Theme 3- public health attitudes and values Flashcards
What is the inverse care law?
Those who most need medical care are least likely to receive it. Conversely, those with least need of health care tend to use health services more (and more effectively).
What affects health status?
variations in factors outside the control of the NHS - wealth, lifestyle, genetic and environmental considerations
those living in areas of high socio-economic deprivation, suffer on all three counts: they use poor quality services, to which they have relative difficulty securing access and they suffer multiple external disadvantage.
How can you reverse the inverse care law?
- GP surgery
- Street health team
- Pathway team- people go into hospital to allow a better discharge
- Intermediate care hostel for homeless patients
- Asylum seeker and refugee clinics
- Late night clinics for women involved in prostitution
- Wellbeing Centre – social prescribing team
What are wider determinants?
Income and wealth, education, housing, transport and leisure
What lifestyle
What is advocacy?
An ‘advocate’, is defined as: ‘a person who publicly supports or recommends a particular cause or policy.’
What can be the issues for someone that is homeless?
- Adverse childhood events- trauma as a child
- Homelessness
- Addiction
- Isolation/loneliness
- Poverty and basic essentials, food, warmth, shelter
- Lack of trust in health care professionals and system
- homeless people feeling stigmatised and discriminated against
- being discharged before they were ready
- lack of coordination between hospitals and community services and lack of follow up care
How can you advocate for a homeless patient?
- Forming a trusting relationship
- Obtaining good understanding of Darren’s social context
- Helping with the essentials – food, housing, clothes
- Referring for support
- Help getting to appointments
How can you advocate for a patient that is over weight?
- Non judgemental
- Limitations to behaviour change
- Referral for support with diet and weight management
- Social prescriber referral – support groups- football teams for example
- Follow up
What are the issues for this patient?
31 year old Refugee from Syria
Presented regularly with multiple minor physical health conditions
Had poorly controlled asthma
Elicited past history of trauma in Iran, brother imprisoned
Diagnosed anxiety and depression
Social history – damp housing, social isolation, language barrier
- Past trauma
- Somatisation
- Anxiety and depression
- Isolation
- Language barrier
- Poor quality housing
What is somatisation?
Somatisation is generally defined as the tendency to experience psychological distress in the form of physical symptoms and to seek medical help for these symptoms. For example, many people have occasional headaches caused by mental stress.
How can you advocate for a patient like this?
31 year old Refugee from Syria
Presented regularly with multiple minor physical health conditions
Had poorly controlled asthma
Elicited past history of trauma in Iran, brother imprisoned
Diagnosed anxiety and depression
Social history – damp housing, social isolation, language barrier
- Listening deeply
- Building trust
- Reassure
- Understanding Hassan’s social context
- Social prescriber – english classes
- Write to the housing association re damp house
How do you advocate for a patient who has:
- High risk factors for covid-19 infection and mortality
- Anxiety
- Isolation
- No support
- Listening
- Compassion
- Support - social prescribing team
- Pharmacy – can they deliver medication
- Write to employer- ask to help with anxiety, any PPE available, work in areas at less risk
- Discuss vaccination
- And wider advocacy
What levels can you advocate for public health?
- individual care
- social issues making patients unwell
- community level
- health policy
- political decisions
What is in place to help homeless people, gypsies, vulnerable migrants, sex workers within hospitals?
- Pathway teams work in 11 hospitals in the UK to prevent the ‘revolving door of homelessness’.
- Assess patients in hospital who are homeless or at risk of homelessness and make arrangements to support them on discharge so they aren’t going back to the same conditions that made them ill in the first place.
