Health Servises HES

1. Primary prevention

   • Prevention before it occurs by promoting and maintaining good health.

   • E.g. interventions to address wider health determinants (poverty, housing, eduction, employment). Reduce risk factors (exercise, quit smoking). Immunisation

2. Secondary prevention

   • Early Dx & Rx of disease before onset of Sx - to reduce the impact of a disease

   • E.g. Screening (breast Ca), care pathways, Rx like diet or exercise to reduce risk

3. Tertiary prevention

   • Optimal Rx of established condition to soften the impact and improve QOL.

   • E.g. limit disease progression, rehabilitation, support groups

4. Quaternary prevention

   • Avoid over medicalisation - protect from unnecessary intervention / medical harm

1. Absence of disease - medical model of health

2. Well being - health seen as complete physical, mental and social wellbeing

3. A resource - Health is resource of everyday life, benefits social and personal factors not just physical and mental health

• Income

• Education

• Employment

• Housing

• Social connection

• Environment

• Commercial influences

• Healthcare

Doctors treat disease while health promotions addresses the conditions that create diseases

• The process of enabling people to increase control over, and improve their health (Ottawa charter)

• The combination of educational and environmental supports for actions and conditions of living conducive to health (Green L, Kreuter M 1990)

Healthcare

• Vaccination programmes

• Diabetes Prevention Programme

• Smoking cessation

Community

• Active travel schemes

• Green social prescribing

Policy

• Soft drinks levy

• Tobacco legislation

Digital

• Online safety regulations

• Digital literacy programmes

• Bio Medical (clinicians)- Absence of disease, promoting models

  • Rx BP, assess risk factors, GP review

• Behavioural (individual)- Health as energy, functional ability of an individual, disease-preventing lifestyles.

  • salt reduction, smoking cessation, weight management

• Socio-environmental (local athority / Gov)- Connected to one’s family/friends/community, being in control, ability to carry out tasks that are important or have meaning.

  • living condition, active travel, work/school health policies

1. High-risk approach

   • identify few who are at high risk & target intervention on them > large benefit to those at high risk. E.g. CVD screening in primary care

   • Cons: leaves the root cause untouched > small impact on total disese burden

2. Population approach

   • target whole population for intervention - modify their risk > great population benefit. E.g get everyone to reduce salt to better their BP

   • Cons: although huge benefit to community, it offers little benefit to each individual

BCT help to understand why people behave the way they do.

• Individual level theories

• Interpersonal level theory

• Community level theories

Note: learn about behaviour change wheel (COM-B model)

• Capability - do they know how?

• Opportunity - can they?

• Motivation - Do they want to?

It demonstrate the strategies that are available.

• Eliminate choice - isolation of patients with infectious diseases.

• Restrict choice - remove unhealthy ingredients from food.

• Guide choice through disincentives - taxes on cigarettes

• Guide choices through incentives - tax breaks for buying bikes used to travel to work.

• Guide choices through changing the default policy: instead of chips provide another healthy option

• Enable choice: enable individuals to change their behaviours > participation in stop smoking programmes.

• Provide information to public - encourage to walk more.

• Do nothing or simply monitor the current situation.

1. Health communication - to positively influence e.g ads, billboards, leaflets, food labelling

2. Health education - aim to improve knowledge / skills beneficial to health to patient / community. E.g how to manage asthma / DM, 1:1 sessions

3. Self-help / mutual aid - people with common experiences support eatch other e.g. alcoholic anonymous, CVD rehabs

4. Organisational change - create supporting evironment to make healthy choices e.g no smoking /healthy eating policy

5. Community development / mobilisation - petitions by locals

6. Policy / legislation - enforced by law e.g smoke free zones, seat belt, sugar tax

Tuberculosis

• Social interventions (improved housing, hygiene, wealth) allowed for a drastic reduction in the prevalence of TB

•  Medical interventions (antibiotics and immunization) allowed for further reductions in prevalence.

• Should consider health promotion in all consultations. 

• Ask about lifestyle (smoking / exercise)

• Offer advice and appropriate referral, e.g., dietician and smoking cessation service

• Empower patients to manage chronic disease and offer appropriate support.

• Goal setting, review, monitor

• Undertake public health research.

• Contribute to national reports.

• Advocacy by professional bodies/coalitions (have huge influence in governments - help change policies)