Theme 1 key areas Flashcards
What is the WHO/UN definition of health?
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
Define population health
Population health is defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group.
Population health is made up of public health, public policy and health care.
Define public health
The World Health Organization defines public health as ‘the art and science of preventing disease, prolonging life and promoting health through the organised efforts of society’.
Public health focuses on infectious diseases and has an increased focus on equity and social justice in recent years.
What is the biomedical model of health?
The biomedical model of health focuses on purely biological factors and excludes psychological, environmental, and social influences. It is considered old-fashioned and doesn’t consider to social determinants of health.
What is the socioecological model of health?
The Socio-Ecological Model takes into consideration the individual, and their affiliations to people, organisations, and their community at large to be effective. There are five stages to this model – Individual, Interpersonal, Organisational, Community, and Public Policy.
Describe the components of population health
- Health care - the organised provision of medical care to individuals and the community.
- Public health - the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention, and detecting, preventing and responding to infectious diseases.
- Public policy - national, state and local laws
Discuss the the key differences between the biomedical model and the socioecological model:
Biomedical model:
> sees illness as the result of biological pathology.
> can result in seeing an individual as their disease not as a person.
>does not always consider the reasons for illness
> sees health problems as a result of an individual’s risk factors and lifestyle
> has a focus on the hospital environment
Socioecological model:
> believes in a relationship between health related behaviours and the surrounding environment
> considers the determinants of health
Describe the key factors influencing contemporary population health
- Improved agricultural techniques mean we have ensured food supply.
- The introduction of vaccines
- The introduction of life-saving health technologies like X-Ray, MRI etc.
- Improved health education
- Improved public sanitation
How do we apply the biomedical model of health in a clinical setting?
We can see that the biomedical model is using in a clinical settings during the diagnosis of a disease.
How do we apply the socioecological model in a clinical setting?
For example, if a patient is smoking heavily, we may address this at several key points:
Individual - increase knowledge surrounding the dangers of smoking
Interpersonal - identify what kind of social support networks the individual may have when trying to quit. If they don’t have adequate support, you may refer them to a support group.
Organisational - is the individual’s environment conductive to quitting smoking?
Community - is it a cultural norm to smoke in the individual’s community? If so, educating the whole community may be necessary.
Public Policy - for example, you can’t smoke within a certain distance of the hospital.
Define demography
Demo = people Graphy = to write or record
Demography = the study of human populations. Has a focus on: size, distribution and composition of populations in relation to changes brought about by an interplay of dynamic processes such as: death, birth, marriage, income, social mobility and migration.
Describe the relationship between health, healthcare and demography
Demography affects an individual’s health status which in turn, affects what kind of healthcare they receive.
Changes in demography determine the healthcare resources needed.
What is the scope of demography?
The scope of demography is very broad as almost every aspect of health is applicable for means of study. by demographic techniques.
Define population size
The actual number of individuals in a population
Define distribution
The pattern of where people live.
Distribution is often uneven - ie. we often see places that are sparsely populated and places that are densely populated.
Define concentration/population density
The number of people per unit of area - ie. population size divided by total land area.
How do trends in population affect healthcare delivery?
Smoking during pregnancy example:
>We have a high number of Indigenous-Australian women living in very remote areas under the age of 20 who smoke during pregnancy. This means that as nurses, we have the obligation to educate these young mothers on the dangers of prenatal smoking - to do this, we may rely on rural and remotely situated nurses or we may have to deliver care via teleconference of videoconference.
What are the components of population change?
There are 3 components of population change:
- Births (fertility) - result in an increase in population.
- Deaths (mortality) - result in a decrease in population.
- Migration (movement of people) - immigration results in an increase in the population whilst emigration results in a decrease in populations size.
Define a rate
The occurrence of an event in a population during a specific period of time.
Define ratio
Expresses a relation between 2 random quantities.
Define proportion
Usually expressed as a %. Indicates the magnitude of a part as a whole.
Define incidence rate
A measure of a number of NEW cases of a disease/health outcome that develops WITHIN A POPULATION during a SPECIFIC TIME period.
Define prevalence rate
The proportion of EXISTING people with a disease/health outcome WITHIN A POPULATION at a SINGLE POINT IN TIME.
Understand the 5 stages of demographic transition
- High stationary - characterised by high birth rates, high death rates and a stable population. eg. Amazon & rural Bangladesh. Looks like a con-caved triangle.
- Early expanding - characterised by stable birth rates, declining death rates and a rapid population increase. eg. Africa, Yemen & Afghanistan. Looks like a perfect triangle.
- Late expanding - characterised by declining birth rates, low death rates and a slowed population increase. eg. Columbia, India and Mexico. Looks like a semi-circle.
- Low stationary - characterised by declining birth rate, declining death rate and a stable population. eg. Australia, Singapore & Canada. Looks like a cut-off oval.
- Declining - characterised by low birth rate, declining death rate and stable/slow increase in population. eg. Japan, Germany & Greece. Looks like a pentagon.
Identify the social determinants of health and how they intersect with biological and pathophysiological dimensions of health from a nursing perspective.
The social determinants of health are the conditions in which we live, grow, work and age. They are mostly responsible for health inequities.
Define the structure/agency debate
An issue that tries to determine whether an individual acts as a free agent (autonomy) or in a manner dictated by social structure.
ie. Is health a result of a series of choices made by an individual or that of the circumstances presented to them by social groups, government and available health care.?
We know that in reality, structure affects agency.
Understand the social gradient and it’s relationship with health status.
The phenomena that we see in which people who are less advantaged ($ wise) have poorer health outcomes and live shorter lives compared to more advantaged ($ wise) people who experience better health outcomes and longer lives.
ie. Wealth = Health!
Understand the Dahlgren and Whitehead Model
A model that theorises that some social determinants of health are easier to change than others.
ie. From upstream (easy to change) to downstream (difficult to change):
General socioeconomic, cultural and environmental conditions.
Living and working conditions including - agriculture and food production, education, work environment, unemployment, water and sanitation, health care services & housing.
Social and community networks
Individual lifestyle factors
Biomedical factors including - age, sex & genetics.
So, we can see that the general socioeconomic and cultural factors are the easiest things affecting health to change whilst biomedical factors are the most difficult things affecting an individual’s health to change.
Define and discuss equality in the context of health
Equality is when everyone is treated the same way.
eg. Everyone goes to school and receives the same health education.
Define and discuss equity in the context of health
Equity is achieved when every individual has the opportunity to achieve his or her full health potential. No one is stopped or excluded from reaching that potential because of social status or any other socially determined circumstance.
ie. When instead of giving everyone the same thing (equality), we target a group at higher risk and give them special treatment to help them reach the same level of health as everyone else.
What evidence do we have that inequity in health exists?
The Whitehall studies found that the lower a person’s economic position, the worse their health outcomes were. The studies showed that things like job security can affect health.
This relates to both the income/working conditions part of the social determinants and also the income section.
What is the difference between primary care and primary health care?
Primary care is the first stage of contact an individual has with the healthcare system.
Primary health care is a framework for a broad vision of health in which all sectors of the health care system work collaboratively in the pursuit of health.
Understand the Declaration of Alma Ata (1978)
A conference that did the following:
- Reaffirmed the WHO definition of health. And that health is a human right.
- Declared that the massive inequality in health status was a major cause for concern in all countries.
- Declared that the promotion and protection of the health of al people is essential for economic and social development.
- Reaffirmed government responsibility in promoting health (adequate provision of health and social measures).
- defined primary health care.
Define comprehensive and selective primary health care
Comprehensive health care addresses issues of social justice and equity through multidisciplinary services.
eg. Medicare
Selective health care is focused on the treatment and management of selective disease.
What differences/problems arose from comprehensive and selective primary health care?
Comprehensive PHC was seen as “poor care for poor people”. After Alma Ata, progress with comprehensive PHC was slow because it was seen as a vague concept that was very expensive. It was seen as idealistic and unaffordable by many.
The comprehensive model saw health as positive wellbeing. Control over health was focused on communities and individuals. Health care was provided in multidisciplinary teams. The main strategy for healthcare was multi-sectoral collaboration.
Selective PHC was seen as the “more reasonable” approach. However, health outcomes were not very well defined which resulted in less ambition to change the determinants of health. There was a reduced focus on primary care, causing healthcare to revert back to the biomedical model.
The selective model of PHC viewed health as the absence of disease. Health professionals had control over individual’s health. The main healthcare provider was the doctor. The main strategy for health was the use of medical intervention.
How does primary health care address the social determinants of health?
PHC and the social determinants of health both share a focus on health equity as a core value for policy.
Define globalisation
Globalisation is understood to include 2 inter-related elements:
- The opening of international borders to increasing fast-flows of goods, services, finance and ideas
- The changes in institutions and policies at national and international levels that facilitate or promote such flows
Describe the impact of globalisation on health
Globalisation has the potential to have both a positive and negative impact on health and has has a profound affect on the delivery of healthcare in the 21st century.
Positive:
> Environmental - clean water and vector control
> Political - global health governance and partnerships with other countries
> Technological - increased health literacy and education, increased access to health information and increased sharing of health info
> Socio cultural - increased travel and migration, population growth and culturally appropriate health care
> Economic - poverty reduction strategies, governance and aid and improved nutrition.
Negative:
> Environmental - increased disease and depleted resources
> Political - ineffective governance and health policies with economic intent
> Technological - spread of sedentary lifestyle and the communication of inaccurate health messages
> Socio cultural - loss of skill in developed nations as skilled workers migrate to find better $
> Economic - instability in the world’s economy eg. GFC
Describe the 3 stages of epidemiological transition
- Pestilence and famine - pre-industrialisation
- Receding pandemics - economic, social and environmental change ie. industrialisation. Saw an increase in wealth and infant mortality.
- Chronic disease - an increased ageing population results in a higher incidence of chronic, complex non-communicable diseases. We also see an increase in sedentary lifestyles and energy dense food.
Define the key global health challenges
Emerging a re-emerging diseases Antibiotic resistance Rising non-communicable diseases Climate change Bio security Widening health gaps worldwide The burden of mental illness Population ageing
Define the key global health goals
Universal health coverage Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria and other diseases Ensure environmental sustainability Global partnership for development
