Module 3

Cards (32)

  • Population strategy
    Approaches the population as a whole, aims to reduce health risks and improve the health of all individuals
  • High-Risk Strategy

    Focuses on the individual who is high risk, specific and tailored intervention to the individual needs and concerns
  • Advantages and disadvantages of population and high-risk approaches
    • Population Strategy: Radical - addresses DOH, Large potential benefit for the whole population, Behaviourally appropriate, Low motivation, Small benefit for individuals, Whole population could be exposed to the consequences of the intervention
    • High Risk: Addresses issues appropriate for individuals, Individually motivated, Cost-effective use of resources, Good benefit-to-risk ratio, Cost of screening is needed to test for individuals, Temporary effect of screening, Limited potential, Behaviourally inappropriate as it singles individuals out against social norms
  • Health promotion
    Acts on DOH, Health and Wellbeing focus, Empowers health, Involves whole population in everyday contexts
  • Ottawa Charter acknowledges

    • Health is a fundamental right for each person, Requires collective and individual responsibility, Opportunity to have good health should be equally available, Good health is an essential element of social and economic development
  • 3 basic strategies of the Ottawa Charter
    • Enable, Advocate, Mediate
  • Enable
    To provide opportunities for all individuals to make healthy choices through access to information, life skills and supportive environments
  • Advocate
    To create favourable political, economic, social, cultural, and physical environments by promoting health and focusing on achieving equity in health
  • Mediate
    To bring together individuals, groups and parties with opposing interests to work together/come to a compromise to promote health
  • 5 promotion action areas of the Ottawa Charter
    • Develop personal skills, Strengthen community action, Create supportive environments, Reorients health services towards Primary Health Care, Build healthy public policy
  • Primary prevention
    Limit the occurrence of disease by controlling specific causes and risk factors, Reduces disease incidence
  • Secondary prevention
    Early detection to reduce more severe consequences of disease, Reduces prevalence
  • Tertiary prevention
    Reduces the complications of the established disease
  • Te Pae Mahutonga
    Maori Health Promotion - Process of enabling Maori to increase control over the DOH and strengthen their identity as Maori, improving their health and SEP
  • 4 key tasks of Te Pae Mahutonga
    • Mauriora - Access to Te Ao Maori, Waiora - Environmental Protection, Toiora - Healthy lifestyles, Te Oranga - Participation in society
  • 2 pre-requisites of Te Pae Mahutonga
    • Nga Manukura - Leadership (Health professional and Community Leadership), Te Mana Whakahaere - Autonomy (Capacity for self-governance, community control and enabling political environments)
  • Te Pae Mahutonga - Maori Health Promotion Principles: Led and designed by Maori, for Maori, Promotes self-determination and control, Based on valid models, frameworks and concepts, Uses contemporary tools and methods, Allows for diverse realities, Focuses on DOH, Evidence-based
  • Screening
    Can be primary, secondary or tertiary
  • Examples of screening types
    • Primary: Screening for alcohol intake, Secondary: Screening for breast cancer, Tertiary: Screening bone density after chemotherapy
  • For screening to be successful
    • Suitable disease, Suitable screening test, Suitable treatment, Suitable Screening programme
  • Characteristics of a suitable disease for screening
    • An important public health problem, Knowledge of the natural history of the disease
  • Characteristics of a suitable screening test
    • Reliable, Safe, Simple, Affordable, Acceptable, Accuracy - Sensitivity and Specificity
  • Characteristics of suitable treatment
    • Evidence of early treatment leading to better outcomes, Effective, acceptable and accessible treatment, Evidence-based policies covering who should be offered treatment and the appropriate treatment to be offered
  • Characteristics of a suitable screening programme
    • Benefits must outweigh the harm, RCT evidence that screening programme will result in reduced mortality, increased survival time, lead time bias, length time bias, Adequate resourcing and agreed policy for testing, diagnosis, treatment and programme management, Cost effective, The heath care system must be able to support all elements of the screening pathway, Needs to reach all those who are likely to benefit from it
  • Breast cancer is a suitable disease for screening in New Zealand: NZ has one of the highest breast cancer rates, Most common cancer among NZ women, 2nd most common cause of cancer deaths among NZ women, Rates are high for Maori and Pasifika women, Incidence increases with age and rises steeply from the age of 50
  • Screening mammogram
    Detects breast lumps before it can be felt, Sensitivity 75-90%, Specificity 90-95%
  • Breast cancer screening in New Zealand: Women with positive tests are offered a diagnostic test/referred to a specialist, Screening reduces mortality up to 45%, Goal of improving screening participation rates Maori and Pasifika women, Ten year survival rate - Screen detected in Maori was 5.2% higher than NZ European
  • Healthcare requires prioritisation due to limited resources and funds
  • Criteria to consider when prioritising population health problems
    • Descriptive: Who is most/least affected? Where are we now? What are the trends over time? Where are we going?, Explanatory: What are the DOH? What are the risks? WHY are we getting worse/better? Why are populations different?, In terms of equity: Does the problem/risk factor disproportionately affect population subgroups? Why? Take into account Te Tiriti, Evaluative: What can improve population heath outcomes? Is the intervention improving health outcomes?
  • Epidemiological measures used to prioritise population health issues
    • Age at death and premature mortality, Time lived with disability, Population Attributable Risk (PAR)
  • Population Attributable Risk (PAR)

    The amount of extra disease attitubable to a risk factor in a particular population. If the association is causal - This is the amount of disease we could prevent if we removed the risk factor the particular population.
  • Breast cancer is a high priority population health issue in New Zealand: NZ has one of the highest breast cancer rates, Most common cancer among NZ women, 2nd most common cause of cancer deaths among NZ women, Rates are high for Maori and Pasifika women, Modifiable risk factors include Alcohol, Oral contraception, Obesity, Lack of Physical exercise, Screening reduces mortality up to 45%, Goal of improving screening participation rates Maori and Pasifika women