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Inequities
• Services not targeted according to need this is the key determinant in health inequality
• Relate to – Access to service– Availability of responsive service – Utilisation of services
Social control role
• Societal and political mechanisms or processes that regulate individual and group behaviour with the aim of maintaining social order
‘Intention to treat’ analysis
• Compare all participants • Reflects actual effect outside in clinical
practice
Race
• A concept that concentrates on assumed biological/genetic differences between groups of people
• Racialisation is the process with creates the conditions for groups to be recognised as races and which makes racism possible
Direct racism
• Treated less favourably due to ethnicity or religion
• Basically – you know you’re doing it
Incidence
• The number of new cases arising of a specified disease in a defined population at a given time
Indirect racism
• People unaware that their actions are undermining the position of people from ethnic minority groups
• You don’t realise you’re doing it
Inverse care law
• The availability of good medical care tends to vary inversely with the need for it in the population served
Biopsychosocial model
• The biology, psychology and social context of an individual which all play a role in their health
Lay belief
• Peoples common sense understanding and knowledge about health and illness
• Can be derived from scientific knowledge and/or evidence based practice
• Generally rooted in peoples own experiences • Not necessarily different from medical
understanding
Disability free life expectancy
• The number of years an individual can expect to live with out a limiting chronic illness or disability
Access Inequality
• A difference in the level or service provided to different areas or social groups
P-value
• The probability that we could have obtained the observed data if the null hypothesis were true
• Good p-value = less than 0.05
Ethnicity
• A long shared history distinguishing one group from another
• Cultural tradition including family, social customs and manners
• Often but not necessarily associated with religious observance
Placebo effect
• The patients attitude to their illness and indeed the illness itself, may be improved by a feeling that something is being done about it
Culture
• Shared experiences, beliefs and values • Members of a particular ethnic group may not
share the same cultural experiences, beliefs or values -> need to be sensitive
Need
• A claim for services and implies a capacity to benefit from an intervention
• 4 main categories– Felt– Expressed– Normative– Comparative
Institutionalised racism
• The collective failure of an organisation to provide an appropriate and professional service to people because of their colour/culture/ethnic origin
Social capital
• Social networks and norms that facilitate co-ordination and co-operation
• 2 types– Bonding – strong ties between individuals of a
social network that see themselves as homogenous
– Bridging – links across social groups in society who do not necessarily share similar social identities
4 definitions of health
• Health is the absence of illness • Health is functional ability • Health is equilibrium• Health is freedom
• WHO definition – complete physical, social and mental well being and not merely the absence of disease or infirmity
Cohort study
• Recruit DISEASE FREE individuals • PROSPECTIVE study • And classify according to their exposure status
The Census
• A simultaneous recording of demographic date by the government at a particular time pertaining to all persons who live in a particular territory
Clinical trial
• Any form of planned experiment that involves patients and is designed to elucidate the most appropriate method of treatment for future patients with the disease in question
Total fertility rate
• Average number of live children that a group of women would have if they experienced the age specific fertility rates of the calendar year in question throughout child bearing years
‘As-treated’ analysis
• Only compare those that completed and complied fully with treatment
• Compares physiological effects of treatment but loses randomisation
Attributable risk
• (Incidence rate exposed – incidence rate non-exposed)/incidence rate exposed
• How much risk can we assign to a factor and therefore how much disease/problem would we get rid of if we eliminated that factor
Confounder
• A factor that is associated with the exposure under investigation but independently affects the disease risk
Null hypothesis
• No effect
• If they ask it in an exam – you might be asked to write out a possible null hypothesis for a scenario they give – basically there is NO difference between the two groups/treatments/studies – how ever they phrase it
Case-control study
• A RETROSPECTIVE study • Recruiting a group of cases based on their
disease state • Then identify a group of suitable non-cases
Placebo
• An inert substance identical in taste, colour, size etc
• Packaged and labelled in an identical container to active drug