Sem 1 ASBHDS

Question 1

Describe the WHO definition of health. (3)

Answer 1

A state of complete physical mental and social well-being, and not merely the absence of illness or infirmity.

Question 2

Describe the five major “causes” of the association between ill-health and deprivation. (10)

Answer 2

Artefact - associations aren’t real, just exist in the data due to the way we measure it.
Social selection - health determines socio-economic status due to ability to work.
Behavioural - people I’m deprived areas are more likely to smoke / drink / not exercise.
Psychosocial - stress of working low paid, low autonomy jobs creates ill-health.
Material - direct effects of the poverty.

Question 3

Explain the difference between the biological model and the biopsychosocial model. (5)

Answer 3

Biological - only biological factors eg pathogens cause all disease, we need to intervene medically always, psychology has no effect on physical health.
Biopsychosocial - biological, social and psychological factors matter eg lifestyle has an influence, mental health can cause physical disease, people have an influence on their own health.

Question 4

Describe the characteristics that a condition needs to have to be classes as “chronic” (5)

Answer 4

Lasts long time
Significant impact on the patient
Co-morbidities 
Controlled but not cured 
Manifestation can change day to day.

Question 5

Explain “the work of chronic illness”. (4)

Answer 5

Illness work - symptom management
Everyday life work - draining
Emotional work - difficult to keep happy
Identity work - maintain sense of self

Question 6

Describe the two views of disability and critique them both. (4)

Answer 6

Medical - disability is deviation from medical norms - stereotyping, lack of social and psychological recognition.
Social - environment finals to adjust, so disability is a form of social oppression - body is left out.

Question 7

Explain the differences between an impairment and a disability. (2)

Answer 7

An impairment is an abnormality in structure of functioning of the body.
A disability is the affect of the impairment on the functioning of the body.

Question 8

Define “lay belief”. (2)

Answer 8

The meaning of health to different people, and the socially embedded belief of what health is.

Question 9

Describe the three definitions of health. (3)

Answer 9

Positive - a state of well-being and fitness
Functional - ability to perform certain things
Negative - absence of illness

Question 10

Define these behaviours:
Health behaviour
Illness behaviour 
Sick role behaviour
(3)

Answer 10

Health behaviour - activity undertaken to maintain health.
Illness behaviour - activity of ill people to define their illness and find a solution.
Sick role behaviour - the formal response to symptoms including seeking help.

Question 11

List 7 factors that influence illness behaviour. (7)

Answer 11

Culture 
Visibility of symptoms
Extent of disruption to normal life 
Information
Tolerance
Frequency and persistence of symptoms 
Lay referral.

Question 12

Describe the three groups of people that occur when considering adherence to treatments. (6)

Answer 12

Deniers - don’t believe they have the proper disease (eg asthma) and undergo complex strategies to hide it.
Acceptors - normal life achieved, not stigmatised.
Pragmatists - accept it, but see it as unimportant.

Question 13

Describe the two types of rationing that could be used to allocate new drugs. (2)
Describe advantages and disadvantages for both. (6)

Answer 13

Explicit: defined characteristics for entitlement and transparency.
+ accountable, debatable, evidence-based.
- outcomes assumed to be the same for all, complex, leaves patients in distress if they don’t meet the criteria.

Implicit: care is limited, but decisions not transparent.
+ faster, undebatable.
- discrimination, based on “social deservingness” doctors don’t like it.

Question 14

Define these concepts:
Scarcity
Efficiency 
Equity 
Effectiveness
Utility 
Opportunity cost 
(6)

Answer 14

Scarcity - resources are limited so prioritisation is inevitable.
Efficiency - getting the most out of limited resources.
Equity - the extent to which distribution is fair.
Effectiveness - intervention provides the desired outcome.
Utility - value an individual places on a health state.
Opportunity cost - the cost of an intervention viewed as “other things we could have bought with this money” foregone.

Question 15

Explain the difference between technical and allocative efficiency. (2)

Answer 15

Technical - most efficient way of meeting a need.

Allocative - choosing between the many needs to be met.

Question 16

Describe the four ways of comparing cost and benefits. (8)

Answer 16

Cost minimisation - outcomes assumed to be equivalent, choose cheapest input.
Cost effectiveness - compares interventions with a common outcome. Compared in terms of cost per unit outcome.
Cost benefit - all outputs and inputs are put in monetary terms; this is hard, so “willingness to pay” used.
Cost utility - cost per QALY gained.

Question 17

Describe an algorithm for working out which is the best type of cost benefit analysis. (6)

Answer 17

Are all interventions equally effective?
- yes: cost minimisation analysis 
- no > 
Can outcomes be measured in money?
- yes: cost benefit analysis 
- no > 
Can outcomes be measured in QALYs? 
- yes: cost utility analysis 
- no: cost effectiveness analysis

Question 18

Describe 1 QALY. (2)

Answer 18

1 year of perfect health
OR
2 years at 50% health 
OR 
10 years at 10% health

Question 19

Describe how to work out cost per QALY. (2)

Answer 19

(Expected number of years x cost per year) / QALYs gained = cost per QALY.

Question 20

Describe 4 disadvantages of the QALY system. (4)

Answer 20

Resented by patients, politicians and pharmaceutical companies.
Don’t assess impact on careers
May not be representative
Not distributed according to needs.

Question 21

Define PRO and PROM. (2)

Answer 21

Patient Reported Outcome - a report on the patient health direct from the patient.
Patient Reported Outcome Measure - tools used to measure PROs.

Question 22

Describe 4 types of PROM. (4)

Answer 22

Generic - any patient population
Disease specific - developed for a particular condition
Unidimensional - focused on one specific symptom
Multidimensional - focused on global health related QoL.

Question 23

Why are PROMS important? (3)

Answer 23

Symptoms burden / psychological impact is often under recognised
QoL important as well as length
Allows clinicians to team with patients in decision making.

Question 24

Describe the 8 characteristics that a PROM must have to be released to the public. (16)

Answer 24

Appropriateness - is it going to get what we want?
Acceptability to patients
Feasibility of administration and processing
Interpretability
Precision
Reliability and reproducibility
Validity (claiming what it says it does)
Responsiveness - is it important to patients.

Question 25

Describe three learning theories that influence health related behaviour. (6)

Answer 25

Classical conditioning - memories of “the good times” can prompt a relapse
Operant conditioning - withdrawal sucks and unhealthy food tastes good.
Social learning theory - learning through observed behaviours.

Question 26

Describe the COM-B model. (3)

Answer 26

The impacts that capability to make a decision, motivation to do so, and the opportunity to show the behaviour influence the eventual outcome of behaviour.

Question 27

Describe the neoliberalism model of health inequality. Give one major criticism of this. (3)

Answer 27

Choosing to be happy and healthy.
Presents being healthy as something that is equally easy for everyone, meaning the poor people who can’t afford healthy foods don’t deserve to be healthy.

Question 28

Describe 3 treatment models for substance abuse. Explain how each treats addiction. (9)

Answer 28

Medical - Pharm treatment, focuses on physical conditions eg withdrawal, tolerance.
Disease - avoidance is the only treatment, addiction is a genetically predetermined illness with loss of control as the primary symptom. Uses 12 steps
Behavioural - addiction doesn’t exist, it’s just poorly learnt coping mechanisms. Address experiences and teach coping.

Question 29

Give three examples for harm reduction in substance abuse. (3)

Answer 29

Alcoholism - vitamin B suppliments
Opiates - naloxone
Injecting - needle exchange, BBV screening.

Question 30

Give three examples of relapse prevention in substance abuse. (3)

Answer 30

Disulfiram
Buprenorphine
Methadone

Question 31

Describe the inverse care law. Give an example. (3)

Answer 31

We don’t even have equity, we have it the wrong way (ie benefitting the rich). Eg rich people and poor people get assigned the same 9am appointment, but it advantages the rich because they can drive.

Question 32

Describe the inequality paradox. (3)

Answer 32

The most needy fail to get what they need, but when you target the most needy, their needs are not addressed. The well off adapt better to change.

Question 33

Explain proportionate universalism using an example. (4)

Answer 33

Eg universal child benefit that is not means tested.
This is helpful because everyone can access it without means testing.
Benefits that are means tested have lower uptake in the lower classes (the people who need them) because eg the forms need internet or they don’t understand the forms.
Proportionate universalism means giving everyone the same even if it seems counterintuitive because it will benefit the poor more.

Question 34

Describe moral individualisation.
Give an example.
(2)

Answer 34

A self-centred approach to problems that doesn’t help the greater good. Eg a person smokes to have a few moments to themselves as stress relief, so telling them to not smoke is unhelpful.