Lecture 22: Prevention, Promotion, Protection Flashcards
How does epidemiology play an important role in preventing disease?
It unravels the causal pathway
It directs preventative action
It evaluates the effectiveness of the intervention
Why is disease prevention needed?
Because of the growing limitations in curing disease and the escalating costs of medical care
What are three population health actions?
- Health promotion
- Disease prevention
- Health protection
What are the two types of strategies that all population health actions can divide into?
- Population based (mass) strategy
2. High risk individual strategy
What is the focus of population based (mass) strategy?
The whole population
What are the aims of population based (mass) strategy?
To reduce health risks/improve the outcome of all individuals in a population
What is population based (mass) strategy useful for?
A common disease or widespread cause
What are examples of population based (mass) strategy?
Immunisation programmes
Seatbelt legislation
Fluoridation
Low-salt foods in supermarkets
Who are the focus of high risk individual strategy?
Individuals perceived to be at high risk
What is the purpose of the high risk individual strategy?
To move these individuals towards the rest of the population
What are high risk individual strategy interventions like?
Well matched to individuals and their concerns
What are examples of high risk individual strategies?
Interventions targeting obese adults, intravenous drug users, those with systolic bp >160mmHg
What’s a specific NZ example of a high risk individual strategy?
The Needle exchange programme, introduced to reduce risk of HIV among drug users- involved decriminalisation of sale of needle/syringes, provided buyers involved in needle swap. Extremely effective
3 advantages of population (mass) strategy?
- Radical, addresses underlying cause
- Large potential benefit for whole population
- Behaviourally appropriate (eg no smoking on airplanes)
3 disadvantages of population (mass) strategy
- Small benefit to individuals (eg legislation use of seat belts)
- Whole population is exposed to downside of strategy (less favourable benefit to risk ratio)
- Poor motivation of individuals
4 advantages of high risk individual strategy?
- Appropriate to individuals
- Individual motivation
- Cost effective use of resources
- Favourable benefit to risk ratio
4 disadvantages of high risk individual strategy?
- Cost of screening to identify group
- Temporary effect (eg annual breast screening)
- Limited potential (ie Down syndrome baby screening)
- Behaviourally inappropriate (cultural norms)
4 key concepts of health promotion?
- Acts on determinants of wellbeing
- Health/wellbeing focus
- Enables/empowers people to increase control over, and improve, their health
- Involves whole population in every day contexts
Examples of health promotion?
5+aday
Push play
Define tertiary care?
Hospital based care, rehabilitation
Define secondary care?
Specialist care eg dermatologist
Define primary care?
First point of contact, ie the GP, physio, pharmacist - community based
What was the declaration for primary health care, established at the international co defence on primary health care in Kazakhstan, called?
Alma Ata 1978
What were the aims of the Alma Ata?
- Protect and promote health of all
2. Advocate a health promotion approach to primary care
What were the 7 Alma Ata prerequisites for health?
- Peace and safety from violence
- Shelter
- Education
- Food
- Income and economic support
- Stable ecosystem and sustainable resources
- Social justice
What campaign began at the first international conference on health promotion in 1986?
The Ottawa Charter for health promotion (WHO)
What was the Ottawa Charter phrase?
“Mobilise action for community development”
What does the Ottawa charter acknowledge?
- That health is a fundamental right for everybody
- Health requires individual and collective responsibility
- The opportunity to have good health should be equally available
- Good health is an essential element of social and economic development
What are the three basic strategies of the Ottawa Charter?
- Enable
- Advocate
- Mediate
Define Enable
Individual level strategy
“To provide opportunities to all individuals to make healthy choices through access to info, life skills and supportive environments
Define advocate
System level strategy
“To create favourable political, economic, social, cultural and physical enviro ones by advocating health
Define mediate
Individual and system strategy
“To facilitate individuals/groups with opposing interests to work together/come to compromise to promote health
What are 5 Ottawa Charter priority action areas?
- Develop personal skills
- Strengthen community action
- Create supportive environments
- Reorient health services towards primary health care
- Build healthy public policy
What’s an example of develop personal skills? (Ie individual empowerment)?
Life skills education in schools
ICT for health
Awareness campaigns
Example of strengthen community action (community empowerment)?
Self help groups
Community organised services (eg for HIV sufferers)
Community initiatives to promote healthy schools, healthy cities, youth health projects
Examples of creating supportive environments?
Implementing air control measures, water and sanitation programmes, building speed bumps, requirement of work place safety measures
Examples of reorient health services towards primary health care?
Care responsive to needs of patient and families, health education services, amenities to enhance hospital experience
Example of build healthy public policy?
Taxation on alcohol and cigarettes Mandatory seatbelt use Banning smoking in public places Food and drug control Mandatory school sport
What is disease prevention?
It’s disease focused
Looks at a particular disease (or injury) and ways of preventing them (ie the incidence, prevalence, risk factors or impacts)
What is primary disease prevention?
Limiting the incidence of disease by controlling specific cause and risk factors ie acts before biological onset
What is an example of primary disease prevention?
Vaccination
Seatbelt legislation
What is secondary disease prevention?
To reduce the risk of the more serious co sequences of disease, before clinical diagnosis, after biological onset
Example of secondary disease prevention?
Screening people 65+ for hip fractures
Rescue services for preventing drowning
What is tertiary disease prevention?
To reduce the progress of complications of an established disease (before outcome ie recovery, death, disability)
Examples if tertiary disease prevention?
Counselling services for PTSD
Rehab service for stroke patients
Does high uptake of vaccine maybe provide here immunity to the general population?
Yes
What is the focus of health protection?
Environmental hazards
What are the four key actions of health protection?
- Risk/hazard assessment (ie environmental Epi, safe air, water, bio security)
- Monitoring (biomarkers of exposure to hazardous substances ie red flags on beach)
- Risk communication (ie relaying environmental risks to public)
- Occupational health (safety regulations on work sites)
