What is health - Answers "The complete state of physical, mental, and social well-being, and not
merely the absence of disease or infirmity" -WHO
Top 10 Causes of Mortality - Answers Coronary artery disease, Stroke, Chronic Obstructive Pulmonary
Disease, Lower Respiratory Infections, Lung Cancer, Diarrhea, Road Traffic
Injuries,Diabetes,Tuberculosis
What is a Medical Model - Answers Viewed as absence of disease, see a physician if you have signs or
symptoms, sign see symptom feel, physician is responsible for your health, goal is to prevent
morbidity and mortality, focus on the disorder rather than the person, mechanistic model
Health through Prevention of Illness | Wellness Prevention - Answers Empowers people to be
responsible of their own health, includes empowerment, community support, healthy public policy,
education, prevention, risk factors.
3 levels at which this model can be considered: individual level > ur responsibility to change your own
health behaviour, population level > educators, health promoters, policy makers can target high risk
prevention, health care provider level > physicians can raise awareness
Health Viewed Holistically - Answers Individuals health and wellness if best understood in the context
of their environment
Ex, physical environments, genetics, politics (gun control), social factors, health care, economics,
psychological factors
Internal vs external
The Framingham Study
Peeps who dont smoke, drink moderately, exercise, and ate 5 servings of fruits and vegetables a day
lives 14 years older
Smoking, obesity, diabetes, and hypertension significantly reduce risk of reaching 90
Social Determinants of Health - Answers 1. Employment status and occupation
2. Education and care in early life
3. Income inequity
4. Marital status
5. Housing and food security
6. Ethnicity
7. Sense of community engagement // positive connections
8. Religion
Strategies to Improve Social Determinants - Answers Social inclusion, reducing social injustice
Full employment, job security, healthy working conditions
Universal health care access
High-quality public education
Adequate housing (issue in vancouver, having sufficient number of low income houses available) and
food
Reduced income disparities (minimum wage)
Empowerment
Choices, Chances, Circumstance - Answers Choices: lifestyle decisions, ex exercise... that was a c h o i
ce
Chances: genetic makeup, ethnicity, sex, early childhood
Circumstances: neighbourhood, work environment
Changing Behavior - Answers Lower risk → identify risky behaviour and change that shit
Knowledge alone isn't enough
They need to WANT to change
Need to be ready to change and have the support
WANT, NEED, SUPPORT
Predisposing → Reinforcing → Enabling
SMART GOALS - Answers Specific
Measurable (in terms of progress, list steps, OVERALL CHANGE YOU're going to look at, trying to lose
5lbs in a month)
Attainable
Realistic
Trackable (can you track the variables overtime → during the time its changing or nah)
,Psychological factors that improve likelihood of behaviour change - Answers Self-efficacy → belief in
your ability
Internal locus of control → you are in control, responsible
Internal positive reinforcements → congrats @ myself instead of waiting for external
Self-talk → encouragement
Low dichotomous thinking → usually not one or the other, not good vs bad day, instead i did this well,
i can do this to improve
Support → reach out
Stages of Change - Answers Precontemplation, contemplation, preparation, action, maintenance,
termination
Wellness Model of Health - Answers "Health is the complete state of physical, mental and social well-
being and not merely the absence of disease or infirmary" -WHO
Health is more of a process, something we're trying to achieve
Growth toward highlevel wellness area by area
PROCESS INSTEAD OF STATE
What is Wellness? - Answers Purposeful, enjoyable living
Unlike health, more of a process
"A dynamic process of continually moving toward one's potential for optimal functioning" -Dunn
LIFESPAN VS EXPECTANCY - Answers Life expectancy is how long you are projected to live depending
on other factors such as race, environment etc, life expectancy includes infant mortality, based on an
average, Life expectancy is an average
Different for different countries, slowly increasing
MORBIDITY VS MORTALITY - Answers Morbidity → signs of illness, rate of disease, how many people
have this disease
Mortality → fatality/death
Morbidity is the condition of being ill, diseased, or unhealthy. ... One morbidity may lead to another
morbidity. Mortality, on the other hand, is the condition of being dead.
Welfare State Model - Answers quality care regardless of what citizens earn or where they live
Fed and prov gov are in charge for about 70%, the rest is based on employers and etc
Value universality, portability, comprehensiveness, accessibility, and administration by government
Strengths of Welfare State Model - Answers Health treated as a necessity
High satisfaction rate and strong endorsement
Reasonable rate to individuals
Weaknesses to Welfare State Model - Answers Increasing cost to government
Long wait times
Treatment vs prevention, more emphasis on treatment
Unequal distribution of resources
iatrogenic illnesses, problems that arise from treatment
Fee For Service Model - Answers A traditional type of insurance in which the health plan will either
pay the medical provider directly or reimburse you after you have filed an insurance claim for each
covered medical expense. When you need medical attention, you visit the doctor or hospital of your
choice.
Ages 0-1, 80+ costs more
USA vs. Canada - Answers Ours vs USA
Canada is welfare model ( = service is provided to people no matter where they live or what they
earn) vs free enterprise model (^ demand, ^ price)
Gov in Canada pays 70%, USA pays somewhere less than 50
Insurance companies have more power in the States (less support)
USA
Free enterprise model → high demand, high price
Cost and distribution based on supply and demand
Federal and state participate but <50%
Complex - insurance companies (have more say, define a georgraphic area and list all th e physicians u
can go to, if u go to anyone else, we cant cover you), no single payer system
Insuracne companies limit the network individuals can use
Health care treated as any other service (i.e accountant, mechanics)
BC HEALTH - Answers Fee for service, you don't pay, government pays
, Insurance premiums (MSPs) SPECIAL TO BC we pay that fee monthly that covers everything for us,
accidents, emergencies, chronic diseases, coverage outside of country
Funding comes from income tax
Negotiations between Medical SErvices commission and BC Medical ASsociation → negotiate to
determine what the fee is
Medical Rights - Answers Needs to be stored in canada
Right to be aware of any risks
Consent
Hierarchy of Experiments - Answers Experimental : controlled, well-designed experiments based on
scientific method
Epidemiological: use data to examine associations between populations and disease
Clinical: what is evidenced in clinical practice
Personal: something you have experienced
Anecdotal: based on a story you hear
The Scientific Model - Answers Experimental evidence starts with a hypothesis
Question → hypothesis → test → analyze
Control + experimental group
Scientific Evidence: Sample Size → You want large
The variability of the measured value in the population
THe expected magnitude of the treatment effect
THe possiblity of negative side effects and the expected size of this effect compared to the population
Size matter?
(smaller effect, need a lot more than vs a whopping large af effect)
Usually bigger is better
Depends on the question as well as cost/benefit analysis
Whats the ultimate experiment? - Answers THE ULTIMATE STUDY IS RANDOMIZED, DOUBLE BLIND,
CROSSOVER shows results twice
Scientific Evidence Problems and Alternatives - Answers Time
Ethics
Alternatives:
Animal model
Tissue culture
Computer modelling
Epidemiology: Correlation - Answers Use of population data without intervention
Info is taken from associations that do not necessarily imply cause and effect. The evidence is
observational only
Careful about making claims about causation
Epidemiology: Causation - Answers Strength of association (smoking vs lung cancer)
Dose-response ie smoking 20 packs a day and getting cancer
Consistency ie smoking is leading cause of lung cancer
Temporally correct - time, cancer develops over a period of years right amount on time between
exposure
Specificity - specifically A causes just B
Biological plausibility - reasonable from a mechanistic standpoint, smoke causes dna mutations
Can do all this, case for causation is strong
Clinical Evidence - Answers Experiences observed by people at a clinic
Not a study, just observed in practice
Some of it has been study, much of it is not
Not been trained as scientists and researchers, so they'll work with them
Personal Experience - Answers Something you have personally experienced
Anecdotal Evidence - Answers Vaccinations cause autism
Celebrity says something about how their diet of eating 6 dogs a day cured their cancer
ANTIBODY - Answers generated by cells that control foreign invaders
ANTIBIOTIC - Answers kills bacteria, attacks cell walls of bacteria, control the multiplication of
bacteria
ANTIGEN - Answers produced by pathogens, antigens invade our body