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Lecture 2

HSCI 130 Lecture Notes - Lecture 2: Health Canada, James Buchanan Duke, Confounding


Department
Health Sciences
Course Code
HSCI 130
Professor
Kate Tairyan
Lecture
2

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HSCI 130 Lecture 2
Health Determinants
- what makes us healthier? sick?
Behaviour (what people choose to do)
Infection (exposed to bacteria, etc., that can cause diseases. even certain types of
cancers can be attributed to long term exposure to viruses)
Genetics (what is their genetic predisposition to certain diseases. i.e diabetes, heart
disease, etc. Not many diseases are only genetically predisposition.
Geography (many diseases occur in certain geographic regions more than others.
especially tropical diseases transmitted by mosquitos (lime disease, west nile= endemic
diseases)
Environment (air pollution, water in sanitation, exposure to chemicals)
Medical care (access to medical care could be critical. i.e. to pregnant women it is
critical)
Social-economic cultural (income, occupation, living status, culture, religion, education,
economic status, role, gender, status of women)
- this is just one approach to health determinants
Determinants by Health Canada
- Key Determinants
1) income and social status
2) social support networks
3) education and literacy
4) employment/working conditions
5) social environments
6) physical environments
7) personal health practices
WHO commission on Social Determinants of Health
- part of united Nations
- old countries have represented it (ministries of health)
- provide technical support, reproduces reports and statistics of health of global
population
- came up with report called "changing the gap in a generation"
- ministers of health work alone in separation form other countries will not make any
difference. there is a need to work together.
Evidence Based Public Health Approach
- we look for more and more scientifically based evidence to improve the health of
people in communities
Cigarette Smoking and Lung Cancer (example)
- is there causal relationship?
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- when did we first hypothesized about it?
- widespread consumption of manufactured cigarettes
- targeted ads
- lets see a couple of those that might seem very disturbing today, and would be even
illegal in many countries
- change happened when cigarettes where manufactured. aggressive advertisement
used.
- tobacco introduced to europe in 1600s, was not that widespread, only started in late
19th century, with James Buchanan Duke in 1880s. He invented automatic system of
manufacturing cigarettes. before that people were rolling by hand.
- in WWI cigarettes were distributed free to american soldiers; men started smoking and
rate was dramatically increasing in first half of 20th century.
- physicians and dentists were enrolled in advertisements for cigarettes
- women became target
- increased cigarette production lung cancer rate
Evidence Based Public Health Approach (circular process)
- problem- what is the problem?
- etiology- what is or are the contributory causes?
- recommendations- what works?
- implementation- how to get it done?'
(this is the framework or paradigm that we will use for our homework assignment,
convince everyone that that is an issue then look into contributory factors and the
causes)
Problem- What is the problem?
- Describe the health problem and its impact
- Burden of disease- morbidity (disability) and mortality (deaths)
- Questions to ask and be prepared to answer
- Q1. "What is the burden of disease and how has it changed over time?" its not
just looking into the status of the problem today, but historically how has it changed.
what is the change in time? going back to lung cancer issue, thats what we can clearly
see starting from 1930s when production and rate of cancer increased.
- distribution of disease
- "person"- age, gender, race, socio-economic status
- "place"- physical and even virtual (where do we see more of this disease?
urban area? rural area? lower economic status area of the city? campus vs general
public? look into physical environment and location)
- group associations (risk indications) (man vs. woman, smoker vs. non smoker)
- questions to ask and be prepared to answer
- Q2. "Are there differences in the distribution of diseases and can we generate
hypothesis about the cause?"
- artificial or real differences
- comparing the right groups
- questions to ask and be prepared to answer
- Q3. "Are the differences and changes used to suggest group associations
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