GPs are crucial to health promotion

Encouraging healthier living is an important part of a GP's work, says Dr Mona Kular.

Health promotion is about giving patients advice that encourages them to stay healthy. It can come in the form of guidance on lifestyle choices or it can be implemented through immunisation or screening programmes. The RCGP's GP curriculum statements say that GPs have 'a crucial role to play in promoting health'.

Effective health promotion in primary care can help prevent the onset or delay the progression of diseases such as diabetes, COPD, IHD and STIs. Health promotion can also help bridge the gap in equality between the disadvantaged in society and others. By starting from a young age, future generations will also benefit from healthy lifestyle choices.

Government priorities
Publication of the White Paper, 'Choosing Health: making healthier choices easier', in 2004 has pushed health promotion up the agenda.

It outlines the key public health priorities: reducing smoking, excessive alcohol intake and obesity, and improving sexual and mental health. The paper suggests that addressing health promotion in children and targeting the disadvantaged in society will help tackle these problems. It also emphasises the important role the NHS has to play in primary prevention and health.

Smoking
Smoking is a major risk factor for conditions such as COPD, lung cancer, IHD, sudden infant death syndrome, osteoporosis and diabetes. On average, cigarette smokers die about 10 years younger than non-smokers. For those with a smoking-related disease, smoking cessation can slow or halt its progression.

NICE recommends that all smokers are advised to quit at every consultation. A good way to approach smoking cessation is: ask the patient if they smoke; advise them to give up; assist them with this, for example, with nicotine replacement therapy; and arrange support and follow-up. In addition there are 35 quality points related to smoking and cessation advice.

Alcohol
Excessive alcohol intake has wide-ranging consequences. Physical complications include an increased risk of mouth, pharyngeal and oesophageal cancers, liver disease, hypertension, gastritis and ulcers. Social implications are found in alcohol dependence, increased crime and violence. Psychological problems involve the increased risk of depression and suicide, particularly in men.

Government recommendations on alcohol intake are no more than 21 units per week for women and 28 units per week for men. However, the BMA and royal colleges still use the previous limits of 14 units per week for women and 21 units per week for men.

Advocating these limits form part of this area of health promotion. The current recommended screening tool for alcohol consumption is the 'Alcohol use disorders identification test' (AUDIT-C), which identifies around 75 per cent of problem drinkers. Those identified should be offered further help and support to reduce their alcohol intake.

Obesity
NICE guidance recommends a minimum of 30 minutes of exercise at least five times a week, and states that those not doing so should be classed as inactive.

The DoH has developed the general practice physical activity questionnaire, which classifies a patient's current physical activity as inactive, moderately inactive, moderately active or active. Those deemed to need more exercise should be helped to set specific goals that can be followed up at three- to six-month intervals.

The quality framework also includes an obesity register but no indications for tackling the problem as yet.

A healthy balanced diet is vital in preventing obesity from occurring in the first place. Eating a minimum of five portions of fruit and vegetables daily, reducing fat intake, eating less processed and fried food and eating fibre-rich meals based on starchy foods should be advocated. For those trying to lose weight, NICE recommends aiming for a calorie deficit of around 500-600kcal per day and to expect weight loss of no more than 0.5-1kg per week.

Other health promotion contexts
Other contexts in which health promotion is important include advising patients on safe sexual health practices, ensuring women are fully informed about cervical screening and mammography, pre-conceptual counselling, travel health advice and immunisations for children.

Many practices' IT systems will have a generalised health promotion template and this can be useful in aiding health promotion in practice.

Dr Kular is a GP registrar in Gamston, Nottingham.

Learning Points

NHS promotion for a healthier lifestyle

  1. Health promotion is high on the government's agenda and is a crucial aspect of primary care.
  2. Section 5 of the RCGP's GP curriculum addresses the range of health promotion issues.
  3. 'Ask, advise, assist, arrange' summarises a good approach to encourage smoking cessation.
  4. Use AUDIT-C to identify problem drinkers.
  5. Diet and exercise form the mainstay of health promotion in obesity.

Resources

  • AUDIT-C: http://afcrossroads.com/websites/corc_docs/ SG_Toolkit/Bucket2/ audit-c.pdf
  • General practice physical activity questionnaire:
  • http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publica tions PolicyAndGuidance/DH_063812
  • RCGP curriculum statement: www.rcgp-curriculum.org.uk/PDF/curr_5_Healthy_people.pdf.

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