In this series of public health articles, you will be able to learn about the fundamentals of public health which will serve you well for your medical school interviews. These principles will help you to understand how medicine and public health are intertwined especially as a result of the Coronavirus pandemic.
Health promotion is a key discipline of public health which highlights the idea that a healthy lifestyle should be actively encouraged, stimulated and fostered. This reflects on the ‘prevention is better than cure’ ideology which is at the core of public health.
Promoting health and healthy behaviours is the role and responsibility of all healthcare professionals, including doctors and also medical students. Therefore, it is important to understand some of the key theories and models which are used in health promotion and disease prevention programmes. These theories and models allow us to understand and explain health behaviour and to guide the identification, development and implementation of interventions.
Behaviour change theory is a key concept in health promotion which explains why people do and do not adopt certain health behaviours. This theory is used in many models to try to promote healthy behaviour within people to prevent disease.
One of the earliest and most widely used models is the Health Belief Model which was developed in 1966. This model focuses on individual beliefs about health conditions which in turn impacts health behaviours.
It encompasses six factors which influence health behaviours:
Perceived susceptibility – a person’s subjective perception of the risk of acquitting an illness/disease
Perceived severity – a person’s feeling of the seriousness of getting an illness/disease
Perceived benefits – person’s perception of the effectiveness of an action/behaviour change
Perceived barriers – the obstacles in performing a certain health action
Cue to action – stimulus needed to trigger a decision-making process
Self-efficacy – level of confidence a person has in their own ability to successfully perform an action.
When creating health promotion programmes and interventions using this model, researchers aim to target these six areas to enable healthy behaviour change.
Let’s see how this Health Belief Model fits in the recent 2020 Better Health Campaign introduced by the UK Government to help promote behaviour change and to tackle obesity in the UK. This campaign reiterates and clarifies the health consequences of obesity such as cardiovascular disease, type 2 diabetes, some types of cancer and a range of other chronic conditions.
It also provides new information about COVID-19 and how it can increase the risk of being admitted to hospital, to intensive care units and die from COVID-19, compared to those of healthy body weight status. This information will influence perceived susceptibility, severity and benefits.
This campaign also understands that the main issues surrounding obesity is not that people are not aware of the negative impacts, but more so the many barriers that prevent people from making healthy choices. Hence, it has introduced new legislations to help tackle these barriers such as expanding weight management services so a wider range of people can get help, adding calories labels on menus in restaurants, cafes and takeaways as many people face the barrier of just not knowing which foods contain a lot of calories.
It has also provided weight loss plans to assist in overcoming barriers that individuals face. GPs and healthcare professionals are often a first port of call for people seeking health advice, therefore, they act as strong cues for action. Therefore, a new programme will be brought forward to provide incentives for GPs and referral pathways into weight management services. This will act as a stronger trigger for people to start thinking more about obesity when it comes from expert medical advice.
Finally, this new campaign really empathises on empowering to make right and informed choices by providing easy and accessible ways for people to understand healthy choices surrounding weight. Schemes such as ‘traffic light’ food labelling and calories on menus aim to empower people to be able to make their own choices and feel confident that they are informed.
Although this new campaign has used the Health Belief Model to target individual behaviour change, it does have some limitations. The Health Belief Model fails to take into consideration individual attitudes, beliefs and other determinants which might dictate a person’s acceptance of a health behaviour.
One example of this in the Better Health campaign is the addition of calories on menus which may actually prevent people with certain eating disorders to wisely pick their food options. Individuals with eating disorders have different beliefs around calories and food, therefore, although adding calories may make people pick options with less calories in, is it hindering people with eating disorders to even eat comfortably further affecting their mental health?
Further, this model does not account for socioeconomic and environmental factors which play a huge role in eating healthy.
Obesity is often more prevalent within areas of lower socioeconomic status. Access to healthy food options, which are generally more expensive, is limited within these populations. Therefore, people resort to cheaper unhealthier food options. Sometimes individual health beliefs cannot be implemented due to the environment that people live in.
To account for this, other models have been created such as Tannahill’s New Model of health promotion which understands there are overlapping areas of: social, economic, physical environment and cultural factors; equity and diversity; education and learning; services, amenities and products and community-led and community-based activities.
This is a much better model for health promotion as it considers the many interacting determinants of health. Healthcare professionals should understand such models and how they have been implemented in health promotion programmes to ensure all their patients are able to improve their health regardless of their background.