7. Health Improvement: disease prevention and health promotion

Question 1

3 DOMAINS of PUBLIC HEALTH

Answer 1

• HEALTH IMPROVEMENT
• HEALTH SERVICES
• HEALTH PROTECTION

Question 2

what is HEALTH IMPROVEMENT

Answer 2

HEALTH PROMOTION

’ the process of enabling people to INCREASE CONTROL over their HEALTH and its DETERMINANTS, and thereby IMPROVE THEIR HEALTH’

Question 3

what are CONTRIBUTORY CAUSES

Answer 3

Immediate causes of disease

ie smoking

Question 4

what are DETERMINANTS

Answer 4

UNDERLYING CAUSES

ie what determines whether people smoke

Question 5

‘WHEN in the course of the disease the program occurs’
3 LEVELS OF PREVENTION:

Answer 5

• PRIMARY PREVENTION
  NO DISEASE
• SECONDARY PREVENTION
  PRECLINICAL PHASE (LATENT or HIDDEN)
• TERTIARY PREVENTION
  CLINICAL PHASE

Question 6

when is PRIMARY PREVENTION

Answer 6

when there is NO DISEASE
(BEFORE onset)

REMOVE RISK FACTORS

• PREVENT DISEASE from occurring the first place

1. PROMOTE OVERALL HEALTH
2. PREVENT SPECIFIC DISEASE eg vaccination, sunscreen

(decrease incidence)

Question 7

when is SECONDARY PREVENTION

Answer 7

in PRECLINICAL phase (LATENT or HIDDEN)

AFTER biological onset but BEFORE first symptoms
- ASYMPTOMATIC

• EARLY DETECTION AND PROMPT TREATMENT (treatment can be more effective)
• can REDUCE SPREAD of disease
• SCREENING is secondary prevention

Question 8

when is TERTIARY PREVENTION

Answer 8

CLINICAL PHASE
AFTER FIRST SYMPTOMS and DIAGNOSIS

REDUCES COMPLICATIONS after disease declared itself

GOAL: IMPROVE SURVIVAL, LIMIT DISABILITY and REHABILITATE

• another term for TREATMENT
  but focuses on LONG-TERM HEALTH EFFECTS

Question 9

what is PRIMORDIAL PREVENTION

Answer 9

TYPE of PRIMARY PREVENTION

• TARGETS the most DISTAL DETERMINANTS of health (social, economic, environmental and cultural)

Question 10

STATEGIES for PREVENTION

Answer 10

HIGH RISK STRATEGY (common in clinical practice)
- intervention targets individuals at High Risk in the population
ie high blood pressure

MASS OR POPULATION STATEGY
- intervention aims to reduce health risks of the ENTIRE POPULATION
eg. legislation to lower salt in packaged foods

Question 11

ADVANTAGES and DISADVANTAGES of HIGH RISK STRATEGY

Answer 11

ADV-
- Intervention appropriate to individual
- Motivation
- Cost-Effective use of resouces
- Risk/Benefit ratio favourable

DISADV-
- prevention Limited to a medical and health care model
- Poor Ability to Predict future risk of individuals
- only SMALL NUMBER of cases of disease PREVENTED in the small number of people at high risk. most cases occur in the majority who are not at high risk

Question 12

ADVANTAGES and DISADVANTAGES of MASS/POPULATION STATEGY

Answer 12

ADV-
- Large scale CHANGES in health
- Normalises healthy behaviour
- not necessarily restricted to immediate causes, can address Underlying social, economic and political determinants

DISADV-
- poor motivations for Drs
- Politically challenging
- No Profits for Pharma industry
- Small benefit for individual

Question 13

5 AREAS of HEALTH PROMOTION
(Micro level -> meso level -> macro level)

Answer 13

• Develop PERSONAL Knowledge & Skills
  (individual interventions)
• Reorient HEALTH SERVICES
• Strengthen COMMUNITES
  (community interventions)
• Create a SUPPORTIVE ENVIRONMENT
• Build Healthy PUBLIC POLICY
  (legislative and fiscal interventions)