2HI3 midterm

one who is 100 or older

Longevity hotspots (5 total)

Life span- the oldest age to which humans can survive (biological and uncontrollable)

Longevity - the ability to resist death (biological, lifestyle and social components --> somewhat controllable)

A country's development

Most: old people and very young (less that 1 year)

Least: young adults

(Total # of deaths per year / total population) x 1000

The study of the distribution and determinants of disease in populations

Morbidity - the prevalence of disease in a population

Mortality - the pattern of death

The average length of life or average expected age at death
--> predictability increases with age

Public health aims to prevent the onset of disease

Clinical health aims to cure disease

a group of people with some common characteristic

A state of complete physical, mental and social well-being and not merely the absence of disease

The opposite of ease, when something is wring with bodily function OR a physiological/psychological dysfunction

Healthy --> Disease onset --> symptoms --> seek care --> diagnosis --> treatment --> outcome (cure, death, disability)

hospital records, screening programs, phone surveys, physician records, phone surveys/interviews, autopsy

a direct count of individuals with a disease

The number of NEW cases in a POPULATION AT RISK in a given time interval

(New cases/population at risk) x per #

The TOTAL cases (new and old) in a population during a given time interval

Point: prevalence of the disease at a SINGLE POINT in time

Period: prevalence of disease at ANY TIME during specified period

Prevalence = incidence x disease duration

Prevalence - a measure of disease burden

Incidence - helps calculate risk (ie. planning and policies)

Decrease - when infected individuals are cured or die

Increase - when disease is managed so people live longer

A study done using hospital and sociodemographic data that highlighted inequalities in different Hamilton neighbourhoods

the study of how variations in the distribution, characteristics, migration, growth and decline of populations are linked to the nature of places

Improved sanitation and availability of modern medicine

A sequence of demographic changes in which a country moves from high birth and death rates to low birth and death rates through time.

1- high birth and death rates
2- high birth rate, declining death rate
3- declining birth rate, low death rate
4- low birth and death rates

the growth rate of a population (ie. birthrate - death rate)

A model for when the birth rate drops below the 2 children needed to replace the current population

A measurement of the number of people per given unit of land

The pattern of how people are organized over space

the characteristics of people in a given area

Attributed - biologically or culturally assigned and cannot be changed (ex. age, sex, race)

Achieved - open to individual choice and can be changes (e. education, occupation)

A graphic representation of gender and age in a population
--> useful for demographic projections

movement of people from one place to another voluntarily or involuntarily

Migration accounts for a larger proportion of the overall population increase than natural increase in Canada

The theory that people move because they are pushed out of their former location or because they have been pulled somewhere else

- Age - young adults are most likely to move
- Life stage - jobs, marriage and retirement all influence where we live
- Gender
- war

The examination of the distribution and dispersal of disease and health outcomes

Dr. john snow plotted the incidence of cases on a map which helped lead to the discovery of a contaminated well causing the outbreak

cross-sectional, case-control, cohort

Observational epidemiological study in which individuals are identified based on exposure status and followed FORWARDS over time
--> they are used to evaluate an association between an exposure and a subsequent disease

Experimental:
- Random
- All other variables can be controlled
- statements of causation can be made
- often impose ethical issues
- may not reflect real-life conditions

Observational:
- Non-random
- Unable to make statements of causality
- Can be more representative of real-life conditions
- Get around ethical barriers

Prospective - looks first at PRESENT (exposed or unexposed) than at future (disease or no disease)

Retrospective - looks first at PAST records (exposed or unexposed) than at present (disease or no disease)

**Both track forward progression

- exposed and unexposed populations may not be comparable
- Prospective studies are expensive and time-consuming
- inefficient when disease is rare

Blind - participants don't know what group their in

Double bind - participants and experimenter don't know which group participants are in

Study design used to identify factors that may contribute to a medical condition by comparing a group of patients who have that disease (cases) with a group of patients without the disease (controls).
**Starts at the outcome and moves BACKWARDS

Strengths:
- fast
- high information yield from few subjects (can be used for rare diseases)
- useful for hypothesis generating

Weaknesses:
- only one outcome possible
- limited info available since you're looking backwards
- does not yield prevalence, incidence or excess risk

A study design in which subjects and measurements are made within a limited period of time to estimate the prevalence of an exposure or disease

**Looks at outcome and exposure at the same time

Strengths:
- quick
- inexpensive
- yields prevalence of many predictors and outcomes

Weaknesses:
- unclear temporal relationship
- hard to establish causal relationships
- impractical for rare diseases
- does not yield incidence

- when a follow-up explanation of quantitative findings is warranted
- when a theory to address caps in understandings is developed
- when there is no way to quantitative measure the problem
- when a complex/detailed understanding is needed
- when the researcher wishes the empower individuals (lived experience)
- when a flexible style of reporting is appropriate

The options put into a survey are all assumptions which limit the options for participants

Methods - behaviour or tools used to select research techniques
*applied during the research

Methodology - an analysis of the methods and procedures of an investigation
*applied before and during the research

The underlying lens with which we approach research:

Ontological - what is the nature of reality?

Epistemological - what counts as knowledge?

Axiological - what is the role of values?

Methodological - what is the process/language of research?

Qualitative research analysis is based on the researchers interpretation and therefore one must realize one's inherent biases or philosophical assumptions

An interpretive framework provides the theoretical constructs, analytical focus and general forms of research questions that guide the researcher to read his or her data in a particular way. It primarily focuses on questions of how things happen instead of why.

Post-positivism
Social constructivism
Transformative Postmodern
Pragmatism
Critical, race, feminists, queer, disabilities

Philosophical assumptions - underlying lens

Interpretive frameworks - operate at a specific level
--> each interpretive framework applies the 4 philosophical assumptions

Quantitative:
Reliability- consistency of a measure
Validity - accuracy of a measure

Qualitative:
Rigour - many factors

- length of engagement and persistence of observation
- Triangulation - many sources/methodologies
- peer-reviewing
- negative case analysis
- clarifying researcher bias
- member checking - solicit views of participants
- thickness of description
- external audits - bringing in an external person to assess quality

- unsafe water
- poor sanitation
- indoor smoke
- malaria
- urban air pollution
- climate change

any pathological process that has a characteristic set of signs and symptoms that are detrimental to the well-being of an individual and are a consequence of external factors

Sub-Saharan Africa

Traditional examples:
- poor water
- bad indoor air quality

Modern examples:
--> consequences of living in an urban environment
- industrial pollution
- hazardous waster

When one experiences both traditional and modern health hazards

non-living and physical parts of the environment that affect living organisms
ex. air, land, water

The burning of low-grade fuels indoors. Usually for cooking or heating - more prevalent in improperly ventilated homes

Children in developing countries!

Indoor and outdoor air pollutants, soil contaminants, water contaminants

Acute - immediate effects
ex. burns, damage to internal organs, or poisoning

Toxic - often causes harm in smaller does administered over longer periods of time
ex. cancer, birth defects and developmental problems

The time between the excretion of the pathogen and the time that it is infective to a new host

The longer an organism can persist, the more likely it is to have the opportunity to come into contact with a susceptible host

Water-borne - microorganism enters water through faecal contamination and transmits by ingestion of contaminated water

Water-washed - causes disease due to poor personal domestic hygiene or lack of readily available water

Water-based - worm infections in which the pathogen is present in the aquatic environment

Water-related insect vectors - diseases transmitted by insects that breed in water

A water-borne disease transmitted through the ingestion of water and food contaminated with faecal matter

Symptoms: slow fever, profuse sweating, gastroenteritis, rash and diarrhoea

Prevention: vaccine and clean food/hand washing

Endemic - a disease that is prevalent in specific regions

Pandemic - a disease that is prevalent globally

Virulent E. coli contaminated water supply that infected 5000 people and killed 7

True

The study of relationships between living organisms and their environment

the ecological study of host-pathogen interactions within the context of their environment and evolution

Desertification
Deforestation
Salination

Mechanisation
Monoculture
Intensification

substandard housing
crowding
air pollution
insufficient or contaminated drinking water
inadequate sanitation
solid waster disposal services
vector-borne diseases
motor traffic
poverty stress

Smog = $36 billion
managing Contaminated sites = $238 million
Heat waves = $1.6 billion

bacterium, virus or other microorganism that can cause disease

an organism that harbours the pathogen

An agent which carries and transmits an infectious pathogen into host

Habitat in which the agent normally lives grows and multiplies

The interaction of host, pathogen and environment
--> created by Dr. Snow

Direct - host to host

Indirect - transfer of infectious agent from a reservoir to a host
ex. vector, inanimate object

Don't further spread the disease (ie. human cannot pass on to another human)
ex. humans with west nile virus

Most common in hot, equatorial climates

Larger zones for vectors to live with warmer season = spread

Longer warm seasons for vectors to live

A vector borne infection spread by tick bites. Ticks live on squirrels birds, etc.

Symptoms: circular rash, fatigue, muscle pain, etc.

--> the spread in increasing due to climate change

Effectiveness - the degree to which something performs in the real world

Efficacy - the degree to which something performs under ideal conditions

The conditions in which people are born, grow, work, live, age and the wider set of forces and systems shaping the conditions of daily life

The social standing or class of an individual or group; often measured as a combination or education, income and occupation

An earlier name for social determinants - Lalonde report

Divides the health field into 4 elements:
1. human,
2. biology,
3. environment,
4. lifestyle,

--> follows a social gradient

Lower income:
- less access to health services
- increased chronic conditions
= worse health and earlier death

Increased education:
- upward mobility
- better informed
- higher paying work
- safer work
= better health

differences in health outcomes that are closely linked with social economic and environmental disadvantage
--> systemic, avoidable and unjust issues

Black, hispanic and asian people have substantially higher rates of infection, hospitalization, and death than white people

highlights the connections and interactions between various forms of inequality, especially race, class, and gender
--> suggests that the layers don't just add but amplify

Proximal - downstream: the crisis point
ex. increases services for the poor

Distal - upstream: the original impacts that create the problem
ex. increase living wages, adjust tax

Focus on both upstream and downstream factors at once

1. Improve daily living conditions
2. Tackle the inequitable distribution of power, money and resources
3. Measure and understand the problem and asses the impact of action

A composite index that consolidates 64 indicators into a single index
ex. living standards, education, time use, leisure and culture, etc.
--> looks beyond just GDP to assess well-being

Politics - authoritative allocation of resources

Policy - a set of interrelated decisions taken by a political actor or group of actors concerning the selection of goals and the means of achieving them within a specified situation where decisions should, in principle, be within the power of the actors to achieve

The distribution of goods and services to programs and people

Macro - governments (ex. national, provincial , municipal)

Meso - at the level of institutions (ex. hospitals)

Micro - practitioner level (ex. beside rationing)

Funding - federal

Distribution - provincial
**except to first nations, Canadian forces, inmates and some refuges (federal)

Public - better for higher income countries

Private - more beneficial for low-income countries?

Taxation based, publicly funded, universal programs that cover core medical and hospital services for all eligible Canadians and are free

Pharmaceuticals, dental, rehab, ambulance, home nursing, speech therapy, private hospital costs, acupuncture, eye

The founder of Medicare (universal healthcare). He was the premier of Saskatchewan and implemented universal healthcare in his province before it spread to the Canada Health Act

1. Portability - Canadians can access healthcare from any province

2. Universality - access is on uniform terms (no preferential treatment)

3. Accessibility - no user fees

4. Comprehensiveness - all medically necessary services must be covered

5. Public administration - healthcare must operate as a non-profit

- Long wait times for elective care
- Services outside of medicare are often inaccessible

1. Systems of healthcare are based on geographical bias
2. Healthcare facilities are concentrated in specific locations
3. Geographical inequalities in health exist ('area effects')

Easier access to healthcare results in more use/engagement in healthcare

- gender roles: men are less likely to seek healthcare
- fear of the system
- questions of what constitutes sickness
- religion

Population health systems - focus on improving health across whole populations including the distribution of health outcomes

Integrated care models - focus on co-ordination of care services for defined groups of people
*a tool used by population health systems

There used to be 5 provincial agencies that all transferred into one called "Ontario health"

There used to be 12 Local Health Integration Networks (LHINs) that are now clustered into 5 interim and transitional geographic regions

The idea was to connect and coordinate the province's healthcare system to make it more efficient and support the best patient-centred care

The idea that many healthcare services should be offered in the same place.

Importance:
1. captures synergies in care for related pathologies (brings together treatments)
2. improves reach and access for patients
3. enables better utilization of scarce personnel and facilities
4. Cost-efficient setting while integrating care

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