EM

Lecture 1: Learning Outcomes

Context

This section discusses critical health issues that impact populations, focusing on developing an understanding of how various factors influence health outcomes.

Excess Mortality

  • Refers to the number of deaths during a specific period that exceeds the expected number based on historical data or statistical models.

  • Commonly assessed during significant public health events, such as pandemics and natural disasters, providing insight into the broader implications of these events on population health.

  • Essential for understanding the long-term health impacts of crises.

Key Health Issues in Scotland

  • Cardiovascular Disease (CVD)/Stroke: Leading causes of morbidity and mortality.

  • Cancer: Notably prevalent, with multiple types varying in impact on different demographics.

  • Type 2 Diabetes/Obesity: Growing concerns linked to lifestyle factors and dietary habits.

  • Alcohol/Drugs: Significant public health issues leading to increased mortality rates.

  • Socioeconomic Factors: High mortality rates correlate with socioeconomic deprivation, emphasizing the urgent need for targeted interventions.

Determinants of Health

  • Emphasizes the interconnectedness of socioeconomic, cultural, and environmental factors that significantly shape health outcomes.

  • Carstairs Experiment Findings:

    • Notable reductions in the proportion of Scottish citizens without access to cars, indicating an improvement in mobility and access.

    • Decrease in unemployment rates among adult males, correlating with better overall health outcomes.

    • Reduction in overcrowding highlights advancements in living conditions.

    • Healthier Life Expectancy (HLE) is consistently higher in less deprived areas, revealing persistent health inequalities that need addressing.

Major Health Conditions

  • Ischaemic Heart Disease: The most significant cause of death, commonly linked to lifestyle-related risk factors.

  • Chronic Liver Disease: Increasingly problematic, often related to alcohol consumption and hepatitis infections.

  • Cerebrovascular Disease: Showing a decline, possibly due to improved health interventions.

  • Colorectal Cancer: Generally stable in terms of incidence and mortality rates.

Causality vs. Association

Understanding causality is crucial in public health research:

  • Causal Relationships: Investigate if X causes Y, or whether Y causes X.

  • Confounding Factors: Identifying if a third variable (Z) influences both X and Y.

  • Artifact and Chance: Assess whether associations exist purely by chance or due to measurement errors.

Risk Factors

  • Definition: Variables that increase the likelihood of developing diseases.

  • Modifiable Risk Factors for CVD: Smoking, diet, physical inactivity, and hypertension are key targets for public health interventions.

  • Non-modifiable Risk Factors: These include age, genetic predispositions, and ethnicity, which cannot be changed but must be accounted for in health evaluations.

Proposed Hypotheses for Health Disparities

  • Deprivation: Direct correlation with poorer health outcomes.

  • Migration: Influences health demographics and resource allocation.

  • Genetic Differences: Impact on disease prevalence and severities among certain ethnic groups.

  • Health Behaviours & Cultural Factors: Influence on individual and community health practices.

  • Social Context: Roles of family, gender relations, and social capital play critical roles in shaping health outcomes.

  • Environmental Factors: Such as deindustrialization and political policies that exacerbate socioeconomic inequalities and limit access to health resources.

Lecture 2: Learning Outcomes

  • Evaluate the World Health Organization (WHO) definition of health critically.

  • Discuss inherent limitations, particularly in relation to chronic diseases and evolving modern healthcare landscapes.

  • Understand alternative strategies that prioritize adaptability, resilience, and self-management of health.

WHO's Definition of Health

  • Defined as a state of complete physical, mental, and social well-being, not merely the absence of disease.

  • Criticisms:

    • The use of the term “complete” is considered problematic as it may not reflect the realities of diverse health experiences, leading to potential medicalization of health where individuals may perceive themselves as unhealthy if they are not entirely well.

    • Reflects inadequacies in addressing chronic disease management, suggesting those with chronic conditions are labelled as perpetually ill, which downplays their coping mechanisms and resilience strategies.

Fundamentals for Health

Key health determinants include:

  • Peace and Safety

  • Access to Shelter

  • Quality Education

  • Nutrition

  • Stable Income

  • Eco-system Stability

  • Social Justice and Equity

Physical Health

  • Body's adaptation processes encompass maintaining balance (allostasis); failure in adaptation can contribute to allostatic load, a state linked to various chronic conditions.

Mental Health

  • The concept of sense of coherence as per Antonovsky illustrates its importance in navigating stress and potentially preventing conditions like PTSD.

  • Emphasizes the role of Cognitive Behavioural Therapy (CBT) in managing chronic fatigue and other mental health disorders.

Lecture 3: Epidemiological Evidence

  • Defined by WHO: Study of distribution and determinants of health states/events and application for health problems.

Types of Studies in Epidemiology

Observational Studies:

  • Descriptive Studies (Case Reports)

  • Analytical Studies (Correlational, Cross-sectional, Case-control, Cohort).

Experimental Studies:

  • Randomised controlled trials (RCTs).

  • Example of Ecological Research: Investigated serum cholesterol and mortality in multiple cohorts.

Understanding Causality

  • Importance of confounders (variables affecting both exposure and outcomes).

  • Assessing reverse causality and establishing appropriate sequences.

Randomised Controlled Trial (RCT)

  • Gold standard in establishing causation through random allocation of participants to control and intervention groups.

  • Example: Da Qing Study on lifestyle interventions.

Hierarchy of Evidence

  1. Systematic Reviews and Meta-analyses

  2. RCTs

  3. Cohort Studies

  4. Case-Controlled Studies

  5. Case Series/Reports

  6. Background info/Expert opinion.

Lecture 4: Learning Outcomes

  • Define biological risk factors contributing to excess mortality.

  • Identify modifiable/non-modifiable risk factors.

Risk Factors Overview

  • Characteristics increasing likelihood of disease.

  • Modifiable: diet, exercise, smoking.

  • Non-modifiable: age, genetics, gender.

Life Expectancy and Risk Factors

  • Higher risk associated with multiple risk factors.

Health Demographics

  • Global population aged 65+ expected to rise significantly.

  • FTO Gene and Obesity: Genetic link to obesity and higher hunger hormone levels.

Biological Risk Factors

  • Sex differences in longevity and disease prevalence.

  • Family history and ethnicity impact on health outcomes.

Socioeconomic Status and Health

  • Understanding the Carstairs Index limitations.

  • Examples of smoking prevalence trends and their health implications.

Alcohol Consumption Trends

  • Decrease in harmful drinking in Scotland but still significant concerns including alcohol-related liver disease and binge drinking.

Economic and Social Policies

  • Influence on alcohol consumption patterns and health outcomes over time.

Lecture 7: Learning Outcomes

  • Understanding and identifying major risk factors contributing to excess mortality.

Specific Risk Factors

  • Obesity and its indicators (BMI, waist circumference).

  • Associated health risks.

Importance of Measuring Obesity

  • Collecting data can reveal health trends.

  • BMI association with mortality following a U-shaped trend.

Environmental Factors

  • Study demonstrating air pollution link to increased all-cause mortality.

  • Microplastics as Health Hazards: Effects of microplastics on health, immunological impacts, and chemical exposures.

Health Outcomes by Socioeconomic Status

  • Significant disparity in life expectancy based on location in Glasgow.

Lecture 8: Learning Outcomes

  • Define obesity and examine energy balance.

  • Evaluate intervention designs for obesity treatment.

Obesity Categories

  • BMI is the classification standard for obesity.

Intervention Studies

  • Comparison of diet and exercise interventions on health outcomes.

  • Real-world study on the impact of neighbourhood walkability.