Describe the modes of intervention and health promotion.

Modes of Intervention and Health Promotion

• 1. Health promotion — measures that are not directed at any particular disease but improve general health and well-being: health education, nutrition, environmental modification, lifestyle change, genetic and marital counselling, and periodic health examination
• 2. Specific protection — measures directed at a particular disease: immunisation, chemoprophylaxis, use of specific nutrients (iodised salt, iron and folic acid, vitamin A), protection against occupational hazards and accidents, protection from carcinogens and allergens, and control of environmental hazards
• 3. Early diagnosis and treatment — screening, case-finding and prompt treatment, which halts progression, prevents complications, shortens the period of communicability and limits disability. It is the weakest link in developing countries, and the point at which curative and preventive medicine meet
• 4. Disability limitation — adequate treatment to arrest the disease and prevent further complications
• The sequence of disability should be known, since it is examined — disease → impairment → disability → handicap
• Impairment is a loss or abnormality of structure or function (an organ level concept — a corneal opacity); disability is the resulting restriction of ability to perform an activity (a person level concept — inability to see); and handicap is the resulting social disadvantage (a society level concept — inability to work or attend school)
• The modern ICF terminology prefers impairment, activity limitation and participation restriction, which avoids the pejorative connotation of "handicap" and emphasises that disability arises from the interaction of the person with their environment rather than from the impairment alone
• 5. Rehabilitation — the combined and coordinated use of medical, social, educational and vocational measures to train the individual to the highest possible level of functional ability, with its medical, vocational, social and psychological components
• Health promotion in the modern sense goes beyond health education, and was redefined by the OTTAWA charter (1986) as "the process of enabling people to increase control over, and to improve, their health"
• The five action areas of the OTTAWA charter are regularly examined:
• 1. Build healthy public policy — legislation, taxation and regulation, such as tobacco control and food policy
• 2. Create supportive environments — making the healthy choice the easy choice
• 3. Strengthen community action
• 4. Develop personal skills — through education and information
• 5. Reorient health services toward prevention and promotion rather than cure alone
• Its three strategies are to enable, mediate and advocate
• The key conceptual shift is from blaming the individual to changing the environment in which choices are made
• Telling a person to eat better achieves little if healthy food is unaffordable or unavailable; legislation, pricing and availability achieve far more than exhortation — which is why tobacco taxation outperforms health education, and why victim-blaming is both unfair and ineffective
• The approaches to health promotion — medical, behavioural, educational, empowerment and social change approaches, which differ in where they locate the responsibility for health
• Make the healthy choice the easy choice, which is the phrase that captures the whole shift in health promotion
• Health promotion is not specific to any disease, unlike specific protection, which is aimed at one condition
• Disease, impairment, disability, handicap runs organ, person, society, and the sequence is examined directly
• A corneal opacity illustrates all three levels — the opacity, the blindness and the unemployability
• Modern terminology avoids the word handicap, preferring activity limitation and participation restriction
• Disability arises from interaction with the environment, not from the impairment alone, which is the social model
• Early diagnosis is the weakest link in developing countries, and is where curative and preventive medicine meet
• Taxation outperforms exhortation in tobacco control, which is the clearest evidence for structural over individual approaches
• Victim-blaming is both unfair and ineffective, since telling people to eat better achieves nothing if food is unaffordable
• Enable, mediate and advocate are the three Ottawa strategies, alongside its five action areas
• Reorienting health services is an action area, and is the one health professionals can most directly influence
• Rehabilitation aims at the highest possible function, not at cure, and coordinates medical, social, educational and vocational measures
• Specific protection includes iodised salt and iron-folic acid, which are nutrient interventions rather than vaccines