Flashcards in Health determinants, equity and interventions Deck (24):
What is public health?
The science and art of preventing disease, prolonging life and promoting health through organised efforts of society
How does public health differ from individual medicine?
Information is gathered from data, studies and surveys (rather than Hx + examination)
What are the determinants of health?
- Environment (physical, social and economic environment)
- Lifestyle factors (smoking, diet, exercise...)
- Health care
What is the difference between inequality + equity?
Equity is about what is fair + just
Equality is concerned with equal shares
What is horizontal equity? Give an example
Equal treatment for equal need
E.g. individuals with pneumonia (with all other things being equal) should be treated equally
What is vertical equity? Give an example
Unequal treatment for unequal need
E.g. individuals w/ common cold vs pneumonia need unequal treatment
E.g. areas with poorer health may need higher expenditure on health services
What are the different forms of health equity?
- Equal expenditure for equal need
- Equal access for equal need
- Equal utilisation for equal need
- Equal health care outcome for equal need
- Equal health
What are the dimensions of health equity?
Social (age, gender, class [socioeconomic], ethnicity)
What 7 things can you examine in health equity?
1. Supply of healthcare
2. Access to healthcare
3. Utilisation of health care
4. Health care outcomes
5. Health status
6. Resource allocation (health services, education, housing...)
7. Wider determinants of health (diet, smoking, healthcare seeking behaviour, socioeconomic + physical environment
How can you assess health equity?
Typically assess inequality first and then decide if inequitable
Inequalities need to be explained (e.g. may be equity [fair] that there is more money put into poorer areas than richer areas [inequality])
Equality (e.g. equal utilisation) may not be equitable
Equity often defined in terms of equal access for equal need but is measured usually by utilisation, health status or supply
What are the 3 domains of public health practice?
1. Health improvement
2. Health protection
3. Improving services (healthcare)
What is health improvement concerned with?
Concerned with societal interventions aimed at preventing disease, promoting health and reducing inequalities. The interventions are not primarily delivered through health services (e.g. campaigns)
What is health protection concerned with?
Concerned with measures to control infectious disease risks and environmental hazards
What is improving services (healthcare) concerned with?
The organisation and delivery of safe, high quality services for prevention, treatment, and care
Give some examples of 'health improvement'
Give some examples of what 'health protection' works against
- infectious diseases
- Chemicals + poisons
- Emergency response
- Environmental health hazards
How might improving services occur?
- Audit + evaluation
- Service planning
- clinical governance
What types of interventions may be used to improve public health?
- Health service/public health interventions
- Non-health interventions which have an impact on public health (e.g. education)
How can public health / non-health interventions be delivered?
- Individual level
- Community level
- ecological (population) level
What are the key concerns in public health?
- Wider determinants in health
- prevention (primary, secondary and tertiary)
- inequalities in health
Exam Q: explain the difference between primary, secondary and tertiary prevention giving an example for each.
Primary prevention: aims to prevent the onset of disease (reduce its incidence). E.g. Immunisation or statins to prevent CVD
Secondary prevention: aims to detect and treat the disease (already established) early on and prevent complications (i.e. via screening). E.g. breast cancer screening (Early stages), T2DM Rx + complication screen (prevent complications of DM), HTN Rx/monitoring (prevent CVD)...
Tertiary prevention: DISABILITY LIMITATION (prevention/delay of consequences of the advanced symptomatic disease) and REHABILITATION (prevent complete disability after anatomic/phsyiologic changes are stabilised). Aims to improve QoL + reduce symptoms already present. E.g screening for + Mx of DM complications, PT for stroke pts
Exam Q: Explain the difference between horizontal + vertical equity
Horizontal equity: Equal treatment for equal need. E.g. individuals with pneumonia (with all other things being equal) should be treated equally
Vertical equity: unequal treatment for unequal need. E.g. individuals w/ common cold vs pneumonia need unequal treatment. OR areas with poorer health may need higher expenditure on health services
vertical equity shows inequality but is still equitous (fair/just)
Horizontal equity argues that everybody with the same needs should receive the same treatment/access to health care – so two people with diabetes in two different parts of the country should receive the same level of health care. Vertical equity argues that some people have greater needs than others and so should receive unequal treatment, for example it would be equitable for someone with a chronic disease to have more GP appts than someone who is generally healthy.
Exam Q: Explain the difference between public health interventions delivered at the population (ecological) and individual levels, using one example for each to illustrate your answer.
Was covered in health psychology lecture
Health interventions at population level are aimed at health promotion. It involves enabling people to exert control over the determinants of health, thereby improving health. It is done by public health england. E.g. Change 4 life campaign (or Stoptober)
Individual level interventions is based upon a pt centred approach. it is care responsive to individual needs. E.g., smoking cessation clinics?