week 1

Question 1

How does Marx define health

Answer 1

The capacity to do productive work

Question 2

How does Parsons define health

Answer 2

(Sociologically) a state of optimum capacity for the effective performance of valued tasks

Question 3

How does the World Health Organization (WHO) define health

Answer 3

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)

Question 4

What determines health

Answer 4

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

Question 5

Obesity- is it individual choice

Answer 5

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

Question 6

Role of clinical medicine

Answer 6

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

Question 7

What is medicalisation

Answer 7

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

Question 8

Iatrogenesis (doctor caused illness)

Answer 8

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

Question 9

Why measure the health of the population

Answer 9

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

Question 10

Measuring health status

Answer 10

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

Question 11

Key methods of measuring health and disease

Answer 11

Birth and fertility rates
Incidence
Prevalence
Mortality rate (crude and standardised)

Question 12

How do we use mortality and morbidity rates

Answer 12

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

Question 13

Direct standardisation

Answer 13

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

Question 14

Indirect standardisation

Answer 14

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)

Question 15

Pitfalls in interpreting health and disease

Answer 15

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)

Question 16

Why might health be associated with socioeconomic deprivation

Answer 16

An artefact of measurement error
Social selection
Behavioural/ cultural
Psychosocial
Material/structural conditions

Question 17

Artefact

Answer 17

Observed associations are not genuine but exist because of the ways in which we measure health and deprivation

Question 18

Social selection

Answer 18

Health determines social-economic status rather than socioeconomic status determining health
Poor health — less likely to work— more deprived

Question 19

Psychosocial

Answer 19

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

Question 20

The biopsychosocial model of illness (Engel 1977)

Answer 20

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

Question 21

A definition of health needs to be multi-dimensional including factors such as

Answer 21

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’

Question 22

Methods of calculating birth or fertility rates

Answer 22

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

Question 23

Incidence rate

Answer 23

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

Question 24

Infant mortality rate IMR

Answer 24

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)

Question 25

Crude mortality rate

Answer 25

Crude mortality rate= total number deaths in one year/ total mid years population
Don’t take into account structure of population

Question 26

Disease specific death rate

Answer 26

Disease specific death rate per 1000= no. Deaths from disease/ total mid year population *1000
Can also have age specific rate or sex specific rate for disease or death

Question 27

SMR usage

Answer 27

Can compare SMR for a disease with the national average
Identify diseases that have higher than national rates in an area and need investigation
Consider preventative measures
May raise hypotheses about cause of disease

Question 28

Behavioural/cultural

Answer 28

Those in deprived areas are more likely to smoke, eat poor diets, not exercise, less capital, more crime etc

Question 29

Material

Answer 29

Direct effects of poverty, cold damp housing, more likely to end up with lung disease, dangerous areas more likely injured

Question 30

Social construct

Answer 30

An idea that has been created and accepted by the people in a society
Sociologists claim that health and illness are social constructions because the concepts mean different things to different people
Not everyone experiences symptoms in the same way
Different societies have different methods of diagnosis and treatment
Constructs are under moral, social and religious influence
Illness is not randomly distributed

Question 31

Health as relative societies

Answer 31

Different societies can differ widely in their beliefs about the causes and solutions to illness
They can also differ in terms of the levels of discomfort and pain that are considered as normal

Question 32

Critiques of biomedicine

Answer 32

Medicalisation
Iatrogenesis- illness caused by medical treatment
Surveillance and the clinical gaze
Feminism