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williams poplhlth (maintenance error) > module 3: preventing dis-ease & improving (promoting) health of population > Flashcards

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

lectures 22-26 (57 cards)

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1
Q

What are the 3 population health actions

A

Health promotion, disease prevention, health protection

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2
Q

What is a population based (mass) strategy

A

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

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3
Q

What is a high risk (individual) stategy

A

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

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4
Q

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

A

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

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5
Q

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

A

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)

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6
Q

What is health promotion

A

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

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7
Q

What is primary, secondary and tertiary care in healthcare system

A

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

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8
Q

Where level of healthcare service does health promotion act on

A

Primary care mostly

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9
Q

What is Alma Ata 1978

A

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

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10
Q

What are the prerequisites for health according to the Ottawa Charter

A

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

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11
Q

What is the Ottawa Charter for health promotion

A

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

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12
Q

What are the 3 basic strategies of the Ottawa Charter 1986

A

Enable, advocate, mediate

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13
Q

What are the 5 priority action areas of the Ottawa Charter

A

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)

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14
Q

What is disease prevention

A

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

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15
Q

What are the types of disease prevention strategies

A

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

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16
Q

What is health protection

A

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

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17
Q

Is screening a primary, secondary or tertiary prevention?

A

Screening can be primary, secondary or tertiary

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18
Q

What is the flow diagram of screening for disease

A

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

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19
Q

What is the 4 parts of screening criteria

A

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

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20
Q

What are the main features of a suitable disease for screening

A

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

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21
Q

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

A

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

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22
Q

What are the factors of a suitable test

A

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

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23
Q

What is sensitivity of a screening test

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A

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

24
Q

What is specificity of a screening test

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A

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

25
What are the fixed characteristics of a screening test
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
26
What is Positive Predictive Value (PPV) in screening test
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)
27
What is negative predictive value (NPV) in screening tests
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)
28
Why are PPV and NPV not fixed characteristics
They reflect both the test accuracy and the prevalence of disease in the population
29
What happens to PPV and NPV if the prevalence is high or low?
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)
30
What are the factors of a suitable screening programme?
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
31
What are the 2 types of time bias in screening programmes
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
32
Describe Te Pae Mahutonga
Based on the Southern Cross as a navigational aid 4 central stars (key tasks) and 2 pointers (pre-requisites)
33
What are the 4 key tasks of Te Pae Mahutonga
Mauriora - Access to Te Ao Māori Waiora - environmental protection Toiora - healthy lifestyles Te Oranga - Participation in society
34
What are the 2 prerequisites of Te Pae Mahutonga
Ngā Manukura - health professional and community leadership Te Mana Whakahaere - capacity for self governance and autonomy, community control and enabling political environment
34
Why do we need to prioritise in health
There is limited resources such as money to find all the health problems we would like to
35
What are the 4 parts of the population health framework
1. Define the problem 2. Identify risk and protective factors 3. Develop and test prevention strategies 4. Assure widespread adoption
36
What are the evidenced-based measures of establishing priorities
Descriptive Explanatory Evaluative
37
What is Attributable Risk (AR)
The amount of extra disease attributable to a particular risk factor in the exposed group (Same as RD, EGO-CGO)
37
What are epidemiological measures used in prioritisation?
Population Attributable Risk (PAR) YLL and YLD
38
What is population attributable risk (PAR)
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)
39
What is the equation for PAR
PAR = PGO - CGO PGO = positive cases / total population
40
What happens to PAR when prevalence of disease increases in the population
As prevalence increases, PAR will increases
41
What type of prevention strategy is PAR used in
PAR is used as a measure for population based (mass) strategies
42
Describe descriptive evidence, explanatory evidence and evaluative evidence
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?
43
What are the other factors for prioritisation?
Community expectations, values & lived realities Public attitudes Te Tiriti, Human Rights etc.
44
What are community expectations
Access to necessary care Confidence in the health system Culturally appropriate Good information about their options
45
Define 'rights' in health ethics
An entitlement to do something or be in a certain state. Create claims and sometimes duties for others
46
What does 'liberty' mean in health ethics
Freedom.
47
What does liberty right mean in health ethics
A protected sphere in which one can decide how to act for onself, without a risk of being coerced
48
What does coercion mean in health ethics
Force or threats of force
49
What does autonomy mean in health ethics
Self-determination. The capacity to make decisions for onself, according to one's own values
50
What does respect for autonomy mean in health ethics
Recognition of the capacity and entitlement of others to make decisions concerning their own lives
51
What is the principle of necessity
Coercion must be necessary to protect welfare
52
What is the principle of proportionality
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)
53
What is the harm principle
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
54
What is kotahitanga
Unity, togetherness, collective action
55
What is solidarity
A commitment to engage in mutual support

williams poplhlth (maintenance error) (5 decks)

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