HKS All

Mostly from PSP Y1S1 Revision Session

1. State the WHO definition of health

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

2. What are the pros and cons of the WHO definition of health?

Pros:

-Recognises that health is not purely a physical, bodily or physiological issue, instead broadening its scope to mental and social domains as well.

-Reinforces that not having a disease does not mean someone is in good health.

Cons:

-‘Complete’ suggests that people with comorbidities or chronic illnesses can never be considered healthy, which can exclude them.

-Subjective in what ‘well-being’ means

3. Distinguish between equity and equality

Equity: providing fair opportunities, catering for disadvantages

Equality: providing same opportunities for everyone

4. Distinguish between avoidable and unavoidable health disparities/inequalities.

Avoidable: Can be changed e.g. financial status, social status, location (rural, remote, urban), etc…

Unavoidable: Can’t be changed e.g. genetics

5. State the WHO definition of equity.

Equity is the absence of avoidable, unfair, or remediable differences among groups of people, whether those groups are defined socially, economically, demographically or geographically or by other means of stratification

6. What is a DALY. What is the formula for calculating DALY.

Disability Adjusted Life Years (DALYs): refers to how many years of life are impacted as a result of having disease.

Considers both mortality and morbidity

DALY = YLD + YLL

YLD = Years lived with disability
YLL = years life lost

7. List the 4 S’s and distinguish between them.

STAFF: Members of the healthcare team and those involved with the healthcare team, e.g. medical practitioners, nurses, pharmacists, PTs, OTs, technicians, etc

SYSTEMS: Staffing systems, parole systems, softwares in healthcare environments

SPACES: Environments involved in healthcare, e.g. hospitals, clinics, labs, etc

STUFF: Things used by the healthcare team, e.g. medical equipment, sanitary equipment, surgical equipment, technology, imaging machines, etc

8. What is managed by the federal government (healthcare)?

• National policies

• medical

• PBS

• Regulate private health insurance

• Research funding

9. What is managed by the state government (healthcare)?

• Public hospital management

• Private hospital licensing

• Ambulance services

• Community based and primary health services

• Health complaints

10. What is managed locally/non-governmental/shared?

• Pharmaceutical regulations

• Health workforce

• Education and training

• ATSI funding

• Quality control

11. What is covered under Medicare?

1. Free hospital treatment

2. Low/no cost treatment for those with medicare provider number

12. Where do you find info about what is eligible for Medicare?

Medicare benefits schedule (MBS)

13. What percentage of the Commonwealth government’s health funding is allocated towards Medicare?

25%

14. Where does Medicare get its funding?

-Medicare receives its funding from the Medicare Levy, which is up to 2% of taxable income.

-For people who do NOT use private healthcare insurance, there is an additional surcharge of 1.5%

15. What are the objectives of the pharmaceutical benefits scheme (PBS)?

1.Reducing the cost of medication to consumers

2.Regulation of how safe medications are, and their quality. → TGA must approve these drugs.

16. What percentage of the cost of medication is covered by the government under the PBS?

87%

17. What is the PBS safety net? What are the specific threshold amounts?

However, there is the PBS safety net, which further subsidises/eliminates the cost of prescription medication after reaching the threshold amount.

Concession card holders: $277.20. Prescription medication is free after reaching this value.
General medicare holders: $1694.00. Prescription medication is subsidized after reaching this value

18. List some structural determinants of health.

Environmental differences: Global warming, environmental influence on agriculture, soil quality, urbanisation

Sociocultural factors: cultural blindness, cultural safety, social determinants

Geopolitical factors: Political issues, displacement (forced relocation/refuge, asylum etc)

Legal/historical factors: Colonial impacts and after-effects, legislation (e.g. health legislation)

19. List some social determinants. (As reported by Marmot and Wilson’s WHO report).

Social exclusion

Employment/unemployment

Stress

Access to healthy food

Religion

Socioeconomic status

Access to transport

Early childhood development

Psychological changes

20. List some health indicators.

Mortality rates

Neonatal mortality rate

Cause-specific mortality

Infant mortality

Life expectancy

Prevalence of disease/conditions

Admissions to hospital by diseases/conditions

Utilisation of general practice services

Frequency of health risk factors

DALYS

21. Distinguish between primary, secondary and tertiary healthcare.

Primary Healthcare: Initial interaction with the healthcare system, often through a GP or paramedic, nurse, pharmacist, etc.

Secondary Healthcare: After the primary healthcare encounter, a specialised referral (e.g. paediatrician, hepatologist) or ICU in the emergency dept

Tertiary Healthcare: Care received as a hospital in-patient, from specialists. So not the initial encounter with specialists, but subsequent ones.

22. What is the Whitehall study?

Whitehall study are series of research projects that find link between social status and health.

23. What are the results of the Whitehall study 1?

Whitehall Study 1:

Increased life expectancy and reduced rates of cardiovascular disease in highly ranked civil servants in comparison to lower ranked ones

Participants: 18,000

Age range: 20-64

24. What are the results of the Whitehall study 2?

Whitehall Study 2:

Validated the correlation between health status and employment grade, where this relation was due to social status, perceived control and social support networks available → social determinants are relevant!

This study is still going! It began in 1985 so conveniently about 40 years

The only whitehall study to include female participants

Total participants (male and female): 10,000

25. What are the first 10 SDGs?

1. No poverty

2. Zero hunger

3. Good health and well-being

4. Quality education

5. Gender Equality

6. Clean water and sanitation

7. Affordable and clean energy

8. Decent work and economic growth

9. Industry, innovation and infrastructure

10. Reduced inequalities

26. What is structural violence? What does it include?

Systemic ways in which people are subjected to constant disparities in the healthcare system, leading to poorer health outcomes.

Includes:

Significant poverty

Racism and violence

Breach of human rights

27. Distinguish between upstream and downstream in the ‘river’ metaphor of healthcare.

Upstream:

Think about how the healthcare system is designed e.g. through legislation, policies, structure. System focused rather than individual focused

Downstream:

Think about how individuals are directly being impacted by the efforts of those higher up in the system.

28. How can we improve upstream factors?

Tackle Social and Structural Determinants: Implement changes in legislation, public health policies, and systemic frameworks

Preventive Healthcare: Focus on measures that prevent illness, such as vaccinations, screenings, and lifestyle modifications.

Strengthen Health Systems:
Improve infrastructure, staffing, and resource allocation within healthcare systems.

29. How can we improve downstream factors?

Therapeutic interventions: treatment to manage/cure existing health conditions

Access to medicine

Allied health services

Behaviour change initiatives: Develop programs that encourage healthier behaviors, such as quitting smoking, improving diet, and increasing physical activity.

30. Define primary healthcare.

Defined as healthcare that is:

Practical, scientifically sound and socially acceptable methods of using technology

Universally accessible to all community members through their full participation

Affordable

Directed towards self reliance and self determination.

31. Reforms to primary healthcare are focused on:

• Universal coverage

• Healthcare service delivery

• Public policy

• Health leadership

32. Compare Aboriginal Australian life expectancy vs non-Aboriginal.

8.8 years lower for males and 8.3 years lower for females when compared to their non-Indigenous counterparts.

33. Rheumatic heart disease is how many times higher than non-indigenous in NT, QLD and WA?

Rheumatic heart disease is 37x more common in Indigenous populations than non-Indigenous populations in the Northern Territory, 167x more higher in Queensland and 630x higher in Western Australia

34. What are some other diseases with higher occurrence in Indigenous communities?

HepB, HepC, asthma, TB, meningococcal disease, etc

35. According to the 2021 census, what percentage of Australia’s population is indigenous? What percentage of them live in major cities?

As per the 2021 census by the AIHW, 3.8% of Australia’s population is Indigenous. However, only 41% of these live in major cities.

36. What are 3 requirements to be indigenous?

1. Be of Aboriginal or Torres Strait Islander Origin

2. Identify as of Aboriginal or Torres Strait Islander

3. Be accepted as an Aboriginal or Torres Strait Islander person by the Aboriginal or Torres Strait Islander community they reside in

37. What are the 4 time periods in the timeline of Indigenous injustice?

1778: Displacement (Arrival of first fleet)

1837-1937: Segregation

1937-1960s: Assimilation

1960s-Present: Structural discrimination

38. When were voting rights given to Indigenous people?

1962 (??)

39. Distinguish between vertical and horizontal health equity.

Vertical health equity: People should be treated differently based on their needs to address disparities present.

Horizontal health equity: Equal treatment for people of similar circumstances/health requirements regardless of their ability to pay.

40. How much more likely are people living in rural and remote areas to have a mental health disorder?

10%

41. Distinguish between the 5 parts of Tanahashi framework.

-Availability: Who are the services designed for and are available to use?

-Accessibility: Can people engage with these services or are there barriers preventing them from doing so, e.g. financial, social, cultural, etc?

-Acceptability: Are people willing to use the service? What is preventing them? E.g. cultural blindness, discrimination, structural violence, etc.

-Contact coverage: Who uses the service (Rather than who is supposed to/encouraged to use it)

-Effectiveness coverage: Care and follow up.

42. What are some conditions which refugees and asylum seekers are more prone to include.

Reduced medicare and PBS services

Increased incarceration

Poor mental health

More communicable disease rates

Reduced access to healthcare as a result of linguistic and cultural barriers

43. Define refugee

Someone who “owing to well-founded fear of being persecuted for reasons of race, religions, nationality, membership of particular social group or political opinion, is outside the country of their nationality and is unable/unwilling to avail themselves to the protection of the country or return to it

44. Define asylum seeker

Someone who has left their home country due to fear of persecution but has not yet been granted legal refugee status

45. Define migrant

Someone who chooses to leave their home country and cross an international border, not necessarily for fear of persecution. Umbrella term that can include refugees but also voluntary migrants who are in search of a better life.

46. Define internally displaced person (IDP)

Someone who has fled their home but not crossed an international border to seek sanctuary

47. ASK guidelines

Country of departure and when they arrived

Languages (interpreter?)

Occupation

Circumstances

Any family present

48. SCREEN guidelines

A thorough health assessment.

Screening investigations to detect infectious disease or pre-existing health condition they may be unaware of due to lack of access to healthcare.

Informed consent - must be clear communication→interpreter

49. What should everyone be screened for

Hepatitis B, strongyloids, HIV, varicella, NCDs, dental/hearing/visual diseases

50. What should people be screened for based on threat

rubella, vitB12

51. What should people be screened for depending on country

HepC, malaria, schistoma

52. KINDNESS guidelines

Understand the difficult circumstances people may be in

Direct them to support if/when they need it.

53. What official document contains the international definition of human rights?

United Nations Universal Declaration of Human Rights (1948)

54. Distinguish between neoliberal globalization and globalization

55. Key features of pharmaceutical patents

• Apply to technologies (including medicines) that are new, useful, or non-obvious.

• Grant exclusive rights to the owner or manufacturer for making, using, or selling the patented product.

• Enable patent holders to set higher prices, often resulting in monopoly-like conditions.

• Are territorial—valid only within the country where they are granted. For example, a patent granted in Australia does not apply in Brazil.

• Must be registered separately in each country where protection is sought.

• Countries that are members of the World Trade Organization (WTO) must adhere to multilateral trade agreements when exporting pharmaceuticals.

56. What is a TRIPs agreement?

• A key multilateral agreement managed by the WTO.

• Sets a minimum of 20 years of patent protection.

• Allows governments to bypass patent laws during national emergencies through a "compulsory licence.”

57. What is a compulsory license?

A compulsory licence permits another company to produce or sell a patented product without the consent of the patent holder, which breaks the monopoly, encourages competition, and often reduces the original company's profits.