week 1 Flashcards
How does Marx define health
The capacity to do productive work
How does Parsons define health
(Sociologically) a state of optimum capacity for the effective performance of valued tasks
How does the World Health Organization (WHO) define health
A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
Pros: emphasis on all 3 facts, positive dimensions of health
Cons: is wellbeing= good health, utopian (idealistic)
What determines health
Biology- age, sex, genetic
Lifestyle- tobacco, nutrition, alcohol, physical activity, ‘risky’ behaviours
Environment- air, water, radiation, microbes, social cohesion and inequality, employment, education, political stability, over-abundance
Health service
Obesity- is it individual choice
Rise in childhood obesity affects children from more deprived areas disproportionally.
The availability of cheap junk food high in sugar affect disadvantaged children more
Other factors- access to safe spaces for outdoor play and exercise
Role of clinical medicine
Preventing death
Improving length and quality of survival in fatal conditions
Improving quality of life in non fatal conditions
Preventing and treating genetic disorders
Care
What is medicalisation
The expansion of medical jurisdiction into areas that were considered non-medical. Solutions to problems also become medical
This can occur on a number of different levels
Conceptual-use of medical terms
Institutional- doctors used as gatekeepers
Interactional- direct interaction with patients
Iatrogenesis (doctor caused illness)
Medical iatrogenesis- illness caused or made worse through treatment e.g. side effects, cascade prescribing
Social- medicalisation
Cultural- ability to cope with illness and death is eroded by handing over to professionals
Why measure the health of the population
Find out how common a disease is (prevalence) and how many new cases (incidence)
Identify longitudinal trends in disease
Are interventions or policies to improve health having an effect
identify difference in disease patterns between different population groups or locations
Service planning
Measuring health status
Death certificates
Census
Health service for England HSE
General lifestyle survey
Hospital episode stats (health service usage)
General practice research databases
Health protection reports
Cancer registration
National/ regional/ local audits or surveys
Key methods of measuring health and disease
Birth and fertility rates
Incidence
Prevalence
Mortality rate (crude and standardised)
How do we use mortality and morbidity rates
Compare areas- identify areas where people experience poor health, identify need for preventive services, may raise hypothesis about cause of disease
Look at change over time to see if preventative strategies are working
Direct standardisation
Direct- age specific death rates from a study population are applied to a standard population structure
Allows you to see what would be the death rate in the standard population if it had the age and sex specific death rates experienced by population study
Adv: compares disease rates across areas and time frames
Disadv: requires age specific rates not always available at local level, rates may not be stable for an small number of events
Indirect standardisation
age specific rates from a standard population are applied to a study population structure (standardised mortality ratio)
SMR= observed no. Deaths for study pop/ expected no. Deaths for study pop.
ADV: does not require local rates only absolute number of events, interpretation easier
Disadv: areas cant be directly compared, doesn’t give idea of burden of disease (because it’s ratio)
Pitfalls in interpreting health and disease
Different criteria used to define the disease between areas
Not all cases of disease have been identified in each area
Use of hospital data to describe disease or death in an area (omits people who are treated in GP or die in community)
Why might health be associated with socioeconomic deprivation
An artefact of measurement error
Social selection
Behavioural/ cultural
Psychosocial
Material/structural conditions
Artefact
Observed associations are not genuine but exist because of the ways in which we measure health and deprivation
Social selection
Health determines social-economic status rather than socioeconomic status determining health
Poor health — less likely to work— more deprived
Psychosocial
The stress of working in poorly paid low status jobs with little autonomy creates biological changes in the body which in turn create patho-physical changes
The biopsychosocial model of illness (Engel 1977)
Health tri-product of:
Biological (genetic, virus)
Psychological (lifestyle, stress, health beliefs)
Social (cultural influences, social support)
Patient takes responsibility for own health and is not passive victim. All physical signs are experienced via psychological processes. Health psychology (behavioural medicine)- field of medicine that looks at how thoughts and behaviour affect their health and disease
A definition of health needs to be multi-dimensional including factors such as
Disease
Disability
Frequently of illness
Malaise- general feeling of discomfort, illness or unease whose exact cause is difficult to identify
Fitness
Also needs to be sensitive to society’s demands ‘a state of wellbeing conforming to the ideals of a prevailing culture’
Methods of calculating birth or fertility rates
Birth rate: number of live births per 1000 population (all ages and sexes)
General fertility rate: number of live births per 1000 women aged 15-44
Total fertility rate: the average number of children a woman would bear if they experienced the age-specific fertility rates at that point in time.
Total fertility rate often used over general fertility rate as it allows for comparisons to be made over time or between areas after taking into consideration differences in age structure between populations
Incidence rate
Represents rate of disease development in a population
Number of new cases of a disease arising over a time period/ person-years at risk
Person-years at risk= total population at risk * time period
Infant mortality rate IMR
IMR (per1000)= no. Of deaths in children aged< 1 / all live births * 1000
Why do we measure IMR:
It’s highly correlated with expectation of life and with overall economic status
High IMR are amenable to change through public health measures (e.g. care of pregnant women, supporting breastfeeding, infant immunisation, nutrition programmes)
