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NEW XIA POPLHLTH > Mod4 > Flashcards

Mod4 Flashcards

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1
Q

Prior to the GBD project

A

There was a large individual healthcare focus

We only considered mortality data and hospitalization

There was very limited global, regional information on behaviours/exposures that are important risk factors for death/disability

Many countrie’s data on non-fatal disease and injury was incomplete

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2
Q

What are the aims of the GBD project

A

Use a systematic approach to summarise the burden of disease and injury at the population level, using epidemiological principles and evidence, and aid in setting health service and research priorities

Aid in identifying disadvantaged groups and targeting interventions

Develop projection scenarios of mortality and disability

Take into account non-fatal outcomes as well as deaths

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3
Q

What are the 3 groups of diseases in the GBD project

A

1) communicable diseases
2) Non-communicable diseases
3) Injuries

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4
Q

Definition of DALYs

A

disability adjusted life years- this is a summary measure that combines data on premature mortality and non-fatal outcomes to represent a population’s health as a single number

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5
Q

Why do we use DALYs

A

It enables comparisons between outcomes and diseases by giving a common ground
It enables assessment of changes in disease burden over time

It can be used to test interventions

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6
Q

YLD

A

Years of life lived with disability

Number of cases of non fatal outcome

average duration of non fatal outcome until death/recovery

A disability weight

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7
Q

YLL( recheck this definition with teacher slide)

A

Years of life lost due to premature death

Number of deaths from a disease per year

Number of years lost per death relative to the idea age in that population

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8
Q

What are the biggest gains of the DALYs approach

A

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

Recognised that NCDs are a major and increasing problems in low /middle income countries

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9
Q

What are the limitations of DALYs apprach

A

Who decides on disability weights-need a fair panel

A global set of disability weights is unreasonable as there is different impact on societal opportunities, and the burden of disease may be different in different countries

Considers only biological disability and not how physical/social environments influence disability expereince

May represent the disabled as a burden

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10
Q

Policy complications from GBD findings

A

eVIDENCE BASED HEALTH POLICY FORMATION REQUIRES REGULAR update of global, regional, national and subnational information

Since the epidemiological transition is underway in developing regions, the focus of policy debate/research must shift to adult health agenda

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11
Q

What is the medical model of disability

A

Defines disabled people by their condition

Regards disability as the individual’s problem

Views the disabled people as dependent

Control resides with professionals

Choices for individuals are limited to options provided by experts

Deficit model

Systematic exclusion

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12
Q

Social model of disability

A

Sees disability as a social issue(policies, practices, attitudes, environment)

Focuses on ridding society of barriers (not curing)

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13
Q

What are the 3 recommendations by the WHO Commision on the social determinants of health

A

Improve daily living conditions
tackle the inequitable distribution of power, money and resources

Measure and understand the problem and assess the impact of action

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14
Q

Epidemiologic transition

A

The characteristic shift in common causes of death/disability from perinatal and communicable to non-communicable diseases

Influenced by the strength of causal association between the risk factor and health condition

Prevalence of risk factor in a population

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15
Q

Risk transition

A

As countries shift from low to high income, risk factor profiles change from communicable to nocommunicable risks,

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16
Q

Double burden of disease

A

Middle income countries are in the middle of the risk transition, so are struggling with both G1 and G2 riks factors and diseases. This places enormous pressure on the health care systems

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17
Q

Industrial epidemic

A

Diseases arising from overconumption of unhealthy commercial products

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18
Q

What is WHO’s MPOWER strategy for tobacco

A

Monitor tobacco use and preventative policies
Protect non smokers from tobacco

Offer help to quit programs
Warn about dangers of tobacco
Enforce bans on tobacco promotion
Raise taxes on tobacco

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19
Q

hOW DOES THE COMMERICAL SECTOR DRIVE ncd inequalities

A 
Marketing unhealthy commodities
Marketing to vulnerable targets
Changing environments
Reinforcing power inequalities
Targeting young children
Higher outlet density in poor areas
Exposure in films

Exploiting behavioural change difficulties

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20
Q

What is the right to health

A

The right to the enjoyment of the highest attainable standard of physical and mental health available in a community

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21
Q

What are the 5 key aspects of the right to health

A

An inclusive right-includes underlying determinants of health
Contains freedoms- from torture, cruel treatment, non consensual medical treatment

Contains entitlements- to equal opportunity, to access, to health information to participation in health decision making

Non discrimination- health services/ goods without discrimination

Services, facilities must be available, accessible, acceptable and of good quality

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22
Q

What are the 3 obligations of the state

A

Respect- the state cannot infringe on/interfere with the right to health

Protect- the state must prevent 3rd parties from interfering with the right to health

Fulfil- the state must proactively adopt active measures to achieve equity

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23
Q

What is meant by discrimination

A

Any distinction/restriction/exclusion made on the basis of various grounds which impairs/nullifies the recognition or exercise of huma rights and fundamental freedoms

i.e, linked to marginalisation of specific groups

Marginalised/discriminated groups bear a disproportionate share of health problems

Impacts many layers of determinants

Root of fundamental structural inequalities
Even unintention, it is still a violation if it impairs the enjoyment of rights

A right to health implementation is under political/legislative judicial action at a national or global level. Right to health framework goes beyond medical, ethical quality issues to focus on accountability

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24
Q

A human rights approach

A

Human rights are interdependent, indivisible and interrelated

A point of leverage to promote action

Internationally agreed upon standards that governments sign up to and are held accounatble for

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25
What are the 3 different determinants of health inequalities of Maori health
differential access to health determinants, exposures leading to different disease incidence Differential access to health care Differences in quality of care received
26
Disparities minorities feel
Minorities feel 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
27
What are some structural issues of inequality
Some people find it easier to access services than others. The power, resources and opportunities of NZ are organised by ethnicity and deprivation
28
What are some social issues of health inequalities
Social values play a role in equities There are values, or assumptions widely held in NZ about deservedness of different groups of people
29
What are some trends with Maori
Maori have a higher mortality rate for all non-elderly ages A gap in life expectancies has persisted over decades between Maori and non Maori Maori are overrepresented in more deprived quintiles deciles They have lower participation in the health workforce Worse rates of survival Less interaction with health services
30
Historical processes that drove Maori inequalities
Colonisation Land seize Effect of inferior citizenship
31
How did colonisation have an effect on Maori
Colonists harboured assumptions No respect for indigenous people There are notions of superiority and civilisation Notions of deserving and undeserving Many of these beliefs persist today, creating social barriers
32
Maori land
confiscation- basis of settler wealth Maori were land based people, it caused social disruption, poverty, economic depletion, resentment, breakdown of political powers and alliances Child women ratios fell
33
Effects of inferior citizenship
entrenchment of poverty, dependency Increased barriers to development acceptance of inequity by the colonists Resentment and anger among Maori Social breakdown, crime, high risk behaviors
34
What are some stats about adolescents
1 They are one sixth of the world's population 2) There is a larger cohort of adolescents today than ever before 86% of them live in low income and middle income countries 3)Many adolescent disease and injury burdens are preventable or treatable but are often neglected
35
What is the global trend of DALYs
Mental health and substance abuse has been the leading cause of DALYs some communicable diseases going down, and some non-communicable diseases going up
36
Youth is defined as
10 to 24 year olds
37
Trends of deaths for global
Injuries are the leading cause of deaths in 2016 Some communicable diseases- diarrhoea and lower respiratory infections going down HIV going down
38
Where you live matters for youth causes of DALYs
high income countries are a lot about mental health+ road injuries Like in africa, you see a lot of communicable diseases and HIV asia gives a mixxed picture, injury typically at the bottom except for africans though patterns variable
39
Leading global risk factors trends
alcohol use always no.1 cause for deaths for 15-19 year olds Unsafe sex exploded from 11 to 2. Communicable disease risk factors tend to go down the board but still quite damn high.
40
Youth NZ facts
It was a cross-sectional survey that included a random sample of students attending NZ secondary schools Each student in secondary schools had an equal probability of being invited to complete the survey if they were at school
41
Recruitment error of Youth2000
Survey response rate was about 70% so it was reasonably representative of young people in secondary schools in NZ However, there is recruitment bias as it did not interview people not at school- those who dropped out or have significant disability that cannot complete the survey These people's interests are likely to be under-represented
42
Youth 2000 | blind and objective measurements
It employed M-CASI technology, which hopefully promoted a sense of privacy of information among students Strengths- This may more likely cause young people to provide honest answers, hence less measurement bias Students are more likely to respond and complete the survey because they enjoyed the experience of a novel technology- maybe better response rates This again may have some errors- We can't get back to youth whose responses may indicate they are vulnerable or at risk because the survey is anonymous Students with some disabilities or language difficulties may not complete the survey
43
Measurement bias of youth2000
It was anonymous and confidential which would increase the likelihood of honesty But it was self reported: youth may feel more inclined to provide socially desirable rather than completely honest answers
44
What is the inverse care law
The availability of good medical or social care tends to vary inversely with the need for it in the population served
45
Causal relation error | Youth 2000
cross sectional studies | bradford hill criterion of temporality unlikely to be fulfilled
46
Resilience
refers to the ability to spring back despite adversity People with various protective or resiliency factors may be less vulnerable to harm despite exposure to risk The presence of resiliency factors is associated with a reduction in health risk behaviours
47
What the youth 2000 has found about neighborhood caracteristics and wellbeing
Family connections School connections Community connections all play a role Family members care, time with family, feel safe, feel part of school, friendships, caring neighbours, workmates, volunteer roles, etc
48
What are the 4 systematic disparities exemplified in Maori health
There are systematic disparities in health outcomes, in exposure to the determinants of health In health system responsiveness and in representation in health workforce
49
What are the determinants of ethnic inequities in health
1) Differential access to health determinants or exposures leading to differences in disease incidence 2) Differential access to health care 3) Differences in quality of care received
50
Right to health | Universal declaration of human rights-1948
everyone has a right to the standard of living adequate for the health and wellbeing of himself including medical care and... Didn't define parameters of right to health but noted they both include and transcend medical care
51
international covenant on economic, social and cultural rights 1966 UN
explicity right to health and steps states should take to realise progressively the maximum available resources to the highest attainable standard of health gives examples of inclusions able to evolve etc and expectation of international co=operation
52
Right to health is not right to be healthy
memorise
53
What are some things icesr (international covenant on economic, social and cultural rights) clarifying
right to health is not the same as right to be healthy R2H is related to other health rights and health equity Itemises some freedoms from and entitlements to obligations of the state
54
5 basic facts about right to health
enshrined in international law extends beyond health care to pre-conditions Includes freedoms and entitlements States oblighed to respect, protect and fulfil social epidemiology links good health with social justice
55
What does respect mean in r2h
no discrimination
56
what does protect mean
no interference from 3rd parties
57
what does fulfil mean
adopt measures to achieve equity
58
Human rights framework to R2H
Health inequities are evidence of laws, policies and practices that distribute resources and opportunities in a discriminatory manner and limit full participation Health is acknoledged as political and health policy decisions have a legal dimension rather than being purely political discretion
59
Right to health in NZ | The code of health and disability service consumer's rights
Outlines 10 rghts including freedom from discrimination and services of an appropriate standard Aligns with human rights act Code in part a response to ethical issues in health services research
60
purpose of NZ Public health and disability act
reducing inequalities as one of it's purposes No explicit mention of R2H but main purpose a district health base based health system to foster community participation to acknowledge a treaty of waitangi clause-that no one will have special privileges on basis of race
61
Treaty of Waitangi and right to health
affirms indigenous rights as does 1835 declaration of independence good governance didn't sign for a bad deal Active protection taonga-te reo claim

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