PPHC Flashcards

What is the World Health Organization definition of health?

The state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

What is the Health Triangle definition of health?

A measure of our body’s efficiency and overall well-being.

What are the three aspects of the health triangle?

• Physical Health

• Mental Health

• Social Health

What does “physical health” deal with?

The body’s ability to function.

What are the five components of “physical health”?

• Physical activity/exercise

• Nutrition

• Weight management

• Sleep

• Alcohol and drugs

What does “mental health” deal with?

How we think, feel, and cope with daily life.

What are the three aspects of “mental health”?

• Learning

• Stress

• Mental illnesses

What is learning?

The development of skills, behaviours, and knowledge.

What is stress?

The body’s reaction to any change that requires a adjustment or response.

What is distress?

A negative reaction to stress.

What are mental illnesses?

Mental health problems that are diagnosed and treated by mental health professionals.

What does “social health” deal with?

The way we react with people within our environment.

What are the three components of “social health”?

• Family relationships

• Peer relationships

• Public health

What is public health according to the World Health Organization?

The art and science of preventing disease, prolonging life and promoting health through the organized efforts of society.

What were three major achievements of public health in the 20th century?

• Having safer and healthier foods through hand washing, sanitation, pasteurization, refrigeration, and improved supply safety.

• Recognizing tobacco as a health hazard.

• Eradicating disease through immunization.

What are five top public health priorities in Canada?

• Obesity

• Cardiovascular disease

• Diabetes

• COVID-19

• Opioid crisis

What is epidemiology?

The study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems.

How does the word “epidemiology” break down?

epi = upon

demi = demos = people

logy = logos = study of

epidemiology = the study of people

What is health care?

Refers to chemicals (e.g. drugs), biologicals (e.g. immune modulators), devices (e.g. artificial knee), and services (e.g. medication review) used by people to improve their health.

What are the six types of healthcare?

• Diagnosis

• Treatment

• Health promotion

• Disease prevention

• Rehabilitation

• Palliative

What is health promotion?

Process of enabling people to increase control over and to improve their health.

What is disease prevention?

Process through which individuals, particularly those with risk factors for a disease, are treated in order to prevent a disease from occuring.

What is rehabilitation?

Process that can help individuals get back, keep, or improve abilities (physical or mental).

What is palliative care?

Process for supporting individuals with serious illnesses.

What are the three healthcare levels?

• Primary

• Secondary

• Tertiary

What is primary healthcare?

First contact with the healthcare system that may involve diagnosis, treatment, health promotion, or disease prevention.

Who would provide primary healthcare?

Primary care providers that deal with a broad range of physical, psychological, and social problems. 

E.g. family physician and community pharmacist

What is secondary healthcare?

Mainly involves specialist care that may involve diagnosis and treatment.

How can you receive secondary healthcare? Who would provide secondary healthcare?

Need referral from primary care provider to proceed to secondary healthcare. Patients seeking secondary health care cannot directly contact the specialist.

E.g. rheumatologist, cardiologist, oncologist

What is tertiary healthcare?

Specialized consultative healthcare. Involves advanced medical investigation and treatment that usually, though not always, involves inpatient care. 

What are three examples of tertiary healthcare?

• Pediatric rheumatology program at BC Children’s Hospital

• Cancer treatment at BC Cancer Agency

• Coronary artery bypass at St. Paul’s Hospital

How can you receive tertiary healthcare?

Need referral from primary or secondary health care to proceed to tertiary health care.

What is a health care system?

An organization of people, institutions, and resources that deliver health care to meet the health needs of target populations.

What are the four requirements of a health care system?

• Well-trained and adequately paid workforce (WHO)

• Well maintained facilities and logistics to deliver healthcare (WHERE)

• Financing mechanism (HOW)

• Reliable information on which to base decisions and policies (HOW)

Who is Tommy Douglas?

The father of the Canadian health care system.

What is the Canada Health Act?

The legislation that defines national principles for provincial and territorial health insurance plans.

Provinces and territories are constitutionally responsible for the organization and delivery of health care.

The Canada Health Act sets conditions for provincial and territorial health care system to meet in order to obtain federal contributions via the Canada Health Transfer.

When did the Canada Health Act come into effect?

1984

What is the Canada Health Transfer?

Federal transfer payment program to support provincial and territorial health care systems.

Provides long-term funding for health care and supports principles of the Canada Health Act.

What percent of Canadian tax dollars go towards the Canada Health Transfer?

11%

What are the five major criteria provinces and territories must meet to receive the Canada Health Transfer?

• Public Administration

• Comprehensiveness

• Universality

• Portability

• Accessibility

What is the “public administration” requirement of healthcare?

All administration of provincial health insurance must be carried out by a public authority on a non-profit basis.

What is the “comprehensiveness” requirement of healthcare?

All necessary health services, including hospitals, physicians, and surgical dentists (in hospital), must be insured.

What is the “universality” requirement of healthcare?

All insured residents are entitled to the same level of health care.

What is the “portability” requirement of healthcare?

A resident that moves to a different province or territory is still entitled to coverage from their home province.

What is the “accessibility” requirement of healthcare?

All insured persons have reasonable access to health care facilities.

Why does health care coverage differ between provinces/territories?

Provincial and territorial insurance plans decide on what are medically necessary for health care insurance purposes. Each can define “medically necessary” differently.

How is the health care of residents temporarily away from their home province covered?

Must continue to be covered by their home province for insured health care services.

How is the health care of residents permanently moving from one province/territory to another covered?

Must continue to be covered for insured health services by the home province during any minimum waiting period, not to exceed 3 months, imposed by the new province of residence. After the waiting period, the new province/territory of residence assumes health care coverage.

What are the three major roles of the BC health care system?

• Set policies (definition of insured health care services)

• Set budget

• Regulate health professional bodies (licensure and discipline)

What are the seven health authorities in BC?

5 regional health authorities:

• Northern Health (NHA)

• Interior Health (IHA)

• Fraser Health (FHA)

• Vancouver Island (VIHA)

• Vancouver Coastal (VCHA)

1 provincial health authority (PHSA) for the coordination and delivery of provincial programs and highly specialized health care services.

First Nations Health Authority established in 2013

How does inpatient healthcare work?

Many provinces/territories have regionalized inpatient health care.

• One or several regional entities

• Region is responsible for inpatient health care for residents through hospitals and long-term care facilites

Funded by the province within the global budget (the province funds the health authority, which funds the hospitals).

How does outpatient healthcare work?

• Provided by physicians, predominantly with a fee for service

• Fee schedules are negotiated

• Fee schedules are administered by the province

• Funded directly by the province

What is critical appraisal?

The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform decisions.

What are the three main questions to ask during critical appraisal?

• Validity - Is it trustworthy?

• Results - What did it show?

• Relevance - How applicable is it (to context of interest)?

What does critical appraisal involve?

Asking questions about article’s research methods, scrutinizing data collection and analysis, and evaluating how results are presented.

Why does critical appraisal matter?

It is an important step in the process of putting research into practice.

What is the goal of a scientific article?

To communicate the results of a research study, to share and further knowledge on a particular area of research.

What are the eleven key components of a scientific paper?

• Title

• Authors

• Author Affiliations

• Abstract

• Introduction

• Results (with figures)

• Discussion

• Conclusion

• Acknowledgements

• Author Contributions

• References

What is in the abstract section of a scientific paper?

• Provides an overview of the article

• Can be structured or unstructured

  • Structured - separated into sections (e.g. objective/background, methods, results, conclusion)

  • Unstructured - single paragraph

What is in the introduction/background section of a scientific paper?

• Usually a few paragraphs (2-5) on the problem the article is trying to tackle and the context of the article, including relevant prior research

• Usually the last paragraph is a statement of the objective (or purpose) of the research study

What is in the methods section of a scientific paper?

• How did the researchers conduct their study in terms of:

  • Study design

  • Data collection

  • Data analysis

• Important considerations of the methods include:

  • How well was the study designed to minimize errors (bias), this speaks to the validity of the study

What is in the results section of a scientific paper?

• What were the findings?

• If applicable, who was studied? What are their characteristics?

• Were findings presented logically?

• Did researchers use figures and tables to facilitate interpretation of results?

What is in the discussion section of a scientific paper?

• What were key findings highlighted/discussed by researchers?

• How did the researchers contextualize their findings (with other studies)?

• Did researchers state strengths and limitations of their study?

• Did researchers discuss potential implications (applications) of their study?

What two key points does epidemiology focus on?

The science of distribution and frequency of disease.

What three components determine the distribution of a disease?

• Person

• Place

• Time

What two components determine the frequency of disease?

• Incidence

• Prevalence

What four things can epidemiology do?

• Describe health of a population

• Explain cause of disease

• Predict occurrence of disease

• Control distribution of disease

What important thing did John Snow do?

He traced the source of a 1854 cholera outbreak in England to the Broad Street pump.

What are the two assumptions of epidemiology?

• Disease does not occur randomly

• Disease has causal and preventative factors that we can identify through systematic investigations of different people at different places or times

What are the three types of epidemiology?

• Descriptive

• Analytic

• Experimental

What is the goal of descriptive epidemiology?

To examine patterns of disease and health behaviours.

What is the goal of analytic epidemiology?

To evaluate relationships between risk/protective factors and disease

What is the goal of experimental epidemiology?

To evaluate effect of treatment/intervention on a disease.

What are the key questions of descriptive epidemiology?

Who? Where? When?

What are the key questions of analytic epidemiology?

Why? How?

What are the key questions of experimental epidemiology?

What happens if we intervene?

What are the typical study designs of descriptive epidemiology?

• Case reports

• Cross-sectional surveys

• Use of surveillance or registry data

What are the typical study designs of analytic epidemiology?

• Cohort studies

• Case-control studies

• Cross-sectional analytic studies

What are the typical study designs of experimental epidemiology?

Randomized control trials (RCTs)

What is an example of descriptive epidemiology?

Comparing lung cancer rates by age, sex, and region.

What is an example of analytic epidemiology?

Following smokers vs. non-smokers to see heart disease risk.

What is an example of experimental epidemiology?

Randomizing patients to new medications vs. standard care.

What are five types of measures of disease occurrence?

• Rank

• Count(s)

• Ratio

• Proportion

• Rate

For what four measures of disease occurrence is a key consideration who/what is in the numerator and/or denominator? For which one is this not a consideration?

Key consideration for:

• Count(s)

• Ratio

• Proportion

• Rate

Not a consideration for rank.

What does rank measure?

The order of disease occurrence.

What are three examples of a disease rank description?

• Arthritis and other rheumatic conditions are the leading cause of work disability among US adults

• Diabetes is the 7th leading cause of death in the US

• Cancer is the #1 leading cause of death in Canada

What does count(s) measure?

The number of persons who have a given disease (no denominator).

What are two examples of a disease count description?

• Number of female(s) with disease X

• 229,200 Canadians will be diagnosed with cancer in 2021

What is a ratio?

The quotient of two numbers in which the numerator is not necessarily included in the denominator (no specific relationship between numerator and denominator).

This allows for comparison of quantities of different natures.

What are two examples of a ratio description?

• Male to female ratio

• In 2022 there were 270 family doctors for every 100,000 British Columbians

What is a proportion?

The quotient of two numbers in which is numerator is necessarily included in the denominator. It is expressed as a fraction (1/5), decimal (0.2), or percentage (20%).

What are two examples of a disease proportion description?

• 2 in 5 Canadians will develop cancer in their lifetime

• 1 in 4 Canadians will die from cancer

What is a rate?

The quotient of two numbers in which the numerator is the number of ‘events’ observed for a given time, and the denominator is the population in which the events occur and includes time.

Numerator usually included in denominator unless the event makes them no longer at risk of the same event (e.g. death).

What is an example of a rate description?

• Five-year cancer survival is about 64%

• 10% of people develop condition X each year

What is prevalence?

All individuals affected by disease at a particular time.

Refer to individuals as “prevalent cases” or “active cases”.

What is incidence?

New individuals with a disease during a particular period of time. 

Refer to individuals as “incident cases” or “new cases”.

What is prevalence expressed as a proportion?

The proportion of a population affected by a disease at a specific time, usually expressed as a percentage.

What is point prevalence?

Proportion of a population affected by a disease at a point in time (e.g. prevalence of type 2 diabetes on December 31, 2020).

What is period prevalence?

Proportion of a population affected by a disease during a certain period of time (e.g. prevalence of diabetes in 2020).

What is cumulative incidence?

Incidence expressed as a proportion.

The number of new cases of disease over a period of time compared to the number of individuals at risk for disease at the beginning of time period.