Case 6- health promotion

Question 1

Public health

Answer 1

The science of preventing disease and promoting health through the organised efforts and informed choices of society, organisations, public and private communities and individuals.

Question 2

Globalisation of risk factors

Answer 2

The increase in risk factors across the world such as drinking and smoking. As well as the ageing population

Question 3

Public health interventions

Answer 3

An action that bring about identifiable outcomes. It is applied to many, most or all members in a community. It aims to deliver a net benefit to the community or population as well as benefits to individuals. It involves various sectors and organisations, for example education or the police. Aims to prevent disease a well as promote health and well being. It aims to improve health and reduce health inequalities.

Question 4

What does public health encompass

Answer 4

Health promotion and disease prevention

Question 5

Health promotion

Answer 5

Enables people to increase control and improve their health. Health promotion encompasses health education, prevention and health protection

Question 6

Health education

Answer 6

Aimed at promoting positive health and preventing or reducing ill health in individuals and groups, through influencing the beliefs, attitudes and behaviour of those with power and the whole community. This could be advertisement or formal education in school

Question 7

Health protection

Answer 7

Comprises legal controls over regulations and policies and voluntary codes of practise which aim to enhance positive health and prevent ill health.

Question 8

3 Types of health protection with examples

Answer 8

Legal controls= wearing seat belts in cars, not smoking in public areas.
Fiscal control (monetary measures)= congestion charge reduces air pollution and improves health. The sugar, alcohol and tobacco tax.
Voluntary codes- calorie count on goods, challenging under 21 when asking ID.

Question 9

Difference between health promotion and disease prevention

Answer 9

Disease prevention differs from health promotion because it focuses on specific efforts aimed at reducing the development and severity of chronic diseases and other morbidities. Health promotion is more general and is about the actions that a person can take to be healthier, like brushing your teeth

Question 10

Primordial prevention

Answer 10

Prevents the initiation of the risk factors in the first place through social and economic policies affecting health, i.e. making binge drinking less socially acceptable.

Question 11

How can a physician promote health

Answer 11

1) Screen their patients for risk factors
2) Provide up to date public health information
3) Maintaining systems about collecting data about the health of their clients
4) Going into the community and taking about health promotion i.e. at schools
5) Communicating sensitive information i.e. sexual health
6) Travel health advice

Question 12

Health impact pyramid

Answer 12

1) Counselling and education
2) Medical care
3) Preventative medicine
4) Making healthy decisions the default
5) Socioeconomic factors.
Near the top are factors which require increasing individual effort, near the bottom are factors that have increasing public health impact

Question 13

Public health- counselling and education

Answer 13

For example tobacco warning labels. Though it is cheap it is not often effective though it may be the only thing available. More effective when maintained over time. Relies on individuals making a lot of change with not a lot of support.

Question 14

Public health- medical care

Answer 14

Medication, inhaler etc. These are very expensive, will not be effective if the patient is not willing to engage. You may not be able to access these patients, for example, if they are not formerly diagnosed. Not useful in reducing the chances of them getting a disease.

Question 15

Public health- preventitive medicine

Answer 15

For example, smoking cessation interventions. Can be accessed via your GP. Are open to a lot of the population and use simple techniques to encourage cessation. Requires the patient to want to stop smoking

Question 16

Public health- making health decisions the default

Answer 16

For example, the smoking ban (Health act 2006). Legally stops people from making unhealthy decisions. Make a big impact. May not effect what people do in private. Though it reduces passive smoking wont affect active smoking

Question 17

Public health- socioeconomic factors

Answer 17

Such as poverty/health inequality, will make the biggest difference. Affects a large section of society. Very expensive and political, some governments may choose not to implement them. May take a long while to make a difference.

Question 18

How can you measure effectiveness of health promotion

Answer 18

Using QALY- quality adjusted life year

Question 19

Effectiveness of health promotion

Answer 19

They can change people’s health behaviours both now and in the future. This is likely to have impact on the individuals family as well. It is also very cheap. Improves a patients health outcome

Question 20

Health promotion evaluation

Answer 20

During evaluation we assess whether an intervention has worked (outcome) and how an intervention has performed (process). When looking at outcome you need to assess both short term and long term. By looking at the process we can see if it is reproducible and could be done again.

Question 21

Evaluation

Answer 21

An assessment that is as systematic and impartial as possible of a strategy or policy

Question 22

Why do we look at the process in evaluation

Answer 22

To see if the process is feasible and if people will realistically implement the change in their everyday life. This is important if the process is to be scaled up as you would need to avoid unacceptable side effects. You ask for qualitative advice on the service, for example, it may need lengthening

Question 23

What to do when evaluating

Answer 23

You will want to evaluate at the end (summative) and during (formative) an intervention. You may want to interview people during the process. You will need to use multiple methods of evaluation as lots of factors will determine whether the intervention was successful. You will need both quantitative and qualitative data

Question 24

Challenges with public health

Answer 24

There are several interacting components, asking people to change several often challenging behaviours, involves many groups or organisations, have a number of different desired outcomes. You have to allow for a level of variability or tailoring of the intervention.

Question 25

The MRC framework for developing and evaluating complex interventions

Answer 25

1) Development
2) Feasibility/piloting
3) Evaluation
4) Implementation
It is a circle and you can move backwards and forwards between the different steps

Question 26

MRC framework-Development

Answer 26

1) Identifying the evidence base
2) Identifying/developing theories
3) Modelling process and outcomes

Question 27

MRC framework- feasibility/piloting

Answer 27

1) Testing procedures
2) Estimating recruitment/retention
3) Determining sample size

Question 28

MRC framework- Evaluation

Answer 28

1) Assessing effectiveness
2) Understanding the change process
3) Assessing cost-effectiveness

Question 29

MRC framework- Implementation

Answer 29

1) Dissemination
2) Surveillance and monitoring
3) Long term follow up

Question 30

Public health and health inequality

Answer 30

Poor health is closely liked to social and economic disadvantage. Though smoking has decreased in the UK it has barely changed in the lowest socio-economic groups. To challenge this you can implement smoking cessation clinics within the most deprived areas. Tobacco use will reduce the amount of money in the household purse. Later in life it can affect their ability to work

Question 31

Mental health and smoking

Answer 31

People with more complex needs or with mental health problems are more likely to smoke more. People in this group are more likely to face extra barriers to quitting. They will suffer from higher levels of addiction so will require more intense support. A tailored approach delivered via mental health services is more likely to be successful. Especially when it is through a health practitioner that the patient already has a relationship with

Question 32

Types of public health interventions

Answer 32

1. Policies of governments and non-government organisations- school meals
2. Laws and regulations- production of harmful substances, food safety laws.
3. Organisational development- putting a physiotherapist in a health centre.
4. Community development- building a sports centre.
5. Education of individuals and communities.
6. Technological innovations- vaccination programmes, seat belts.
7. Service development and delivery- screening.
8. Resources (discounts or rewards)- free immunisation.

Question 33

A health indicator

Answer 33

A characteristic of an individual, population or environment which is subject to measurement which shows their health either indirectly or directly. It can be qualitative (how good is someone’s health) or quantitative, how many people have this disease at a particular time.

Question 34

UK census

Answer 34

Every 10 years, a survey which everyone has to fill out about your health and socio-economic status. For example, they ask abut your job and religion. Also includes questions about your health.

Question 35

Health survey

Answer 35

Monitors trends in the nation’s health and lifestyle. It monitors the prevalence of specific health conditions. Ask’s 8000 randomly selected adults and 2000 children. If they consent a trained nurse will visit them to gather the information such as weight, blood pressure and height. They also have to fill out a survey. Includes questions on lifestyle and wellbeing as well as illness.

Question 36

Public health examples

Answer 36

1) Vaccinations- MMR, small pox eradication
2) Improved global sanitation
3) Reduced deaths from heart disease and stroke- awareness of high BP
4) Combatting HIV and malaria

Question 37

Evidence based approach to health promotion and disease prevention

Answer 37

1) Effectiveness vs cost effectiveness
2) QALY- quality adjusted life year
3) Cost per QALY

Question 38

Clinical pathway

Answer 38

Mutual decision making and organisation of care process for a well defined group of people over a well defined period. It is disease specific and highly focused, Requires the co-ordination of a multi-disciplinary team

Question 39

Patient pathway

Answer 39

The route a patient takes from their first NHS contact to the completion of treatment

Question 40

Advantages of care plans

Answer 40

1) Equal and uniform treatment
2) Nothing is missed
3) Manages clinical risk
4) Continuity of care
5) Reduces variability between trusts

Question 41

Problems with care plans

Answer 41

1) People may not fit specific boxes
2) Out of date quickly
3) Discourages patient centred care
4) May not follow patients best interest