Understanding & Communicating Risk

Question 1

What is “absolute risk”?

Answer 1

the probability of disease

e. g. a percentage or proportion of a given population
* “the population prevalence of cardiovascular disease in England was 13% in 2011”*
* “2 in every 10 smokers will develop cardiovascular disease”*

Question 2

What is “relative risk”?

Answer 2

the probability of disease given presence or absence of some other characteristic

e. g. a ratio of two probabilities or risks
* “smokers are twice as likely to develop cardiovascular disease than non-smokers”*

Question 3

How do we quantify treatment benefit?

Answer 3

the extent to which the absolute or relative risk of disease is expected to reduce with a given treatment

“smoking cessation can reduce the risk of cardiovascular disease by 40% within 5 years time”

Question 4

What are the missing numbers?

Answer 4

Question 5

What is the definition of privilege?

Answer 5

privilege describes the norms, patterns and structures in society that work for or against certain groups of people, which are unrelated to their individual merit or behaviour

Question 6

What are examples of factors that contribute into the system of inequality?

How is this related to privilege?

Answer 6

there are (often invisible) systemic forces at play that privilege some social groups over others

e.g. sexism, heterosexism, racism, ableism, colonialism, classism

these unfair social structures have profound effects on health, producing inequities in morbidity and mortality

systems of inequality and privilege interact to produce complex patterns of unearned disadvantage (oppression) and advantage (privilege)

Question 7

What are the possible influences of privilege and oppression on patient care?

Answer 7

• lack of insight and understanding into the needs of others
• stigmatizing attitudes
• designing health services withou the expert knowledge of the disadvantaged or oppressed
• giving advice that is unrealisitic for the patient
• not being aware of the health needs of that group (e.g. trans men needing cervical screening?)

such effects are usually unintended and unknown to those reproducing them, but profoundly impactful all the same

Question 8

What are examples of aspects of a patient’s life which may make it hard for them to follow “healthy habits”?

Answer 8

• if you are homeless, you may prioritise arranging housing over regular exercise
• if you are lonely, you may struggle to motivate yourself to quit smoking
• if you are struggling to afford food, you may be less likely to be able to choose healthy options such as fruit and vegetables
• if you are struggling to afford electricity, you may struggle to afford sportswear / visiting the gym

Question 9

If you were a GP giving lifestyle advice to disadvantaged individuals, how might you tailor the advice to help them?

Answer 9

• ask the patient what they think is possible for them
• acting in solidarity with the patient and being their ally
• acknowledging the challenges they might face (e.g. eating 5 portions of fruit/vegetables daily) and making suggestions that are feasible
• not blaming individuals for their problems

Question 10

What is shown in this graph?

“the prevalence of selected risk factors in adults by deprivation decile in England”

Answer 10

for all 4 risk factors, the lowest prevalence was in the least deprived decile group

and, with the exception of excess weight, the highest prevalance was in the most deprived decile group

Question 11

What is shown in this graph?

“cardiovascular disease mortality under 75 years for persons, by deprivation decile, in England 2013-2015”

Answer 11

mortality rates under age 75 from heart disease and stroke were highest in the most deprived decile group of England and lowest in the least deprived decile group

Question 12

What is the difference between sensitivity and specificity?

Answer 12

sensitivity:

• the proportion of people with the disease who are identified as having it by a positive test result

specificity:

• the proportion of people without the disease who are correctly reassured by a negative test result

Question 13

What is the difference between the positive predictive value and the negative predictive value?

Answer 13

positive predictive value:

• the probability that a person with a positive test result actually has the disease

negative predictive value:

• the probability that a person with a negative test result does not actually have the disease

Question 14

Using this table, how would sensitivity and specificity be calculated?

Answer 14

sensitivity = A / (A + C)

specificity = D / (B + D)

Question 15

Using this table, how would positive predictive value and negative predictive value be calculated?

Answer 15

positive PV = A / (A + B)

negative PV = D / (D + C)

Question 16

What is the APEASE criteria used for critiquing health interventions?

Answer 16

A - Affordability

P - Practicability

E - Effectiveness & cost-effectiveness

A - Acceptability

S - Side effects / safety

E - Equity

Question 17

What is meant by “affordability” in the APEASE criteria?

Answer 17

interventions often have an implicit or explicit budget

it doesn’t matter how effective or cost-effective it may be if it cannot be afforded

an intervention is affordable if within an acceptable budget it can be delivered to, or accessed by, all for whom it could be relevant or of benefit