1. What is the overall topic of paper 1? The paper involves a debate on two different approaches of improving health, namely, Individual approach and Population approach. The central message of paper is that the both approaches are fundamentally different and achieve different goals. The “High risk strategy” is an individual oriented approach where health professional focus on individuals with increased risk of exposure only whereas “Population strategy” is a public oriented which aims to shift the whole distribution of exposure in a population in a favourable direction. 2.
What is the main argument (or ‘thesis’) that paper 1 makes about the topic? Geoffrey Rose’s paper, revolutionised the health promotion and is still has a huge impact on modern public health practice. He made a distinction between the cause of illness at individual level and at population level. He states that causes of causes (individual level) are not necessarily same as the causes of incidence (population level). This was supported by idea of involving more regions with wide range of exposure to get clear picture in the study conducted on relationship of water quality and cardiovascular mortality in UK and Scotland.
3. What are the most important arguments or pieces of evidence that paper 1 offer in support of its thesis? Rose found the answer to most debatable questions about demographic differences in the incidence of disease by emphasising that the determinants of population are more important than individual characteristics. He supported his argument by providing evidence of the study on population distribution of serum cholesterol in East Finland and differences in the distributions of blood pressure among Kenya and London.
Thus, the characteristics of population are more important in determining the incidence and prevalence of disease than characteristics of individual. The statement that occurrence of disease can be more in large number of people with small risk compared to small number of people with high exposure risk further outweighed the population approach over individual approach. 4. Explain how paper 2 challenges the thesis of paper 1. 1. Inequalities in Health: Frolich paper argued that Rose population approach inadvertently brings social inequalities in health.
The population strategic interventions such as cervical cancer screening programs and neonatal intensive care and surfactant therapy both benefitted the socioeconomically well strata of population. In other words population based strategies have been proved to be more accessible or beneficial to group who were initially at low risk rather than involving the high risk category of people. It follows the ‘Inverse Square’ Law that means those with maximum resources derive maximum benefits from population based approach.
2. Prevention Paradox: No doubt that the programs such as immunisation, wearing of seat belts have been proved of utmost importance to the whole population but these offer only limited short term benefit to each individual. These small benefits can be easily outweighed by the risks of the intervention resulting in poor motivation both for physician as well as his subject. People often act for small immediate reward but overall framework of motivation gets weakened. 3.
Vulnerable population: Rose population approach does not take into consideration factors like concentration of risks and life course in while designing the health strategy. Hence focussing on single risk factor without taking into account the life trajectory of risk exposure make population approach least useful in case of vulnerable population. PART B 1. Describe the burden of cancer globally and in New Zealand, and which population groups are most at risk. Provide references for this information Cancer has been figured among the leading cause of mortality around the globe, accounting for 8.
2 million deaths in 2012. (Cancer, 2014). This rising burden is expected to reach up to 15 million new cases in 2020. (P. Kanavos, 2006). The rise in the burden of cancer incidence, prevalence and mortality is more significant in the developing countries due to wide transition from infectious diseases towards non communicable diseases. In context to New Zealand, epidemiological data shows a significant increase in number of deaths per year from 6746 in 1990 to 8593 in 2010 with predominance within males (Cancer: Historical summary 1948–2010 , 2013).
According to WHO report based on 2012 data, New Zealand has topped worldwide bowel cancer rate along with Australia. It has become second most common cause of death among males and females (Quillian, 2014). As far as ethnic comparisons are concerned, the overall rate of cancer registration is similar for both Maori and Non- Maori but mortality rates are higher for Maori population. This is attributed to poor survival rate of lung cancer which is more common among them. 2.
Briefly describe five important modifiable risk factors for cancer. Provide references for this information. 1. TOBACCO CESSATION AND PREVENTION: Tobacco is the main cause of preventable deaths across the globe causing about 5 million deaths each year due to negative consequences of smoking (Colditz, 2004). Both smoked and non-smoked tobacco poses the risk of cancer (passive smoking). Introducing the tobacco cessation programs and policies to facilitate youth are necessary to reduce the global burden of cancer.
2. PHYSICAL ACTIVITY: Inactivity or sedentary life style accounts to 2 million deaths each year through major chronic diseases such as Diabetes type 2, cancer etc. the co-relationship has been shown between physical inactivity and cancers of colon and breast. Programmes promoting car free days and encouraging walking and cycling can provide an effective public participation Negative effects of physical inactivity are reversible so 30 min daily moderate exercise significantly reduces the risk. 3.
ALCOHOL USE: Alcohol has been documented as a solvent, irritant and a transporter with a carcinogenic potential for esophageal and oral cancer. In addition to creating awareness among people on benefits and risks of alcohol, some population based strategies such as setting minimum age for legal purchase of alcohol, drink and drive laws, restriction on hours of sale can be used to create an effective approach. 4. DIETARY IMPROVEMENTS: In terms of cancer, healthy diet should include fruits and vegetables with limited red meat and animal fat and folate multivitamin daily.
Improvements in diet both at population and individual level can be brought by providing financial incentives, school meals and nutritional advice as part of health services. 5. CONTROL OF ONCOGENIC VIRUSES: Vaccinations strategies against oncogenic viruses (Hepatitis B virus and Human Papilloma Virus) have been proved as most cost effective interventions in primary prevention of cancer. Furthermore, WHO recommends universal infant immunisation through national.