Theme 1 key areas

Question 1

What is the WHO/UN definition of health?

Answer 1

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Question 2

Define population health

Answer 2

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.

Question 3

Define public health

Answer 3

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.

Question 4

What is the biomedical model of health?

Answer 4

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.

Question 5

What is the socioecological model of health?

Answer 5

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.

Question 6

Describe the components of population health

Answer 6

1. Health care - the organised provision of medical care to individuals and the community.
2. 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.
3. Public policy - national, state and local laws

Question 7

Discuss the the key differences between the biomedical model and the socioecological model:

Answer 7

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

Question 8

Describe the key factors influencing contemporary population health

Answer 8

1. Improved agricultural techniques mean we have ensured food supply.
2. The introduction of vaccines
3. The introduction of life-saving health technologies like X-Ray, MRI etc.
4. Improved health education
5. Improved public sanitation

Question 9

How do we apply the biomedical model of health in a clinical setting?

Answer 9

We can see that the biomedical model is using in a clinical settings during the diagnosis of a disease.

Question 10

How do we apply the socioecological model in a clinical setting?

Answer 10

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.

Question 11

Define demography

Answer 11

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.

Question 12

Describe the relationship between health, healthcare and demography

Answer 12

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.

Question 13

What is the scope of demography?

Answer 13

The scope of demography is very broad as almost every aspect of health is applicable for means of study. by demographic techniques.

Question 14

Define population size

Answer 14

The actual number of individuals in a population

Question 15

Define distribution

Answer 15

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.

Question 16

Define concentration/population density

Answer 16

The number of people per unit of area - ie. population size divided by total land area.

Question 17

How do trends in population affect healthcare delivery?

Answer 17

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.

Question 18

What are the components of population change?

Answer 18

There are 3 components of population change:

1. Births (fertility) - result in an increase in population.
2. Deaths (mortality) - result in a decrease in population.
3. Migration (movement of people) - immigration results in an increase in the population whilst emigration results in a decrease in populations size.

Question 19

Define a rate

Answer 19

The occurrence of an event in a population during a specific period of time.

Question 20

Define ratio

Answer 20

Expresses a relation between 2 random quantities.

Question 21

Define proportion

Answer 21

Usually expressed as a %. Indicates the magnitude of a part as a whole.

Question 22

Define incidence rate

Answer 22

A measure of a number of NEW cases of a disease/health outcome that develops WITHIN A POPULATION during a SPECIFIC TIME period.

Question 23

Define prevalence rate

Answer 23

The proportion of EXISTING people with a disease/health outcome WITHIN A POPULATION at a SINGLE POINT IN TIME.

Question 24

Understand the 5 stages of demographic transition

Answer 24

1. High stationary - characterised by high birth rates, high death rates and a stable population. eg. Amazon & rural Bangladesh. Looks like a con-caved triangle.
2. Early expanding - characterised by stable birth rates, declining death rates and a rapid population increase. eg. Africa, Yemen & Afghanistan. Looks like a perfect triangle.
3. 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.
4. Low stationary - characterised by declining birth rate, declining death rate and a stable population. eg. Australia, Singapore & Canada. Looks like a cut-off oval.
5. Declining - characterised by low birth rate, declining death rate and stable/slow increase in population. eg. Japan, Germany & Greece. Looks like a pentagon.

Question 25

Identify the social determinants of health and how they intersect with biological and pathophysiological dimensions of health from a nursing perspective.

Answer 25

The social determinants of health are the conditions in which we live, grow, work and age. They are mostly responsible for health inequities.

Question 26

Define the structure/agency debate

Answer 26

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.

Question 27

Understand the social gradient and it’s relationship with health status.

Answer 27

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!

Question 28

Understand the Dahlgren and Whitehead Model

Answer 28

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.

Question 29

Define and discuss equality in the context of health

Answer 29

Equality is when everyone is treated the same way.

eg. Everyone goes to school and receives the same health education.

Question 30

Define and discuss equity in the context of health

Answer 30

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.

Question 31

What evidence do we have that inequity in health exists?

Answer 31

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.

Question 32

What is the difference between primary care and primary health care?

Answer 32

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.

Question 33

Understand the Declaration of Alma Ata (1978)

Answer 33

A conference that did the following:

1. Reaffirmed the WHO definition of health. And that health is a human right.
2. Declared that the massive inequality in health status was a major cause for concern in all countries.
3. Declared that the promotion and protection of the health of al people is essential for economic and social development.
4. Reaffirmed government responsibility in promoting health (adequate provision of health and social measures).
5. defined primary health care.

Question 34

Define comprehensive and selective primary health care

Answer 34

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.

Question 35

What differences/problems arose from comprehensive and selective primary health care?

Answer 35

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.

Question 36

How does primary health care address the social determinants of health?

Answer 36

PHC and the social determinants of health both share a focus on health equity as a core value for policy.

Question 37

Define globalisation

Answer 37

Globalisation is understood to include 2 inter-related elements:

1. The opening of international borders to increasing fast-flows of goods, services, finance and ideas
2. The changes in institutions and policies at national and international levels that facilitate or promote such flows

Question 38

Describe the impact of globalisation on health

Answer 38

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

Question 39

Describe the 3 stages of epidemiological transition

Answer 39

1. Pestilence and famine - pre-industrialisation
2. Receding pandemics - economic, social and environmental change ie. industrialisation. Saw an increase in wealth and infant mortality.
3. 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.

Question 40

Define the key global health challenges

Answer 40

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

Question 41

Define the key global health goals

Answer 41

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