Module 2 Flashcards
(104 cards)
1
Q
What are downstream determinants of health?
A
Micro, proximal level, near to the change in health status. Eg, lifestyle behaviour
2
Q
What are upstream determinants of health?
A
Macro, distal, distant in time and/or place from the change in health status eg. national, policy, legal
3
Q
What is level 1 of the rainbow model?
A
The individual, non-modifiable factors such as age, sex
4
Q
What is habitus?
A
Norms adapted to be socially accepted through influence by people around you
5
Q
What is level 2 of the rainbow model?
A
The community, social and community networks and working conditions. Families and friends,
6
Q
What is social capital?
A
The value of social networks that facility bonds between similar groups of people
7
Q
What are the 6 factors of level 2 - community ?
A
- Physical environment
- Built environment
- Cultural environment
- Biological environment
- Ecosystem
- Political environment
8
Q
What are the 3 high-level components of the living standards framework
A
- Individual and collective wellbeing
- Institutions and governance
- Wealth of NZ
9
Q
What are the 4 capitals
A
- Social capital
- Natural capital
- Physical/financial capital
- Human capital
10
Q
What does structure refer to and what levels of the rainbow model does it fit ?
A
Social and physical environmental conditions that influence choices available. Fits into level 2 + 3 of the rainbow model, determinants
11
Q
What does agency refer to and what levels does it fit on the rainbow model?
A
Capacity of an individual to act independently and make free choices. Fits levels 1 + 2 of rainbow models, empowerment
12
Q
What is SEP
A
The social and economic factors that influence positions individuals in groups hold within the structure for a society
13
Q
Why measure SEP?
A
- Quantify levels of inequalities within or between societies
- Highlight changes to population structures over time
- Show relationship between health and other social variables
14
Q
What are the key measures of SEP for individuals?
A
Education, income, occupation, housing, assets/wealth
15
Q
What are the SEP factors on level 1 of rainbow model?
A
Individual lifestyles factors such as eduction, occupation, income.
16
Q
What are SEP factors on level 2 of the rainbow model?
A
Social and community influences like your parents income, education, occupation
17
Q
What can be used to measure SEP on level 3 of rainbow model?
A
Living and working conditions are area-based measures and can be measured using NZDEP and IMD.
18
Q
What are the 9 features of NZDEP?
A
Communication, income, income, employment, qualifications, owned home, support, living space, living conditions.
19
Q
What is deprivation?
A
Deprivation is a state of observable and demonstrable disadvantage relative to the local community or wider society or nation to which an individual, family or group belongs.
20
Q
What does the Preston curve show?
A
The relationship between life expectancy and income. An increase of GDP has greater impact on life expectancy for low GDP countries/
21
Q
What is equity?
A
Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes
22
Q
what does PROGRESS stand for?
A
Place of residence
Race
Occupation
Gender
Religion
SEP
Social capital
23
Q
What is the Gino coffeficaint equation and number of equity?
A
Gini- A/A+B
0= very equal society
1= very unequal
24
Q
What is RD measure and equation?
A
RD is absolute measure
EGO-CGO
25
What is RR measure and equation?
Relative measure
EGO/CGO
26
What’re teh implications of incomes inequalities?
Unequal society
Less ocail cohesion
Less trust between groups
Increased stress
Reduced economic productivity
Poorer health outcomes
27
Why reduce inequities?
They’re unfair
They’re avoidable
They effect everybody
Cost effective
28
What is meant by commercial determinants of health?
Structures, rules, norms and practices by which business activities designed to generate wealth and profits influence patterns of health and disease across
29
What aren’t h 4 strategies used by the industry (commercial determinants)
Snapping the evidence
Employing narritavives and framing techniques
Constituency building
Policy substitution, development, and implemention
30
What aer the a dimensions of access?
Avalibaity, accessibility, accomodation. Acceptability, affordability
31
What is the definition of access?
Access is the end result of a process flowing from predisposing characteristics and enabling resources through need to ultimate health outcomes
32
What is available (5A’s)
Relationship of the volume and type of existing services to the clients volume and type of needs
33
What is accessibility (5A’s)
Geographical barriers
Relationship between the location of supply and the location of clients
34
What is accommodation (5A’s)?
Organisational barriers
Relationship between the manner in which supply resources are organised and the exception of the clients
35
What is affordability (5A’s)?
Finically barriers
Cost of provider services in relation to the clients ability and willingness to pay for these services
36
What is acceptability (5A’s)
Psychosocial barriers
Relationship between clients and provider attitudes to what constitutes appropriate care
37
What are population based (mass) strategies?
Target whole population, to reduce health risks, improve the outcome of all individuals in the populations, effect full for common diseases or widespread cause. Eg. Vaccine programs
38
What are the advantages and disadvantages of populations based stategies?
Radial- addresses underlying causes
Large potential benefits for whole population
Behaviourally appropriate
Small benefit for individuals
Poor motivation for individuals
Whole population is exposed to downside of strategies
39
What are high risk (individual) strategies?
Focuses on individuals perceived ‘high risk’
Intervention is well matched to individuals and their concerns
Eg. Targets obese adults / drug users
40
What are the advantages and disadvantages of high risk strategies?
Appropriate for individuals
Individual motivation
Cost effective use of resources
Favourable benefit-to-risk ratio
Cost of screening, need to identify individuals
Temporary effect
Limited potential
Behaviourally inappropriate
41
What is the focus of health promotion?
Acts of determinants of wellbeing
Health / wellbeing focus
Enables / empowers people to increase control over and improve their health
Into;lives whole population in everyday contexts
42
Explain the 3 types of healthcare services
Primary: patients regular source of healthcare. Eg GP
Secondary: specialist care, these services are accessed through primary services. Eg. Neurologist
Tertiary: hospital bases care. Eg. Rehab
43
What is the Alma ata ? And what are the prerequisites?
Deceleration for primary healthcare to promote and protect health for all. Health promotion approach to health care.
Prerequisites: peace and safety from violence, shelter, education, food, income, stable ecosystem, social justice and quite
44
What are teh 3 basic strategies of the Ottawa charter for health promotion?
Enable: individual level strategy
Advocate: systems level strategy
Mediate: strategy that Jin’s up individuals, groups and systems
45
What are the 5 priority action areas of the Ottawa charter?
Develop personal skills
Strengthen community action
Create supportive environment
Reorient health services towards primary health care
Build healthy public policy
46
What is the focus of disease prevention?
Disease focus, looks at incidence, prevalence risk factors or impacts
47
What is the primary natural history of disease and prevention strategies?
Occurs before biological onset, before exposure
Limits occurrence of the disease by controlling specific causes and risk factors
Reduced disease incidence
48
What is the secondary natural history of disease and prevention strategies?
After biological onset, asymptomatic phase, early detection to reduce the more serious consequences of disease. Reduces prevalence
49
What is the tertiary natural history of disease and prevention strategies?
Symptomatic phase of biological onset, reduce the complications of established disease. Prior to outcome (recovery, death, disability)
50
What is the focus of health protection?
Environmental hazard focused.
Risk / hazard assessment
Occupational health and monitoring
Risk communication
51
What are the 4 categories of screening criteria?
Suitable disease
Suitable screening test
Suitable treatment
Suitable screening program
52
What falls under suitable disease? (Screening)
Should be an important and common health problem
Early detection does lead to better outcome
Detectable disease
Knowledge about disease and treatment
53
What fall sunder suitable screening test ?
Reliable test with consistent results
Safe, simple, cheap, accurate (sensitivity and specificity)
54
What falls under suitable treatment (screening)?
Effective and accessible treatment
Evidence based policies covering who should be offered treatment and the appropriate treatment to be offered
55
What falls under suitable screening program?
Benefits must outweigh harms
The healthcare system must be able to support all elements of the program
Needs to reach all who are likely to benefit
Increased survival time (lead and length time bias)
56
What is sensitivity? + equation
The likelihood of a positive test in those with the disease
True positives / all with disease x100
If value is high, proportion of true positives is high
57
What is specificity + equation?
The likelihood of a negative test in those without the disease
True negatives / all without disease x100
If value is high, proportion of true negatives is high
58
Are sensitivity + specificity and PPV and NPN fixed or not?
sensitivity + specificity- fixed
PPV and NPN - not fixed
59
What is PPV and equation?
The probebility of having disease if the test is positive
True positives / all who test positive x 100
60
What is NPN and equation?
The probability of not having disease if the test if negative
True negatives / all who test negative x 100
61
What is lead time bias?
Overestimation of survival duration due to earlier detection by screening than clinical presentation.
62
What is length time bias?
Overestimation of survival duration due to the relative excess of cases detected that are slowly progressing.
63
What are the 3 evidence bases measures?
Descriptive, explanatory, evaluative
64
What does the evidence based measure - descriptive- cover?
Who is effected and the trend of the disease
65
What does the evidence based measure - explanatory- cover?
The determinants and risks, who the disease mainly effects
66
What does the evidence based measure - evaluative- cover?
How to improve health outcomes, does an intervention improve health outcomes, economic feasibility
67
What is PAR and the equation?
PAR is the amount of ‘extra’ disease attribution to a risk factor in a particular population
PAR= PGO-CGO
68
What was the purpose of GBD project?
To create a source of data on the burden of disease globall
69
What are the 2 aims of the GBD project?
Use a systematic approach to summarise the burden of disease and injury at the population- level
To account for deaths as well as non-fatal outcomes when estimating the burden of disease
70
What does DALY sand for and what is the equation (in words )
DALY= YLL +YLD
Disability adjusted life years = Years of life lost + years lived with disability
71
What is YLL?
YLL represents mortality by counting the years lost to premature death in comparison to the average life expectancy in that country
72
What is YLD?
YLD represents morbidity by counting the years lived with disease - cases with non-fatal outcomes
73
What are the 3 groups in GBD? and their trends on a global level
1. Communicable disease- global decrease
2. Non-communicable disease - global increase
3. Injury- global increase
74
What are DALY trends globally in 1990 vs 2019?
1990: communicable diseases as main cause of DALYs
2019: non-communicable disease as main cause of DALYs
75
What are the trend in NZ of DALYs 1990 vs 2019?
1990: non-communicable disease as main cause of DALYs
2019: non-communicable disease as main cause of DALYs
- neoplasms is no.1 cause in 2019
76
What groups from the GBD are expressed mainly in low and high income countries?
Low: communicable disease
High: non-communicable disease
77
What were the 2 gains from the GBD project ?
Drew attention to previously hidden burden of mental health and injury’s as major public health outcomes
Recognised NCDs as major and increasing problem in low and middle income countries
78
What are the 2 challenges faced by GBS project?
1. Disability weights are considered the same as the severity of an impairment relating to a disease
2. Criticised for representing people with disabilities as a burden
79
What is the medical model of disease?
View taken by GBD, that disabled people are defined by their condition and therefore disability is an individual problem. This promotes the view of disabled people as dependant and needing to be ‘cured’ or cared for
The dabbled person is the problem not society
Control resided with professionals
80
What is the social model of disability?
Disability is no longer seen as a individual problem but as a social issue caused by police’s, practices nad attitudes
Social model focuses on ridding society of barriers rather than relying on ‘curing’ those who have conditions
81
What is the global trend in NCD’s and what is this transition called?
The leading cause of DALYs have changed from communicable diseases to NCDs since the 1990s, this is known as the epidemiologic transition
82
What are the causes of deaths contributing to GBD by socioeconomic status?
Low income: increase in non-NCD and NCD
Middle income: NCD + non-NCD present - “double burden”
High income: NCD increasing
83
What is the definition of risk transition?
Changes in risk factor profiles as countries shift from low to high income countries, where common risks for perinatal and communicable disease are replaced by risks for NCDS
84
What is the definition of ‘double burden of disease’?
The presence of pronation, communicable and NCD coexisting with increasing risks. Mainly an issue in middle income countries, which requires a double response
85
What are the 2 things that have driven commercially the smoking epidemic?
1. Social norms have changed
2. A greater emphasis on downstream strategies has put equity in public health at risk
86
What is the definition of ‘industrial epidemic’?
Diseases arising from over-consumption of unhealthy commercial products
87
What are the 5 strategies used by the industry?
Shaping the evidence
Employing narriavtes and framing techniques
Consistency building
Policy substituents
Opposition to policy development
88
How was NZ prepared from Covid? + position on Global Health Security index.
NZ was ranked 35 by the GHS, the only plan was a 6 phase that catered to influenza virus not Covid
89
What 5 factors shaped NZs initial response to Covid?
Clear objectives,
Modeling of potential scenarios
Expert technail advice from range of scientists
Constant observation of the situation globally
Discussions with aus colleagues
90
What were teh trends in Covid case number NZ + Aus and globally?
NZ + Aus: similar case numbers per 1 million people
Global: Higher case numbers despite lockdowns in place
91
What are teh 3 things disease impact is detemined by?
1. How many people get infected
2. How severe the infection is
3. The availability and effectiveness of vaccines
92
What is there to know about the Covid vaccine?
Vacines were developed in record time, highly effeicvte (95% protection), population needed to be double vax to achieve herd immunity. Nz reached >90% double dose
93
What were teh 3 important things when communicating information about Covid 19
1. Channels: relevant, accessible, trustworthy
2. Message: appropriate, co-designed, tested
3. Messenger: trusted, credible
94
What can be said about ‘trust; in relation to Covid ?
no was the only country in the western democracy that had an increase in trust between 2021 and 2022.
Kiwis have lower trust in journalist and CEO but High trust in government leaders + health authority compared to global .
80% more trust in public health service
Scientists are most trusted group in NZ
95
What stats are there about equity for Covid?
Māori and Pacific have 2-2.5 times higher death risk compared to Auropean in all age groups
The most deprived 20% of the population had 3 times the risk of those in the least 20% deprived
Those with 1 or more comorbidites had 6.3 times the risk of those without
96
What are the global HIV trends- cases, new cases, death?
Cases: increasing
New causes: decreasing
Deaths: decreasing
97
Who are at high risk for HIV?
Gay men, women and men, sex workers, injecting drug users, those receiving injections with in-sterilised needles, infants born to or breast fed by HIV+ mother, anyone receiving un-screening blood products
98
What are the 3 social determinants driving the HIV pandemic?
1. Harmful social norms that promote harmful power dynamics
2. Early school drop out, poverty and financial dependence
3. Lower access to health services
99
What is feminisation?
The observation that increasing proportion of new infections are among women, primarily, due to heterosexual transmission of the infection
100
What are the 3 preventions to address social determinants of HIV infection?
1. Safer sex
2. Safer products
3. Increase access to health
101
What are the impacts of antenatal screening? - stats
Without treatment 1/3 of children born to HIV+ women will become infected
Risk is reduced with anti-retroviral drugs
102
What are the direct and indirect effects of climate change?
Direct: drought, heat, fire
Indirect: spread of disease
103
How will a plant based diet help reduce greenhouse emissions?
More effective land use, less water use/ pollution
104
What does the planetary boundaries show?
A guide for sustainable development, where fundamental social goals are met without breaking ecological ceiling
