15 Public Health and Health Promotion Interventions

Question 1

Q: Define health.

Answer 1

A: WHO defines health as: “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

Q: Define public health.

Answer 2

A: The science and art of preventing disease, prolonging life and promoting health through organised efforts of society

Question 3

Q: Public Health, as a speciality, has 3 main domains. What are they?

Answer 3

A: – Health Improvement/ Health Promotion i.e. healthy lives, health inequalities
– Health protection i.e. focused on infectious diseases and emerging hazards, emergency planning etc.
– Health services/ Health Care- ensures health services are efficiently managed and run

Question 4

Q: Describe life expectancy as an indicator of health. Example of an epidemiological transition? Divide? Sex?

Answer 4

A: increased considerably since 1970s (this is an example of an epidemiological transition)- result of increase healthcare knowledge and hygiene (UK)
o North-South divide with those living in Northern parts of the UK having a lower expectancy
o Females tend to have a higher life expectancy rate

Question 5

Q: Describe socio-economic status as an indicator of health.

Answer 5

A: There is a clear link that your status can have some bearing on your health e.g. higher status people tend to have a lower percentage of longstanding illness

Question 6

Q: What are the factors that you can’t change that have bearings on death? (4)

Answer 6

A: Age, sex, ethnicity, family history/genetics

Question 7

Q: Describe smoking as an indicator of health. Where are rates higher? How many people in the UK die annually from diseases caused by smoking? Education? Ethnicity?

Answer 7

A: o Smoking rates are much higher among poorer people
o Approximately 96,000
o Effect of education also decreases with the percentage that smoke (adults with a degree are less likely to smoke)
o Ethnic and social norms can increase smoking habit- Black Caribbean and Bengali men are more likely to smoke, whereas white women smoke the most in comparison to other ethnicities

Question 8

Q: Describe obesity as an indicator of health. Started to become a major problem where? Prevalence?

Answer 8

A: o Obesity has started to become a major problem with 1 in 5 children in reception being obese
o Obesity prevalence by deprivation is actually higher (most deprived are shown to be at higher risk of being obese)

Question 9

Q: Describe drinking alcohol as an indicator of health. What do drinking patterns increase with? Young people?

Answer 9

A: o Drinking patterns increase with increased household income

Young people are less likely to have consumed alcohol in the last week than those who are older, but more likely than any other age group to consume more than the weekly recommended limit in one day

Question 10

Q: Describe sexual behaviour and STI levels over time. (5)

Answer 10

A: o Levels increased rapidly after the war as soldiers were returning after a long period of abstinence
o Levels dropped again after the introduction of new antibiotics
o Levels rose again during 60s and 70s due to liberal thinking and increase social acceptance of taboo topics
o The drop is quite dramatic after 1985 as HIV was seen to spread and infected many resulting in people being more cautious
o This rose again after the introduction of antiretroviral treatment

Question 11

Q: What are the factors that contribute to population health? (4)

Answer 11

A: • Health behaviours (smoking, diet, exercise, alcohol/drugs, sexual health)
• Clinical care (access to care and quality of care)
• Socioeconomic factors (education, employment, income, community safety)
• Physical environment (housing, environmental quality)

Question 12

Q: What are upstream determinants? and downstream determinants?

Answer 12

A: life circumstances i.e. housing, education

risk factors ethnicity, gender, alcohol consumption, familial history, obesity, stress

Question 13

Q: What are the 3 main causes of health inequalities?

Answer 13

A: wider determinants of health
lifestyle
the health services people use

Question 14

Q: What is health promotion? What is essential for its action? Focus?

Answer 14

A: process of enabling people to increase control over, and to improve their health. (Ottawa Charter for Health Promotion, WHO. Geneva, 1986)

Participation is essential to sustain health promotion action

health rather than disease

Question 15

Q: What 4 things does health promotion involve?

Answer 15

A: Clinical intervention

Health education (Knowledge transfer and health literacy)

Healthy public policy

Community devolopment

Question 16

Q: What does the health improvement approach take into account? (4)

Answer 16

A: o A broad definition of health
o The scope of prevention
o Limitations of health services
o Role of individuals, groups and governments

Question 17

Q: Give an example of clinical intervention.

Answer 17

A: Biomedical-screening/ immunisation (classically thought of under the category Prevention-but others can be prevention too!)

Question 18

Q: Describe health education as a form of health promotion.

Answer 18

A: Traditional type of health promotion (knowledge-attitudes-behaviour-practice) e.g. smoking cessation, healthy eating, exercise promotion

Question 19

Q: Describe health public policy as a form of health promotion. (2)

Answer 19

A: – Legal, fiscal and social measures to make healthy choices easier (HIA, European directive). E.g. sugar tax
– Sustainable policies, actions and infrastructure to address the wider

Question 20

Q: Describe community development as a form of health promotion. (2)

Answer 20

A: – Radical-individuals or groups setting their own agenda
– Partnerships with public, private, non-governmental and international organizations and civil society to create sustainable actions 


Question 21

Q: List 3 health promotion models.

Answer 21

A: dahlgren
whitehead
tannahill

Question 22

Q: What does the Tannahill Health Promotion model involve?

Answer 22

A: 3 overlapping circles

prevention- medical interventions to reduce risk

protection- legislative, fiscal, social measures

education- influencing knowledge and attitudes

3 components needed for good health promotion programme

Question 23

Q: What are the 4 levels of prevention?

Answer 23

A: 1) Primordial

2) Primary
3) Secondary
4) Tertiary

Question 24

Q: What is primordial prevention?

Answer 24

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

Question 25

Q: What is primary prevention?

Answer 25

A: 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 26

Q: What is secondary prevention?

Answer 26

A: To halt progression once the illness is already established. Early detection followed by prompt, effective treatment.

Special consideration of asymptomatic individuals.

Question 27

Q: What is tertiary prevention?

Answer 27

A: rehabilitation of people with established disease to minimise residual disability and complications.

Quality of life action even if disease cannot be cured.

Question 28

Q: What are the 2 main approaches to Disease Prevention? Describe.

Answer 28

A: high risk- identifying those in special need “targeted rescue operation”, then controlling exposure or providing protection against effect of exposure, screening among minority groups for specific disorders

population- begins with recognition that the occurrence of common diseases and exposures reflects the behaviour and circumstances of society as a whole

Question 29

Q: What is the prevention paradox?

Answer 29

A:  Many people exposed to a small risk may generate more disease than the few exposed to a large risk
 SO 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.
 E.g. With Down Syndrome the risk increases with age. However those under 30 are having the majority of babies. Therefore, a high-risk approach (i.e. targeting older mothers with higher risk) would mean a large majority of the babies were missed out.
 Low risk effecting a lot of people leads to a large number of cases.

Question 30

Q: What are the strengths and weaknesses of the high risk approach? (5, 4)

Answer 30

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

Weaknesses
 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 31

Q: What are the strengths and weaknesses of the population approach? (4, 4)

Answer 31

A: Strengths
	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

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

Question 32

Q: Draw the pyramid of interventions. (5) (2 arrows)

Answer 32

A: counselling and education

clinical interventions

long-lasting protective interventions

changing the context to make the individuals’ default decisions healthy

socioeconomic factors

arrow down- increasing population impact

arrow up- increasing individual effort needed

Question 33

Q: Where can health promotion operate? (4)

Answer 33

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

Question 34

Q: At what level can health promotion impact? (3)

Answer 34

A: • The population
• The community
• The individual

Question 35

Q: What is a good example of the Health

Promotion role of doctors working with individuals? List why. (5)

Answer 35

A: Smoking Cessation

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

Question 36

Q: What is a broader Health Promotion role that doctors can play? How? (3)

Answer 36

A: Wider health promotion – Advocacy – E.g. higher taxes, NRT
on prescription, ban on tobacco advertising, smoke-free public
and work places by:
• writing / speaking to politicians (lobbying)
• letters to the press (media advocacy)
• influencing decision-makers

Question 37

Q: Name 3 key current Health Promotion policy documents in the UK.

Answer 37

A: Wanless report

Government White paper – Choosing Health

Strategic Review of Health Inequalities in England
post-2010 - The Marmot Review

Question 38

Q: Name 6 current key Public Health programmes in the UK.

Answer 38

A: • Smoking Cessation
• Alcohol Harm Reduction Strategy
• Sexual Health - National Chlamydia Screening
Programme
• Tackling Teenage Pregnancy
• Tackling obesity
• Immunisation Programmes

Question 39

Q: Summarise the Marmot Review’s 6 policy objectives.

Answer 39

A: • Give every child the best start in life
• Enable all children, young people, and adults to maximise
their capabilities and have control over their lives
• Create fair employment and good work for all
• Ensure healthy standard of living for all
• Create and develop healthy and sustainable places and communities
• Strengthen the role and impact of ill health prevention

Question 40

Q: Describe the Wanless report. (4)

Answer 40

A: • The Disease Burden
• “Fully Engaged Scenario”
• Focus on prevention and the wider determinants of health
• Cost-effectiveness of actions to improve health and
reduce inequalities

Question 41

Q: What is involved in the ‘National Alcohol Strategy’? (4)

Answer 41

A:  end sales of the cheapest alcohol
 strengthen the ban on irresponsible promotions in pubs and clubs
 reduce the availability of high-strength products
 promote and display alcohol responsibly, and improve education