module 3: preventing dis-ease & improving (promoting) health of population

Question 1

What are the 3 population health actions

Answer 1

Health promotion, disease prevention, health protection

Question 2

What is a population based (mass) strategy

Answer 2

Focuses on the whole population
Aims to reduce the health risks/ improve the outcome of all individuals in population
Useful for a common disease or widespread cause

Question 3

What is a high risk (individual) stategy

Answer 3

Focuses on individual perceived to be a high risk
The intervention is well matched to individuals and their concerns

Question 4

What are advantages and disadvantages of a population-based (mass) strategy

Answer 4

Advantages:
Radical - addresses underlying causes
Large potential benefit for whole population
Behaviourally appropriate

Disadvantages:
Small benefit to individuals
Poor motivation of individuals (unless legislative)
Whole population is exposed to any downsides

Question 5

What are advantages and disadvantages of a high risk (individual) strategy

Answer 5

Advantages:
Appropriate to individuals
Individual motivation
Cost effective use of resources
Favourable benefit to risk ratio

Disadvantages
Cost of screening, need to identify individuals
Temporary effect (e.g must screen often)
Limited potential (small proportion of entire population
Behaviourally inappropriate (against social norms)

Question 6

What is health promotion

Answer 6

Acts on determinants of wellbeing
Health/wellbeing focus
Enables, empowers people to increase control over and improve their health
Improves whole population in everyday contexts

Question 7

What is primary, secondary and tertiary care in healthcare system

Answer 7

Primary care: regular source of healthcare, e.g GP, pharmacist
Secondary care: specialist care, e.g dermatologists
Tertiary care: hospital based care, rehabilitation

Question 8

Where level of healthcare service does health promotion act on

Answer 8

Primary care mostly

Question 9

What is Alma Ata 1978

Answer 9

Decleration for primary health care
Protect and promote health of all
Advocated a health promotion approach to primary care

Question 10

What are the prerequisites for health according to the Ottawa Charter

Answer 10

Peace and safety from violence
Shelter
Education
Food
Income and economic support
Stable ecosystem and sustainable resources
Social justice, equity

Question 11

What is the Ottawa Charter for health promotion

Answer 11

Acknowledges that health is a fundamental right for everyone
Equity lens - equally available for everyone
That good health is an essential element of social and economic development

Question 12

What are the 3 basic strategies of the Ottawa Charter 1986

Answer 12

Enable, advocate, mediate

Question 13

What are the 5 priority action areas of the Ottawa Charter

Answer 13

Develop personal skills
Strenghten community action
Create supportive environments
Reorient health services towards primary health care
Build healthy public policy

(Big Cats Smell Dead Rats)

Question 14

What is disease prevention

Answer 14

Disease focused
Looks at particular diseases (or injuries) and the ways of preventing them

Question 15

What are the types of disease prevention strategies

Answer 15

Primary - limits the occurrence of disease by controlling specific causes and risk factors (reduces incidence)
Secondary - early detention to reduce the more serious consequences of diease (reduces prevalence)
Tertiary - reduces the complications of established disease

Question 16

What is health protection

Answer 16

Predominantly environmental hazard focused
Risk/Hazard assessment
Occupational health and monitoring
Risk communication

Question 17

Is screening a primary, secondary or tertiary prevention?

Answer 17

Screening can be primary, secondary or tertiary

Question 18

What is the flow diagram of screening for disease

Answer 18

Screening test, then diagnostic test. If +ve then intervention / specialist care treatment

Question 19

What is the 4 parts of screening criteria

Answer 19

Suitable disease, suitable screening test, suitable treatment, suitable screening programme

Question 20

What are the main features of a suitable disease for screening

Answer 20

A relative common condition
Or a relatively uncommon disease if we know that early detection can lead to better outcome

Question 21

Why is a disease marker at an early stage good for screening

Answer 21

Increased duration of pre-clinical phase, so more time for interventions

Question 22

What are the factors of a suitable test

Answer 22

Reliable (provides consistent results)
Safe
Simple
Affordable
Acceptable
Accuracy (sensitivity, specificity)

Question 23

What is sensitivity of a screening test

Answer 23

The likelihood of a positive test in those with the disease
True positives / (True positives + False negatives) or a/(a+c)

Question 24

What is specificity of a screening test

Answer 24

The likelihood of a negative test in those without the disease
True negatives / (True negatives + false positives) or d/(d+b)

Question 25

What are the fixed characteristics of a screening test

Answer 25

Sensitivty and specificity The sensitivity is high if the proportion of true positives is high The specificity is high if the proportion of true negatives is high

Question 26

What is Positive Predictive Value (PPV) in screening test

Answer 26

The proportion who really have the disease of all people who test positive The probability of having the disease if the test is positive a/(a+b)

Question 27

What is negative predictive value (NPV) in screening tests

Answer 27

The proportion who are actually free of the disease of all people who test negative The probability of not having the disease if the test is negative d/(c+d)

Question 28

Why are PPV and NPV not fixed characteristics

Answer 28

They reflect both the test accuracy and the prevalence of disease in the population

Question 29

What happens to PPV and NPV if the prevalence is high or low?

Answer 29

If prevalence is high, there will be more false negatives (so NPV decreases, PPV increases) If prevalence is low, there will be more false positives (so PPV decreases, NPV increases)

Question 30

What are the factors of a suitable screening programme?

Answer 30

Benefits must outweigh harm RCT evidence that screening programme will result in: reduced mortality and increased survival time The healthcare system must be able to support all elements of the screening pathway Cost effective Needs to reach all those who are likely to benefit from it

Question 31

What are the 2 types of time bias in screening programmes

Answer 31

Lead time bias - bias due to earlier diagnoses, hence an apparent increase in life expectancy Length time bias - screening is more likely to detect 'slow forms' of disease compared to rapidly progressing disease

Question 32

Describe Te Pae Mahutonga

Answer 32

Based on the Southern Cross as a navigational aid 4 central stars (key tasks) and 2 pointers (pre-requisites)

Question 33

What are the 4 key tasks of Te Pae Mahutonga

Answer 33

Mauriora - Access to Te Ao Māori Waiora - environmental protection Toiora - healthy lifestyles Te Oranga - Participation in society

Question 34

What are the 2 prerequisites of Te Pae Mahutonga

Answer 34

Ngā Manukura - health professional and community leadership Te Mana Whakahaere - capacity for self governance and autonomy, community control and enabling political environment

Question 34

Why do we need to prioritise in health

Answer 34

There is limited resources such as money to find all the health problems we would like to

Question 35

What are the 4 parts of the population health framework

Answer 35

1. Define the problem 2. Identify risk and protective factors 3. Develop and test prevention strategies 4. Assure widespread adoption

Question 36

What are the evidenced-based measures of establishing priorities

Answer 36

Descriptive Explanatory Evaluative

Question 37

What is Attributable Risk (AR)

Answer 37

The amount of extra disease attributable to a particular risk factor in the exposed group (Same as RD, EGO-CGO)

Question 37

What are epidemiological measures used in prioritisation?

Answer 37

Population Attributable Risk (PAR) YLL and YLD

Question 38

What is population attributable risk (PAR)

Answer 38

The amount of "extra' disease attributable to a risk factor in a particular population This is the amount of disease we could prevent if we removed the risk factor from the population (theoretically)

Question 39

What is the equation for PAR

Answer 39

PAR = PGO - CGO PGO = positive cases / total population

Question 40

What happens to PAR when prevalence of disease increases in the population

Answer 40

As prevalence increases, PAR will increases

Question 41

What type of prevention strategy is PAR used in

Answer 41

PAR is used as a measure for population based (mass) strategies

Question 42

Describe descriptive evidence, explanatory evidence and evaluative evidence

Answer 42

Descriptive - who is most/least affected? Explanatory - WHYs? Why are populations different, why are the issues getting worse/better? Evaluative - how well are the interventions working?

Question 43

What are the other factors for prioritisation?

Answer 43

Community expectations, values & lived realities Public attitudes Te Tiriti, Human Rights etc.

Question 44

What are community expectations

Answer 44

Access to necessary care Confidence in the health system Culturally appropriate Good information about their options

Question 45

Define 'rights' in health ethics

Answer 45

An entitlement to do something or be in a certain state. Create claims and sometimes duties for others

Question 46

What does 'liberty' mean in health ethics

Answer 46

Freedom.

Question 47

What does liberty right mean in health ethics

Answer 47

A protected sphere in which one can decide how to act for onself, without a risk of being coerced

Question 48

What does coercion mean in health ethics

Answer 48

Force or threats of force

Question 49

What does autonomy mean in health ethics

Answer 49

Self-determination. The capacity to make decisions for onself, according to one's own values

Question 50

What does respect for autonomy mean in health ethics

Answer 50

Recognition of the capacity and entitlement of others to make decisions concerning their own lives

Question 51

What is the principle of necessity

Answer 51

Coercion must be necessary to protect welfare

Question 52

What is the principle of proportionality

Answer 52

Use of coercion must be proportionate to the harm that might otherwise occur (harm that is being prevented must be more significant than coercion used)

Question 53

What is the harm principle

Answer 53

The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others

Question 54

What is kotahitanga

Answer 54

Unity, togetherness, collective action

Question 55

What is solidarity

Answer 55

A commitment to engage in mutual support