Health Promotion and Disease Prevention - Lectures
Lecture 1 Introduction
This lecture is aimed to refresh the student’s knowledge about the basic elements of the field of health
promotion & disease prevention. Next, information about the set-up of the course, content and
assignment will be provided.
Types of prevention
Primary = to prevent (develop) of diseases
Secondary = early detection/screening diseases
Tertiary = prevent/reduce the seriousness/or complications of diseases
Universal, selective and indicated prevention
Universal = designed to reach the entire population, without regard to individual risk factors and are
intended to reach a very large audience
Selective = target subgroups of the general population that are determined to be at risk for a disease.
Subgroups may be distinguished by traits such as age, gender, family history, or economic status
Indicated = involves a screening process, and aims to identify individuals who exhibit early signs of a
disease and other problem behaviours
Primary, secondary of tertiary prevention?
→ primary (increase awereness, knowledge)
→ tertiary (self-management)
→ secondary and tertiary
1. stepped care = providing care within steps, starting
with doing nothing and building up to
2. subthreshold depression = subclinical depression
3. cluster randomized controlled trial
4. outcome = preventing depression
5 setting = e.g. hospital, GP’s
, Types of prevention
Palliative care = to relieve the pain of the
patient, mostly for terminally ill patients
Levels of interventions
- Society
- Community
- Organization
- Interpersonal
- Individual
Tools or instruments
- Education
- Facilities
- Legislature/law → control and sanction/penalties
- Prising
Many health problems... (CVD, obesity, DM type 2, hypercholesterolemia, high blood pressure,
STD’s, asthma, depression) ...are determined by both environmental and lifestyle factors (health
behavior).
Lifestyle factors
1. BRAVVO (acronyme)
> Bewegen, Roken, Alcohol, Voeding, Veilige seks, Ontspanning/stress
2. the BeeBOFT Study (acronyme)
> primary prevention of overweight in preschool children
> Breastfeeding, Breakfast daily, Outside playing, Few sugar sweetened drinks, TV viewing
Health problems ←→ Lifestyle factors
CVD Physical activity
Obesity Smoking
DM type 2 Alcohol
Hypercholesterolaemia Nutrition
High blood pressure Nutrition
STD’s Sexual behavior
Lifestyle factors Risk factors
Physical exercise Low level of physical exercise
Smoking 20 cigarettes per day
Alcohol > 7 units a day
Nutrition High fat, salt, sugar intake, low fiber intake
Sexual behavior No condom use
Health promotion = maintain peoples current health status...and
ideally a shift towards better health
> ‘smoking reduction’ with the aim to maintain an optimal
respiratory- and CV-system
Disease prevention = to prevent people getting a disease...and
prevent a shift towards the seriousness of a disease
> ‘smoking reduction’ with the aim to reduce the chance of getting lung cancer
,Relation HP ←→ DP: many lifestyle factors…focus of HP → effect on DP
Lecture 2 Environment
This lecture is about the environment of healthy lifestyles and more specifically about "Geographies of
Food Consumption". It will focus on how busy and dynamic lifestyles of urban dwellers, in combination
with the food-abundant environment we live in nowadays, affect dietary behavior.
Environment determinants for behavior and health
When it comes it overweight and obesity, an environmental factor is the availability of healthy food. A
person may have the knowledge of how to eat healthy, but if the resources are not available, he
cannot change this (bad) behavior.
The ANGELO-framework: there are different types of environments and size
“Dissecting Obsesogenic Environments: The Development and Application of a Framework for
Identifying and Prioritizing Environmental Interventions for Obesity.”
Micro Meso Macro
Socio-cultural
Physical
Economic
Policy
Socio-ecological models
Lalonde Framework
Dahlgreen and Whitehead
EnRG Framework
Evidence?
, - SEP (socio-economic position)
- Influence of social network
Conclusion of a research article among obesogenic environments, a systematic
review of the association between the physical environment and adult weight
status, the SPOTLIGHT project:
“With the exception of urban sprawl and land use mix in the US the results of
the current review confirm that the available research does not allow robust
identification of ways in which that physical environment influences adult weight
status, even after taking into account methodological quality.”
- Evidence is scarce: healthy food often more expensive; taxes on sugary drinks
are outcomes of latest researches
Scarce evidence due to
1. study designs (cross-sectional (often used),
longitudinal (difficult), experimental (not always
ethical))
2. self-selection
3. definition of exposure
4. subjective vs objective measurements (mismatch:
environment measurements, behavior, health)
5. complex system (we don’t live in a grid:
knowledge, motivation, self-regulation)
Summary
• Environment has great influence on behavior and health
• Environment: broad concept, structuring (ANGELO)
• Relationship between environmental factors, behavior and health: socio-ecological models
• Do offer handholds for practice and research
• Do not always do justice to the complexity of ‘real life’
• Diverse issues in research
• The whole system (cannot) be captured – parts can
• No ‘silver bullet’
Lecture 3 Intervention Mapping
Sets out insight into the fundamental elements of Intervention mapping; designing theory- and
evidence-based health promotion programs. It will focus on the rationale for a systematic approach to
intervention development and will list the steps, processes, and products of intervention mapping
making use of examples, with a special attention to step 2, the formulation of program objectives.
Why are we interested in Intervention Mapping?
- planning
- development
- maps the path from recognition of a need or problem to the identification of a solution
Why do we use planning?
Maps the path from recognition of a need or problem to the identification of a solution; this is also
what we do in Health Promotion:
Solution → Problem
Intervention → Health Problem
Lecture 1 Introduction
This lecture is aimed to refresh the student’s knowledge about the basic elements of the field of health
promotion & disease prevention. Next, information about the set-up of the course, content and
assignment will be provided.
Types of prevention
Primary = to prevent (develop) of diseases
Secondary = early detection/screening diseases
Tertiary = prevent/reduce the seriousness/or complications of diseases
Universal, selective and indicated prevention
Universal = designed to reach the entire population, without regard to individual risk factors and are
intended to reach a very large audience
Selective = target subgroups of the general population that are determined to be at risk for a disease.
Subgroups may be distinguished by traits such as age, gender, family history, or economic status
Indicated = involves a screening process, and aims to identify individuals who exhibit early signs of a
disease and other problem behaviours
Primary, secondary of tertiary prevention?
→ primary (increase awereness, knowledge)
→ tertiary (self-management)
→ secondary and tertiary
1. stepped care = providing care within steps, starting
with doing nothing and building up to
2. subthreshold depression = subclinical depression
3. cluster randomized controlled trial
4. outcome = preventing depression
5 setting = e.g. hospital, GP’s
, Types of prevention
Palliative care = to relieve the pain of the
patient, mostly for terminally ill patients
Levels of interventions
- Society
- Community
- Organization
- Interpersonal
- Individual
Tools or instruments
- Education
- Facilities
- Legislature/law → control and sanction/penalties
- Prising
Many health problems... (CVD, obesity, DM type 2, hypercholesterolemia, high blood pressure,
STD’s, asthma, depression) ...are determined by both environmental and lifestyle factors (health
behavior).
Lifestyle factors
1. BRAVVO (acronyme)
> Bewegen, Roken, Alcohol, Voeding, Veilige seks, Ontspanning/stress
2. the BeeBOFT Study (acronyme)
> primary prevention of overweight in preschool children
> Breastfeeding, Breakfast daily, Outside playing, Few sugar sweetened drinks, TV viewing
Health problems ←→ Lifestyle factors
CVD Physical activity
Obesity Smoking
DM type 2 Alcohol
Hypercholesterolaemia Nutrition
High blood pressure Nutrition
STD’s Sexual behavior
Lifestyle factors Risk factors
Physical exercise Low level of physical exercise
Smoking 20 cigarettes per day
Alcohol > 7 units a day
Nutrition High fat, salt, sugar intake, low fiber intake
Sexual behavior No condom use
Health promotion = maintain peoples current health status...and
ideally a shift towards better health
> ‘smoking reduction’ with the aim to maintain an optimal
respiratory- and CV-system
Disease prevention = to prevent people getting a disease...and
prevent a shift towards the seriousness of a disease
> ‘smoking reduction’ with the aim to reduce the chance of getting lung cancer
,Relation HP ←→ DP: many lifestyle factors…focus of HP → effect on DP
Lecture 2 Environment
This lecture is about the environment of healthy lifestyles and more specifically about "Geographies of
Food Consumption". It will focus on how busy and dynamic lifestyles of urban dwellers, in combination
with the food-abundant environment we live in nowadays, affect dietary behavior.
Environment determinants for behavior and health
When it comes it overweight and obesity, an environmental factor is the availability of healthy food. A
person may have the knowledge of how to eat healthy, but if the resources are not available, he
cannot change this (bad) behavior.
The ANGELO-framework: there are different types of environments and size
“Dissecting Obsesogenic Environments: The Development and Application of a Framework for
Identifying and Prioritizing Environmental Interventions for Obesity.”
Micro Meso Macro
Socio-cultural
Physical
Economic
Policy
Socio-ecological models
Lalonde Framework
Dahlgreen and Whitehead
EnRG Framework
Evidence?
, - SEP (socio-economic position)
- Influence of social network
Conclusion of a research article among obesogenic environments, a systematic
review of the association between the physical environment and adult weight
status, the SPOTLIGHT project:
“With the exception of urban sprawl and land use mix in the US the results of
the current review confirm that the available research does not allow robust
identification of ways in which that physical environment influences adult weight
status, even after taking into account methodological quality.”
- Evidence is scarce: healthy food often more expensive; taxes on sugary drinks
are outcomes of latest researches
Scarce evidence due to
1. study designs (cross-sectional (often used),
longitudinal (difficult), experimental (not always
ethical))
2. self-selection
3. definition of exposure
4. subjective vs objective measurements (mismatch:
environment measurements, behavior, health)
5. complex system (we don’t live in a grid:
knowledge, motivation, self-regulation)
Summary
• Environment has great influence on behavior and health
• Environment: broad concept, structuring (ANGELO)
• Relationship between environmental factors, behavior and health: socio-ecological models
• Do offer handholds for practice and research
• Do not always do justice to the complexity of ‘real life’
• Diverse issues in research
• The whole system (cannot) be captured – parts can
• No ‘silver bullet’
Lecture 3 Intervention Mapping
Sets out insight into the fundamental elements of Intervention mapping; designing theory- and
evidence-based health promotion programs. It will focus on the rationale for a systematic approach to
intervention development and will list the steps, processes, and products of intervention mapping
making use of examples, with a special attention to step 2, the formulation of program objectives.
Why are we interested in Intervention Mapping?
- planning
- development
- maps the path from recognition of a need or problem to the identification of a solution
Why do we use planning?
Maps the path from recognition of a need or problem to the identification of a solution; this is also
what we do in Health Promotion:
Solution → Problem
Intervention → Health Problem
