FINAL POPHLTH CRAM

Question 1

What are the reasons for the GBD project

Answer 1

Data on the burden of disease and injury from many countries were incomplete

Available data largely focused on deaths and there is little information on non-fatal outcomes

Lobby groups can give a distorted image of which problems are most important

Unless the same approach is used to estimate the burden of different conditions, it is difficult to decide which conditions are most important and which strategies may be the best buys

Question 2

What are the aims of the GBD project

Answer 2

To use a systematic approach to summarize the burden of diseases and injury at the population-level based on epidemiological principles and best available evidence

To take account of deaths as well as non-fatal outcomes when estimating burden of disease

Question 3

What were the key sources of data for DALYs

Answer 3

statistical models developed to get best estimates when data were incomplete

epidemiological studies and surveys
disease surveillance system

vital registration data

Question 4

What were the major impacts of the GBD approach

Answer 4

informed priority setting based on premature death as well as disability

avoided biases due to incomplete data

Methods used could be applied to any population

Non-communicable diseases recognised as a major and increasing problem in low and middle income countries

Drew attention to previously hidden burden of mental health problems and injuries as major health prolems

Question 5

Right to health

Answer 5

1) enshrined in international law
2) extends beyond health care to pre-conditions
3) States obliged to respect
protect and
fulfil
Socal epidemiology links health with social justice and thus links to good government

Question 6

Respect

Answer 6

No discrimination against ethnicity, gender, etc

Question 7

Protect

Answer 7

No interference from 3rd pparties

Question 8

Fulfill

Answer 8

adopt measures to achieve equity

Question 9

What are 2 aspects of right to health that makes it fit with the human rights framework

Answer 9

1) Health inequities are evidence of laws, policies and practices that distribute resources and opportunities in a discriminatory manner and limit full participation

Health is acknowledged as political( power, social context and politics_ and health policy decisions have a legal dimension rather than being purely at political discretion

Question 10

Difference of right to health compared with right to be healthy

Answer 10

Right to health is the responsibility of governments or political power to equalise health outcomes whereas right to being healthy is an individual responsibility

Right to being healthy cannot be guaranteed as it is a function of an individual’s family history and other risks

Question 11

Why should we eliminate discrimination

Answer 11

Because discrimination causes impairment of enjoyment of rights

Question 12

Right to Health history

Answer 12

Universal declaration of Human rights-1948
-didn’t define the parameters of right to health but noted they both include and transcend medical care

The determinants of health contextualised

ICESCR-international covenant on economic, social and cultural rights, that explicitly states rights of health needed

Then in 2000, ICESCR clarified in article 14
that the right to health is not equal to the right to be healthy
related to other human rights and health equity

And gives examples of what the obligations of the states should be

Question 13

What are the 3 levels of influence

Answer 13

The person
The community
The environment

Question 14

The person

Answer 14

Age, sex, biology, behaviour

Question 15

The community

Answer 15

Includes local influences such as the home, workplace and neighbourhood

social capital and

The wider societal levels such as education and the healthcare system

Question 16

What is in The environment

Answer 16

Refers to the cultural, social, political, physical and the built environments

Water quality, clean air
Design of communities, buildings roads, light rail

Knowledge, beliefs, values accepted by a group of people

Emerging or re-emerging toxins affecting populations

Biodiversity, climate change, ecological footprint

Approaches to improving population health

Question 17

Alma ata1978

Answer 17

Protect and promote health of all
advocated a health promotion approach to primary care

gives us the pre-requisites for health

• peace and safety from violence
• shelter
• education
• food
• income and economic support
• stable ecosystem and sustainable resources
• social justice and equity

Question 18

What does the ottawa charter acknowledge

Answer 18

That health is a fundamental right for everybody
It requires both individual and collective responsibility

The opportunity to have good health should be equally availabele
And that good health is an essential element of social and economic development

Question 19

What are the 5 priority action areas

Answer 19

Develop personal skills
Strengthen community action
create supportive environments
Reorient health services towards primary health care

Build healthy public policy

Question 20

Develop personal skills

Answer 20

Life skills education in schools

Question 21

Strengthen community action

Answer 21

self-help groups and community organised services, community initiatives that promote healthy schools, healthy cities
youth health

Question 22

Create supportive environments

Answer 22

implementing air control measures, water and sanitation promgrammes, b

Question 23

Reorient health services towards primary health care

Answer 23

Care process responsive to needs of patients and families

Question 24

How is data collected to estimate HIV prevalence in populations

Answer 24

surveillance systems
epidemiological studies
surveys in health facilities, especially antenatal clinics

Question 25

What are the 5 key things that happen in health protection

Answer 25

predominantly environmental hazard focused Risk/hazard assessment Monitoring Risk communication Occupational health

Question 26

List 6 things that make a suitable screening program

Answer 26

Benefits must outweigh harm RCT evidence that screening program will result in reduced mortality and increase survival cost effective health care system must be able to support all the elements of the screening pathway Needs to reach all those who are likely to benefit from it

Question 27

What is a suitable test

Answer 27

``` reliable safe simple affordable acceptable accurate ```

Question 28

Discrimination

Answer 28

Discrimination travels on various axes of identity-isms Acts on access to and thru' care and quality of care Even if not intentiional, discrimination causes impairment of enjoying rights

Question 29

Right to health in NZ

Answer 29

The code of health and disability service consumer rights

Question 30

What's in the code of health and disability service consumer's rights

Answer 30

Outlines 10 rights including freedom from discrimination and services of an appropriate standard alighns with human rights act

Question 31

What are the 4 features of the NZ Public health and disability ACT

Answer 31

Reducing inequalities one of its purposes main purpose a DHB based health system to foster community participation Treaty of Waitangi clause that notes that no-one will have special privileges on basis of race reducing inequalities focus re-iterated in overarching policy documents

Question 32

UN Declaration on Rights of Indigenous peoples

Answer 32

Preamble states everyone has human rights Indigenous peoples have rights not fully realised Declaration seeks to facilitate full realisation of rights and stronger relationships between indigenous peoples and states

Question 33

What are the 4 factors that shape HIV/AIDS

Answer 33

AIDS related deaths are decreasing and people are living longer with HIV due to improved treatment and expanded access to treatment and care But globally, a high proportion of people with HIV do not know their HIV status, and most people living with, or at risk for HIV do not have access to HIV prevention, treatment and care HIV/AIDs is really multiple epidemics-not all communities regions and populations are affected in the same way In order to reduce the burden of HIV/AIDs-it is essential to tailor the response and interventions to local circumstances and prevalent risk factors

Question 34

Feminisation of the HIV epidemic

Answer 34

refers to the observation that increasing proportions of new infections are among women, primarily due to heterosexual transmission of the infection

Question 35

What are social determinants that influence the acquisition and treatment of HIV

Answer 35

Gender inequalities in rules governing sexual relationships, negotiating condom use, sexual abuse Poverty and low social status, and consequent limited access to education and reproductive health services( less likely that women can access the opportunity for prevention and treatment) Social norms, stigma and discrimination that prevent access to prevention efforts and treatment Problems with disclosure of HIV status, partner notification and confidentiality

Question 36

Gender inequities in feminisation

Answer 36

Women rights to safe sexuality and to autonomy in all decisions relating to sexuality is intimately related to economic independence. This right is most violated in those places where women exchange sex for survival as a way of life Basic social and economic arrangement between the sexes which results both women and men means that often male control increases over women's lives in a context of poverty Unless and until the scope of human rights is fully extended to economic security, women's right to safe sexuality is not going to be achieved

Question 37

Impact on young people

Answer 37

Children particularly vulnerable done through mother to child transmission Half of new HIV infections are among people under 25

Question 38

Mother to child transmission is reduced

Answer 38

by screening pregnant mothers and treating those who are HIV+ with anti-retroviral drugs

Question 39

What are the key sources of bias whe generalising antenatal clinic surveys

Answer 39

Prevalence among pregnant women may not be similar to prevalence among men, children, women-can't extrapolate directly Data from urban antenatal clinics will not represent the prevalence in remote or rural populations Estimates among people attending clinics can defer from those who do not attend clinics

Question 40

How is HIV prevented and controlled

Answer 40

Safer sex: Media, education condoms Safer products: screen blood products for HIV Needle and syring exchange programmes for IV drug users Protect against needle stick injuries INCREASE ACCESS TO HEALTHCARE-voluntary testing, counselling, support REDUCE DISCRIMINATION OF THOSE DISABLED

Question 41

What are the 3 major challenges for the future regarding HIV

Answer 41

Global resources for prevention and care for HIV fall well short of the needs Successful efforts for prevention need to combat stigma and discrimination Inequities in resources and access to health care, make it essential to address the social determinants of health and human rights

Question 42

obesity causes

Answer 42

genetic, metabolic, behavioral and environmental

Question 43

How is obesity distributed

Answer 43

In high income countries, both ages are affected, but disproportionately more in the more disadvantaged groups In low middle income countries, the most affected are middle aged people in urban environments, especially women Underdeveloped countries face a dual burden, as they are still dealing with undernutrition, yet some areas hit with obesity

Question 44

Stereotypic progression of the obesity pandemic

Answer 44

starts in women, middle age, high wealth | then it progresses to men, children low SES, rural

Question 45

What are the 4 kinds of consequences of obesity

Answer 45

Metabolic disorders-Diabetes, cancers Mechanical disorders-arthritis Psychological problems-low self esteem Social consequences-weight discrimination

Question 46

Obesogenic environments

Answer 46

The sum of influences that the surroundings/opportunities/conditions have on promoting obesity in individuals and populations Obesity is the result of people responding to the obesogenic environments they find themselves in The obesogenic environment has physical, exonomic, policy and sociocultural aspects

Question 47

What are 3 global forces that drive the pandemic

Answer 47

Food systems- globalised food supply and technological changes creating cheaper and more available food calories Changes to lifestyle-levels of occupational physical activity, sedentary lifestyles, increased mechanisation, fewer active transport and recreation opportunities Political and economic drivers-drive us to consume in an attempt to improve the economy via market based growth

Question 48

Moderators

Answer 48

Factors which attenuate/accentuate the rise in obesity

Question 49

Drivers

Answer 49

Changes in drivers over time drive changes in outcomes over time

Question 50

Mediators

Answer 50

factors through which the drivers operate

Question 51

What prevents implementation of WHO's prevention strategies

Answer 51

policy resistance-strong opposition by powerful food companies Political timidity and susceptibility to lobbying Muzzling of civil society organisations Weak accountability services Lack of public pressure Inadequate present systems for monitoring population nutrition and weight

Question 52

What are the 3 determinants of health inequalities

Answer 52

Differential access to health determinants and exposures leading to different disease incidence Differential access to health care Differences in quality of care received

Question 53

Globally minorities feel

Answer 53

less listened to spend less time with the healthcare provider Less likely to receive adequate explanations More likely to have unanswered questions More dissatisfied with health service and system

Question 54

Structural issues

Answer 54

Some people find it easier to access services than others. The power, resources and opportunities of NZ society are organised by ethnicity and deprivation

Question 55

Social issues

Answer 55

Social values and moves play a role in inequities There are values and assumptions widely held in NZ about deservedness of different groups of people

Question 56

Leveling interventions

Answer 56

Levels opportunity and risk and removes structural barriers | This is not privilegeing as it raises those in need

Question 57

Treaty of Waitangi ARTICLES

Answer 57

1-Construction of a state sector-who gets to vote Art2- Give Maori sovereignty over their own lands Art3-Different/denied citizenship

Question 58

The Maori text is increasingly recognised because

Answer 58

More hapu signed the Maori text Those who signed it fully knew what they were agreeing to International legal principle grants and preference

Question 59

What are the disparities in health outcome for Maori

Answer 59

Maori have higher mortality rates for all non-elderly ages A gap in life expectancies has persisted over decades between Maori and non-Maori Maori are over-represented in more deprived quintiles

Question 60

What are the 3 reasons why there are disparities in Maori health

Answer 60

1) Colonization 2) Maori land 3) Effects of inferior citizenship

Question 61

colonization

Answer 61

Colonist harboured assumptions No respect for indigenous Notions of superiority and civilisation Notions of deserving and undeserving Many of these beliefs persist today creating social barriers

Question 62

Maori land

Answer 62

confiscation: basis of settler wealth Land alienation: directly impacted health Social disruption: poverty, economic depletion, resentment, breakdown of political power and alliances Child-women ratios fell

Question 63

Effects of inferior citizenship

Answer 63

Entrenchment of poverty, dependency increased barriers to development Acceptance of inequity by the colonists Social breakdown, crime, high risk behaviors