Health Promotion

Question 1

What is the high risk approach to public health intervention?

Answer 1

Identifying those at most risk of disease and targeting them with an intervention to protect from the effect of exposure (and screening risk groups).

Question 2

What are the advantages and disadvantages of a high risk approach to public health intervention? (x4 and x6)

Answer 2

ADVANTAGES: effective, efficient, cost effective as there are clearly defined interventions, appropriate and easily evaluated. DISADVANTAGES: palliative (relieves the condition without dealing with cause), temporary (misses a large number of cases – those who are not at such a high risk), risk prediction not always accurate, difficult, costly to screen, hard to change behaviour.

Question 3

What is the population approach to public health intervention?

Answer 3

Recognising that common disease occurrence and exposure reflects society.

Question 4

What are the advantages and disadvantages of population approach to public health intervention? (x3 and x3)

Answer 4

ADVANTAGES: equitable (fair), radical, larger potential for population. DISADVANTAGES: small individual advantage, poor motivation for subjects/doctors, questionable benefit:risk ratio for each individual.

Question 5

What is public health?

Answer 5

Efforts to prevent disease, prolonging life and promoting health through organised SOCIETAL efforts.

Question 6

What three domains does public health operate in?

Answer 6

HEALTH IMPROVEMENT/PROMOTION. PROTECTION (monitoring and emergency prevention/response). SERVICES/CARE (e.g. management, evaluation of efficiency and audits).

Question 7

What are the indicators of health? (x2)

Answer 7

Can look at timeframes or locations/populations. LIFE EXPECTANCY. INFANT MORTALITY.

Question 8

What has happened to life expectancy since the late 1700s and why?

Answer 8

Increased due to epidemiological transition to non-communicable disease – through various interventions e.g. improvement in medicine, focus on public healthcare, hygiene practices…

Question 9

What should be considered when implementing a public healthcare measure? (x4)

Answer 9

COST: is it feasible to roll it out to the whole population? Screening approaches can be expensive, so should it be confined to high-risk groups only? BENEFIT:RISK RATIO: if the individual risk of disease is SMALL, and the intervention carries RISK, can you justify using it? EASE: can the intervention be performed by a range of practitioners across the whole population? ACCESSIBILITY: can all groups in society access the intervention? Will high risk groups see the intervention?

Question 10

What is the prevention paradox?

Answer 10

Most cases of disease come from populations where each individual has a LOW risk, and few come from HIGH risk individuals (e.g. low risk population = 1% of 1million; high risk population 50% of 5000. Statistically, most will come from the low risk population). Therefore, in order to prevent disease, you would have to target everyone, which will only prevent disease in a small proportion, while inconveniencing many. Think of many vaccines, for example.

Question 11

Why do public health decisions vary in different populations and settings? Give three examples.

Answer 11

Different populations will have different health needs, as levels of deprivation play a role in health and disease. E.g. the more affluent a person, the more alcohol consumed, yet binge drinking more common in North. Obesity is more prevalent in lesser deprived regions. 1/4 in manual jobs smoke compared to 1/10 in managerial roles.

Question 12

What are the levels of disease prevention? (x4)

Answer 12

PRIMORDIAL: conditions created so that bad habits never emerge. PRIMARY: targets individuals who MAY BE AT RISK to develop a medical condition and intervenes to prevent the onset of that condition. SECONDARY: targets individuals who have DEVELOPED an ASYMPTOMATIC (no symptoms) disease, and institutes treatment to PREVENT complications. TERTIARY: rehabilitation, damage limitation. Targets individuals with a known disease with the goal of preventing or limiting future complications.

Question 13

What example is there of primordial disease prevention?

Answer 13

National strategy of sex and relationships education to prevent teen pregnancy, because it forms a spiral with teen mums likely to have babies who will also become teen mums – hard to catch up economically and socially which statistically impacts health.

Question 14

What example is there of primary disease prevention?

Answer 14

Women between 25 and 64 years old are offered regular cervical cancer screening to catch disease early.

Question 15

What example is there of secondary disease prevention?

Answer 15

Many clinics now available for STI/Chlamydia testing for early detection and treatment to reduce the spread of STIs.

Question 16

What example is there of tertiary disease prevention?

Answer 16

Policy initiatives bring together mental health, acute and community trusts to support those with a drinking problem in order to help reduce drinking and rehabilitate – helping to prevent future illness e.g. liver cirrhosis.

Question 17

List three commonly targeted public intervention campaigns.

Answer 17

SMOKING: OBESITY: DRINKING:

Question 18

Why is smoking, obesity and drinking common public health campaigns?

Answer 18

SMOKING: 15% population over 18yo smoke, with unemployed and single people smoking more. OBESITY: 26% population are obese, family/living circumstances play a role and there is significant north/south divide – deprived areas have higher levels. DRINKING: approx. 60% over 16yo drink, with binge drinking more common in the North.

Question 19

What is the current population burden of cardiovascular disease?

Answer 19

Account for approximately 30% of deaths and is the most common cause of death. Globally, it is declining, but still high in the middle east and former USSR.

Question 20

What is the trend in age with cardiovascular disease incidence and deaths?

Answer 20

Increases with age.

Question 21

What is the trend in gender with cardiovascular disease?

Answer 21

Higher incidence in men.

Question 22

What are the main risk factors of cardiovascular disease? (x4)

Answer 22

High blood pressure. Smoking. Cholesterol. High BMI – attributable to poor diets and lack of exercise.

Question 23

How can trends in age in cardiovascular disease be linked to high blood pressure and smoking?

Answer 23

High blood pressure increases with age. Smoking is more prevalent in elderly populations. Given that these are both risk factors of CDV, this explains somewhat, the increase CDV incidence with age.

Question 24

How does cholesterol contribute to cardiovascular disease?

Answer 24

Contributes to atherosclerosis and can be caused by obesity.

Question 25

How is cholesterol controlled?

Answer 25

Statins.

Question 26

What cancers are most prevalent in women? (x3)

Answer 26

Breast, colorectum and thyroid – in order. Lung isn’t up there because of how many deaths there are.

Question 27

What cancers have highest mortality in women?

Answer 27

Breast, lung, colorectum – in order.

Question 28

What cancers have highest incidence in women?

Answer 28

Breast, colorectum, lung – in order.

Question 29

What cancers are most prevalent in men? (x3)

Answer 29

Prostate, colorectum, lung – in order.

Question 30

What cancers have highest mortality in men?

Answer 30

Lung, liver and stomach – in order.

Question 31

What cancers have highest incidence in men?

Answer 31

Lung, prostate and colorectum – in order.

Question 32

Why is liver and lung cancer higher in men?

Answer 32

Because men, statistically, smoke and drink more.

Question 33

Where in the world is there greater cancer burden?

Answer 33

Asia.

Question 34

What are the relative mortality rates of cancer across the world? What may this suggest?

Answer 34

Relative mortality rates are higher for cancer in Asian countries (higher percentage when compared with incidence). North America and west Europe – mortality rates are lower relative to incidence. Africa – mortality rates are similar to incidence rates. This suggests that European and US healthcare is potentially more sophisticated or the prevalence of each cancer in each population may differ e.g. Asia may have more higher prevalence of more aggressive cancers.

Question 35

What are the major difference in cancer prevalence between low HDI (human development index) and high HDI countries? (x2) Why may this be?

Answer 35

Cervical cancer has marked higher incidence and mortality in low HDI countries. This may be because of lack of screening, sanity… Liver cancer has marked lower incidence and mortality in low HDI countries – because poorer populations cannot afford alcohol.

Question 36

What are the major risk factors of cancer?

Answer 36

Smoking, alcohol, low intake of healthy food, unsafe sex, obesity?

Question 37

What is the proportion of cancer deaths from infection between developing and developed countries?

Answer 37

8.1% of all cancers attributable to infection in developed countries. 26.9% of all cancers attributable to infection in developing countries.

Question 38

What are the major viruses that lead to cancers?

Answer 38

Hepatitis (leads to liver cancer) and Human papillomavirus (mainly cervical cancer).

Question 39

What is the preventability of cancer and why?

Answer 39

Cancer 1/3 likely to be preventable by controlling environment/lifestyle. Smoking, alcohol and obesity are major risk factors for cancer.

Question 40

What is the difference between incidence, mortality and prevalence?

Answer 40

Incidence: number of new cases in a given year. Mortality: deaths per year. Prevalence: number of people affected with the condition.

Question 41

Why does incidence not necessarily reflect prevalence?

Answer 41

Prevalence of some diseases may be less than their incidence because of higher mortality in the disease.

Question 42

What is the difference between clinical medicine and epidemiology?

Answer 42

Clinical medicine: concerned with CASES OF DISEASE and the disease burden for the INDIVIDUAL PATIENT. Epidemiology: concerned with DISEASE RATES and the burden of disease in POPULATIONS.

Question 43

What is the significance of migrant studies in epidemiology?

Answer 43

Shows that differences in disease prevalence between populations are/are not genetic, and instead are environmental because migrants assumed the same disease profiles as the communities they moved to, rather than retaining those where they came from.

Question 44

What are the most common non-infectious causes of world mortality? (x3)

Answer 44

In order: ischaemic heart disease (coronary heart disease) = 12% deaths; cerebrovascular disease (brain blood vessel disease e.g. atherosclerosis leading to STROKES) = 10% deaths; chronic obstructive pulmonary disease.

Question 45

What is the current burden of infectious diseases – most common diseases? (x6)

Answer 45

Lower respiratory infections – 3.9million deaths in 2002. HIV/AIDS – 2.8million deaths in 2002. Diarrhoeal disease – 1.8million deaths in 2002. TB. Malaria. Measles.

Question 46

What treatment is there for AIDS?

Answer 46

Antiretroviral treatment – ART. Reduced mortality, so prevalence increases. Incidence also increases, because patients are living longer so higher likelihood of transmission. ART decreases viral load – so does still dramatically reduce transmission.

Question 47

What are the disparities in infectious disease burden worldwide?

Answer 47

Much more common in the developing world, and in sub-Saharan Africa – where infectious disease is the LEADING cause of death.

Question 48

Why is there disparity in the incidence of infectious disease across the world? (x4)

Answer 48

Poor sanitation and reduced access to healthcare/medicines. Lower education, and more crowded living conditions.

Question 49

What is screening?

Answer 49

Practice of investigating apparently healthy individuals with objective of detecting unrecognised disease or disease precursors, in order to prevent delay or development of disease.

Question 50

What is the ‘perfect test’?

Answer 50

No false positive or negative results. Not usually the case.

Question 51

Why may screening be important? (x3)

Answer 51

Early intervention may lead to better prognosis. It can identify high risk individuals, which means that interventions can be targeted at them so that the risk of developing the disease is lower. Can help with spread – when diseases pose a risk to others.

Question 52

What are the challenges of screening?

Answer 52

Most participants will not have the disease, and if the negative predictive value (NPV) is not high, the number of false positives will be higher – but at the same time, you don’t want to make a screening test where there’s lots of false NEGATIVES. Screening tests NEED a high sensitivity. May trade for a lower specificity.

Question 53

What are the current UK screening programmes for the antenatal level? (x2)

Answer 53

Screening for ULTRASOUNDS (foetal anomalies, physical abnormalities), and BLOOD TESTS (infection (syphilis, HIV, HepB), Sickle cell disease). Screening can indicate the need for a diagnostic test e.g. amniocentesis. For example, if screening has a positive result for a certain disease, a diagnostic test will be needed to confirm – remember, screening can give false positives.

Question 54

What are the current UK screening programmes for newborns? (x3)

Answer 54

Physical examination. Hearing test. Blood spot for rare metabolic conditions – heel prick test.

Question 55

What are the current UK screening programmes for adult cancers? (x3)

Answer 55

Breast cancer (50-70f), Cervical (25-64f), and bowel (60-74m/f).

Question 56

What other screening tests are offered to adults in the UK? (x2)

Answer 56

AAA (abdominal aortic aneurysm) for 65yo males. Diabetic retinopathy for 12+ males/females.

Question 57

What is validity?

Answer 57

Ability to distinguish between subjects with the condition and those who do not. Denotes high sensitivity AND high specificity.

Question 58

What are the definitions for sensitivity and specificity?

Answer 58

SENSITIVITY: probability that those with the disease are identified. SPECIFICITY: probability that those without the disease are identified.

Question 59

How is sensitivity and specificity calculated?

Answer 59

SENSITIVITY: identified with disease/total number with the disease. SPECIFICITY: identified as healthy/total number who are healthy.

Question 60

What are the definitions for PPV and NPV?

Answer 60

PPV: probability that subjects with a positive test do have the disease. NPV: probability that subjects with a negative test do not have the disease.

Question 61

How is PPV and NPV calculated?

Answer 61

PPV: true positives/total number of positive results. NPV: true negatives/total number of negative results.

Question 62

What must be known/characteristic of a disease for screening programmes to be implemented? (x4)

Answer 62

Disease must be an IMPORTANT health problem – e.g. major cause of death where screening programmes would have wide population benefit. Well-recognised pre-clinical stage – need to be able to recognise the disease before it takes hold. Prognosis of the disease WITHOUT intervention must be known. Long latency period – can’t be a sudden condition that could appear and be fatal between screening periods.

Question 63

What are the criteria for screening programmes? (x8) DVSCSRDT Dave’s Very Sad Crisis Story: Real Dave Tv

Answer 63

Disease characteristics and knowledge – as already mentioned (please see previous flashcard). Valid (sensitive and specific). Simple – needed to be able to administer to the whole population. Cheap – needed to be able to administer to the whole population. Safe and acceptable – otherwise rate of uptake will be low. Reliable. Consequent diagnosis and treatment must be cost effective and sustainable e.g. monogenic diabetes screening will result in need for expensive genetic testing for diagnosis. Effective, acceptable and safe treatment must be available – it is UNETHICAL to screen for something that you cannot treat. DVSCSRDT Dave’s Very Sad Crisis Story: Real Dave Tv – anagram is like a TV programme title and series name.

Question 64

What was the Marmot review?

Answer 64

2010, UK: 6 policy objectives based on social determinants of health. Intervention needs to be upscaled for factors like work, age, where you are born, or health inequalities are widened.