Public Health - Healthy and Unhealthy Communities Flashcards
What does the social model of health address
The social, economic, and political conditions in which people grow, live, work and age and the structural drivers of those conditions.
Social model of heath
Age, sex, hereditary factors Individual lifestyle factors Social and community networks Structural factors General socioeconomic, cultural and environmental conditions
What does individual lifestyle factors look at
Personal behaviour and way of living that can promote or damage health e.g. smoking, whether or not we are physically active, the foods we choose to eat, alcohol consumption
What does social and community networks influence
Influence our individual actions e.g. drinking culture
What are health inequalities
Unjust and avoidable differences
Examples of health inequalities
Differences in mortality rates between people from different social classes, or
The impact of income groups on school readiness, vocabulary, and behaviour
Overarching recommendations of WHO CSDH
Improve daily living conditions
Tackle the inequitable distribution of power, money and resources
Measure and understand the problem and assess the impact of actions
Marmot review policy objectives
Give every child best start in life
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Create fair employment and good work for all
Ensure healthy standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen the role and impact of ill health prevention
National marketing campaigns
Stoptober
Regional marketing campaigns
UCLH Pathway programme
UCLH Pathway Programming
For homeless patients admitted to hospital. Involves hospital GP’s and nurses working with others to address the social determinant’s of housing, financial and social issues of patients. After its introduction, A&E attendance by supported individuals fell by 38% with a 78% reduction in bed days
Local marketing campaigns
PHE support local areas on risk factors e.g. smoking
Published ‘Smoking Cessation: A briefing for midwifery staff’ and launched an online training module, ‘Very brief advice on smoking for pregnant women’
What is screening
Testing people who do not suspect they have a health problem (without symptoms)
Why do we have screening
Reduce risk of future ill health by earlier detection and treatment
Provide information to help make choices
NHS national cervical screening programme
Cervical cancer Breast cancer Bowel cancer Abdominal aortic aneurysms Antenatal and neonatal testing Diabetic eye disease
NHS general health check
Screen adults 40-74 for early signs of stroke, kidney disease, T2DM or dementia
GP management of risk factors
Cardiovascular risk factors
Bp Cholesterol Obesity (BMI) Glucose (or HbA1c) Smoking
National Diabetes Prevention Programme
Based on glucose (or HBA1c) testing in health check
Diagnosis of prediabetes –> lifestyle interventions
Diagnosis of diabetes –> GP
Stages of screening
Screening phase
Dx phase
Intervene
Outcomes of screening
Outcome better because of early detection
Outcome good but early detection made no difference
Condition would have no impact, intervention was unnecessary
Outcome poor and early detection made no difference
Components of a screening programme
Register of eligible people System of invitation and recall Screening tests Confirmation of dx Treatments of other interventions Info and support for patients Staff training Standards and quality assurance
Drawbacks of screening
Over dx
False +ve
False -ve – false sense of security
Unnecessary treatment – might never have progressed to severe disease/ death
Costs of screening, further testing and treatment
False -ve
Has disease and screening test -ve
False +ve
Does not have disease and screening test +ve
Sensitivity
% of people with disease who test +ve. Screening tests should be highly sensitive
Specificity
% of people without disease who test -ve. Diagnostic tests should be highly spp
Evidence about effectiveness of screening
RCTs provides best evidence
Time trends in disease incidence and outcomes – compared to countries/ regions without screening
Case control studies
Systematic reviews of evidence
Modelling (combining a variety of evidence)
Common sources of bias in screening evaluation
Healthy Screening effect
Length time bias
Lead time bias
Healthy Screening effect
People who take part tend to be healthier than those who don’t
Lead time bias
Earlier detection makes duration of survival after diagnosis longer, even if treatment is ineffective
Length time bias
Disease is more likely to be detected in people with longer lasting and slowly progressive types of the disease —> have better outcomes anyways
Common chemical hazards
Arsenic Asbestos Benzene Vinyl Chloride Alpha-naphtylamine Hydrocarbons Nitrates
Which cancer site does arsenic affect
Lung
Which cancer site does asbestos affect
Lung
Which cancer site does benzene affect
Leukaemia
Which cancer site does vinyl-chloride affect
Liver
Which cancer site does alpha-napthylamine affect
Bladder
Which cancer site does hydrocarbons affect
Scrotum
Which cancer site does nitrates affect
Stomach
Vector for malaria
Anopheles Mosquito (female)
Environment needed for malaria
Needs suitable temperature and rainfall
IPCC main risks of climate change
Greater risk of injury, disease and death due to more intense heat waves and fires
Increased risk of undernutrition resulting from diminished food production in poor regions
Consequences for health of lost work capacity and reduced labour productivity in vulnerable population
Increased risks of food and water-borne disease and vector-borne diseases
IPCC main opportunities of climate change
Modest reductions in cold-related mortality and morbidity in some areas due to fewer cold extremes
Geographical shifts in food production
Reduced capacity of disease-carrying vectors due to exceedance of thermal thresholds
What does the impact of the environment on human health depend on
Vulnerability both at the individual and society levels
What can heat and air pollution exacerbate
Cardiovascular, cerebrovascular and respiratory issues
What can cause GE and cholera
Contamination due to floods and disruption of clean water supplies and sewage treatment
How can climate change cause more vector-borne infectious
Changes in vector number and geographic distribution of clean water supplies and sewage treatment, after heavy rains and other environment disasters
How can climate change cause malnutrition
Changes in local climate that disrupt crop production
Xenobiotics
Exogenous chemicals in the environment that may be absorbed by the body through inhalation, ingestion, or skin contact
Metabolism of xenobiotics
Phase 1: Chemicals undergo hydrolysis, oxidation, or reduction
Phase 2: reactions of glucuronidation, sulfation, methylation, and conjugation with glutathione (GSH). Water-soluble compounds are readily excreted
Air pollution
Cause of morbidity and mortality
Airborne micro-organisms
Chemical and particulate pollutants found in the air
Who does air pollution especially affect
Individuals with pre-existing pulmonary or cardiac disease.
Air in industrialised nations
Sulfur dioxide CO Ozone Nitrogen dioxide Lead Particulate matter
How does the ozone affect healthy individuals
Decreased lung function
Increased airway reactivity
Lung function
How does the ozone affect athletes and outdoor workers
Decreased exercise capacity
How does the ozone affect asthmatics
Increased hospitalization
How does NO2 affect healthy individuals
Increased airway reactivity
How does NO2 affect asthmatics
Decreased lung function
How does NO2 affect children
Increased respiratory infections
How does SO2 affect healthy adults
Increased respiratory symptoms
How does SO2 affect pts w/ chronic lung disease
Increased mortality
How does SO2 affect asthmatics
Increased hospitalisations
How do acid aerosols affect asthmatics
Decreased lung functions
Increased hospitalizations
How do acid aerosols affect children
Increased respiratory infections
How do acid aerosols affect healthy adults
Altered mucociliary clearance
How do particulates affect children
Increased respiratory infections
Decreased lung function
How do particulates affect pts w chronic lung/ heart disease
Excess mortality
How do particulates affect asthmatics
Increased attacks
Ozone as pollutant
Gas formed by sunlight-driven reactions involving nitrogen oxides
Forms smog
Participates in chemical reactions that generate free radicals, which injure the lining cells of the respiratory tract and the alveoli
Sulfur dioxide, particles and acid aerosols
Emitted by coal and oil power plants and industrial processes burning fuel
Inhalation causes infl response
Sources of carbon monoxide
Automotive engines
Fossil fuels
Home oil burners
Cigarette smoke
Mechanism of carbon monoxide in body
Systemic asphyxiant that binds to haemoglobin and prevents oxygen transport
Systemic hypoxia appears at 20-30%
Unconsciousness and death at 60-70%
Damage with bioareosols
Can cause pathogenic microbiologic agents, such as those that can cause legionnaires’ disease, viral pneumonia and the common cold
What are health inequalities usually dressed in relation to
Socioeconomic Factors e.g. income.
Geography
Specific Characteristics
Socially Excluded Groups e.g. those experiencing homelessness
What does specific characteristics involve
Protected characteristics such as sex, ethnicity, religion and disability.
Key measure of population’s health status
Life expectancy
Avoidable mortality
Refers death that can be prevented by timely healthcare and intervention
Global examples of health inequalities
32-year gap in life expectancy globally - 85 in Japan and 53 in Central African Republic
Children in sub-Saharan Africa are 15 x more likely to die before their fifth birthday
People 60+ make up 94% of COVID-19 deaths in the EU
Short term effects of air pollution
Pneumonia Bronchitis Irritation to nose, throat, eyes or skin Headaches Dizziness Nausea Unbearable odours make living difficult
How humans impact land and water
Contamination of bodies of water
Contamination of soil
Acid rain
Global warming
Effect of water and land pollution on human health
Breeding ground for illness and disease
Contaminated water is linked to disease transmission
