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Define 'determinants of health'

A range of factors that have a powerful and cumulative effect on the health of populations, communities and individuals. Eg. physical environment, social/economic environment, individual genetics, characteristics and behaviours


Describe briefly the history of health promotion in developed countries

1910s-1940s: Public Health (reform of physical environment)
1950s-1960s: Health Education (target individual health behaviour)
1970s onwards: Health Promotion (broader political/social approach to health)


Define 'health promotion'

The process of enabling people to increase control over and to improve their health


What are the seven principles of health promotion?

1) empowering
2) participatory
3) holistic
4) intersectoral
5) equitable
6) sustainable
7) multi-strategy


What's the difference between health promotion and public health?

Public health places more emphasis on the end goals, while health promotion is about the MEANS of achieving the goals (education and healthy public policy).


What are the three aspects of health which are critiqued in a sociological perspective on health promotion?

1) structural critiques
2) surveillance critiques
3) consumption critiques


What are the five approaches to health promotion?

1) medical/preventative
2) behaviour change
3) educational
4) empowerment
5) social change


What is the aim of primary prevention?

The prevent the onset of disease or injury by reducing exposure to risk factors


What are the approaches to primary prevention?

- immunisation
- prevention of contact with environmental risk factors
- taking appropriate precautions concerning communicable disease
- reducing risk factors from health related behaviours


What is the aim of secondary prevention?

To detect and treat a disease or its risk factors at an early stage to prevent progression/potential future complications and disabilities from the disease - mostly types of screening, eg screening for cervical cancer


What is the aim of tertiary prevention?

To minimise the effects of established disease, eg renal transplants or steroids for asthma


Explain this 'health promotion dilemma': the ethics of interfering in people's lives

- potential negative psychological impact of health promotion messages
- state intervention into individuals' lives may be seen as too great


Explain this 'health promotion dilemma': victim blaming

Focusing on individual behavioural change plays down the impact of wider socioeconomic and environmental determinants of health


Explain this 'health promotion dilemma': 'fallacy of empowerment'

Giving people information does not give them power, and unhealthy lifestyles are not due to ignorance but due to adverse circumstances


Explain this 'health promotion dilemma': reinforcing of negative stereotypes

Health promotion messages have the potential to reinforce negative stereotypes associated with a condition or group, eg leaflets aimed at HIV prevention in drug users suggest that they are to blame


Explain this 'health promotion dilemma': unequal distribution of responsibility

Implementing healthy behaviours in the family is often left to women


What is the 'prevention paradox'?

The idea that interventions that make a difference at population level might not have that much effect on the individual. This has a link with lay beliefs, as people may not see themselves as a 'candidate' for disease and therefore ignore the health warnings, and may also be aware of anomalies and randomness of disease


Define 'evaluation'

The rigorous and systematic collection of data to assess the effectiveness of a program in achieving predetermined objectives


Why must health programmes be evaluated?

- need for evidence based interventions
- accountability
- ethical obligation
- programme management and development


What is process evaluation?

Focuses on assessing the process of programme implementation, and employs a wide range of mainly qualitative methods. AKA formative/illuminative evaluation


What is impact evaluation?

This assesses the immediate effects of an intervention. It is the more popular choice, as it is the easiest to do


What is outcome evaluation?

This measures more long-term consequences, eg improvement in patients' lives. The timing of the evaluation can influence outcome, as some interventions may take a long time or wear off quickly


What difficulties are there in demonstrating an attributable effect?

- design of intervention
- possible time lag to effect
- many potential intervening or concurrent confounding factors
- high cost of evaluation research (studies are likely to be large scale and long term)


What are the three ways in which a health professional may discover an illness in a patient?

- spontaneous presentation (patient presents with symptoms at GP/A&E/etc)
- opportunistic case finding (health professional takes opportunity to check for other potential conditions when person presents with symptoms related to a disease/problem)
- screening


Define 'diagnosis'

The definitive identification of a suspected disease or defect by application of tests, examinations or other procedures (which may be extensive) to label people as either having or not having a disease


What is screening?

A systematic attempt to detect an unrecognised condition via tests, examinations or other procedures which may be applied rapidly and cheaply to distinguish apparently well persons who probably have a disease from those who probably do not


What is the purpose of screening?

To give a better outcome compared with finding something in the usual way, as treatment cannot wait until there are symptoms


What are the areas of criteria for whether there will be a national screening programme or not?

1) condition
2) test
3) intervention
4) screening programme
5) implementation


What are the requirements of a particular condition for it to be screened for nationally?

- must be an important health problem in terms of frequency/severity with epidemiology, incidence, prevalence and natural history understood
- cost-effective primary prevention should have been implemented


What is a false positive?

This is when a test refers well people for further investigation

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