WACE Health Studies ATAR cheat sheet

Health is a resource for living, not merely the absence of disease; the WHO (1948) definition adds physical, mental and social dimensions but is criticised for not requiring measurability.

Epidemiological measures: incidence = new cases ÷ population at risk per time period; prevalence = all existing cases ÷ total population at a point or period.

Mortality rate = deaths in a period ÷ population × 100,000; infant mortality rate uses live births in the denominator and is a sensitive indicator of population health.

Life expectancy at birth estimates average years lived if current age-specific death rates persist; it is not a prediction for any individual.

Burden of disease uses DALYs = YLL (years of life lost to premature death) + YLD (years lived with disability); one DALY equals one lost healthy year.

Disability-adjusted measures weight conditions by severity; a condition with low mortality but high morbidity (e.g. mental disorders) can rank high in DALYs while ranking low in mortality.

Population health status is compared using crude, age-standardised and age-specific rates; crude rates are distorted by age structure, so standardisation is needed for fair comparison.

Socioeconomic gradient: health status improves stepwise with income and education rather than showing only a poor-versus-rich divide; the gradient appears across the whole distribution.

Determinants span biological, behavioural, social, economic, environmental and cultural factors; they interact, so single-cause explanations of health outcomes are incomplete.

The social determinants model (Dahlgren & Whitehead) layers individual, lifestyle, social/community, living and working conditions, and general socioeconomic/cultural/environmental conditions.

Ottawa Charter (1986) five action areas: build healthy public policy, create supportive environments, strengthen community action, develop personal skills, reorient health services.

Ottawa Charter three basic strategies are enable, mediate and advocate; health promotion is defined as enabling people to increase control over and improve their health.

Health promotion differs from health education (which builds knowledge/skills) and from disease prevention (which targets specific risks); promotion is population-wide and upstream.

Upstream, midstream and downstream approaches: upstream targets policy and living conditions, midstream targets community and settings, downstream targets individual behaviour and treatment.

The three levels of prevention are primary (prevent onset), secondary (early detection/screening) and tertiary (reduce complications and restore function).

The Health Belief Model predicts behaviour from perceived susceptibility, severity, benefits, barriers and cues to action; self-efficacy was added later.

The Transtheoretical Model stages are precontemplation, contemplation, preparation, action, maintenance (and termination); relapse is treated as a normal cyclical event.

Hierarchy of evidence from strongest to weakest: systematic reviews/meta-analyses, randomised controlled trials, cohort studies, case-control studies, cross-sectional studies, case series, expert opinion.

Study design decision rule: to measure incidence or establish temporality, use a cohort or trial; to study rare outcomes efficiently, use case-control; to estimate prevalence, use cross-sectional.

Randomisation reduces selection bias by distributing known and unknown confounders; blinding reduces performance and detection bias; allocation concealment protects randomisation integrity.

Validity types: internal validity concerns whether the study measured what it intended; external validity concerns generalisability to other populations and settings.

Reliability concerns consistency and repeatability of a measure; validity concerns accuracy of the measure; a measure can be reliable without being valid but not valid without being reliable.

Bias categories: selection (non-representative sampling), information/measurement (recall, interviewer, misclassification), and confounding (a third variable linked to both exposure and outcome).

Sampling methods: random, stratified, cluster and systematic are probability-based; convenience, purposive and snowball are non-probability and limit generalisability.

Ethical research requirements include informed consent, voluntary participation, confidentiality, minimisation of harm, and ethics committee approval; vulnerable groups need extra safeguards.

Correlation does not establish causation; causal inference is strengthened by temporality, dose-response, consistency, biological plausibility and control of confounding.

The Ottawa Charter defines health advocacy as action to create favourable conditions by influencing political, economic, social and cultural factors.

Advocacy types: self-advocacy (individuals speak for themselves), peer advocacy, and public-interest advocacy (acting for a group or population, often by NGOs).

Levels of advocacy action: individual/patient level, community/group level, and systemic/policy level; tactics differ by level and target.

The policy cycle stages are agenda setting, policy formulation, adoption/decision, implementation, and evaluation; advocacy can target any stage but is most efficient at agenda setting.

Lobbying, media campaigns, petitions, community mobilisation, coalition building and submission writing are advocacy strategies; each has different reach, cost and evidence requirements.

A coalition multiplies legitimacy and resources but slows decision-making and can dilute a message; single organisations act faster but with less political weight.

The National Health and Medical Research Council and similar bodies fund and set standards; advocacy messages are stronger when matched to the priorities of the funding or decision-making body.

Social marketing applies commercial marketing principles (product, price, place, promotion) to behaviour change; segmentation and audience testing raise effectiveness.

Evaluation of advocacy uses reach, engagement, policy change, and health outcome indicators; outcome attribution is difficult, so intermediate indicators are commonly used.