PP continued

Tannahill Model

(Health Promotion)

Health Protection

  • Fiscal legal policies to protect health

Health Education

  • Enhancing positive health by changing beliefs, attitudes and behaviours

Disease prevention


Primary Prevention

  • Aims to stop disease starting (Mass vaccination)

Secondary prevention

  • Aims to catch disease early and prevent progression. Screening programme of at risk popn

Tertiary prevention

  • Prevention of disability/ becoming handicap. Reduction of impacts of long term conditions

Impairment, Disability and Handicap


Impairment

  • Any loss of abnormality of psychological, physiological and anatomical structure or function
    (e.g. cloudy vision inoperable cataracts)

Disability

  • Any restriction/lack of ability to perform activity in manner within range considered normal
    (e.g. progressively difficult to read/use computer)

Handicap

  • Disadvantages for given individual, limits/ prevents fulfillment of role normal for that individual
    (e.g. register oneself partially sighted unable to continue working as office manager)

Birth rates + Death rates

Definitions


Females of childbearing age

  • 15-44 ish

Infant

  • <1 year after live birth

Early neonatal

  • <1/52

1/52<Late neonatal<28/365


28/365<Post neonatal<1Y

Crude birth rate:
Most common measure fertility
Doesn't take into account child bearing age

  • (Number of live-births to residents in specific area and calendar year)
  • (Average or mid-year popn for same area and year)
  • *1000

General fertility rate
More specific than crude

  • (Number of live-births to residents in specific area and year)
  • (mid year female popn aged 15-44 for same area and year)
  • *1000

Total Period Fertility Rate

  • Average number of children born to woman over her lifetime
  • She experienced exact, current, age specific fertility rates through her lifetime
  • She survived for all her reproductive life

Perinatal Mortality Rate
Demonstrates number of late fetal/early infant deaths which are considered preventable

  • (Fetal Deaths (24 weeks+ gestation) + Postnatal deaths (1wk)
  • (Fetal Deaths (24 weeks+ gestation) + Live births
  • *1000

Infant Mortality Rate
Easier to record than PMR

  • (Infant Deaths)
  • (Live Births)
  • *1000

Post Neonatal Mortality rate

  • Number of infant deaths between 28 days - 1 year in given year per1000

Abortion rate

  • Estimated annual number of abortions (still birth after 24 weeks gestation) per 1000 women reproductive age

Case Fatality Rate

  • (Number of deaths from disease)
  • (Number of diagnosed cases of disease)
  • % people that die form specific disaes

Stuff

Communicable Diseases

  • Certain diseases have to be reported by law under Public Health Act
  • usually reported to Consultant in Communicable Disease Control (CCDC)
  • Their role:
    • Identify source of infection
    • Prevent further dissemination

Birth Notification and Registration within 36 hours and then 42 days

When a person dies, medical certificate stating cause of death is issue (by hospital/doctor/GP/coroner)

Standardisation

Standardization

  • Method removing confounders allow comparison two incomparable popns

Indirect Standardisation

  • Produces Standardised Mortality Ratio
  • Ratio of number of deaths observed in study population to number that would be expected if study population had specific rate as standard popn
  • Produces % to indicate difference between groups
    • SMR = 100: Study area same mortality rate as those of standard popn
    • SMR < 100: Study area lower mortality rate than seen in standard
    • SMR > 100: Study area higher mortality rate than seen in standard
    • SMR = 180: Study area mortality rate 80% higher than seen in standard popn
  • *Adjusted for age

Direct standardisation

  • Standardised mortality ratio
  • Actual number can be used to compare study popn with other populations similar to standard popn

Defintions

QALY

  • Capture expected years of life left and quality of that time
  • Derived from mortality, morbidity and quality of life value

DALY

  • Measure of burden of disease
  • Often used in states of chronic disease
  • Alternative to QALYs

Endemic

  • Disease always prevalent in popn

Epidemic

  • Temporary but clear increase in incidence of disease in area

Pandemic

  • Epidemic crosses international boundaries and affects large number of people

Ecological Fallacy

  • Error of applying conclusions to individuals based on analytical findings from group data

Cohort Effect

  • Variation in health and disease for different generations
  • Due to exposure different risk factors
  • Attributed to environmental and societal changes

Types of Bias

  • Selection
  • Recall
  • Lead time: early diagnosis leads to over estimation of survival/cure rate
  • Length time: Disproportionate number of long duration cases
  • Observer

Black Report 1980
Proposed inequalities in health

  • Artefacts - Nothing exists
  • Natural/socieal selection: Poor health = poor people
  • Cultural/Behavioral: Poor people = poor health
  • Structural: Economics and structural factors