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Block 2 > Promoting Health & Preventing Illness > Flashcards

Promoting Health & Preventing Illness Flashcards

1
Q

What is the definition of health prevention?

A

Actions aimed at eradicating, eliminating or minimising the impact of disease + disability, or if none of these is feasible, retarding the progress of disease + disability

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2
Q

What is the definition of health promotion?

A

The process of enabling people to increase control over their health + its determinants thereby improve their health

OR

Offers a positive + inclusive concept of health as a determinant of the quality of life + encompassing mental + spiritual well-being

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3
Q

What are the 3 types of disease prevention?

A
  1. Primary
  2. Secondary
  3. Tertiary
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4
Q

What is primary prevention?

A

Pre-disease stage aiming to:

- avoid a disease starting in the first place

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5
Q

What are examples of primary prevention?

A

Immunisation

Health education in schools

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6
Q

What is the service context of primary prevention?

A

Public health

General practice

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7
Q

What is secondary prevention?

A

Latent or early stage of disease aiming to:

  • Detect disease early
  • Treat early to halt/slow progression
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8
Q

What are examples of secondary prevention?

A

Screening/case detection
Brief interventions
Adequate treatment

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9
Q

What is the service context of secondary prevention?

A

General practice

Hospitals

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10
Q

What is tertiary prevention?

A

Symptomatic disease stage (irreversible disease or disability) aiming to limit damage to:

  • Reduce progress/severity
  • Maximise quality of life
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11
Q

What are examples of tertiary prevention?

A

Rehabilitation programmes

Pain management

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12
Q

What is the service context of tertiary prevention?

A

Rehabilitation + palliative services

Hospitals

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13
Q

Who can you target for primary + secondary prevention?

A

Individuals at high-risk of disease

Whole population

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14
Q

What is the high-risk strategy of prevention?

A

Aims to bring preventive care to individuals at high risk - requires detection of high risk individuals

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15
Q

What is the population strategy of prevention?

A

Directed at whole population irrespective of individual risk levels

Directed towards socio-economic, behavioural + lifestyle changes

-> small reduction in average BP or cholesterol of population would produce large reduction in CVD incidence

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16
Q

What are the strengths + weaknesses of the high risk prevention strategy?

A

S: extension of clinical approach:

  • High patient motivation
  • High doctor motivation

W: high resources on identifying high risk, medicalise prevention, stigmatise individuals + does not produce lasting change at population level

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17
Q

What are the strengths + weaknesses of the population prevention strategy?

A

S: benefit for population as whole, attempts to control root causes/determinants of disease, shifts cultural norms, can work passively + more permanent

W: benefit is small for each individual + low subject motivation

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18
Q

What is Rose’s Prevention Paradox?

A

A preventive measure that brings large benefits to the community offers little to each participating individual

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19
Q

What are the action areas of the Ottawa Charter?

A 
Build healthy public policy
Create supportive environments
Reinforce community actions
Develop personal skills
Reorient health services from treatment to prevention
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20
Q

What do models of entity of health promotion aim to do?

A

Map field of health promotion via a range of methods

Make explicit our aims + choice of strategies

Help select the most effective/acceptable strategies

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21
Q

Name 2 models of entity of health promotion.

A
  1. Ewles + Simnett (5 approaches)

2. Beattie (4 quadrants)

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22
Q

What is the Ewles & Simnett’s approach to health promotion?

A
  1. Medical: screening + immunisation
  2. Behaviour change: encourages healthier behaviours
  3. Educational: provide information + informed choice
  4. Client centered: health issues identified by client/community
  5. Societal change: change physical, social + economic environment (policy, legislation)
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23
Q

What is the Beattie model of health promotion?

A

Devised from 2 bipolar axis:

  • Mode of intervention: authoritative (top down i.e. government) -> negotiated (bottom up i.e. community)
  • Focus of intervention: individual -> collective
24
Q

What 4 types of health promotion can come from Beattie’s model?

A
  1. Health persuasion (conservative ideology): behaviour change, education/advice + mass media/social marketing
  2. Legislative action (reformist ideology): legislation, policy making/implementation + health surveillance
  3. Personal counselling (libertarian ideology): counselling + empowering individuals to make changes
  4. Community development (radical pluralist ideology): lobbying, community development, action research + skills sharing
25
Q

How can the Ewles & Simnett’s approach be applied to smoking?

A
  1. Medical: ask if they smoke, detect early smoking-related disease + provide NRT
  2. Behaviour change: smoking cessation programme
  3. Educational: adverts on packs + teaching in schools
  4. Client centred: choice of type of NRT
  5. Societal change: smoking bands + tax
26
Q

How can Beattie’s model be applied to smoking?

A

Health persuasion: NHS smoking cessation services

Legislative action: tobacco tax, ban on tobacco advertising + sports sponsorship + no smoking policies

Personal counselling: NHS health trainers/lifestyle coaches

Community development: community led action on smoking

27
Q

What do you need to consider for health interventions?

A

Range of methods
Targets
Research evidence(effectiveness + cost-effectiveness)
Impact on health inequalities

28
Q

Why should tackling health inequalities be a concern of doctors?

A
  • Profound effect on people’s lives
  • Health is a human right; systematic differences are unfair
  • Reduce costs associated with premature deaths + illness
  • Good medical practice makes a difference
  • Key theme in government health policy
29
Q

What are the key themes win the government health policy?

A
  • Help people live longer, healthier + more fulfilling lives

- Improve health of the poorest, fastest

30
Q

What is the aim in terms of health inequalities?

A

To yield a more equal distribution of health across population groups

31
Q

What reports from major independent inquiries have published recommendations for health inequality?

A

The Marmot Review

WHO Commission on Social Determinants of Health

32
Q

What is the conclusion of major reports regarding health inequality?

A

Major determinants of health inequalities are:

Structural determinants + conditions of daily life

So tackling health inequalities require tackling the determinants of social inequality

33
Q

How do social determinants affect health?

A

Social + economic circumstances can affect health directly or indirectly

Can be the causes of the causes

34
Q

What does the Marmot Review mainly focus on?

A

Children + families over the lifecourse as this affects next generation

35
Q

What does the Marmot Review recommend for health inequalities?

A
  • Reduce social gradient (progressive universalism)
  • Action across all social determinants
  • Action across all sectors
  • Participatory decision making at local level
36
Q

What is progressive/proportionate universalism?

A

Population wide approach aiming for a more equal distribution of health chances across socio-economic groups i.e. reducing social gradient by improving health of these groups

Provides resources + services at a progressively greater level as needs increase

37
Q

What do you need for progressive/proportionate universalism to work?

A

Absolute improvement for all groups but a rate of improvement which increases at each step downwards on the socio-economic ladder

38
Q

What would be the aim if you tackle social disadvantage?

A

Aims to improve health of worst off only

39
Q

Why is tackling social disadvantage not a recommended strategy for health inequality?

A

Strong moral arguments for it but not a population wide strategy so wont tackle social gradient in health

40
Q

How can we tackle the upstream factors of health inequality?

A

Tackle wider influences on health through public policy approaches

41
Q

How can we table the downstream factors of health inequality?

A

Tackle health behaviours of individual, lifestyles e.g. smoking, diet + access to care

42
Q

Why do you need to tackle both upstream and downstream factors of health inequality?

A

Tackling downstream factors alone would not prevent patient from starting the unhealthy health behaviours in the first place so need to address factors upstream to stop patients falling into these behaviours (fast flowing river analogy)

43
Q

What upstream interventions have been shown to reduce health inequality?

A
  • Workplace interventions e.g. increase employee control over work environment
  • House interventions e.g. improve standard of housing + more choice for low income families
  • Water fluoridation
  • Free folic acid supplements
  • Tobacco price increase
  • Improve educational level for young people
  • High quality parenting programmes + smoothing transition from home to school
  • Incentivised prescribing e.g. preventive medication for IHD
44
Q

What effect has water fluoridation had on the population’s health?

A

Reduces dental caries in 5 year olds in materially deprived areas more than in affluent areas - reduces inequalities in dental health

45
Q

What interventions can increase health inequality?

A
  • Down-stream
  • Mass media campaigns on stop smoking + folic acid
  • Work place smoking bans
46
Q

What upstream policy initiatives have been put in place to tackle health inequality in the UK?

A
  • Reduce poverty
  • Improve educational outcomes for young people
  • Regenerate local areas
  • Reduce unemployment
47
Q

What downstream policy initiatives have been put in place to tackle health inequality in the UK?

A
  • NHS: tackle infant mortality + reduce teen pregnancy
  • Children’s centres: increase parenting skills + access to early education
  • Influencing lives people lead by tackling unhealthy/risky behaviour e.g. smoking, obesity + sexual health
  • Tackling inequalities in access to care
48
Q

Are health inequalities reducing?

A

Continue to exist

No significant reduction in inequality in mortality between most + least deprived groups

49
Q

How can health professionals contribute to reducing health inequality?

A
  • Knowledge + skills
  • Working with individuals + communities
  • Tackling health inequalities among NHS staff
  • Working in partnership with other agencies
  • Working as advocates for individuals, communities + general population
50
Q

What knowledge and skills as a health care professional can help you reduce health inequality?

A

Knowledge of social determinants

Practice-based skills: taking a social history, referring patient to non-medical service + placements in disadvantaged areas

51
Q

What different levels can doctors promote action on social determinants of health?

A

Personal
Community
National
Global

52
Q

What can we do as clinicians to reduce health inequality?

A

Ensure access to high quality health care for vulnerable groups + refer to support services (e.g. housing, debt advice+ data on inequality attributable admissions)

53
Q

What can we do as advocates to reduce health inequality?

A

Development of services/programmes for better health outcomes

54
Q

What can we do as managers and clinical leads to reduce health inequality?

A

Model employer

55
Q

What can we do as educators to reduce health inequality?

A

Provide placements in disadvantaged areas, investigate social determinants + local projects

Block 2 (45 decks)

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