Health Promotion

Question 1

What is health promotion?

Answer 1

Enabling people to increase control over and to improve their health

Question 2

What are Ottawa Charter’s 3 basic strategies?

Answer 2

• Advocating for health- to create essential conditions for health
• Enabling people to achieve their full health potential
• Mediating between the different interests in society, in pursuit of health

Question 3

What are the four health promotion disciplines?

Answer 3

1. Fiscal- making healthy things cheaper (as a proportion of income) and less healthy things more expensive
2. Legislate- making participation is some unhealthy or risk activities illegal
3. Service provision- how the routine activities of services can modify risk exposure (not just health services)
4. Education- increasing consciousness, awareness and knowledge

Question 4

What is the strategy currently in favour for health promotion , without impinging freedom?

Answer 4

Nudge- libertarian paternalism: Guiding choice by architecture, rather than coercion (tax, law, other)

Question 5

What are micro and macro changes?

Answer 5

Micro: Individual level. E.g. debates prevention trials (v.successful), smoking cessation (good and cost effective at individual level, limited effects at population level)

Macro: Subsidies/taxes ro effect behaviour change. Not likely to be popular

Question 6

What makes a difference to population health?

Answer 6

Method 6: Randomised control trial:

• Pros: Strongest evidence for causality, selection bias and confounding removed (if randomised), less observer bias (if blinded)
• Cons: Not real life, high cost, inappropriate/unethical for many research questions

Clinical trial is gold standard- tests how well an intervention works

Question 7

Define:

• Error
• Bias
• Diagnostic bias
• Self-selection bias
• Information bias

Answer 7

• Error: difference between estimated/measured value and true value
• Bias: Systematic, non-random deviation of results and interference from the truth, or processes leading to such a deviation
• Diagnostic Bias: when diagnosis is made based on exposure
• Self selection Bias: Participants contact study (through advert, word of mouth). More likely to participate due to family history. Healthy worker effect- workers self selecting as more likely to be healthier
• Information Bias: Recall Bias, Interviewer Bias or Surrogate Bias. All types lead to misclassification bias. When data is placed into categories (discrete variables) THE IGNORED SHOULD BE SAMPLED

Question 8

Childhood obesity: What four things are measured?

Answer 8

BMI, skinfold thickness, waist circumference, bio-impedence

Question 9

What is the national child measurement programme?

Answer 9

Record height and weight of over 1 million children eath year in the 4-5 age bracket and 10-11 age bracket. Reception (4-5yo)- 9.5% obese. Year 6 (10-11yo)- 19.2% obese

Question 10

What is the national obesity observatory?

Answer 10

Single point of contact for wide ranging authoritative information on data, evaluation and evidence related to weight status and its determinants

Question 11

What does obesity prevalence have a strong positive correlation with?

Answer 11

Deprivation

Question 12

Foresight report (2007) found that…

Answer 12

Obesogenic environment, obesity is a normal response to an abnormal environment, its locked into lifestyles. Food away from home has increased in proportion of daily energy, fat and sugar. Paternal obesity is the most consistent risk factor for childhood obesity

Question 13

Well being of the population: what is psychological well being?

Answer 13

As well as good feelings and happiness, people need:

• Sense of individual vitality
• To undertake activities which are meaningful, engaging and which make them feel competent and autonomous
• A stock of inner resources to help them cope when things go wrong and be resilient to changes beyond their immediate control
• It is also crucial that people feel a sense of relatedness to other people

Question 14

What are some measures of wellbeing?

What does GDP measure?

Answer 14

• Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS)- extensively validated
• ONS measures of subjective wellbeing- some validation
• Social Trust Question (generally would you say that most people can’t be trusted?)

GDP measures everything in short- except that which makes life worthwhile (wellbeing)

Question 15

Vaccination: What is herd immunity?

Answer 15

All members of the population (herd) are protected by (immunity) the proportion already immune. Provides indirect protection of unvaccinated/susceptible as well as the vaccinated individuals. Means the infection will be unable to invade a population, so reduction in probability of an epidemic and the infection itself may be eradicated.

Question 16

What does uptake of vaccine depend on?

Answer 16

Depends on public consent:

Factors redcuing vaccine uptake include:

• The paradox of parental concern- parental concern of the risk of vaccines can dwarf the original concern about the risk of disease
• Health services and general insufficiencies within them

Question 17

Qualitative approaches to research: What does qualitative research allow and enable?

Answer 17

Enables researcher to gain an understanding of the target population’s behaviours, attitudes, experiences- why and how

Enables understanding of patient choices

Enables exploration of factors affecting patient choices

Reaches parts of a subject matter that other methods cannot reach- research topic that us concerned with interaction or process, complex, non quantifiable or sensitive

Question 18

What is an example of qualitative research?

Answer 18

Prenatal testing:

• Screening tests- non invasive. Identifies higher risk populations. In 1st and 2nd trimester. Biochem and/or ultrasound)
• Diagnostic tests- invasive. Used for higher risk populations. Risk of miscarriage

Allows parents to make informed decisions concerning their pregnancy outcome

Question 19

Cultural competence in healthcare- what is it?

Answer 19

Describes ability of a system to provide care to meet patients with diverse values, beliefs and behaviours needs. Includes patients social, cultural and linguistic needs

Question 20

What is institutional racism?

Answer 20

Collective failure of an organisation to provide s proper service to people due to their colour, culture or ethnic origin. Normally through unwitting pressure, ignorance, thoughtlessness and stereotyping which disadvantages minority groups

Question 21

What are some causes of ethnic health inequalities?

Answer 21

Long term impact of migration, differences in culture and lifestyles, biological susceptibility, poor delivery and take up of healthcare, racism and discrimination

Question 22

What is the difference between a stereotype and a generalisation?

Answer 22

A stereotype is an ending point. It is assumptions about behaviour. It has a negative impact

A generalisation is a beginning point. It requires further information from the individual. It has a positive impact.

Question 23

What is NICE?

Answer 23

An idependent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. Standardize quality of care across the NHS.

Question 24

What do NICE make guidelines on?

Answer 24

Evidence based medicine. Review of RCTs, randomized controlled trials, cohort studies, case control studies, case series and expert opinion.

Helps to prevent the postcode lottery of patient care.

Question 25

NICE: What is the citizens council?

Answer 25

Independent body of 30 people (not within NICE) who reflect the social makeup of the population in England and Wales. They consider the societal and ethical issues e.g. should NICE take age into account when determining recommendations? Should the NHS pay premium prices for drugs for people with very rare diseases?

Question 26

NICE: What three things is the central funding broken down into?

Answer 26

Treasury: Public expenditure survey (health, education, transport etc.)
Geographic allocation: principle for equal allocation for equal need
Capitation allocation: Adjusted for additional health need and unavoidable variation in costs of providing healthcare

Question 27

NICE: What is the QALY concept?

Answer 27

Quality-adjusted life years. A graph showing lengh of life in years against health related quality of life, comparing treatment to no treatment. The area between the two lines represents to number of QALY. The lines may cross, due to early negative side effects of medication for example.

Question 28

What are patient access schemes?

Answer 28

Mechanism to share the cost of new drugs between the NHS and the company- to make the drug more available. NICE has no role in negotiations