Health Promotion
Core concepts
Know the major models: the Ottawa Charter health promotion actions (build healthy public policy, create supportive environments, strengthen community action, develop personal skills, reorient health services), the health belief model, the transtheoretical (stages of change) model, social cognitive theory, and the socio-ecological model. Be able to match an intervention to a model - for example, using stages of change to design smoking cessation support.
Approaches and evaluation
Distinguish the three classic approaches: preventive (behaviour change to avoid disease), educational (information and skills) and radical/empowerment (community and policy change). Understand the difference between health promotion, health education and disease prevention. Know the principles of evaluation: process, impact and outcome; formative and summative; and the importance of reach, uptake and sustainability.
Inequalities and ethics
Be familiar with the inverse care law, the social determinants of health, and the risk of interventions widening inequalities (the prevention paradox: a measure that brings large benefit to the population may offer little to each individual). Consider ethics: autonomy, beneficence, non-maleficence, justice, and the risk of victim-blaming.
Worked example
A campaign to reduce sugar intake that reaches mostly affluent, health-literate groups may widen the gap. A candidate should identify that upstream policy measures (taxation, reformulation, labelling) are more likely to shift population-level behaviour and reduce inequality than downstream individual advice.
Traps
Assuming information alone changes behaviour; confusing health education with health promotion; and evaluating only outcomes while ignoring process and reach.
Health Improvement and Health Service Delivery
Core concepts
Know the determinants of health (biological, behavioural, social, economic, environmental) and the concept of health inequalities and their measurement (e.g., deprivation indices, life expectancy gaps, infant mortality). Be familiar with health needs assessment (epidemiological, comparative, corporate approaches) and how it informs commissioning.
Service delivery
Understand the structure of health systems: primary, secondary and tertiary care; gatekeeping; integrated care; and the balance of access, quality, equity and cost. Know the principles of quality improvement (PDSA cycles, clinical audit, clinical governance), evidence-based commissioning, and the role of public health in commissioning. Be able to distinguish clinical audit (against standards) from research (generating new knowledge).
Prioritisation and economics
Understand the basic concepts of health economics: opportunity cost, cost-effectiveness, QALYs, and priority setting. Know that resources are finite and that rationing is inevitable; be able to reason about equity versus efficiency.
Worked example
When asked to prioritise, use a structured approach: burden of disease, effectiveness of intervention, cost-effectiveness, equity impact, acceptability and feasibility. A common trap is choosing the most clinically dramatic intervention rather than the one with the greatest population health gain per pound.
Traps
Confusing audit with research; ignoring equity when prioritising; assuming more spending always means better outcomes; and forgetting that need, demand and supply are distinct concepts.