Public Health and health promotion

Question 1

What is public health?

Answer 1

science of preventing disease and promoting health through organised efforts in society

Question 2

3 domains of public health?

Answer 2

health improvement/promotion
health protection
health services/care

Question 3

2 indicators of health?

Answer 3

life expectancy

• epidemiological transition (increased LE since 1970s)
• more knowledge and hygiene
• Lower LE in Wales than England
• North South divide in life expectancy
• females higher

socioeconomic status
- higher status lower % of longstanding illness

Question 4

Effect of smoking?

Answer 4

decreased to 1 in 5 from 50/60% 1970s
higher rates amongst poorer people
accounts for 1/3 respiratory deaths
educated adults less likely to smoke
ethnic and social norms increase smoking habit (Black/Bengali men more likely to smoke)

Question 5

Effect of obesity?

Answer 5

• greater problem with 1 in 5 children in reception obese

- prevalence by deprivation higher

Question 6

Effect of alcohol?

Answer 6

drinking patterns increase with increase household income

Question 7

Effect of sexual behaviour and STIs?

Answer 7

• levels increased rapidly after war as soldiers returned after abstinence
• levels rose in 60/70s due to liberal thinking, social acceptance
• drop dramatic after 1985 as HIV spread and infected many so people more cautious
• rose again after ART introduced

Question 8

Factors that contribute to population health?

Answer 8

health behaviours (smoking, diet, alcohol/drugs, sexual health
action to social, economic, environmental conditions
strengthening skills of individual

Question 9

What does health promotion involve?

Answer 9

clinical interventions
(biomedical - screening/immunisation)

knowledge transfer/health literacy
(smoking cessation, healthy eating, exercise promotion)

healthy public policy
(legal, fiscal and social measures to make healthy choices easier/ policies to address wider health determinants/equal opportunities for health and wellbeing TANNAHILL MODEL)

community development
(partner with public, private, NGOs, international organisations to create sustainable actions)

Question 10

Primordial prevention?

Answer 10

prevent factors that promote emergence of lifestyle/behaviour/exposure patterns that increase disease risk

Question 11

Primary prevention?

Answer 11

actions to prevent onset of disease by limiting risk factor exposure by individual behavioural change, actions in community, vaccination, diets, health education

Question 12

Secondary prevention?

Answer 12

halt progress of illness once establishes

Question 13

Tertiary prevention?

Answer 13

rehab those with disease to minimise residual disability

Question 14

2 approaches to disease prevention?

Answer 14

high risk

• identify those in special need ‘targeted rescue operation (Rose) then control exposure
• provide protection against exposure
• screen minority group for specific disorder

population
- recognise that common disease and exposure occurrence reflects behaviour and circumstances of society as a whole

Question 15

Benefit of high risk approach?

Answer 15

effective
efficient (cost effective)
easy to evaluate

Question 16

Negatives to high risk approach?

Answer 16

temporary/palliative - misses large amount of disease
cost of screening
hard to change individual behaviours

Question 17

What is the prevention paradox?

Answer 17

people exposed to small risk generate more cases of disease than small number at high risk

so if many receive small benefit, total benefit is large

Question 18

Strengths of population approach?

Answer 18

radical
large potential for population
attributable risk may by high even if low risk as many are exposed to low risk

Question 19

Weakness of population approach?

Answer 19

small advantage to individual

poor motivation of subject/physician

Question 20

What is the Wanless report?

Answer 20

focus on prevention and wider health determinants

cost effectiveness of actions to improve health and reduce inequalities

Question 21

What is the national alcohol strategy?

Answer 21

• end sales of cheapest alcohol
• strengthen ban on irresponsible promotions in pubs/clubs
• reduce availability of high strength products
• promote/display alcohol responsibly
• improve education

Question 22

6 policy objectives of Marmot review?

Answer 22

1. give every child best start in life
2. enable everyone to maximise capabilities and control their lives
3. create fair employment and good work for all
4. ensure healthy living standard
5. create/develop healthy/sustainable places and communities
6. strengthen role and impact of ill health prevention