Membership of the Faculty of Public Health (MFPH) Disease Prevention, Health Promotion and Screening Syllabus

Disease Prevention, Health Promotion and Screening syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Disease Prevention, Health Promotion and Screening in Membership of the Faculty of Public Health (MFPH), not a summary of it.

1. 1

   Principles of Prevention

   4 topics

   • Levels of prevention
     • Primary, secondary and tertiary prevention
     • Primordial prevention
   • High-risk vs population strategies
     • Rose's prevention paradox
     • Shifting the population distribution
   • Natural history of disease and the iceberg concept
   • Wider determinants and the prevention pyramid
2. 2

   Screening Programmes

   5 topics

   • Wilson and Jungner criteria for screening
   • UK National Screening Committee appraisal process
   • National screening programmes
     • Antenatal and newborn screening
     • Cancer screening (breast, cervical, bowel)
     • Abdominal aortic aneurysm and diabetic eye screening
   • Biases in screening evaluation
     • Lead-time bias
     • Length-time bias
     • Overdiagnosis and selection bias
   • Quality assurance and informed choice in screening
3. 3

   Health Promotion and Behaviour Change

   5 topics

   • Models of health promotion
     • Tannahill model
     • Beattie's typology
   • Behaviour change theories
     • Transtheoretical (stages of change) model
     • Health belief model
     • Theory of planned behaviour
     • COM-B and behaviour change wheel
   • Settings-based approaches and Ottawa Charter
   • Social marketing and mass media campaigns
   • Nudge theory and choice architecture
4. 4

   Immunisation and Vaccination Programmes

   5 topics

   • Principles of immunisation
     • Active vs passive immunity
     • Herd immunity thresholds
     • Vaccine efficacy and effectiveness
   • UK routine immunisation schedule
   • Vaccine safety, adverse events and pharmacovigilance
   • Vaccine hesitancy and uptake interventions
   • Cold chain and programme delivery

Disease Prevention, Health Promotion and Screening flashcards for Membership of the Faculty of Public Health (MFPH)

22 of 66 cards from the Disease Prevention, Health Promotion and Screening deck — real questions with worked answers.

1. What are the four levels of disease prevention, with a defining example of each?

   Primordial (prevent emergence of risk factors, e.g. policies fostering healthy environments); Primary (prevent disease onset in susceptible people, e.g. immunisation); Secondary (early detection/treatment of pre-symptomatic disease, e.g. screening); Tertiary (reduce impact/complications of established disease, e.g. rehabilitation).

2. Define primary prevention and give two examples.

   Action taken to prevent the onset of disease by reducing exposure to risk factors before the disease process begins. Examples: immunisation, smoking cessation, seat-belt legislation.

3. Distinguish secondary from tertiary prevention.

   Secondary prevention detects and treats disease early in its latent/pre-symptomatic phase to halt or slow progression (e.g. screening). Tertiary prevention limits disability and complications in people with established disease (e.g. cardiac rehabilitation, stroke physiotherapy).

4. What is primordial prevention and who introduced the concept?

   Prevention of the emergence and establishment of the social, economic and environmental conditions and behavioural risk factors that lead to disease, acting at the population/societal level. The concept was introduced by Strasser (1978).

5. Contrast Rose's 'high-risk' and 'population' strategies of prevention.

   High-risk strategy targets individuals at greatest risk (e.g. statins for those above a risk threshold): appropriate to the individual, good benefit-to-risk ratio, but limited population impact and requires screening. Population strategy shifts the whole distribution of a risk factor (e.g. salt reduction): large population impact but small individual benefit (the 'prevention paradox').

6. State Rose's prevention paradox.

   A preventive measure that brings large benefit to the population (population strategy) often offers little benefit to each participating individual, because most cases of disease arise from the large number of people at low/moderate risk rather than the small high-risk group.

7. What is the 'iceberg concept' of disease?

   The idea that clinically diagnosed/symptomatic cases (the visible tip) represent only a small proportion of all cases; the much larger submerged portion consists of pre-symptomatic, subclinical, undiagnosed and untreated cases in the community.

8. List the stages in the natural history of disease.

   Stage of susceptibility (risk factors present, no disease) → subclinical/pre-symptomatic stage (pathological changes begin, including a latent/incubation period) → clinical stage (signs and symptoms appear) → outcome (recovery, disability, or death).

9. What is the 'critical point' in the natural history of disease and why does it matter for screening?

   The point in the pre-symptomatic phase before which intervention (e.g. via screening) alters outcome and after which it does not. Effective screening must detect disease and allow treatment before the critical point to confer benefit.

10. Define the 'detectable pre-clinical phase' (sojourn time) in screening.

    The interval during which disease is detectable by screening but has not yet produced symptoms. A longer sojourn time generally makes a disease more amenable to screening.

11. What are the 'wider (social) determinants of health'?

    The conditions in which people are born, grow, live, work and age, shaped by the distribution of money, power and resources, e.g. income, education, employment, housing, environment and access to services, depicted in the Dahlgren and Whitehead rainbow model.

12. Describe the layers of the Dahlgren and Whitehead 'rainbow' model of health determinants.

    From inner to outer: fixed individual factors (age, sex, constitution) at the core; then individual lifestyle factors; social and community networks; living and working conditions (housing, education, work, food, healthcare); and the outermost layer of general socio-economic, cultural and environmental conditions.

13. What is the Health Impact Pyramid (Frieden) and what is its ordering?

    A five-tier pyramid ranking interventions by potential population impact (bottom = greatest impact, least individual effort): 1) Socioeconomic factors; 2) Changing the context to make default decisions healthy; 3) Long-lasting protective interventions; 4) Clinical interventions; 5) Counselling and education (top = smallest population impact).

14. List Wilson and Jungner's (1968) criteria for screening relating to the CONDITION.

    The condition should be an important health problem; its natural history (including from latent to declared disease) should be adequately understood; and there should be a recognisable latent or early symptomatic stage.

15. List Wilson and Jungner's criteria relating to the TEST.

    There should be a suitable test or examination; the test should be acceptable to the population; and case-finding should be a continuing process, not a once-and-for-all project.

16. List Wilson and Jungner's criteria relating to TREATMENT and the PROGRAMME.

    There should be an accepted/effective treatment for patients with recognised disease; facilities for diagnosis and treatment should be available; there should be an agreed policy on whom to treat as patients; and the cost of case-finding should be economically balanced against expenditure on medical care as a whole.

17. How many criteria does the UK National Screening Committee (UK NSC) use, and what are the broad categories?

    The UK NSC uses a modernised set of around 20 criteria grouped into four categories: the condition; the test; the intervention/treatment; and the screening programme (including evidence of effectiveness, acceptability and cost-effectiveness).

18. What is the role of the UK National Screening Committee (UK NSC)?

    An independent expert advisory body that reviews evidence and advises ministers and the NHS across the four UK nations on whether population screening programmes should be introduced, modified or stopped, against its evidence-based criteria.

19. Outline the UK NSC appraisal/recommendation process for a screening programme.

    Topics are proposed/reviewed on a roughly three-yearly cycle; an evidence review is commissioned and published; a public consultation is held; the UK NSC assesses the evidence against its criteria and makes a recommendation to ministers; if introduced, the programme is then implemented, quality assured and periodically re-reviewed.

20. Name the UK antenatal and newborn screening programmes.

    Fetal anomaly screening; infectious diseases in pregnancy (HIV, hepatitis B, syphilis); sickle cell and thalassaemia; newborn bloodspot (heel-prick) screening; newborn and infant physical examination (NIPE); and newborn hearing screening.

21. Name the three adult cancer screening programmes in England and their eligible age ranges.

    Breast (mammography) for women aged 50–70 (extension to 47–73 being phased in), every 3 years; cervical (HPV primary screening) for those aged 25–64; and bowel cancer (faecal immunochemical test, FIT) for adults aged 50/54–74.

22. What conditions are screened for in the UK newborn bloodspot test?

    Nine conditions: sickle cell disease, cystic fibrosis, congenital hypothyroidism, and six inherited metabolic diseases (PKU, MCADD, MSUD, IVA, GA1 and homocystinuria).

See more Disease Prevention, Health Promotion and Screening flashcards →

Planning Disease Prevention, Health Promotion and Screening for Membership of the Faculty of Public Health (MFPH)

Disease Prevention, Health Promotion and Screening (Membership of the Faculty of Public Health (MFPH)) FAQ