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Health Policy > Test > Flashcards

Test Flashcards

1
Q

Who was John Snow?

A

Father of epidemiology. Measured the outbreaks of cholera in London in 1854 and found that cases were concentration in really poor areas. Prior to him, disease blamed on miasma. Found that impure drinking water was the cause of the outbreaks so removed broad street pump.

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2
Q

What was the historical and traditional views of poor health?

A

Historically: demons, sin, retribution, god is angry
Traditional: individualistic, poor lifestyle, bad luck, genetic fate

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3
Q

What was the 1946 WHO definition of health and why was it criticized?

A

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Criticized for being too utopian, complete being too much. Does not account for environmental, occupational or spiritual health as well as differences across gender.

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4
Q

What was the leading cause of death in the early 1900s in Canada?

A

Infectious diseases with an average life expectance of 60 years until the discovery of penicillin in 1928 and due to the improvement in living conditions.

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5
Q

Who were the radium girls?

A

They were female factory worked who contracted radiation poisoning from painting watch dials with glow in the dark paint with radium in it. 5 women filed a court case that established the right of individual workers who contracted occupational diseases to sue their employees.

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6
Q

Who was Dr. Thomas McKeown?

A

He proved that population health improvements between 1850 and 1950, was due to improvements in living conditions not medical advances, as many believed previously.

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7
Q

Define morbidity.

A

The occurrence of disease or impairment resulting from accidents or environmental causes that adversely affect health (disease).

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8
Q

Define mortality.

A

The occurrence of deaths resulting from disease, accidents, or environmental causes (death).

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9
Q

What is the social constriction of health and illness?

A

There are aspects of health that we now consider socially constructed who has the power to define and illness. This means that science is not value-free, objective, or universally true as it is influenced by human culture and social factors. Ex. Postpartum depression used to be blamed on the mother not being able to handle it, but now seen as a serious health condition.

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10
Q

Who was Mary Anning?

A

She was a fossil collector/palaeontologist who sold fossils as a living. Due to being a woman, she was not allowed to participate in the scientific community despite being a great scientist. Proof that not everyone was included in science and might have biased the results.

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11
Q

How is health viewed today?

A

It is now seen as a continuum as opposed to binary or linear, it is a continuous work in progress. We aim to integrate many different modalities of health around the world and aim to live with chronic conditions in a state of wellness. Technology is helping redefine health.

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12
Q

Why were tori eggs so popular even after being de-bunked by a professional?

A

We live in an post-truth world with internet-empowered patients in a wellness culture. There is no one right way in the world any more and women who may feel dismissed by the doctors may seek out alternative treatments. This results in peoples opinions of experts not being what they used to be.

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13
Q

What must we now consider when looking at health?

A

Health problems must be considered social issues as circumstances beyond an individuals control my often be behind ill health.

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14
Q

What is the medical model of health?

A

Treatment of diseases and injuries that is supported by OHIP with the medical prof at the centre of the HC system with doctors controls approximately 80% of HC costs.

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15
Q

What is the social model of health?

A

Medical care is only one part of a complete HC system with care in the community also playing a large part. Health care takes on a team approach.

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16
Q

What is the biomedical model of health?

A

The body is like a machine and the doctor is the mechanic where there is a specific cause or origin for each specific disease with individual focus and the acute treatment of ill individuals.

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17
Q

What is pasteur?

A

Germ theory of disease. Used in the biomedical model of health.

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18
Q

What are some challenges to medical dominance?

A
  1. The emergence of the welfare state (medicare): government role in health care.
  2. Professionalization of other occupations: traditional chinese medicine, women’s health movement
  3. Conflicts with medicine: not heterogeneity, extra-billing discord, community based vs. research
  4. The demystification of medicine: public skepticism of medical authority as scientific and infallible, iatrogenesis, docs and big pharma
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19
Q

What is iatrogenesis?

A

Harm caused by medical activities. Ex. false positive resulting in administration of medicine causing harm

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20
Q

What are five criticisms of the biomedical model?

A
  1. Fallacy of specific ethology: not one reason for disease
  2. Objectification and biological determinism
  3. Reductionism and biological determinism: looking at smaller and smaller features of human biology, forgetting the broader societal effects
  4. Interventionist bias: more and more looking for magic bullet solution
  5. Victim blaming: we are responsible for our own health when in fact there are many issue.
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21
Q

What is the health promotion model?

A

Focuses on prevention and self-care keeping people healthy. Involves lifestyle changes for healthier behaviours.

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22
Q

What are the three levels of prevention?

A

Primary: stop problems before they start
Secondary: intervention early to reduce symptoms or halt the progression
Tertiary: treatment or rehab after a person is sick to limit effects of the disease

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23
Q

What is social marketing in health promotion?

A

Uses marketing techniques to persuade a target audience to act in a more healthy fashion. This requires knowledge of attitudes and behaviours and may involve promotions, direct marketing, PR or special events. It moves from health being at the mercy of the gods to manipulating more healthy behaviour based on evidence based knowledge of what works.

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24
Q

Define population health

A

A framework for gathering and analyzing information about conditions that affect the health of a population. Aims to both maintain and improve the health of the entire population and to reduce inequities in health status among population groups.

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25
Q

What are the red hatters?

A

A social group that encourages senior women to get out and have fun.

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26
Q

What is the Lalonde Report?

A

Came out in 1974 and was the first report to talk about the social determinants. Was a report that said human biology, environment, lifestyle, and healthcare organizations were all determinants of health.

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27
Q

What was the ottawa charter for health promotion?

A

Declared that health is created and lived by people within the settings of their everyday life, where they learn, work, play, and love. Named several prerequisites for health.

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28
Q

What was the Epp report?

A

Came out in 1986, it was a frame work for health promotion that identified reducing health inequities between income groups as an important government policy.

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29
Q

How did british research support the Epp report?

A

Two reports in 1992 (The Black report and Health Divide) found that the lowest employment groups are more likely to suffer wide range of diseases and premature death from illness or injury at every stage in the life cycle. Rich = healthier.

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30
Q

What was the black report?

A

Commissioned by a labour government, it examined inequalities in health in the UK and confirmed that wealth=health. However, it was published under a conservative government who buried it.

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31
Q

Who was richard wilkinson?

A

He was a british economist who studied health disparities in first-world nations. He found that unequal societies are more unhealthy societies and that health and life expectancy are greatly determined by social position.

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32
Q

What are the different dimensions to wellness?

A

Physical, social, mental, and occupational health

Is an ongoing active process of trying to achieve the highest level of health possible in each dimension.

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33
Q

What is africville?

A

A town in Nova Scotia that was established after the civil war by black people claiming land promised by the british. Became a black slum. As halifax grew, services were extended to everywhere expect africville. Later, everyone was forced out when Halifax decided to turn it into a municipal dump. Became a good example of community health.

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34
Q

How were social determinants involved in hurricane Maria?

A

When the initial mortality rates for the hurricane were announced, they only included those who died as a direct cause of the storm. Later, however, Harvard performed their own study taking into the account the long-term, social determinants of the storm, finding a significantly higher mortality rate due to the lack of response and health infrastructure.

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35
Q

What are the 12 key determinants of health?

A 
Income and Social Status
Social Support Networks
Education and Literacy
Employment/Working Conditions
Social Environments
Physical Environments
Personal Health Practices and Coping Skills
Healthy Child Development
Biology and Genetic Endowment
Health Services
Gender
Culture
36
Q

How are income and social status a health determinant?

A

Higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.

37
Q

How is education a health determinant?

A

Low education levels are linked with poor health, more stress, and lower self-confidence

38
Q

How is physical environment a health determinant?

A

Safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health.

39
Q

How are employment and working conditions health determinants?

A

People in employment are healthier, particularly those who have more control over their working conditions.

40
Q

How are social support networks health determinants?

A

Greater support from families, friends, and communities is linked to better health.

41
Q

How is culture a health determinant?

A

Customs, traditions, and beliefs of the family and community all affect health.

42
Q

How are genetics a health determinant?

A

Inheritance plays a part in determining lifespan, healthiness, and the likelihood of developing certain illnesses.

43
Q

How are personal behaviour and coping skills a health determinant?

A

Balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.

44
Q

How are health services a health determinant?

A

Access and use of services that prevent and treat disease influences health

45
Q

How is gender a health determinant?

A

Men and women suffer from different types of diseases at different ages.

46
Q

What was the dutch hunger winter?

A

in 1944/1945, a combination of a Nazi food blockade and a severe, long winer caused a famine in a normally well-nourished population in a very specific region for a very specific time. Studies have found that babies in the first trimester had lower birthweight and remained so for the rest of their life. It also found that the individuals exposed to this famine in utero were more susceptible to diabetes, CVD, obesity, and other health problems.

47
Q

What is rickets?

A

It is a disease caused by the softening and weakening of bones in children, usually because of an extreme and prolonged vitamin D, phosphorous, or calcium deficiency. Often causes bowed legs or knock knees as a result of severe malnutrition.

48
Q

What caused the severe increase in orphans in romania in the 1970s?

A

In 1967, in an effort to increase the population, Romania’s Nicolae Ceausescu passed decree 770, which banned all forms of contraception and abortion for women under 45 (40 later) or who had less than 4 kids. Resulted in 170000 orphans as parents could not afford to keep their kids, resulting in 700 overrun orphanages. It also resulted in an increased rate of maternal mortality due to increased rate of botch abortions.

49
Q

What was found after the romania orphan crisis?

A

Children were being neglected due to the lack of staff to look after them. Resulted in developmental delays, poor hygiene, malnutrition, and several other problems. Many were adopted into high earning canadian families but still suffered life-long problems, such as higher risks of mental health problems such as depression, self-harm, drug abuse, and suicide. Ex. Audrey hepburn.

50
Q

What is cumulative advantage?

A

The process whereby individuals who have early opportunities for success (ex. better life chances) most often build on that success to perpetuate their advantage later in life

51
Q

What is cumulative disadvantage?

A

Carry forth disadvantages of early life, may lead to later life poverty or poor health.

52
Q

What are the three pathways that poor living circumstances can effect your later health?

A

Latent: early life environment affects adult health (malnutrition = rickets)
Pathway: early life environment like poverty sets you on a pathway that impacts your health status over time ex. poverty effects readiness for school
Cumulative: the intensity and duration of exposure to negative conditions adversely affects your health depending on the level of negative exposure, resulting in accumulated disadvantages.

53
Q

How was Zika a public health issue?

A

When it broke out in south America, the rich were able to afford to put chlorine in their water to prevent breeding and were made aware of the problem. Many lower income weren’t even aware of the issue until they were pregnant with a symptom-positive child. Were unable to get abortions due to high population of religion and begged Canadians to send abortion pill. There was a lack of public awareness.

54
Q

Who was Engles?

A

Wrote The Conditions of the Working Class in England in 1845, writing about the health conditions of workers in England, specifically one suburb in Manchester. Found that death rates varied based on housing quality and street in the same neighbourhood. Claimed poverty, poor housing, clothing, diet, and lack of sanitation led directly to infections and diseases among the poor as well as stress.

55
Q

What in intersectionality?

A

The belief that oppressions are interlinked and cannot be solved alone. We cannot just look at one aspect as they are all interconnected. A theoretical framework that attempts to be inclusive and identify all forms of oppression and power within society by being aware of multiple frameworks that subordinate people.

56
Q

Describe the health state of poverty and women in Canada.

A

Almost 1/4 of Canadian women raising children alone and 14% of single older women are poor. Single mothers are 5x more likely to be poor and the low income rate of older women on their own is 13X higher than those living with a family. Poverty affects single women disproportionately to men.

57
Q

Why are women disproportionatly effected by poverty in Canada?

A

Elderly women were more effected as they were housewives and stay at home moms who do not have an income once the husband passes away.

58
Q

What is equity in health?

A

Equity is a moral and ethical dimension, talking about differences which are unnecessary and avoidable but also unfair and unjust. These are things that can be addressed and changed. Ex. Marshal Islands

59
Q

Describe aboriginal medicine.

A

Usually done through the shaman or medicine man. They believed in a connection to the spirit world and mother earth, focusing on the balance and harmony. If you were ill, it may have been linked to you disrespecting nature. Medicinal traditions were passed down through generations through oral teachings and observations, using over 500 plants.

60
Q

How were the aboriginal populations key in the early settlers survival?

A

Aboriginal communities kept them alive during the harsh winters by teaching them how to hunt and fish, which nuts and plants to gather, how to preserve meat, and how to build snowshoes, canoes, and toboggans. In return, we brought small pox, measles, and the flu as they had no immunity.

61
Q

What was the medicine of the black robes?

A

When settlers brought over disease, priests wanted to baptize the sick and dying aboriginal people, unknowingly bringing more disease into the communities, causing the aboriginals to perceive them as the veil medicine of the black robes.

62
Q

After confederation, how were health care responsibilities divided?

A

Federal: marine hospitals, quarantine management, care of aboriginals
Provincial: hospitals and asylums, charities and charitable institutions, and public health (more by default)

63
Q

Describe medical care in early Canada.

A

Doctors were mostly civilians and military with only the rich being able to afford physician care. The less wealthy turned to religious or charitable organizations and family as well as the remedies shared by the aboriginals. Hospitals were for the poor as the rich saw it as somewhere people went to die.

64
Q

What was Canada’s first hospital?

A

Hotel Dieu de Quebec - established by the order of Augustinian nuns from France. These early hospitals were charitable institutions that the rich avoided.

65
Q

What caused the rich and middle class to begin using hospitals?

A

The introduction of anesthesia and aseptic techniques in the 1880s reduced the death rates in hospitals from infection, making them safer.

66
Q

What was St. Boniface?

A

The 1st hospital in Western Canada (Winnipeg). It opened in 1871 with four beds, founded by the 4 sisters of Charity of Montreal.

67
Q

What caused strife among religious hospitals after St. Boniface opened?

A

A few years later, a second hospital run by village housewives was opened, tending to gunshot wounds, typhoid fever, and malaria.

68
Q

How did healthcare change in the early 1990s in Canada?

A

As the population grew, so too did disease and poverty. People paid for their own healthcare. Common issues included STIs and child welfare. Along the same time, industrial development was booming.

69
Q

How were doctors trained in the 1900s?

A

Medicine was a mans world that focused on training in lecture halls as opposed to the bedside, as doctors were gentlemen. Women were not welcome, despite nursing schools predating the 1st medical school in Canada.

70
Q

Who was William Osler and how did he change medical education?

A

Was a physician who placed an emphasis on bedside training. Began using cadavers that they stole as it was seen as unsightly to tamper with a cadaver.

71
Q

How does the history of midwives differ between us and Britain?

A

In Britain, midwifery was seen as a partnership with medical professionals, helping deal with the large families that came in and around the first world war and right afterwards. In the US and Canada, there was a movement to push midwives out as expertise was seen to be associated with university and high eduction as opposed to info being passed down from one person to another on the job. Midwives ended up taking jobs up north that doctors didn’t want.

72
Q

Who was typhoid mary?

A

She was a cook and maid in the 1900s who carried the typhoid disease but was asymptomatic. She was the cause of several outbreaks in households and was isolated for three years. After being released and swore not to work around food, she returned to work in a hospital under a pseudonym and caused several more outbreaks and two deaths. (She needed money, no man in the picture). After this, she was placed in custody and lived alone on an island until her death in 1958.

73
Q

What province was the first to establish a Board of Health?

A

Ontario in 1832, then Quebec in 1833. Saskatchewan established the Bureau of Public Health in 1909 and the Department of Health was established in Alberta (1918), Manitoba (1928), and NS (1931).

74
Q

What act was introduced in 1867?

A

BNA act

75
Q

What was the role of volunteer organizations in the early 19th century?

A

They provided healthcare or raised funds for healthcare. Common organization included The Order of St.John, The Canadian Red Cross, the Canadian National Institute for the Blind, the Victorian Order of Nurses, the Children’s Aid Society, and the YMCA.

76
Q

What was the cottage hospital system?

A

Established in 1934, it was a system of hospitals on the coast of NFLD to serve 1500+ rural communities. Doctors and nurses would travel to the communities and provide healthcare, sometimes by hospital boat.

77
Q

Why were more women dying in childbirth while with doctors than with midwives?

A

Midwives washed their hands constantly as opposed to midwives, so they were less likely to have patients contract an illness.

78
Q

Who was Henry E. Sigerist?

A

He was a Swiss doctors that was recruited by the US. He was studying health during wwII and saw that people desperately needed healthcare services. He proposed a more socialized approach to healthcare, similar to what Russia had at the time. Aimed to get state-run and financed health services When USSR went cray-cray in the 1930s, people turned on him and the US continued to have an individualized system.

79
Q

Who was Norman Bethune?

A

Hailed as a national hero in China and was essentially the original doctor with boarders. He organized the first mobile blood-transfusion service along the front and wanted to move towards a socialized health care system. He later moved to China to support Mao and became a military doctor, where he trained other people in healthcare.

80
Q

Who was the father of Medicare?

A

Tommy Douglas. He was the premier of Saskatchewan in the 1940s-60s. He immigrated to Canada from Scotland, lived through the great depression and became a Baptist Minister where he witnessed the inequalities of the HC system on the population. He later joined the SK labour party to work towards a more equal health care system. Eventually established the first provincial health insurance program that covered universal hospital costs then doctors costs, sharing the costs 50/50 with the federal government beginning in 1957 (for hospitals) and in 1968 (for doctors).

81
Q

How did views on health care change after the second world war?

A

Canadians believed that the government had a role to play in providing its citizens with reasonable standard of living and access to basic health care. Wanted security and equity that a publicly funded system would bring.

82
Q

Who was mostly pressing for public health care?

A

The middle class. They felt the most brunt of not being able to afford health care as the rich could pay for their own and the poor could seek help from charities.

83
Q

What was implemented in 1968?

A

The National Medical Care Insurance Act. The federal government agreed to pay 50% of provincial insurance plans. At this point, all provinces had a form of socialized health care that was paid by taxes.

84
Q

What did the Canada Health Act outlaw that caused issues?

A

Outlawed the direct billing of patients by doctors for covered procedures. Doctors got mad because they felt they were being told what to do so they went on strike for 25 days in 1984. The public was not with them however and when the government threatened to import British doctors, they went back to work.

85
Q

What are the five principles of the Canada Health Act?

A

1) Universally available
2) Reasonably accessible
3) Medically comprehensive (everything deemed medically essential was covered)
4) Portable between provinces
5) Publicly administered

86
Q

Compare libertarian and egalitarian views on health care.

A

Libertarian: believed that you should be free to do as you choose with your own life and property, as long as you don’t harm anyone else, advocating the maximizing of individual rights while minimizing the role of the state.
Egalitarianism: believed individuals have a moral right to healthcare and that autonomy and freedom cannot exist in any other society as freedom cannot exist without equality of conditions. We are all in this together mentality of Canadians.

Health Policy (2 decks)

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