Membership of the Faculty of Public Health (MFPH) Health Improvement and the Wider Determinants of Health Syllabus

Name the brief screening tool commonly used to detect harmful and hazardous alcohol use, and the structured brief intervention approach used in primary care.

Screening: AUDIT (Alcohol Use Disorders Identification Test) or its short forms AUDIT-C / FAST. The approach is IBA — Identification and Brief Advice (screen then deliver brief structured advice, escalating to referral if dependent).

How is Body Mass Index (BMI) calculated, and what are the WHO adult cut-offs for overweight and obesity?

$$BMI = \frac{\text{weight (kg)}}{[\text{height (m)}]^{2}}$$ Underweight $<18.5$; normal $18.5\text{–}24.9$; overweight $25\text{–}29.9$; obese $\geq 30$ (Class I 30–34.9, II 35–39.9, III $\geq 40$) $\text{kg/m}^{2}$.

What is the UK Chief Medical Officers' recommendation for physical activity in adults aged 19–64?

At least 150 minutes of moderate-intensity activity per week, or 75 minutes of vigorous activity (or a combination); muscle-strengthening activities on at least 2 days per week; and minimise prolonged sedentary time.

Explain the concept of an 'obesogenic environment'.

An obesogenic environment is the sum of influences that surroundings, opportunities or conditions of life have in promoting obesity in individuals or populations — e.g. cheap energy-dense food, large portion sizes, motorised transport, and limited opportunities for physical activity.

What is the difference between 'food security' and 'food poverty'?

Food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food for an active healthy life. Food poverty is the inability to acquire or consume an adequate quantity/quality of food in socially acceptable ways (or uncertainty that one can).

Define mental health 'promotion', 'prevention' and 'treatment' and how they differ.

Promotion: enhancing positive mental wellbeing and protective factors in the whole population. Prevention: reducing the incidence/risk of mental disorders (universal, selective or indicated). Treatment: managing existing disorders. Promotion targets wellbeing; prevention targets disorder onset.

What are the 'Five Ways to Wellbeing' (New Economics Foundation)?

Connect; Be active; Take notice; Keep learning; Give. They are evidence-based actions individuals can take to improve personal mental wellbeing.

What is the distinction between universal, selective and indicated prevention (Gordon/IOM classification)?

Universal: targets the whole population regardless of risk. Selective: targets subgroups with above-average risk. Indicated: targets high-risk individuals already showing early signs/symptoms but not meeting full diagnostic criteria.

Name the levels of prevention in the classic public health framework (primordial, primary, secondary, tertiary).

Primordial: prevent emergence of risk factors. Primary: prevent disease onset in susceptible people (e.g. immunisation). Secondary: detect and treat early/pre-symptomatic disease (e.g. screening). Tertiary: reduce complications and disability in established disease (rehabilitation).

What are the WHO 'ABC' elements at the heart of sexual and reproductive health behaviour change for HIV/STI prevention?

Abstinence (or delay of sexual debut); Be faithful (reduce number of partners/mutual monogamy); Condom use (correct and consistent). Modern approaches add combination prevention including PrEP, testing and treatment-as-prevention.

What does 'unmet need for family planning' mean, and why is it a key reproductive health indicator?

It is the proportion of women of reproductive age who are fecund and sexually active, want to avoid or delay pregnancy, but are not using any contraceptive method. It signals a gap between fertility intentions and contraceptive access/use.

What is PrEP and how does it fit within combination HIV prevention?

PrEP (pre-exposure prophylaxis) is the use of antiretroviral medication (e.g. tenofovir/emtricitabine) by HIV-negative people at substantial risk to prevent acquiring HIV. It is one component of combination prevention alongside condoms, testing, treatment-as-prevention (U=U) and behavioural interventions.

State the maternal mortality ratio (MMR) and its standard denominator.

$$MMR = \frac{\text{maternal deaths}}{\text{live births}} \times 100{,}000$$ It counts deaths of women while pregnant or within 42 days of termination of pregnancy from causes related to or aggravated by pregnancy/its management, per 100,000 live births.

Differentiate the infant mortality rate, neonatal mortality rate and perinatal mortality rate.

Infant mortality rate: deaths under 1 year per 1,000 live births. Neonatal: deaths in first 28 days per 1,000 live births. Perinatal: stillbirths plus deaths in the first 7 days (early neonatal) per 1,000 total births (live + still).

What are the 'first 1,000 days' and why are they emphasised in child health policy?

The period from conception to a child's second birthday (~1,000 days). It is a critical window for brain development, growth and lifelong health; nutrition, attachment and stimulation during this period strongly shape later cognitive, physical and health outcomes.

What does the WHO define as adolescence, and why is it a distinct public health focus?

Adolescence is the period 10–19 years. It is distinct because of rapid physical, cognitive and social development, the onset of many health behaviours and mental health conditions, and reproductive transitions — making it a key window for prevention and health promotion.

Define 'frailty' in the context of healthy ageing.

Frailty is a state of increased vulnerability resulting from age-associated decline in reserve and function across multiple physiological systems, such that the ability to cope with everyday or acute stressors is compromised, increasing risk of adverse outcomes (falls, disability, hospitalisation, death).

Contrast the two main conceptual models of frailty (phenotype vs accumulation of deficits).

Fried's phenotype model: frailty present if $\geq 3$ of 5 criteria — unintentional weight loss, weakness (grip), exhaustion, slow walking speed, low physical activity. Rockwood's deficit-accumulation model: a frailty index = number of deficits present divided by total deficits assessed, treating frailty as a continuum.

Define 'compression of morbidity' (Fries).

The hypothesis that if the onset of chronic illness/disability can be postponed to later in life faster than gains in life expectancy, the period of morbidity is compressed into a shorter interval before death, increasing healthy life expectancy.

What is the difference between life expectancy and healthy (disability-free) life expectancy?

Life expectancy is the average number of years a person is expected to live. Healthy/disability-free life expectancy (HLE/DFLE) is the average number of years expected to be lived in good health or free of disability. The gap represents years lived in poor health.

What does the 'hierarchy of controls' for managing workplace hazards specify, in order of effectiveness?

From most to least effective: (1) Elimination; (2) Substitution; (3) Engineering controls (isolation/ventilation); (4) Administrative controls (procedures, training, rotation); (5) Personal protective equipment (PPE). Higher-level controls that remove the hazard are preferred over relying on PPE.

Distinguish a hazard from a risk in occupational health.

A hazard is something with the potential to cause harm (e.g. a chemical, noise, a machine). Risk is the likelihood that the hazard will cause harm combined with the severity of that harm. Risk assessment estimates and controls risk arising from hazards.

What is the difference between a prescribed industrial disease and a work-related disease?

A prescribed industrial disease is a specific disease legally recognised as caused by a particular occupation, attracting compensation (e.g. mesothelioma from asbestos). A work-related disease is any condition that work causes, contributes to or aggravates, but is multifactorial and not necessarily compensatable.

Define 'health equity audit'.

A systematic process of reviewing how fairly services or resources are distributed in relation to the health needs of different groups, identifying inequities, agreeing actions to narrow the gap, and monitoring impact. It links needs assessment to action and review.

Who are typically considered 'inclusion health' (vulnerable and marginalised) groups, and what characterises them?

Groups socially excluded and experiencing multiple overlapping risk factors and extreme health inequities — e.g. people experiencing homelessness, Gypsy/Roma/Traveller communities, sex workers, people in contact with the justice system, and people with substance dependence. They share social exclusion, stigma and very poor access to services.

Define 'asset-based community development' (ABCD) and contrast it with a deficit-based approach.

ABCD identifies and mobilises the existing strengths, skills, relationships and resources ('assets') within a community to drive locally led change. A deficit approach focuses on problems, needs and what is lacking, positioning the community as passive recipients. ABCD emphasises capacity rather than deficiency.

What is 'social capital', and distinguish its bonding, bridging and linking forms (Putnam et al.)?

Social capital = the networks, norms of reciprocity and trust that enable collective action. Bonding: ties within homogeneous groups (family, close community). Bridging: ties across diverse/heterogeneous groups. Linking: ties across power/authority gradients (e.g. citizens to institutions).

Distinguish social capital from social cohesion.

Social capital refers to the resources embedded in social networks (trust, reciprocity, ties) available to individuals/groups. Social cohesion is a property of a whole society/community — the extent of connectedness, solidarity, shared values and absence of latent social conflict. Cohesion is the macro-level outcome; capital is the network-level resource.

What is 'Health in All Policies' (HiAP)?

An approach to public policy across all sectors that systematically and explicitly takes into account the health and equity implications of decisions, seeks synergies, and avoids harmful health impacts — recognising that health is largely shaped by policies outside the health sector (transport, housing, education, finance).

What is a Health Impact Assessment (HIA) and name its main stages?

HIA is a combination of procedures, methods and tools by which a policy, programme or project may be judged as to its potential effects on the health of a population and the distribution of those effects. Stages: screening, scoping, appraisal/assessment, reporting and recommendations, and monitoring/evaluation.

Distinguish Rose's 'high-risk' (targeted) prevention strategy from the 'population' (whole-population shift) strategy, and state the prevention paradox.

High-risk strategy targets individuals at greatest risk; well-matched to individuals but limited total impact and requires screening. Population strategy shifts the whole distribution of a risk factor; small individual benefit but large total impact. Prevention paradox: a measure bringing large benefit to the population often offers little to each participating individual.