Public Health and Health Promotion Interventions

Question 1

What is health?

Answer 1

“A resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities”.

Question 2

What is public health and what are the 3 domains of public health?

Answer 2

The science and art of preventing disease, prolonging life and promoting health through organised efforts of society

Public Health has 3 domains:

• Health Improvement /Promotion
• Health Protection
• Health Services / Health Care

Question 3

How is life expectancy an indicator of health and is it uniform within a country?

Answer 3

This is a result of increase healthcare knowledge and hygiene (sanitation and safe water), improve socioeconomically conditions.

The life expectancy in Wales is actually lower than in England, so there are clear differences within the countries. There is also a North-South divide with those living in Northern parts of the UK having a lower expectancy - baby boys born in Chelsea have an expectancy of nearly 10 years greater than boys born in Blackpool. Females tend to have a higher life expectancy rate

Question 4

How does socio-economic status affect health?

Answer 4

There is a clear link that your status can have some bearing on your health e.g. higher status people tend to have a lower percentage of longstanding illness

Question 5

What are some factors that your can’t change that have bearings on death?

Answer 5

Age, sex, ethnicity, family history/genetics, stress

Question 6

How are smoking trends affected by wealth, education and ethnicity?

Answer 6

Smoking rates are much higher among poorer people

Effect of education also decreases with the percentage that smoke (adults with a degree are less likely to smoke)

Ethnic and social norms can increase smoking habit- Black Caribbean and Bengali men are more likely to smoke, whereas white women smoke the most in comparison to other ethnicities

Question 7

How is the incidence of obesity changing and how does its prevalence vary with deprivation?

Answer 7

Obesity has started to become a major problem with 1 in 5 children in reception being obese (starting when younger), this value increases to 1 in 3 in children from year 6

Those most deprived are shown to be at higher risk of being obese.

Question 8

How many people in the UK die annually from diseases caused by smoking?

Answer 8

96,000 people in the UK - it accounts for > 1/3rd of respiratory deaths

Question 9

How many adults in Britain smoke, and how has this changed from the 1970s?

Answer 9

1 in 5 adults in Britain smoke - this has decreased from around 50-60% in the 1970s

Question 10

How do changes in household income affect alcohol consumption?

Answer 10

Drinking patterns increase with increased household income

Question 11

How have the number of diagnoses of gonorrhoea changed in the last 100 years?

Answer 11

Levels increased rapidly after the war as soldiers were returning after a long period of abstinence

Levels dropped again after the introduction of new antibiotics

Levels rose again during 60s and 70s due to liberal thinking and increase social acceptance of taboo topics

The drop is quite dramatic after 1985 as HIV was seen to spread and infected many resulting in people being more cautious

This rose again after the introduction of antiretroviral treatment

Question 12

What factors contribute to population health?

Answer 12

• Health behaviours (smoking, diet, exercise, alcohol/drugs, sexual health)
• Clinical care (access to care and quality of care)
• Socioeconomic factors (education, employment, income, community safety)
• Physical environment (housing, environmental quality)

Question 13

What is health promotion?

Answer 13

Health promotion is the process of enabling people to increase control over, and to improve their health

Question 14

What is health improvement?

Answer 14

An approach to health that takes account of:

• A broad definition of health
• The scope of pevention
• Limitations of health services
• Role of individuals, groups and governments
• Focus is on health rather than disease

Question 15

What does health promotion involve?

Answer 15

Clinical interventions : Biomedical - screening / immunisation

Knowledge transfer and health literacy : Traditional type of health promotion (e.g. smoking cessation, healthy eating, exercise promotion)

Healthy public policy : Legal, fiscal and social measures to make healthy choices easier, Sustainable policies, actions and infrastructure to address the wider determinants of health. Enabling equal opportunities for health and well-being

Community development :
Partnerships with public, private, non-governmental and international organizations and civil society to create sustainable action

Question 16

What are the levels of prevention?

Answer 16

Primordial - Prevention of factors promoting the emergence of lifestyles, behaviours, exposure patterns which contribute to increased risk of disease.

Primary - Actions to prevent the onset of disease. To limit exposure to risk factors by individual behaviour change and by actions in the community. Includes health promotion (e.g. health education, prescriptive diets) and specific protection (e.g. vaccination)

Secondary - To halt progression once the illness is already established. Early detection followed by prompt, effective treatment (Special consideration of asymptomatic individuals)

Tertiary - rehabilitation of people with established disease to minimise residual disability and complications. Quality of life action even if disease cannot be cured

Question 17

What are the approaches to disease prevention?

Answer 17

High Risk Approach : Identifying those in special need targeted rescue operation, then controlling exposure (e.g. reducing house dust mite in the home of asthmatic child), providing protection against effect of exposure (occupational and post-exposure vaccination), screening among minority groups for specific disorders (sickle cell disease, thalassemia).

Population Approach : Begins with recognition that the occurrence of common diseases and exposures reflects the behaviour and circumstances of society as a whole

Question 18

What are the strengths of the high risk approach?

Answer 18

• effective (high motivation of individual and physician)
• efficient (cost-effective use of limited resources)
• benefit:risk ratio is favourable- appropriate to individual
• easy to evaluate

Question 19

What are the weaknesses of the high risk approach?

Answer 19

• palliative and temporary (misses a large amount of disease)
• risk prediction not accurate
• difficulty and costs of screening
• hard to change individual behaviours

Question 20

What are the strengths of the population approach?

Answer 20

• equitable (attributable risk may be high where risk is low if a lot of people are exposed to that low risk)
• radical
• large potential for population
• behaviourally appropriate

Question 21

What are the weaknesses of the population approach?

Answer 21

• small advantage to individual
• poor motivation of subject
• poor motivation of physician
• benefit:risk ratio can be questioned

Question 22

What does the Wanless report focus on?

Answer 22

prevention and the wider determinants of health

Question 23

What are the health priorities in the UK?

Answer 23

Smoking
Alcohol
Obesity
Sexual Health (the most commonly diagnosed STI is Chlamydia)
Teenage Pregnancy
Mental Health

Question 24

What’s the national alcohol strategy?

Answer 24

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

Question 25

What did the 2008 WHO commission on the social determinants of health aim to do?

Answer 25

Improve the conditions of daily life – the circumstances in which people are born, grow, live, work, and age

Tackle the inequitable distribution of power, money, and resources – the structural drivers of those conditions of daily life – globally, nationally, and locally

Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health

Question 26

What are the 6 policy objectives of the Marmot review?

Answer 26

Give every child the best start in life

Enable all children, young people and adults to maximise their capabilities and have control over their lives

Create fair employment and good work for all

Ensure a healthy standard of living for all

Create and develop healthy and sustainable places and communities

Strengthen the role and impact of ill health prevention