PREVENTION AND HEALTH PROMOTION
Introduction
What is prevention science?
It is an interdisciplinary specialty that requires integration from multiple disciplines including
psychology, counseling, social work, education, health sciences, economics, and public affairs.
Psychological prevention science tries to prevent psychological and physical illnesses and to promote
overall health and wellbeing through evidence base practice at individual and systemic levels
Imagine you want the public to quit smoking: which disciplines do you need to reach? Think
of the economy for example
It is an evidence based discipline with two general aims: Advancing health and the individual and
societal levels by informing policymakers => How we will complete these aims, we will see in this
course
Other aims of prevention:
1. Reduce preventable deaths
2. Reduce the number of lost years
3. Increase the healthy life years
4. Increase quality of life
5. Reduce the economic impact of diseases
Life and illness
The differences in life expectancy across the world are a result of lifestyle and genetics:
Defining the problem and area of intervention: what are the causes of death?
Top ten global causes: vascular disorders, COPD, respiratory infections, dementias, cancers,
diabetes, road injury,…
Causes of death depends on where you live:
In high income countries the top causes of death are heart disease, stroke, dementia, lung
cancers and COPD
In low income countries they are lower respiratory infections, diarheol disease, heart disease,
AIDS, stroke and malaria
Communicable diseases are diseases spread between humans (contact sick) and hold a higher place in
the cause of death list in low income countries => different type of prevention needed in these
countries compared to high income countries
Examples: lower respiratory infection, AIDS, malaria, tuberculosis, birth complications
Knowing the background/context of your campaign is a must!
Definitions
Preventable deaths: Number of deaths that could be potentially prevented either by prevention, or by
medical intervention (treatable)
Premature deaths: Deaths occurring before the age of 75 (number of deaths calculated as a
percentage of the total deaths)
Years of Life Lost: Number of years that people loose due to death/illness (if someone is expected to live to
80y and she dies at 60, then the YLL equals 20)
1
,Years Lost to Disability (YLD): Number of years that a person lives with a limitation
Healthy life expectancy: Life expectancy in good health
Disability-Adjusted Life Years (DALY): Years lost by being sick or premature death, so DALY =
YLL + YLD
Quality-Adjusted Life Years (QALY): Improvement in quality of living after an intervention
Disability: an umbrella term, covering impairments, activity limitations, and participation restrictions.
An impairment is a problem in body function or structure; an activity limitation is a difficulty
encountered by an individual in executing a task or action; while a participation restriction is a
problem experienced by an individual in involvement in life situations. Disability is thus not just a
health problem. It is a complex phenomenon, reflecting the interaction between features of a person’s
body and features of the society in which he or she lives
Disability is always chronic – it is different from a temporary health restriction like a broken
bone for several weeks versus a disability being paralysed from a car crash
Quality of life: The individual’s perception of their position in life in the context of the culture and
value systems in which they live and in relation to their goals.
Risk factors:
Tobacco use and alcohol use
High blood pressure
High BMI (overweight)
Lifestyle is bound to time and culture: for example the limit of alcohol per week before
becoming problematic is ten units, but perhaps in thirty years this will be reduced to five or in
another culture then units is seen as a problem
What can we prevent?
Is cancer preventable?
Cervical cancer, linked to HPA virus is completely preventable
Lung cancer, oral cavity, oesophagus, melanoma and stomach are partly preventable
Ovary cancer, leukaemia and Non-Hodgkin lymphoma are less
than 20% preventable
Prostate and brain cancers are completely unpreventable
o We don’t even know exactly why people get brain cancer
and there are so many variants that it is too hard to decern
Coronary heart disease is preventable (graph):
Mortality rates of CHD differs across countries due to lifestyle
2
, USA and Australia highest risk, Japan lowest and Sweden middle risk
Not due to genes! Japanese people who move to USA will have same risk rates to US citizens
after few years of living there => lifestyle change
Over the years the risks have declined in Japan, USA and Australia, but have risen in England
and Sweden
We need to measure risks and benefits in absolute rather than relative terms for setting up prevention
policies:
Although such measures will describe the situation for individuals they tell us next to nothing
about the effects on the whole community of a strategy based on identifying and caring for
high-risk individuals.
The effects of a "high-risk strategy" may be more limited than we imagine, for the community
benefit depends not only on the benefit that each individual receives but also on the
prevalence of the risk factor.
o If a large benefit is conferred on only a few people then the community as a whole is
not much better off.
o Example: in familial hypercholesterolaemia affected men have a risk of premature coronary death or
more than 50'%; but fortunately it is rare. The deaths resulting from it make up less than 1 % of all
coronary deaths.
Population attributable risk = the excess risk is associated with a factor in the population as
a whole -> this depends on the product of the individual attributable risk (the excess risk in
individuals with that factor) and the prevalence of the factor in the population.
Fundamental principle in the strategy of prevention = a large number of people exposed to a low risk
is likely to produce more cases than a small number of people exposed to a high risk
We are therefore driven to consider mass approaches, of which the simplest is the endeavour
to lower the whole distribution of the risk variable by some measure in which all participate.
o For coronary heart disease: supposing that some dietary measure, such as moderation of salt
intake, were able to lower the whole blood pressure distribution, we may estimate how the
potential benefits might compare with what is currently achieved by the "high-risk" strategy of
detecting and treating hypertension.
The mass approach is inherently the only ultimate answer to the problem of a mass disease.
But, however much it may offer to the community as a whole, it offers little to each
participating individual.
o The prevention paradox = "a measure that brings large benefits to the community
offers little to each participating individual."
o To influence mass behaviour we must look to its mass determinants, which are largely
economic and social.
We may usefully distinguish two types of preventive measure.
1. The removal of an unnatural factor and the restoration of "biological normality"
a. For coronary heart disease such measures would include a substantial reduction in our intake
of saturated fat, giving up cigarettes, avoiding severe obesity and a state of permanent physical
inactivity, maybe some increase in the intake of polyunsaturated fat, and maybe avoidance of
those occupational and social conditions that are conducive to so-called "type A" behaviour.
2. Adding some other unnatural factor, in the hope of conferring protection => result: to
increase biological abnormality by an even further removal from those conditions to which we
are genetically adapted.
a. For coronary heart disease such measures include a high intake of polyunsaturates and all
forms of long-term medication. Long-term safety cannot be assured, and quite possibly harm
may outweigh benefit.
3
, Countries with higher
health expenses, in general,
have put more money in
prevention as a discipline
Graph 1: countries with
higher life expectancy
spend more per capita
(person) in healthcare ->
prevention goes hand in
hand with the accessibility
to medical treatment and
the level of this treatment
Modification of risk behaviours is level one of prevention: we want to limit risk factors as a start of
preventing illness
Tobacco use differs greatly across cultures: some countries still smoke significantly more than
others due to ideas about health etc
Alcohol use: men consistently use more alcohol than women -> who will you target in a
prevention campaign? The middle aged men with the most overuse or perhaps the teens?
When do you stop preventing alcohol, from which age?
Healthy eating and drinking: some countries let their children drink over-sugared sodas, some
countries eat less vegetables and fruits than others
Sedentary behaviour: it is known that non-active people have more health problems
Three main topics in this course: types of prevention, target groups and psychological theories => how
do we invoke change?
Definitions:
Primary prevention (Caplan): interventions designed to prevent a problem for ever occurring
across the population or within a subgroup or a system
o Like vaccinations, exercise, healthy eating, stopping with smoking, use of masks (Covid) etc
Secondary prevention (Caplan): Targets groups that are at risk for developing a problem
o Like early mammograms for women with family history of cancer
4
Introduction
What is prevention science?
It is an interdisciplinary specialty that requires integration from multiple disciplines including
psychology, counseling, social work, education, health sciences, economics, and public affairs.
Psychological prevention science tries to prevent psychological and physical illnesses and to promote
overall health and wellbeing through evidence base practice at individual and systemic levels
Imagine you want the public to quit smoking: which disciplines do you need to reach? Think
of the economy for example
It is an evidence based discipline with two general aims: Advancing health and the individual and
societal levels by informing policymakers => How we will complete these aims, we will see in this
course
Other aims of prevention:
1. Reduce preventable deaths
2. Reduce the number of lost years
3. Increase the healthy life years
4. Increase quality of life
5. Reduce the economic impact of diseases
Life and illness
The differences in life expectancy across the world are a result of lifestyle and genetics:
Defining the problem and area of intervention: what are the causes of death?
Top ten global causes: vascular disorders, COPD, respiratory infections, dementias, cancers,
diabetes, road injury,…
Causes of death depends on where you live:
In high income countries the top causes of death are heart disease, stroke, dementia, lung
cancers and COPD
In low income countries they are lower respiratory infections, diarheol disease, heart disease,
AIDS, stroke and malaria
Communicable diseases are diseases spread between humans (contact sick) and hold a higher place in
the cause of death list in low income countries => different type of prevention needed in these
countries compared to high income countries
Examples: lower respiratory infection, AIDS, malaria, tuberculosis, birth complications
Knowing the background/context of your campaign is a must!
Definitions
Preventable deaths: Number of deaths that could be potentially prevented either by prevention, or by
medical intervention (treatable)
Premature deaths: Deaths occurring before the age of 75 (number of deaths calculated as a
percentage of the total deaths)
Years of Life Lost: Number of years that people loose due to death/illness (if someone is expected to live to
80y and she dies at 60, then the YLL equals 20)
1
,Years Lost to Disability (YLD): Number of years that a person lives with a limitation
Healthy life expectancy: Life expectancy in good health
Disability-Adjusted Life Years (DALY): Years lost by being sick or premature death, so DALY =
YLL + YLD
Quality-Adjusted Life Years (QALY): Improvement in quality of living after an intervention
Disability: an umbrella term, covering impairments, activity limitations, and participation restrictions.
An impairment is a problem in body function or structure; an activity limitation is a difficulty
encountered by an individual in executing a task or action; while a participation restriction is a
problem experienced by an individual in involvement in life situations. Disability is thus not just a
health problem. It is a complex phenomenon, reflecting the interaction between features of a person’s
body and features of the society in which he or she lives
Disability is always chronic – it is different from a temporary health restriction like a broken
bone for several weeks versus a disability being paralysed from a car crash
Quality of life: The individual’s perception of their position in life in the context of the culture and
value systems in which they live and in relation to their goals.
Risk factors:
Tobacco use and alcohol use
High blood pressure
High BMI (overweight)
Lifestyle is bound to time and culture: for example the limit of alcohol per week before
becoming problematic is ten units, but perhaps in thirty years this will be reduced to five or in
another culture then units is seen as a problem
What can we prevent?
Is cancer preventable?
Cervical cancer, linked to HPA virus is completely preventable
Lung cancer, oral cavity, oesophagus, melanoma and stomach are partly preventable
Ovary cancer, leukaemia and Non-Hodgkin lymphoma are less
than 20% preventable
Prostate and brain cancers are completely unpreventable
o We don’t even know exactly why people get brain cancer
and there are so many variants that it is too hard to decern
Coronary heart disease is preventable (graph):
Mortality rates of CHD differs across countries due to lifestyle
2
, USA and Australia highest risk, Japan lowest and Sweden middle risk
Not due to genes! Japanese people who move to USA will have same risk rates to US citizens
after few years of living there => lifestyle change
Over the years the risks have declined in Japan, USA and Australia, but have risen in England
and Sweden
We need to measure risks and benefits in absolute rather than relative terms for setting up prevention
policies:
Although such measures will describe the situation for individuals they tell us next to nothing
about the effects on the whole community of a strategy based on identifying and caring for
high-risk individuals.
The effects of a "high-risk strategy" may be more limited than we imagine, for the community
benefit depends not only on the benefit that each individual receives but also on the
prevalence of the risk factor.
o If a large benefit is conferred on only a few people then the community as a whole is
not much better off.
o Example: in familial hypercholesterolaemia affected men have a risk of premature coronary death or
more than 50'%; but fortunately it is rare. The deaths resulting from it make up less than 1 % of all
coronary deaths.
Population attributable risk = the excess risk is associated with a factor in the population as
a whole -> this depends on the product of the individual attributable risk (the excess risk in
individuals with that factor) and the prevalence of the factor in the population.
Fundamental principle in the strategy of prevention = a large number of people exposed to a low risk
is likely to produce more cases than a small number of people exposed to a high risk
We are therefore driven to consider mass approaches, of which the simplest is the endeavour
to lower the whole distribution of the risk variable by some measure in which all participate.
o For coronary heart disease: supposing that some dietary measure, such as moderation of salt
intake, were able to lower the whole blood pressure distribution, we may estimate how the
potential benefits might compare with what is currently achieved by the "high-risk" strategy of
detecting and treating hypertension.
The mass approach is inherently the only ultimate answer to the problem of a mass disease.
But, however much it may offer to the community as a whole, it offers little to each
participating individual.
o The prevention paradox = "a measure that brings large benefits to the community
offers little to each participating individual."
o To influence mass behaviour we must look to its mass determinants, which are largely
economic and social.
We may usefully distinguish two types of preventive measure.
1. The removal of an unnatural factor and the restoration of "biological normality"
a. For coronary heart disease such measures would include a substantial reduction in our intake
of saturated fat, giving up cigarettes, avoiding severe obesity and a state of permanent physical
inactivity, maybe some increase in the intake of polyunsaturated fat, and maybe avoidance of
those occupational and social conditions that are conducive to so-called "type A" behaviour.
2. Adding some other unnatural factor, in the hope of conferring protection => result: to
increase biological abnormality by an even further removal from those conditions to which we
are genetically adapted.
a. For coronary heart disease such measures include a high intake of polyunsaturates and all
forms of long-term medication. Long-term safety cannot be assured, and quite possibly harm
may outweigh benefit.
3
, Countries with higher
health expenses, in general,
have put more money in
prevention as a discipline
Graph 1: countries with
higher life expectancy
spend more per capita
(person) in healthcare ->
prevention goes hand in
hand with the accessibility
to medical treatment and
the level of this treatment
Modification of risk behaviours is level one of prevention: we want to limit risk factors as a start of
preventing illness
Tobacco use differs greatly across cultures: some countries still smoke significantly more than
others due to ideas about health etc
Alcohol use: men consistently use more alcohol than women -> who will you target in a
prevention campaign? The middle aged men with the most overuse or perhaps the teens?
When do you stop preventing alcohol, from which age?
Healthy eating and drinking: some countries let their children drink over-sugared sodas, some
countries eat less vegetables and fruits than others
Sedentary behaviour: it is known that non-active people have more health problems
Three main topics in this course: types of prevention, target groups and psychological theories => how
do we invoke change?
Definitions:
Primary prevention (Caplan): interventions designed to prevent a problem for ever occurring
across the population or within a subgroup or a system
o Like vaccinations, exercise, healthy eating, stopping with smoking, use of masks (Covid) etc
Secondary prevention (Caplan): Targets groups that are at risk for developing a problem
o Like early mammograms for women with family history of cancer
4
