Health Promotion Flashcards
Outline the theory of the health career.
Genetics, Behaviours, & Coping Skills
+ culture + physical environment + socio-economic environment
Childhood: family, peers, local community, advertising
antenatal classes —> maternity services —> health visitors —> school
Adolescence: family doctor, peers, mass media, family planning, further education
Maturity: relationships, further education, mass media, workplace, hospital, screening, health education campaigns,
Old age: social services, voluntary bodies & age concern, health education campaigns
Give a brief history of health promotion in the UK.
1910s-1940s = public health (more emphasis on final result), reform of physical environment e.g. sanitation
1950s-1960s = health education, target individual health behaviours e.g. alcohol, STDs, contraception
1970s onwards = health promotion (more emphasis of means of achieving result), broader approach including political/social
Declaration of Alma Ata (1978):
- health is a fundamental right
- unacceptability of inequalities in health
- improvements in health required involvement of other sectors
- global strategy: “Health For All” by 2000
Ottawa Charter (1986): health promotion is “process of enabling people to increase control over and to improve their health…health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector…)
What are the principles of health promotion?
EMPOWERING = enabling individuals & communities to assume more power over health determinants
PARTICIPATORY = involving all concerned at all stages of the process
HOLISTIC = fostering physical, mental, social, and spiritual health
INTERSECTORAL = involving the collaboration of agencies from relevant sectors
EQUITABLE = guided by concern for equity and social justice
SUSTAINABLE = bringing about changes that individuals and communities can maintain once the funding has ended
MULTI-STRATEGY = uses a variety of approaches, including: policy development, organisational change, community development, legislation
What are the criticisms of health promotion in the UK?
Structural = material conditions that give rise to ill health marginalised, focus on individual responsibility
Surveillance = monitoring and regulating population
Consumption = lifestyle choices not just seen as health “risks” but also tied up with identity construction
Give some examples of the different approaches to health promotion.
Medical/preventative e.g. tells smokers to go to doctor for check-ups
Behavioural e.g. encourage smokers to quit
Educational e.g. educate people on risks of smoking
Empowerment e.g. quit smoking campaigns encouraging people to quit (e.g. based on money)
Social e.g. demonising smokers, banning indoor smoking at pubs/restaurants
What are the different levels of prevention?
PRIMARY = prevent the onset of disease/injury by reducing exposure to risk factors
- immunisation
- prevention of contact with environmental factors
- taking appropriate precautions regarding communicable disease e.g. barrier contraception
- reducing risk factors from health related behaviours e.g. quit smoking
SECONDARY = detect and treat disease/risk factors at an early stage to prevent progression/potential future complications & disabilities
e.g. screening for cancer, monitoring BP
TERTIARY = minimise effects of established disease
- maximise remaining capabilities & functions of an already disabled patient
- renal transplants (prevent someone dying of renal failure)
- steroids for asthma (to prevent asthma attacks)
What are the consequences of health promotion?
Ethics of interfering in people’s lives
- potential psychological impact of health promotion messages
- state interventions in individuals’ lives (“nanny state”)
Victim blaming = focusing on individual behavioural change plays down the impact of wider socioeconomic & environmental determinants of health (e.g. housing conditions, water & air quality)
Fallacy of empowerment = giving people information does not give them power; unhealthy lifestyles are not due to ignorance but due to adverse circumstances & wider socioeconomic determinants of health
Reinforcing negative stereotypes = health promotion messages have potential to reinforce negative stereotypes associated with a condition or group (e.g. leaflets aimed at drug users with HIV reinforces that they are “to blame” for their situation)
Unequal distribution of responsibility = implementing healthy behaviours in the family is often left up to women e.g. diet
Prevention paradox = interventions that make a difference at population level might not have much of an effect on the individual
(awareness of anomalies and randomness affects whether people see themselves as a “candidate” for a disease)
How can the effectiveness of a health programme be assessed?
EVALUATION = rigorous & systemic collection of data to assess the effectiveness of a programme in achieving predetermined objectives
- provide necessary evidence for evidence-based interventions
- provide legitimacy to interventions & political support
- ensure no direct/indirect harm
What are the different types of evaluation?
PROCESS EVALUATION = assessing the process of a programme’s implementation (mainly qualitative)
IMPACT EVALUATION = assessing the immediate effects of the intervention (easiest)
OUTCOME EVALUATION = measures what is achieved in the longterm
note: timing of evaluation can influence the outcome
- delay = some interventions might take a long time to have an effect
- decay = some interventions wear off rapidly
What are some of the difficulties with evaluation?
Demonstrating an attributable effect is difficult:
- design of intervention
- possible lag time to effect
- initial effects might wear off (decay)
- many potential intervening/concurrent/confounding factors
- high cost of evaluation research (large scale & longterm)
What are determinants of health?
Range of factors that have a powerful & cumulative effect on the health of populations, communities, and individuals
Includes the physical environment, social & economic environment, individual genetics, characteristics & behaviours
WHO: “context of people’s lives determine their health…individuals are unlikely to be able to directly control many of the determinants of health”
What is the fallacy of empowerment?
Giving people information will not be enough to change their behaviour
Health-damaging behaviours are rarely solely due to ignorance
e.g. everyone knows smoking is bad for your health, but knowing this is not enough to prevent starting smoking/stop smoking
What is the prevention paradox?
Interventions that work at a population level may not have much effect on an individual
