WEEK 2 Flashcards
Define health
The state of complete physical, mental and social well-being, not merely the absence of disease or infirmity
What are 5 of the multi-dimensional aspects of health?
Disease Disability Frequency of illness Malaise Fitness
Is health a fixed concept?
No, it is sensitive to society’s demands/ideals
What are the four key determinants of health?
1) Biological
2) Lifestyle
3) Environment
4) Health Service
Give three examples of biologically-related determinants of health
1) Age (direct link with mortality and morbidity after adolescence)
2) Sex (higher death rate in men)
3) Genetics (obesity/diabetes/heart disease)
Give five examples of lifestyle-related determinants of health
1) Tobacco
2) Nutrition (mal/overnutrition)
3) Alcohol
4) Physical activity
5) “Risky” behaviours
What is an important question to do with lifestyle-determinants of health?
Are these factors entirely determined by individual choice?
Give three aspects of environment-related determinants of health
1) Physico-chemical (air/water/radiation)
2) Biological (microbes)
3) Socioeconomic and sociopolitical (education/employment/political stability/’convenience society’)
Describe the role of the health service in disease/mortality prevention in recent times
Clinical medicine has played a smaller role, prevention attributed to fall in infectious disease (eg. hygiene)
Is the fact that vaccination against certain disease not having a large impact an argument against them?
No, just that medical interventions fall secondary to environmental changes in some cases
What are five important roles of clinical medicine?
1) Preventing deaths
2) Improving length and quality of survival in fatal conditions
3) Treating and improving quality of life in non-fatal conditions
4) Preventing and treating genetic dorsers
5) Care for chronically mentally ill, mentally disabled and elderly
What are the four main reasons for measuring population health?
To identify:
1) disease prevalence and incidence
2) longitudinal disease trends
3) if interventions or policies are having an effect
4) differences in disease patterns in different groups/locations
What is the difference in the top causes of disease in HICs and LICs?
Most communicable in LICs, most non-communicable and chronic in HICs
Give 9 examples of data sources for measuring population health
1) Death certification
2) Census
3) Health Survey for England (HSE)
4) General Lifestyle Survey
5) Hospital Episode Survey
6) Clinical Practice Research Datalink
7) Health protection reports for notifiable infectious diseases
8) Cancer registration
9) National/regional/local audits/surveys
Describe Death Certification
A legal requirement (recording Pt age, sex, occupation, where they died and cause/contributing diseases)
Describe Census
Occurs every 10 years counting everyone in a household on one particular night (recording age, gender, migration, education, marital status, health, housing conditions, family structure, employment and travelling habits)
What is a Census used for?
Measurement of population demographics to make population pyramids
Describe Hospital Episode Statistics
Details all admissions to NHS hospitals and outpatient appointments in England (recording diagnoses and operations, age, gender, ethnicity, time waited and date of admission, where treated, outcome-discharge/death)
Describe the Clinical Practice Research Datalink
Anonymised longitudinal data from 625 general practices (for clinical research planning, drug utilisation, studies of treatment patterns, drug safety, health outcomes)
Describe the Health Survey for England
Annual population survey (recording demographic info., smoking status, illness, treatment, health service usage, height/weight plus additional key theme each year)
Describe the General Lifestyle Survey
Sample from whole of GB (recording demographic info., housing, vehicle access, employment/education, smoking/drinking, family info.)
What are notifiable diseases?
Certain infectious diseases of particular significance
What are the key methods of measuring health and disease?
Birth and fertility rates
Incidence
Prevalence
Mortality rate (crude and standardised)
What are the advantages to using mortality data as a measure of population health?
Legal requirement in UK to register each death
Little delay in data collection
International classification of diseases ensures comparability
Cheap source of health data
What are the disadvantages to using mortality data as a measure of population health?
Potential for error
Death may result from many diseases acting together
Problems in allocation of resources as some diseases with low mortality rate may be resource intensive
What are two ways to use mortality or morbidity rate?
Area comparison or change over time
What is direct standardisation?
Where age-specific death rates from a study population are applied to a standard population structure
What are the advantages of direct standardisation?
Can be used to compare disease rates across areas and time
Can be used to access the relative burden of different diseases in a population
What are the disadvantages of direct standardisation?
Requires age-specific rates which are not always available at a local level
Rates may not be stable for small number of events
What is indirect standardisation?
Where age-specific death rates from a standard population are applied to a study population structure
Standardised Mortality Rates (SMR)=
observed no. of deaths from study population/expected no. of deaths from study
What are the advantages of indirect standardisation?
Doesn’t require local rates, only absolute number of events
Easier to interpret rates
What are the disadvantages of indirect standardisation?
Areas cannot be directly compared
Doesn’t give an idea of actual burden of disease
What are the pitfalls of health and disease data interpretation?
Different criteria define disease between areas
Not all cases of disease identified in each area
Use of hospital data omits certain cases (GP/community)
Define incidence
New cases of disease over a defined time period
Incidence rate=
no. of new cases of a disease over time period/Person-years at risk
Person-years at risk=
total population at risk x time period
What does 1 Person-year at risk equate to?
1 individual at risk for 1 year or 2 individuals at risk for 6 months
How can Person-years at risk be approximated?
The population at the mid-point of the time period
Define prevalence
How many people have a disease at one point in time
What is prevalence often used for?
Ascertaining the burden of long-term conditions
Point prevalence=
no. of people with a disease at a point in time/total population at risk of the disease at the point in time
What are three measures of birth and fertility rates?
Birth rate
General fertility rate
Total fertility rate
Define birth rate
Number of live births per 1000 population
Define general fertility rate
Number of live births per 1000 women aged 15-44
Define total fertility rate
Average number of children that a woman would bear if they experienced the age-specific fertility rates at that point in time
Why is total fertility rate used in preference to general fertility rate?
Allows comparison over time/between areas
Infant Mortality Rate/IMR (per 1000)=
no. of deaths in children aged < 1 year/all live births (x1000)
Why measure IMR?
highly correlates with life expectancy and overall economic status
Crude Mortality Rate=
total no. of deaths in 1 year/total mid-year population
Disease-specific death rate (per 1000)=
no. of deaths from disease/total mid-year population (x1000)
What are Merinker’s Three Levels?
1) Disease
2) Illness
3) Sickness
Define disease
a pathological process-often physical-causing deviation from the biological norm
Define illness
a feeling/experience of being unhealthy which is subjective interior to the patient
Define sickness
a social status/perception of someone suffering from a disease
Define Mental Health
A state of well-being in which every individual realises 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
What is the major theory of health and disease contributing to the biomedical model?
Germ theory/Pathogenic medicine
What are 5 concepts associated with the biomedical model?
1) Mind/body dualism (separate entities)
2) Mechanistic (sees body as machine)
3) Over-reliance on technology
4) Reductionist (biological causation)
5) Ignores social, cultural, biographical and environmental explanations
How is illness treated in the biomedical model?
Vaccination/Surgery/Chemotherapy
Who is responsible for treatment in the biomedical model?
Medical professional
What is the relationship between health and illness in the biomedical model?
Qualitatively different, no continuum between them
Four reasons for belief that health and illness are social construction
1) Different symptomatology experienced by different people
2) Different societies have different methods of treatment and diagnosis
3) Illness isn’t randomly distributed
4) Constructs open to interpretation and moral/social/religious influence
What is medicalisation?
The process by which non-medical problems become medical problems
What is a criticism of the biomedical model?
Medicalisation
What are the three levels of medicalisation?
1) Interaction=telling Dr symptoms
2) Conceptual=signs and symptoms->diagnosis
3) Institutional=organisation uses medical approach to manage problems
Give two examples of previous drivers for medicalisaiton
Professional dominance and industry pressure (pharmaceutical companies)
Give three examples of present drivers for medicalisation
Biotechnology, consumerism and ‘care’ industry
Define iatrogenesis?
The causation of a disease, harmful complication or other ill effect by any medical activity including diagnosis, intervention, error or negligence
Give two examples of iatrogenesis
Antibiotic resistance and US opioid crisis
