Public Health (summary sheets) Flashcards
What is the main determinant of population health?
The extent of income division
What is the Gini coefficient?
A statistical representation of nation’s income distribution
amongs its residents - the lower the coefficient, the greater the equality amongst people. UK has a rather high inequality coefficient compared to some
What is the most powerful predictor of health experience?
Socio-economic model of health
What are 3 responses to health inequalities?
- The Black report
- The Acheson report
- Proportionate Universalism
What was mentioned in the Black report?
- Material (environmental causes, might be mediated by behaviour)
- Artefact (an apparent product of how the inequality is measured)
- Cultural/behavioural (poorer people behave in unhealthy ways)
- Selection (sick people sink socially and economically)
What was mentioned in the Acheson report?
- Income inequality should be reduced
- Give high priority to the health of families with children
What was mentioned within Proportionate Universalism?
- Focusing on the disadvantaged only will not help to reduce the inequality
- Action must be universal but with a scale and intensity proportional to the
disadvantage (hence the name) - Fair distribution of wealth is important
What are the 3 broad topics within the theories of causation?
Psychosocial, neo-material and life-course
What is the psychosocial theory of causation?
- Stress results in inability to respond efficiently to body’s demands
- Impact on blood pressure, cortisol levels and on inflammatory and neuro-
endocrine responses
What is the Neo-material theory of causation?
- More hierarchal societies are less willing to invest into the provision of public goods
- Poorer people have less material goods, quality of which is generally lower
What is the life-course theory of causation?
- A combination of both Psychosocial and Neo-material explanations
- Critical periods - possess greater impact at certain points in the life course
(childhood) - Accumulation - hazards and their impacts add up -> hard work leads to injuries
resulting in disabilities that may lead to more injuries - Interactions and pathways - sexual abuse in childhood leads to poor partner choice in adulthood
What are the 4 domains of public health?
- Health protection
- Improving services
- Health improvement
- Addressing the wider determinants of health
What is health protection?
Infectious diseases, chemicals and poisons, pollution, radiation,
emergency response
What is health improvement?
Lifestyles, family & community, education, employment,
housing, surveillance and monitoring
What is meta-ethics?
Exploring fundamental questions - right/wrong/defining the good life
What is ethical theory?
Philosophical attempts to create ethical theories
What are applied ethics?
A recent emergence of ethical investigation in specific areas
What are the 5 structural determinants of health?
- Social class
- Material deprivation/poverty
- Unemployment
- Discrimination/racism
- Gender and health
What is the biomedical model?
- Mind and body are treated separately
- Body, like a machine, can be repaired
- This privileges use of technological interventions
- It neglects social and psychological dimensions of disease
When is confidentiality allowed to be broke?
- When required by law (notifiable disease, regulatory bodies, ordered by judge or police)
- Patient consent
- Public interest (serious communicable disease, serious crime, research, education)
What are the criteria for disclosure of confidentiality?
- Anonymous if practicable
- Patient’s consent
- Kept to a necessary minimum
- Meets current law (data protection)
What are the three main notifiable diseases (reported by WHO)?
- Cholera
- Yellow fever
- Plague
What is health behaviour?
Aimed to prevent disease (eating healthily)
What is illness behaviour?
Aimed to seek remedy (going to doctor)
What is sick role behaviour?
Aimed to getting well (compliance, resting)
What are 5 lifestyle factors which promote mortality?
- Smoking
- Obesity
- Sedentary life
- Excess alcohol
- Poor diet
What is the health belief model of behavioural change (Becker 1974)?
- Individuals must believe they are susceptible to the condition
- Individuals must believe it has serious consequences
- Individuals must believe that taking action reduces their risks
- Individuals must believe that the benefits of taking action outweigh the costs
What is the transtheoretical model of behavioural change?
- Pre-contemplation (no intention giving up smoking)
- Contemplation (considering quitting)
- Preparation (getting ready to quit in the near future)
- Action (engaged in giving up smoking)
- Maintenance (steady non-smoker)
- Relapse?
What is utilitarian/consequentialism?
- An act is evaluated solely in term of its consequences
- Maximising good and minimising harm
What is Kantianism?
- Features of the act themselves determine worthiness (goodness) of that act
- Following natural law and rights
What is virtue ethics?
- Focus is on the kind of person who is acting, deemphasises rules
- Integration of reason and emotion
What are the 5 focal virtues?
- Compassion
- Discernment
- Trustworthiness
- Integrity
- Conscientiousness
What are the 4 principles (Prima Facie)?
- Autonomy
- Benevolence
- Non-maleficence
- Justice
What does autonomy consist of?
- The decision is intentional
- The decision is done with understanding
- There are no major controlling influences over the decision
What is included in the Katz ADL scale?
- Bathing
- Dressing
- Toilet use
- Transferring (in/out of bed or chair)
- Urine and bowel continence
- Eating
What does the mini mental state examination (MMSE) test?
- Orientation, immediate memory
- Short-term memory
- Language functioning
What is acute illness?
A disease of short duration that starts quickly and has severe symptoms (often can be cured)
What is chronic illness?
A persistent or recurring condition, which may or may not be severe, often starting gradually with slow changes (can’t be cured but can be treated)
What is polypharmacy?
The use of multiple medications or administration of more medications than are clinically indicated
What are the key challenges of an ageing population?
- Strains on pension and social security systems
- Increasing demand for health care
- Bigger need for trained health workforce
- Increasing demand for long-term care
- Pervasive ageism (denying older people the rights and opportunities available for other
adults)
What are the causes of ageing population?
- Improvements in sanitation, housing, nutrition & medical interventions
- Life expectancy is rising around the globe
- Substantial falls in fertility (higher age of first pregnancy?)
- Decline in premature mortality
- More people reaching older age while fewer children are born
What is intrinsic ageing?
Natural, universal, inevitable
What is extrinsic ageing?
Dependent on external factors (UV ray exposure, smoking, air pollution, etc.)
What are the causes of gender bias at an older age?
- Women tend to live to older ages
- 20% biological - premenopausal women are protected from heart disease by hormones
- 80% environmental - men take more lifestyle risks
What are the consequences of higher lifestyle expectancy?
- Pensions will have higher pay outs than those currently planned
- Chronic and co-morbid conditions will prevail
- Rising inequalities as more affluent groups will use health services for longer
What is the Glaser & Strauss (1965) awareness of dying?
- Observational study of interactions between dying people, relatives and staff in USA Hospitals
- Identified 4 awareness contexts:
- Closed awareness
- Suspicion awareness
- Mutual Pretence
- Open awareness
What is social death?
When people die in social and interpersonal terms before their actual
biological death - lonely, impersonal death
What is the chain of infection?
- Susceptible host - low immunity, low white cell count, imbalance in normal flora, invasive
procedures - Causative micro-organism - increase number in hospital, resistant strains
- Reservoir - patients, visitors, stuff, fomites -> where the spread originates
- Portal of entry/exit - respiratory tract, GI tract, GeUri tract, broken skin
- Mode of transmission:
- exogenous spread (direct/indirect contact, vector spread, airborne)
- endogenous spread (self spread)
What are the physiological effects of nicotine?
- Activation of nicotinic ACh receptors in the brain
- Causing dopamine release in the NAcc (nucleus accumbens)
- Stimulant, tolerance and withdrawal
What are the health problems connected with smoking?
- Cardiovascular problems (strokes, heart attacks, DVTs)
- Other cancers (stomach, kidney, pancreas, bladder, mouth, throat,…)
- Stomach ulcers
- Impotence
- Diabetes
- Oral health (gum disease)
- Cataracts
What are the methods used for smoking cessation?
- NRT (Nicotine Replacement Therapy):
- Patches, gums, nasal spray, microtab, inhalator
- Non-nicotine pharmacotherapy:
- Varenicline (Champix)
- Bupropion (Zyban)
What is the patient approach (3 A’s)?
Ask, advise, assist
What are the three leading causes of death in children in developing world?
- Pneumonia
- Diarrhoea
- Malaria
How can a migrant be defined?
- Country of birth
- Country of nationality
- Duration of stay
What are the two broad types of migrant?
- Asylum seekers
- Economic migrants
What are some vulnerability causes in migrants?
- Persecution, war, political and social unrest
- Exploitation, torture, rape, bereavement
- Burden of disease and socio-economic status
What are some of the NHS goals?
- Equity of access
- Reducing gap in health inequalities
- Providing services for the vulnerable
- Ensuring the services are appropriate and accessible
What is screening?
A process which sorts out apparently well people who probably have a disease
from those who probably do not
What is primary prevention?
To prevent a disease from occurring
What is secondary prevention?
Detection of early disease in order to alter the course of the disease and maximise the chances of a complete recovery
What is tertiary prevention?
Trying to slow down the progression of the disease
What is sensitivity?
a/a+c: the proportion of people with the disease who are correctly identified by the screening test
What is specificity?
d/b+d: the proportion of people without the disease who are correctly excluded by the screening test
What is PPV (positive predictive value)?
a/a+b: the proportion of people with a positive test result who actually have the disease
What is NPV (negative predictive value)?
d/c+d: the proportion of people with a negative test result who do not have the disease
What is prevalence?
The proportion of a population found to have the disease
What is incidence?
The number of new cases within a specified time period divided by the size of the population initially as risk
