4. Natural History of Disease & Social Determinants of Health

Question 1 What are the four major stages in the natural history of disease?

Susceptibility, pre-symptomatic disease, clinical disease, and disease outcome.

Question 2 What characterizes the stage of susceptibility?

Disease has not yet developed, but risk factors are present.

Question 3 What interaction sets the stage for disease during susceptibility?

Agent-host-environment interaction.

Question 4 Does a person already have the disease during susceptibility?

No.

Question 5 Which level of prevention is most effective during susceptibility according to the file?

Primary prevention.

Question 6 Give examples of primary prevention during susceptibility.

Health promotion and risk reduction.

Question 7 What characterizes the pre-symptomatic stage?

No manifest disease is present, but pathogenic changes are already occurring.

Question 8 What is the incubation period?

The time between entry or exposure to an infectious agent and symptom onset.

Question 9 For what type of disease is the term latency period used in the file?

Chronic diseases.

Question 10 What characterizes the stage of clinical disease?

End-organ changes allow disease recognition, symptoms become noticeable, and clinical diagnosis becomes possible.

Question 11 What happens to disease classification during the clinical stage?

Classification and staging occur.

Question 12 What are the four phases listed under clinical disease?

Incubation period, prodromal stage, acute stage, and convalescent stage.

Question 13 What is the prodromal stage?

A stage of vague, non-specific symptoms.

Question 14 Why is the prodromal stage difficult to diagnose?

Because symptoms are vague and non-specific.

Question 15 Why is early detection important during the prodromal stage?

It can reduce severity and spread.

Question 16 What characterizes the acute stage?

Rapid onset and maximum intensity of symptoms.

Question 17 When is a patient most likely to seek medical care according to the file?

During the acute stage.

Question 18 What possible outcomes may follow the acute stage?

Recovery, chronic illness, disability, or death.

Question 19 What is the convalescent stage?

The recovery phase following acute illness.

Question 20 What are the possible disease outcomes listed?

Complete resolution, chronic illness, disability, remission, or death.

Question 21 What determines disease outcome according to the file?

Severity of illness, effectiveness of treatment, host resistance, and social/environmental conditions.

Question 22 What is primordial prevention?

Prevention of the emergence of risk factors.

Question 23 Give an example of primordial prevention involving children and food.

Laws banning junk food advertising to children.

Question 24 Give an example of primordial prevention involving transportation and physical activity.

Bike lanes.

Question 25 Give an environmental example of primordial prevention.

Pollution control.

Question 26 Give a behavioral-social example of primordial prevention.

Promotion of safe sexual norms.

Question 27 What is primary prevention?

Action before disease occurs in a person with risk factors.

Question 28 Give examples of primary prevention.

Health education, sanitation, immunization, and quarantine.

Question 29 What is the key difference between primordial and primary prevention?

Primordial prevention prevents risk factors themselves from emerging; primary prevention prevents disease when risk factors are already present.

Question 30 A child never starts smoking because of preventive policies. What level of prevention is this?

Primordial prevention.

Question 31 A smoker quits with therapy to prevent disease. What level of prevention is this?

Primary prevention.

Question 32 What is secondary prevention?

Early diagnosis and prompt treatment.

Question 33 What activities are included in secondary prevention?

Screening, periodic examinations, and case finding.

Question 34 What is the first objective of a good screening program?

Detect disease early so treatment can be more effective.

Question 35 What is the second objective of a good screening program?

Identify and modify risk factors.

Question 36 What is one key characteristic of a good screening test regarding detection?

It detects a high proportion of preclinical disease.

Question 37 What is one key characteristic of a good screening test regarding safety?

It is safe.

Question 38 What is one key characteristic of a good screening test regarding cost?

It is low cost.

Question 39 What is one key characteristic of a good screening test regarding outcomes?

It improves health outcomes.

Question 40 What is one key characteristic of a good screening test regarding access?

It is widely available.

Question 41 Give examples of screening tests listed in the file.

Chest x-ray, ECG, fasting blood sugar, Pap smear, digital rectal examination, newborn screening, hearing test, mammography, and Mantoux test.

Question 42 What is tertiary prevention?

Prevention that limits disability, supports rehabilitation, and improves quality of life.

Question 43 What long-term clinical intervention may be part of tertiary prevention?

Long-term medical treatment.

Question 44 What types of rehabilitation may be part of tertiary prevention?

Physical, psychological, social, and vocational rehabilitation.

Question 45 What end-of-life approach may be part of tertiary prevention?

Palliative care.

Question 46 What social component may be included in tertiary prevention?

Support systems.

Question 47 What is quaternary prevention?

Prevention of over-medicalization and harm from unnecessary interventions.

Question 48 What kind of care is emphasized in quaternary prevention?

Ethical, evidence-based care.

Question 49 What harms does quaternary prevention protect patients from?

Overdiagnosis, overtreatment, and overuse of technology.

Question 50 What is quinary prevention according to the file?

Prevention of unnecessary or harmful medical practices.

Question 51 What medication-related issue is emphasized in quinary prevention?

Polypharmacy.

Question 52 What diagnostic and treatment issues are emphasized in quinary prevention?

Overdiagnosis and overtreatment.

Question 53 What principles are emphasized in quinary prevention?

Patient safety, shared decision-making, and rational medical use.

Question 54 Which stage comes immediately after susceptibility?

Pre-symptomatic disease.

Question 55 Which stage comes immediately after pre-symptomatic disease?

Clinical disease.

Question 56 Which stage follows clinical disease?

Disease outcome.

Question 57 A person has risk factors but no disease. What stage is this?

Susceptibility.

Question 58 Pathogenic changes are present but symptoms have not appeared. What stage is this?

Pre-symptomatic disease.

Question 59 Symptoms become obvious and diagnosis is possible. What stage is this?

Clinical disease.

Question 60 The patient recovers completely after disease. Which stage is represented?

Disease outcome.

Question 61 A policy prevents the development of obesity-promoting environments before risk factors arise. What prevention level is this?

Primordial prevention.

Question 62 Vaccination before disease occurs is what level of prevention?

Primary prevention.

Question 63 A Pap smear used to detect disease early is what level of prevention?

Secondary prevention.

Question 64 Physical rehabilitation after disabling disease is what level of prevention?

Tertiary prevention.

Question 65 Avoiding an unnecessary diagnostic procedure to prevent harm is what level of prevention?

Quaternary prevention.

Question 66 Reducing harmful polypharmacy through shared decision-making is what level of prevention?

Quinary prevention.

Question 67 Why is the incubation period important in infectious disease control?

It helps guide quarantine and monitoring.

Question 68 What is the central purpose of studying the natural history of disease?

To guide prevention, early detection, treatment planning, prognosis, public health action, and reduction of over-medicalization.

Question 69 Arrange the disease stages in order.

Susceptibility -> Pre-symptomatic disease -> Clinical disease -> Disease outcome.

Question 70 Arrange the prevention levels in the order listed in the file.

Primordial -> Primary -> Secondary -> Tertiary -> Quaternary -> Quinary.

Question 71 What is the difference between incubation and latency as presented in the file?

Incubation is used for infectious disease between agent entry and symptoms; latency is used for chronic disease.

Question 72 Which stage is most closely associated with screening?

The pre-symptomatic stage, using secondary prevention.

Question 73 Which prevention level focuses on preventing disability after disease is established?

Tertiary prevention.

Question 74 Which prevention level specifically guards against overuse of medical technology?

Quaternary prevention.

Question 75 Which prevention level specifically emphasizes polypharmacy and rational medical use?

Quinary prevention. /

Question 1
What does SDH stand for?

Social Determinants of Health.

Question 2
How does the CDC definition describe social determinants of health?

Specific features of and pathways by which societal conditions affect health and can potentially be altered by informed action.

Question 3
What kinds of life-enhancing resources are included in the CDC description of SDH?

Food supply, housing, economic and social relationships, transportation, education, and health care.

Question 4
What does the distribution of life-enhancing resources across populations affect?

Length and quality of life.

Question 5
How does WHO define social determinants of health?

The conditions in which people are born, grow, work, live, and age, plus the wider forces and systems shaping daily life.

Question 6
What broader structures are responsible for many health inequities according to the file?

Complex, integrated, and overlapping social structures and economic systems.

Question 7
What four broad areas are included in the broader view of SDH?

Social environment, physical environment, health services, and structural and societal factors.

Question 8
What is the first key SDH listed?

Income and social protection.

Question 9
What is the second key SDH listed?

Education.

Question 10
What is the third key SDH listed?

Unemployment and job insecurity.

Question 11
What is the fourth key SDH listed?

Working life conditions.

Question 12
What is the fifth key SDH listed?

Food insecurity.

Question 13
What is the sixth key SDH listed?

Housing, basic amenities, and environment.

Question 14
What is the seventh key SDH listed?

Early childhood development.

Question 15
What is the eighth key SDH listed?

Social inclusion and non-discrimination.

Question 16
What is the ninth key SDH listed?

Structural conflict.

Question 17
What is the tenth key SDH listed?

Access to affordable health services of decent quality.

Question 18
A patient cannot afford food consistently. Which SDH is involved?

Food insecurity.

Question 19
A person loses employment and fears unstable work. Which SDH is involved?

Unemployment and job insecurity.

Question 20
A family lives in unsafe housing without basic amenities. Which SDH is involved?

Housing, basic amenities, and environment.

Question 21
A child lacks supportive developmental conditions early in life. Which SDH is involved?

Early childhood development.

Question 22
A minority group experiences exclusion and discrimination. Which SDH is involved?

Social inclusion and non-discrimination.

Question 23
A community has poor access to affordable, quality healthcare. Which SDH is involved?

Access to affordable health services of decent quality.

Question 24
A worker is exposed to harmful job conditions. Which SDH is involved?

Working life conditions.

Question 25
A community is affected by war or persistent social instability. Which SDH is involved?

Structural conflict.