Other for the Exam Flashcards
(108 cards)
1
Q
What is epidemiology?
A
The study of the distribution and patterns of health: events, characteristics and their causes or influences in well-defined populations.
2
Q
Why do we need to prioritize?
A
- Health resources are finite
- Each prioritization has an opportunity cost
- Rationing involves an ethical component and evidence-bsed judgement
- It’s difficult to compare apples with oranges
- Individual needs may differ with population needs
3
Q
Why was the GBD study needed?
A
- Many countries (especially low/middle income) had incomplete data, mainly focussing on deaths, with little information on disability
- Some lobby groups give a distorted version of disease burden- needed to counteract this
- Methods used to measure/record dis-ease weren’t consistent
- Those not heard (in L/MICs) needed a voice
4
Q
What were the aims of the GBD project?
A
- Use a systematic approach to summarize the burden of disease/injury of a population based on epidemiology & evidence
- Take account of deaths AND disability when estimating the burden of disease. (Real life disability is a hidden health issue)
5
Q
What are DALYs?
A
Summary measures of population health combining mortality and non-fatal health outcome data to represent the health of a particular population as a single number
6
Q
What are DALYs made up of?
A
- Years of Life Lost to premature death (YLL)
- Years lived with Diability (YLD).
- YLD involves the average duration of the non-fatal outcome and its disability weight (based on its severity)
7
Q
What is interesting about the DALY rat in HICs?
A
In HICs, the DALY rate is higher than the mortality rate.
8
Q
In the GBD, what are Group 1 diseases?
A
Communicable, infectious diseases- this group includes diarrhea, AIDS, and TB. This group also includes injury or death during pregnancy, birth, or very early childhood.
9
Q
In the GBD, what are Group 2 diseases?
A
Non-communicable diseases and chronic diseases. They include heart disease, cancer and diabetes.
10
Q
In the GBD, what are Groups 3 diseases?
A
Injuries, both unintentional and intentional.
11
Q
What is a demographic transition?
A
A decline in the mortality and fertility rates. It’s observable in most developed and some developing areas. It results in an ageing population.
12
Q
What is an epidemiological transition?
A
A characteristic shift in causes of death and disability from communicable diseases to non-communicable diseases. Happens especially often in HICs.
13
Q
What is a risk transition?
A
Occurs when risk factors for communicable diseases (such as dirty water) are outstripped by risk factors for non-communicable diseases (such as tobacco). This happens when a country transitions from low- to high-income
14
Q
What is a double burden of disease?
A
Many middle income countries have risk factors for both communicable and non-communicable diseases co-existing in the population, forming a double burden of disease as both communicable AND non communicable diseases are prominent. This has major ramifications for health policy
15
Q
What were the results of the GBD project?
A
- Informed priority setting on death and disability
- Bias avoided due to incomplete or ‘mortality-only’ data, especially and L/MICs.
- A method applicable to any population (DALYs)
- NCDs being recognized as not just a HIC problem
- Attention drawn to mental health and injury as a major issue. Prior to the GBD, information on it was not included and tended to to feature prominently in prioritisation
16
Q
How did the GBD project identify leading risk factors?
A
By looking at Population Attributable Risk.
(Recall: PAR is the amount of extra disease in a population attributable to a particular risk factor. If their relationship is causal, PAR = how much death can be removed)
17
Q
How are risk burdens’ severities influenced?
A
- Strength of association between risk factor and outcome
- How common the exposure to the risk factor is for a population.
18
Q
How are NCD risk burdens changing?
A
The risk burden and their exposures are increasing.
19
Q
What are the NCD underlying factors and their modifiers?
A
- Caused by environmental determinants, including globalization, urbanization and population ageing
- Modified by hereditary factors
- Modified by lifestyle factors (diet, exercise, smoking)
- Further risk factors are physiological: high BP or blood/glucose, abnormal blood lipids and obesity.
20
Q
How does industry affect the prevalence of NCDs?
A
- They market unhealthy commodities and promote unhealthy consumption.
- They seek vulnerable targets, reinforce power inequalities within the population and change our environment
21
Q
How does industry feature on the population health radar?
A
Population health must recognize the tension between commercial and health objectives and seek to address broader health determinants.
22
Q
What is an example of why broader health determinants must be addressed when dealing with industry-promoted health issues?
A
In NZ, smoking rates decrease but inequities are still high. This is because broad health determinants were not targeted. Instead:
- Social norms changed as smoking became popular among different groups
- More intervention was taken downstream
- Industries actively exploit those with difficulty changing their behaviour.
23
Q
How can we control tobacco using a ‘right to health’ approach?
A
- Increasing tobacco prices/taxes
- Legislating smokefree environments
- Banning advertising/sponsorship
- Packaging interventions - plain, or with warnings
- Anti-smoking campaigns
- Cessation support (downstream)
24
Q
What is an industrial epidemic?
A
- Disease arises due to overconsumption of unhealthy product
- The industry acts as a ‘vector’, driving consumption by manipulating individual behavior (acting as hosts)
- Focus must be shifted upstream to combat it.
25
What are some examples of industrial epidemics?
- Tobacco
- Alcohol
- Fast Food
- Pokies
(Their distribution in different areas is not random, but placed to actively exploit those most at risk)
26
What makes somebody maori?
- Their ancestry, whakapapa and descent
27
What is a difference between maori and non-maori ageing structure?
Maori have a younger age structure than non-maori
28
When was the right to health first acknowledged?
The Universal Declaration of Human Rights.
Right to health = people have the right to a standard of living adequate for health, including medical care and security.
It didn't define the parameters of the right to health (what is meant by this standard of living), but acknowledged the the RTH includes and transcends medical care.
29
How did the ICESCR further develop the idea of the RTH?
It specifically mentioned RTH, and the steps which govts should take to do what they can to give their citizens the best health possible.
Additionally, it acknowledged that the implementation of these policies was more and less reasonable depending on the country, and encouraged international cooperation to help with this.
30
How did the UN clarify the RTH in 2000?
Stated that RTH is not the same as the right to be healthy, as this cannot be guaranteed by the government.
It is related both to other human rights and to equity.
31
What components make up the RTH?
- It is enshrined in international law
- It extends beyond just medicine, and includes health determinants
- It's linked to social justice and good governments
- Governments must :
- Protect (no interference from 3rd parties like industry)
- Respect (no discrimination)
- Fulfil (adopt measures to achieve equity)
their citizens' right to health
32
What do inequities in health show?
Laws/policies which distribute resources and opportunities in a discriminatory manner. Health is political, but it also has a legal element.
33
How does discrimination affect health, and what should be done about it?
- It impacts many layers of determinants, and access and quality of care.
- The state should prohibit and eliminate discrimination using affirmative action, such as disabled carparks.
- The RTH framework focusses on govt. accountability for this.
34
What does the enforcement of the Right to Health depend on?
Political, legislative and judicial action on a national scale
35
How does the NZ code of health and disability service consumers agreement protect the RTH?
- Outlines 10 rights for consumers, including freedom from discrimination and treatment of an appropriate standard
- It aligns with the human rights act
36
How does the NZ Health and Disability Act protect the RTH?
1. Has 'reducing inequalities' as a purpose
2. DHB system to foster community participation
3. TOW clause states nobody shall be given special privileges based on race.
4. The reduction of inequalities is reflected in the NZ health strategy/disability strategy, and He Korowai Oranga.
37
How does the TOW protect the RTH?
1. Affirms indigenous rights
2. It provides a framework (albeit with different strengths and weaknesses)
3. Ensures good governance
4. Promises active protection of Maori
5. Health is outlined as a Maori taonga (treasure)
6. Inequities in health breach this.
38
What is stated in the UN rights of the indigenous peoples which reinforces the RTH?
- Everyone has human rights, but indigenous people often struggle to fully recognize them
- Wants to facilitate realization of rights and stronger relationships between indigenous and colonizers.
39
What are the instruments for the RTH?
- Declaration of human rights
- ICESCR
- International rights conventions
- Indigenous rights (TOW, UN)
- NZ legislation and policies (NZPHDS, Patient rights)
40
What are the two main downsides of DALYs?
- They can be stigmatising as they represent those who are disabled as a burden
- The weight of a disability is purely based on medicine, so doesn't account for a person's life circumstances
41
What is the medical model of disability?
- Used by the GBD Project
- Disabled are defined by their illness
- Disability is an individual problem
- Disabled person must be cared for/cured
- Justifies their exclusion
- Control is with professionals, who decide the disabled person's choices
- Patronizing approach, focussed on what they CAN'T do
42
What is the social model of disability?
- Disability is a societal problem
- Caused by policies, practices, attitudes, environments
- Disabling factor is the surroundings, not the person
- Focusses on ridding society of barriers, not cure
- Right to Health approach
43
What is the social gradient (caused by), according to WHO?
- Caused by unequal distribution of power and resources globally and nationally
- Results in unfairness in life circumstances
- Not a natural phenomenon but product of structural determinants of health and conditions of daily life.
44
What does WHO recommend to reduce the effect of the social gradient?
- Improve daily living conditions
- Tackle inequitable distribution of power, money and resources.
- Measure and understand the problem while assessing the impact of actions.
45
What proportion of HIV sufferers live in Africa?
2/3rds.
46
What has HIV done to the life expectancy & DALY rate in Africa?
Life expectancy has plummeted. DALYs increased in Africa due to more YLL.
47
What is the current trend in HIV deaths?
They are decreasing as treatments help to manage the condition and prolong life. However, this also means HIV has a greater global prevalence.
48
Why is HIV considered as being multiple epidemics? What does this mean for intervention strategies?
Different populations have vastly different access and care statistics, and so some of those most at risk for HIV have no access to proper care or prevention. This discrepancy is necessitating two fights, rather than just one. Therefore, interventions must be targeted to specific risk groups, rather than just a 'one size fits all' intervention.
49
How is HIV transmitted?
- The main method is via unprotected sex, making homosexual men, heterosexual women and sex workers the most at risk. Heterosexual men can also get the virus from women, but it's much less likely.
- It can be passed by sharing contaminated needles, making drug-users an at risk group
- Finally it can be passed from mother to child through breast milk.
- Anyone receiving unscreened blood or blood products, organs or unsterile injections are also at risk, although this is more typical in countries with poor screening programmes.
50
What are the majority of new infections?
- 95% are in L/MICs
- 47% are in women- heterosexual transmission has become dominant
- 39% are in the 15-24 age bracket (most are female in sub-saharan Africa)
51
What is the feminization of the HIV epidemic?
Increasing proportions of infection are among women, mainly transmitted heterosexually. In fact, more than half of HIV+ people in sub saharan Africa are women.
52
What are the statistics of HIV within women?
- HIV is the leading cause of death in 15-49yos worldwide
- Experience of domestic violence is associated with a 3x greater risk of HIV
- Women are more likely to face treatment and care barriers
- Women are often the primary caregivers in a family- their death or illness puts great strain on others they care for.
53
What are the social determinants of development and treatment of HIV?
- Gender inequities: relationships, condom use and abuse/violence
- Poverty or Low SES: limited education and health services
- Social norms- these prevent access
- Stigma of HIV: prevents people from disclosing their HIV status
54
What does HIV have to do with women's rights?
HIV is strongly connected with women's rights and independence. This is most violated where women must use sex as means to survive. It leads to male control over female lives in the context of poverty.
- Until human rights extend to economic security, a woman's right to safe sexuality won't be realized.
55
What proportion of the HIV+ population are getting treatment?
Only about 40%. This is because of low access to treatment in L/MICs.
56
What are the statistics around children with HIV?
More than 90% of HIV+ children were infected by their mother during pregnancy, birth or breastfeeding
These children often lose both parents to HIV and are therefore particularly vulnerable.
57
How do we reduce the risk of passing HIV from mother to child?
About 1/3rd of children born to HIV+ mothers will be infected, but the risk can be reduced by screening and treating the mother
58
How do we estimate HIV prevalence?
Surveillance systems (wealthy countries)
Epidemiological studies
Surveys in health centers, eg. antenatal clinics (most common in less developed countries)
59
What is the issue with surveying for HIV in health centers and antenatal clinics?
- Prevalence in pregnant women may be different to the prevalence in men, other women and children
- Data in urban clinics doesn't represent rural clinics
- Prevalence will be different between those who can and do attend clinics and those who can't or won't.
60
What is the story with HIV in the pacific?
PNG is the most affected
| High STD prevalence also increases the HIV risk
61
How do we prevent and control HIV?
- Safe sex
- Safer blood and needles
- Increased healthcare access
- Reduced discrimination against HIV
62
How do we promote safe sex?
- Media campaigns
- Education
- Promoting condoms, making them available and affordable
63
How do we promote safer blood/needles?
- Screen blood and blood products
- Have needle exchange programmes
- Protect health professionals against needle injuries.
64
How do we increase healthcare access?
- Voluntary testing and counselling
- Provide treatment, care and support
- Provide antenatal screening and treatment for HIV+ mothers
- Family Planning and STI treatment
65
How do we reduce discrimination against HIV?
- Ensure rights of HIV+ people are upheld.
66
What are the impacts of global initiatives on HIV?
- Attention raised due to the severity of DALYs involved
| - Contributions from aid donors lead to reduced drug costs and addressing of Millenium Development Goals.
67
What are the major challenges of these initiatives?
- Resources for care and prevention fall short
- Need to combat stigma
- Inequities and resources must be addressed as well as social determinants, especially women, poor, migrant and marginalized groups.
68
What are the strengths of the Youth 2000 survey?
- Mostly representative of NZ teens
- Collected data on many exposures and outcomes at the same time
- Technology used was popular and the anonymity increased the sense of privacy
69
What are the disadvantages of the Youth 2000 survey?
- Those not represented would have been dropouts or those in apprenticeships/sick. This is especially important as they probably have a different profile of health
- As it only looks at one point in time, there is no temporality so causation cannot be proven.
70
What did anonymity contribute to the Youth 2000 survey?
Responses were confidential and self reported, reducing but not eliminating bias (respondents less likely to give 'socially desirable' answers over true answer)
71
What is the disadvantage with anonymity?
Some of the questions may have changed the respondents emotional state during the survey, skewing the next question. This also burdens youths, but as they are anonymous we cannot offer them support if they need it.
72
What is resilience?
The ability of a person to spring back despite adversity. This means that people with various resiliency factors may be less vulnerable to harm despite their exposure to risk factors.
73
What is the PCAP model of resiliency?
Within schools, resiliency of an individual is impacted by:
- Place (safe spaces, enables friendships)
- Contributions (opportunities to contribute to neighbourhood, family etc.)
- Activities- school/community (fosters a sense of belonging)
- People (Adult who cares, network of involved adults)
74
What are other sources of resilience?
- Faith
- Pets
- Humour
- Sport
- Coping skills
- Problem solving skills
75
What are the three types of connections which aid resiliency?
- Family connections (members care, time with family- especially at meals)
- School connections (adults care, teachers fair, feel part of and safe at school)
- Community connections (neighbours, friends, workmates, volunteer/community groups)
76
What were the 3 main finding of the youth 2000 survey?
- Most NZ teens healthy, but health risk behaviors are common
- Presence of resiliency factors is associated with a reductio in risk behaviors
- Reducing risk and enhancing resilience offers new opportunities for intervention (strengths based approaches to youth development)
77
What is the story with (crash) injuries as a global burden?
- They're not always considered a health issue, but they're predicted to increase dramatically as a contributor to the GBD.
Specifically, crash injuries are a large problem, but they gain little health attention as they're commonplace
78
Who has the highest rate of crash injuries?
Males, between 15-29yos.
Crash frequencies exhibit steep socioeconomic gradients in both rich and poor countries, especially for pedestrian injuries.
79
What is occurring with NZ's crash injury rate?
It is currently decreasing
80
Where is the crash injury rate increasing and why?
Increasing in India, Columbia Botswana
| This is because the country is becoming motorized rapidly, but in a place with harsh or difficult terrain to drive on.
81
Who are most at risk of crash injury?
Pedestrians, bicyclists and motorized 2 wheeler users. This is because they have little to no physical protection from a crash.
82
What are WHO's 5 key risk factors to target for road safety in L/MICs?
- Speed
- Alcohol
- Seatbelts/child restraints
- Helmets
- Visibility
83
What is the most cost effective way of implementing strategies targeting the risk factors for road safety?
Targeting all 5 at once is the most effective way, rather than one at a time- the cost per DALY is the least.
84
What are the statistics involving pedestrian injuries vs. strategies in LMICs?
More than 1/3rd of LMIC prash deaths are in pedestrians/cyclists, but less than 35% of these countries have strategies to prevent this
85
What seems to show the most decrease in crash deaths? Where are these implementations most common?
Road design- traffic calming features such as roundabouts, bicycle lanes, speed bumps). However, these are more evident in affluent areas with lower rates of pedestrian injury
86
What is the difficulty with applying interventions to other areas?
Just because it works for one area doesn't mean it will work for another: This is especially important for indigenous peoples, who must have their way of life integrated into any new invention.
87
What are the current trends in energy use?
Approx. 85% of the world's energy is from fossil fuels, but the biggest increase in energy use has been among renewable energy (last 5 years)
88
What is important about CO2 levels (for NZ) ?
They are now higher than any time in the past 400k years, due to human impact. It's doubly important for NZ as CH4 and NO make up almost half our footprint, even though they're not Carbon dioxide derivations
89
What do greenhouse gasses do? What is the evidence for this?
They trap the sun's heat within the atmosphere. This is shown as after our CO2 levels increased, the upper atmosphere cooled while the lower atmosphere warmed
90
What are the future predictions of global temperature?
If we continue as currently, 100% chance of +2 degrees by about 2060. 100% chance of +4 degrees by about 2140
91
What is unique about the current rate of change in temperature?
It is 20-100 times faster than any other time in its history- the world will have greater trouble adjusting to it.
92
What is the main concern with increasing temperature?
What is known as extreme heat now may become average, even if the temp shifts a couple of degrees- eg. currently, fiji has mean temp of 26 degrees with only 5% above 28- but in 50 years it could be that the extreme 28 is now them mean
93
How does climate change affect health?
- Ecosystem disruption
- Social disruption
- Directly
94
How does climate change affect health through ecosystems?
-Eg. mosquito borne diseases.
Mosquitoes are temperature sensitive, so as temperature increases, mosquitoes proliferate. This makes it harder to control mosquitoes as there are exponentially more of them
- temperature sensitive crops like wheat will affect food production and malnutrition
95
How does temperature directly affect human health?
Using the wet bulb globe temperature (temp index accounting for heat, humidity and wind velocity). As index temp rises, some work becomes impossible or unsafe. This decreases productivity, possibly resulting in low food production, economic difficulty
96
Why is humidity important?
High humidity means sweat evaporates less quickly
97
What is worrying about the wet bulb globe temperature?
Already some parts of the world have hit unsafe temp levels in their hottest month
98
What must we do to decrease our impact on temperature?
We must make a large cut in CO2 emissions if we want only a 50% chance of +2 degrees. However, emissions flattened in 2014/15
99
What is the paradox in finding CO2 free fuels?
Some are actually worse for our health than CO2- they increase local pollution, plus damaging side effects for human health, even though they reduce our CO2 emissions
100
What is an example of how climate change might be a health opportunity?
- There may be co-benefits between health and environmental protection. Eg. biking short commutes instead of driving- saves fuel, increases exercise, less deaths.
- Changing india's indoor dung/straw fireplaces to clean stoves saves 500k deaths and 4% of their emissions
101
What causes global warming?
High demand for energy and a reliance on fossil fuels
102
How is vulnerability to climate change patterned?
Location, poverty and health status are predictors of vulnerability.
The vulnerable are at the greatest risk and are the most affected.
103
How do we phrase ideas in terms of the haddon matrix?
(idea) is an intervention to affect a change in (factor), having its effect at the time of (time) phase.
104
What are the rows in the Haddon matrix?
Pre event
Event
Post- event
105
What are the columns in the Haddon matrix?
- Host
- Agent/Vehicle
- Social environment
- Physical envrionment
106
What are the value criteria in the 3rd dimension of the Haddon matrix?
- Freedom
- Cost
- Stigmatization
- Effectiveness
- Equity
- Preferences
- Feasability
- Other
107
What is horizontal equity?
Treating everybody in a universal fashion (equality)
108
What is vertical equity?
- Unequal treatment of unequally stationed individuals- different groups get different things based on need
