L13: Social Factors in health promotion

Question 1

How did health promotion come about?

Answer 1

Public health developed to change the physical environment
Health education→ targeted individual behaviour
Health promotion→ broader approach which includes education and public health→ targets everyone and includes political and social side

Question 2

What are the different types of health promotion?

Answer 2

Medical or preventive 
Behaviour change
Educational 
Empowerment 
Social change

Question 3

What is the medical or preventive approach?

Answer 3

Inform doctors and patients about the link between behaviour and disease

Question 4

What is the behaviour change approach?

Answer 4

Change activitities/ belief and approaches to it

For doctors and patients

Question 5

What is the education approach?

Answer 5

Educate why we should change
Teach about the negative side of behaviour
Educate how we can change

Question 6

What is the empowerment approach?

Answer 6

Encourage people, make them feel like they are actually achieving it
Give them an incentive
Make them see that it is possible

Question 7

What is the social change approach?

Answer 7

Change peoples opinions
Social pressure and influence
Add a legal aspect→ enforce a social pressure

Question 8

How is health promotion viewed from a sociological perspective?

Answer 8

3 different viewpoints
Structural critiques
Surveillance critiques
Consumption critiques

Question 9

What is a structural critiques view?

Answer 9

Material conditions (e.g. economic wellbeing) that give rise to ill health are marginalised 
Focus on individual responsibility which may miss the point→ not everyone has the same access to things

Question 10

What is a surveillance critiques view?

Answer 10

Monitoring and regulating the population
Is it ethically correct?
Should we limit treatment to those who don’t change behaviour?
Don’t have to be healthy if people don’t want to

Question 11

What is the consumption critiques view?

Answer 11

Lifestyle choice not just seen as health ‘risk’ but also tied up with identity
Make choices on how we want to be identified as

Question 12

What are some on the dilemmas around health promotion?

Answer 12

Should we interfere with peoples lives?
Potential psychological impact of health promotion?
Rights and choices?

Question 13

Who’s ‘fault’ is poor health?

Answer 13

• Promotion often focuses on individual behaviour change–> blame the individual
• Structural and socio-economic changes are not often factor in
• Plays down the impact of wider socioeconomic and environmental determinants of health
• All influence the perceptions individuals have of their health and the choices they make

Question 14

What is mistaken belief about empowerment?

Answer 14

Giving generic information does not automatically give them power to act on healthier choices
Unhealthy lifestyles not normally due to ignorance but due to adverse circumstances and wider socio-economic determinants of health → not always able to opt for the ‘healthier/ better’ choice

Question 15

How can health promotion reinforce negative sterotypes?

Answer 15

Associates certain behaviours with certain groups or conditions
e.g. HIV prevention in drug users →blames drug users for HIV, why are they sharing needles? why are they using drugs? etc… doesn’t look at what made them start using drugs

Question 16

What is another negative impact of health promotion?

Answer 16

Unequal distribution of responsibility
Implementing healthy behaviour in the family is often left up to women
Women do disproportionately more family work than men (cooking, cleaning, washing etc)

Question 17

What is the prevention paradox?

Answer 17

Intervention that make a difference at population level might not have much effect on the individual

Question 18

How does the prevention paradox and lay beliefs affect health promotion?

Answer 18

Person doesn’t think disease ‘applies’ to them they wont take the health promotion message on board
Awareness of anomalies and randomness will also impact views
Need to engage with lay beliefs to make a difference

Question 19

Why does health promotion need to be evaluated?

Answer 19

Evidence based interventions needed 
Accountability 
Evidence provides legitimacy→ get political support
Ethical obligation 
Ensure no direct or indirect harm 
Programme management and development

Question 20

What are the different types of health promotion?

Answer 20

Process
Impact
Outcome

Question 21

How does process evaluation work?

Answer 21

Assess the process of programme implementation
‘Formative’ or ‘illuminative’ evaluation
Employs wide range of mainly qualitative methods

Question 22

How does impact evaluation work?

Answer 22

Assess the immediate effects of the intervention

Popular choice of evaluation as it is easy to do

Question 23

How does outcome evaluation work?

Answer 23

Measure the long term consequences
What is achieved
Timing of evaluation can influence outcome
→ delay: some interventions take long time to have an effect
→ decay: some interventions wear off rapidly

Question 24

What are the difficulties with evaluation?

Answer 24

Difficult to demonstrate an effect becuase:

• Possible lag time
• Design of intervention
• Potential intervening or concurrent confounding factors
• High cost of evaluation research- studies are likely to be large scale and long term