Lecture 5- Improving health at the population level Flashcards
3 domains of public health
health protection
health improvement
healthcare public health
What is health improvement?
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
Cycle of public health
Takes a long time to see economical benefit
2 ways to improve health
- Whole population approach -shift whole populations health to the right
- Improve health of high risk individuals to reduce their risk
health is multifactorial
think of the determinants of health
5 levels of intervention (health promotion)
poppy can see her reflection
- personal skills
- community action
- supportive environments
- healthy public policy
- reorient health services
health needs assessment
logic model with example
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
Gibbs cycle of behaviour change (Prochaska and Diclemente’s)
intevrentions can be expert or community driven
Types of prevention ( a form of health improvement)
primordial
primary
secondary
tertiary
primordial
targets the general population
aim to eliminate risk factors
e.g. health promotion and immunisation
primary prevention
susceptible population
aimt o reduce the risk of developing the disease
e.g. screening, immunisation, more health promotion
secondary prevention
asymptomatic populations
try to slow down disease progression
e.g. screening/start treatment
tertiary prevention
symptomatic population
aim to try and minimise the consequences of the disease/treat the patient
e.g. treatments
screening
secondary prevention
issues with screening
lead time bias
length time bias
volunteer bias
Lead time bias
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
Length time bias
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.
lead time vs length time bias
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.
Volunteer bias
Those who sign up to screening are more likely to be concerned about their health and live healthier lifestyles
Risk assessment questions for patients to help give lifestyle changes to become healthier
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
What is social prescribing?
“a means of enabling health professionals to refer people to a range of local, non- clinical services”
How a referral of social prescribing works
- 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
social prescribing can provide
Can provide
- Social interaction
- Increase exercise
- Life given meaning
- Structure to a week
- Feeling part of a community
Can use a risk of CVS disease to help put things into perspective
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?
