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The health promotion movement recast the role of individual people, who moved from being passive recipients of health education to active participants encouraged to take responsibility for their health, mainly through improving lifestyles. As diseases of lifestyle became more prominent in the 1960s and 1970s, attention shifted towards changing behaviour and “health education” was born, subsequently broadened to “health promotion” in the 1980s. During the 1950s the social context became formally recognized and university departments were named “community health,” or “community medicine” to emphasize the role of doctors. Then, between 19, in a society concerned with diseases introduced by migrants, the development and mass application of vaccines encouraged a shift toward “health protection”. The earliest approach, termed “public hygiene”, focused on environmental sanitation. As patterns of disease evolved historically, the discipline saw a succession of names as it wrestled with whether environmental factors, or individual behaviour, or social problems should form the main target of interventions.Īs new patterns of disease unfolded during the twentieth century, the nature of public health efforts changed to keep pace, and this was reflected in changing names for the discipline. This is because, unlike other branches of medicine, public health does not address a particular organ system, type of disease or therapeutic approach, but employs a variety of approaches to address whatever health issues are most pressing in each place and time. It is a combination of programs, services, and policies that protect and promote the health of all Canadians.” 1 Unfortunately, this definition does not specify what public health actually does. “Public health is defined as the organized efforts of society to keep people healthy and prevent injury, illness, and premature death. The public health system focuses on preventing disease and protecting health (See HEALTH PROTECTION in Glossary). Rao work within the acute care system that operates alongside public health and social services systems designed to address contextual factors that exacerbate illnesses such as Peter’s asthma. It is therefore helpful to combine clinicians’ interventions for individual patients with interventions to address determinants at the community and population levels. The goal is to avoid a revolving door cycle of repeat symptomatic treatments for the effects of an enduring environmental cause. Perhaps he should notify the local public health department …Įffective disease management requires attending to the patient’s immediate problem, then tackling any modifiable factors that gave rise to the condition – in Peter Sulawesi’s case, his dilapidated and perhaps mouldy living environment. Someone else will move into the apartment, likely creating another chronic case. Rao feels pleased that he has advocated for his patient but recognizes that he cannot address the underlying cause. Sulawesi a better apartment for an affordable price. He talks to his practice nurse whose sister may be able to rent Ms. Rao’s immediate task is to treat the asthma symptoms, but he is fully aware that this will do nothing to correct the factors that will likely continue to exacerbate the asthma. The landlord refuses to make repairs to the apartment and winter is approaching. Rao tried involving social services, but they are overwhelmed with more pressing issues. She is working as a cleaning lady in the local school, in the evenings and on week-ends.
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Sulawesi is a single mother who recently immigrated to Canada with no family and few friends here. They live in a damp and poorly heated apartment above a dry-cleaners Peter has had three emergency room visits in the past month for poorly controlled asthma. Rao yet again for Peter, her three-year-old son. Linking these topics to the Medical Council exam objectives, especially section 78-1. Describe one or more models of behaviour change, including predisposing, enabling, and reinforcing factors.Discuss interventions to modify personal risk factors, and interventions to modify health at the population level.Show how these factors interact in determining health status, leading to an eco-social model of health and introducing the epidemiological triad.List the major determinants of health and describe possible mechanisms by which each determinant influences health status:.Define the basic concepts used in discussing causes of health and illness: causes, risk factors, and determinants.
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