public health & promotion Flashcards
what is Health Inequality:
- Measurable differences in health between groups or individuals.
- Can be due to various factors (biological, social, economic).
- e.g. geographical inequalities life expectancy is a good indicator: direct correlation of socio economic status impacting life expectancy
what is Health Inequity:
Subset of health inequalities that are avoidable and unnecessary differences.
* Unfair and unjust
* Systematic across populations
* Rooted in social, economic, or environmental conditions
characteristics of Dahlgren and Whitehead model of Social Determinants of Health
- personal characteristics occupy the core of the model and include sex, age, ethnic group, and hereditary factors
- individual ‘lifestyle’ factors include behaviours such as smoking,
alcohol use, and physical activity - social and community networks include family and wider social circles
- living and working conditions include access and opportunities in
relation to jobs, housing, education and welfare services - general socioeconomic, cultural and environmental conditions include
- factors such as disposable income, taxation, and availability of work
whitehall study I & II
- Whitehall Studies investigated CVD prevalence and mortality
rates among British civil servants. - British government highly stratified.
- Whitehall I Study (initial prospective cohort* study) examined over 18,000 male civil servants between the ages of 20 – 64 over 10 years since 1967.
- Whitehall II Study was conducted from 1985 -1988 and examined the health of 10,308 civil servants aged 35 - 55, of whom 2/3rds were men and 1/3rd women.
- A long-term follow-up of study subjects from the first two
phases is ongoing.
whitehall study findings:
- strong association between grade levels of civil
servant employment & mortality rates from a range
of causes: the lower the grade, the higher the
mortality rate. - Men in the lowest grade (messengers,
doorkeepers, etc.) had a mortality rate 3 x higher
than that of men in the highest grade
(administrators).
what is social capital?
in the context of social determinants of health refers to
the resources & benefits individuals can access through their social
relationships, networks, & community connections.
how many components does social capital encompass
three
what are the names of the 3 components social capital encompasses
social support
social networks
social cohesion
what is social support
Direct assistance available through social
relationships
what are social networks
The web of social relationships surrounding an
individual
what is social cohesion
The strength and solidarity of a group or
community
how does build/natural environment affect health
- neighbourhood design and housing
- air quality = fine particulate matter (PM2.5) linked to mortality + disadvantaged communities have higher exposure
- Access to green spaces benefit physical and mental wellbeing, but these are usually unequally distributed
→ Private rented sector had highest proportion (27%) of substandard dwellings
what is particulate matter / what its composed of
- PM: Non-gaseous particles suspended in air
- Composition: Sulfate, nitrates, ammonia, sodium chloride, black carbon, mineral dust, water
why does the size of PM matter
- Size matters: PM10 (≤10 micrometers) can enter lungs.
- PM2.5 (≤2.5 micrometers) most dangerous: can enter bloodstream
Health: defined as:
a state of complete physical, mental & social well being, not merely the absence of disease or infirmity.
how we would define/characterise public health
preventing disease, prolonging life and promoting health through the
organised efforts and informed choices of society, organisations, public and private, communities and individuals
include a wide spectrum of activities that
influence global and national policies such as reducing carbon emissions, creating fairer societies and include legislative measures e.g. banning smoking in public places and providing social services.
The Ottawa Charter for Health Promotion states that…
“Health promotion is the process of enabling people to increase control over and to improve their health.”
how many strategies does the Ottawa charter for health promotion have
5
what are the 5 Ottawa strategies for success:
1) Build healthy public policy
2) Create supportive environments 3) Strengthen community action
4) Develop personal skills
5) Re-orient health services
The three aspects to Health Promotion suggested by Tannahill (Downie et.al. 1996) are:
- Prevention – reducing or avoiding the risk of diseases and ill health.
- Positive Health Education – communication to enhance well-being and prevent ill-health through improving knowledge and attitudes.
- Health Protection-safeguarding population health through legislative, financial or social measures.
Health Promotion = (formula)
Health Education x Healthy Public Policy
what are three ways we can promote health
- health education
- service improvement
- advocacy
what do we mean by using health education to promote health
Communication directed at individuals, families and communities to influence:
Behaviour change
Determinants of behaviour change:
awareness/knowledge
decision-making
beliefs/attitudes
empowerment
community participation
what do we mean by using service improvement to promote health
Improvements in quality and quantity of services:
- accessibility
- case management
- counselling
- patient education
- outreach
- social marketing
what do we mean by using advocacy to promote health
Agenda setting and advocacy for healthy public policy:
- policies for health income generation
removal of obstacles
discrimination
inequalities
gender barriers
What is Health Advocacy?
Influencing policy makers, leaders and media to raise profile of health programmes
* Addressing legal, financial and service obstacles to health action
* Tackling discrimination and inequalities
What makes a good public health campaign?
An effective response should
* Provide the information and power for the community to make decisions
* Make the healthy choice the easiest option
* Remove barriers to action
* Reach across socio-economic strata
Most successful campaigns contain…?
a variety of messages
– ‘threatening’ and ‘supportive’ styles of delivery can complement each other.
Content and style of delivery are of unequal/equal importance ?
equal importance – smokers can accept unpalatable messages if the context is encouraging & supportive.
The role of media in health promotion:
- Mass media provides an important link between the rural residents and vital health information.
- The distribution of pamphlets created by specialized health bodies can disseminate vital
health info reliably (e.g. AIDs campaign under Thatcher). - Internet- Misinformation can have potentially dire consequences, triggering
mass panics, misleading uninformed policy-makers etc.
how do mass media campaigns reinforce public health messages
- Mobilising & supporting local agencies/professionals who have direct access to individuals within the target population.
- Bring together partnerships of public, voluntary, professional and private sector bodies.
- Inform and educating the public.
- Influence public opinion.
- Encourage local and national policy changes to create supportive environments.
What interventions are used to
change health behaviours?
- Increasing knowledge & awareness of risks
- Increasing physical or interpersonal skills ,e.g.in using condoms
- Changing beliefs & perceptions, e.g. through interventions aimed at increasing testicular self- examination in men by raising their awareness of risk and ‘normalising’ self-examination.
- Influencing social norms ,e.g. by changing public perceptions of secondary smoking, or public acceptance of breastfeeding.
- Changing structural factors & influencing the wider determinants of health,e.g. by implementing clean-air policies to decrease pollution and improve health.
- Influencing the availability and accessibility of health services.
Evidence-based strategies to support change include what key elements
- Using theoretical models in developing interventions e.g. HBM, BMQ
- Targeted + tailored (age, gender, culture, etc)
- Providing accurate information through clear, unambiguous messages
- Using behavioural skills training, including self-efficacy,MI
- Joining up services with other community provisions e.g .providing transport links from community centres to clinics, or situating health services in accessible community settings
- Working with community members as advocates of appropriate services (local action).
Past campaigns show the importance of what?
policy impact as well as of cultural change
- attention must also be paid to the political dimension of a concern such as alcohol
The role of fear in health promotion:
Fear arousing imagery can be good at attracting attention and is often memorable
Fear-based campaigns are more persuasive for individuals who are already engaging in the desired, health-protective, behaviour (justifies their hard work)
Arousing fear in individuals can have many unintended consequences, such as denial or othering
Arousing fear is not an effective means of facilitating sexual behaviour change
When we are afraid we may engage in a number of different coping strategies including: (4 strategies)
1) Avoidance
2) Denial
3) Counter-arguing
4) Deflection/Othering
Each year pharmacies are required participate in up to how many campaigns at the request of NHS England.
6
examples are stopover, quit kits, etc
what does it mean to ‘participate’ in a health campaign
involves the display and distribution of leaflets provided by NHS England.
When is it good to use the media in health promotion?
- When awareness is the main goal for wide populations (e.g., How to protect yourself from COVID-19)
- Facilitate health education
- Urgent timeframe
- Generous budget available
- Simple behavioural goals
