Unit 7.1: Public Health Principles

• Topic 01

  Social Determinants and Health Inequalities

  42 questions
• Topic 02

  Public Health Frameworks

  47 questions
• Topic 03

  NHS Prevention Agenda

  44 questions
• Topic 04

  Screening Programmes

  47 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. A health commissioner reviews data showing that mortality rates from cardiovascular disease are 40% higher in the most deprived quintile of the population compared with the least deprived (a relative measure), but the absolute difference is only 3 deaths per 10,000 per year. A colleague argues the absolute difference is small and the problem is not serious. How should the commissioner respond?

   • A
     Both measures are needed; the relative measure reveals the underlying inequity and the absolute measure helps prioritise resource allocation — neither alone gives the full picture
     Correct answer
   • B
     Relative measures should be discarded in health inequality analysis because they systematically exaggerate the true extent of the problem
   • C
     The absolute measure is more meaningful for policy decisions than the relative measure and should be the primary metric used by commissioners
   • D
     If the absolute difference in mortality rates is small, cardiovascular disease inequality is not a public health priority worth resourcing
   Explanation

   Absolute and relative measures of health inequality capture different dimensions of the same problem. A 40% higher relative risk of cardiovascular mortality in deprived populations is substantial and reveals underlying inequity driven by social factors.

   The absolute difference (3 per 10,000) reflects population size and prevalence, useful for resource planning. The Marmot Review framework emphasises that both must be used together — absolute and relative inequalities can even move in opposite directions as conditions improve. Dismissing inequality because the absolute figure appears small is a common and serious analytical error.

2. How frequently is cervical screening offered to women and people with a cervix aged 25–49 in England?

   • A
     Once only in this age range
   • B
     Every 5 years
   • C
     Every 3 years
     Correct answer
   • D
     Every year
   Explanation

   In England, cervical screening is offered every three years to women and people with a cervix aged 25–49. From age 50–64, it is offered every five years, reflecting the slower rate of HPV infection progression and cervical cell change in this age group.

   After age 64, women with a normal screening history are discharged from recall. This two-interval structure (3 years vs. 5 years) is a commonly tested factual detail in the NMC CBT and should not be confused with breast screening (every three years for all ages 50–70) or bowel screening (every two years).

3. The Beattie model of health promotion is organised around which two axes?

   • A
     Enabling vs. mediating and individual vs. collective
   • B
     Upstream vs. downstream and primary vs. secondary prevention
   • C
     Mode of intervention (authoritative vs. negotiated) and focus of intervention (individual vs. collective)
     Correct answer
   • D
     Clinical vs. social and curative vs. preventive
   Explanation

   The Beattie model (1991) uses two axes to create a four-quadrant framework: the mode of intervention axis (authoritative = top-down, expert-driven at one end; negotiated = bottom-up, client-led at the other) and the focus of intervention axis (individual at one end; collective at the other). These two axes produce four quadrants: Health persuasion (authoritative/individual), Legislative action (authoritative/collective), Personal counselling (negotiated/individual), and Community development (negotiated/collective).

   NMC candidates should know both axes and all four quadrants.