MODULE 2 Explore why disparities exist and why we reduce them Flashcards

Question

New Zealand's Population from 1971-2031

Answer 1

Year 1971 1991 2011 2031 Population (mil) 2. 9 3. 5 4. 41 5. 19 Median Age 26 31 37 40

Answer 2

Natural decline and absolute decline

Answer 3

occurs when there are more deaths than births in a population - a combination of absolute and structural ageing - more elderly = more deaths

Answer 4

occurs when there is insufficient migration to replace the 'lost' births and increased deaths - not expected to happen in NZ for 70+ years - Happening in some European/Asian countries

Answer 5

measure the pressure on the (economically) productive population Elderly: pop 65+ years/ 15-64 years x 100 Youth pop aged 0-14/ 15-64 years x 100 The dependents per 100 working age population value is increasing for the elderly over the years; For youth, fairly stable, very slightly decreasing. Elderly: from 20-42 per 100 working age pop Youth: 30 to under 30 2026 overlap at about 30

Answer 6

- ethnic and regional variations - dependency ratios cross in 2026

Answer 7

e.g. prevalence of hearing loss expected to double by 2015 Population change in NZ will impact on the health needs of many populations, especially the elderly.

Answer 8

- potentially similar to rural doctor problem? - ethnic-specific needs

Answer 9

In 2011: Every 100 people of working age are 'supporting' 50 dependents in 2061: there will be 70 dependents per 100 working age people. (supporting= paying taxes, buying goods/services)

Answer 10

as the number of dependents increases, the amount of money for the government to spend on other resources (health, education, roads) will decrease (the govt would have to find other ways to obtain revenue)

Answer 11

any event, characteristic or other definable entity, that brings about change for better or worse in health often not due to one factor or exposure usually multi-factorial (multiple factors)

Answer 12

water, shelter, sanitation (VIP) income, employment, education housing and neighbourhoods societal characteristics (e.g. racism, attitudes to alcohol or violence, value on children) - broader level autonomy & empowerment- social cohesion (trust and reciprocity etc)- broader level

Answer 13

Components: **Non-modifiable factor:** - age, sex & hereditary factors **Modifiable factors:** - personal behaviour - family and community influences - rural and urban living and working conditions - national socioeconomic, cultural and environmental conditions (policies to regulate behaviours) - global, financial and ecological conditions.

Answer 14

**concepts** are similar as for individuals, but **nature** of determinants is often different. (not just application of individual perspective to whole population, but including characteristics of the population itself) - determinants of health in populations are also related to the context in which the population exists.

Answer 15

**Agency= empowerment:** personal behaviour family and community influences **Structure= social determinants:** family and community influences rural and urban living and working conditions national socioeconomic, cultural and environmental conditions global, financial and ecological conditions.

Answer 16

- helps **identify risk factors** and **consider levels of intervention** - age, sex & hereditary factors (non-modifiable risk factors) - dashed lines= premeability between factors (no arch operates in isolation from the others; events at one level may impact on factors at another (higher or lower) level - recognises that determinants operate at different scales (micro (individual), meso (family, living, work), macro (national/global))

Answer 17

**Age, Sex and Hereditary Factors:** Age \< 10 years; Parents have asthma **Personal behaviour:** Being active (swimming, football) or not; using inhaler **Family and community influences:** parents etc smoke in the car/house **Rural and urban living and working conditions:** rural areas- 'cleaner' air; urban areas- pollution? opportunities for child to be active **National socioeconomic, cultural and environmental ****conditions:** socioeconomic conditions may dictate the area of residence quality of housing etc. **global financial and ecological conditions:** international trade agreements may impact on the cost of medications for asthma patients

Answer 18

**social and physical environmental conditions/pattern**s (social determinants) that influence choices and opportunities available e.g. eating choices.

Answer 19

capacity of an individual to act independently and make free choices e.g. eating choices

Answer 20

Downstream and upstream interventions

Answer 21

operate at the **micro (proximal) level,** including treatement systems, and disease management

Answer 22

operate at the **macro (distal) level**, such as government policies and international trade agreements

Answer 23

- provides effective intervention points without victim blaming - potentially more efficient economically and more successful than focusing on individuals

Answer 24

- income - education - occupation

Answer 25

**- Personal income** - can be sensitive issue- reporting bias? - absolute measures - categorial measures **- household income** - useful indicator for women, who may not be the main income earner - should be 'equivalised' for comparisons between populations (requires information on family size, dependents etc)

Answer 26

“The social and economic factors that influence what positions individuals or groups hold within the structure of a society” Galobardes B et al. 2006 Indicators of socioeconomic position (part 1) JECH;60:7-12

Answer 27

These must be: objective measurable meaningful

Answer 28

socio-economic status social class social stratification socio-economic background (used at UoA)

Answer 29

1. used to quantify the **level of inequality** within or between societies 2. may highlight **changes to population structures** overtime, between Census periods or even between generations 3. Needed to help **understand relationship between health and other social variables** (age, sex, ethnicity) 4. have been associated with **health and life chances** for as long as social groups have existed.

Answer 30

1. most directly measure the material resources aspect of SEP 2. have a dose-response association with health (the more the better etc) 3. have a cumulative effect over the life course 4. have the greatest potential to change over a short duration

Answer 31

- Attempts to measure knowledge-related assets of an individual - can be measured as a continuous variable (years to complete educ; time in educ considered more impt than achievements) - can be measured as a categorical variable (educational attainment/milestones; specific achievements are important in determining SEP)

Answer 32

1. capture transitions from parent's SEP to personal SEP 2. believed to be associated with our ability to respond to health promotion messages 3. easy to obtain, often good response rate, relevant to all age groups 4. Problems/complications: cohort effects, e.g. different standards of education in different countries

Answer 33

1. jobs grouped by potential income or SEP 2. can be measured as: 3. occupation is transferable 4. widely available 5. difficult to include individuals not currently employed 6. cohort effects: different meanings of different cohorts 7. closely associated with income 8. reflects social standing 9. individuals experience occupational or 'social' mobility over the life-course 10. occupation influences/impacts on:

Answer 34

- The NZ Socioeconomic Index of Occupational Status (NZSEI) - Social class in the UK

Answer 35

- current of longest held occupation - parental occupation in studies of younger populations

Answer 36

occupation of "Head of household" for spouse and dependents

Answer 37

- census data, vital events, surveys - sources of bias (recall, numerator: denominator)

Answer 38

possibly certain privileges resulting from SEP (lawyers, doctors etc)

Answer 39

- social networks - work-related stress - occupational exposure to environmental risks

Answer 40

Housing Culture Population-based services and facilities Social Capital

Answer 41

- tenure- private or social rented? owner occupier? (problematic as many houses are now owned by family trusts) - conditions- overcrowding, insulaiton, damp, mould etc.

Answer 42

- accepted patterns and norms of behaviour within identifiable groups in society - e.g. ethnicity, religion, gender

Answer 43

-access to, and utilisation of, services

Answer 44

- connection with other people - trust, fear and reciprocity

Answer 45

townsend 1990: A state of observable and demonstrable disadvantage relative to the local community or the wider society or nation to which an individual, family or group belongs

Answer 46

another way of measuring people's relative position in society (another way is SEP) - measures focus on **material** deprivaiton

Answer 47

1. **communication** (no access to telephone) 2. **income** (people (18-59) on means-tested benefit) 3. **employment** (people (18-59) unemployed) 4. **income** (households with equivalised income below current threshold) 5. **transport** (no access to a car) 6. **support** (under 60 yo living in a single parent family) 7. **qualifications** (18-59 yo w/o qualifications) 8. **owned hom**e (not living in own home) 9. **living space** (people living in households below equivalised bedroom occupancy threshold)

Answer 48

\* A common mistake that occurs when information for groups of people or areas is used by researchers to describe characteristics of individual participants in a study-- **ECOLOGICAL FALLACY**

Answer 49

- planning and resource allocation - research - advocacy

Answer 50

* Measureable differences or variations in health * differences in health experience and outcomes between different population groups- according to socio-economic position, geographical area, age, disability, gender, ethnic group * i.e. 'the social gradient'

Answer 51

* those inequalities that are deemed to be unfair or stemming from some form of injustice * health inequities are differences in the **distribution** of resources/services across populations which do not reflect health needs * relations of equal and unequal power (political, social and economic) as well as justice and injustice

Answer 52

if average health status is improving, why does the gradient matter? 1. unfair when they are the result ofo underlying structural factors 2. affect everyone 3. largely avoidable 4. reducing it can be cost-effective

Answer 53

Gini= the ratio of the area between the Lorenz Curve and the line of absolute equality (numerator) and the whole area under the line of absolute equality (denominator)

Answer 54

rate difference (absolute measure of inequalities/inequities) rate ratio (relative measure or inequalities/inequities)

Answer 55

a gradient exists for almost all indicators of health, illness or health service utilisation, risk factors and behaviours, regardless of which SEP measure we use - no threshold effect

Answer 56

NZ study of healthy homes (retrofitting insulation RCT) Wider implications: more health society- greater productivity, improve wealth of country, more money in economy

Answer 57

1. in health outcomes 2. in exposure to the determinants of health 3. in health system responsiveness 4. in representation in health workforce disparities in: cardiovascular diseases cancer injury diabetes mantal health (incl self-hearm and suicide) infectious diseases disability (among others) participation in the health workforce

Answer 58

differences

Answer 59

1. differential access to health determinants of exposures leading to differences in disease incidence 2. differential acces to healthcare 3. differences in quality of care received

Answer 60

Structural contribution and societal contribution

Answer 61

that there are values and assumptions widely held in NZ society about the deservedness of different groups of people. both of these powerful drivers have historical (and contemporary) underpinnings. (Societal and structural contributions)

Answer 62

that the power, resources and opportunities of NZ society are organised by ethnicity (as well as clall (deprivation)) in NZ (both Structural and societal contribution are powerful drivers that have historical (and contemporary) underpinnings.

Answer 63

Titanic: remember that an escalator that allows only third class passenger to get to the lifeboats is a leveling intervention, not privileging as prior to this, third class passengers were at a disadvantage in acessing lifeboats as they are farther.

Answer 64

1. structural interventions (more lifeboats, no barriers) 2. social interventions (rights based approach, commitment to review and 'level playing field') 3. not aimed at individual behaviour (not swimming lessons)

Answer 65

Always take into account the history of the problem. e.g. Maori and Pakeha relationship * **know early contact** (initiallly flourished-economically, socially; the beginning of complex changes) * **know official engagement** (colonisation; declaration of independence; treaty of Waitangi, NZ; heralding an era of depopulation, disease and dispossession)

Answer 66

we need to address the structural barriers to equitable access to the determinants of health and to address attitudes in society that stigmatises one group or assigns them differing value

Answer 67

* land alienation * policy alienation (treaty implication) * unequal (inferior) citizenship

Answer 68

social disruption of community breakdown of political power and alliances economic resource depletion and poverty resentment by indigenous people

Answer 69

Treaty Implications (also of colonisation) Different or denied citizenship – Art III – Pensions – Old Age Pensions – 1898 • Equal provisions for Māori and pākehā • [Asians particularly excluded] • Māori access difficult – thru Māori Land Court • Māori regularly removed from rolls • Reduced amount paid to Māori – Social Security Act 1938 • Underpayment continued until after WWII

Answer 70

– entrenchment of poverty & dependency – increased barriers to development – acceptance of inequity by non-indigenous groups – resentment, frustration and anger – social breakdown, crime, high risk behaviours

Answer 71

1. availability 2. accessibility 3. accommodation 4. affordability 5. acceptability

Answer 72

* the relationship of the volume and type of existing services (and resources) to the clients' volume and types of needs. * (provider's side)

Answer 73

* the relationship between the manner in the manner in which supply resources are organised and the expectations of clients * (provider's side)

Answer 74

* the relationship between clients and providers' attitudes to what constitutes appropriate care * (patient's side)

Answer 75

* The relationship between the location of supply and the location of clients, takinga ccount of clients transportation resources, and travel time, distance and cost * (patient's side)

Answer 76

* The cost of provider services in relation to the client's ability and willingness to pay for these services. * (patient's side)

Answer 77

Existence of service barriers Existence, supply, personnel, equipment, materials, facilities related to the provision of resources on both volume and distribution, but NOT the organisation of those resources (that's accommodation)

Answer 78

Organisational Barriers organisation, design, delivery, skill mix increasing the efficiency of existing services through **reorganising** the service delivery so that a **greater output** is achieved for each unit of input. May sometimes overlap with "acceptability" (organisational barriers and facilitators (accommodation) e.g. opening hours; pschosocial aspects relating to improved understanding and communication between clients and sevice providers (acceptability))

Answer 79

Psychosocial barriers psychosocial, health beliefs, cultural, linquistic, racial, ethnic, indigenous, minority status, clients' attitude health beliefs are attitudes, values and knowledge that people have about health and health services that might influence subsequent perceptions of need and use of health services

Answer 80

Geographic barriers Geographic, spatioal, location, transport, distance, remoteness, travel time also considers geographical barriers to services (time, cost, distance)

Answer 81

Financial barriers economic, socioeconomic, cost, financial poverty, disadvantaged, ability to pay financial barrier to access direct cost vs indirect cost (e.g. time taken off work; travel time; petrol etc)

Answer 82

cluture and health beliefs cost language knowledge and awareness service quality etc

Answer 83

types of health services available not all services are recognised and subsidised by ACC lack of knowledge of the services and eligibility of ACC (**_Potential and Realized Access_**)

Answer 84

transportation for the elderly

Answer 85

direct cost vs indirect cost GP surcharge (esp for after hours) value of cost

Answer 86

Opening hours of the srvices (costm ore for after hours services) interpretation services (quality of the interpreter)

Answer 87

Health beliefs (what is a serious injury?) Cultural appropriate services vs guidelines

Answer 88

The physical, social or political setting(s) that prevent dispease while enhancing human health and well-being chronic diseases such as CVD and obesity are associated with environments that favours more sedentary lifestyles and/or poor nutrition (see de chalain and stephenson reading)

Answer 89

* Clean air and water * appropriate housing * access to wholesome food * safe community spaces * access to transport * opportunities to incorporate excercise as part of daily life these are required to keep people healthy

Answer 90

Physical activity obesity cardiovascular disease mental illness traffic calming measures access to resources money spent on food days off work

Answer 91

"all the buildings, spaces and products that are created, or at least significantly modified by people"

Answer 92

Structures Urban Design

Answer 93

homes schools workplaces

Answer 94

Parks business areas roads 1. Above ground: parks, business areas and roads 2. below ground: waste disposal, subway trains 3. across land: motorways/transportation network

Answer 95

1. street network characteristics and design 2. land-use mix 3. housing density 4. site design 5. transport planning

Answer 96

interconnectivity of roads grid-like pattern reduces distance between destination, encouraging the use of 'active transport' \*\* traffic calming and other street design features street width, cycle lanes, traffic management, pedestrian crossings facilities that encourage walking and cycling and discourage driving

Answer 97

food retail accessible supermarkets and local food stores provides a range of nutritious foods at competitive prices \*\* mix of residential, commercial and business uses different uses of land within a given zone increases opportunities for active transport \*\* public open spaces and physical activity spaces open spaces in close proximity to residents; pools, parks, playgrounds increase opportunities for physical activity

Answer 98

density (private dwellings/m2) increasing the number of residential and commercial premises in an area increases active transport

Answer 99

food production home/community gardens cheap, fresh produce may also provide educational and mental-health benefits \*\* street aesthetics adequate lighting, clean parks, provision of public transport and facilities improved safety, creates and environment that promotes active transport and well-being

Answer 100

improve/develop public transport systems bus stops, cycling facilities, access to public transport stops increases active transport

Answer 101

36 facilities representing 6 domains: 1. recreational 2. public transport 3. educational 4. shopping facilities 5. health 6. social

Answer 102

parks beaches

Answer 103

bus ferry stops

Answer 104

childcare primary intermediate

Answer 105

dairy supermarket banks

Answer 106

plunket GP pharmacy A and E

Answer 107

marae churches community halls etc

Answer 108

* measures are often context-specific * urban density * land use mix * street connectivity * community resources

Answer 109

depending on the research question/health outcome of interest

Answer 110

population and/or employment density

Answer 111

residential, commercial, industrial, wasteland

Answer 112

'lollipop' neighbourhoods vs well connected streets

Answer 113

access to recreational facilities or healthy foods

Answer 114

special housing areas

Answer 115

* fast-tracked resource consents for developers * existing neighbours have no right to object * in each SHA, at least 10% of the places must be affordable--defined as about $500k--although officials are hoping for a higher count of cheap places

Answer 116

1. Sites affected by previous uses of the site 2. derelict, or underused 3. mainly in fully or party developed urban areas 4. often require intervention to bring them back to beneficial use 5. may have real or perceived contamination problems

Answer 117

1. 'not good' health 2. limiting long-term illness 3. mortality than wards with no or relatively small amounts of brownfield land

Answer 118

geographical information system a combination of CAD and spreadsheet features have added value

Answer 119

• ‘see’ patterns hidden in tables • Useful for surveillance resource allocation & emergency response • Real‐time tracking and analysis • Data exploration/hypothesis testing • Integration of many data sources easily

Answer 120

• The data – Map is only as good as the raw data – Some users don’t know the basics of map making! – Spatial datasets can be large and/or expensive • GIS requires a steep learning curve – But an increasingly important skill in health! • Not just a map but complex processes and procedures to enable the benefits

Answer 121

used in pop health to identify areas with an elevated 'risk' of a disease

Answer 122

transportation land use census tracts structures postal codes raster imagery

Answer 123

**Relative measures** * risk ratio * extremal quotient (highest rate/lowest rate) * no units **Absolute measures** * risk difference * range (highest rate-lowest rate) * have units

Answer 124

social connectedness access to primary care urban design psychosocial impacts on health

Answer 125

refers to **individual psychological effects** impacting on how people feel AND **social effects** impacting on how they relate to each other chronic stress, disturbed sleep, dislocation, feelings of insecurity, loss, uncertainty, anger

Answer 126

1. initial heroic phase 2. honeymoon phase 3. disillusionment (long-term recovery and rehabilitation) phase 4. the new equilibrium phase

Answer 127

people help not taking into account the cost

Answer 128

people see some help arriving and believe that things will change

Answer 129

people begin to realise how long the recovery will take

Answer 130

in the long term, when things never return to previous state, people find a new "normal" state

Answer 131

screening--trying to see if someone has a specific condition monitoring--seeing people who are already known to have a specific condition

Answer 132

needs to support majority of population (listening, community-led interventions) and cater for the most severely affected (efficient referral systems, specialist care)

Answer 133

relationships people have with others and the benefits these relationships can bring to the individual as well as to society family, whanau, colleagues, neighbours connections made through sport, school, work and vountary/community service networks and skills that help society function effectively = **social capital**

Answer 134

spontaneous volunteering sharing resources with neighbours response agencies to assess wellbeing of residents heightened sense of community due to EQ spending more time with family

Answer 135

1. **context** 2. **character** 3. **choice** 4. **connections** 5. **creativity** 6. **custodianship** 7. **collaboration**