Week 13: Revision Flashcards
1
Q
Biomedical model is about?
A
- looking at inside the body (looks for pathology or disease within body functions and structures)
- strong focus on cure
2
Q
Biomedical model is the dominant approach to disease in?
A
Western medicine
3
Q
Biomedical model defines health as?
A
the absence of disease
4
Q
The biomedical model also focuses on individual?
A
lifestyle and choices - responsibilities, behavioural interventions as well as clinical
5
Q
limitations of the biomedical model?
A
- demand for perspective and understanding beyond the body
6
Q
Bio-psychosocial Framework includes
A
(Body, psychology, social) - Body - self worth - social support = body-mind connection
7
Q
Compare biomedical definition of health to bio-psychosocial
A
Biomedical: absense of disease
Biopsychosocial: health is not merely the absense of disease (overall state of mental, physical and social well-being)
8
Q
In a hospital setting, what model would a Social work assessment follow?
A
- both biomedical and biopsychosocial
- individualistic approach (health interventions at individual level, lifestyle, behaviour modifications)
- coping, adaptation, grief, loss, pain management
9
Q
In the Socio-ecological Framework, diseases are considered to be caused by ?
A
- combination of factors e.g;
- social, economic, cultural & environmental
10
Q
What interactions is the Socio-ecological Framework interested in?
A
- complex interactions between;
- people
- social and physical environments
11
Q
What is the aim of the Socio-ecological Framework?
A
- create social and environmental conditions that are conducive to health
12
Q
What is the focus of the Socio-ecological Framework?
A
- social responsibilities of governments and other organisations rather than the responsibilities of individual citizens
- Important Distinction from other models*
13
Q
which model is concerned with the influence of policies, service systems, infrastructure on health and health outcomes? why?
A
- socio-ecological model
- because these environmental factors in interaction w/ personal factors generate opportunities for health and health outcomes
14
Q
What is the traditional view of global health inequalities?
A
first world, second world, third world
15
Q
What is the United Nations view of global heath inequalities?
A
developed and developing
16
Q
What is the World Bank view of global health inequalities?
A
High vs. low income
17
Q
How do epidemiologists who study health view global health inequalities?
A
- patterns of disease
- from infectious diseases: treatable; preventable to
- chronic, non-communicable: life-style related (e.g heart disease, stroke, cancer)
18
Q
Life expectancy gap between Indigenous and non-indigenous (closing the gap, 2013)
A
- 11.5 years for males
- 9.7 years females
19
Q
what is structure
A
- way social life and social interactions are organised
20
Q
what is agency
A
- ability of people, individually or collectively to influence their own lives and the society they live in
21
Q
the structuralist perspective assumes that features of society (political/economic) shapes?
A
- individual/group behaviour
- determines the type of person you are
- influences opportunities / life chances you have (health, wealth, happiness)
22
Q
the agency perspective is interested in the capacity of individuals to?
A
freely select their behaviour
23
Q
the agency perspective believes that individuals are influenced by?
A
- experiences past and present and orientations toward future (critically evaluate and choose course of action)
24
Q
according to the agency perspective, what is the debate in regards to how individuals choose their course of action?
A
- the debate is not about either/or as both are important; rather, which is dominant
25
social context of health is made up of?
class along with characteristics such as age, gender, ethnicity, geographical location nd living and working conditions
26
what emerges from the social context of health
patterns of health and disease
27
what is the major form of social inequality in the social context of health
class
28
class structure in Australia
```
upper class 15%
middle class 47%
working class 38%
```
29
low SES groups have higher rates of
morbidity and mortality
30
health gradually worsens as you
move down the social hierarchy
31
social structure leads to the
clustering of advantage and disadvantage
32
what are the intersecting factors that contribute to the social distribution of illness
age, gender, ethnicity
33
How did Germov, 2014 describe the social determinants of health?
- economic, social and cultural factors that directly and indirectly influence individual and population health
34
what are the groupings of the social determinants of health?
- biomedical and genetic
- health behaviours
- socio-cultural
- socio economic
- environmental
35
History of the social determinants of health
- individual to social context
- complexity
- interrelationship of social determinants of health
- explored health promotion programs
36
According to WHO, 2013, what are the social determinants of health?
1. early life and childhood
2. employment, income and work
3. access to health care
4. social gradient: social circumstances vs. economic wellbeing
5. education
6. social security
7. lifestyle factors (food, addiction, stress)
8. urban design
9. social exclusion
37
a central premise of the socioecological approach
the biggest impact on inequalities in health will come from addressing the underlying social determinants of poor health
38
Assumptions of socio-ecological framework: to address multiple determinants, there needs to be a ?
combination of strategies, not one-off programs
39
Assumptions of socio-ecological framework: what are inter-sectoral strategies?
since many determinants are beyond health sector these strategies rely on collaborations and partnerships
40
Assumptions of socio-ecological framework: people will take action if?
they are involved and enabled to take active roles
41
what are the steps to a determinants approach?
- measure population health status
- identify risk factors (behavioural and biomedical)
- calculate the contribution of risk and protective factors to health and disease (pop. level estimation).
42
How to measure population health status in a determinants approach?
- national surveys
- vital statistics: births and deaths
- life expectancy
43
a determinants approach does not discount individual risk factors, rather it ?
uses a pop. view of risk factors to identify what the significant public health issues are and what groups/pops. to target
44
How did Mills, 1959 describe the sociological imagination?
only through understanding the PUBLIC issues that we can understand PERSONAL troubles
45
what are the factors of the sociological imagination?
- historical
- cultural
- structural
- critical
46
historical factors
how past influences the present
47
cultural factors
how culture impacts on our lives
48
structural factors
how particular forms of social organisation affects our lives
49
critical factors
how we can improve the current environment
50
ethnocentrism?
our own culture is superior to others or the standard by which others are measured
51
intersocietal vs intrasocietal?
intersocietal: between different societies
intrasocietal: within the same society
52
Change the Course: National Report on Sexual Assault and Sexual Harassment at Australian Universities (2017)
- 21% students report sexual harassment
- women 3x more likely as men sexually assaulted
- 51% assaulted, 45% harassed knew the perpetrator
- harassment/assault were rarely reported
53
1986 Ottawa Charter for Health Promotion aim:
- underpin new public health (stronger focus on health promotion)
- behaviour change strategies w/ broader structural changes
- focus on underlying determinants of health (social systems)
- multi-dimensional strategies targeting risk and protective factors and addressing multiple settings (home, school, communities)
54
Build healthy public policy:
Combines: legislation, fiscal measures, taxation and organizational change
Coordinated action that leads to health, income and social policies that foster greater equity
Identification of obstacles to the adoption of healthy public policies in non-health sectors, and ways of removing them.
Make the healthier choice the easier choice for policy makers as well
55
Create supportive environments
Societies are complex and interrelated
Link between people and their environment
Changing patterns of life, work and leisure impact health
Systematic assessment of the health impact of a rapidly changing environment
Protection of the natural and built environments and the conservation of natural resources
56
strengthen community action
```
Health promotion through concrete and effective community action
Setting priorities
Making decisions
Planning strategies
Implementation
```
57
strengthen community action: empowerment of communities
Enhance self-help and social support
Develop flexible systems for strengthening public participation
Access to information, learning opportunities for health, as well as funding support
58
develop personal skills
Information
Education for health
Enhancing life skills
59
develop personal skills: increased options to
More control over own health
Control over environment
Make positive choices
60
develop personal skills: educations throughout life
Coping with chronic illness and injury
School, home, work and community settings
Action through educational, professional, commercial and voluntary bodies, and within the institutions themselves
61
Reorient Health Services
Shared responsibility for health promotion
Work together
Beyond providing clinical and curative services
Respects cultural needs
Open channels between the health sector and broader social, political, economic and physical environmental components
Stronger attention to health research and professional education and training
Refocus on the total needs of the individual as a whole person
62
Social determinants of child health: foundations of adult health are laid in?
in-utero, perinatal and early childhood
63
Social determinants of child health: what provides building blocks for future social, emotional, cognitive and physical wellbeing?
healthy physical development and emotional support
64
Social determinants of child health:disadvantage as a determinant of child health leads to?
- poor school performance
- affecting adult opportunities for employment, income, health literacy and care
- contributes to inter generational transmission of disadvantage
65
what is responsible for most childhood illness and death?
- social determinants
66
social determinants of child health involve a complex inter-relationships of what factors?
distal social factors (income and education) and proximal factors (health behaviours)
67
distal factors predict
proximal factors
68
Compared to women from the highest socioeconomic areas, women from the lowest socioeconomic areas:
More likely to begin antenatal care later in pregnancy
Smoke in pregnancy
Overweight or obese in pregnancy
30% more likely to have a low birthweight baby
More likely to give birth early (or pre-term)
69
Professor Fiona Stanley: The most important health issues facing our children and youth?
- complex issues
| - mental health issues (suicide, depression ,anxiety, substance abuse)
70
how is ethnic origin a risk factor for adolescent development?
- experience racial discrimination (unemployment, education, financial support, teenage births)
71
what are the mental health concerns for adolescent development?
- mental health problems
| - suicide
72
health concerns for adolescent development?
- alcohol and drugs
- accidents and injury
- smoking and illicit drugs
73
historic factors of youth mental health?
- rates of mental health problems are increasing
(2015: 14.9% to 33.7% in 2017)
- increase in service use between 98 and 2013/14 (68.4% w/ mental health issues used services over 12 month period)
74
Youth smoking 2016 National Drug Strategy Household Survey (NDSHS, 2016)
historical factors of youth smoking?
- it's declining
- age of initiation has increased from 14.2 in 1995 to 16.3 in 2016
- use of e-cigarettes
- consistent and marked reductions in adolescent and young adult smoking
75
Lifetime risk: Alcohol, NDSHS, 2016
| historical factors of alcohol consumption?
- reduced: fewer adolescents exceeding lifetime risk guidelines
76
Lifetime risk: Alcohol, NDSHS, 2016
| females 18-24 cohort
most likely to drink more than 2 standard drinks per day average REDUCED
2007: 20% vs. 2016: 13%
77
Lifetime risk: Alcohol, NDSHS, 2016
males proportion consuming more than 2 standard drinks per day
REDUCED
| 2007: 39% vs 2016: 23%
78
Lifetime risk: Alcohol, NDSHS, 2016
which age group was most likely to exceed the guidelines
males aged 40-49
79
cultural, religious, community factors to adolescent health
```
Family
Peers
School
Neighbourhood
Society
```
Sexual/gender norms
Ethnic group
80
structural factors of adolescent health
```
Global and national economic system
National wealth
Income inequality
Political system
Social welfare
Education
Family environment
Food
Housing
Recreation
```
81
structural factors relating to teenage pregnancy
teen pregnancy is associated with both poverty and income inequality
82
structural factors relating to access to employment
greater youth unemployment leads to poorer health outcomes (mental health, suicide, violence related mortality)
83
adolescent all-cause mortality associated w/?
national wealth and income inequality
84
critical factors of adolescent health
mental, health, alcohol and drugs, equity and discrimination
85
critical factors: young people need access to?
Educational engagement and opportunities to re-engage
Financial support for university and training
Targeted investment in youth employment programs
Address transport barriers
Encourage participation in extra-curricular activities
Improve employment supports for parents and guardians
Adequate income support for families
Youth friendly programs
Co-design youth services with young people
86
Working Through It: A Youth Survey Report on economically disadvantaged young people (Mission Australia, 2019)
findings:
Comparison of ‘economically disadvantaged’ youth with those ‘not economically disadvantaged’
Economic disadvantage defined as:
Neither parent or guardian currently in paid employment
11% of all families with dependents
87
health concerns of early adulthood 18-30
```
Transition from paediatric to adult health care models
Sexual health
Fertility
Chronic health
Mental health
```
88
what ages are middle age
The period after early adulthood and before old age, about 45-65
89
australian context: home ownership
31% own homes outright, 36% with mortgage, 26% renting (private), 4% renting
90
australian context: life expectancy
one of highest in world and increasing
91
australian context: health inequalities
indigenous people and those living outside urban areas
92
australian context: employment
– rising employment over past 40 years (65-72%) - 3 downturns & recovery & improvement.
93
australian context: most common underlying cause of death for over 45 y.o?
coronary heart disease (higher in men)
94
australian context: people losing jobs in 50s and 60s y.o often
don't find new work
95
how has home ownership changed over decades?
- 1980s: dual incomes were norm, mortgage easy to obtain
- 90's: house prices rise faster than inflation (low proportion of social housing)
- 2019 property 'bubble' predictions
96
what is the sandwich generation
- caring for both older parents and their children (some with disabilities)
- often combined w/ working full-time
97
how many australians are considered the sandwich generation
effects approx. 1.5 million middle aged
98
issues with services for the sandwich generation
services for people who need it (NDIS, my aged care) but no services for the carers
99
impact on sandwich generation?
- unpaid carers need support
- they neglect their own health needs because they don't have time
- strain and stress is enormous
100
social determinants of health for adults: early life and childhood
Grew up in prosperous period (except short recession in early 1980s)
101
social determinants of health for adults: access to healthcare
Universal Healthcare - Medicare, (Medibank 1980s)
| 1970 & 1980s focus on public health initiatives, maternal & child health services
102
social determinants of health for adults: education
Free tertiary education from 1975
103
social determinants of health for adults: lifestyle factors: food, addiction, stress
Middle age means patterns of advantage & disadvantage have accumulated over a long period of time
104
Emerging health challenges for policy and prevention (health of adults)
Increasing differentiation historically in early life and across the life span
Cumulative inequalities across all phases of life
Pace of social change disrupting existing norms and expectations about age and life course stages
Ambiguities in age-linked identities and behaviour
New economic and demographic realities
Shifts in the goals, values and preferences of individuals
Changing structural contexts
Cross-cohort variations in the experiences of individuals of the same age in different time periods
Increasing diversity within age categories and cohorts
105
comparing population structure of indigenous vs total aus. population.
- many more young indigenous than old.
| - many more young indigenous than young non-indigenous
106
health conditions and ageing
arthritis, dementia and hearing loss
107
how much did people aged 65+ contribute to hospitalisations in 2013,14
40%
108
29% of deaths among older Australians in 2013 due to
Coronary heart disease
Cerebrovascular diseases (including stroke)
Dementia and Alzheimer disease
109
dementia
1 in 4 people in Australia will have dementia by age 85
| Dementia seen as an ‘epidemic’ in some Indigenous communities
110
prevalence of dementia in indigenous
5x more than non-indigenous (epidemic)
111
Benefits of a social context perspective
| health of ageing adults
Assists in understanding multiple factors influencing health
Assists in identifying structural factors for intervention
Avoids victim-blaming
112
Commonwealth Age Discrimination Act 2004
- Protection of older workers from discrimination in the workplace
- Continue working past what was formerly the compulsory retirement age of 65 years
113
Prevalence of age discrimination in the workplace
27% of people over 50 years had recently experienced discrimination in the workplace mainly when applying for a job leading to giving up looking for work
114
Human Rights Commission Fact or Fiction? Stereotypes of Older Australians 2013
Commonly held stereotypes
18-24 year old most negative about older people
One in ten business have an age limit (average 50 years)
115
what is the third age
- new stage of life post-retirement
- opportunity for self-fulfillment
- need for cognitive challenges and learning opportunities
- health education focus on benefits of exercise and diet
116
the fourth age:
frailty and dependence
117
Willing to Work: National Enquiry into Employment Discrimination Against Older Australians and Australians with a Disability 2016
‘Individuals who are subject to negative assumptions, stereotypes and discrimination can experience stress, and a decline in physical and mental health. The experience can also diminish a person’s self-confidence, self-esteem and motivation to remain in the workforce.’
118
Ottawa charter for health ageing: strengthen community action?
- provide opportunities for community and consumer involvement and local action to support and promote health ageing
119
Ottawa charter for health ageing: develop personal skills?
- provide info. and encouragement to enable people to make informed decisions and take action to maintain/improve health
- raise awareness of benefits of health promoting behaviours
120
Ottawa charter for health ageing: create supportive environments?
- encourage development of pop. health strategies inclusive of older people.
- deliver social and economic conditions to optimise opportunities for physical,social and mental well-being
121
Ottawa charter for health ageing: reorient health services?
- develop solid research base to inform and drive healthy ageing
- well structured and distributed health care workforce to support health ageing
- lifelong approach to disease and disability prevention and management
- prioritise prevention, early detection and management
122
Ottawa charter for health ageing: build healthy public policy
- carer support initiatives
- sustainable housing
- age friendly transportation and communities
123
why is the indigenous population markedly younger than non-In
- lower life expectancy
- more than half ind. women have babies before 24
- more than 21/100 are teenagers w/ first baby vs. 4/100 for non- Ind.
124
Close the Gap Close the health and life expectancy gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians within a generation
805.5 million Commonwealth & $771.5 million State and Territories
Tackling Smoking (Chronic Disease Risk Factors)
Primary Health Care Services that Deliver (Improving Chronic Disease Management and Follow Up)
Fixing the Gaps and Improving the Patient Journey (Workforce expansion, training and support)
125
Overcoming Indigenous Disadvantage Key Indicators 2016
mortality rates for indigenous children
- improved beween 1998 and 2014, particularly for <1 year olds, whose mortality rates more than halved
126
Overcoming Indigenous Disadvantage Key Indicators 2016
| education improvements
increased proportion of 20-24 yrs completing year 12 or above
- increased proportion of 20-64yrs working towards post-school qualifications
127
Overcoming Indigenous Disadvantage Key Indicators 2016
trends in main income from employment
increased from 32% in 2002 to 43% in
128
Overcoming Indigenous Disadvantage Key Indicators 2016
| trends in family and community violence
unchanged between 2002 and 2014/15
129
Overcoming Indigenous Disadvantage Key Indicators 2016
trends in risky long-term alcohol use
unchanged
130
Overcoming Indigenous Disadvantage Key
Indicators 2016
trends in psychological distress
increased
| 27% in 2004 to 33% in 2014
131
Overcoming Indigenous Disadvantage Key Indicators 2016
trends in substance misuse
increased
| 23% in previous 12 months in 2002 to 31% in 2014
132
Overcoming Indigenous Disadvantage Key Indicators 2016
trends in adult imprisonment
increased
| 77% between 2000-2015
133
Overcoming Indigenous Disadvantage Key Indicators 2016
trends in juvenile detention rates
decreased BUT
| still 24x the rate of non-indigenous youth
134
critical factors for indigenous health
Empowering Aboriginal and Torres Strait Islander peoples to make healthy choices
Self and family
Stop smoking
Eat good food
Exercise daily
135
what is race
```
Does not describe
national
religious
geographic
linguistic
ethnic groups
Race does not relate to mental characteristics such as intelligence, personality or character.
```
Based on appearance
Misconceptions about genetics (many sad histories)
All human groups belong to the same species (Homosapiens).
136
what is ethnicity
A sense of peoplehood
Feeling close because of sharing a similarity. It is when you share the same things, for example:
physical characteristics
linguistic characteristics
behavioural or cultural characteristics (e.g. religion or customs)
environmental characteristics (where you’re from)
137
what is cultural competence
knowledge of the specific values, beliefs, customs and traditions of a particular cultural group
138
self awareness
Attitudes
Stereotypes
Assumptions
139
individual models: charity/ deficient model (mallet and runswick-cole, 2014).
- personal tragedy
- deficit focus
- onus is on the individual to manage their difference, to conform
140
individual models: medical model (mallet and runswick-cole, 2014).
- condition
- functional limitation of biological or physiological origin
- object is to ameliorate or fix
141
societal models of disability (Rioux, 1997)
- disability as part of the social structure
- disability as difference rather than anomaly
- inclusion of people with disabilities a public responsibility
142
compare impairment to disability: international definition
impairment: the functional limitation within the individual caused by physical, mental or sensory impairment
disability: the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others due to physical and social barriers
143
WHO definition of disability
an umbrella term, covering body functions and structures, activity limitations, participation restrictions and contextual influences
144
social determinants of health that impact disabled people
1. (oppressive) distribution of power, income, goods and services
2. (poor) access to health care, education
3. (poor) acces to employment, to community participation (conditions of work and leisure)
4. institutionalisation, peripheral community status (conditions of homes, communities, rural or urban settings)
145
Some examples of disparities (health of disabled)
1. Increased rates of obesity and mental illness (people with intellectual and physical disabilities)
2. Higher rates of heart disease, stroke, high blood pressure and diabetes (people with mental health problems)
3. Poorer health outcomes for family carers of children and adults with a disability
146
using sociological imagination to make change for people with disability- NDIS
- roll-out of personalised budgets, marketisation of disability services has the potential to both empower people w/ disability and create greater inequalities
- requires capacity on part of service users, availability of services, collaboration between mainstream (state gov.) services and NDIA.
147
World Health Organization, mental health is
‘a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.’
148
Conditions affecting mental health (mental illness or mental health disorder)
Depression, anxiety, schizophrenia and bipolar disorder
149
Australia
| Framework for mental health services:
highly complex mixture of public and private systems, funding shared between the Australian, state and territory governments, individuals and private health insurers
150
social construction of mental health and illness
- deviance
- institutionalisation and labelling (diagnosis)
- human rights
- recovery
151
reasons for the Burdekin Report? (concern for human rights)
- ignorance about nature/ prevalence of mental illness
- discrimination
- misconceptions about people who are dangerous
- belief that people w/ mental illness never recover
152
how was the Burdekin Report different from other inquiries?
1. national inquiry: aim to evaluate laws and provisions in each state and territory (had not been done before)
2. had been sufficient time to see the effects/defects of deinstitutionalisation
3. rights-based rather than service-based (major shift in emphasis)
4. conducted w reference to Aust. international treaty obligations
153
Changes after the Burdekin Report: implications for services
Community mental health services (note: no longer called psychiatry)
Consumer consultation & advisory positions
Reorienting services toward prevention
154
Changes after the Burdekin Report: whole of government report
Commencement of the National Mental Health Strategy with a focus on prevention of mental health problems
Population health
Intersectoral action / partnerships
155
Changes after the Burdekin Report: more attention to?
the social determinants of health
156
intersectoral action
Refers to actions affecting health outcomes undertaken by sectors outside the health sector, possibly, but not necessarily, in collaboration with the health sector
