Summative III - FND I

Question 1

Health Disparities

Answer 1

• differences in health that is closely linked to social or economic disadvantage
• obstacles due to characteristics historically linked to discrimination or exclusion

Question 2

Health Equity

Answer 2

• A right to the highest possible standard of health
• Reducing and eliminating disparities in health and its determinants, including social determinants
• No one is denied the possibility to be healthy for belonging to a group that has historically been economically or socially disadvantaged

Question 3

The contribution of pharmacists to public health and health promotion

Answer 3

• FDA authorized pharmacists to prescribe paxlovid with limitations
• Vaccinations
• AMA APhA ASHP came together to call for immediate end to prescribing dispensing and use of Ivermectin to prevent/treat covid outside of clinical trials
• ASHP calls for medicare and medicaid payment for paxlovid prescribing by pharmacists
• Covid testing

Question 4

Pharmacy Practice Setting

Answer 4

Question 5

Upstream (Society Level)

Answer 5

Policy and Programs
- Corporations and other businesses
- Government agencies
- Schools
Social Inequities
- Class
- Race/Ethnicity
- Gender
- Immigration Status
- Sexual Orientation

Question 6

Midstream (Community Level)

Answer 6

Physical Environment
- Housing
- Land Use
- Transportation
- Residential Segregation
Behavior
- Smoking
- Nutrition
- Physical Activities
- Violence

Question 7

Downstream (Patient Level)

Answer 7

Disease and Injury
- Infectious Diseases
- Chronic Disease
- Injury
Mortality
- Infant Mortality
- Life Expectancy

Question 8

Differentiate between individual and population-based strategies for health improvement.

Answer 8

There are things we can do to impact health on a societal level (on the left) and things we can do specifically for a patient (on the right). They go in opposite directions. For example counseling and education is good on an individual level but not a very good impact on the health of the society per se. The goals for society vs individual don’t always align in terms of resources, so you have to consider the effect you want when allocating resources/money into a program.

Question 9

Primary Prevention

Answer 9

Prevent development of disease or injury

Question 10

Secondary Prevention

Answer 10

Early detection and treatment to reduce impact of disease

Question 11

Tertiary Prevention

Answer 11

Clinical treatment & minimize the impact of disease

Question 12

Social Justice

Answer 12

Fair and equitable division

Question 13

Social Determinants of Health

Answer 13

The conditions in the environment where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Question 14

Common Good

Answer 14

• Concept dealing with healthcare policies (like mandatory vaccines and lockdowns) in order to safeguard the general public.
• May infringe on individual rights
• Ex. Collateral damage of lockdown - mental health, economic, education etc.

Question 15

Herd Immunity

Answer 15

• When individuals are protected from infection by virtue of the other members of the population (the herd) being incapable of transmitting the virus to that individual
• Protects everyone-even those who cannot get vaccinated (e.g., allergies, or weak immune systems, children)
• Threshold for herd immunity varies by infectious disease

Question 16

R0

Basic reproduction number

Answer 16

• Number of cases that are expected to occur on average as a result of a single infected individual.
• Assumptions:
• Population is homogenous
• Everyone in the population is susceptible (e.g., start of the pandemic)
• No widespread immunity yet
• R0 is affected by:
• Proportion of susceptible people at the start, density of the population
• Infectiousness of the agent
• Rate of disappearance of the cases (either recovery or death)
• R0 > 1 infection will spread
• R0 < 1 slow spread, will eventually disappear
• Ex. R0 = 2, then the infected person infects 2 people and those two people infect 2 people each etc.
• When R0 high = more of population needs to be vaccinated/immune to achieve herd immunity

Question 17

Re

Effective reproduction number

Answer 17

• The number of people in a population that can be infected by an individual at a given time
• Assumption: population has mixed susceptibility and immunity
• Changes with time due to:
• Increasing immunity in the population
• Rate of death
• The pathogen itself (e.g., alpha vs. delta vs. omicron)
• Re is affected by:
• Number of people infected
• Number of susceptible people in contact with infected people
• If Re >1, spread increases exponentially, faster spread, cases go up
• If Re <1, spread slows down, cases decline
• GOAL : Re < 1

Question 18

Chicken Pox Party

Answer 18

An attempt to achieve natural immunity - meaning people not vaccinated, just exposed to virus and develop natural immunity

Question 19

What is the significance of the Re for Omicron compared to Delta? What does this mean with respect to the herd immunity threshold and the number of people getting infected?

Answer 19

a) The Re for Omicron is almost three times higher for Omicron compared to Delta. An Increased Re implies the virus is much more transmissible and the immune population has dropped below the vaccine threshold. Because of this, the number of people getting infected will go up (e.g., a surge).

Question 20

Suggest two upstream strategies to lower the Re for Omicron

Answer 20

In order to lower the Re for Omicron, you want to stop the chain of transmission. In order to do so, upstream strategies could include mandatory vaccinations, masking campaigns, and lockdowns, basically any policy-driven prevention strategy

Question 21

List two social determinants of health that could potentially lead to increased childhood obesity compared to an affluent neighborhood in Palo Alto

Answer 21

Lack of playgrounds, lack of grocery stores selling fresh food, lack of transportation to stores that sell fresh food, crowding, SES, etc.

Question 22

Describe two specific interventions to decrease this health disparity and increase health equity

Answer 22

Providing access to those who need it, in a way that fits their specific needs. Examples include health promotion materials in different languages, bringing farmer’s markets to the neighborhood, community outreach programs to those who are isolated, increasing safe transportation to those who need it, etc.

Question 23

A San Francisco City Supervisor proposes a plan to give each family in San Francisco a $50 voucher to buy fresh fruits and vegetables as a mechanism to promote healthy eating. The $50 vouchers will be equally distributed to all districts in San Francisco. Do you think this will be effective in eliminating health inequities and promote health disparities? Why or why not? Provide two reasons to support your answer.

Answer 23

This is not likely to eliminate health inequities, but it may have some minimal benefit. Providing everyone with the same benefit (e.g., giving everyone $50) treats everyone equally without regards to individual needs (equity). Families have different needs (different number of kids, income, etc). This approach also does not factor in social determinants of health such as the neighborhoods they live in. Some neighborhoods do not have grocery stores that sell fresh vegetables and residents may not have resources to travel to another neighborhood.

Question 24

You are the pharmacist at the California Poison Control Center. A concerned mother calls to ask for advice. Her two-year-old son bit through a glow stick on Halloween and ate the fluorescent liquid. You advise the parent on treatment.

Is this an upstream, midstream, or downstream intervention, and why?

Answer 24

Downstream intervention because it is clinical treatment for the ingestion of the glow stick (which is actually harmless).

Question 25

You accompany your 74-year old grandfather to his checkup. As part of his routine health maintenance, his doctor recommends a bone density test to see if he has osteoporosis and is at an increased risk of breaking a bone. This is an example of what type of prevention:

Answer 25

a) Primary prevention is incorrect since primary prevention is used to prevent the onset of osteoporosis/osteopenia.

b) Secondary prevention is correct since the bone density test is for early detection and treatment of his osteoporosis in the hopes of preventing bone fractures.

c) Tertiary prevention is incorrect since that would be treatment of low bone density (osteopenia or osteoporosis).

Question 26

Describe why doctors should be interested in epidemiology and biostatistics.

Answer 26

• Our goal should be to practice evidence based medicine (EBM)!
• Half of the current medical literature will be proven wrong or obsolete in 10 years – we don’t know which half!
• “Evidence-Based Medicine: A Science of Uncertainty and an Art of Probability”
• To provide the best care for patients, we need to keep current with the evidence base
• Need to critically and independently evaluate the literature
• Is it fake news or good science? (internal validity)
• Does it apply to my patient? (external validity)