Master Health Promotion & Illness Prevention
for MCCQE Part 1

Core Concepts

Health Promotion & Illness Prevention focuses on maintaining health and reducing disease incidence, prevalence, and impact. It emphasizes a proactive, holistic approach to well-being.

• Health Promotion: The process of enabling people to increase control over, and to improve, their health (e.g., advocating for healthy public policies, fostering supportive environments).
• Illness Prevention: Specific interventions to prevent the onset or progression of disease.
• Levels of Prevention:
  • Primary Prevention: Aims to prevent disease or injury before it ever occurs (e.g., immunizations, lifestyle modifications, public health campaigns).
  • Secondary Prevention: Aims to reduce the impact of a disease or injury that has already occurred (e.g., screening for early detection, prompt treatment to halt progression).
  • Tertiary Prevention: Aims to soften the impact of an ongoing illness or injury that has lasting effects (e.g., rehabilitation, chronic disease management to prevent complications, palliative care).
• Determinants of Health: Broad range of personal, social, economic, and environmental factors that influence health (e.g., income, education, housing, access to healthcare, social support, genetics, environment).
• Evidence-Based Guidelines: Crucial for guiding preventive actions (e.g., Canadian Task Force on Preventive Health Care (CTFPHC), National Advisory Committee on Immunization (NACI)).

Clinical Presentation

• Identifying Risk Factors: Patients present with modifiable (e.g., smoking, physical inactivity, poor diet, excessive alcohol, unsafe sexual practices) and non-modifiable (e.g., age, genetics, family history) risk factors for various diseases.
• Lifestyle & Behavioural Patterns: Discussion around current diet, exercise habits, substance use, stress coping mechanisms, sleep patterns.
• Immunization Status: Incomplete or unknown vaccination history.
• Screening Status: Lack of participation in recommended cancer screenings (breast, cervical, colorectal), blood pressure checks, diabetes screening, lipid profiles.
• Knowledge Gaps: Patients may lack awareness regarding healthy behaviours, disease risks, or available preventive services.
• Readiness for Change: Patients present at various stages of change (pre-contemplation, contemplation, preparation, action, maintenance).
• Social Determinants of Health (SDH): Patients may present with challenges related to their SDH that impact health choices and access to care.

Diagnosis (Gold Standard)

Diagnosis in health promotion and illness prevention involves comprehensive risk assessment and needs identification, not disease diagnosis.

• Comprehensive History: Detailed medical, family, social, occupational, and lifestyle history (diet, exercise, smoking, alcohol, drug use, sexual health).
• Physical Examination: Baseline measurements (BP, BMI, waist circumference) and targeted exams based on risk factors.
• Validated Screening Tools: Use of standardized questionnaires for depression, anxiety, substance use, domestic violence, fall risk, nutritional assessment.
• Laboratory & Imaging Screening: Appropriate utilization of evidence-based screening tests (e.g., lipids, A1c, mammography, Pap tests, FIT/colonoscopy).
• Review of Immunization Records: Verification against NACI guidelines.
• Assessment of Social Determinants of Health: Inquiry into housing, income, education, employment, social support, food security.
• Risk Stratification: Using validated risk calculators (e.g., Framingham Risk Score for CVD) to guide interventions.

Management (First Line)

• Primary Prevention:
  • Immunizations: Administer vaccines according to NACI guidelines (e.g., childhood, adult boosters, influenza, HPV, herpes zoster, COVID-19).
  • Lifestyle Counseling:
    • **Diet:** Promote balanced nutrition (Canada's Food Guide), limit processed foods, sugar, unhealthy fats.
    • **Exercise:** Encourage regular physical activity (e.g., 150 min moderate-intensity aerobic/week).
    • **Smoking Cessation:** Offer pharmacological (NRT, bupropion, varenicline) and non-pharmacological support.
    • **Alcohol Moderation:** Counsel on safe drinking limits.
    • **Sun Protection:** SPF use, protective clothing.
    • **Injury Prevention:** Seatbelts, helmets, fall prevention strategies.
    • **Safe Sex Practices:** Condoms, STI screening, pre-exposure prophylaxis (PrEP) where indicated.
  • Chemoprevention: Aspirin for high-risk cardiovascular patients (individualized decision), fluoride for dental health.
• Secondary Prevention:
  • Screening Programs: Refer/order according to CTFPHC guidelines (e.g., Pap test, mammography, colorectal cancer screening, BP, diabetes, hyperlipidemia, osteoporosis).
  • Early Detection & Management: Prompt intervention for newly identified asymptomatic conditions (e.g., hypertension, dyslipidemia).
• Tertiary Prevention:
  • Chronic Disease Management: Optimize control of existing conditions (e.g., diabetes, asthma, heart failure) to prevent complications.
  • Rehabilitation: Physical, occupational, speech therapy post-injury/illness.
  • Self-Management Support: Empower patients with chronic conditions to manage their health effectively.
• Patient-Centered Care: Employ motivational interviewing, shared decision-making, and culturally sensitive approaches.
• Referrals: To dietitians, physiotherapists, social workers, smoking cessation programs, mental health services.