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Flashcards in Public Health and helath promotion Deck (47)
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1
Q

Define health

A

“A resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities”.

2
Q

What are the aims of public health

A

The science and art of preventing disease, prolonging life and promoting health through organised efforts of society

3
Q

What are the 3 domains of public health

A

health improvement (including people’s lifestyles as well as inequalities in health and the wider social influences of health), health protection (including infectious diseases, environmental hazards and emergency preparedness) and health services (including service planning, efficiency, audit and evaluation)

4
Q

List some indicators of health

A
Life expectancy at birth
Systolic BP
Serum Cholesterol
Smoking
Obesity
Drinking patterns
Gender, sexual behaviour and STI
5
Q

What is life expectancy at birth a measure of

A

Life expectancy at birth indicates the number of years a newborn infant would live if prevailing patterns of mortality at the time of its birth were to stay the same throughout its life.
Life expectancy at birth is also a measure of overall quality of life in a country and summarizes the mortality at all ages. It can also be thought of as indicating the potential return on investment in human capital and is necessary for the calculation of various actuarial measures.

6
Q

What happens during an epidemiological transition

A

Indemographyandmedical geography,epidemiological transitionis a phase of development witnessed by a sudden and stark increase in population growth rates brought about by medical innovation in disease or sickness therapy and treatment, followed by a re-leveling of population growth from subsequent declines infertility rates.

7
Q

What does health and illness follow

A

The poorest of the poor have high levels of illness and premature mortality. But poor health is not confined to those worst off. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.

8
Q

Describe the changes in the life expectancy at birth in England and wales

A

Newborn life expectancy has steadily increased in England and Wales since 1991-93. Life expectancy is higher in England then in Wales, while the gap between both countries has widened over the last 2 decades.
The gap between male and female life expectancy at birth has also narrowed in both countries.

9
Q

What is meant by period life expectancy

A

Period life expectancy at a given age for an area is the average number of years a person would live, if he or she experienced the particular area’s age-specific mortality rates for that time period throughout his or her life.

10
Q

Describe the indices of deprivation

A

Indices of deprivation combine indicators like education, income, employment, housing, access to services to assign a composite score to an area, which are then ranked in quartiles, deciles or twentieths. Here the SE groups are broadly classified into 3 tiers. There is a clear gradient of illhealth in the 3 groups across both genders. This covers limiting longstanding illness that impairs your ability to work.

11
Q

Describe the risk factors for ischaemic heart disease

A
Risk factors for IHD are – Age, sex, ethnicity, family history, and these are the risk factors that cannot be changed. But there are other risk factors that can be modified. The main modifiable risk factors for Ischaemic Heart Disease are:
• Elevated blood pressure
• Elevated blood cholesterol, High triglyceride with low HDL
• Diabetes or Pre-diabetes
History of Pre-eclampsia
• Smoking
• Obesity / Inactivity
• Excessive alcohol
• Excessive stress
12
Q

Relate the curves for survivors and deaths from CHD in the distribution of systolic BP

A

The curves are not so different
It would require a lot of effort for the people from the high BP distribution to move to the other group with benefit only for a few.
But if we are talking millions making up these distributions (and we are) the lives/illness that we save/prevent are huge
To reduce the steepness of the social gradient in health, actions must be universal, but with a scale and intensity that is proportionate to the level of disadvantage. Prof Sir Marmot has called this “proportionate universalism”.

13
Q

How can we prevent exposure and how has this changed in recent years

A

To shift the whole distribution of an exposure in a more favourable direction. To lower the mean level of risk factors, to control determinants of incidence. In traditional public health it has sought to change environmental factors on a large scale (the great sanitation movement in the 19th century). In its more modern form it is trying to change / alter society’s norms of behaviour on a large scale….

14
Q

Describe the factors that can effect your likelihood to smoke

A

Economic Activity: proportion of smokers among
Unemployed = 29.6%
Employed= 15.5%
Economically inactive = 13.4%

Relationship status: proportion of smokers among
Married / in a civil partnership = 9.9%
Cohabiting = 22.1
Single = 21.5%
Widowed, divorced or separated =17.7%

Education: proportion of smokers among
those with a degree = 7.6%
no qualifications = 29.1%

Ethnicity: current smokers ranged from 8.8% in Chinese respondents to 20.1% in the mixed ethnic group

15
Q

What is child obesity prevalence closely associated with

A

Child obesity prevalence is closely associated with socioeconomic status. More deprived populations tend to have higher obesity prevalence.
Obesity prevalence in the most deprived 10% of areas in England is more than twice the prevalence in the least deprived 10%.

16
Q

Describe the variation of alcohol consumption with age

A

Young people aged 16 to 24 - less likely to drink than other age group; but consumption on their heaviest drinking day is > than other ages.

17
Q

Describe the relationship between alcohol consumption and income

A

A higher income is associated with an increased alcohol consumption.

18
Q

Why are STI diagnoses preferable to self confessions of STIs as an indicator of sexual health

A

Sexually transmitted infection diagnoses are amongst the best indicator of sexual risk. They are usually better indicators than self-reported sexual behaviour, which is subject to ‘social desirability bias’, defective recall, and other confounders. Of the STIs, gonorrhoea is seen as the most reliable indicator of unprotected sex in the absence of HIV data, although because it is much more contagious, infections are not so closely correlated with anal intercourse and therefore not concentrated so much amongst gay men.

19
Q

Describe the proximate causes of health inequalities

A

The lifestyle factors which influence health inequalities are sometimes referred to as the “proximate” causes of health inequalities, because they are the immediate precursors of disease. They include: smoking, alcohol consumption, nutrition, exercise, drug use, sexual behaviour, stress. This is opposed to the ‘distal’, ‘upstream’ or ‘wider determinants’, such as income, housing, employment, education, social networks, community safety, living and working conditions, which influence healthy behaviours. And are the “causes of the causes”.

20
Q

Describe the aims of health promotion/improvement

A

Health Promotion is the process of enabling people to increase control over, and to improve their health
(Ottawa Charter for Health Promotion, 1986)

Action toward social, economic and environmental conditions

Strengthening skills and capabilities of individuals and communities

21
Q

What is health promotion/improvement an approach for

A

Health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health. It is a core function of public health and contributes to the work of tackling communicable and non-communicable diseases and other threats to health.
An approach to (action for) health that takes account of :
A broad definition of health
The scope of prevention
Limitations of health services
Role of individuals, groups and governments
Focus is on health rather than disease

22
Q

What is essential to sustain health promotion action

A

Participation (both social and political)

23
Q

What does health promotion involve

A

Clinical interventions
Biomedical - screening / immunisation
Knowledge transfer and health literacy
Traditional type of health promotion (– e.g. smoking cessation, healthy eating, exercise promotion)
Healthy public policy
Legal, fiscal and social measures to make healthy choices easier
Sustainable policies, actions and infrastructure to address the wider determinants of health
Enabling equal opportunities for health & well-being
Community development
Radical - through groups setting their own agenda
Partnerships with public, private, non-governmental and international organizations and civil society to create sustainable actions

24
Q

Describe the Tannahill model of health promotion

A

practical framework that advocated 3 principle health promotion principles; prevention, health education and health protection (legal and fiscal). ▪

25
Q

What are the two main approaches to disease prevention

A

High Risk – identifying those in special need “targeted rescue operation” (Geoffrey Rose, 1992), then controlling exposure (e.g. reducing house dust mite in the home of asthmatic child) or providing protection against effect of exposure (vaccination).
Population – begins with recognition that the occurrence of common diseases and exposures reflects the behaviour and circumstances of society as a whole.

26
Q

What are the 4 levels of disease prevention

A

Primordial, primary, secondary and tertiary

27
Q

Describe primordial prevention

A

Prevention of factors promoting the emergence of lifestyles, behaviours, exposure patterns which contribute to increased risk of disease.

28
Q

Describe primary prevention

A

Actions to prevent the onset of disease. To limit exposure to risk factors by individual behaviour change and by actions in the community. Includes health promotion (e.g. health education, prescriptive diets) and specific protection (e.g. vaccination)

29
Q

Describe secondary prevention

A

To halt progression once the illness is already established. Early detection followed by prompt, effective treatment. Special consideration of asymptomatic individuals.

30
Q

Describe tertiary prevention

A

Tertiary: rehabilitation of people with established disease to minimise residual disability and complications. Quality of life action even if disease cannot be cured.

31
Q

What are the arguments for population prevention

A

Societal: society has characteristics which influence health they change and prevention must consider this level of influence
Ethical: The deviant tail of a population belongs to the distribution “we are all responsible for all” Dostoevsky “Ask not for whom the bell tolls” John Dunn
Medical: 1) Risks are changing all the time => indicates that they can be modified, diet exercise, environment, tobacco, alcohol.
2) Behaviours depend on supply as well as social conditioning
3) Most cases are attributable to groups which are not at high risk

32
Q

What are the strengths of a high risk approach

A

Effective (high motivation of individual and physician)
Efficient (cost-effective use of limited resources)
Benefit : risk ratio is favourable
Appropriate to individual
Easy to evaluate

33
Q

What are the weaknesses of a high risk approach

A

Palliative and temporary (misses a large amount of disease)
Risk prediction – not accurate
Difficulty and costs of screening
Hard to change individual behaviours

34
Q

Why may risk prediction not be accurate

A

Case-centred epidemiology identifies individual susceptibility, but it may fail to identify the underlying causes of incidence. The ‘high-risk‘ strategy of prevention is an interim expedient, needed in order to protect susceptible individuals, but only for so long as the underlying causes of incidence remain unknown or uncontrollable; if causes can be removed, susceptibility ceases to matter.

35
Q

Describe the prevention paradox

A

Many people exposed to a small risk may generate more cases of disease than the small number who are at a high risk

So When many people receive a small benefit the total benefit may be large

However
Individual inconvenience may be high to the many when benefit may only be to a few
The prevention paradox is such – A preventive measure which brings much benefit to the population offers little to each participating individual.

36
Q

In which areas is the prevention paradox observed

A

This phenomenon is observed for a range of health

areas including alcohol, tobacco, obesity and injury.

37
Q

What is a key limit to the high risk approach of prevention

A

The lesson from this example is that a large number of people at a small risk may give rise to more cases of disease than the small number who are at a high risk. This situation seems to be common, and it limits the utility of the ‘high-risk’ approach to prevention.

38
Q

What are the strengths of the population approach

A

Equitable
Radical
Large potential for population
Behaviourally appropriate

39
Q

What are the weaknesses of a population approach

A

Small advantage to individual
Poor motivation of subject
Poor motivation of physician
Benefit : risk ratio can be questioned

40
Q

Describe the pyramid of interventions

A

Improvements at the base of the pyramid generally improve health for more people, at lower unit cost, than those at the top.

41
Q

Describe the wanless report

A

detailed how we should focus on the wider prevention of disease so that the avoidable burden on the health system could be essentially avoided.
Cost-effectiveness of actions to improve health and reduce inequalities
“Fully Engaged Scenario”

42
Q

What are the current key public health programmes

A
Smoking
Alcohol
Obesity
Sexual Health
Teenage Pregnancy
Mental Health
43
Q

Describe the government white paper on delivering choosing health

A

Choosing a Better Diet: a food and health action plan

Choosing activity: a physical activity action plan

44
Q

Describe the commission on the social determinants of health

A

Improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age

Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally, and locally

Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health

45
Q

What are the 6 policy objectives of the marmot review

A

Give every child the best start in life
Enable all children, young people and adults to maximise their capabilities and have control over their lives
Create fair employment and good work for all
Ensure a healthy standard of living for all
Create and develop healthy and sustainable places and communities
Strengthen the role and impact of ill health prevention

46
Q

What did the marmot review stem from

A

The commission on the social determinants of health.

47
Q

Describe some important health promotion documents

A

o Ottawa Charter for Health Promotion (1986) – this aimed to achieve health for all by the year 2000 and beyond and was a commitment and call for international involvement. o Jakarta Declaration (1997) – the aim was to re-iterate the importance of the Ottawa charter and to add emphasis on certain aspects of health promotion. o Bangkok Charter (2005) – to identify actions, commitments and pledges required to address the determinants of health in a globalised world through health promotion.