Final Exam Flashcards
(103 cards)
1
Q
programming
A
- A metaphor from computing
- Fetal or childhood events may determine a set of predispositions which have implications for future health and function
- You’ve been programmed by your childhood development for certain predispositions
- Instructions are laid down for how future events will unfold
- The implications are not immediately obvious
2
Q
barker hypothesis
A
- Low birth weight predisposes the child for serious negative health outcomes in later life, particularly heart disease
- Physiologic underdevelopment early in life is not compensated for by future development
- Related idea that epigenetic markers arising from early life events may have phenotypic consequences through development into adulthood
- Mothers that are poor, smokers, food insecure, etc. are at highest risk
3
Q
Low Birth Weight and Future Health Events
A
Poor cardiovascular and respiratory health
Lower cognitive function
Schizophrenia
Susceptibility to stress and emotional disorders
Increased risk of breast cancer
Lower educational attainment, lower income and higher rates of smoking
Childhood and adult obesity (predisposed to low metabolism to store food)
Lower stature
4
Q
Programming: Neurology
A
- Early childhood stress may affect brain growth and development, as well as lifetime capacity for cognitive activity and emotional regulation
- Fetal and early childhood nutrition affects brain growth, IQ, and cognition
- Early childhood experiences affect brain development
- Neurons in the amygdala learn fear, anxiety, and aggressive responses through conditioning
- maternal and infant nutrition programs improve chronic diseases and life expectancy
5
Q
DNA Methylation
A
- DNA methylation is a biological process that can change the activity of a DNA segment without changing the sequence. When located in a gene promoter, DNA methylation typically acts to repress gene transcription
- Healthy mother reduces DNA methylation
- Unhealthy mothers increase DNA methylation
6
Q
epigenetic effects
A
environmental conditions (stress, nutrition, etc) activate or deactivate genes
7
Q
neural sculpting
A
- Neural pathways and brain connectivity is shaped by early childhood experience
- neural sculpting occurs mainly in childhood but still occurs into adulthood but not as quick or obvious (stroke → have to redevelop neural pathways)
8
Q
Thalidomide
A
drug used in the 70’s to treat nausea in pregnancy, caused long bones not to develop and babies were born deformed → drug affected the bones that were developing at the time the medication was taken
9
Q
latent effects
A
- Early life experiences and contexts affect people independently of what happens later
- Lack of development in early childhood will have detrimental impact on overall life-long capabilities, regardless of the quality of care/development provided in school years
- Sits in the background until it comes out later in life (not day to day impact) (cardiovascular risk for low birth weight infants → risk factor for later)
10
Q
cumulative effects
A
- The longer one is exposed to negative environment, the worse the health effects
- The more intense a negative event or set of events, the worse the health effects
- The impacts of negative experiences interact, often synergistically, and accumulate over time
- Adverse childhood experiences (ACE)
- If any of the above ACE criteria apply, elevated lifetime rise of mental illness, substance abuse, and chronic disease
- Factors are cumulative, risk rises exponentially with multiple ACE factors
11
Q
pathway effects
A
- Early life experiences set the stage for future experiences, which in turn give shape to the subsequent ones. (cyclical, generational)
- A poor start developmentally means a child is ill-prepared to start school → will likely do poorly in school → may become anxious, depressed or a behavioural problem, all of which compound poor performance and contribute to → early school leaving, poor job prospects, low income, bad housing in a bad neighbourhood, etc.
12
Q
attachment theory
A
- By the age of 6 months, children develop critical attachment to their caregiver (seen a lot around 2 years old)
- Attached figure provides a safe base from which an infant can “venture forth”
- Attachment failure undermines self-esteem (Stress, Social dysfunction)
13
Q
early childhood policy
A
- Canada ranks poorly in childhood development
- Most programs in Canada are very limited in scope and target only high-risk families
- High-quality child care is expensive and difficult to access
- The best strategy would be one of progressive universalism - support for every family with additional support going to those with greater needs
14
Q
injury
A
- Injury is a leading cause of death and the major cause of non-congenital disability for teens in Canada (accidents, risky behaviours)
- Young people aged 12–19 have the highest probability of injury (27%)
- Gender differences are present
- Sport-related injury
- Two-thirds of injuries involve falls
- Suicide is a major cause of death for teens in Canada, especially for boys
- Much higher among Indigenous youth
15
Q
obesity
A
Childhood experiences may have role in obesity
- Breastfeeding versus bottle-feeding (neither is better)
- Good gut health production in the infant (vaginal birth > C section)
- Early childhood experiences
Canadian and American teens are more likely to be obese even though they are more physically active
16
Q
Childhood and the Transition to Adulthood: Summary
A
- The beginning of life has major implications for the rest of the life course
- Most of the disadvantages at birth can be compensated by positive early life experiences
- More support should be provided in Canada to parents and children in their early years
- Early childhood development programs can have stunningly large effects, both immediately and latently, but these are difficult to achieve at large scale
- Government should continue to support and invest in public schools, paying special attention to early reading and literacy programs
- Governments at all levels should be more mindful of the needs of teenagers and young adults
17
Q
diet and the health of populations
A
- The availability, affordability, and quality of food are major social determinants of health
- There is a strong link between income, education, and food
- People with lower income rely on low cost, high-energy diet, which is nutrient-poor
- Bread in medieval Europe
- Potato in 19th-century Ireland
Whole country was reliant on potato crops for low cost high energy food
Hardy food, last through the winter (easy to store)
Early 1800’s lots of farmers growing potatoes
Mid 1800’s - fungal infection in potato crop → potato famine
Their other crops were being exported out (low amount of food left for irish people)
Thousands of people died (starvation, disease, malnourishment) - Processed foods, refined carbohydrates and fats in today’s Canada and the US (junk food)
18
Q
Factors Impacting People’s Choice and Use of Foods
A
- Stability of income and cost of other necessities (food budget is cut to pay rent)
- Capacity to plan and budget
- Features of home (fridge, oven, microwave, pots and pans, etc.)
- Knowledge and skills (ability to cook, life skills)
- Availability and affordability of foods
- Marketing of food choices (typically targets sugary foods to children)
- Ethnic, cultural, religious and family background (perception of acceptable food)
- Peer pressure, norms, behavioural impact (social network)
- Time and energy (ordering food is less time consuming than cooking)
19
Q
Canada’s Food Guide
A
History of Canada’s Food Guide
- Established during WWI
- Nutrition concerns during the Great Depression
- Wartime issuance of Canada Official Food Rules (1942)
- First (less prescriptive) Food Guide issued 1961
- Very strict - prescriptive
- Focused on whole population
- More about conserving food
Recent revisions to Food Guide
- More emphasis on fish, fruit, vegetables
- Food Guide for Indigenous People
- Focused on health
- Plate size breakdown vs number of servings
- More tailored to different backgrounds
- (dairy and meat industries have input in the food guide/public policy → want people to buy their products)
20
Q
food insecurity vs nutrition insecurity
A
- Food insecurity - The inability to acquire or consume an adequate diet quality or sufficient quantity of food in socially acceptable ways, or the uncertainty that one will be able to do so (not being able to access any food)
- Nutrition insecurity - Inability to access at all the times the nutrients needed for a healthy and active life (access to nutrient poor food, not healthy food)
- Worst situation regionally is in the Maritimes where nearly 15% of households face food insecurity
- Over one-third of indigenous households face food insecurity
- Approximately 25% of lone parent female households face food insecurity
21
Q
food banks
A
- Introduced as short-term stop-gap measure to deal with the fallout from the economic downturn in the early 1980s
- There are over 2332 food banks in Canada supporting 750,000 people (probs more)
Largely accessed by single adult households
On social assistance
⅓ children - Food banks have been criticized because
they were meant to be a stop-gap measure, and lack demonstrated effectiveness - provide a limited amount of food to people who’s real problems are low income and expensive housing
they obscure the issue of food security by creating the illusion of a solution to the problem (allow government to look the other way and ignore issues)
22
Q
obesity part 2
A
The lower the woman’s income and education, the higher the probability that she will become obese
- Disordered eating patterns
- Overeating due to food insecurity
- Dieting and bingeing
- Body storing food because it’s not always available → obesity
Contextual factors
- Poor neighbourhoods (less diverse availability of food, low cost processed foods) (really prominent in the US)
- Regional differences in obesity rates in Canada
23
Q
rising obesity rate suspicions
A
- Progressively cheaper food, more accessible (meat, pork, highly processed, packaged foods) these foods don’t support a healthy diet alone
- Processed foods readily available, cheap and convenient (energy dense)
- Increased eating in fast-food restaurants/full-service restaurants (high in fat, sugar, salt)
- Portion sizes skyrocketed since 1970s
- Disordered eating – “eating on the fly”, snacking
- Soft drinks
- Cheap ingredients for processed food (high-fructose corn syrups)
- Increased car ownership, reduced walking, built environments (sedentary work)
24
Q
Can Supplement Compensate for Poor Diet?
A
- Supplements have been shown to be ineffective to compensate for poor diet
- Exceptions are folate and iron in pregnancy and Vitamin D
- Better nutrition can result from better diet diversity
- Better diet does not necessarily change health outcomes at the individual level (with the exception of the seriously malnourished)
- However, there will be benefits at the population level if Canadians’ diets were to improve
25
How Much Does Our Diet Matter to Our Health?
- Surprisingly, we have very little evidence suggesting that diet is directly linked to either positive health outcomes or to disease
- Because of genetics and a variety of factors we can’t explicitly say these are the foods you need to eat to not get heart disease
- There are recommendations but no guarantees
- A varied diet is essential to human health
- Eat widely, incorporating as many foods as possible into diet, but not too much
- Don’t binge on any food type
- Fad diets = bad (keto, atkins)
26
Food, Food Insecurity, Obesity, and Nutrition: Summary
- Compared to other places in the world, people in affluent Liberal regime countries are well nourished and/or over-nourished
- A significant proportion of Canadians (15%) are food insecure
- The rising levels of obesity have been styled an “epidemic”
- The causes of rising levels of obesity are contested
- Current policies aimed to improve food choices are ineffective
- Policies need to be developed that embrace a population-health approach, are multi-factoral, and operate on several different levels of determination
27
Models of Health
Biomedical Model
- Health is absence of disease
- Host characteristics, environmental variables, health related behaviors
Behavioural Model
- Individual choice
- Individual makes the decisions that impact their health
- Choices depends on what's available to the individual (limitations)
Contextual Approach
- Taking into consideration the context that the individual lives in
- SDOH
Multi-level Approach
- Individual, micro, macro level
- Individual → community → population
- Political context
- Need for social reform
28
Robert Wood Johnson Foundation’s Commision to Build a Healthier America (2009)
US based
US based
| Attributes health to personal choice (behavioural model)
29
Marmot & Bell (2010) - Fair Society, Health Lives
UK based
In response to Robert Wood Johnson report
Population-level health differences arise from social inequalities (SDOH)
Reducing health inequalities = social justice
Large gaps in income and education create an patterns of advantage and disadvantage
30
biomedical model
- Conditioned by the marketplace of health care
- Money is made → it is a business
- It is a service and the patient is paying for it
- It is treatment based (not preventative)
- Pharmaceutical sales, advertising
- This is more so in areas where healthcare is more privatized not government regulated (US)
- Illness = money to be made
31
behavioural model
- You are free to choose what health choices you make
- No interference from the government
- Individuals responsibility to make health choices (good or bad choices)
32
Ideologies
- Luck versus Hard Work
- What factors external to the individuals control play into social position and access?
- What has got you to the position you are in today?
- Was it luck or all hard work and dedication
- Most times both
- SDOH have to align to put you in a position to attend university, for example
- Some people overcome their situations with hard work
- Cyclical (low income parents → low access to schools → can’t go to university → low income → cycle continues)
33
neo-liberalism
- Characterized by a) faith in free markets b) suspicion of governments c) low taxes - and low levels of public services
- Government size continue to shrink (fewer people in power)
- Reduction of regulations on corporations/markets (independent decision making) (taxes)
- Every man for himself
34
solidarity
- Norway, sweden, denmark
- All of society is focusing on the rest of society
- Ensure each person has equal access
- Supporting vulnerable groups
- Better social services, welfare, childcare, healthcare
35
Globalization and Human Health
Globalization = easy access around the globe
Ease of money movement around the world
Stagnation or reduction in wages for Lower- and Middle-Income
Increase in residential segregation by income
Increase in educational segregation through use of private schools
Cuts to publicly funded programs
Removing regulations on big corporations/markets
Undermining of labor unions
Undermining of employment standards
Reduction in environmental standards
Promotion of global free trade
All leads to class divides
36
Globalization, Carbon Emissions, and Climate Change
Consumer Culture = Increase in Carbon Emissions
- Always want to buy the next thing
- More carbon is produced to keep up with production of products
Rising Temperatures, Changes in Ice Cover and Weather Patterns
- Impacts food production
- Changes concentration and temperature of ocean (ice melting) → affects habitats of animals
Severe Weather Events
Loss of Arctic Surface
- Changing the celination of the ocean
- Not reflecting the sun anymore → ocean temperatures are rising → atmospheric temperatures rising
Paris climate change agreement
- Looking to reduce climate change at the country level
- Establish expectations for countries to reduce carbon emissions
- US removed themselves in 2019
Canada
- Big cause of emissions is oil and big energy sectors
- Automobiles
- Regulation: transport trucks must be full to be transported (don’t waste gas)
37
Globalization, Food Security, and Nutrition
2012 Food Crisis
- Cost of production and transport increased due to rising fuel costs
- Fertilizers became more costly
- Concern over oil prices led to US subsidies for biofuel production
Factory Farming
- Large amounts of food at a lower cost
- More fertilizer and pesticides → can contaminate water
- Soil depletion
- High water use
- Large release of CO2 emissions
Distribution and Sales
- Major food distributors and retailers (big boxes stores)
- Difficult for small businesses to keep up (food is cheaper at a big box store than at the farmers market)
Marketing of Foods
- Marketing is highly focused on high profit convenient foods
- Cheap high sugar cereals, pop, chips (easy access foods with little nutritional value)
- Primarily targeted at children
- Placed at eye level in stores → easy access
38
Coordinated Market Economies (CMEs)
- Norway, sweden (solidarity countries)
- Highly regulated wages and benefits, Standardized working conditions, Shorter working hours, Guaranteed Paid-Leave Provisions and Pensions, Generous
- Unemployment Insurance and Job-Training Benefits (helping you grow in the business/company)
- Flatter health gradient, better overall population health
- Actively address low wages, poor working conditions and unstable employment
- Continuity of income through well-developed unemployment insurance programs
39
liberal market economies
- Priority of the workplace is consumption and profit
- Flexible Employment – Insecure hours, wages and benefits
- 1/3 of Canadians are employed in shift work – disrupts circadian rhythm (impacts BP, Hormones Levels, Appetite, Blood Sugar levels)
40
climate change
About 1ºC average warming over the past 100 years; rate has increased rapidly since 1950
A clear trend, not a variation
At least partly, and probably mostly, caused by human activity
CO2 and methane emissions
Deforestation
Implicated in polar seas getting warmer, melting of sea ice (not reflecting heat), fresh water glaciers melting, marine species collapse, unprecedented rates of plant and animal extinction, and extreme weather events
41
health implications of climate change
- Climate change can affect health in 2 ways:
- By changing the severity or frequency of health problems that are already affected by climate or weather factors (seasonal allergies, asthma, arthritis, diseases that react to changes in weather)
- By creating unprecedented or unanticipated health problems or health threats in places where they have not previously occurred (exposure to health threats)
- Diminished and degraded potable and irrigation water (fresh water availability)
- Extreme weather events causing human casualties and widespread damage to homes and infrastructure (eg. hurricanes)
- Fisheries collapse and droughts and floods impacting food supplies
- Rise in infectious diseases from yellow fever, to dengue, to Zika, to chikungunya, to West Nile
42
vector borne diseases
Vector-borne diseases are transmitted by vectors (insect becomes the vector, then transmits the disease to the host/human)
- Mosquitoes
- Ticks
- Fleas
Vectors carry infectious pathogens that can be transferred from one host (carrier) to another. These include:
- Viruses
- Bacteria
- Protozoa
Examples: Lyme disease, West Nile virus, malaria, dengue fever
43
Climate Change and Vector Borne Diseases
- Increased temperature shortens pathogen development time in vectors.
- This increases the duration of infectiousness, allowing for prolonged periods of transmission to humans (pathogen can sit in vector for longer)
- Changes in climate may expand the geographic range and abundance in both vectors and reservoir hosts. (temperature dependent → global warming → more environments it can survive in)
- Warming and altered rainfall patterns may increase populations of reservoir animals and their predators (e.g., rabbits and foxes).
- Flooding provides breeding habitats for vectors and reservoir hosts, increasing their abundance and geographic range, which may lead to more frequent outbreaks of diseases.
- Increased risk of travel-associated illnesses. (globalization = more travel → can pick up vector borne diseases of that area)
44
climate change and Lyme disease
- Tick distribution greatly affected by land use, animal host communities (e.g., deforestation decreases predators small mammals that carry ticks)
- Climate change changes distribution by warming the edges of the normal range (cold and altitude edges)
- Survival of ticks depends on climate suitability (amongst other factors)
- The burden of Lyme disease is likely to change significantly in NA and Europe.
45
Climate Change and Food Borne Diseases
There are two overarching means by which increasing carbon dioxide (CO2) and climate change alter safety, nutrition, and distribution of food:
1) Rising global temperatures and the subsequent changes in weather patterns and extreme climate events - Current and anticipated changes in climate and the physical environment have consequences for contamination, spoilage, and the disruption of food distribution.
2) The direct CO2 “fertilization” effect on plant photosynthesis - Higher concentrations of CO2 stimulate growth and carbohydrate production in some plants, but can lower the levels of protein and essential minerals in a number of widely consumed crops, including wheat, rice, and potatoes, with potentially negative implications for human nutrition.
46
Climate Change and Water Borne Diseases
- Survival and persistence of disease-causing organisms directly influenced by temperature. (increased temperature = better environment for pathogens to grow)
- Increased air and water temperatures improve the survival and proliferation of some pathogens (e.g., Vibrio).
- Climate conditions affect water availability and quality.
- Heavy rainfall and flooding facilitates rapid transportation of disease-causing pathogens into water supplies.
47
Indigenous Populations in Northern Canada
- Unreliable water infrastructure, mistrust of water system and drinking untreated water → population is more susceptible to weather related water-borne illness outbreaks (eg. cat lake reservation)
- Increased temperature affects the ability to safely air dry meat or use below-ground storage
48
Intensive Large Scale Agriculture
- Growing monocultures (one type of crop, in one area, over and over) (vast fields of wheat, or rapeseed for oil, or soya, or corn) reduces genetic diversity of plant and increases risk of plant disease requiring more use of chemicals and increasing the likelihood of catastrophic crop failures
- Heavy use of irrigation (wastes water), fertilizers, herbicides, and pesticides degrades the soil and contaminates surface and ground water
- Run-off poisons lakes and the oceans, killing aquatic life
49
production of chicken, beef, and pork
- Billions of pigs, chickens, and ducks are raised in sheds, fed commercial feeds, and produce prodigious amounts of waste
- Animal waste is spread over agricultural land (if it is contaminated it is being spread into the soil → water → drinking system)
- Close proximity, poor diet, and terrible living conditions for animals foster disease, hence the need for widespread use of drugs
- Many diseases incubated in factory farms are zoonotic—i.e. are transmittable to humans—including deadly strains of influenza, SARS, e-coli.
50
fish farming
- Fish farms transmit disease to wild fish
- Components for artificial foods used to feed farmed fish are unsustainably sourced from Antarctic seas
- Fish have to be fed a host of chemicals and drugs to stay healthy, grow, and have flesh that resembles natural fish
51
The Impact of Modern Agri-Business
- Agri-business delivers cheap, but low-quality, food at enormous environmental cost
- By-products from the massive scale of milk, corn, and soy production are the fuel-stocks for ultra-cheap manufactured convenience and junk foods contributing to obesity and diabetes (corn byproduct → corn syrup (put in pop and all kinds of sugary things)
- Factory production of pork and beef drive up meat consumption, harming health
52
air pollution
- Outdoor air pollution contributes to nearly 8000 premature deaths in Canada annually
The main sources are:
- Coal and oil fired electricity generating plants
- Motor vehicles
- Emissions from domestic and commercial heating
- Aviation and shipping
Gaseous toxins
- CO, SO2, N2O, O3
Particulates
- Larger particles from smoke, dust, plants (e.g. pollens, spores) irritate the airways and mucous membranes, exacerbate asthma and allergies
- Smaller particles from vehicle exhausts, fibers from synthetics, smoking, etc. travel deep into the lung, cross over into the blood stream, and even enter cells, causing inflammation, brain damage, heart attack, and much else
53
lead
- Widespread historic use of lead in drinking water pipes
- Lead held in situ can be readily mobilized, dissolved into the water, if the pH drops (and the water becomes slightly acidic)
- Lead was also in widespread use in paint and is still found in older homes; when the paint degrades, the flakes and powder release lead creating a health hazard
- Lead water pipes and lead paint are commonplace in older, lower-quality homes
- Flint Michigan
- Results: reduction in intellectual functioning and IQ and alzhimers in the long term
54
mercury
- Mercury, especially in its organic forms, is a potent toxin
- Mercury is released in large quantities by the mining industry and by burning coal
- Mercury accumulates in the food chain
- It is absorbed by plants and small animals in waterways, accumulates in larger animals that feed on the plants and small animals, and reaches dangerous levels in the top aquatic predators that eat the larger animals (e.g.tuna fish, swordfish) → gets to us when we eat animals that have been infected with mercury
55
arsenic
- Arsenic was the favourite poison of history, because a small dose could be given to an enemy for weeks or even months with no obvious effect. Then the threshold would be met, and they would die
- Like mercury, large amounts are released into the environment by mining
- Excessive use of groundwater for irrigation also draws arsenic to the surface, poisoning the crops (e.g. rice from South Asia).
56
the household environment
- Poor ventilation, high humidity, or water infiltration lead to growth of toxic moulds and mildews (often inside walls or under carpets or floors where they are not visible)
- Indoor air pollution
57
plastics
- Since the 1950s, plastics have become ubiquitous in the environment
- They do not biodegrade, but fracture into smaller and smaller pieces, becoming ingestible by animals and absorbed by plants
- Microfibers from synthetic clothing and ultra fine dust from the wear of synthetic rubber vehicle tires are very dangerous micro-particles
- 300 million tons of plastic are dumped into the environment each and every year
58
The Environment & Health: Summary
Climate change, natural disasters, unsustainable agricultural practices, and protecting outdoor and indoor environments from hazards all raise the same issues:
- Appropriate planning and regulation by local and regional authorities
- Monitoring of risks by government
- Science-informed policies that best protect vulnerable populations
- Infrastructure that ensures appropriate levels of resources for residents
Poorer, as opposed to more affluent, people are
- More likely to be exposed to toxins in their workplace
- More vulnerable to natural disasters and their consequences
- More vulnerable to food insecurity as fisheries fail and extreme weather events reduce food supply
59
is health care really about health
A healthy person doesn’t seek health care
Health care is
To manage illness and disability
Mitigate pain
Restore or maintain function
Prolong life when there is a risk of premature death
Brings people back to normal (treatment) does not promote good health (prevention)
60
preventative medicine
- Aims to identify health risks, execute intervention to modify the risk and reduce the probability of adverse health outcomes
Two Parts
- Screening for risk factors
- Applying therapy believed to change the risk profile (eg. high risk factor for heart disease → start taking cholesterol meds to reduce blood pressure and risk of heart disease before it happens)
61
barriers to healthcare
Absence of qualified HCP
Issues of Cultural Safety
Stigma
Lack of Primary Care Facilities
62
financial barriers to healthcare in canada
- Covers only 70% of total cost
- Supplementary Health Insurance (does not cover everything/not everyone has it)
- provincial social assistance programs (provides some support)
- non insured benefits program (coverage for First Nations)
63
social care
Includes nursing homes, group homes, community mental health services, child development centres, home support services etc
- Partially integrated into provincial health authorities
- Many are quasi-autonomous
- Most are poorly funded and uncoordinated
- Depend, in-part, on feeds paid by user
- Quality and accountability is variable
64
public health
- Programs and services exist not for the benefit of any identifiable person needing care or treatment but for the good of the general public.
- eg, immunization
- Scope of broad-based public health interventions are shrinking due to Canadians becoming increasingly concerned with individuals rights and personal impacts than a solidarity perspective (big public health campaigns are shrinking cause of this)
65
health research methods
- Epidemiologic Research - Examines patterns and probable causes of health and disease in populations
- health services research - Evaluating effectiveness and efficiency of treatment, interventions, programs and services
66
cross sectional studies
- Simplest, most-common observational study
- Data from a specified one point in time are collected, then statistical methods applied to determine the strength of association between variables of interest
- Limitations – which variable came first in impact, difficult to rule out variables that are the real effect
- Correlations are NOT causes (results should be treated cautiously)
- Should be considered exploratory (good starting point)
- Political polls
67
case control study
- Looks at association between factor and disease
- Stronger than Cross-Sectional
- Odds Ratio is used to determine exposure has discernable effect of disease outcome
- Retrospective (memory based )
68
odds ratio
<1 - protective factor
1 - no correlation
>1 - correlation/association
69
cohort studies
- Most powerful, observational study
- More or less uniform population, gather baseline health status information, and followed overtime (prospective)
- Data is collected in intervals and changes noted, which is then evaluated to find associations between exposures and health outcomes
- Time consuming and can be rare
- Calculates incidence and prevalence
- Attrition and mortality
70
experimental studies
- In theory, the most powerful
- Testing hypothesis on the nature of the relationship between defined variables
- Experimental group that will be exposed to intervention and control group that will not – outcomes are measured
- Randomized populations are ideal but difficult to achieve
71
human behaviour and its contexts
- Health-related behaviours cluster (If a person smokes, they are more likely to drink alcohol)
- Risky behaviours are more common among less well-off people
- Exceptions: where affluent are more likely to take risks (more exclusive risks) (eg. extreme sports, horse riding)
72
the health belief model
The model relies of four variables:
- Self-perceived personal risk
- Self perceived severity of the outcomes associated with unhealthy behaviour
- Self-perceived barriers to and costs of behavioural change
- Self-perceived benefits of making the behavioural change
Note: the social influence is missing in this model
73
"rational behaviour" and incentives
- Recent research undermines models of agent rational choice
- People choose what’s fair, even at personal cost—i.e. people do not operate in their own interests, at least not consistently
- Incentives have an effect when people want to change their behaviour and the incentive is quite large
- Otherwise, the effect is quiet small
- Incentives have unintended consequences
- Paradoxically, incentives may actually decrease the desired behaviour
- Incentives only work if the thing incentivized is something the person wanted to do anyways and the incentive is quite large
74
"rational behaviour" and our brains
- Research from neurology also undermines our understanding of agency
- Humans as more or less rational who decide based on evidence, experience, and their wants/desires
- The brain can determine action before the person has considered what they want to do and become aware of that decision.
- What is experienced by the person as a choice or decision in fact is not
- Rather, people justify and defend what they do after the fact (to themselves and others)
- Activity in the brain precedes consciousness
- “Enculturing brains”
- Brain plasticity and neural sculpting incorporate our experience and understandings into physical pathways that determine future thought and action
- Risky behavior over and over again, forms a pathway for more risky behavior
- Systematic differences in brain organization and function arising from social context and past experience can be detected in brain scans
75
the stupid hypothesis
people don’t know what is good for them (not true)
76
feckless hypothesis
people don’t care, they’re reckless or irresponsible (not true)
77
lifestyles are not freely chosen
- Lifestyles are driven by class, education, income, and opportunity
- Critically shaped by whom we know and interact with, and the context of that interaction
- Elements tend to reinforce one another
If you’re preoccupied with fitness you’ll also stress about your diet
If you drink too much alcohol, you’ll probably not eat well or get much exercise
78
tanning beds
- tanning beds are a “category one carcinogen” – the highest cancer-causing risk (cigarettes are also in this category).
- In 2015, the Canadian Cancer Society estimated that 6800 Canadians would be diagnosed with melanoma (the most dangerous type of skin cancer) that year, with about 1150 resulting in death.
- The WHO warns that in those under age 30, the use of tanning beds raises the risk of melanoma by 75 per cent.
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social patterning of behaviour: summary
- Because health-related behaviours are socially patterned, cluster, and follow the social gradient, health behaviour reinforces and expands the differences we see in people’s health based on their income, education, and social position
- Healthy lifestyles make little or no difference to the health of less well off people (because other variables are much more powerful determinants of health)
- We must remain cognizant of the limitations of efforts to change health-relevant behaviour through education, incentives, punitive measures, and regulation. Broader social and economic change is required to improve population health
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how disability effects people
- Disabled women are often treated unfairly because they are women and because of their disability
- Children with hearing, sight or intellectual disabilities usually do worse at school than children with physical disabilities
- People with mental health problems or intellectual disabilities find it more difficult to get and keep jobs
- People with severe disabilities have most problems getting the same rights as other people
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sex differences with disability
- women have more disabilities
- Women experience higher rates of most types of disabilities, including those classified as memory, learning, dexterity, seeing, mental-health related, mobility, flexibility, and pain-related. In contrast, men experience slightly more unknown disabilities, as well as developmental and hearing disabilities.
- sex and gender differences also persist as people age, with more women reporting disability in all age groups
- prevalence of disabilities is increasing for all groups
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disability associated with low employment rates
- The labour force participation rate of people with disabilities is 53.6%, compared with a 76.9% rate across the total population of Canada (Statistics Canada, 2012)
- There is an age- standardized unemployment rate of 14.3%, compared with 7.8% across the country (Statistics Canada, 2012)
- In other words, there is lower rate of employment participation, and the unemployment experienced by people living with disabilities is nearly double that of the total population
- Difficulty sustaining employment (can’t work full time, etc.)
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reasons for disability
- More people are getting diseases which can cause disabilities
- People cannot always get good health care
- People are disabled by war, road crashes or disasters like floods or hurricanes
- People do not eat the right food, or are taking drugs or drinking too much alcohol
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people that are more likely to be disabled
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Are poor
Are women
Are older
Do not have a job
Did not do very well at school
There are more disabled children from poor families or from minority ethnic groups
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barriers for people with disabilities
- People do not use rules properly to give children with disabilities the chance to go to school (integration)
- People do not expect children with disabilities to do well (not setting goals/expectations)
- People with disabilities do not get the services and support they need (accessibility) (lack of funding or available services)
- People with disabilities do not get good quality services
- There is not enough money to pay for services
- People with disabilities can find it difficult to get around, communicate or use transport
- Many people with disabilities are not involved or listened to. This stops them having choice and control
- People do not have enough information about disability, and how different things can effect disabled people.
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human rights code
- The Code clearly protects people against discrimination based on mental, developmental and learning disabilities
- Students with disabilities have the right to be free from discrimination in school
- “Equal” means achieving equal outcomes and substantive equality. Sometimes this means treating people the same way, but it may also mean treating people differently
- For example, building a ramp for a person with a disability is not “equal treatment” in the strict sense because a ramp is something built especially for persons with disabilities; but it is a requirement for a person who uses a wheelchair to have equal access to a building
- If you are a person with a disability, and you are able to do the job or meet the requirements once your needs are met, there is a duty to accommodate those needs unless they are unduly costly or would create real health or safety dangers
- The employer, landlord or service provider should consider outside sources of funding to accommodate your needs if not otherwise affordable
- The requirement must be reasonable and genuine
- If you cannot perform the essential duties or requirements of a job, you should identify any needs that may allow you to do these essential duties or requirements
- Your employer then must try to meet your needs, to the point of undue hardship, which considers costs, any outside sources of funding, and any health or safety concerns
- If needs simply cannot be met or you cannot do the job even after your needs are met, your employer’s duty to accommodate ends and there is no violation of the Code
- A landlord or service provider must then try to meet these needs to the point of undue hardship, which considers cost, any outside sources of funding and any health or safety concerns
- If your needs simply cannot be met or you still cannot access housing or use the service even after your needs have been met, the landlord’s or the service provider’s duty to accommodate ends, and there is no violation of the Code
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health care: people with disabilities need...
- Good, clear information
- Communication in the way that works best for them
- Buildings and services they can get into and use
- Healthcare in places near where they live
- More choice and control over their health care
- Money to help them pay for their health care
- The chance to be involved in training people who give health care so they understand about disability.
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people with disabilities and doing things for themselves
they need:
- Early help and support before things get too bad
- Services and support at home or close to where they live
- Technology like wheelchairs and electrical gadgets that can help them be more independent
- More well trained workers who understand about supporting people to do things for themselves
- Services and organizations that work together to make sure there is enough money for the support they need
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people with disabilities getting help and support
- More support to live in their community
- More services in the community
- Better support for their families or other people who are not paid to care for them
- Support that is planned around their individual needs
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people with disabilities and school
- Most disabled children do better in schools that everyone uses (integration better than segregation)
- Because children grow up and learn together it can help other children understand about disability
- Children with disabilities need:
- Rules to say they have the same right to learn as any other child
- Schools, support and learning plans that meet their needs
- Well trained teachers who know how to involve children with disabilities in ordinary schools
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people with disabilities and getting a job
Most countries have laws to say a disabled person has the same right as anyone else to get and keep a job
People with disabilities need:
- People to think about changes that help someone with a disability do a job
- Training and support to do the job
- Support to keep their job if they become disabled when they are working
- Money to help them set up their own business
- Benefits or other payments to make sure they have more money if they have a job than if they stay at home (does job pay more than welfare)
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role of the government and people with disabilities
- Make sure their laws give disabled people the same rights as everyone else
- Have plans to make sure disabled people can use ordinary services
- Have a national plan for disabled people
- Have rules about good quality services and check people stick to them
- Make sure there is enough money, people, etc. to make the national plan work
- Have rules about making sure disabled people can use buildings, services, transport and information
- Find ways to stop disabled people from being poor
- Collect information about disabled people
- Help the public understand about disability
- Setup ways for people to complain if they think disabled people are not getting their right
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mental illness
disturbances in thoughts, feelings, and perceptions that are severe enough to affect day-to-day functioning
Examples:
- anxiety disorders
- Schizophrenia
- mood disorders (major depressive disorder and bipolar disorder)
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mental health
a state of well-being, and we all have it. Just like we each have a state of physical health, we also each have our mental health to look after. It’s not just about surviving, it’s about thriving. It’s enjoying life, having a sense of purpose, and being able to manage life’s highs and lows
- 1/5 people in Canada will experience a mental health problem or illness in any given year. But 5/5 of us have mental health
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factors that can impact mental health
- available support system
- religion/spirituality
- family influence
- developmental effects
- personality
- demographic location
- negative influences
- culture
- health practices/beliefs
- hormones
- biology
- inherited factors
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who is affected by mental illness?
- 70% of mental health problems have their onset during childhood or adolescence.
- Young people aged 15 to 24 are more likely to experience mental illness and/or substance use disorders than any other age group.
- 34% of Ontario high-school students indicate a moderate-to-serious level of psychological distress (symptoms of anxiety and depression). 14% indicate a serious level of psychological distress.
- Men have higher rates of addiction than women, while women have higher rates of mood and anxiety disorders.
- Mental and physical health are linked. People with a long-term medical condition such as chronic pain are much more likely to also experience mood disorders. Conversely, people with a mood disorder are at much higher risk of developing a long-term medical condition.
- People with a mental illness are twice as likely to have a substance use problem compared to the general population.
- Canadians in the lowest income group are 3 to 4 times more likely than those in the highest income group to report poor to fair mental health.
- Studies in various Canadian cities indicate that between 23% and 67% of homeless people report having a mental illness.
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access to mental health services
- While mental illness accounts for about 10% of the burden of disease in Ontario, it receives just 7% of health care dollars. Relative to this burden, mental health care in Ontario is underfunded by about $1.5 billion.
- Only about half of Canadians experiencing a major depressive episode receive ‘‘potentially adequate care.’’
- An estimated 75% of children with mental disorders do not access specialized treatment services.
- In 2013-2014, 5% of ED visits and 18% of inpatient hospitalizations for children and youth age 5 to 24 in Canada were for a mental disorder.
- Wait times for counselling and therapy can be long, especially for children and youth. In Ontario, wait times of six months to one year are common
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process of addiction development
1) no use
2) experimental use (tried it once or twice) (curious)
3) social use (I use it with friends/on weekends)
4) regular use (use it daily)
5) problem/harmful use (getting in the way of doing things I need to do)
6) dependent use (I need it to function)
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dependency
- tolerance reaction to substance decreases with repeated administration of the same dose. withdrawal symptoms from stopping use will occur
- high rates of dependency: men, young people, Caucasian, aboriginal, low income, unmarried
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epidemiology of substance use
- Binge drinking among Canadian men ranked highest in the world
- Prevalence of alcohol use for Canadians over age 15 years is 78%
- Higher rate of drug use in 15-24 yo compared to 25 yo and older
- Alcohol abuse is tied to suicide attempts and violence
- Of the three categories of pharmaceuticals, opioid pain relievers were the most commonly used in 2017
- Overall smoking prevalence has fallen to 15% of the population
- The rate of death due to alcohol for Indigenous people in Canada is twice that of the general population
- The top 3 substances used in 2012 were alcohol, cannabis, cocaine/crack
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what is harm reduction
- Often used in the context of global health policy, harm reduction is an approach that attempts to reduce adverse health, social, and economic consequences.
- Focus on keeping people safe, and minimizing the negative consequences of when individuals engage in higher risk behaviours, such as using substances.
- There is no universal definition of or formula for implementing harm reduction, as it demands the consideration of the needs and unique circumstances of each individual.
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examples of harm reduction
Needle exchange programs
Safe injection sites
Medical cannabis
Safer sex programs
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tertiary prevention
- Limit and reduce complications related to substance or behavioural abuse and addictions.
- Examples: Specialized addiction detoxification programs (Balmoral Centre), Recovery programs, and concurrent disorder programs.
