Lectures Health Promotion
& Disease Prevention
Course of the master Health Sciences (VU)
Content
Introduction lecture .......................................................................................................................................................... 1
Upstream determinants of lifestyle behaviours and chronic disease risk ........................................................................ 2
Hearing impairments ........................................................................................................................................................ 7
Community action: a transdisciplinary approach to health promotion ......................................................................... 14
Quality of life ................................................................................................................................................................... 20
Evaluation ....................................................................................................................................................................... 24
Sample size calculation and analysis of RCT data ........................................................................................................... 27
Green spaces and health................................................................................................................................................. 33
Economic evaluations ..................................................................................................................................................... 41
Implementation .............................................................................................................................................................. 48
Ethics ............................................................................................................................................................................... 59
,Introduction lecture
Aims
- To provide a solid basis in understanding elementary aspects of evidence- and theory-based designing of a
health promotion and disease prevention program
- To write a scientific study protocol in English about the design and evaluation of a preventive health
intervention program
- Needs assessment/problem analysis
- Program objectives
- Theory based methods and practical strategies
- Program plan
- Implementation plan
- Evaluation plan
➔ Mainly aimed at the last three (but you incorporate all 6 stages in a study protocol)
Learning objectives of this lecture:
- Able to name and apply different types of prevention and intervention levels
- To name and determine the different tools and instruments for HPDP interventions
- Able to distinguish lifestyle and risk factors & HPDP definitions
Types of prevention
- Primary = to prevent (development) of diseases
- For example: eating healthy to prevent
overweight
- Secondary = screening of diseases/early
detection (in a stage where you can intervene)
- For example: screening programs for
breast cancer, colon cancer, cervical cancer
- Tertiary = prevent/reduce the seriousness/or complications of diseases
- For example: physiotherapy for back pain
- Palliative = end of life care, to relieve the pain of the patient, mostly for terminally ill people
A different categorization:
- 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
Levels of interventions
- Most interventions focus on the individual level
1
,Tools or instruments
- Education
- Facilities
- Legislature/law → control and sanction/penalties
- Prising → also legislation, but on prising
Difference between lifestyle and risk factors
Many health problems are determined by both environmental and lifestyle factors (health behaviour) → CVD,
obesity, DM2, hypercholesterolaemia, high blood pressure, STDs, asthma, depression, etc.
- Lifestyle factors: BRAVVO (physical activity, smoking, alcohol, nutrition, safe sex, stress)
- Health problems and lifestyle factors are related
- Risk factors: low level of physical exercise, >10 cigarettes a day, >7 units a day (alcohol), high fat/salt/sugar
intake, low fiber intake, no condom use
Difference between health promotion and disease prevention
- 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
Example:
- ‘Smoking reduction’ with the aim to maintain an optimal respiratory- and cardiovascular-system = health
promotion
- ‘Smoking reduction’ with the aim to reduce the chance of getting lung cancer = disease prevention
Relation HP <-> DP:
- Many lifestyle factors
Assignment: Writing a study protocol
- Read the course manual: literature, instructions for authors, structure of study protocol and abstract,
guidelines for peer review
- Study protocol about the planned development of a preventive health intervention
- Topic related to the lifestyle and chronic diseases field
- Three tutorials
Upstream determinants of lifestyle behaviours and chronic disease risk
Learning objectives:
- Know what upstream determinants are, and how they can be structured
- Know the key challenges in upstream research
- Know how theoretic frameworks evolved, and why complex adaptive systems are now in fashion
- Have a better picture of this field in research
2
,What are upstream determinants?
- Non-communicable diseases are caused by unhealthy metabolic states (high blood pressure, overweight,
etc.) driven by unhealth lifestyle
- The lifestyle behaviours are determinants like unhealthy metabolic states, but they are more
upstream
- There are also individual determinants, like knowledge and psychological factors
- Even higher upstream: the environment (build environment, friends, economy, policy) → for
example there are many more fast-food options in shopping malls compared to healthy options
- Genome vs. exposome
Structuring environmental determinants
ANGELO framework
The evidence
The socio-cultural environment
- SEP (socio-economic position)
- Social capital
- Social network
3
, The evidence is mostly from economic field:
- Healthier diets are more costly
- Pricing strategies are effective: taxing/discounts; especially if salient
- Effect on NCDs (non-communicable diseases) yet to be determined
Political environment
- Taxation of SSB (sugar-sweetened beverages) is effective
- Mandatory food labelling
- Car-free streets/Sundays
- Advertisement ban
- Schools: healthier canteens
- Physical education policy
Physical/build environment
- Fast-food exposure, urbanisation, land use mix and urban sprawl → associated with obesity
- Higher degree of urbanization → higher degree of obesity
- Urbanized area → more diabetes
- Higher green space → lower risk of diabetes
- Higher walkability → lower risk of diabetes
Evidence base is relatively thin
Challenges in upstream research
- Study designs: RCTs of environmental factors often not possible
- Self-selection: people who are more active look to live in an environment where they can be active (so is
activity caused by the environment then?)
- Area of exposure: what is a person’s activity space (what area does he/she face)?
- Defining exposure: for example how do you measure the amount of food outlets
- Mismatch
- Subjective/objective data (self-reported questionnaires vs. accelerometer)
- Interactions
4
& Disease Prevention
Course of the master Health Sciences (VU)
Content
Introduction lecture .......................................................................................................................................................... 1
Upstream determinants of lifestyle behaviours and chronic disease risk ........................................................................ 2
Hearing impairments ........................................................................................................................................................ 7
Community action: a transdisciplinary approach to health promotion ......................................................................... 14
Quality of life ................................................................................................................................................................... 20
Evaluation ....................................................................................................................................................................... 24
Sample size calculation and analysis of RCT data ........................................................................................................... 27
Green spaces and health................................................................................................................................................. 33
Economic evaluations ..................................................................................................................................................... 41
Implementation .............................................................................................................................................................. 48
Ethics ............................................................................................................................................................................... 59
,Introduction lecture
Aims
- To provide a solid basis in understanding elementary aspects of evidence- and theory-based designing of a
health promotion and disease prevention program
- To write a scientific study protocol in English about the design and evaluation of a preventive health
intervention program
- Needs assessment/problem analysis
- Program objectives
- Theory based methods and practical strategies
- Program plan
- Implementation plan
- Evaluation plan
➔ Mainly aimed at the last three (but you incorporate all 6 stages in a study protocol)
Learning objectives of this lecture:
- Able to name and apply different types of prevention and intervention levels
- To name and determine the different tools and instruments for HPDP interventions
- Able to distinguish lifestyle and risk factors & HPDP definitions
Types of prevention
- Primary = to prevent (development) of diseases
- For example: eating healthy to prevent
overweight
- Secondary = screening of diseases/early
detection (in a stage where you can intervene)
- For example: screening programs for
breast cancer, colon cancer, cervical cancer
- Tertiary = prevent/reduce the seriousness/or complications of diseases
- For example: physiotherapy for back pain
- Palliative = end of life care, to relieve the pain of the patient, mostly for terminally ill people
A different categorization:
- 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
Levels of interventions
- Most interventions focus on the individual level
1
,Tools or instruments
- Education
- Facilities
- Legislature/law → control and sanction/penalties
- Prising → also legislation, but on prising
Difference between lifestyle and risk factors
Many health problems are determined by both environmental and lifestyle factors (health behaviour) → CVD,
obesity, DM2, hypercholesterolaemia, high blood pressure, STDs, asthma, depression, etc.
- Lifestyle factors: BRAVVO (physical activity, smoking, alcohol, nutrition, safe sex, stress)
- Health problems and lifestyle factors are related
- Risk factors: low level of physical exercise, >10 cigarettes a day, >7 units a day (alcohol), high fat/salt/sugar
intake, low fiber intake, no condom use
Difference between health promotion and disease prevention
- 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
Example:
- ‘Smoking reduction’ with the aim to maintain an optimal respiratory- and cardiovascular-system = health
promotion
- ‘Smoking reduction’ with the aim to reduce the chance of getting lung cancer = disease prevention
Relation HP <-> DP:
- Many lifestyle factors
Assignment: Writing a study protocol
- Read the course manual: literature, instructions for authors, structure of study protocol and abstract,
guidelines for peer review
- Study protocol about the planned development of a preventive health intervention
- Topic related to the lifestyle and chronic diseases field
- Three tutorials
Upstream determinants of lifestyle behaviours and chronic disease risk
Learning objectives:
- Know what upstream determinants are, and how they can be structured
- Know the key challenges in upstream research
- Know how theoretic frameworks evolved, and why complex adaptive systems are now in fashion
- Have a better picture of this field in research
2
,What are upstream determinants?
- Non-communicable diseases are caused by unhealthy metabolic states (high blood pressure, overweight,
etc.) driven by unhealth lifestyle
- The lifestyle behaviours are determinants like unhealthy metabolic states, but they are more
upstream
- There are also individual determinants, like knowledge and psychological factors
- Even higher upstream: the environment (build environment, friends, economy, policy) → for
example there are many more fast-food options in shopping malls compared to healthy options
- Genome vs. exposome
Structuring environmental determinants
ANGELO framework
The evidence
The socio-cultural environment
- SEP (socio-economic position)
- Social capital
- Social network
3
, The evidence is mostly from economic field:
- Healthier diets are more costly
- Pricing strategies are effective: taxing/discounts; especially if salient
- Effect on NCDs (non-communicable diseases) yet to be determined
Political environment
- Taxation of SSB (sugar-sweetened beverages) is effective
- Mandatory food labelling
- Car-free streets/Sundays
- Advertisement ban
- Schools: healthier canteens
- Physical education policy
Physical/build environment
- Fast-food exposure, urbanisation, land use mix and urban sprawl → associated with obesity
- Higher degree of urbanization → higher degree of obesity
- Urbanized area → more diabetes
- Higher green space → lower risk of diabetes
- Higher walkability → lower risk of diabetes
Evidence base is relatively thin
Challenges in upstream research
- Study designs: RCTs of environmental factors often not possible
- Self-selection: people who are more active look to live in an environment where they can be active (so is
activity caused by the environment then?)
- Area of exposure: what is a person’s activity space (what area does he/she face)?
- Defining exposure: for example how do you measure the amount of food outlets
- Mismatch
- Subjective/objective data (self-reported questionnaires vs. accelerometer)
- Interactions
4
