Lecture 5- Improving health at the population level

Question 1

3 domains of public health

Answer 1

health protection

health improvement

healthcare public health

Question 2

What is health improvement?

Answer 2

Health improvement can mean different things to different people

• “Lifestyle medicine”
• “Social prescribing”
• “Health prevention”
• “Health education”
• “Health promotion”
• “Population health medicine”

About physical, mental and emotional wellbeing

Question 3

Cycle of public health

Answer 3

Takes a long time to see economical benefit

Question 4

2 ways to improve health

Answer 4

1. Whole population approach -shift whole populations health to the right
2. Improve health of high risk individuals to reduce their risk

Question 5

health is multifactorial

Answer 5

think of the determinants of health

Question 6

5 levels of intervention (health promotion)

Answer 6

poppy can see her reflection

• personal skills
• community action
• supportive environments
• healthy public policy
• reorient health services

Question 7

health needs assessment

Answer 7

Question 8

logic model with example

Answer 8

A logic model is a graphic which represents the theory of how an intervention produces its outcomes. It represents, in a simplified way, a hypothesis or ‘theory of change’ about how an intervention works. Process evaluations test and refine the hypothesis or ‘theory of change’ of the int

Question 9

Gibbs cycle of behaviour change (Prochaska and Diclemente’s)

Answer 9

Question 10

intevrentions can be expert or community driven

Answer 10

Question 11

Types of prevention ( a form of health improvement)

Answer 11

primordial

primary

secondary

tertiary

Question 12

primordial

Answer 12

targets the general population

aim to eliminate risk factors

e.g. health promotion and immunisation

Question 13

primary prevention

Answer 13

susceptible population

aimt o reduce the risk of developing the disease

e.g. screening, immunisation, more health promotion

Question 14

secondary prevention

Answer 14

asymptomatic populations

try to slow down disease progression

e.g. screening/start treatment

Question 15

tertiary prevention

Answer 15

symptomatic population

aim to try and minimise the consequences of the disease/treat the patient

e.g. treatments

Question 16

screening

Answer 16

secondary prevention

Question 17

issues with screening

Answer 17

lead time bias

length time bias

volunteer bias

Question 18

Lead time bias

Answer 18

Lead time is the length of time between the detection of a disease and its usual clinical presentation and diagnosis. It is the time between early diagnosis with screening and the time in which diagnosis would have been made without screening

Lead time bias refers to the phenomenon where early diagnosis of a disease falsely makes it look like people are surviving longer

Question 19

Length time bias

Answer 19

Length time bias is an overestimation of survival duration due to the relative excess of cases detected that are asymptomatically slowly progressing, while fast progressing cases are detected after giving symptoms.

Question 20

lead time vs length time bias

Answer 20

Lead-time bias: Overestimation of survival duration due to earlier detection by screening than clinical presentation.

Length-time bias: Overestimation of survival duration due to the relative excess of cases detected that are slowly progressing.

• Imagine all 12 cases below are the same disease. Instead of being seen as rapidly progressive 50% of the time, rapidly progressive disease is only detected in 33% of positive screens.

Question 21

Volunteer bias

Answer 21

Those who sign up to screening are more likely to be concerned about their health and live healthier lifestyles

Question 22

Risk assessment questions for patients to help give lifestyle changes to become healthier

Answer 22

Lifestyle:

• Alcohol
• Smoking
• Exercise levels
• Diet

Relevant Past Medical History

• Diabetes
• CVD
• CKD
• AF
• Rheumatoid arthritis

Family History

• CVD
• Diabetes

FURTHER ASSESSMENT

• Weight and height (calculate BMI)
• Blood tests?
  
  • Lipids
  • HbA1c
  • U&E
  • LFTs

Question 23

What is social prescribing?

Answer 23

“a means of enabling health professionals to refer people to a range of local, non- clinical services”

Question 24

How a referral of social prescribing works

Answer 24

• 30 minute appointment with a Link Worker.
• Person-centred consultation
• Not “what’s the matter with you”, but “what matters to you”?
• Link worker has access to directory of local voluntary services and organisations

Question 25

social prescribing can provide

Answer 25

Can provide

• Social interaction
• Increase exercise
• Life given meaning
• Structure to a week
• Feeling part of a community

Question 26

Can use a risk of CVS disease to help put things into perspective

Answer 26

QRISK

NOT AN URGENT DECISION!

• Bob will be back!
• Give the information in a way the patient can understand (decision aids)
• Give him some time to think
• Pros and cons of any intervention
• How much is Bob willing to do to help himself?
• How can you facilitate that?