Midsem Exam Notes

8/3/2019 Midsem Exam Notes

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WEEK ONE INTRODUCTION 9/1/2010 3:06:00 AM

8 priority areas of hprm

y heart diseasey cancery arthritisy mental healthy type 2 diabetesy asthma / pulmonary disordersy injuries and falls preventiony obesity

Health promotion definition

y A combination of educational and environmental supports foractions and conditions of living conducive to health

Levels of prevention

y Primary action before risk factors emergey Secondary early stage action disease risk factorsy Tertiary action to prevent reoccurrence rehabilitation

Approaches to prevention

y Individualcommunity populationIndividual approaches

Advantages:

y Intervention appropriatey Interactivey Reactive

Disadvantages

y Limited impact on incidencey Cost effectiveness and time

Community / population approaches

Disadvantages

y Insensitive to specific needsAdvantages

y Large potential to impact incidencey Time and cost effectiveness


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y Targets the environment and sustained impact** combined individual and population approach is preferred option

21stcentury

y hprm challenges based on chronic diseasey involves education and environmental approachesy focus will be on primary and secondary preventiony individual strategies are important but need to focus on

population


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Week two evolution of health promotion9/1/2010 3:06:00 AM

Foundations

Ancient Greece

y Hippocrates and Hippocraticcorpus ( body of work devised byscholars)

y Physiocraticschoolof thoughty Natural theory of disease aetiologyy Viewed health as a dynamic equilibrium between man and his

environment

y Greek society placed an emphasis on lifestyle behaviours whichmaintained this equilibrium

y More than just medical approach set standard for how weapproach disesae

Modern beginnings

y Industrial revolutiony Movement from manual to machine based manufacturey Massive concentrations of people in citiesy Cramped living conditions encouraged infectious epidemicsy In response to industrial revolution public health came to deal

with infectious idseases

The landscape of public health modern era

y Communicablediseasey Small pox vaccination 1796 edward jennery Pasteurization (1862 louis Pasteur and claude Bernard)y Antiseptic (1867: joseph lister)y John snows influence 1854 cholera epidemicy Developed important epidemiological processesy Encouraged the use of evidence to support practice and policyy Provides an example ofchallenges that face health promoters in

the real world

Changing nature of disease

y From communicable or infectious (cholera, malaria, hiv, tb) tonon communicable (diabetes, cvd, cancers, asthma)


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y Look closely at the WHO charters and how they shapecontemporary approaches

WHO

y Organization for effective health changey Established 7th April 1948 in Genevay 193 member states, 6 regional areasy responsible for providing leadership on global health matters

initial milestones

y WHO 30th assembly 1977y resolved: attainment of all citizens of the world of a level of

health that will permit a socially and economically productive life

y Declarationofalma ata 1978 134 nations. Emphasis on healtheducation and primary prevention

y Ottawa charter 1986 first international conference on healthpromotion. A response to growing expectations for new public

health movement

Ottawa

Five key action areas:

y Health public policyy Supportive environmentsy Community actiony Development of personal skillsy Reorientations of health services

Onwardsfrom Ottawa

y Jakarta declarationon leading heath promotion into the 21stcentury reiterated Ottawa, emphasized infra strucure,

investment and empowerment

y Bangkokcharterfor hprm political action, broad participationand sustained advocacy

Nairobi charter 2009

y Implications for hprmy Transitional gap between research and practicey Health gab between countriesy Health gap within Australia


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y Strengthen leadership andworkforcesy Mainstream health promotiony Empowercommunities and indiviualsy Enhance participatory processesy Build andapply knowledge

30th assembly alma atta Ottawa and 5 key areasBangkoknairobi

Trends globally

y 20% of deaths are under 5 years oldy 1/3 of all deaths attributable to communicable, maternal and

nutritional deficiencies

y developing countries have highest rate ofcommunicable andchronic disease

y SES importancey Substantial differences in health relative to SES in Australian

population

y Those with highest ses have most resources etcy Lower ses groups are more likely to: smoke, inactive, obese, eat

less fruit, have diabetes, cvd, arthritis, mental health, problems,

visit doctors and emergency services

Importance of health milestones

y Drive national public health policy which determines individualenvironmental and sociocultural action


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Week three health promotion perspective on

practice 9/1/2010 3:06:00 AM

ROSE

y Professor of epidemiologyy Transformed approaches to health intervention and prevention

strategiesy Large number of people at a small risk may Ive rise to more

cases than small number at high risk

y Individual approach is strongly intervention appropriatey Population approach is essential in tackling disease incidencey DEAL WITH LARGER AMOUNT OFPEOPLE WHO ARE AT LOWER

RISK TO EFFECTIVELY DEAL WITH INCIDENCE

Two key aetiology questions

y Why do some individuals have ..y Why do some populations have a lot of whilst in others it is

rare

High risk / individual strategy

y Why do some individuals have..?y The deviant minority with the high risk statusy Is the traditional approach to medical prevention

Advantages

y Intervention appropriate can base it on the individualy High participant motivation want to stop being sick personallyy High researcher motivation want to be successful in their joby Cost effective uses of resources big results for resourcesy Benefit to risk ratio favorable push benefits while managing

risks

disadvantages

y screening ignores borderline peopley impact is palliate and temp take away support and people may

returny time and resource intensivey behaviorally inappropriate goes against social normsy does not deal with disease incidence

low risk / population strategy

y why do some populations have a lot of .. while in others it is rare


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y public health orientated approach to preventative mediciney shift population distribution of disease

advantages

y radical removes underlying causes of diseasey has large potential for change if distribution lowered by small

amount = huge change in mortality

y behaviorally appropriate targets socio cultural norms andenvironments

disadvantages

y big benefits to population but small to most individualNotes from reading: ROSESICKINDIVIDUALSANDSICK

POPULATIONS

y Central ethos of medicine: acceptance of responsibility for sickindividuals

y Why did this patient get this disease at this time?y To determine cause of disease depends on population and norms

if everyone smoked 20 cigarettes a day then clinical case

control studies would show that lung cancer was genetic this is

true as everyone is exposed to the agent but cases are based on

susceptible

y Places where everyone is exposed case control is futile aseveryone is exposed and other factors operate to determine the

varying risk

y More widespread a cause the less it explains the distributiony Two determinants of incidence: first seeks causes ofcases and

second seeks cause of incidence

y What distinguishes two groups isnt about the individuals butabout the whole distribution need to study characteristics of

populations not of individuals

y Migrants acquire disease rates ofcountry of adoption not onindividual merits

y Two methods: differences between populations and differencesin populations

High-risk strategy


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y Traditional approach, screening used. Detect and treatsymptomless diseases. Patient goes from being well to being

susceptible and having to do something about it

Advantages:

y Intervention is appropriate to individualsy Subject motivation they are special and hence more motivatedy Physician motivated can make a difference and feel they are

justified by tests etc done

y Cost effective use of resources once off advice is pointless, thismethod allows for counseling time and follow up more effective

to concentrate limited services and time where there is need

y Favorable benefit: risk ratio if intervention has some adversecosts and if the risk and cost are the same for everyone then the

ratio is favorable

Disadvantages

y Difficulties and costs of screening high cost to screen everyone,those who get screened are often least at risk of the diseases,

screening finds people who receive advice but also finds a large

number of borderlines for whom there is no treatment

y Palliative and temporary effects doesnt get to root of diseasebut protects the vulnerable to it

y Potential is limited power to predict future is weak, most withrisk factors will be well for an amount of time

y Behavioral ineffective if social norms are there, trends will notchange as people will stick to norms

Population strategy

y Attempts to control determinants of incidence, lower mean levelof risk factors to shift whole distribution of exposure in a

favorable direction

Advantages

y Radical remove underlying causes that make disease commony Large potential for population - affects whole populationy Behaviorally appropriate if non smoking becomes normal then

people will not smoke social norms

Disadvantages

y Small benefit to individual most of the people were going to beok anyway little benefits to each participating individual


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y Poor motivation of subject people act on immediate rewardsy Poor motivation of physician practitioners disheartened at small

results in prevention there is little expectation of benefit

y Benefit risk ratio is worrisome


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Week 5 health promotion approaches, the individual appro

Ecological model:

y Combination of individuals, society and culture, policy andenvironment

What are individual approaches

y Focusing on one person in group or multiple individual contactsy Can include facilitating others t provide individualized attentiony Assisting people to develop the knowledge, attitudes and skills

they need to optimize health

y Vs working with environment, communities, organizations,settings, policies, regulations, systems, service delivery

y Assisting people to develop knowledge, attitudes and skillsneeded to optimize health

y Reflected in Ottawa and Nairobi charterWhy individual approaches

y Clinical basis, secondary or tertiary managementy Educational basisy Knowledge as a determinanty Buildson relationship personal contact and influencey Relevant to those involved reaches those most likely to benefit,

cost effective use of resources

y Allowsfor personalization and individual tailoring meetsindividuals needs, allows for individual translations

y Can result in large amount ofchange for client but not forpopulation

Examples of individual level hprm 5 TO REMEMBER **

y Patient educationy Self managementy Primary health carey Risk factor assessmentsy Education materials

Patient education

y You are the leader


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y Helping individuals better informed about conditions, procedureschoices

y Enables better selfcare and informed decisionsy Knowledge basedy Secondary or tertiary managementy Integrated into patient carey Developed in conjunction with patientsy Interdisciplinaryy Measurable goalsy Combination of who delivers, setting, method of info transfer,

topic, audience

examples

y understanding surgical proceduresy prescribing exercise regines based on fitness testsy demonstrating use of an inhalery sex edy dealing with metnal health implications of bullyingy sun safety instructions

Self management

y Individual involved in and responsible for aspects of treatmentsy Getting people to deal with issues and solve them via

motivational processes

y Facilitate this as the HP professionaly Facilitating and letting patients take control

Mainskills

y Problem solvingy Decision makingy Resource utilizationy Formation of patient provider partnershipy Action planningy Self tailoringy Often involves acting as a counselor systematic guidance and

problem solving using your expertise and experience

Motivational interviewing process of questioning to resolve ambivalence

and increase motivation

examples

y pan management for arthritis


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y carioca rehaby diabetesy caring for dementiay stress management

Primary health care

y Still dominant individual approachy Continuity ofcare coordinate primary secondary tertiaryy Toward q2 highlights y Universally accessible based on ideal of equitable distributiony Resources for intermediate and long term needsy Focus on first point ofcontact for health related issuesy General medical practicey Common first contacty Credibilityy Time constraintsy How affective are gps as hprm?

Alternative primary health caresettings

Pharmacies

y Home health care providersy informationy advice

venuefor activities

y governmenty privatey telecommunications

risk factor assessments

y blood screening lab, home and community testingy lifestyle behaviours like diet and physical activityy health risk appraisals, questionnaires, computer services

educational materials

y informational brochures, information sheets, postersy prescriptional medication regimey contractual gym, therapyy evaluational diaries, log sheets


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y culturally specificy accuratey appealingy easily comprehendedy pertinent to the desired objective

TOWARD Q2 NOTES

federal and state priorities

will be tested on health section of toward q2 key messages, what its

asking us as citizens and experts to engage with

* = key reading we need to read Q2

challenges highlighted

y climate changey unhealthy lifestylesy preventable diseasesy growing populationy ageing statey global competitiony entrenched disadvantaged

goals:

y strong create diverse economy powered by bright ideasy green protect lifestyle and environmenty smart deliver world class education nadn trainingy healthyy fair support safe an caring community

health goals

y cut by 1/3 obesity, smoking, heavy drinking and unsafe sunexposure

y have shortest public hospital waiting times in Australiay


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Week 6 environmental approaches 9/1/2010 3:06:00 AM

environment includes

y social physical how people interact together in differentcontexts, within schools, within workplaces: social feelings and

connections which are very important

y perceivedactual need to talk to people to see how theyperceive the environment. People may perceive diet as healthy

but may not be so

y builtnatural how cities are designed, how they link into parksetc

y macro micro key one on one environmentsPolicy and the environment

y Laws and legislationy laws are adopted to guide individual and collective behaviour

change

y legislation makes the healthy choice the only legal choicey informal rules and regulationsy families healthy eating family rule: sit around the dinner table

for a meal

y workplacesy schools

Technology and environment

y way we use technology to benefit and negatively impact our livebenefits:

y technology can impact the environment at a massive populationlevel

y internet connectivity: websites linking information to thepopulation

y use Nintendo wii to increase energy expenditurecosts

y energy balance many children sitting in front of tvs and gamesy graph: even though we have increased energy expenditure with

wii it will only contribute small difference to amount they need in

a day not contributing that greatly to getting kids particularly

active


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benefits

y medical breakthroughs vaccinesy internet connectivity links to community environments

costs

y sedentary nature of modern day livingy energy balance in and out

advantages of environmental approaches

y able to influence entire populationy acknowledge contexty cost effectivey can reach hard to reach who must respond if environment is

changing

y radicaly lasting effect on behavioury useful in complex behaviours

Gilson experiment

y did a pre intervention environmental audity looked at campus characteristics size etcy then used audit to determine walk abilityy large differences in campus size, staff, length and route numbersy sites 8 9 10 were very poor need to change this before started

intervention

y these campus scored very lowy many campuses had poor trafficcontrols and poor cover on

routes important in terms of sustainability due to weather

changes

pop quiz

y most recently added aus gov health policy obesityy how much did maccas pay the heart foundation for tick of

approval 320 thousand

y Hippocrates and Hippocraticcorpus developed the physiocraticschool of thought

y director general of WHO Margret chow


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y when did Geoffrey rose publish his paper on individuals andpopulations 1985

y who wrote the forward in the toward q2 document Anna blighy according to q2 how many qlders are living with long term

chroniccondition 70%?


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SOCIAL MARKETING AND POP RESEARCH9/1/2010 3:06:00 AM

What is marketing?

y Process responsible for identifying, anticipating and satisfyingcustomer requirements

o Commercial marketing = financial gaino Social marketing benefits to people

y Trying to highlight benefits to peopley Commercial and social marketing beginning to blur as joint

ventures with big corporations

Why do social marketing?

y Rise in mass media, technologyy Focus on prevention and lifestyle conditionsy Individualism and free choice movementy Need for persuasive communication and behaviour changey Encouraging and advocating change

Methods of social marketing

y Limited reacho Pamphletso Info sheetso Newsletterso Posterso Tshirtso Videos, dvds

y Mass reacho Televisiono Radioo Newspaperso Magazineso Internet

y We are bombarded with images shock value may be effectiveMass media

y Tool of social marketing used to educate, motivate and advocateat population level

Social marketing: 6 principles


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y 1. Consumerorientationo What are the audiences wants, needs and motivationso Eg why would people want good food: healthy family, but

also want to save money- need

y 2.Conceptofexchangeo between supplier and consumero acknowledges cost of product eg time money etco what is got and what is given up?o Barriers and facilitators like time money and efforto What if spending the time etc gives little results?

y 3.Customer value: marketing mixo product, actual product, core product and augmented

product

o product: eg chicken free rangeo core product: healthiero augmented product: tshirts, stickers etco price - consumers perspective cheaper isn necessarily

better

o promotion how to involve peopleo place supermarkets, schoolso people ripple effect- info is passed on

y 4.Marketsegmentationo heterogeneous groupso divide market into segments and develop profile of each

segment

o develop marketing mix for each groupo ego demographic segmentationo risk factor segmentation identifying people most in need

and attacking this group

o stage segmentation divide by if they are ready to,thinking about or against change etc

y 5.Competition anddifferential advantage


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o what advantages does the product have over competition?o Who else is offering similar products?o Who is offering what how do we deal with competition

y 6.Market researcho identifies consumer priorities and valueso establishes how best to promote the heath issueso focus group and surveys may be used people involved in

decisions

o beginning middle and end ofcampaigno establish how best to promote health issue

successful media campaigns

y based on formative researchy fully understand the topicy skilled creative personnely target the messagey credible source of spokespersony realistic goals and timeframesy provide environmental supports for changey scientific input

review

y social marketing is process through which we aim to facilitatesocial change for health

y 6 principles of ity marketing mix is important concepty different types of mass media approachesy social marketing through mass media is effective for population

change


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9/1/2010 3:06:00 AM

EXAMREVIEW

what health promotion is how its defined

levels of health promotion primary secondary tertiary

aware of individuals and populations

be aware of key figures who contributed to hprm evolution

john snow, Hippocrates, industrial revolution, how hprm grew out of these

key developments

policy issues WHO how developments in our area ran through Ottawa

into alma atta into Bangkok to Nairobi

levels of prevention and their importance primary, secondary, tertiary

20thcentury getting to large groups of people

aware of government health priorities and their importance

aware of recent findings in data around Australias health 2010

key issues we are dealing with?

federal and state priorities

will be tested on health section of toward q2 key messages, what its

asking us as citizens and experts to engage with

* = key reading we need to read Q2

aware of how things have progressed on from Ottawa

not to be tested on Ottawa document itself

will be tested on Nairobi its key commitments and its ethos

readings that we have been highlighted as important for learning

issues around individuals vs populations

roses arguments MUST READ THISPAPER

have to be very aware of advantages and disadvantages of both

approaches

population section will take into account things weve talked about in

regard to environment this week and social and cultural health promotion

issues that we deal with next week

aware of individual processes talked about 5 key processes patient

education, self management etc


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some questions will be factual, some around key figures and some around

concepts

Documents

Midsem Exam Notes