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health
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the combination of physical, mental/emotional, and social well-being
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holistic
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dealing with something as a whole rather than by its individual parts
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2 eyed seeing approach
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combination of Western & Indigenous knowledge that originated from the Mi'Kmaq tribe
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4 health promoting conditions
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available health services, adequate housing, nutritious food, and safe work
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Western approach
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based on scientific data & evidence
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Indigenous approach
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based on the impact of colonization & marginalization
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Indigenous medicine wheel
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aligns different health dimensions - spiritual, physical, mental, and emotional
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centre of medicine wheel
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represents learning, beauty, and harmony
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shape of medicine wheel
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represents interconnectivity of different healthcare aspects
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East portion of medicine wheel
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spiritual, yellow, eagle, spring, tobacco
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South portion of medicine wheel
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emotional, red, coyote, summer, cedar
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West portion of medicine wheel
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physical, black, bear, autumn, sage
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North portion of medicine wheel
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mental, white, deer, winter, sweetgrass
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How much more prone are Indigenous People to infectious disease compared to the general population?
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8-10x more
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How many more deaths by suicide are there among Indigenous Peoples compared to the general population?
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2x more
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How much more overcrowding is there in Indigenous homes compared to the general population?
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6x more
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What percent of Indigenous Peoples live in overcrowded homes?
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40%
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How many Indigenous Peoples have food/water shortages compared to the general population?
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4x more
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What ways do Indigenous Peoples have more employment barriers?
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More work part-time jobs (which are more prone to economic downturn), systemic discrimination, and more hospitalizations from unsafe work
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When was the Indian Act created?
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1876
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What was the purpose of the Indian Act?
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Assimilate Indigenous Peoples - the government did this without consultation with these populations
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How did the Indian Act harm Indigenous Peoples?
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People were "civilized" by Christianizing them, disconnecting them from their ways, and forcing them into permanent agricultural settlements
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What did the Opaskwayak Cree Nation accomplish in July 2020?
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They signed a declaration for control over their child/family services and raised their first pride flag
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What are the accomplishments of the Mohawk Bay of Quinte?
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Made a Community Health Act to provide care to all, regardless of status, as well as contributed to the Prenatal Nutrition Program
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global health
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worldwide health problems, issues, and concerns
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4 principles of global health
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data/evidence, population-focused, social justice, focus on prevention
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government contribution to global health
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programs, services, and policies
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societal contribution to global health
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using resources, following guidelines
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public health contribution to global health
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maintenance, protection, promotion, prevention
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World Health Organization (WHO)
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a group within the United Nations responsible for human health, including combating the spread of infectious diseases and health issues related to natural disasters
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How many staff does the WHO have?
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7000 in 150 different countries
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Where are the WHO headquarters?
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Geneva, Switzerland
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What is the main principle of the WHO constitution?
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"health is a human right"
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When was the WHO formed?
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April 7, 1948
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When was the WHO declaration made?
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December 10th, 1948
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What did the WHO focus on in the 1950s?
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promoting primary health programs & launching campaigns
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What did the WHO focus on in the 1960s?
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campaign to eradicate malaria & was the main pharmaceutical authority
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What did the WHO focus on in the 1970s?
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expanded immunizations & made the declaration of alma-ata
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What did the WHO focus on in the 1980s?
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HIV prevention & the smoking or health program
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What did the WHO focus on in the 1990s?
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eliminating leprosy, controlling tuberculosis, and giving children the hepatitis B vaccine
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What did the WHO focus on in the 2000s?
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mental health, Indigenous health, and the millenium development goals
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What did the WHO focus on in the 2010s?
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non-communicable diseases & sustainable development goals
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What did the WHO focus on in the 2020s?
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COVID-19
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human rights
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basic freedoms and rights that all people should enjoy
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What is #25 in the human rights constitution?
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the right to health - universal coverage, ending discrimination, and individual-centered care
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United Nations Declaration on the Rights of Indigenous Peoples
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made to ensure survival and well-being for Indigenous populations
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When was resiliency added to the health promotion movement?
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1980s
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social resiliency
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support networks & social environments
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personal resources
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health practices & coping skills
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physical resources
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health & abilities
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social determinants of health
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the conditions in which people are born, grow, live, work, and age
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14 factors of Mikkonen/Raphael's SDHs
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gender, disability, housing, social safety net, health services, early life, income, education, Indigenous status, food insecurity, race, employment, social exclusion, unemployment/job insecurity
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protective factor
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anything that decreases the likelihood of developing a disease or injury
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upstream intervention
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addressed early-on; treats the cause of health problems (SDHs)
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downstream intervention
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individual care level; treats the health problem itself, but not its social causes
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advocacy
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pleading a cause or supporting another's interest
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benefits of advocacy
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helps groups achieve equity and improves global health of marginalized people
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drawbacks of advocacy
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can lead to oppression of other groups & views on certain issues are prone to change
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What is the responsibility of an advocate?
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identifying SDHs, promoting health, and focusing on patient and community needs
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levels of advocacy
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individual, community, global humanitarian
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What groups were compared in the 2016 Health Quality Ontario Study?
answer
5 income levels - low, low-middle, middle, middle-upper, upper
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What were the findings of the 2016 Health Quality Ontario Study?
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lower income = less health and a lower life expectancy
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How much of our life, environment, biology, and healthcare account for our health outcomes?
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50% our life, 10% our environment, 15% our biology, and 25% our healthcare
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What were Hans Rowling's discoveries in his Gapminder study?
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the rich and health have 4 things in common - time, trade, peace, and green technology
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inequity
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unfair, avoidable systemic disadvantage
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inequality
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different health in different populations
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epidemiology
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the branch of medicine that deals with the incidence, distribution, and possible control of diseases and other factors relating to health
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Where does Indigenous epidemiological data come from?
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colonization
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2 ways to reach data sovereignty
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decolonizing data & controlling data governance
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Maggie Walter's 5 colonization categories
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disparity, depravation, disadvantage, dysfunction, difference
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What is the problem with Maggie Walter's classifications?
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sometimes they rationalize dispossession and marginalization, causing a false sense of dependency in Indigenous communities
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data governance
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who gets control over data - how info is collected, used, and shared
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prevalence
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fraction of a population having a specific disease at a given time (prevalence = # of cases/total population)
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point prevalence
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# of cases at a specific time/total population at that time
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period prevalence
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# of cases at a period of time/average population during that time
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incidence
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the number or rate of new cases of a particular condition during a specific time for an at-risk group
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cumulative incidence/incidence proportion
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# of new cases over time period/total at-risk population
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incidence density rate/person-time incidence rate
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# of people who get the disease/# of person-years at risk (# of people at risk x # of years at risk)
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crude mortality rate
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# of deaths over a time period x 100,000/population at midpoint of time period
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specific mortality rate
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# of deaths over a time period (in a subgroup) x 100,000/population at midpoint of time period
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all-cause mortality
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deaths for any reasons
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cause-specific mortality
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deaths from the disease
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When is mortality standardized?
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when comparing mortality in 2 populations with different mortality influencing factors (not with crude/specific rates)
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vital event registration
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government tracking of events (prevalence, distribution, cause)
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importance of vital event registration
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identifies inequalities and helps plan services
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odds ratio
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used when there is no given population incidence, for example with a rare outcome of a case control study (odds ratio = a x d / b x c)
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relative risk
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likeliness of different groups to get a disease [a/(a+b)]/[c/(c+d)]
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What does it mean when RR is less than 1?
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E+ has a lower disease risk
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What does it mean when RR is more than 1?
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E+ has a higher disease risk
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When does it mean when RR is 1?
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equal disease risk for both groups
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Disability Adjusted Life Year (DALY)
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years lost from disability & disease, measures the burden of it (DALY = years lived with disability + years of life lost)
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YLD
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prevalence x disability weighing factor
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YLL
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# of deaths x (life expectancy - age of death)
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pros of DALY
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easy comparison of disease burden & potential to contribute is the best evaluation there is
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cons of DALY
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ableist & does not account for age (affects ability to contribute)
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What is the purpose of oral histories and stories?
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explain past events to offer caution
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oral history
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time period or event specific recollection
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story
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creatively told to emphasize lessons
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orator
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speakers/tellers - tell stories and add their own experiences (done via dancing/drumming)
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What is an example of blending of oral histories and storytelling?
answer
COVID/SARS - records/experiences from past illnesses were used to fight COVID