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Public Health > Social determinants of health inequalities > Flashcards

Social determinants of health inequalities Flashcards

1
Q

what did Semmelweis do?

A

1847 - Ignacz campaigned for hand washing after discovering a correlation between purpureal fever and dissection

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2
Q

what is the main determinant of population health?

A

not mean income, but extent of income division

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3
Q

what is the Gini coefficient?

A

a statistical representation of the nation’s income distribution amongst its residents - the lower the coefficient, the greater the equality amongst people

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4
Q

what is the Gini coefficient like compared to other countries?

A

high, compared to Scandinavian countries (e.g. Denmark)

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5
Q

what is the most powerful predictor of health experience?

A

socioeconomic model of health

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6
Q

what were responses to health inequalities?

A

black report, Acheson report, proportionate universalism

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7
Q

what is the Black Report?

A

1980

material: environmental causes, maybe mediated by behaviour
artefact: apparent product of how inequality is measured
cultural/behavioural: poorer people behave in unhealthy ways
selection: sick people sink socially and economically

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8
Q

what is the Acheson Report?

A

1998

income inequality should be reduced
give high priority to the health of families with children

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9
Q

what is Proportional Universalism?

A

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

fair distribution of health is important

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10
Q

what are theories of causation?

A

psychosocial, neo-material, life-course

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11
Q

what is the psychosocial theory of causation?

A

stress results in inability to respond efficiently to body’s demands

impact on BP, cortisol levels and inflammatory and neuroendocrine responses

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12
Q

what is the neo-material theory of causation?

A

more hierarchal societies are less willing to invest into the provision of public goods

poorer people have less material goods, and the quality of these is usually lower

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13
Q

what is the life-course theory of causation?

A

combination of psychosocial and neo-material explanations

critical periods - greater impact at certain points in life course

accumulation - hazards and impacts add up -> hard work leads to injuries, -> disability

interactions and pathways - sexual abuse in childhood -> poor partner choice in adulthood

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14
Q

what are types of interactions and pathways that can affect life course?

A

sexual abuse in childhood -> poor partner choice in adulthood

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15
Q

what are the domains of public health?

A

health protection, improving services, health improvement, addressing the wider determinants of health

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16
Q

what are examples of health protection?

A

infectious diseases, chemicals and poisons, pollution, radiation, emergency response

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17
Q

what are examples of improving services?

A

clinical effectiveness, efficiency, service planning, equity

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18
Q

what are examples of health improvement?

A

lifestyles, family and community, education, employment, housing, surveillance, monitoring

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19
Q

what are examples of addressing the wider determinants of health?

A

seeing the big picture - making sense of data

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20
Q

what are ethical levels?

A

meta-ethics, ethical theory, applied ethics

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21
Q

what is meta-ethics?

A

exploring fundamental questions: right/wrong/defining good life

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22
Q

what is ethical theory? what are its categories?

A

philosophical attempts to create ethical theories

virtue, categorical, imperative, utilitarianism, 4 prinicples

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23
Q

what is applied ethics?

A

recent emergence of ethical investigation in specific areas (environmental, medical, public health)

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24
Q

what are ethical arguments?

A

deductive, inductive, considering what we believe in, ethical analogies

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25
Q

what are types of ethical fallacies?

A

ad hominem, authority claims, begging the question, dissenters, motherhoods, confusing necessary and sufficient, no true scotsman

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26
Q

what is ad hominem?

A

responding to arguments by attacking the person’s character rather than the content of their argument

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27
Q

what are authority claims?

A

saying a claim is correct because authority has said so

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28
Q

what is begging the question?

A

petition principii

assuming initial point of the argument

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29
Q

what are dissenters?

A

identifying those who disagree does not itself prove the claim is not valid

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30
Q

what are motherhoods?

A

inserting a soft statement to disguise the disputable one

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31
Q

what is the no true Scotsman argument?

A

modifying the argument e.g. “no true Scotsman would do that” “but this one did” “well, no true Scotsman would”

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32
Q

what are structural determinants of illness?

A

social class, material deprivation/poverty, unemployment, discrimination/racism, gender and health

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33
Q

what is the biomedical model?

A

mind and body are treated separately

body, like a machine, can be repaired

this privileges use of technological interventions

neglects social and psychological dimensions of disease

34
Q

when is disclosure allowed?

A

if required by law (notifiable disease, regulatory bodies, ordered by judge/police)

patient consent

public interest (communicable disease, serious crime, research, education)

35
Q

what are criteria for disclosure?

A

anonymous if practicable

patients consent (overrule?)

kept to necessary minimum

meets current law (data protection)

36
Q

what happens to duty of confidentiality after death?

A

continues

37
Q

what are the main notifiable diseases?

A

must be reported to WHO

cholera, yellow fever, plague

38
Q

what are the types of health behaviour?

A

health, illness and sick role behaviour

39
Q

what is health behaviour?

A

aimed to prevent disease (eating healthily)

40
Q

what is illness behaviour?

A

aimed to seek remedy (going to the doctor)

41
Q

what is sick role behaviour?

A

aimed at getting well (compliance, resting)

42
Q

what are five lifestyle factors promoting mortality?

A

smoking, obesity, sedentary life, excess alcohol, poor diet

43
Q

what are theories of behavioural change?

A

Health Belief Model, Transtheoretical model

44
Q

what is the Health Belief model?

A

Becker (1974):
individuals must believe they’re susceptible to the condition

individuals must believe it has serious consequences

individuals must believe that taking actions reduces their risks

individuals must believe that the benefits of taking actions outweigh the costs

45
Q

what is the Transtheoretical model?

A

pre-contemplation (no intention to give up smoking

contemplation (considering quitting)

preparation (getting ready to quit in near future)

action (engaged in quitting)

maintenance (steady non smoker)

relapse?

46
Q

what are the key theories in ethics?

A

utilitarian/consequentialism, Kantianism, virtue ethics, four principles

47
Q

what is morality?

A

concern with the distinction between good and evil or right and wrong (universal)

48
Q

what is ethics?

A

system of moral principles and a branch of philosophy which defines what’s good for individuals and society (may differ in different culture)

49
Q

what is utilitarian/consequentialism?

A

teleological

act evaluated solely in terms of its consequences

maximising good and minimising harm

greatest happiness principle of John Stuart Mill

50
Q

what are the types of utilitarian/consequentialism?

A

hedonistic, rule, act, preference

51
Q

what are the criticisms of utilitarian/consequentialism?

A

future consequences are difficult to predict

measuring and comparing the goodness of consequences is difficult

easy to bias in favour of particular groups

ignores intentions, past actions, character and fairness

doesn’t take account of fairness of result and may be inconsistent with human rights

52
Q

what is utilitarianism?

A

states that people should maximise human welfare/well-being

53
Q

what is hedonism?

A

states that people should maximise human pleasure

54
Q

what is act consequentialism?

A

looks at every single moral choice anew

a particular action is morally good only if it produces more overall good than any alternative action

55
Q

what is rule consequentialism?

A

bases moral rules on their consequences

whether acts are good or bad depends on moral rules

moral rules are chosen solely for basis of consequences

56
Q

what rules should be adapted in rule consequentialism?

A

rules that would produce best results if they were adopted by most people

57
Q

what is consequentialism based on?

A

whether an act is right or wrong depends only on the results of that act

the more good consequences an act produces, the better/more right the act

58
Q

what is Kantianism?

A

features of the act themselves determine worthiness (goodness) of that act

following natural laws and rights

59
Q

what are categorical imperatives of Kantianism?

A

set of universal moral premises from which duties are derived (e.g. do not lie)

60
Q

what is deontological?

A

duty (from Greek)

focuses on rightness/wrongness of actions themselves, as opposed to wrongness of consequences of actions/character of actor

61
Q

what is Kantianism founded on?

A

Kant’s view of rationality as ultimate good, all people being fundamentally rational

62
Q

what is Kant’s main contribution towards ethics?

A

theory of Categorical Imperative

63
Q

what is the Categorical Imperative?

A

one should act only in such a way that you’d want your actions to become a universal law - applicable to everyone in a similar situation

64
Q

what are semi-Kantians? when did they arise?

A

1790s - altered features of Kant’s system that they saw as inadequate, unclear or wrong

Friedrich Schiller (1759-1805)
Friedrich Bouterwek (1766-1828)
Jakob Friedrich Fries (1773-1843)
65
Q

when was the period of post-Kantianism?

A

1790 - 1835

German Idealists

66
Q

what is idealism?

A

theory that fundamental reality is made up of ideas or thoughts and not physical matter

67
Q

what is Rationalism?

A

knowledge could be attained by reason alone, a priori

dominant philosophical school of 18th century

68
Q

what is Empiricism?

A

knowledge could be arrived at only through the sense, a posteriori

69
Q

what is transcendental idealism? who proposed it?

A

Kant - we directly know of at least the possibility of noumena (things in themselves) - both empirically and transcendentally real even if they can’t be directly/immediately known

70
Q

what are noumena?

A

things in themselves

71
Q

who created Kantianism?

A

german idealist philosopher Immanuel Kant

72
Q

when was Kantianism founded?

A

centred in Germany during Age of Enlightenment of late 18th and early 19th century

73
Q

what are the criticisms of Kantianism?

A

Hegel - provide no specific info about what people should do as moral law is a principle of non-contradiction

Hegel - forces humans into an internal conflict between reason and desire

Schopenhauer - argues that ethics should be practical and offer a solution to real-world problem, whereas Kantianism is more idealised/perfect world-ish

Nietzsche - system benefits interests of people over others. Kantianism undermines his views of autonomy.

Mill - Kantianism can’t explain why certain actions without appealing to utilitarianism (bad reliance on reason, can’t explain why actions are right/wrong)

74
Q

what is virtue ethics?

A

approach to ethics that emphasises an individual’s character as the key element of ethical thinking, rather than rules about acts themselves (deontology) or their consequences (consequentialism)

75
Q

what are the three main strands of virtue ethics?

A

eudaimonism, ethics of care, agent based theories

76
Q

what is eudaimonism?

A

classical formation of virtue ethics

eudaimonia: proper goal of human life. happiness/good life. can be achieved by lifetime of practicing virtues in everyday activities (phronesis - practical wisdom) to resolve any conflicts

77
Q

what is a virtue?

A

habit/quality that allows individuals to succeed at their purpose

78
Q

what is a teleological belief?

A

includes an account of the purpose or meaning of human life

79
Q

when is virtue ethics only intelligible?

A

if it’s teleological

80
Q

what are moral and intellectual virtues?

A

moral: prudence, justice, fortitude, temperance
intellectual: theoretical and practical wisdom

81
Q

what did Aristotle argue about the moral virtues?

A

they’re each a golden mean (desirable middle ground) between two undesirable extremes

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