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Topic 2: Sick individuals and Sick populations

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by

Cindy Holroyd

on 29 August 2014

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Transcript of Topic 2: Sick individuals and Sick populations

Why do some individuals have hypertension?
Image by Tom Mooring
Range of responses
Topic 2:
Sick individuals and Sick populations

Geoffrey Rose's paper
Individual preventive strategy
- identify high-risk susceptible individuals and offer individual protection


Why do some populations have much hypertension, whilst in some others it is rare?
Why is hypertension absent in Kenyans and common in London?
the causes of cases
(individual)
the causes of incidence
(population)
Population strategy
- control the determinants of incidence

difficulties and cost of screening
palliative/temporary, not radical
limited potential for individuals and populations
weak ability to predict future disease
behaviourally inappropriate
subject motivation
physician motivation
cost-effective
‘benefit-risk ratio’ favourable
radical
large potential for population
behaviourally appropriate
small benefit to individual
poor motivation of subject and physicians
benefit:risk ratio worrisome
Contribution
Prevention Paradox
a large number of people at low risk gives rise to more cases than a small number of people at high risk
Health Promotion
critical thinking revolution/epidemiological wars
Seminal article has been cited over 2000 times
Health Policies
What makes people healthy?
Health of Nation, UK, 1992-1997
WHO Healthier Cities
Health Promotion schools, prisons, universities
Health in all policies, Finland
two prevention strategies
high-risk individual approach
population approach
High Risk Approach
Population Approach
Vulnerable
population
Prevention and management of obesity and diabetes
Implications
Individual focus

Population focus
Medical
Behavioural
Socioenviromental
Screening
individual risk
assessment
immunisation
Health
information
Health
education
counselling
and
skll development
Social
marketing
Organisational
development
Community
development
Economic
and
regulatory
activities
Primary care

Health promotion
Downstream
Midstream
Upstream
Ottawa Charter for Health Promotion Action Areas
Strengthening community action
Healthy public policy
Reorienting health services
Creating supportive environments

Developing personal skills
Makenbach et al., 2010
Population Approach
Adams & White, 2012
Cooney et al., 2009
Charlton, 1995
Combination of both
Burton et al., 2012
Your approach?
Full transcript