifestyle/relapse
Why are the physiological effects of smoking?
- Activation of nicotinic ACh receptors in brain
- Dopamine release in nucleus accumbens
- Stimulant, tolerance, withdrawal
Which sex smokes more? Is smoking prevalence increasing or decreasing? Which socioeconomic group is more likely to smoke? What happened in the UK in 2005 and 2007 to help combat smoking?
- Men smoke more than women
- Smoking prevalence is decreasing
- The gap between men and women is closing
- People from lower socioeconomic groups smoke more than those from higher ones
What are some ways to stop smoking?
- Nicotine replacement therapy (NRT):
- Patches, gums, nasal spray, lozenges, inhalators (available on NHS)
- Non-nicotine pharmacology:
- Varenicline, bupropion
The Stop Smoking service works on the principle that it is only possible to help people who want to quit. What model is this?
- Transtheoretical (stages of change) model:
- Pre-contemplation = smoking
- Contemplation = thinking about quitting
- Preparing to change
- Action = ex-smoker less than 6 months
- Maintenance = longer than 6 months not smoking
- Stable changed lifestyle/relapse
When discussing stopping smoking with a patient, what are the three A’s?
- ASK your patient about smoking
- ADVISE your patient on cessation methods
- ASSIST your patient + refer to NHS services
What are the differences between qualitative and quantitative research?
What is screening?
In most cases screening the population is to spot the individuals who are more likely to have a disease. It is not intended to be diagnostic
What type of prevention would breast cancer screening fall under?
Secondary prevention = aim is to detect early disease in order to alter the course of the disease
Screening isn’t always 100% accurate, there will be false positives and false negatives. What are the 5 ways of measuring the effectiveness of screening?
- Sensitivity
- Specificity
- PPV (positive predictive value)
- NPV (negative predictive value)
- Prevalence
What is sensitivity?
- Proportion of people with the disease who are correctly identified by the screening test. It is a measure of how well a test picks up those
What is specificity?
- Specificity of a test is the probability of a person without the disease testing negative. It is a measure of how well a test recognises those without the disease.
What is the positive predicted value (PPV)?
- Proportion of people with a positive result who actually have the disease
What is NPV?
- Proportion of people with a negative test result who don’t have the disease
What is incidence? How is it measured? How can incidence be increased and decreased?
- The number of cases per unit time, measures the rate at whihc disease occurs
- People per year per 1000 of population
- Incidence can be increased by screening identifying new cases and increasing risk factors. It can be reduced by decreasing risk factors e.g. primary preventions
What is prevalence?
- Number of individuals who have a condition at a certain time divided by the population at risk
What happens to the false positive value is the disease prevalence is increased?
If the prevalence of a disease is high, the incidence of false positives will fall. The positive predictive value therefore increases and the negative predictive value falls.
The reverse is true for a rare disease.
What is the criteria for screening?
Wilson and Junger criteria:
- Condition sought should be an important health problem
- Natural history of condition should be well understood
- Should be a detectable early stage
- Should be an accepted treatment for patients with recognised disease
- Facilities for diagnosis + treatment should be available
- Adequate health service provision should be made for the extra clinical workload resulting from screening
- A suitable test should be devised for the early stage
- The test should be acceptable
- Intervals for repeating the test should be determined (not a one off)
- There should be an agreed policy on who to treat
- The costs should be balanced against the benefits
When screening, what are the 3 types of bias that can occur?
- Selection bias = people who choose to participate in screening programmes may be different from those who do not, e.g. women in higher socioeconomic groups more likely to attend but have lower risk of cervical cancer
- Lead-time bias = when screening appears to increase survival time simply because the disease is detected earlier. Once this is taken into account, there may be little or no effectiveness of the screening test (i.e. improvement in survival time). Someone is identified 7 years earlier than another person but both die at same time, looks like person caught 7 years earlier has had 7 years extra. In reality, his survival would be the same without screening
- Length-time bias = an overestimation of survival because long-duration cases are more likely to be detected that short-detection cases, e.g. annual PSA screening more likely to detect slow-growing tumour of the prostate, which is also more likely to be detected while still at a treatable stage. Fast, aggressive tumours fall through gals in screening
What are 5 types of screening?
- Population-based screening programmes
- Opportunistic screening
- Screening for communicable diseases
- Pre-employment + occupational medicals
- Commercially provided screening
Give 3 examples of screening tests.
- Guthrie test – for Phenylketonuria, congenital hypothyroidism, sickle cell disease, Cystic fibrosis or MCADD
- Newborn hearing screening test
- Green tie disease
What are the arguments for and against screening?
For:
- Prevent suffering
- Early identification being beneficial
- Early treatment is cheaper
- Patient satisfaction tends to be high
Against:
- Damage caused by false positives and false negatives
- Adverse effects of screening tool on healthy people
- Personal choice is compromised
What are the definitions of:
a) impairment
b) disability
c) handicap?
a) any loss or abnormality of psychological, physiological or anatomical structure or function
b) any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner within the range considered normal for a human being
c) a disadvantage for a given individual that limits or prevents the fulfilment of a role that is normal
Give some examples of types of migrants.
- Asylum seekers = departed country of origin + officially applied for asylum in another country but is awaiting a decision.
- Refugees = person who left their country in fear or persecution, e.g. war, political unrest
- Undocumented migrants = foreign born nationals who do not have a right to remain in the UK
- International students
Asylum seekers and immigrants are generally highly vulnerable people, in terms of physical and mental health. What sort of conditions might they have/develop?
- Many may be healthy upon arrival but may develop conditions due to side-effects of immigration policy, barriers in health access + unawareness of entitlement
- Communicable diseases
- Malnutrition
- Obesity from western diet
- Anaemia
- Musculoskeletal complaints
- Oral disease
- STIs and STDs
- Pregnancy
- Female genital mutilation
- Psychological disturbance, e.g. PTSD and depression
What is the definition of obesity? How do we calculate BMI?
- Obesity = BMI > 30 kg/m^2
- BMI = weight (in kg) / height (in metres) squared
- Becoming increasingly more common in Western societies
What are the three classes of obesity in terms of BMI score?
- Class I = 30-34.9
- Class II = 35-39.9
- Class III = over 40
List some health problems associated with obesity.
- Type 2 diabetes mellitus
- Ischaemic heart disease
- Stroke
- Osteoarthritis
- Obstructive sleep apnoea
- Heart failure
What are some treatment methods for obesity?
- Diet
- Exercise
- Mediaction: orlistat
How do we define metabolic syndrome?
Three or more from:
- Central obesity - raised waist circumference
- Elevated triglyceride
- Low HDL
- Hypertension
- Raised fasting plasma glucose
Improvements in what have had the most significant effect in the reduction of TB?
Social conditions
What factor determines population health (above a threshold)?
- The extent of income division within a society that determines population health. Therefore more unequal societies have worse health
- Between countries there is no relationship between mean income and health (above a threshold)
What is the inverse care law?
The availability of good medical care tends to vary inversely with the need for it within a population
What do the terms primary prevention, secondary prevention and tertiary prevention mean?
- Primary prevention: the aim of primary prevention is to prevent a disease becoming established. It aims to reduce or eliminate exposures and behaviours that are known to increase an individual’s risk of developing a disease. It can be aimed at individual behaviour change or as a population approach (e.g. immunisations or high risk approaches such as weight management).
- Secondary prevention: the aim of secondary prevention is to detect early disease and slow down or halt the progress of the disease.
- Tertiary prevention: once disease is established, detectable and symptomatic, tertiary prevention aims to reduce the complications or severity of disease by offering appropriate treatments or interventions.
What is the prevention paradox?
The prevention paradox states that a larger number of people at small risk of disease may contribute to more cases of that disease than a smaller number of people who are individually at greater risk
What is the high risk approach to prevention? What is the population approach to prevention?
- High risk approach:
- Target highest risk individuals
- Aim to reduce risk to below set limit
- Accepted by society - treat those outside “normal levels”
- Population approach:
Target all individuals
- Aim to reduce the risk for each individual
- Recognises that the low risk majority may contribute most cases
- Concerns over treating the well and the “nanny state”
Which group does the high risk approach generally favour? What does the population approach generally achieve?
The high risk approach favours those who are more affluent and better educated. They are:
- More likely to engage with health services
- More likely to comply with treatments
- More likely to have the necessary means to change their lifestyle
The population approach generally reduces social inequalities.
How many deaths does cardiovascular disease affect in the UK? Are the rates increasing or decreasing?
Cardiovascular disease accounts for 40% of deaths in the UK (1 in 5 men and 1 in 8 women). Rates are decreasing due to lifestyle changes and effective treatments
What does primary prevention in cardiovascular disease consist of? What does SNAP stand for?
- Primary prevention in CHD involves lifestyle changes and prevention and management of the related conditions of hypertension, hypercholesterolaemia and diabetes
- SNAP:
- Smoking (taxation, no public places, cessation services, health warnings, tobacco control)
- Nutrition (recommendations e.g. 5 a day, food standards/regulation/labelling and food in schools)
- Alcohol (know your limits, taxation, alcohol pricing and regulation)
- Physical activity (At least 5 times a week, PE in schools etc)
What are the four phases in cardiac rehabilitation?
- Phase 1 – in hospital
- Phase 2 – Early post discharge
- Phase 3 – 4 – 16 weeks
- Phase 4 – long term maintenance of lifestyle change (SNAP)
What actions are taken in the secondary prevention of cardiovascular disease?
- Primary care CHD registers
- Medical management: Aspirin, B-blockers, ACE inhibitors, statins
- Phase 4 cardiac rehabilitation
What are some unmodifiable and modifiable risk factors for cardiovascular disease?
Unmodifiable:
- Sex
- Age
- Ethnicity
- Family history
- Early life circumstances
Modifiable:
- High blood cholesterol
- Hypertension
- Type 2 diabetes
- Smoking – single avoidable risk factor which causes more death and disability than any other. Decreasing in rate.
- Physical inactivity
- Overweight. BMI = weight in kg/(height in metres)2 normal BMI is 18-25
- Poor nutrition
- Alcohol intake
Name 4 psychosocial influences for cardiovascular disease.
- Personality
- Depression/anxiety = those people with higher depression ratings have higher CHD rates and associated mortality. Major depression is associated with higher mortality in CHD.
- Work = a job with high demand and low control (leading to stress) has an association with MI.
- Social support = quantity and quality of social relationships helps a patient to cope with life events and motivate them to engage in healthy behaviours. This leads to decreased morbidity and mortality
What is the incubation period for influenza? When is it mainly infectious from? How is influenza A different from infleunza B? What is the reproduction number?
- Incubation period is 1-3 days
- Mainly infectious from onset of symptoms to 4-5 days later
- Influenza A is the strain which causes pandemics, influenza B is seasonal influenza
- Reproduction number is the mean number of secondary cases following a single infection
What is the virus family called? What are the three types of virus called? What are two types of surface antigens? How can viruses be carried?
- Viral family: orthomyoxovirdae
- Three types: A, B, C
- Surface antigens: Hemagglutinin, neuraminidase
- Carried by pigs, horses, birds and humans
What are the criteria for pandemic spread?
- A novel virus
- Capable of infecting humans
- Capable of causing human illness
- Large pool of susceptible people
- Ready and sustainable transmission from person to person
What are the phases of a pandemic?
- Phases 1-3 (mostly animal infections with few human infections)
- Phase 4 (sustained human to human transmission)
- Phases 5-6 ( Widespread human infection)
- Post peak (possibility of recurrent events)
- Post pandemic (disease returns to seasonal levels)
What has changed in modern life that increases the risk of pandemics?
- International travel
- Large population
- Crowding has increased
- Animal husbandry has changed
- Interdependence between countries
What are some public health interventions during a pandemic?
- Hand washing
- Respiratory hygiene
- Reduce social contact
- Travel restrictions
- Restricting mass gatherings
- School closures
- Voluntary home isolation of cases
- Screening people entering UK
What are some direct and indirect types of transmission for diarrhoea?
- Direct:
- Direct route e.g. STIs
- Faecal oral route e.g. Viral gastroenteritis
- Indirect:
- Vector-borne e.g. malaria/dengue
- Vehicle-borne e.g. viral gastroenteritis/hep B
- Airborne:
- Respiratory route e.g. TB/Legionella
What are some common causative organisms for disease?
- Rotavirus
- Shigella
- E. Coli
- Salmonella typhi
- Salmonella paratyphi
- Hepatitis A
- Hepatitis E
- Campylobacter
- Cryptosporidium
- Vibrio cholerae
- Norovirus
- Clostridium difficile
Give a statistic for diarrhoea in children. Give some control measures for diarrhoea.
- Diarrhoea kills more children than AIDs, malaria and measles combined: nearly one in 5 child deaths
- Control measures:
- Hand washing with soap
- Safe drinking water
- Safe disposal of human waste
- Breastfeeding of infants and young children
- Safe handling and processing of food
- Control of flies/vectors
- Vaccination
What is a standard unit of alcohol? Roughly how many units is a bottle of wine?
- A standard unit is 10ml/8g of ethanol
- (% alcohol by volume x amount of liquid in millimetres)/1,000
- 1 bottle of wine is approximately 10 units
What features does foetal alcohol syndrome cause? What symptoms does alcohol withdrawal cause?
- Foetal alcohol syndrome = growth retardation, CNS abnormalities, craniofacial abnormalities, congenital defects, increased risk of birthmarks and hernias
- Alcohol withdrawal = tremors, activation syndrome (agitation, shakes, rapid heart rate, high blood pressure), seizures, hallucinations, delirium tremens
What are the CAGE questions for alcohol dependency?
- Ever felt you should cut down?
- Been annoyed by people telling you to cut down?
- Do you feel guilty about how much you drink?
- Eye opener: ever had a drink first thing in the morning?
What is compliance? What are some reasons for non-compliance?
- Compliance is the extent to which a patient’s behaviour coincides with medical or health advice. It is professionally focused rather than patient focused and assumes doctors know best
- Reasons for non-compliance can be unintentional, e.g. forgetting or not understanding instructions, or intentional, e.g. patient beliefs about their condition or treatment and personal preferences
What is adherence? What is concordance?
- Adherence acknowledges the importance of patients’ belief
- Concordance thinks of patients as equals in care. It is expected that they will take part in treatment decisions. The consultation is now a negotiation between equals
What is the difference between specialist and general palliative care?
- Specialist palliative care = this involves health professionals who specialise in palliative care within and MDT
- General palliative care = available to anyone with advanced progressive disease likely to end in death by practitioners not exclusively concerned with specialist palliative care, e.g. GPs and hospital doctors, district nurses, nursing home staff, social workers etc.
What is the difference between gerontology and geriatrics?
Gerontology is concerned with studying the changes in the body and mind that accompany aging, while geriatrics is concerned with the diagnosis and treatment of disorders that occur in old age.
What are the differences between COPD and lung cancer patients in quality of care?
- COPD patients report a worse quality of life and have more cases of depression
- COPD patients receive fewer visits from district nurses and are less likely to be aware of their prognosis
- Lung cancer patients receive support from specialist palliative care.
D
D
E
B
C
B
E
C
B
E
C
B
D
D
What are the direct and indirect controls of meal size?
- Direct: all factors relating to the direct contact of food to the gastrointestinal mucosal receptors
- Indirect: everything else - metabolic, endocrine, cognitions, individual differences, social and environmental factors
What do the terms satiation and satiety?
- Satiation = what brings a meal to an end
- Satiety = inter-meal period
How many kcal/g are in protein, carbohydrates, fat and alcohol?
- Protein = 4.7 kcal/g
- Carbohydrate = 3.6kcal/g
- Fat = 9.5kcal/g
- Alcohol = 7kcal/g
What is the variety effect?
Exposure to a variety of foods undermines development of meal satiation, e.g. all-you-can-eat buffets
What are the factors affecting health economics?
- Size of problem
- Effectiveness of intervention
- Whether there are alternatives
- Whose ‘fault’ is the disease?
- Is this a health problem?
- Is the NHS responsible for this problem?
- Special population, e.g. preterm babies
- Is there a large payback from treatment?
- Is this disease population particularly ‘deserving’?
What is the basic economic problem?
Scarcity - we have an infinite desire for goods and services, but a finite limit to resources
What is opportunity cost?
The sacrifice in terms of the benefits forgone from not allocating resources to the next best activity, e.g. to spend resources on one activity (e.g. heart transplants) means a sacrifice in terms of a lost opportunity cost elsewhere (e.g. fewer hip replacments)
What is economic efficiency?
Achieved when resources are allocated between activities in such a way to maximise benefit
What is economic evaluation?
- The assessment of efficiency
- It is a comparative study of the costs and benefits of health care interventions for some given disease
How can we measure health benefit?
- Natural units, e.g. blood pressure
- QALYs (1 year perfect health, 2 years with a utility of 0.5)
What are the 4 types of economic evaluation?
- Cost-effective analysis = outcomes measured in natural units
- Cost-utility analysis = outcomes measured in QALYs
- Cost-benefit analysis = outcomes measured in monetary units
- Cost-minimisation analysis = outcomes, measured in any units, are the same in both treatments. Therefore, just minimise cost
When we fund new, more expensive treatment, we need to stop funding another treatment somewhere else in the NHS to pay for it. What does NICE think that any services closed down to fund new services probably generate benefits at a cost of?
£20,000 per QALY gained
What is equity?
Equity is concerned with the fairness or justice of the distribution of costs and benefits
What are the alternatives to an economic approach?
- Spend the whole UK GDP on health
- Let waiting lists do the rationing for us
- Let those who shout the loudest get what they want
- Ignore the problem until the money runs out
- Borrow larger and larger sums of money, and leave the debt to our children
What has the WHO identified as the key challenges of an ageing population?
- Strains in pension and security systems
- Increasing demand for health care
- Bigger need for trained-health workforce
- Increasing demand for long-term care
- Pervasive ageism that denies older people the rights and opportunities available for other adults
What are some causes of an ageing population?
- Improvements in sanitation, housing, nutrition, medical interventions
- Life expectancy is rising around the world
- Substantial falls in fertility
- Decline in premature mortality
- More people reaching older age while fewer children are born
What are some key facts about old people in the UK?
- Currently there are as many people aged over 65 as there are aged under 15 in the UK
- By 2025 there will be more people aged over 65 than aged under 20 in the UK
- Between now and 2025, the proportion of the population aged over 85 will increase by over 60%
What are the two types of ageing?
- Intrinsic = natural, universal, inevitable
- Extrinsic = dependent on external factors, e.g. exposure to UV rays, smoking, air pollution etc.
What are the physical changes in later life?
- Loss of skin elasticity
- Loss of hair and hair colouring
- Decrease in size and weight
- Loss of joint flexibility
- Increased susceptibility to illness
- Decline in learning ability
- Less efficient memory
By how much do women tend to live longer than men?
What happened to life expectancy in England and Wales between 1981 and 2012? What is life expectancy expected to reach by 2030?
- Between 1981 and 2012, life expectancy increased by 8.2 years for men and 6 years for women
- Life expectancy in 2030 is expected to reach 85.7 for men and 87.6 for women
What is mental health like in later life in the UK?
- Up to 25% of over 65’s have symptoms of depression requiring treatment
- 23% of suicides are in over 65’s, these are also higher in men than women
What happens to bones when they are loaded?
Deformation
What happens to bone if we increase our activity?
Higher than customary strains = bone formation
Which cells respond to loading?
Osteoblasts and osteocytes
