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Silas Phase 1 Medicine > Public Health > Flashcards

Public Health Flashcards

1
Q

What is public health?

A 
The science and art of promoting and
protecting health and well-being,
preventing ill-health and prolonging life
through the organised efforts of
society
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2
Q

What is the Nuffield Ladder of Interventions?

A

Do Nothing or simply monitor the situation

Provide Information: Inform & Educate People

Enable choice: enable people to change their behaviours

Guide choice through changing the default: make healthier choices the default option

Guide choice through incentives: use financial or other
incentives to guide people to pursue certain activities

Guide choice through disincentives: use financial or other disincentives to guide people to not pursue certain activities

Restrict choice: regulate to restrict the options available to people

Eliminate choice: regulate to eliminate options entirely

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3
Q

What are the types of prevention?

A

Primary Prevention
• Preventing the onset of disease

Secondary Prevention
• Preventing the progression of disease from a
pre-clinical stage

Tertiary Prevention
• Preventing morbidity and mortality through
treatment of clinical disease

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4
Q

Give examples of factors that affect health outcomes?

A
  • Income
  • Environment
  • Occupation
  • Culture
  • Societal Status
  • Access to education
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5
Q

What are the three domains of public health?

A
  1. Health Improvement
  2. Health Protection
  3. Healthcare Public Health
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6
Q

What is healthcare public health?

A

Helping to ensure that the organisation of the wider
NHS estate is fit for purpose and influencing
expenditure…
• Clinical Effectiveness
• Efficiency
• Service Planning
• Audit & Evaluation

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7
Q

What is health protection?

A

Control of Infectious diseases
Environmental hazards
Chemicals / Radiation
Emergency Response

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8
Q

Give examples of social causes of health damaging behaviour?

A

Tobacco
o Parental and peer pressure
o Educational attainment
o Quit rates and deprivation

• Diet
o The four ‘A’s: access, availability, affordability,
awareness
• Substance misuse, homelessness & mental health
• Physical activity
o Built environment
o Work place

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9
Q

What is health psychology?

A

Health psychology emphasises the role of
psychological factors in the cause, progression
and consequences of health and illness

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10
Q

What are health behaviours?

A 
Behaviours related to health
There are 3 main categories:
➢ Health Behaviour
➢ Illness Behaviour
➢ Sick role Behaviour
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11
Q

What is health behaviour?

A

a behaviour aimed to prevent disease (e.g. eating healthily)

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12
Q

What is illness behaviour?

A

a behaviour aimed to seek remedy (e.g. going to the doctor)

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13
Q

What is sick role behaviour?

A

any activity aimed at getting well (e.g. taking prescribed medications; resting)

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14
Q

What is health damaging/impairing behaviour?

A

Health Damaging/Impairing
e.g. smoking , alcohol & substance abuse, risky sexual behaviour,
sun exposure, driving without a seatbelt

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15
Q

What is health promoting behaviour?

A

e.g. Taking exercise, healthy eating , attending health checks, medication compliance, vaccinations

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16
Q

What are modifiable risk factors?

A 
Risk factors that we can change 
e.g. Diet/ Excessive weight
• Smoking
• Alcohol
• Physical activity
• Sleep, stress…
17
Q

What are non-modifiable risk factors?

A

Risk factors that we cannot change e.g.
Sex
• Age
• Genetics/ Family history

18
Q

What preventative services are delivered by the NHS?

A

• E.g. screening programmes
• Child health protection
• Immunisation programmes from infancy to
adulthood

19
Q

What is a population level health intervention?

A

➢Health promotion

The process of enabling people to exert control over the determinants of health, thereby improving health

20
Q

What is an individual level health intervention?

A

➢Patient centred approach

Care responsive to individual needs

21
Q

What are examples of health promotion activities?

A 
Health promotion campaigns
• ‘Everyone enjoys a drink, no one enjoys a
drunk.’
• Change 4 Life Campaign
• Stoptober, Movember
• Promoting screening and immunisations
• Cervical smear screening
• MMR vaccine
22
Q

What factors influence an individual’s perception of risk?

A
  1. Lack of personal experience with problem
  2. Belief that preventable by personal action
  3. Belief that if not happened by now, its not likely to
  4. Belief that problem infrequent
Other reasons include:
Health beliefs
• Situational rationality
• Culture variability
• Socioeconomic factors
• Stress
• Age
• Etc…
23
Q

What are some models and theories of behavioural change?

A
  1. Health belief model (HBM)
  2. Theory of Planned Behaviour
  3. Stages of change (transtheoretical) model
  4. Motivational interviewing (MI)
  5. Social marketing
  6. Nudging (choice architecture)
  7. Financial incentives
  8. Social norms theory

Top 3 are most important

24
Q

Explain the health belief model?

A

Individuals will change if they:
• Believe they are susceptible to the condition in
question (e.g. heart disease)
• Believe that it has serious consequences
• Believe that taking action reduces susceptibility
• Believe that the benefits of taking action outweigh
the costs

25
Q

Explain the theory of planned behaviour?

A

Proposes the best predictor of behaviour is ‘intention’
e.g. I intend to give up smoking
• Intention determined by:
• A persons attitude to the behaviour
• The perceived social pressure to undertake the
behaviour, or subjective norm
• A persons appraisal of their ability to perform the
behaviour, or their perceived behavioural control

Attitude – I do not think smoking
is a good thing
• Subjective Norm – most people
who are important to me want
me to give up smoking
• Perceived Behavioural Control –
I believe I have the ability to give
up smoking
• Behavioural Intention – I intend
to give up smoking
26
Q

What is the stages of change model?

A

Stage theories see individuals located at discrete ordered stages, rather than on a continuum (this model is key to understanding smoking cessation advice)

• Each stage denotes a greater inclination to change behaviour
• Transtheoretical model, or Stages of change model
(Prochaska & DiClemente, 1984)
• Proposes 5 stages of change: precontemplation,
contemplation, preparation, action, maintenance

27
Q

What is the biomedical model of health?

A

Dominant model in Western medicine
Mind/body can be treated separately: mind/body dualism
The body can be repaired: mechanical metaphor
Solutions therefore in technologies: technological imperative
Reductionist: diseases are often caused by a specific identifiable agent
Knowledge presumed to be objective: neutral and distinct from the social context in which it is produced

28
Q

What is the social model of health?

A

Based in social constructivism
Medical knowledge is itself a sociological construct
Challenges mind/body dualism: embodied and holistic approach
Health, illness are influenced and shaped by wider socio economic context
Medical knowledge is not objective: we are taught how to ‘see’ the body

29
Q

What are the problems of theories that dictate health as an ideal state?

A

Is anyone completely healthy?
What does “complete physical wellbeing mean?” “complete mental wellbeing mean?” and “complete social wellbeing mean?”
Can we ever attain this ideal state? Surely it is dangerously misleading to try to be perfectly healthy?

30
Q

Explain the health as daily functioning to perform social tasks theory?

A

Health is a means towards the end of social functioning
In order for people to be healthy all forms of disease, illness and social handicap need to be removed in order to promote health
We can still be healthy even though chronic illness and disease is present
Frequently alluded to as the biopsychosocial model.

31
Q

Explain health as personal strength or ability?

A

These approaches are typically humanist, they focus on how people respond to the challenges that life throws at them.
Health is a means to a greater end, its about responding positively to various problems.
This definition attempts to recover holistic ideas about health that disappeared in the eighteenth century.
Problems with this approach:
Too vague! It is very unclear what these personal strengths are and where they come from

If the nature of personal strengths are too vague then it is also very difficult to know how to intervene to improve wellbeing and health

32
Q

Define illness and disease and explain why it is not simple?

A

Illness: the social, lived experience of symptoms and suffering
Disease: a technical malfunction or deviation from the norm which is ‘scientifically’ diagnosed (Turner 1984; Kleinman 1988)
Both influenced by social context.
Disease is not a homogeneous concept: professional specialization can influence what information is observed

33
Q

What is functionalism in relation to health?

A

Health is a prerequisite for the smooth running of society
People’s dislocation with society that causes illness (Durkheim (1951) Suicide)
The human body analogy where parts function for the benefit of the whole. If one part malfunctions it upsets the functioning of the rest of the body. Illness is a social problem and not a medical one:
The state of optimum capacity of an individual for the effective performance of the roles and tasks for which s/he has been socialized (Parsons 1951)

Social relations are products of a harmonious society preserved by individuals acting in defined roles and performing certain roles.
Illness as a potential state of social ‘deviance’: failure to conform to social expectations and norms.
Illness is an unnatural state
Doctors are necessary actors of social control, moral guardians, distinguishing between normality and ‘deviance

34
Q

In Talcott Parson’s Sick Role work, what are the rights and duties of the doctor and patients?

A 
Doctor:
Access private domains fulfilment
Right to exclusive trust
Apply highest standards 
To be guided by patients welfare
Patient:
Exemption from role fulfilment
To receive support
Not to malinger
Seek help and follow advice
35
Q

What are the four components of the sick role?

A

Legitimate withdrawal from social obligations
Not blamed for their condition
Patient must want to get well
Patient must seek technically competent help (Parsons 1987)

36
Q

What is the relationship of the sick role?

A

Only a doctor can sanction entry into the sick role
The patient is socially vulnerable, seeking official verification that she is not ‘malingering’
The medical profession is universalistic, functionally specific and affectively neutral in its fulfilment of community interests rather than its own self-interest.

37
Q

What is Parsons two fold model of the aetiology of illness?

A 
The capacity model:
Three stages of aetiology
1. Normality
2. Strain
3. Exhaustion
The deviancy model:
Three stages of aetiology
Normality
Motivational problems
Crisis
38
Q

What are criticisms of the sick role?

A

failure to account for conflict
it cannot account for social change
patients are now much more active and the asymmetrical and hierarchical relationship between the doctor and patient might well need to be revised
the model fails to account for the nature of chronic illness or normal conditions that require medical intervention

Silas Phase 1 Medicine (15 decks)

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