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williams poplhlth (maintenance error) > module 2: identifying the causes of health and dis-ease in populations > Flashcards

module 2: identifying the causes of health and dis-ease in populations Flashcards

lectures 13-21 (62 cards)

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1
Q

What proportion of health outcomes/variation in health outcomes is thought to be about the medical care we receive?

A

11% (10-20%)

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2
Q

What are some of the current health challenges in New Zealand

A

Workforce pressures, infrastructure
Shortage of hospital beds
Budget issues

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3
Q

What are the three goals in the Government Policty Statement on Health

A

Access, timeliness, quality

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4
Q

What are the health targets in the Government Policy Statement

A

Faster cancer treatment
Improved immunisation for children
Shorter stays in ED (95% of patients to be discharged from an ED within 6 hours)
Shorter wait times for first specialist assessment
Shorter wait times for elective treatment (95% of people to wait less than 4 months)

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5
Q

What does ‘gaming’ mean in health

A

Behaviour that makes the measurement of performance better, while not actually improving the quality of care

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6
Q

What are the alternatives to prevent ‘gaming’

A

Make independently verified targets
Have a series of targets that produce a tension - balance across targets
Choose targets that are hard to ‘fix’

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7
Q

What is socio-economic position?

A

The social and economic factors that influence what positions individuals or groups hold within the structure of society

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8
Q

What are the measures of SEP for individuals

A

Education, income, occupation, housing, assets and wealth

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9
Q

Why do we measure SEP?

A

To quantify the level of inequality within or between societies
May highlight changes to population structures over time, between census periods or generations
To help understand the relationship between health and other variables

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10
Q

What are the measures of SEP for populations

A

Area measures - deprivation and access
Population measures - income inequality, literacy rates, GDP per capita

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11
Q

How does SEP relate to health

A

The factors that determine one’s SEP directly influence health

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12
Q

What is deprivation?

A

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
Applied to conditions and quality of life that are of a lower standard RELATIVE to others in society

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13
Q

How is poverty defined

A

Living in poverty refers to a lack of income and resources to obtain the normative standard of living

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14
Q

What are the variables in NZDEP2023

A

Communications - access to internet
Owned home - living in own home
Income - Ages 18-64 receiving a main means tested benefit
Living space - overcrowdedness
Qualifications - Aged 18-64 with no qualifications
Income - income below income threshold
Living condition - Always damp / mould greater than A4 size
Employment - 18-64 unemployed
Support - Aged <75 living in a sole-parent family

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15
Q

What are global determinants of SEP

A

Income inequality
National income (GDP)
Literacy rates
Free trade agreements

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15
Q

What is a social gradient?

A

A linear trend where people who are less advantaged in terms of socioeconomic position have worse health outcomes

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16
Q

What are inequalities

A

Measureable differences or variations in health
Differences in health experience and outcomes between different population groups

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17
Q

What are inequities

A

Inequalities that are deemed to be unfair or stemming from some form of injustice
Health inequities are differences in the distribution of resources which do not reflect health needs

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18
Q

Define inequities (MOH definition)

A

Differences in health that are not only avoidable but unfair and unjust

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19
Q

What are the factors of the PROGRESS model of inequity

A

Place of residence
Religion
Occupation
Gender/sex
Religion
Education
Social capital
Socioeconomic status

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20
Q

Why should we reduce inequities?

A

They are unfair
They are avoidable
They affect everybody
Reducing inequities can be cost effective

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21
Q

What is the Gini Coefficient

A

The ratio between the area between the line of perfect equality and the observed Lorenz curve : The area between the line of perfect equality and the line of perfect inequality

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22
Q

What is the equation to find Gini Coefficient

A

Gini = (A)/(A+B)

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23
Q

What does the Gini coefficient indicate

A

The more concave, the income inequality in a population
0 = very equal society
1 = very unequal society

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24
What are the implications of income inequities
An unequal society Less social cohesion Less trust between groups Increased stress Reduced economic productivity Poorer health outcomes
25
What are the 2 different ways of addressing health inequities
1. Redistribution of resoucres according to need 2. Repractice targets bty using examples of best practice to improve performance of other groups
26
What are the 5 A's of Access
Availability Accomodation Accessibility Acceptability Affordability
27
Define availability
The relationship of the volume and type of existing services to the clients' volume and type of needs
27
Define accommodation
The relationship between the manner in which supply resources are organised and the expectation of clients
28
Define accessibility
The relationship between the location of supply and the location of clients, taking account of client transportation resources and travel time, distance and cost
28
Define affordability
The cost of provider services in relation to the client's ability and willingness to pay for these services
28
Define acceptability
The relationship between clients' and providers' attitudes to what consitutes appropriate care
29
What are the determinants of Ethnic inequities in health
1. Differential access to health determinants 2. Differential access to health care 3. Differences in quality of care received
30
Why do we need population data?
To measure trends (e.g births, mortality, morbidity, migration) Other reasons include unemployment, crime, Health service usage
31
What is population structure and population composition
Population structure is by age & sex Population composition is by other attributes
32
What are sources of data in NZ
The Census Estimated Resident Populations (ERP) Health service utilisation and outcomes (HSU) Integrated Data Infrastructure (IDI) Administrative Population Census (APC)
33
What is an activity-based population
To be counted, you must have had an interaction with the agency
34
What are the benefits of using the Integrated Data Infrastructure (IDI)
Link data from multiple sources to gain system-wide insights View longitudinal, life-course information Identify risk factors and protective factors Predictive risk moedlling Evaluate effectiveness of particular interventions Identify characteristics of groups with positive and negative outcomes Tailor interventions to people based on characteristics they share with groups studied
35
What are the disadvantages of using the Integrated Data Infrastructure (IDI)
Not individual specific (cannot follow individuals who are using services) Selection biases inherent in the data collections?
36
What is structural ageing
The increase in the proportion of the population that is elderly - driven by decrease in fertility rates
36
What is numerical ageing
The absolute increase in the population that is elderly - driven by improvements in life expectancy
37
What is natural decline of population
When there are more deaths than births in a population
38
What is absolute decline of the population
When there is insufficient migration to replace the 'lost' births and increased deaths
38
What is the limitation of NZDEP area deciles
They hide the story in urban neighbourhoods
39
How many deciles and quintiles are there in NZDEP2023
10 deciles, 5 quintiles
40
What are the measures of NZ Index of Multiple Deprivation (IMD)
Employment - the degree at which working age people are excluded from employment Income - the extent of income deprivation Crime - measures the risk of personal and material victimisations: damage to person or property Housing - overcrowded housing and proportion of rented accommodation Health - areas with high level of ill health or mortality Education - yough disengagement and lack of qualification Access - cost and inconvenience of travelling to access basic services
41
What is ecological fallacy
The error that arises when information about groups of peoples, or communities is used to make inferences about individual
42
What is a healthy environment?
Elements needed to maintain good health among the population, example: Clean air and water Appropriate housing Access to wholesome food Access to transport
42
What is the built environment
'All the buildings, spaces and products that are created, or at least significantly modified by people' Includes structures and urban design
43
What are ways in which urban design can improve active travel and physical activity
Street connectivity in a grid-like pattern Traffic calming and other street design features Mix of residential, commerical and business uses (land-mix) Public open spaces
44
What is the Tenants Aid Brigade (T.A.B) equivalent to today
Tenancy Tribunal
45
What is the P.I.G. Patrol equivalent to today
Police Independent conduct authority
46
How many SDGs are there
17 Goals
47
How many SDG targets are there total
169 targets
48
How many indicators are there in total
232 indicators in total
49
What is SDG 3
Good health and well-being
50
What are the 4 "V-s" of big data
Volume: the computing capacity required to store and analyse data Velocity: the speed at which that data are created and analysed Variety: the types of data sources available (text, images etc) Veracity: the accuracy and credibility of data
51
What are the 3 additional 'Vs' of relevance
Variability: the internal consistency of data (reproducable research) Value: the costs required to undertake big data analysis should pay dividends for your organisation and patients Visualisation: the use of novel techniques to communicate
52
What is extremal quotient and how to calculate it
Gap between highest and lowest group (as a ratio)
53
Where do SDGs go on the Dahlgren and Whitehead model?
It can be at any level
54
What are the levels of racism
Internalised, personally mediated, Institutionalised
55
What are the 3 layers of the SDG 'Wedding Cake' model
Biosphere, society, economy

williams poplhlth (maintenance error) (5 decks)

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