Health and society tentamen
WEEK 1
Mackenbach Chapter 1: introduction
Utopia with cemeteries and hospitals on the outskirts in open places. This needed social
justice and good government rising life expectancy accompanied by enormous changes in
health. Years of life spent with disease have increased, total life expectancy has increased
faster than healthy life expectancy.
-lot of dips in life expectancy due to diseases, these health conditions often follow a pattern of
rise and fall.
-economic development not as the only/main driver of changes in population health they
did not always move in parallel so economic growth is not sufficient for health improvement.
Epidemiologic transition: mortality component of the demographic transition: long term
decline of mortality and then fertility that accompanied socioeconomic modernization around
the world.
Most improvements in population health were man-made.
-there were changes in human health as a result of changes in living conditions without any
human involvement/of man-made changes in living conditions unrelated to health/ man made
changes indirectly related to health/ as a result of public health interventions/as a result of
medical care.
Mackenbach Chapter 2: long-term trends in population health
-impact of various factors such as infectious diseases, nutrition, living conditions and
healthcare systems on the health outcomes of populations.
-significant shifts in disease patterns and mortality rates, including the decline of infectious
diseases and rise of chronic conditions.
-emphasis on the long-term trends in population health for informing public health policies
and interventions aimed at improving health outcomes and reducing inequalities.
Marmot et al: Health inequalities among British civil servants
-focusing on various health indicators such as mortality, disease, SRH and behaviours.
-higher-grade civil servants experiencing better health, even after adjusting for age sex and
baseline health status.
-mortality rates were associated with employment grade. Higher-grade employees reported
better SRH and were less likely to engage in unhealthy behaviors.
-this study highlights the existence of significant health inequalities based on occupational
status within a homogeneous population of civil servants importance of addressing
socioeconomic disparities and improving working conditions to promote better health
outcomes.
,WEEK 2
Lecture 2: what is health and how to measure it?
Health is a physical, mental, and social well-being and not merely the absence of disease and
infirmity. Health connotes completeness, proper functions and long life (ware), health
connotes the absence of illness (Idler).
Measure:
Mortality: to compare health between countries. The quality of data can differ because
of the wealth in countries, which makes it harder to study.
Life expectancy: cohort life expectancy CLE as average age at mortality in a birth
cohort, all members of the cohort must have died. PLE is the average number of years
a person is expected to live if they experience the same age-specific mortality rates of
the area and time period for the rest of their lives.
Health-related quality of life: physical, social, and general health used in the survey
Objective meaning is used for comparison, but the subjective meaning will get lost.
Predictive and concurrent validity
-Predictive validity: when SRH is associated with an objectively measured health state or
event that happens in the future.
-Concurrent validity: whether SRH correlates with other -more objective or more specific-
health measures that are assessed simultaneously, how it correlates with something happening
at the same time.
Health related quality of life HRQL: this measure is considered a semi-objective measure of
health, as it captures general health as well as more specific dimensions. Increases cross-
group validity as people in different groups think about more specific aspects of health when
they are directly asked about these aspects.
Subjective Semi-objective Objective
Physical health Self-rated health (5 Physical health Mortality,
categories) scales (SF-12) Ageing (telomere
length)
Functional Physical
limitations performance (grip
(problems walking, strength; walking
standing up, speed; speed of
carrying) standing up from a
chair)
Diagnosed chronic Blood sugar, blood
conditions pressure
Self-reported BMI Measured BMI
Mental health Mental health scales Diagnosed mental
, (SF-12) diseases
Mental problems Sleeping duration
(sleep, appetite …) (measured by an
app), stress levels
(cortisol in blood or
hair)
-Cohort life expectancy: an average age at mortality in a birth cohort.
-Period life expectancy: average number of years a person is expected to live if they
experience the same age-specific mortality rates of the given area and time period for the rest
of their life.
Correlation of SRH with health-related measures: 60% of variance are still not explained. So,
is SRH a good health measure?
-younger people might think more about health behaviors, older people might think more
about diseases.
What is health, how can you study t, what is validity, how can you study validity?
Werkgroep 2 slides and notes
Predictive validity: is het zo data is mensen zeggen dat ze slechte gezondheid hebben, ze
sneller sterven? dit soort gedachtes kunnen het proces versnellen.
-onderzoeksstrategie: hoe gaan de onderzoekers deze vraag beantwoorden?
-objectieve maatstaf gezondheid wanneer overlijdt je? Je leeft of je leeft niet.
-SRH is wel een valide manier voor het meten van mortaliteit, algemeen wel valide, between-
group niet valide.
Ware: standards for validating health measures: definition and content.
5 health concepts: physical, mental, social functional, role function, general health
perceptions.
-length of life + quality of life.
-WHO defines health as: a state of complete physical, mental and social well-being and not
merely the absence of disease or infirmity.
-range of measurements health permits.
-HRQL: health related quality of life: considered a semi-objective measure to health, as it
captures general health as well as more specific health dimensions central to the WHO.
-increases cross-group validity as people in different groups think about more specific aspects
of health.
WEEK 3
