Deck 3 Flashcards
What is ‘downstream’ and ‘upstream’?
Downstream - the disease and curative treatment. Upstream - looking at the causative agent and preventing disease from ever occurring. Doctors primarily focus on the downstream, but also promote health. There are vested interests in the downstream which prevent health promotion and prevention from developing (e.g. companies that make drugs, medical equipment, controversy of closing hospitals in politics etc.)
Describe the epidemiological transition in communicable diseases.
In the mid 19th century, communicable diseases accounted for 75% of all deaths. In the later 20th century, that figure fell to 2%.
Compare the epidemiology of diseases in wealthy nations vs poorer nations.
The characteristic of epidemiological transition in wealthy nations is a fall in infectious diseases and a rise in chronic, non-communicable diseases. Known as ‘diseases of affluence’ because they affect wealthy nations. However, they disproportionately affect the poor in those nations.
What factors are determinants of health outcomes?
- Social and economic (education, housing, employment, poverty, income). - Environment (air quality, pollution, water, transport, climate change). - Lifestyle issues (diet, smoking, drug misuse, excersise). - Health Services (delivery and access, developments in medicine, diagnosis, rehabilitation).
Briefly define health promotion.
The process of enabling people to increase control over, and improve, their health. It moves beyond focus on individual behaviour towards a wide range of social and environmental interventions.
What are the WHO’s 5 aspects of health promotion.
Healthy public policy - by this they mean the health consequences or ‘health impacts’ of ALL areas of policy (education, transport, housing) should be taken into account by policy makers • Supportive environments - action needs to be taken to improve the settings in which people live their everyday lives e.g in home design and safety issues (accidents); workplace – e.g smoke free work places, or working towards sustainable environments • Community action - this is when groups of people, e.g. in a community take action to improve health for example campaign against local pollution or traffic hazzards. • Personal skills - this is about helping individuals to develop life skills which better enable them to deal with health issues e.g stress management, self esteem and so on. • Reorienting health services - this is about shifting the balance of resource from treatment to prevention – trying to ensure a population approach to health care rather than one that is overly individualist.
Define ‘Health Education’
Health education is a type of health promotion. It is any combination of learning experiences that facilitate actions that are conductive to health. Aims to give people knowledge and skills to change potentially health damaging behaviour e.g. advice from health professionals, mass media campaigns.
Define ‘Health protection’
Health protections refers to more legislative approaches to protect public health at a population level, e.g. smoking ban, seat belts etc.
Define primary, secondary and tertiary forms of disease prevention.
Primary Prevention: prevent onset of disease by health promotion (health education and health protection) and screening for risk factors. - Secondary Prevention: detection and cure of a disease at an early stage. - Tertiary Prevention: Preventing a disease from getting worse and minimising effects by symptom management, palliative care etc.
Summarise Beatties typology for different approaches to health promotion.
There are some dilemmas associated with health promotion and the shift from treatment to prevention. What are they?
- The opportunity cost. Resources are already scarce and people are dying of disease. Why should we divert resources upstream to promote health instead putting more effort into helping those afflicted with the disease?
- It is difficult to determine what is effective and what is ineffective because social changes aren’t easily testable in randomised control trials, as effects are often long term, hard to measure and confounding factors difficult to control. Should we assign any resources to health promotion if there is no proof it will work?
- Balance of individual liberty and protection of public health
- Who is responsible for health? Individual? Community? Health service? Government?
Ideally, when thinking about promoting health, we should find the best balance of autonomy, beneficience, non-maleficence and justice.
You’re a doctor and you’re about to engage in some health advice to a patient in order to engage in opportunistic prevention. What guidelines should you follow when talking to patients?
- Awareness of patient’s receptiveness.
- Respectful - listen to the patients views.
- Avoid preaching
- Caring not scaring
-
If individual freedom (autonomy) is important, should the right to treatment be? Should those who take risks (i.e. smoking) be denied treatment?
Argument For:
- Smoking led to disease
- Smoking will limit the effectiveness of surgical intervention.
- Poor outcome will result more surgery
- Expensive when resources are limited - must target where most effective.
Arguments Against:
- Doctors have ethical obligation to treat on basis of need and best available treatment.
- ‘Slippery slope’ - should we also deny treatment to those who self-harm?
- Poor people smoke more than rich people.
- Value judgements - deserving and undeserving.
What is the signiciance of the prevention paradox?
‘A preventative measure which brings much benefit to the population offers little benefit to each participating individual’
For example: increasing tax on alcohol and cigarette - collective effect is less alcohol is consumed, but the individual still buys alcohol.
What practical ways can doctors do to promote health?
- Individual consultationa advice.
- Institutional context (working with other agencies to promote health - HPA, WHO).
- Political and social clout.
