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Distinguishing ’health promotion’ from ’disease prevention’

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Paul B.
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  1. Introduction.
  2. Decreasing the prevalence of disease: Latter half of the nineteenth century.
  3. The movement towards health promotion.
  4. Screening as the active early diagnosis of a disease.
  5. Conclusion.
  6. Bibliography.

Over approximately the past one hundred and fifty years there has seen a series of shifts in our definitions of health and disease and, as a result, also in the approaches taken by governments and health professionals towards it. After an initial focus on sanitation and public health in the late nineteenth century, health policy moved towards formal health care after the 1930s. With escalating costs of welfare, the 1970s and especially the 1980s, saw a greater emphasis on individual responsibility for health and behaviour change? and since then the concept of health promotion has come increasingly to the fore. In this essay we will examine the reasons for this change and its implications in theory and practice, as well as considering some of the criticisms that have been voiced against the health promotion approach.

[...] Tertiary prevention, lastly, intends to minimise the disability from a disease state that cannot be cured or leaves the individual with some loss of function. The workings and limitations of disease prevention are best illustrated using two examples, namely mass screening and targeted individual intervention. Screening is the active early diagnosis of a disease or risk factors with the aim to intervene to prevent the onset or progression of disease (Locker 1997) and thus, as mentioned, forms part of secondary prevention. [...]


[...] For example, someone told to use individual responsibility in order to lose weight could (as a consequence of the approach) suffer from worsened self-esteem. Unrealistic health promotion campaigns focusing on healthy eating and exercise may not seem achievable by people on low income and this too can lead to stress and anxiety. Becker (1986, cited in Locker 1997) warns of the ?tyranny of health promotion', excessive proscription in the name of health, McCormick calls for ?modified hedonism' instead and Reinharz (2001) complains that the never-ending health warnings take the joy out of life. [...]

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