Public Health Flashcards
What is public health?
The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society
What is the Nuffield Ladder of Interventions?
Do Nothing or simply monitor the situation
Provide Information: Inform & Educate People
Enable choice: enable people to change their behaviours
Guide choice through changing the default: make healthier choices the default option
Guide choice through incentives: use financial or other
incentives to guide people to pursue certain activities
Guide choice through disincentives: use financial or other disincentives to guide people to not pursue certain activities
Restrict choice: regulate to restrict the options available to people
Eliminate choice: regulate to eliminate options entirely
What are the types of prevention?
Primary Prevention
• Preventing the onset of disease
Secondary Prevention
• Preventing the progression of disease from a
pre-clinical stage
Tertiary Prevention
• Preventing morbidity and mortality through
treatment of clinical disease
Give examples of factors that affect health outcomes?
- Income
- Environment
- Occupation
- Culture
- Societal Status
- Access to education
What are the three domains of public health?
- Health Improvement
- Health Protection
- Healthcare Public Health
What is healthcare public health?
Helping to ensure that the organisation of the wider
NHS estate is fit for purpose and influencing
expenditure…
• Clinical Effectiveness
• Efficiency
• Service Planning
• Audit & Evaluation
What is health protection?
Control of Infectious diseases
Environmental hazards
Chemicals / Radiation
Emergency Response
Give examples of social causes of health damaging behaviour?
Tobacco
o Parental and peer pressure
o Educational attainment
o Quit rates and deprivation
• Diet
o The four ‘A’s: access, availability, affordability,
awareness
• Substance misuse, homelessness & mental health
• Physical activity
o Built environment
o Work place
What is health psychology?
Health psychology emphasises the role of
psychological factors in the cause, progression
and consequences of health and illness
What are health behaviours?
Behaviours related to health There are 3 main categories: ➢ Health Behaviour ➢ Illness Behaviour ➢ Sick role Behaviour
What is health behaviour?
a behaviour aimed to prevent disease (e.g. eating healthily)
What is illness behaviour?
a behaviour aimed to seek remedy (e.g. going to the doctor)
What is sick role behaviour?
any activity aimed at getting well (e.g. taking prescribed medications; resting)
What is health damaging/impairing behaviour?
Health Damaging/Impairing
e.g. smoking , alcohol & substance abuse, risky sexual behaviour,
sun exposure, driving without a seatbelt
What is health promoting behaviour?
e.g. Taking exercise, healthy eating , attending health checks, medication compliance, vaccinations
What are modifiable risk factors?
Risk factors that we can change e.g. Diet/ Excessive weight • Smoking • Alcohol • Physical activity • Sleep, stress…
What are non-modifiable risk factors?
Risk factors that we cannot change e.g.
Sex
• Age
• Genetics/ Family history
What preventative services are delivered by the NHS?
• E.g. screening programmes
• Child health protection
• Immunisation programmes from infancy to
adulthood
What is a population level health intervention?
➢Health promotion
The process of enabling people to exert control over the determinants of health, thereby improving health
What is an individual level health intervention?
➢Patient centred approach
Care responsive to individual needs
What are examples of health promotion activities?
Health promotion campaigns • ‘Everyone enjoys a drink, no one enjoys a drunk.’ • Change 4 Life Campaign • Stoptober, Movember • Promoting screening and immunisations • Cervical smear screening • MMR vaccine
What factors influence an individual’s perception of risk?
- Lack of personal experience with problem
- Belief that preventable by personal action
- Belief that if not happened by now, its not likely to
- Belief that problem infrequent
Other reasons include: Health beliefs • Situational rationality • Culture variability • Socioeconomic factors • Stress • Age • Etc…
What are some models and theories of behavioural change?
- Health belief model (HBM)
- Theory of Planned Behaviour
- Stages of change (transtheoretical) model
- Motivational interviewing (MI)
- Social marketing
- Nudging (choice architecture)
- Financial incentives
- Social norms theory
Top 3 are most important
Explain the health belief model?
Individuals will change if they:
• Believe they are susceptible to the condition in
question (e.g. heart disease)
• Believe that it has serious consequences
• Believe that taking action reduces susceptibility
• Believe that the benefits of taking action outweigh
the costs
Explain the theory of planned behaviour?
Proposes the best predictor of behaviour is ‘intention’
e.g. I intend to give up smoking
• Intention determined by:
• A persons attitude to the behaviour
• The perceived social pressure to undertake the
behaviour, or subjective norm
• A persons appraisal of their ability to perform the
behaviour, or their perceived behavioural control
Attitude – I do not think smoking is a good thing • Subjective Norm – most people who are important to me want me to give up smoking • Perceived Behavioural Control – I believe I have the ability to give up smoking • Behavioural Intention – I intend to give up smoking
What is the stages of change model?
Stage theories see individuals located at discrete ordered stages, rather than on a continuum (this model is key to understanding smoking cessation advice)
• Each stage denotes a greater inclination to change behaviour
• Transtheoretical model, or Stages of change model
(Prochaska & DiClemente, 1984)
• Proposes 5 stages of change: precontemplation,
contemplation, preparation, action, maintenance
What is the biomedical model of health?
Dominant model in Western medicine
Mind/body can be treated separately: mind/body dualism
The body can be repaired: mechanical metaphor
Solutions therefore in technologies: technological imperative
Reductionist: diseases are often caused by a specific identifiable agent
Knowledge presumed to be objective: neutral and distinct from the social context in which it is produced
What is the social model of health?
Based in social constructivism
Medical knowledge is itself a sociological construct
Challenges mind/body dualism: embodied and holistic approach
Health, illness are influenced and shaped by wider socio economic context
Medical knowledge is not objective: we are taught how to ‘see’ the body
What are the problems of theories that dictate health as an ideal state?
Is anyone completely healthy?
What does “complete physical wellbeing mean?” “complete mental wellbeing mean?” and “complete social wellbeing mean?”
Can we ever attain this ideal state? Surely it is dangerously misleading to try to be perfectly healthy?
Explain the health as daily functioning to perform social tasks theory?
Health is a means towards the end of social functioning
In order for people to be healthy all forms of disease, illness and social handicap need to be removed in order to promote health
We can still be healthy even though chronic illness and disease is present
Frequently alluded to as the biopsychosocial model.
Explain health as personal strength or ability?
These approaches are typically humanist, they focus on how people respond to the challenges that life throws at them.
Health is a means to a greater end, its about responding positively to various problems.
This definition attempts to recover holistic ideas about health that disappeared in the eighteenth century.
Problems with this approach:
Too vague! It is very unclear what these personal strengths are and where they come from
If the nature of personal strengths are too vague then it is also very difficult to know how to intervene to improve wellbeing and health
Define illness and disease and explain why it is not simple?
Illness: the social, lived experience of symptoms and suffering
Disease: a technical malfunction or deviation from the norm which is ‘scientifically’ diagnosed (Turner 1984; Kleinman 1988)
Both influenced by social context.
Disease is not a homogeneous concept: professional specialization can influence what information is observed
What is functionalism in relation to health?
Health is a prerequisite for the smooth running of society
People’s dislocation with society that causes illness (Durkheim (1951) Suicide)
The human body analogy where parts function for the benefit of the whole. If one part malfunctions it upsets the functioning of the rest of the body. Illness is a social problem and not a medical one:
The state of optimum capacity of an individual for the effective performance of the roles and tasks for which s/he has been socialized (Parsons 1951)
Social relations are products of a harmonious society preserved by individuals acting in defined roles and performing certain roles.
Illness as a potential state of social ‘deviance’: failure to conform to social expectations and norms.
Illness is an unnatural state
Doctors are necessary actors of social control, moral guardians, distinguishing between normality and ‘deviance
In Talcott Parson’s Sick Role work, what are the rights and duties of the doctor and patients?
Doctor: Access private domains fulfilment Right to exclusive trust Apply highest standards To be guided by patients welfare
Patient: Exemption from role fulfilment To receive support Not to malinger Seek help and follow advice
What are the four components of the sick role?
Legitimate withdrawal from social obligations
Not blamed for their condition
Patient must want to get well
Patient must seek technically competent help (Parsons 1987)
What is the relationship of the sick role?
Only a doctor can sanction entry into the sick role
The patient is socially vulnerable, seeking official verification that she is not ‘malingering’
The medical profession is universalistic, functionally specific and affectively neutral in its fulfilment of community interests rather than its own self-interest.
What is Parsons two fold model of the aetiology of illness?
The capacity model: Three stages of aetiology 1. Normality 2. Strain 3. Exhaustion
The deviancy model: Three stages of aetiology Normality Motivational problems Crisis
What are criticisms of the sick role?
failure to account for conflict
it cannot account for social change
patients are now much more active and the asymmetrical and hierarchical relationship between the doctor and patient might well need to be revised
the model fails to account for the nature of chronic illness or normal conditions that require medical intervention
