HLTH 1000 Week 2 Definition Paper Example

Promotion, Education and Prevention: Three Definitions, Three Plain Tests and Three Programs That Do Not Sort Cleanly

Student Name

Walden University

HLTH 1000: Concepts of Health Promotion

Instructor Name

Month Day, Year

Promotion, Education and Prevention: Three Definitions, Three Plain Tests and Three Programs That Do Not Sort Cleanly

Introduction

People tend to swap the terms health promotion, health education and disease prevention freely. They name different things, and the difference matters when deciding what a program is trying to change. This paper defines each term from a published source, gives each a plain-language test and then sorts three programs by those tests: a worksite step challenge, a mailed colorectal cancer screening kit and a city rule requiring calorie counts on chain restaurant menus.

Health Promotion

The Ottawa Charter frames promotion around "enabling people" to take more control of their health and to improve it (World Health Organization, 1986, p. 405). The Charter goes on to name action areas that reach well beyond the individual, including building healthy public policy and creating supportive environments. Promotion, in this sense, is about conditions as much as people.

The test for promotion is this: what made the healthier option more available, easier or cheaper? If a program changes the setting in which people make choices, such as what is offered, what it costs or what is visible, it is doing promotion.

Health Education

The health promotion glossary written by Nutbeam (1998) describes health education as consciously constructed opportunities for learning, designed to improve health literacy, including knowledge and the life skills that lead to better health. Education acts on what a person knows and can do.

The test for education is this: what does a person know or know how to do after the program that they did not know before? If the change sits inside the person, in knowledge or skill, the program is doing education. Education can happen without any change to the setting; a pamphlet, a class or a conversation with a nurse can all qualify. That independence is what makes it useful to separate education from promotion, since a program that teaches but changes nothing around the learner is relying entirely on the learner to act.

Disease Prevention

Disease prevention is usually divided into levels by the stage of the condition. Primary prevention acts before a condition exists, secondary prevention detects it early, before symptoms, and tertiary prevention limits harm once it has been diagnosed. Starfield et al. (2008) point out that these levels can blur when risk factors are themselves treated as diseases, which is a warning that the test must look at the condition, not the label.

The test for prevention is this: how far along is the condition the program targets? If a program is defined by a disease and a stage, it is doing prevention.

Applying the Tests to Three Programs

Table 1

Three Programs Sorted by Three Tests

Two of the three programs pass more than one test; only the screening kit sits mostly under one heading.

The Worksite Step Challenge

In a step challenge, employees wear pedometers or use phone apps, record daily steps and compete in teams over several weeks. A systematic review found that pedometer use was associated with increased physical activity, particularly when participants had a step goal (Bravata et al., 2007). The program passes the education test in a narrow way: people learn how much they actually walk. It passes the promotion test only if the employer changes something about the setting, such as a marked walking route or time during the workday. Without those changes, it is mostly an individual tracking exercise. As prevention, it is primary, since it targets inactivity before any related condition develops.

The Mailed Screening Kit

Some health systems mail a fecal immunochemical test to patients who are due for colorectal cancer screening, with instructions and a prepaid envelope. In a randomized trial among patients of a safety-net system, mailed outreach produced higher screening rates than usual care (Gupta et al., 2013). The program fits secondary prevention clearly: it aims to find cancer or precancerous growths before symptoms appear. It also passes the promotion test, because it removes steps such as an appointment, a trip and time off. It does little education beyond a short instruction sheet. This is the program that sorts most cleanly.

The Menu Calorie Rule

In 2008, New York City began requiring chain restaurants to post calorie counts on menus. The rule passes the promotion test by changing the information environment at the point of ordering, and the education test because diners learn something they did not know. Whether it is effective prevention is less clear. A study of low-income neighborhoods found that many customers noticed the labels but that calories purchased did not measurably change (Elbel et al., 2009), while an analysis of transaction data from one large coffee chain found a modest decrease in calories per transaction (Bollinger et al., 2011). The program aims at primary prevention of weight gain, but the evidence on that aim is mixed.

Conclusion

The tests separate the terms clearly: promotion changes conditions, education changes knowledge and prevention is defined by a condition and its stage. Real programs, however, rarely do only one of these. Two of the three programs examined passed more than one test, and the screening kit was the only one that sat mostly under a single heading. The overlap is not a failure of the definitions. It shows that a program's label tells less than its mechanism, and the tests are useful precisely because they ask about mechanism. A program planner who can say which test a program passes, and which it fails, knows what the program is actually trying to change.

References

Bollinger, B., Leslie, P., & Sorensen, A. (2011). Calorie posting in chain restaurants. American Economic Journal: Economic Policy, 3(1), 91-128. https://doi.org/10.1257/pol.3.1.91

Bravata, D. M., Smith-Spangler, C., Sundaram, V., Gienger, A. L., Lin, N., Lewis, R., Stave, C. D., Olkin, I., & Sirard, J. R. (2007). Using pedometers to increase physical activity and improve health: A systematic review. JAMA, 298(19), 2296-2304. https://doi.org/10.1001/jama.298.19.2296

Elbel, B., Kersh, R., Brescoll, V. L., & Dixon, L. B. (2009). Calorie labeling and food choices: A first look at the effects on low-income people in New York City. Health Affairs, 28(6), w1110-w1121. https://doi.org/10.1377/hlthaff.28.6.w1110

Gupta, S., Halm, E. A., Rockey, D. C., Hammons, M., Koch, M., Carter, E., Valdez, L., Tong, L., Ahn, C., Kashner, M., Argenbright, K., Tiro, J., Geng, Z., Pruitt, S., & Sugg Skinner, C. (2013). Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: A randomized clinical trial. JAMA Internal Medicine, 173(18), 1725-1732. https://doi.org/10.1001/jamainternmed.2013.9294

Nutbeam, D. (1998). Health promotion glossary. Health Promotion International, 13(4), 349-364. https://doi.org/10.1093/heapro/13.4.349

Starfield, B., Hyde, J., Gérvas, J., & Heath, I. (2008). The concept of prevention: A good idea gone astray? Journal of Epidemiology and Community Health, 62(7), 580-583. https://doi.org/10.1136/jech.2007.071027

World Health Organization. (1986). Ottawa charter for health promotion. Health Promotion International, 1(4), 405. https://doi.org/10.1093/heapro/1.4.405