Public Health / GP Flashcards
What are 4 determinants of health according to Lalonde Report, 1974
Genes, Environment (physical + socioeconomic), Lifestyle, Health care
What is the difference between equity and equality
Equity = what is fair and just
Equality is concerned with equal shares
Horizontal vs Vertical equity
Horizontal = equal treatment for equal need
Vertical = Unequal treatment for unequal need
What are the 3 domains of public health practice
- Health protection (measures to control infectious disease risks)
- Health improvement (societal interventions)
- Health care (delivery of safe high quality services)
Name a public health intervention at individual level, community level and ecological (population) level
Individual - immunisation
Community - playground for local community
Ecological - Clean Air Act
What is the difference between secondary and tertiary prevention?
Secondary Prevention - trying to detect a disease early and prevent it from getting worse (Screening)
Tertiary Prevention - trying to improve your quality of life and reduce the symptoms of a disease you already have
When we want to improve the health of a population or population subgroup, we start with a heath needs assessment, followed by which other phases of the planning cycle?
(Needs Assessment) > Planning > Implementation > Evaluation
What is the difference between Need, Demand and Supply?
Need - ability to benefit from an intervention
Demand – what people ask for
Supply – what is provided
Give a definition of Health Needs Assessment
a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities
What’s the difference between a Health Need and a Health Care Need?
- Health need
Need for health
Concerns need in more general terms
e.g. measured using mortality, morbidity, socio-demographic measures - Health care need
Need for health care
Much more specific
Ability to benefit from health care
Depends on the potential of prevention, treatment and care services to remedy health problems
(Bradshaw) - What is the difference between a Felt Need, an Expressed Need, a Normative Need and a Comparative Need
- Felt need - individual perceptions of variation from normal health
- Expressed need - individual seeks help to overcome variation in normal health (demand)
- Normative need - professional defines intervention appropriate for the expressed need
- Comparative need - comparison between severity, range of interventions and cost
(PH Faculty) - What are the 3 different approaches to Health Needs Assessment?
Epidemiological, Comparative, Corporate
What are some problems with the Epidemiological approach to Health Needs Assessment?
- Required data may not be available
- Variable data quality
- Evidence base may be inadequate
- Does not consider felt needs of people affected
What are some problems with the Comparative approach to Health Needs Assessment?
- May not yield what the most appropriate level
e.g. of provision or utilisation should be - Data may not be available
- Data may be of variable quality
- May be difficult to find a comparable population
What are some problems with the Corporate approach to Health Needs Assessment?
- May be difficult to distinguish need from
demand - Groups may have vested interests
- May be influenced by political agendas
- Dominant personalities may have undue influence
How does the Epidemiological approach to Health Needs Assessment work?
- Define problem
- Size of problem
- Services available
- Evidence base
- Models of care
- Existing services
- Recommendations
How does the Comparative approach to Health Needs Assessment work?
Compares the services received by a population (or subgroup) with others (may examine: Health status, Service provision, Service utilisation, Health outcomes)
How does the Corporate approach to Health Needs Assessment work?
Not to do with corporations. It is about obtaining the views a range of stakeholders (Commisioners/Providers/Professionals/Patients/Press/Politicians) (Some may give their views even when not sought or seek to influence health needs assessments)
Give a definition of Evaluation of Health Services
Evaluation is the assessment of whether a service achieves its objectives
(Alternative: Evaluation attempts to determine as systematically and objectively as possible the relevance, effectiveness and impact of activities in the light of their objectives)
A widely used framework for health service evaluation proposed by Donabedian
Structure (what is there - buildings/staff/equipment)
Process (what is done - eg. no of patients seen @ A&E)
Outcome (eg. mortality, morbidity, QoL, satisfaction)
What are some issues with health outcomes?
- Link (cause and effect) between health service provided and health outcome may be difficult to establish as many other factors may be involved
- Time lag between service provided and outcome may be long
Large sample sizes may be needed to detect statistically significant effects - Data may not be available
- There may be issues with data quality
Maxwell’s Dimensions of Quality of Health Care (3Es and 3As)
- Effectiveness, Efficiency, Equity
- Acceptability, Accessibility, Appropriateness
Give a definition of epidemiology
study of the frequency, distribution and determinants of diseases and health-related states in populations in order to prevent and control disease
What is the difference between incidence and prevalence?
Incidence = New cases, Denominator (number of disease free people at the start of the study), Time
Prevalence = Existing cases, Denominator, Point in time (point prevalence)