Please refer to the following case for questions that have a notation of (case).
The case:
Skolnikland is in Eastern Africa. It has 30 million people. The country has a plains region, ahill region, and a region with high mountains. It has a number of ecosystems. The plains are dry for much of the year, there is some rainforest, and the rest of the country includes both
hills and mountains. There are two seasons of heavy rainfall. The people come from several ethnic groups that tend to live in their own regions and speak different languages. The ethnic groups largely follow one of three different religions. The
large cities are mixed ethnically. One ethnic group is economically and socially very
dominant. The people from this group live in the capital and most of the large cities. The
national language is the language of this dominant ethnic group.
According to World Bank criteria, Skolnikland is among the poorest countries in the world. Its
per capita income is $790. The economy has been growing at about 4% per year on average
over the last decade, but the economy had very slow economic growth in the decades prior to
that. The richest 10% of the population controls 80% of the national income.
About 80% of the people live in rural areas and 20% in urban areas. The number of people
living in urban areas has been growing recently at an increasing pace. Most people earn their
livelihoods in agriculture but there is a growing garment manufacturing industry in the two
largest cities. There are also a number of mining industries. In addition, other export industries
are beginning to grow, mostly focused on the export of commodities to China.
The total fertility rate is about 4.5 but it has been declining slowly over the last two decades,
from over 6. There are an almost equal number of men and women in the population. Infant
mortality is about 90 per 1,000 live births. Maternal mortality is about 500 per 100,000 live
births. Thirty-five percent of the children are underweight for age.
The adult literacy rate is about 40%. The educational enrollment rate, especially for girls at the
primary and secondary levels, has been growing slowly, but steadily. Most recently, this rate
has been growing at an increasing pace and about 75% of the girls now attend school
regularly, although many of the schools are of very low quality.
Only about 50% of the people have access to safe water. Only about 30% have access to
sanitary disposal of human waste.
HIV prevalence is 7% of the adult population. The number of new HIV cases annually has
begun to plateau. About half of the people eligible for treatment for HIV are on treatment.
Malaria has declined but is still rampant in the plains.
Investments in the road system have been growing at a solid pace in the last decade and the
use of private automobiles has begun recently to increase more rapidly.
Skolnikland has a pluralistic health system that is made up of public and private institutions,
publicly financed providers, licensed private providers, unlicensed medical practitioners, and
traditional healers. There is no health insurance, except for some free services for the poor in
the few publicly financed hospitals, to which the better off people do not go. The health
system is not very effective or efficient and is largely of low quality. The TB and maternal
healthservices are not effective or efficient and they are just beginning to adopt paradigms for
services that follow global best practices.
QUESTION 1
1. Case: If Skolnikland were India, a lower middle-income country in South Asia, with a very large
share of poor people in its population and a per capita income of about $1,900, then what
proportion of the burden of disease, measured in DALYs, would you expect to be Group I –
communicable, maternal, perinatal, and nutritional?
a. 60
b. 10
c. 30
QUESTION 2
1. In a low-income country, the first level at which one could receive emergency obstetric care would
generally be:
a. Primary
b. Secondary
c. Tertiary
d. National hospitals
QUESTION 3
1. The International Covenant of Economic, Social and Cultural Rights says that people are entitled
to:
a. A job
b. The highest possible standard of living
c. The highest attainable standard of physical and mental well-being
d. The highest standard of physical well being
QUESTION 4
1. Cultural competence refers to:
a. One’s ability to work effectively with people in one’s own culture
b. One’s ability to work effectively with people of different cultures
c. One’s ability to work effectively with a specific group
d. None of these are correct
QUESTION 5
1. Case: In Skolnikland, what are likely to be two of the five leading causes of death of adults age 1549?
a. stroke, interpersonal violence
b. HIV, TB
c. Stroke, Heart disease
QUESTION 6
1. Stunting is:
a. Underweight for age
b. Underweight for height
c. Failure to reach linear growth potential
d. Overweight for height
QUESTION 7
1. What is a DALY?
a. A WHO indicator used to summarize the expected # of years to be lived in good health
A composite health gap indicator that measures the amount of health and disability free
b.
life that is lost because of disease, injury, and premature death
An indicator that compares the burden of deaths across the population of different
c.
countries
QUESTION 8
1. The “ladder of sanitation”, as income grows for a poor family in a low-income country is best
represented by:
a. Pit latrine, pour flush toilet, septic tank
b. Pour flush toilet, sewer connection
c. Septic tank
d. Pit latrine, sewer connection
QUESTION 9
1. When taking an equity lens to health, we should consider:
a. Social and economic status, location, ethnicity
b. Religion, sex, age
c. The quality of care in different places
d. All of these are correct
QUESTION 10
1. The Declaration of Helsinki says that anyone participating in human subject research must provide
the following:
a. A waiver of liability
b. Voluntary, informed consent
c. Informed consent
d. Both a waiver of liability and voluntary, informed consent
QUESTION 11
1. Stewardship of the health system refers to:
a. How it is financed
b. Who pays for it
c. How it is governed
d. The amount of external support a system receives
QUESTION 12
1. Estimates suggest that the burden of disease attributable to environmental risk factors is
approximately:
a. 75%
b. 50%
c. 25%
d. 10%
QUESTION 13
1. Addressing food insecurity issues is likely to require:
a. Action by the Ministry of Health
b. Action by the Ministry of Education
c. Action by a number of Ministries and agencies, working in coordinated ways
d. Action by the Ministry of Agriculture
QUESTION 14
1. Intake of red and processed meat is associated with:
a. Type 2 diabetes and some cancers
b. cardiovascular disease
c. iron deficiency anemia
d. Type 2 diabetes some cancers, and cardiovascular disease
QUESTION 15
1. Human capital refers to:
a. The amount of money people have
b. The skills and knowledge people have that allows them to be productive
c. The amount of people’s assets
d. None of these are correct
QUESTION 16
1. What is the most plausible explanation for the exceptionally skewed ratio of men to women in
some parts of East and South Asia?
a. sex-selective abortion
b. the fact that boys survive better at birth than girls do
c. families give better care to boys than to girls
QUESTION 17
1. Which is likely to produce the lest cost per DALY averted?
a. Household water connection
b. Standpost
c. Hygiene promotion
d. Open well
QUESTION 18
1. The leading causes of death of children under one year of age globally are:
a. Neonatal conditions
b. Malaria
c. Measles
d. HIV
QUESTION 19
1. In some traditional cultures, people might believe that disease is caused by:
a. Mixing “hot” and “cold” foods
b. A curse
c. Too much or not enough sexual activity
d. All of these are correct
QUESTION 20
1. The cornerstone of human rights is the:
a. International Declaration of the Human Rights of Children
b. The International Bill of Human Rights
c. The International Declaration on the Rights of Women
d. The Belmont Report
QUESTION 21
1. Case: In Skolnikland, what are likely to be three of the ten leading causes of death of under-five
children, besides perinatal causes?
a. malaria, diarrhea, measles
b. diarrhea, malaria, pneumonia
c. fire, diarrhea, pneumonia
QUESTION 22
1. Case: As a larger and larger share of HIV positive people are put on treatment, what would you
expect will happen in Skolnikland, at least in the short run, if the rates of new infection stay about
where they are now?
a. Prevalence of HIV will go up
b. Prevalence of HIV will go down
c. Prevalence of HIV will stay the same
QUESTION 23
1. Taking and “ecological perspective” to behavior change requires you to:
a. Consider multiple levels of influence on behavior and the social environment
b. Consider having people follow a change agent
c. Consider people’s perceptions of how likely they are to get an illness
d. None of these are correct
QUESTION 24
1. Case: In which of these countries, ranked in order of income per capita and level of development
of their universal health coverage (UHC) scheme, would you expect out of pocket costs for health
to be a lowest share of total health costs?
a. Skolnikland
b. The Phillippines
c. Chile
QUESTION 25
1. Which two conditions are among the top 3 causes of death globally?
a. Diabetes and ischemic heart disease
b. Ischemic heart disease and stroke
c. Chronic kidney disease and chronic obstructive pulmonary disease
d. Diabetes and COPD
QUESTION 26
1. Which force is likely to have the greatest direct impact on the burden of disease in the mediumand long-run on today’s middle-income countries?
a. Population aging
b. Population growth
c. Urbanization
QUESTION 27
1. The regions with the lowest nutritional status for children are:
a. South Asia and the Middle East and North Africa
b. South Asia and Sub-Saharan Africa
c. Sub-Saharan Africa and Latin America and the Caribbean
d. South Asia and Latin America and the Caribbean
QUESTION 28
1. The “three delays” include:
a. The delay of identifying a complication of pregnancy
b. The delay in transporting a pregnant woman to emergency obstetric care
c. The delay in providing appropriate emergency obstetric care
d. All of these are correct
QUESTION 29
1. You would expect the rate of coverage of the measles vaccine to be highest among which
population:
a. Urban
b. Rural
c. Highland dwellers
d. Ethnic minorities
QUESTION 30
1. In many traditional societies, people seek initial health care from:
a. Practitioners of indigenous systems of medicine
b. A range of unlicensed medical practitioners
c. Pharmacists
d. All of these are correct
QUESTION 31
1. What is the most accurate statement about the distribution of age at death in Niger (a very lowincome country) and Norway (a very high-income country) today?
About 30% of the deaths in Niger are among those under 15, while the overwhelming
a.
majority of deaths in Norway are among those over 65
About 5% of the deaths in Niger are among those under 15, while the overwhelming
b.
majority of deaths in Norway are among those over 65
The deaths of children under 15 in both countries are a small proportion of total deaths in
c. those countries.
QUESTION 32
1. Important progress in health has resulted from:
a. Improvements in hygiene, access to safe water, and access to safe sanitation
b. Improvements in technology, such as the dissemination of childhood vaccines
c. Increases in people’s level of education
d. All of these correct
QUESTION 33
1. What is a determinant of health?
a. The range of conditions that determine the health status of an individual
The range of personal, social, economic and environmental factors which determine the
b.
health status of individuals or populations
c. The personal factors that determine the health status of an individual
d. The personal factors that determine the health status of a community
QUESTION 34
1. Which region has a burden of disease that is
predominantly communicable, neonatal, nutritional, and maternal?
a. South Asia
b. The Middle East and North Africa
c. Sub-Saharan Africa
d. Latin America and the Caribbean
QUESTION 35
1. Prisons can often be:
a. Places to get excellent health services
b. Places which are excellent breading grounds for diseases such as TB
c. Places which are excellent breeding grounds for non-communicable diseases broadly
d. Places which are excellent breeding grounds for cardiovascular disease
QUESTION 36
1. The rates of female genital mutilation (fgm) are:
a. staying the same
b. going down
c. going up
d. varying up and down
QUESTION 37
1. Case: If Skolnikland were Chile (a high-income country with a small share of indigenous people),
what share of the burden of disease, measured in DALYs, would you expect to be
noncommunicable – Group II?
a. 80
b. 40
c. 30
QUESTION 38
1. Culture refers to:
a. The language and music of a particular group
b. The behavior patterns of a particular group
c. The entire set of beliefs, art, law, music and customs shared by members of a society
d. The way people of a certain group behave
QUESTION 39
1. The neonatal mortality rate is:
a. The number of children under age 1 who die in a year
b. The number of children under 28 days of age, who die for every 1000 live births
c. The number of children under 28 days of age, who die for every 5000 live births
d. The number of children under 28 days of age, who die for every 10000 live births
QUESTION 40
1. Unsafe abortions are:
Abortions performed by a provider with inappropriate technique and in unhygienic
a.
circumstances
b. Abortions provided illegally
c. Abortions provided in unlicensed clinics
d. All of these are correct
QUESTION 41
1. When conducting subject selection in human subject research
a. Privileged people can be preferred in the selection of participants
Participants should be chosen so the burden and benefits of the research are shared
b.
equitably.
c. Vulnerable people can be preferred in the selection
d. Children should be included
QUESTION 42
1. An example of primary prevention is:
a. Vaccination
b. Treating hypertension with drug therapy
c. Mammography to screen for breast cancer
d. Prostate screening
QUESTION 43
1. The epidemiological transition includes:
The shift from a high rate of non-communicable diseases to a low rate of nona.
communicable diseasese
The shift from a high rate of communicable disease to a low rate of communicable
b.
disease
c. The shift from high fertility and high mortality to low mortality and low fertility
QUESTION 44
1. In which region would you expect to find the highest maternal mortality ratio:
a. South Asia
b. Sub-Saharan Africa
c. The Middle East and North America
d. Latin America and the Caribbean
QUESTION 45
1. Case: In which of these countries, ranked in order of income per capita, would you expect health
expenditure per person in dollars (at purchasing power parity) to be the highest?
a. Skolnikland
b. Nigeria
c. Uruguay
QUESTION 46
1. The best description below of the focus of public health is:
a. Achieving medical care for all
b. Reducing road traffic injuries
Preventing disease, prolonging life, and promoting physical health through organized
c.
community effort
d. Extending life expectancy
QUESTION 47
1. The health system of England can be best described as:
a. Pluralistic
b. A national health service
c. A social health insurance scheme
d. A fragmented system
QUESTION 48
1. Improved sanitation most reduces the burden of:
a. Respiratory infections
b. Measles
c. Parasitic worms
d. Insect borne diseases
QUESTION 49
1. The demographic transition is:
a. The shift from high mortality to medium mortality and high fertility to medium fertility
b. The shift from high fertility and high mortality to low fertility and low mortality
The shift from high rates of communicable diseases to high rates of non-communicable
c.
diseases
QUESTION 50
1. The leading direct cause of maternal mortality is:
a. conditions of hypertension
b. diabetes
c. hemorrhage
d. sepsis

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