Health Promotion and Public Health
Core concepts
Health promotion is the process of enabling people to increase control over, and to improve, their health. Public health works at population level to prevent disease and prolong life. Candidates must know the three levels of prevention: primary (before disease occurs, e.g. immunisation, fluoridation), secondary (early detection, e.g. screening), and tertiary (limiting disability and rehabilitation). Also know the Ottawa Charter's five action areas: build healthy public policy, create supportive environments, strengthen community action, develop personal skills, and reorient health services. Be able to distinguish health promotion (enabling, upstream) from health education (information-giving) and from health protection (regulation, e.g. smoke-free legislation). Models to name include the health belief model, stages of change (transtheoretical) model, and social cognitive theory.
Traps in questions
Examiners often test the difference between equality (same for all) and equity (fair, targeted to need). Another trap is confusing incidence (new cases over a period) with prevalence (all existing cases at a point or over a period). Watch for questions that describe a screening programme and ask which prevention level it represents - screening is secondary, not primary. Also be careful with the precaution adoption process and stages of change: relapse is a recognised stage, not a failure.
Worked rule of thumb
When asked to classify an intervention, ask: does it stop disease before it starts (primary), find it early (secondary), or reduce its consequences (tertiary)? For example, a workplace stop-smoking clinic is primary prevention; a cervical screening invitation is secondary; a cardiac rehabilitation programme is tertiary.
Applying it
Use the health inequalities lens: the Marmot principles emphasise proportionate universalism - actions universal but with intensity scaled to need. Always link interventions to a measurable outcome and a defined population.