Promoting Health & Preventing Illness Flashcards
What is the definition of health prevention?
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
What is the definition of health promotion?
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
What are the 3 types of disease prevention?
- Primary
- Secondary
- Tertiary
What is primary prevention?
Pre-disease stage aiming to:
- avoid a disease starting in the first place
What are examples of primary prevention?
Immunisation
Health education in schools
What is the service context of primary prevention?
Public health
General practice
What is secondary prevention?
Latent or early stage of disease aiming to:
- Detect disease early
- Treat early to halt/slow progression
What are examples of secondary prevention?
Screening/case detection
Brief interventions
Adequate treatment
What is the service context of secondary prevention?
General practice
Hospitals
What is tertiary prevention?
Symptomatic disease stage (irreversible disease or disability) aiming to limit damage to:
- Reduce progress/severity
- Maximise quality of life
What are examples of tertiary prevention?
Rehabilitation programmes
Pain management
What is the service context of tertiary prevention?
Rehabilitation + palliative services
Hospitals
Who can you target for primary + secondary prevention?
Individuals at high-risk of disease
Whole population
What is the high-risk strategy of prevention?
Aims to bring preventive care to individuals at high risk - requires detection of high risk individuals
What is the population strategy of prevention?
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
What are the strengths + weaknesses of the high risk prevention strategy?
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
What are the strengths + weaknesses of the population prevention strategy?
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
What is Rose’s Prevention Paradox?
A preventive measure that brings large benefits to the community offers little to each participating individual
What are the action areas of the Ottawa Charter?
Build healthy public policy Create supportive environments Reinforce community actions Develop personal skills Reorient health services from treatment to prevention
What do models of entity of health promotion aim to do?
Map field of health promotion via a range of methods
Make explicit our aims + choice of strategies
Help select the most effective/acceptable strategies
Name 2 models of entity of health promotion.
- Ewles + Simnett (5 approaches)
2. Beattie (4 quadrants)
What is the Ewles & Simnett’s approach to health promotion?
- Medical: screening + immunisation
- Behaviour change: encourages healthier behaviours
- Educational: provide information + informed choice
- Client centered: health issues identified by client/community
- Societal change: change physical, social + economic environment (policy, legislation)
What is the Beattie model of health promotion?
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
What 4 types of health promotion can come from Beattie’s model?
- Health persuasion (conservative ideology): behaviour change, education/advice + mass media/social marketing
- Legislative action (reformist ideology): legislation, policy making/implementation + health surveillance
- Personal counselling (libertarian ideology): counselling + empowering individuals to make changes
- Community development (radical pluralist ideology): lobbying, community development, action research + skills sharing
How can the Ewles & Simnett’s approach be applied to smoking?
- Medical: ask if they smoke, detect early smoking-related disease + provide NRT
- Behaviour change: smoking cessation programme
- Educational: adverts on packs + teaching in schools
- Client centred: choice of type of NRT
- Societal change: smoking bands + tax
How can Beattie’s model be applied to smoking?
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
What do you need to consider for health interventions?
Range of methods
Targets
Research evidence(effectiveness + cost-effectiveness)
Impact on health inequalities
Why should tackling health inequalities be a concern of doctors?
- 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
What are the key themes win the government health policy?
- Help people live longer, healthier + more fulfilling lives
- Improve health of the poorest, fastest
What is the aim in terms of health inequalities?
To yield a more equal distribution of health across population groups
What reports from major independent inquiries have published recommendations for health inequality?
The Marmot Review
WHO Commission on Social Determinants of Health
What is the conclusion of major reports regarding health inequality?
Major determinants of health inequalities are:
Structural determinants + conditions of daily life
So tackling health inequalities require tackling the determinants of social inequality
How do social determinants affect health?
Social + economic circumstances can affect health directly or indirectly
Can be the causes of the causes
What does the Marmot Review mainly focus on?
Children + families over the lifecourse as this affects next generation
What does the Marmot Review recommend for health inequalities?
- Reduce social gradient (progressive universalism)
- Action across all social determinants
- Action across all sectors
- Participatory decision making at local level
What is progressive/proportionate universalism?
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
What do you need for progressive/proportionate universalism to work?
Absolute improvement for all groups but a rate of improvement which increases at each step downwards on the socio-economic ladder
What would be the aim if you tackle social disadvantage?
Aims to improve health of worst off only
Why is tackling social disadvantage not a recommended strategy for health inequality?
Strong moral arguments for it but not a population wide strategy so wont tackle social gradient in health
How can we tackle the upstream factors of health inequality?
Tackle wider influences on health through public policy approaches
How can we table the downstream factors of health inequality?
Tackle health behaviours of individual, lifestyles e.g. smoking, diet + access to care
Why do you need to tackle both upstream and downstream factors of health inequality?
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)
What upstream interventions have been shown to reduce health inequality?
- 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
What effect has water fluoridation had on the population’s health?
Reduces dental caries in 5 year olds in materially deprived areas more than in affluent areas - reduces inequalities in dental health
What interventions can increase health inequality?
- Down-stream
- Mass media campaigns on stop smoking + folic acid
- Work place smoking bans
What upstream policy initiatives have been put in place to tackle health inequality in the UK?
- Reduce poverty
- Improve educational outcomes for young people
- Regenerate local areas
- Reduce unemployment
What downstream policy initiatives have been put in place to tackle health inequality in the UK?
- 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
Are health inequalities reducing?
Continue to exist
No significant reduction in inequality in mortality between most + least deprived groups
How can health professionals contribute to reducing health inequality?
- 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
What knowledge and skills as a health care professional can help you reduce health inequality?
Knowledge of social determinants
Practice-based skills: taking a social history, referring patient to non-medical service + placements in disadvantaged areas
What different levels can doctors promote action on social determinants of health?
Personal
Community
National
Global
What can we do as clinicians to reduce health inequality?
Ensure access to high quality health care for vulnerable groups + refer to support services (e.g. housing, debt advice+ data on inequality attributable admissions)
What can we do as advocates to reduce health inequality?
Development of services/programmes for better health outcomes
What can we do as managers and clinical leads to reduce health inequality?
Model employer
What can we do as educators to reduce health inequality?
Provide placements in disadvantaged areas, investigate social determinants + local projects
