Health Promotion Flashcards
What are determinants of health?
A range of factors that have a powerful and cumulative effect on the heatlh of populations, communitiies, and individuals
What do the determinants of health relate to?
- The physical environment
- The social and economic environment
- Our individual genetics, characteristics, and behaviours
How does WHO define determinants of health?
‘The context of peoples lives determine their heatlh, and so blaming individuals for having poor health, or crediting them for good health, is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health.’
What was the prominent concept of health promotion from 1910-1940?
Pubic health
What was public health from 1910-1940 focused on?
Reform of physical environment to stop communicable disease, e.g. improvements in santitation
What was the prominent concept in health promotion in 1940-1950?
Health education
What was health education from 1940-1950?
Targeted individuals health behaviour;
- Family planning
- Immunisation
- Alcohol
- STDs
How does health promotion differ from health education?
It is a broad approach, including political and social factors
Who has recognised health promotion as an important issue globally?
WHO
What did the Decleration of Alma Ata say regarding health?
Health was a fundamental right, and inequalities in heatlh are unacceptable
What did the Decleration of Alma Ata say that improvements in health require?
Involvement of other sectors, e.g. education, agriculture, industry
What did the Decleration of Alma Ata outline?
Global strategy called ‘Health for All’ by 2000
How is health promotion defined?
The process of enabling people to increase control over and 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, but goes beyond health lifestyles to well-being
What are the principles of health promotion?
- Empowering
- Participatory
- Holistic
- Intersectoral
- Equitable
- Sustainable
- Multi-strategy
What is meant by empowering in health promotion?
Enabling individuals and communities to assume more power over the determinants of heatlh
What is meant by participatory in health promotion?
Involving all concerned at all stages of the process
What is meant by holistic in health promotion?
Fostering physical, mental, social, and spiritual heatlh
What is meant by intersectoral in health promotion?
Involving the collaboration of agencies from relevant sectors
What is meant by equitable in health promotion?
Guided by a concen for equity and social justice
What is meant by sustainable in health promotion?
Bringing about changes that individuals and communities can maintain once funding has ended
What is meant by multi-strategy in health promotion?
Uses a variety of approaches, including;
- Policy development
- Organsiational change
- Community development
- Legislation
Both top-down and bottom-up strategies
What is the difference between health promotion and pubic health?
Pubic health has tended to place more emphasis on goals, and is more population focused. Pubic health = Health Promotion + Health protection
Health promotion has placed more value on means of achieving the goals. Health promotion = health education x health public policy
What is the purpose of Public Health England (PHE)?
To protect and improve the nation’s health and wellbeing, and reduce health inequalities
What does Public Health England bring together?
Previous agencies;
- Health Protection Agency
- Regional Public Health Directorates
- National Screening Committee
- Public Health Observatories
What is the aim of PHE?
- To empower local communities
- Enable professional freedoms
- Unleash new evidence on public health
What are the categories of sociological critiques of public health?
- Structual critiques
- Surveillance critiques
- Consumption critiques
What are the structural critiques of public health?
- Material conditions that give rise to ill health are often marginalised
- Focus on individual responsibility
What is meant by public health focusing on individual responsibility?
Still neglects overriding social, political, and economic environment, and doesn’t take constraints into account
What are the surveillance critiques of public health?
Is it right for the government to be monitoring and regulating the population
What are the consumption critiques of public health?
Lifestyle choice not just seen as health ‘risks’, but also tied up with identity construction
What does health promotion privilege?
Certain wealthy lifestyles
Why does health promotion privilege certain wealthy lifestyles?
Goods and services marketed as improving health widen inequalities
What are the approaches to health promotion?
- Medical or preventative
- Behaviour change
- Educational
- Empowerment
- Social change
What are the levels of prevention?
- Primary prevention
- Secondary prevention
- Tertiary prevention
What does primary preventation aim to do?
Prevent the onset of disease or injury by reducing exposure to risk factors
What are the 4 main approaches to primary prevention?
- Immunisation
- Preventing contact with environmental risk factors
- Taking appropriate precautions regarding communicable diseases
- Reducing risk factors from health related behaviour
How can communicable diseases be prevented in primary prevention?
Campaigns to inform how they are spread, and how to avoid them
How can risk factors from health related behaviours be reduced?
Campaigns to prevent engagement in unhealth behaviours, e.g. smoking, diet, alcohol
What does secondary prevention aim to do?
Treat a disease, or its risk factors, at an early stage, to prevent progression and potential future complications and disabilities from the disease
What does secondary prevention involve?
- Screening
- Monitoring
What does tertiary prevention aim to do?
Minimise the effects of an established disease from an incurable disease once it has been developed to minimise disability and handicap
What does tertiary prevention involve?
- Transplant
- Medication
- Steroids
What are the dilemmas in health promotion?
- Ethics of interfering with peoples lives
- Victim blaming
- Fallacy of empowerment
- Reinforcing negative stereotypes
- Unequal distribution of responsibility
- Interventions that make a different at population level might not have an effect on the individual
What are the ethical implications of interfering with peoples lives in health promotion?
- Potential psychological impact of health promotion
- State interventions on individuals lives - should we respect individuals right to engage in bad behaviour
What is the problem with victim blaming in health promotion?
Focusing on individual behavioural change plays down the impact of wider socioeconomic and environmental determinants of health
Give examples of the socioeconomic and environmental determinants of health
- Housing conditions
- Water and air quality
- Workplace conditions
- High perceived cost of healthy living
What is meant by fallacy of empowerment?
Giving people information does not necessarily give them power
Why might giving people information not given them power?
‘Unhealthy’ lifestyles are not due to ignorance, but due to adverse circumstances and wider socio-economic condition or a group
What is meant by unequal distribution of responsibility in health promotion?
Implementing health behaviours in the family is often left up to the woman
Why might interventions that make a difference at a population level have an effect on the individual?
If people don’t see themselves as a candidate for a disease, they may not take on board the health promotion message
Why is it important that health promoters engage with lay beliefs?
Awareness of anomalies and randomness of a disease will impact on views about candidacy. People may see no change in themselves, and notice anomalies and randomness, so think there is no point.
What is evaluation defined as?
The rigorous and systematic collection of data to assess the effectiveness of a programme in achieving predetermined objectives
Why is evaluation necessary?
Need for evidence based interventions
Why is evaluation need for evidence based interventions?
- Properly conducted evaluation studies can provide necessary evidence
- Accountability
- Ethical obligation
- Programme development and management
What is needed to be able to roll out schemes on a national scale?
Need to be able to assess efficacy and efficiency to use as evidence
How does evaluation help with accountability?
Evidence gives legitimacy to interventions and political support
Why is there an ethical obligation for evaluation?
Imperative to ensure there is no direct or indirect harm
Where could indirect harm in heatlhcare come from?
- Inappropriate use of resourcse
- Alienating certain groups
What are the different types of health promotion evaulation?
- Process
- Impact
- Outcome
What does process evaluation of health promotion focus on?
Assessing the process of programme implementation
What is process evaluation in health promotion also referred to?
Formative or illuminative evaluation
What does process evaluation of health promotion involve?
Wide range of mainly qualitative methods
What does impact evaluation of health promotion assess?
The immediate effects of the intervention
Why does impact evaluation of heatlh promotion tend to be a more popular choice?
It is the easiest to do
What does outcome evaluation of health promotion measure?
More long-term consequences- what is achieved
What can influence the outcome in evaulation of health promotion?
Timing
What is meant by delay in health promotion?
Some interventions take a long time to have an effect
What is meant by decay in health promotion?
Some interventions wear off rapidly
Why is demonstrating an attributable effect by evaulation difficult?
- Design of intervention
- Possible lab time to effect
- Many possible intervening or concurrent confounding factors
- High cost of evaluation research
Why does evaluation research into health promotion have a high cost?
Studies likely to be of a large scale and long term
