Ethics, public and social health Flashcards
(121 cards)
1
Q
What is primary prevention?
A
Preventing the onset of disease
2
Q
What is secondary prevention?
A
Preventing the progression of disease from a pre-clinical stage
3
Q
What is tertiary prevention?
A
Preventing morbidity and mortality through treatment of clinical diseases
4
Q
What are the 3 domains of public health?
A
Health improvement
Health protection
Healthcare Public Health
5
Q
Describe the biomedical model of health and illness
A
Mind/body can be treated separately (mind/body dualism)
Reductionist
Body can be repaired
Knowledge is objective
More disease/pain = poorer health
6
Q
Describe the social model of medicine
A
Medical knowledge is a sociological construct
Challenges mind/body dualism, more hollistic
Health and illness influenced by wider socioeconomic context
Knowledge not objective
7
Q
What is consequentialism?
A
An act is evaluated solely in terms of its consequences
8
Q
What is utilitarianism (preference and hedonistic)?
A
Maximising good/welfare
Preference utilitarianism: utility rises when preference is satisfied
Hedonistic: more pleasure less pain
9
Q
What is deontology?
A
Features of the actions themselves determine if they are morally right/wrong
10
Q
What are virtue ethics?
A
Focuses on the person
Act morally and ethically
11
Q
Limitations of virtue ethics
A
Culture specific
too broad
ignores social and communal dimensions
12
Q
Which social demographics are more likely to be overweight?
A
Most deprived (areas have more fast food outlets)
Disabled
13
Q
What can define food insecurity?
A
Having smaller meals than usual or skipping meals due to being unable to afford
or get access to food.
Being hungry but not eating due to being unable to afford or get access to food.
Not eating for a whole day due to being unable to afford or get access to food.
14
Q
What are direct costs of disease?
A
Ambulatory and inpatient medical care
Secondary costs of mental health, complications of treatment
15
Q
What are indirect costs of disease?
A
Loss of paid and unpaid activities
Borne by patient, employer, society
16
Q
What are some quality of life costs from disease?
A
Pain, anxiety, emotional
17
Q
What is the definition of ageing?
A
progressive physiological changes in an organism that lead tosenescence, or a decline of biological functions and of the organism’s ability to adapt to (metabolic) stress
18
Q
What is multimorbidity?
A
Co-occurrence of multiple disease at the same time, in the same person. As people age, they are more likely to experience several conditions at the same time
19
Q
What is frailty?
A
characterised by diminished strength, endurance, and reduced physiologic function, increasing an individual’s vulnerability to dependency and/or death
20
Q
What can influence healthy ageing?
A
Socioeconomic status
Working conditions
Diet
Ethnicity
Social networks
Hereditary illness
Health access
21
Q
What are some challenges of the ageing population?
A
Strains on pensions and social security
Increasing demands for health care
Bigger need for trained health workforce
Increasing demand for long term care
Pervasive ageism that denies older people the rights and opportunities for other adults
22
Q
What are the 2 types of ageing?
A
Intrinsic – natural, universal, inevitable
Extrinsic – dependent on external factors, UV rays, smoking, air pollution
23
Q
What affects diet (4As)?
A
access, availability, affordability, awareness
24
Q
What can determine health outcomes?
A
Income
Environment
Occupation
Culture
Societal Status
Access to education
25
What is the Nuffield ladder of interventions?
Do Nothing or simply monitor the situation
Provide Information:
Enable choice
Guide choice through changing the default
Guide choice through incentives
Guide choice through disincentives
Restrict choice
Eliminate choice
26
What are some examples of health protection?
Control of Infectious diseases
Environmental hazards
Chemicals / Radiation
Emergency Response
27
What can health improvement work on?
Inequalities
Education
Housing
Employment
Family / community
Lifestyles
Surveillance / Monitoring
28
What is healthcare public health?
Helping to ensure that the organisation of the wider NHS estate is fit for purpose and influencing expenditure
29
What is evidence based medicine?
the conscientious, explicit, and judicious use of the best evidence in making decisions about the care of individual patients
30
What are the 5 parts of evidence based medicine?
Finding evidence
Assessing the evidence
Synthesising the evidence
Making good decisions
Evaluating performance against the evidence
31
What are 4 major study designs that can be used for evidence?
Cross-sectional survey
Case-control
Cohort
Randomised Controlled Trial (RCT)
32
What does PICO stand for when framing a research question?
Patient or Population (under study)
Intervention (exposure, treatment or procedure)
Comparator/ control (that which is compared against the intervention)
Outcome (endpoint of interest)
33
What is screening?
A process which sorts out apparently well people who probably have a disease (or precursors or susceptibility to a disease) from those who probably do not
34
What is a diagnostic test?
confirms whether the condition is present or not
35
What is the doctrine of double effect?
where certain criteria are met, a person acts ethically when acting to bring about a good or morally neutral effect, even if her action also has certain foreseen, though not intended or desired, bad effects
36
What are the 2 types of imperative?
Hypothetical e.g. eat well to keep healthy
Categorical e.g. don't lie or steal
37
What are the 5 focal virtues?
Compassion
Discernment
Trustworthiness
Integrity
Conscientiousness
38
What are the 4 principles of ethics?
Autonomy
Beneficience
Non-maleficience
Justice
39
What is the purpose of beneficience?
provide benefit to others
Better off than before
40
What is the purpose of autonomy?
patient has the ultimate decision-making responsibility for their own treatment
41
What is the purpose of non-maleficience?
do no harm or allow harm to be caused to a patient through neglect
42
What is justice in medical ethics?
whether it’s compatible with the law, the patient’s rights, and if it’s fair and balanced
43
What does impairment mean?
any loss or abnormality of psychological, physiological or anatomical structure or function
44
What does disability mean?
a restriction or lack (resulting from an impairment) of ability to perform an activity in a manner or within the range considered normal for a human being
45
What does handicap mean?
a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfilment of a role that is normal for that individual
46
What are the 4 criteria of good care?
Co-participation in care and the patient as decision maker
Acceptance of an open agenda
Holistic rather than biomedical orientation: ‘persons’ in context’ rather than managing disease
Development of counselling skills: awareness of impact of illness and advising on coping strategies
47
What is iatarogenesis?
side effects and risks associated with the medical intervention
48
What are some common issues of medicine in the media?
Media requires stories to be “news-worthy”
Stories often from press releases from potentially biased sources
Stories discuss possible implications of research without any information about or critique of actual research findings
Findings, especially statistics, are often mis-represented
49
Features of quantitative methodology
Emphasises quantification in collection and analysis of data
Deductive approach – theory testing
Based on positivism
Views social reality as external and objective
50
Feature of qualitative methodology
Emphasising words, rather than numbers
Inductive approach – generating theories (does not claim ‘truth’ status)
Based on interpretivism – understanding the ways in which individuals and groups interpret their world
51
What is the purpose of screening?
Reduce the risk of developing disease
Provide treatment
Provide information
52
What are the criteria for the condition being screened?
The condition sought should be an important health problem
The natural history of the condition should be well understood
There should be a detectable early stage
53
What is the criteria for the treatment for screening?
There should be an accepted treatment for patients with recognized disease.
Facilities for diagnosis and treatment should be available
Adequate health service provision should be made for the extra clinical workload resulting from screening
54
What is the criteria for the test used in screening?
A suitable test should be devised for the early stage
The test should be acceptable
Intervals for repeating the test should be determined (not a one off)
55
What should be considered for the risks and benefits of screening?
There should be an agreed policy on whom to treat
The costs should be balanced against the benefits
The risks, both physical and psychological, should be less than the benefits
56
What is length time bias in screening?
An overestimation of survival because long-duration cases are more likely to be detected and treated than short-duration cases
57
What is lead time bias in screening?
When screening appears to increase survival time simply because the disease is detected earlier
58
What is the selection bias in screening?
People who choose to participate in screening programmes may be different from those who do not
May be at higher risk e.g. women with family history of breast cancer more likely to attend
May be at lower risk e.g. women in higher socioeconomic groups (lower risk of cervical cancer) more likely to attend
59
What are the different types of screening?
Population-based screening programmes
Opportunistic screening
Screening for communicable diseases
Pre-employment and occupational medicals
Commercially provided screening
60
What is the definition of a learning disability?
Significant impairment of general cognitive functioning acquired in childhood that is lifelong
61
What are some barriers people with learning disabilities face in healthcare?
failure to identify people
discriminatory attitudes
failure to make reasonable adjustments
‘diagnostic overshadowing’
Access to health promotion worse
Lower uptake in screening
62
Who are some key actors in global health?
UN, UNICEF
WHO
Multilateral Developmental Banks
Bilateral agencies
Private foundations e.g. Rockefeller
Non-governmental organisations (Doctors Without Borders/Save The Children)
Global health partnerships
63
What are some hostile policies towards undocumented migrants?
Criminalisation of employing undocumented migrants
Banks and building societies prohibited from opening accounts for undocumented migrants
ID checks and upfront charging of undocumented migrants for hospital treatment and NHS-funded community health services
64
What are some health issues migrants may present with?
Communicable and Non-communicable diseases
Incomplete immunisation history
Malnutrition and micronutrient deficiencies
Obesity
MSK issues
Oral disease
STI
Pregnancies
FGM
Psychological disturbance
65
What are some policies precipitating poverty in migrants?
Need an NI number to claim benefits
Asylum support axed after 28 days
Undocumented migrants not allowed to work
66
What can influence health (global heath)?
Housing
Sanitation
Food safety
Water quality
Environment quality
67
What are some traditional hazards to health?
Related to poverty & insufficient development:
- Lack of safe drinking water,
- Inadequate sanitation,
- Indoor air pollution,
- Inadequate waste disposal
68
What are some modern hazards to health?
Related to development that lacks health & environmental safeguards, & to unsustainable consumption of natural resources:
- Environmental contamination
- Urban air pollution
- Climate change
69
What diseases are prevalent in slums?
hypertension, diabetes, intentional and unintentional injuries, tuberculosis, rheumatic heart disease, leptospirosis and HIV infection exist
70
Why collect routine health data?
monitor health of the population
generate hypotheses on causes of ill health
inform planning of services and policy to meet health needs, including resource allocation
evaluate and assess performance of policies and services
generate research statistics
71
What are the different theories of what health is?
Health as a personal strength or ability
Health as a state of social functioning
Health as an ideal state
72
What are the levels of intervention?
Population and Individual
73
Why might people smoke?
Addiction
Fear of weight gain after cessation
Pleasure
Choice
Advertising
Peer group/family
Coping with stress
Habit
Socialising
Signifier of cultural status
74
What is satiety?
inter-meal period.
75
What is satiation?
What brings an eating episode to an end
76
What are 5 group 1 alternative therapies?
Acupuncture
Chiropractic
Herbal medicine
Homeopathy
Osteopathy
77
What is cardiorespiratory fitness?
Ability of circulatory and resp systems to supply oxygen to skeletal muscles and the muscles ability to absorb and utilise the oxygen, during sustained physical activity
78
Ways to measure physical activity
Self report (e.g. IPAQ, WSQ)
Direct observation
Heart rate monitoring
Accelerometry
Inclinometry
Portable indirect calorimetry
79
What are the proportions of older people in the UK?
Currently as many people aged over 65 as there are aged under 15 in the UK
By 2025 there will be more people aged over 65 than aged under 20 in the UK
The proportion of people aged over 85 is expected to double by 2050 (5% of population)
80
What can cause population ageing?
Improvements in sanitation, housing, nutrition, medical interventions.
Life expectancy is rising around the world.
Substantial falls in fertility.
Decline in premature mortality.
More people reaching older age while fewer children are born
81
What are 4 ways to reduce health inequalities for older patients?
changing how we think, feel and act towards age and ageism
developing communities in ways that foster the abilities of older people;
delivering person-centred integrated care and primary health services responsive to older people
and providing older people who need it with access to quality long-term care
82
What are some consequences of a rise in life expectancy?
Pensions will have larger pay outs than those currently planned
Health and social care services will have to serve an older population with chronic and comorbid conditions.
Rising inequalities as more affluent social groups use health and social services for longer
83
What social roles can influence mental health is older population?
Large numbers of older people living in social isolation – informal mental health support significantly reduced
Increased possibility of loneliness: bereavement, ill health, poverty
People live longer; smaller families; extended family not necessarily close by
84
What are the 3 main categories of health behaviours?
Health behaviour
Illness behaviour
Sick role behaviour
85
What is health behaviour?
A behaviour aimed at preventing disease
86
What is illness behaviour?
a behaviour aimed at seeking remedy
87
What is sick role behaviour?
Any activity aimed at getting well
88
What are some health damaging behaviours?
Smoking
Alcohol and substance abuse
Sun exposure
Driving without a seatbelt
Unsafe sex
89
What are health promoting behaviours?
Exercise
Taking meds
Healthy eating
Attending health checks
Medication compliance
90
What are some modifiable risk factors?
Diet/ Excessive weight
Smoking
Alcohol
Physical activity
Sleep,
stress
91
What are some non-modifiable risk factors?
Sex
Age
Genetics/ Family history
92
What is the health belief model?
Individuals will change if they:
* Believe they are susceptible to the condition in question (e.g. heart
disease)
* Believe that it has serious consequences
* Believe that taking action reduces susceptibility
* Believe that the benefits of taking action outweigh the costs
93
What might influence perceptions of risk?
Lack of personal experience with problem
Belief that preventable by personal action
Belief that if not happened by now, its not likely to
Belief that problem infrequent
94
What does the theory of planned behaviour propose?
Proposes the best predictor of behaviour is ‘intention'
95
What does theory of planned behaviour believe intention is determined by?
A persons attitude to the behaviour
The perceived social pressure to undertake the behaviour, or subjective norm
A persons appraisal of their ability to perform the behaviour, or their perceived behavioural control
96
What are the 5 stages in the stages of change model?
precontemplation
contemplation
preparation
action
maintenance
97
What are the 3 influences at start of TPB?
Attitudes
Subjective norm
Perceived behavioural control
98
What are the 3 main types of error?
Errors of omission
Errors of commission
Professional negligence
99
What is an error?
any preventable event that may
cause or lead to patient harm
100
What is an adverse event?
incident resulting in harm to a patient,
which is not a direct result of their illness or other chance event
101
What is a near miss?
an event which arises during care and has the potential to cause harm but fails to develop further thereby avoiding harm
102
What is an error of ommission?
when required action is delayed or not taken
103
What is an error of commission?
where wrong action is taken
104
What is a skill-based error?
Skill-based errors can be slips of action or memory lapses
When you know the action well but make a mistake by accident
105
What is a knowledge based error?
An incorrect plan or course of action
106
When is a rule/knowledge based error more likely?
tasks are complex (e.g. diagnosis)
people are inexperienced
insufficient information
communication of information is poor
little support/advice from colleagues
107
What are some information processing limitations?
Automaticity: prone to actions
Cognitive Interference: More complex task make greater processing demands
Selective attention: Limited attentional resources, necessary for coherent action,
leave us prey to inattention and information overload
Cognitive biases: memory makes us liable to conformation bias
108
What is involuntary automaticity?
When errors are not identified because people are going through the motions of carrying out a check but are not truly consciously engaged in the checking process
109
What is positive transfer of expectations?
previous experience applies to new situation
110
What is negative transfer of expectations?
previous experience interferes with new situation
111
What are Long, Neale and Vincent's tips for practising safely?
Try to develop your internal alarm bells
Seek help when feeling overwhelmed
Use clinical guidelines where available
Always document your thought processes, actions, and plans
Checking results and all recorded info
Speaking up if an error is suspected
112
What does the NHS constitution state?
NHS provides a comprehensive service, available to all
Access to NHS services is based on clinical need, not an individual’s ability to pay
NHS services must reflect the needs and preferences of patients, their families and their carers
The NHS is committed to providing best value for taxpayers’ money
113
What is opportunity cost?
the sacrifice in terms of the benefits forgone from not allocating resources to next best activity
114
When is economic efficiency achieved?
when resources are allocated between activities in such a way as to maximise benefit
115
What is economic evaluation?
a comparative study of the costs and benefits of alternative health care interventions for some given disease
116
What is a QALY? (Quality adjusted life year)
Combines length of life with quality of life
Length (years) x quality (“utility”) weighting (0 to 1 scale)
117
What is the monetary value in health benefits?
How much is someone prepared to pay for some health benefit
118
How are health benefits measured?
QALYs
Monetary value
Measured in natural units, e.g. bp
119
What are the 4 types of economic evaluation?
Cost-effectiveness analysis (natural units)
Cost-utility analysis (QALYs)
Cost-benefit analysis (monetary units)
Cost-minimisation analysis
120
What does health economic monitoring allow?
Include all relevant comparators
Synthesise all relevant evidence
Translate from surrogate to final endpoints
Extrapolate event risks, outcomes and costs beyond the observed period of a trial
Account for decision uncertainty
121
What is Incremental cost-effectiveness ratio (ICER)?
The ratio of the difference in the mean costs of a technology compared with the next best alternative to the differences in the mean outcomes
