HEALTH PROMOTION & DISEASE PREVENTION
LECTURE 1: INTRODUCTION
Goals
• Able to name and apply different types of prevention & intervention levels.
• To name and determine the different tools and instruments for HPDP interventions.
• Able to distinguish lifestyle & risk factors & HPDP definitions.
Types of prevention
• Primary: to prevent (development) of diseases. Example: pictures on cigarettes,
condoms for preventing HIV.
• Secondary: screening of diseases/early detection. Example: breast cancer screening
• Tertiary: prevent/reduce the seriousness/or complications of diseases.
• Palliative care: end of life care, to relieve the pain of the patient, mostly for terminally
ill people.
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: aims to identify individuals who exhibit early signs of a disease and
other related problem behaviors associated with a health problem and target them
with special programs.
Levels of interventions
Individual: this is your mother, grandmother, sisters, friends.
Interpersonal: for example, help to resolve disputes and
conflicts between individuals or small groups.
Organization: address problems within their teams and may
provide support.
Community: provide intervention and support for individuals
and families within a community.
Society: advocate for societal change, intervene in issues
affecting larger populations.
,Tools or instruments in interventions
• Education
• Facilities: sports facility.
• Legislature/law, for example: sugar tax and it is not allowed to smoke everywhere.
• Control & sanction penalties.
• Prizing
Many health problems are determined by both environmental and lifestyle factors (health
behavior). For example:
• CVD
• Obesity
• Diabetes mellitus 2
• Hypercholesterolemia
• High blood pressure
• STD’s
• Asthma
• Depression
Lifestyle
BRAVVO
• B: bewegen (physical activity)
• R: roken (smoking)
• A: alcohol
• V: voeding (nutrition)
• V: veilige seks (safe sex)
• O: ontspanning/stress
Lifestyle factors
Primary prevention of overweight in preschool children
• The BEEboft study
o B: breastfeeding
o B: breakfast daily
o O: outside playing
o F: few sugars sweetened drinks.
o T: TV viewing.
Lifestyle factors Risk factors
• Physical exercise • low level of physical exercise.
• Smoking • > 10 cigarettes a day.
• Alcohol • > 7 units a day
• Nutrition • High fat, salt and sugar intake. Low fiber intake.
• Sex behavior • No condom use
,HP&DP
• Health promotion: maintain peoples current health status… and ideally a shift towards
better health.
• Disease prevention: to prevent people getting a disease… and prevent a shift
towards the seriousness of a disease.
HP: Smoking reduction with the aim to maintain an optimal respiratory and CV-system.
DP: Smoking reduction with the aim to reduce the change of getting lung cancer.
Relation HP <--> DP
Many lifestyles factors.
, LECTURE 2 UPSTREAM DETERMINANT OF LIFESTYLE BEHAVIORS AND CHRONIC
DISEASE RISK
The problem: our bodies are made to store fats and go for longer periods of time in food
scarcity, but now we live in a world where food is mostly readily available to us.
Factors determining health:
• Socio-cultural
• Physical
• Economic
• Political
At different levels
• Micro
• Meso
• Macro
Micro socio-cultural: eating dinner with the tv on.
Meso physical: what restaurants are there in the neighborhoods.
Macro-economic: international trade relations.
• Commercial determinants of health are also becoming increasingly more important.
The evidence in a nutshell
• Socio-economic position (SEP) is an important determinant of obesity. Lower SEP =
higher odds of obesity
• Healthier diets are generally more costly. Pricing strategies (discounts) are effective,
especially when salient (communicated; ‘’the price was … now it is …’’). Most
evidence from controlled settings.
o Effect on weight status and disease outcomes yet to be determined.
• Political environment:
o Mandatory food labeling works
o Car free streets/Sundays
o Advertisement ban on unhealthy foods.
o Healthier canteens at schools
o Physical education policy
o Taxation of sugar sweetened beverages.
Challenges in up-stream research
• Study designs (cannot perform an RCT on a whole city)
• Self-selection: people decide how much they can spend or where they live. May like
to walk so explicitly decide to live in a walkable city.
• Confounding factors: fast food outlets co-locate with greener/more
walkable/healthier aspects of the neighborhoods.
• Non-linear relations.
• Area of exposure.
• Single exposure studies (but we are exposed to many determinants at the same
time).
o Interaction between these factors.
Evolution of behavioral theories
• There are a lot of behavioral psychology frameworks.
• There is a strong relation between the importance of the environment and the
motivation for healthy behaviors.
LECTURE 1: INTRODUCTION
Goals
• Able to name and apply different types of prevention & intervention levels.
• To name and determine the different tools and instruments for HPDP interventions.
• Able to distinguish lifestyle & risk factors & HPDP definitions.
Types of prevention
• Primary: to prevent (development) of diseases. Example: pictures on cigarettes,
condoms for preventing HIV.
• Secondary: screening of diseases/early detection. Example: breast cancer screening
• Tertiary: prevent/reduce the seriousness/or complications of diseases.
• Palliative care: end of life care, to relieve the pain of the patient, mostly for terminally
ill people.
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: aims to identify individuals who exhibit early signs of a disease and
other related problem behaviors associated with a health problem and target them
with special programs.
Levels of interventions
Individual: this is your mother, grandmother, sisters, friends.
Interpersonal: for example, help to resolve disputes and
conflicts between individuals or small groups.
Organization: address problems within their teams and may
provide support.
Community: provide intervention and support for individuals
and families within a community.
Society: advocate for societal change, intervene in issues
affecting larger populations.
,Tools or instruments in interventions
• Education
• Facilities: sports facility.
• Legislature/law, for example: sugar tax and it is not allowed to smoke everywhere.
• Control & sanction penalties.
• Prizing
Many health problems are determined by both environmental and lifestyle factors (health
behavior). For example:
• CVD
• Obesity
• Diabetes mellitus 2
• Hypercholesterolemia
• High blood pressure
• STD’s
• Asthma
• Depression
Lifestyle
BRAVVO
• B: bewegen (physical activity)
• R: roken (smoking)
• A: alcohol
• V: voeding (nutrition)
• V: veilige seks (safe sex)
• O: ontspanning/stress
Lifestyle factors
Primary prevention of overweight in preschool children
• The BEEboft study
o B: breastfeeding
o B: breakfast daily
o O: outside playing
o F: few sugars sweetened drinks.
o T: TV viewing.
Lifestyle factors Risk factors
• Physical exercise • low level of physical exercise.
• Smoking • > 10 cigarettes a day.
• Alcohol • > 7 units a day
• Nutrition • High fat, salt and sugar intake. Low fiber intake.
• Sex behavior • No condom use
,HP&DP
• Health promotion: maintain peoples current health status… and ideally a shift towards
better health.
• Disease prevention: to prevent people getting a disease… and prevent a shift
towards the seriousness of a disease.
HP: Smoking reduction with the aim to maintain an optimal respiratory and CV-system.
DP: Smoking reduction with the aim to reduce the change of getting lung cancer.
Relation HP <--> DP
Many lifestyles factors.
, LECTURE 2 UPSTREAM DETERMINANT OF LIFESTYLE BEHAVIORS AND CHRONIC
DISEASE RISK
The problem: our bodies are made to store fats and go for longer periods of time in food
scarcity, but now we live in a world where food is mostly readily available to us.
Factors determining health:
• Socio-cultural
• Physical
• Economic
• Political
At different levels
• Micro
• Meso
• Macro
Micro socio-cultural: eating dinner with the tv on.
Meso physical: what restaurants are there in the neighborhoods.
Macro-economic: international trade relations.
• Commercial determinants of health are also becoming increasingly more important.
The evidence in a nutshell
• Socio-economic position (SEP) is an important determinant of obesity. Lower SEP =
higher odds of obesity
• Healthier diets are generally more costly. Pricing strategies (discounts) are effective,
especially when salient (communicated; ‘’the price was … now it is …’’). Most
evidence from controlled settings.
o Effect on weight status and disease outcomes yet to be determined.
• Political environment:
o Mandatory food labeling works
o Car free streets/Sundays
o Advertisement ban on unhealthy foods.
o Healthier canteens at schools
o Physical education policy
o Taxation of sugar sweetened beverages.
Challenges in up-stream research
• Study designs (cannot perform an RCT on a whole city)
• Self-selection: people decide how much they can spend or where they live. May like
to walk so explicitly decide to live in a walkable city.
• Confounding factors: fast food outlets co-locate with greener/more
walkable/healthier aspects of the neighborhoods.
• Non-linear relations.
• Area of exposure.
• Single exposure studies (but we are exposed to many determinants at the same
time).
o Interaction between these factors.
Evolution of behavioral theories
• There are a lot of behavioral psychology frameworks.
• There is a strong relation between the importance of the environment and the
motivation for healthy behaviors.
