question
biomedical approach
answer
talk about cells, then whole body, diet and exercise; personal health status
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Population Health
answer
Focuses on health measurements at a population level
- environmental protection, the safety of food and water
- environmental protection, the safety of food and water
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individual-level analysis of health and disease
answer
Individual level model of health and disease is often referred to as the risk factor model
question
Is age a good predictor of health?
answer
NO
question
why is age not a good predictor of health
answer
- variation at all ages
- variability in potential healthy living at older ages
- variation of health/ life expectancies in different ages in populations
- variability in potential healthy living at older ages
- variation of health/ life expectancies in different ages in populations
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Sex is not a powerful predictor of health...
answer
- two men/women can be different; continuum not a binary- social norms change the way we act- sex is confounded with gender
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Epigenetics
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the study of gene expression
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genetic expression
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- which genes are active and how active each one is- impacted by environmental and social conditions- goes hand in hand with behavior
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levels of analysis: healthy cell
answer
balanced electrolytes, oxygen, available glucose
question
levels of analysis: healthy person
answer
eat fruits/ veggies, exercise, bike helmet
question
levels of analysis: healthy population
answer
effective food safety, good schools/ health care, environmental protection
question
more on genetics
answer
- enviro and social conditions modify behavior and genetic expression - which genes are active/ how active
- very few ambiguous genetic diseases; having a bad gene does not mean you will contract it
- very few ambiguous genetic diseases; having a bad gene does not mean you will contract it
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social patterning of behaviour
answer
the study of the social determination of health behaviour
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two weaknesses of ind level approach to relevant health behavior:
answer
1. modifying individual lifestyle is a daunting task
2. blaming people for illness is often counterprod and unfair "blaming the victim approach"
2. blaming people for illness is often counterprod and unfair "blaming the victim approach"
question
The MR FIT study showed what?
answer
it is extremely difficult to change people's habits
- risk factors focused on: smoking, diet, exercise, reducing blood pressure, and cholesterol
- risk factors focused on: smoking, diet, exercise, reducing blood pressure, and cholesterol
question
MR FIT study must be interpreted cautiously because of...
answer
secular change; the behavior of both groups could have changed over the study in response to interventions and American society
question
what is secular change
answer
biological changes that occur over decades or generations, purportedly due to environmental factors
question
Health according to WHO
answer
a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
question
A population can be defined as
answer
1. geographically
2. common characteristic (membership)
3. common risk factor (smoker, low socioeconomic group)
2. common characteristic (membership)
3. common risk factor (smoker, low socioeconomic group)
question
definition of pop health requires us to consider:
answer
health issues of entire society as well as health issues of vulnerable high-risk groups
question
John Snow
answer
- father of epidemiology
- discovered the cause of cholera
- focused on the environment
- he saw people's living conditions as a source of disease
- maps with disease incidents
- discovered the cause of cholera
- focused on the environment
- he saw people's living conditions as a source of disease
- maps with disease incidents
question
Frederick Engels
answer
-wrote The Condition of the Working Class in England
-showed that death rates of poor people in urban centers were much higher than the death rates of poor people in rural settings
- living and working conditions are determinants of health
-showed that death rates of poor people in urban centers were much higher than the death rates of poor people in rural settings
- living and working conditions are determinants of health
question
Rudolf Virchow
answer
father of modern pathology
- report of the typhus outbreak in upper silesia
- he argued additional medical care/ drugs would not be enough to improve pop health
- he linked civil and human rights to health outcomes
- report of the typhus outbreak in upper silesia
- he argued additional medical care/ drugs would not be enough to improve pop health
- he linked civil and human rights to health outcomes
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Emilie Durkheim
answer
father of sociology; created the concept of social facts
- social facts; human artifacts; they act as determinants of health
- analyzed suicide rates across diff communities
- social enviro shaped individuals
- social facts; human artifacts; they act as determinants of health
- analyzed suicide rates across diff communities
- social enviro shaped individuals
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Field of Health Demography
answer
the study of birth and death rates in human populations
- two core ideas are demographic and epidemiologic transitions
- two core ideas are demographic and epidemiologic transitions
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demographic transition
answer
Describes the impact of falling childhood death rates and extended life spans on the size and the age distribution of populations
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Epidemiologic Transition
answer
Implies that as social and economic development occurs, different types of diseases become prominent
question
epi trans
change from infectious/ parasitic diseases in __ places to chronic diseases in __ ones
change from infectious/ parasitic diseases in __ places to chronic diseases in __ ones
answer
poorer, richer
(occurs when societies reach level of affluence from 6000-1000 per capital income)
(occurs when societies reach level of affluence from 6000-1000 per capital income)
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Phases of demographic transition
answer
1. from high birth rates and high death rates to increased wealth and urbanization
2. from high birth rates to a relatively advanced economic development and declining death rates (modern china)
3. from declining birth rates and death rates to an advanced stage of economic development characterized by stability of the population (modern Canada)
2. from high birth rates to a relatively advanced economic development and declining death rates (modern china)
3. from declining birth rates and death rates to an advanced stage of economic development characterized by stability of the population (modern Canada)
question
three pillars of population health
(overarching, umbrella for...)
(overarching, umbrella for...)
answer
1. public health
2. health care
3. public health policy
2. health care
3. public health policy
question
population health is the KEY to adressing...
answer
most difficult health problems, emerging infectious diseases, cost of health care
question
population health - 3 foundational frameworks for thinking:
answer
1. population health perspective
2. systems thinking. systems doing
3. population health tools for implementation
2. systems thinking. systems doing
3. population health tools for implementation
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population health perspective
answer
examines the components of population health, the determinants of health and disease, how we measure the course of disease in a population, as well as the health status of a population
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individual versus population health
answer
IND: ind problem, diagnosis of their disease/ conditions
POP: pop problem including determinants of of health, diagnosis of prob using systems approach
POP: pop problem including determinants of of health, diagnosis of prob using systems approach
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Population health often looks at the underlying influences and determinants. It's these underlying factors that are thought of as...
answer
upstream forces
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population health science
answer
uses health care and public health research and also the research in a wide range of other professional and disciplines, ranging from economics to psychology and from systems analysis to communications. •
question
determinants have been called
answer
causes of causes
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Determinants of health
answer
BIG GEMS
- behaviors
- infection
- genetics
- geography
- environment
- medical care
- socioeconomic-cultural
- behaviors
- infection
- genetics
- geography
- environment
- medical care
- socioeconomic-cultural
question
social epidemiology
answer
Studies on how social position and context influence human health
question
4 things for social epidemiology
answer
1. takes on pop level perspective
2. concerns itself with the social context of behavior
3. relies on multilevel analyses
4. takes a developmental, life course perspective
2. concerns itself with the social context of behavior
3. relies on multilevel analyses
4. takes a developmental, life course perspective
question
most disease actually occurs in __ risk populations
answer
low; because that is where most of the population is
question
we need to shift __, not just treat the __ risk populations
answer
averages, high
question
Rose's Paradoxes:
If we treat __ risk people, we will not do much to improve the __ health of the population.
If we change the __ risk profile, we will not have much effect on the __ individual.
If we treat __ risk people, we will not do much to improve the __ health of the population.
If we change the __ risk profile, we will not have much effect on the __ individual.
answer
high, overall
average, average
average, average
question
rose's critique of ind level approach
answer
-It addresses only a small proportion of the total incidence of disease, injury, or premature death
-It is palliative, a band-aid approach, failing to address root causes
-It is behaviorally inadequate
-It involves attribution errors and mistakes about causality
-It is palliative, a band-aid approach, failing to address root causes
-It is behaviorally inadequate
-It involves attribution errors and mistakes about causality
question
white hall studies
answer
Studies of English civil servants
results:
-Employees in higher-paid, higher-status jobs enjoyed better health
-Risk factors accounted for only a small fraction of differences
results:
-Employees in higher-paid, higher-status jobs enjoyed better health
-Risk factors accounted for only a small fraction of differences
question
Black Report
answer
Working Group on Inequalities in Health
Showed the gap in health between social classes
Showed that the gap was growing
Showed the gap in health between social classes
Showed that the gap was growing
question
Richard Wilkinson
answer
Examined health disparities in 32 OECD countries
Strong correlation between life expectancy and the proportion of income received by the lower 50% of the income distribution
Unequal societies = unhealthy societies
Strong correlation between life expectancy and the proportion of income received by the lower 50% of the income distribution
Unequal societies = unhealthy societies
question
Materialist Theories
answer
Level of resources at the individual level
*Income
*Education
*Social network
Research shows consistent relationship between resources available at the individual level and health outcomes
*Income
*Education
*Social network
Research shows consistent relationship between resources available at the individual level and health outcomes
question
neo materialstist hypothesis
answer
factoring in the effects of public goods and the distribution of wealth in society
question
Psychosocial Theories
answer
The status of the person plays a central role
The size of the gap between the rich and the poor is what matters most
Focuses on the position of individuals in social hierarchy
Feeling of stress => deterioration in health
The size of the gap between the rich and the poor is what matters most
Focuses on the position of individuals in social hierarchy
Feeling of stress => deterioration in health
question
Systems Thinking/ systems doing provide
answer
framework for population health sciences, including analysis of complex health problems and identification of health problems
question
Systems Thinking
answer
a way of structuring - about health problems, looking for effective ways to address these problems, and measuring the success of our interventions
question
it leads to systems doing, which is
answer
what is needed for successful implementation
question
Steps to systems thinking
answer
- Step 1: ID the key factors or influences that impact an outcome such as disease or the out of disease
- Step 2: Indicate the relative strength of the impact of each of the influences or interventions
- Step 3: ID how these influences or interventions interact - that is, how they work together
- Step 4: ID the dynamic changes that may occur in a system by Identifying the feedback loops that occur in the system
- Step 5: ID bottlenecks that limit the effectiveness of the system
- Step 6: ID leverage points that provide opportunities to greatly improve outcomes
- Step 2: Indicate the relative strength of the impact of each of the influences or interventions
- Step 3: ID how these influences or interventions interact - that is, how they work together
- Step 4: ID the dynamic changes that may occur in a system by Identifying the feedback loops that occur in the system
- Step 5: ID bottlenecks that limit the effectiveness of the system
- Step 6: ID leverage points that provide opportunities to greatly improve outcomes
question
Evidence comes from
answer
surveillance, surveys, studies, synthesis
question
3 basic strategies used to improve population health
answer
1. Reducing high risk
2. improving the average risk
3. narrowing the spread of the risk curve
2. improving the average risk
3. narrowing the spread of the risk curve
question
5 tools of population health
answer
1. Population health communication
2. Population-based behavioral change
3. Health policy interventions
4. Screening for disease and risk factors for disease
5. Population-based vaccination for disease eradication and control
2. Population-based behavioral change
3. Health policy interventions
4. Screening for disease and risk factors for disease
5. Population-based vaccination for disease eradication and control
question
Tool 1: pop health comm
answer
-electronically, social marketing...
-A useful framework for messaging has been called the SUCCESs framework
-A useful framework for messaging has been called the SUCCESs framework
question
success framework
answer
-Simplicity - being able to capture meaning in a few words
-Unexpectedness - Getting a holding people's attention
-Concreteness - Easily visible
-Credibility - Can be reinforced by trustworthy sources of information
-Emotions to emotions; assist in gaining attention and remembering
-Stories - short personalized stories are easily recalled
-Unexpectedness - Getting a holding people's attention
-Concreteness - Easily visible
-Credibility - Can be reinforced by trustworthy sources of information
-Emotions to emotions; assist in gaining attention and remembering
-Stories - short personalized stories are easily recalled
question
tool 2: pop based behavioral change
answer
-A great deal of the success of population health depends on successful efforts to change individual behavior
question
tool 2: stages of change model
answer
-Precontemplation - considered changing behavior
-Contemplation - actively thinking about the benefits and barriers to change
-Preparation - developing a plan of action to make change
-Action - change in behavior is taking place
-Maintenance - new behavior becomes a permanent part of their life
-Contemplation - actively thinking about the benefits and barriers to change
-Preparation - developing a plan of action to make change
-Action - change in behavior is taking place
-Maintenance - new behavior becomes a permanent part of their life
question
tool 3: health policy interventions
answer
Health policies result from federal, state, and local legislation as well as from executive branch action. They also include private action by employers, health insurance corporations, and healthcare providers that influence what individuals can and cannot do
question
tool 3: 3 important approaches
answer
-Global action to address health conditions cross national border, such as pandemic disease
-Health in all policies that view health as a single system
-Health in all policies that view health as a single system
question
tool 4: screening for disease and risk factors for disease
answer
Screening for disease = the use of tests on individuals who do not have symptoms of a specific disease (asymptomatic)
- CDC has screening...
- CDC has screening...
question
tool 5: pop based vaccination for disease eradication and control
answer
- Edward Jenner first introduced vax
- Eradication remains an important goal of population health, it is difficult to achieve
-There are certain characteristics that make a disease ideal for eradication
- important in controlling disease
- Eradication remains an important goal of population health, it is difficult to achieve
-There are certain characteristics that make a disease ideal for eradication
- important in controlling disease
question
gradient in health
answer
- the relationship between income and health is found in all affluent societies: includes mortality and morbidity
-EXcept: breast, portate, rare diseases...
-EXcept: breast, portate, rare diseases...
question
Higher population __ typically signifies __ education levels, improved living conditions, improved housing, better diet, and safer, more rewarding work
answer
income, higher
question
The problem of collinearity
answer
Several predictive variables are highly correlated with each other, making it difficult to ascertain the relative contribution of each to the outcome.
question
The Preston Curve shows that
answer
in general, life expectancy increases rapidly in the world's poorest countries as per capita GDP increases, but for middle and higher income countries, increased per capita GDP has little association with life expectancy
question
country's GDP correlates __ with life expectancy in poorer countries but very __ with life expectancy in richer ones
answer
strongly, weakly
question
Inequality hypothesis
answer
At some point (around $10,000 per capita), the relationship between income and life expectancy virtually disappears.
Each addition to GDP is less important in more affluent countries.
Total income and average income matter most in poor places, but the distribution of available income matters in rich countries.
Each addition to GDP is less important in more affluent countries.
Total income and average income matter most in poor places, but the distribution of available income matters in rich countries.
question
Components of the Wilkinson Synthesis
answer
- Social capital theory
- Sociology and criminology
- Primatology
- Sociology and criminology
- Primatology
question
Social Capital Theory
answer
Putnam's argument about social capital: Social capital is important to social mobility. Integrated communities have better social capital distribution.
question
sociology and criminology
answer
Durkheim claimed that social change is creating chaos. It creates stress, which creates suicide in society. People need to feel united not to have too much problems in society.
question
Primatology
answer
all live in social hierarchies; show that subordinate animals have lower life spans;; levels of cortisol
question
Wilkinson's Theoretical Synthesis
answer
-Income distribution is a marker of how unequal society is.
-The size of income inequalities reflects how hierarchical the society is.
-Big differences in income suggest that there is a big difference in education, housing, etc.
-Big differences between individuals will diminish social capital, fuel envy, and create political instability.
-All of this will work through our biological mechanism.
-The size of income inequalities reflects how hierarchical the society is.
-Big differences in income suggest that there is a big difference in education, housing, etc.
-Big differences between individuals will diminish social capital, fuel envy, and create political instability.
-All of this will work through our biological mechanism.
question
the inequality hypothesis under attack
answer
The problem of scale
The problem of animal models
The problem of inconsistent correlation
The problem of ideological bias
The confounding of status and income
The problem of animal models
The problem of inconsistent correlation
The problem of ideological bias
The confounding of status and income
question
income and income distribution
answer
- Income is key for health
- Disposable income depends on taxes and transfers
- Incomes should be adjusted for household size
- More lone people = low income
- Different tax systems
- Disposable income depends on taxes and transfers
- Incomes should be adjusted for household size
- More lone people = low income
- Different tax systems
question
Flat vs Progressive Tax
answer
flat - same for everyone
progressive - more for higher tax brackets
progressive - more for higher tax brackets
question
Gini Coefficient
answer
A measure of income inequality within a population, ranging from zero for complete equality, to one if one person has all the income.
question
Poverty and Its Mitigation
answer
- poverty is a serious issue
-Poverty is most severe in female sole-support households
-Poverty levels among older adults decreased but did not disappear
-Unemployment and falling income in Canada disproportionally affects youth, immigrants, and people residing in central Canada
-Poverty is most severe in female sole-support households
-Poverty levels among older adults decreased but did not disappear
-Unemployment and falling income in Canada disproportionally affects youth, immigrants, and people residing in central Canada
question
Neo-liberalism
answer
The push to reduce government intervention in business and/or individual lives.
question
problems with neo-liberalism
answer
Much economic development over the centuries is government led
Private economic activities are nested inside a whole array of public laws and regulations without which it could not take place
A combination of low taxes, easy credit, and self-regulation leads to rampant inequality, speculation, economic bubbles, and recession
Private economic activities are nested inside a whole array of public laws and regulations without which it could not take place
A combination of low taxes, easy credit, and self-regulation leads to rampant inequality, speculation, economic bubbles, and recession
question
materialist
answer
- link between household income and health
- income is linked to education, living conditions, and health
- income is linked to education, living conditions, and health
question
Neo-materialist
answer
- the importance of material conditions (social structures, public goods)
- distribution of wealth in society
- distribution of wealth in society
question
psychosocial approach
answer
-Focus on the perception of our status and personal security
-The resources available to us matter less than our social position
-The resources available to us matter less than our social position
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