12 - Public Health and Health Promotion Interventions

Question 1

WHO defines health as

Answer 1

“A resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities”.

Question 2

Public Health

Answer 2

science and art of preventing disease, prolonging life and

promoting health through organised efforts of society

Question 3

Health Promotion

Answer 3

process of enabling people to increase control over the determinants of health and thereby improve their health

Question 4

Health Promotion involves

Answer 4

• clinical intervention
• health education
• healthy public policy
• community development

Question 5

4 Levels of Prevention

Answer 5

primordial prevention
primary prevention
secondary prevention
tertiary prevention

Question 6

Primordial Prevention

Answer 6

Prevention of factors promoting the emergence of lifestyles, behaviours, exposure patterns which contribute to increased risk of disease.

Question 7

Primary Prevention

Answer 7

Actions to prevent the onset of disease. To limit exposure to risk factors by individual behaviour change and by actions in the community. Includes health promotion (e.g. health education, prescriptive diets) and specific protection (e.g. vaccination)

Question 8

Secondary Prevention

Answer 8

To halt progression once the illness is already established. Early detection followed by prompt, effective treatment. Special consideration of asymptomatic individuals.

Question 9

Tertiary Prevention

Answer 9

rehabilitation of people with established disease to minimise residual disability and complications. Quality of life action even if disease cannot be cured.

Question 10

2 Main Approaches to Disease Prevention

Answer 10

HIGH RISK – identifying those in special need “targeted rescue operation” (Geoffrey Rose, 1992), then controlling exposure (e.g. reducing house dust mite in the home of asthmatic child) or providing protection against effect of exposure (vaccination).
POPULATION – begins with recognition that the occurrence of common diseases and exposures reflects the behaviour and circumstances of society as a whole.

Question 11

Prevention Paradox

Answer 11

Many people exposed to a small risk may generate more disease than the few exposed to a large risk
Therefore, when many people receive a small benefit the total benefit may be large
However, individual inconvenience may be high to the many when benefit may only be to a few.

Question 12

Strengths of High Risk Approach

Answer 12

Effective (high motivation of individual and physician) Efficient (cost-effective use of resources)
Benefit : risk ratio is favourable
Appropriate to individual
Easy to evaluate

Question 13

Weaknesses of High Risk Approach

Answer 13

Palliative and temporary (misses a large amount of disease)
Risk prediction – not accurate
Limited potential – misses out on spill over of info
Hard to change individual behaviours

Question 14

Strengths of Population Approach

Answer 14

Equitable (Attributable risk may be high where risk is low if a lot of people are exposed to that low risk)
Radical
Large potential for population
Behaviourally appropriate

Question 15

Weaknesses of Population Approach

Answer 15

Small advantage to individual
Poor motivation of subject
Poor motivation of physician
Benefit : risk ratio worrisome

Question 16

Where can health promotion operate?

Answer 16

Internationally
Nationally (government, advertising, media)
Locally (GP, hospitals, Local Authority, Police, Schools etc) Individually (support groups, neighbourhood schemes, communities)

Question 17

Health Promotion may impact at the level of:

Answer 17

The population
The community
The individual

Question 18

Smoking Cessation is a good example of the Health Promotion role of doctors working with individuals

Answer 18

Smoking cessation guidelines (NICE)
Motivational interviewing
Support for cessation
Prescription of nicotine replacement therapy (NRT) and bupropion (Zyban) 
Referral to specialist services