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FPH exam > 2H Principles and practice of health promotion > Flashcards

2H Principles and practice of health promotion Flashcards

1
Q

2 different view points on the extent to which health is individual or collective responsibility

A

SOCIAL RESPONSIBILITY/
COLLECTIVISM
-doctrine that holds that and entity (be it state, government, organization or individual) has a responsibility to society as a whole

INDIVIDUALISM/ LIBETARIANISM
- a moral, social and political philosophy which emphasises the importance of the individual
- central tenants around individual liberty, personal independence and the virtue of self reliance

In general it falls to politicians to decide which paradigm dominates in health policy ie in the US the lack of universal healthcare reflects the political belief that an individual, not society, is responsible for healthcare

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2
Q

Give 4 examples of healthcare policies emphasising collective (social) responsibility

A

LEGISLATION
- ie drink driving laws which protect both individuals and others who the individual might out at risk

REGULATION
- ie health and safety regulations enable the health and safety executive to inspect business and ensure they a re protecting employees

POPULATION WIDE MEASURES
- ie water fluoridation

PROGRESSIVE HEALTHCARE SERVICE FUNDING SYSTEM
- universal tax where the greatest amount is paid by the richest, even thought the poorest often have most intense health service use

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3
Q

Give 3 examples of healthcare policies emphasising individual responsibility

A

INFORMATION PROVISION
- ie providing information on safe alcohol consumption levels allows people to choose how much to drink give the health risks

DEREGULATION
- ie relaxing licensing laws allowing pubs to serve alcohol 24 hours a day would allow people to choose when and where to drink alcohol

PRIVATE HEALTH INSURANCE
- enables people to choose when and where to access healthcare

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4
Q

What are the determinants of health?

A

Factors with the greatest influence on health

Most of these positive determinants lie outside of the scope of health and social care which tend to deal with ill health

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5
Q

name 4 determinant of health theories/models with names and year

A
  • the health field concept (Lalonde) 1974
  • The policy rainbow (Dahlgreen and whitehead) 1991
  • The health field model (Evans and stoddart) 1990
  • Social determinants model (Diderichsen and Hallqvist) 1998
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6
Q

Describe the health field concept

A
  • Lalonde 1974
  • Canadian health minister
  • explained that other factors alongside healthcare services have a major influence on health
  • described 4 areas with key health influence:
    1. Human Biology
    2. Environment
    3. Healthcare services
    4. Lifestyle
  • criticised for having too much emphasis on lifestyle and not enough on the environment
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7
Q

Describe the policy rainbow

A
  • Dahlgreen and whitehead 1991
  • Acknowledges there are individual characteristics that cannot be changed (age, gender) and those which can be influenced (individual lifestyle factors)
  • model indicated the different levels at which health might be influenced
  • makes no attempt to explain the relationship between layers or elements within a layer
  • aims to stimulate discussion about the relative importance of each layer/ element and the potential for intervention
  • ## the relative importance of each layer and element will vary from population to population
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8
Q

The health field model

A
  • Evans and Stoddart
  • 1990
  • health is explicitly conceptualised as not only the absence of disease but includes functional status and wellbeing
  • helps practitioners understand how the determinants themselves are influenced and therefore how they might be modified
    Factors include:
    1. Social environment: education, employment family, poverty
    2. Physical environment: poor housing, proximity to waste/hazards/conflict
    3. Genetics: genetic factors which interact with the environment
    4. Behaviour: Viewed as an ‘intermediate’ determinant (ie not simply a voluntary act’), behaviour is shaped by a range of determinants ie education, finance
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9
Q

Social Determinants model

A
  • Diderichsen and Hallqvist
  • 1998
  • Social conditions affect individuals social situations which then determine their health risks
  • this model identifies 4 broad conceptual mechanisms:
    1. SOCIAL STRATIFICATION (social conditions such as education and employment will determine peoples social situations)…leading to…
    2 DIFFERENTIAL EXPOSURE ..and..
    3 DIFFERENTIAL VULNERABILITY….which together results in….
    4 DIFFERENT CONSEQUENCES
  • the mechanisms work synergistically to create health inequalities
  • for each mechanism, the possible entry points for policy can be identified on the model
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10
Q

Define social inequalities

A

Systematic differences on health between socioeconomic groups which are socially produced, modifiable and unfair

ie marmot reports 2010 and 2020

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11
Q

consider 3 different possible aims of health promotion

A
  • to improve health?
  • to improve access to healthcare?
  • to enable individuals to improve their own health?
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12
Q

consider some areas health promotion can reach into (3)

A
  • policy
  • community improvement
  • individual choice
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13
Q

The Ottawa Charter general

A
  • est in 1986
  • Participants met to share their knowledge of health promotion and came up with the Ottawa Charter to support the WHO in ‘health for all’
  • the charter implicitly assumes that there are some circumstances beyond individual control and these require community involvement or state intervention
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14
Q

Individual vs community: list 5 things that the Ottawa Charter advocates that people in health promotion should do

A
  1. create supportive ENVIRONMENTS
  2. enable COMMUNITY participation
  3. develop SKILLS for health
  4. Reorientate health services towards PREVENTION
  5. build PUBLIC POLICIES that promote health
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15
Q

Individuals vs community: Healthy lives healthy people

A
  • 2010 public health white paper
  • In contrast to the Ottawa charter promoting health promotion at community and policy levels this promotes health promotion using ‘nudge’ techniques in order to maximise individual choice
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16
Q

targeted Vs universal health promotion: Pros for targeted interventions

A
  • can tailor message to the group
  • can be efficient
  • can target high risk groups to try and reduce health inequalities (universal messages often mostly improve the health of those with the most resources and most able to do so)
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17
Q

Targeted Vs universal health promotion: Disadvantages for targeted interventions

A

Targeting a group:
- assumes members of the group are homogeneous
- can lead to culture blaming (ie blaming men who have sex with men for AIDS epidemic)

targeting a condition:
- tagertting just those at high risk can miss the majority of people who will get the disease
- prevention paradox
- esp for common conditions targeting the whole population can make a big difference to population disease risk.
- however the individual change is very small
- universal targeting can ‘pathologises’ a large number of people who would never have got sick

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18
Q

What are the two competing hypotheses for and against universal health promotion?

A
  • Rose Hypothesis
  • Prevention Paradox
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19
Q

What is the rose hypothesis

A
  • given that risk factors for most diseases are normally distributed in the population, most cases of the disease will occur in those who are at low or medium risk of the disease. A smaller total number of cases will happen in those at high risk.

Therefore, measures to reduce the whole populations risk a little will have the greatest overall impact on disease prevalence/ incidence

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20
Q

Prevention Paradox

A
  • universal interventions will have greater impact on the overall disease than targeted interventions, however, the benefit to each individual who changes their behaviour is small/ not existent

ie seatbelt wearing is an important safety measure, however, everyone has to wear them and only the few people involved in an RTC will benefit

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21
Q

How does the prevention paradox impact health promotion

A
  • the prevention paradox can put the credibility of universal health promotion programmes in jeopardy

ie if a programme aims to reduce fat intake to recued CHD and many people are known to eat high fat diets but not have CHD this might reduce the incentive to follow the advice and may make people distrust/ ignore it

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22
Q

Communication in health education: describe McGuires model

A

McGuire proposed 5 communication inputs for health messages aimed at changing behaviour

  1. SOURCE
    -The person/ organization that generates the message. Source credibility depends on position in society, source training and education, source shared characteristics with the receiver (ie age, gender, ethnicity), any source conflict of interests.
    -ie health message from GP may be percieved as more credible than that from health minister
  2. MESSAGE
    - what is said and how it is said
    - can be verbal or non-verbal
    - can be horizontal (general health messaging ie eat a healthy diet) or vertical (specific health messaging ie stop binge drinking)
  3. CHANNEL
    - the media or medium through which the message is conveyed
    - can be one to one (ie midwife–> patient), small group (ie antenatal class), mass media
  4. RECIEVER
    - the person receiving the communication
    - should be the prime consideration of any health message
  5. DESTINATION
    -what is the communication trying to achieve:
    - change in attitude?
    -change in beliefs?
    - change in behaviour?
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23
Q

what is integrated marketing communication?

A

process of delivering a unified message across multiple different media

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24
Q

Communication for health education: what 5 requirements does a health communication need to fulfil to improve health

A
  1. be seen
  2. Attract attention
  3. Be understood
  4. Be accepted (does the message reinforce current attitudes/beliefs? (ie stop smoking messages likely to be effective to those already considering stopping but much less so to those not interested in stopping)
  5. change behaviour (education may not be enough. Are all factors affecting behaviour being address? ie healthy eating messaging may need to be complimented by subsides for healthy food).
25
Q

Communication in health education : mass media (methods, scope, flexibility, feedback, strengths, weaknesses)

A

METHODS: TV, internet, radio, social media, newspapers, billboards etc
SCOPE: reaches many
FLEXIBILITY: very little , one message delivered to everyone
FEDDBACK: low
STRENGTHS: message reaches many, simple clear message, good for reinforcing attitudes and beliefs
WEAKNESSES: expensive, cannot tailor message to certain groups, weak link between mass media and receiver (ie message may not be seen, may not attract attention and may not be understood)

26
Q

Communication in health education : small group communication (methods, scope, flexibility, feedback, strengths, weaknesses)

A

METHODS: face to face: ie consultations, CBT, small groups
remote: telephone consultations, emails, texts
SCOPE: few recipients
FLEXIBILITYL high, message can be tailored to the individual
FEEDBACK: high
STRENGTHS: can challenge attitudes and behaviours, useful for complex messages (ie relationship between alcohol and health), may use techniques to improve self efficacy
WEAKNESSES: can only reach small numbers, limited control over how messages are conveyed by different practitioners

27
Q

what is social policy?

A
  • measures and structures designed to increase harmonisation in a society
28
Q

List some social policy levers which can be used to promote health

A
  1. LESGILATION: BANS AND RESTRICTIONS (ie age restrictions on buying cigarettes
  2. FISCAL MEASURES (ie taxes and subsidies)

3 OTHER:
ie - health impact assessments of all policies
- funding and support for research

29
Q

List 4 areas which legislation (bans and restrictions) can target when trying to promote health

A
  1. Availability
  2. Usage
  3. Sales
  4. Advertising
30
Q

Give examples of legislation which impacts product availability

A
  1. Children’s and young persons act 1993 - made it illegal to sell cigarettes to people under the age of 16 years

2 Medicines act 1968- restricted access to medicines so some were on general sale and others were prescription only

31
Q

Give examples of legislation which impacts product usage

A
  1. health act 2006- made it illegal to smoke in nearly all public indoor spaces and workplaces
32
Q

Give examples of legislation which impacts product sales

A

The misuse of drugs act 1971
- designated controlled drugs into 3 categories (A, B and C) with corresponding restrictions on their availability and specific penalties for selling or possession

33
Q

Give examples of legislation which impacts product advertising

A

Tobaccon advertising and promotion regulations 2004

made it mandatory to display health warnings on all cigarette packages

34
Q

What do fiscal measures (taxation/subsidies) aim to do?

A

-aim to alter the price of goods to reflect the externalities of consumption
- externality= the cost/benefit of consumption that falls on someone who is not the consumer (ie cigarettes have a negative externality)

35
Q

What can taxation be used to do?

A
  1. raid revenue
  2. decrease demand for a product/activity (depending on elasticity of demand- this will be different from different subsets of the population)
36
Q

Give example of Uk taxation measures

A
  • used for alcohol and cigarettes
  • UK soft drink levy- payable by packager/importer to HMRC for all soft drinks with sugar content >/=5g per 100ml
37
Q

Give example of UK subsidy measures

A

Healthy start scheme, provides money to some people with young children tat can be used to buy milk, fruit and vegetables

38
Q

Implementing health promotion programmes: give an example of a tool that can be used

A

PRECEDE-PROCEED tool

comprehensive tool enabling design, implementation and evaluation of health promotion programmes

39
Q

What is the mnemonic for the broad steps in designing a health promotion programme

A

AS ROME

40
Q

What are the steps in designing a health promotion programme

A

AS ROME

  1. ASSESS NEED
  2. STAKEHOLDER ENGAGEMENT?ANALYSIS (primary stakeholers- potential beneficiaries, secondary stakeholders- those who may be involved in delivery)
  3. RESOURCES (assess required financial and human resources and what is available. may require prioritisation)
  4. OBJECTIVES/AIMS
  5. METHODOLOGY (may be informed by behaviour change models and results from epidemiological studies)
  6. EVALUATION
41
Q

Describe 4 different approaches to health promotion that health promotion programmes often include a combination of

A
  1. changes to POLCIY to tr and influence behaviour
  2. distribution / redistribution of RESOURCES to remove barriers to change
  3. COMMUNITY DEVELOPMENT
  4. information communication/ EDUCATION
42
Q

Implementation of health promotion programmes: staff delivery considerations

A
  • frontline clinical staff and community members do much more health promotion than public health practitioners and are often needed to implement health promotion programmes
  • tou need to consider
  1. VALUES
    - do the values of the staff align with the values of the programme, ie a community that doesn’t believe in sec before marriage is unlikely to support implementation of young person STI testing programme
  2. MOTIVATION
    - what is the motivation for people to change their practice to implement the programme? incentives may be needed.
  3. GUIDANCE
    - do the programmes policies and guidance make it clear what is needed from frontline staff and community members?
  4. SKILLS
    - do the frontline clinical staff/ community members have the skills to deliver the needed for the programme or is training required?
  5. TIME
    - do the frontline staff/ community members have time to deliver the programme ie a GP consultation may be a good time to deliver an intervention but GPs are unlikely to engage in fitting in more into 10 minute appointments
43
Q

what is a community?

A

A group of people with a common characteristic at that time, this might be:

  • geographical (ie housing estate)
  • social (ie students union, LGBQT+)
  • Cultural (ie religion, ethnicity)
44
Q

How does community development differ from social planning?

A

community development = community participation = community renewal

community development = bottom up approach

social planning = top down approach

45
Q

What is the mnemonic for the 5 core activities of community development?

A

Partnership Allows For Incredible Societies

  • the 5 core activities of community development were outlined by Smithies and Adam
46
Q

what are the 5 core activities of community development

A
  • smithies and Adam
  • Partnership Allows for Incredible Societies

(Formal) PARTICIPATION
- formal participation in decision making
- ie focus groups/ consultation days
- (ie LA decides to fund healthy cooking classes after consultation with mothers at local sure start centre)

(community) ACTION
- Priorities are developed by community groups
- ie lobbying/ self help groups
(ie after attending healthy cooking course, trained mothers decide to set up group to train other mothers)

FACILITATION
- Health service employees promote community activities
- ie provision of meeting rooms
(ie LA funds healthy cooking course for local mothers)

INTERFACE
- statutory services working closely with communities and community leaders
- ie consultation with local Imams

STRATEGY
- strategic support from national initiatives
-ie neighbourhood renewal funds

47
Q

Advantages (4) and disadvantages (5) of community development

A

ADVANTAGES
- can get better involvement/ engagement when projects are based on community priorities
- can focus on the root causes of ill health rather than lifestyle choices
- process of enabling communities to participate can enhance self esteem, confidence and control
- can reach hard to reach or excluded groups that conventional interventions often miss

DISADVANTAGES
- time consuming
- resource intensive
- securing funding can be difficult
- outcomes are often intangible and cannot be measured
- health improvements can occur over a very long time

48
Q

why might partnership working be important

A
  • wider determinants of health and need to liaise with health services makes partnership working in public health essential
  • partnerships can:
    1. avoid duplication
    2. allow pooling of resources ( expertise, funding)
  • partnerships can be politically required (ie health and wellbeing boards)
49
Q

Describe 5 challenges to partnership working

A

PIPAC

1 POWER
- big fish/little fish scenario (ie statutory bidy working with community user group)
- how is the agenda developed?
- where is the meeting held?

  1. INFLUENCE
    - are people of equal seniority attending the meeting?
    - given there is no leverage through management structure how is it ensured people deliver on what is promised?
  2. PROCESSES
    - do the organisations function in the same way?
    - can the people attending the meeting authorise decisions or do they have to take decisions back to boards?
  3. ASPIRATIONS
    - do all partners want the same outcome from the partnership?
    - is everyone clear what the objectives are?
  4. COMMITMENT
    - who attends the meeting? is it the right people?
    - do the same people attend every time?
50
Q

Give an example of a framework that can be used to measure the success of a partnership

A
  • can use donabedians framework

STRUCTURE
- ie joint funding
- joint posts

PROCESSES
- ie meetings well attended
- internal and partnership plans are aligned

OUTCOMES
- partnership objectives and milestones are achieved

51
Q

give 4 examples of organisations involved in international health promotion initiatives

A
  1. WHO (part of UN)
  2. World bank (part of UN)
  3. UNICEF (part of UN)
  4. NGOs - particularly from the private sector (ie bill and melinda gates foundation)
52
Q

List some key international health promotion landmarks

A

HEALTH FOR ALL: DECLARATION OF ALMA-ATA
- 1970
-WHO
- WHO stated aim of providing universally accessible primary care

HEALTH FOR ALL 2000: OTTAWA CHARTER
- 1989
- WHO
- WHO established core principles of health promotion internationally

UN MILLENIUM DEVELOPMENT GOALS
- 2000
-UN
- 8 goals to improve the lives of the worlds poorest people

UN SUSTAINABLE DEVELOPMENT GOALS
- 2015
- UN
- 17 targets for 2030 to build on the MDGs for a world free of poverty, hunger, disease and want

53
Q

Name 2 international health promotion initiatives

A
  1. Healthy cities
  2. Baby friendly iniative
54
Q

Talk about ‘healthy cities’

A

-A WHO Europe initiative
- Approach seeks to put health high on the political and social agenda of cities and build a strong movement for public health at the local level
- the healthy cities approach recognises the wider determinants of health and the need to work collaboratively across organisations

55
Q

Talk about ‘ the baby-friendly initiative’

A
  • UNICEF initiative
  • 1992
  • aims to support maternity hospitals to support mothers to breastfeed
  • sets ‘ 10 steps to successful breastfeeding’ including setting organization wide policy, ensuring staff have knowledge and skills and that the facilities are in place to provide support to women
56
Q

Learning from international health promotion initiatives: why might an initiative that was successful in one country not work in another?

A
  • different health care funding
  • different disease epidemiology
  • different culture
  • different health service provision
  • different demographics
  • different health needs
57
Q

Name an agency central to disseminating public health information and potential solution

A

WHO

58
Q

Give 4 methods of disseminating information on health promotion initiatives

A
  1. GUIDELINES AND TOOLKITS
    Where practice and evidence exists
  2. CONSENSUS STATEMENTS
    Where evidence is not conclusive but advice is helpful
  3. EXPERT NETWORKS
    Where opinion at the international level is required
  4. OTHER:
    conferences etc
59
Q
A

FPH exam (29 decks)

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