International Experience in Hospital Health Education and Health Promotion

1
International Experience in Hospital Health
Education and Health Promotion

• Anand S Kurup
• Health Leadership Officer, WHO China
• Presentation made at the Training on Hospital
  Health
• Education and Health Promotion
• 27 April 2006
• Beijing

2
Outline of Presentation

• Health Promotion Definition and Background

• International Initiatives for Health Promotion

• Health promoting hospitals International
  Experience

3
Outline of Presentation

• Health Promotion Definition and Background

• International Initiatives for Health Promotion

• Health promoting hospitals International
  Experience

4
Health Promotion

• Is the process of enabling people to increase
  control over and improve their health. To reach a
  state of complete physical, mental and social
  well being, an individual or group must be able
  to identify and realize aspirations, to satisfy
  needs, and to change or cope with the
  environment
• The Ottawa Charter, 1986

5
Health Promotion

• A core function of public health.
• Health promotion is not just the responsibility
  of the health sector, but goes beyond healthy
  lifestyles to well being
• Contributes to tackling communicable and
  non-communicable diseases and other threats to
  health.
• Contributes to reducing both health and gender
  inequities.

6
Outline of Presentation

• Health Promotion Definition and Background

• International Initiatives for Health Promotion

• Health promoting hospitals International
  Experience

7
International Initiatives for Health Promotion

• Ottawa Charter for Health Promotion 1986
• Sundsvall Statement 1991
• Jakarta Declaration 1997
• Bangkok Charter 2005

8
Ottawa Charter 1986

• First International Conference on Health
  Promotion
• Adopted Ottawa Charter for Health Promotion
• Defined Health promotion
• Specified the prerequisites for health
• peace, shelter, education, food, income, a stable
  eco-system, sustainable resources, social justice
  and equity.
• Improvement in health requires a secure
  foundation in these basic pre-requisites.

9
Ottawa Charter 1986

• Advocates that good health is a major resource
  for social, economic and personal development,
  and an important dimension of quality of life.
• Health promotion and Equity in health
• Called for multi-sectoral approach and
  coordinated action
• health, education, social, economic, NGOs,
  industry, media etc.
• Participants pledged commitment to health
  promotion and called for international action.

10
Ottawa Charter 1986

• Defined Health Promotion Action under five action
  areas
• Build healthy public policy
• Create supportive environments
• Strengthen community action
• Develop personal skills
• Reorient health services

11
Build Healthy Public Policy

• Health promotion is not possible only with health
  sector- needs to involve other sectors and hence
  other public policies.
• Involves legislation, organisational changes,
  taxation
• tobacco taxation as part of discouraging
  consumption
• Ottawa Charter 1986

12
Create Supportive Environments

• Health needs to be part of other social
  development goals.
• Inseparable link between people and their
  environment.
• Take care of each other- communities and their
  natural environment
• Health promotion generates living and working
  conditions that are safe, stimulating, satisfying
  and enjoyable.
• Called for systematic assessment of health
  impact.
• Ottawa Charter 1986

13
Strengthen Community Action

• Concrete and effective community action in
  setting priorities, making decision, planning
  strategies and implementing them to achive better
  health.
• Community empowerment- ownership and control of
  their own endeavors- as a process of health
  promotion.
• Community development, self-help and social
  support and strengthening public participation.
• Ottawa Charter 1986

14
Develop Personal Skills

• Health promotion supports personal and social
  development through providing information,
  education for health and enhancing life skills.
• It increases the options available to people to
  exercise more control over their own health and
  environment and make choices.
• Enabling people throughout their life- in school,
  home, work and community settings
• Ottawa Charter 1986

15
Reorient Health Services

• The responsibility for health promotion is shared
  among individuals, community groups, health
  professionals, health service institutions and
  governments.
• Role of health sector should move increasingly to
  health promotion, beyond providing clinical and
  curative services.
• Reorienting health services requires more health
  research and professional education and training.
• Ottawa Charter 1986

16
Sundsvall (Sweden) Statement on Supportive
Environments for Health 1991

• Highlighted the importance and advantages of the
  healthy settings approach.
• Acknowledged disparities, poverty and lack of
  access to health care.
• Where people live, work and play settings
  provide exceptional entry points for health
  promotion.

17
Sundsvall (Sweden) Statement on Supportive
Environments for Health 1991

• Supportive environments Four dimensions.
• Social dimensions norms, customs, and social
  processes that affect health.
• Political dimensions Government to guarantee
  democratic participation in decision making,
  decentralization etc.
• Economic dimension re-channeling resources
• Need to recognize and use womens skills in all
  sectors.

18
Sundsvall (Sweden) Statement on Supportive
Environments for Health 1991

• Called for
• Social action.
• Strengthening advocacy through communication.
• Enabling communities and individuals to take
  control over their health and environment.
• Building alliances for health and supportive
  environments.
• Mediating between conflicting interests in
  society in order to ensure equitable access.

19
Jakarta Declaration 1997

• Declared health as a basic human right and
  essential for social and economic development.
• Health Promotion is a key investment
• Health promotion is essential for reducing
  inequities and building social capital

20
Jakarta Declaration 1997

• Reiterates the prerequisites of health similar
  to Ottawa Charter- with addition of empowerment
  of women and respect for human rights.
• Declared poverty as the greatest threat to
  health.
• Identified priorities for health promotion in the
  21st century
• Promote social responsibility for health
• Increase investments in health development
• Consolidate and expand partnerships for health
• Increase community capacity and empower
  individual
• Secure infrastructure for health promotion.

21
Bangkok Charter 2005

• Identified actions, commitments and pledges
  required to address the determinants of health in
  a globalized world through health promotion.
• Health promotion is based on the human rights
  approach.
• Recognized that the global context has changed
  markedly since the Ottawa Conference.
• Identified critical factors that influence
  health, challenges, opportunities, and
  strategies, and called for policy coherence.

22
Bangkok Charter 2005

• Critical Factors that affect health
• Increasing inequalities within and between
  countries.
• New patterns of consumption and communication.
• Commercialization.
• Global environmental change, and
• Urbanisation

23
Bangkok Charter 2005

• Challenges Gender disparity, vulnerability of
  children and exclusion of marginalized, disabled
  and indigenous people have increased.
• Opportunities Enhanced communication technology,
  improved mechanisms for global governance and
  sharing experience.

24
Bangkok Charter 2005

• Commitments to Health for All
• Make the promotion of health central to the
  global development agenda.
• Make promotion of health a core responsibility of
  all of Government.
• Make promotion of health a key focus of
  communities and and civil society.
• Make promotion of health a requirement fro good
  corporate practice.

25
WHO Regional Framework for Health Promotion

• Sets out strategic directions for the promotion
  of health.
• The core areas of actions- focused on
  capacity-building
• health promotion leadership,
• health promotion infrastructure and financing,
• strategic partnerships for education,
• strategic partnerships for governance,
• health communication and health promotion
  effectiveness.

26
WHO Regional Framework for Health Promotion

• Five core strategies guide the direction of
  health promotion practice in the Western Pacific
  Region
• Building healthy public policies
• Creating supportive environments
• Strengthening community action
• Developing personal skills and,
• Reorienting health services.

27
Outline of Presentation

• Health Promotion Definition and Background

• International Initiatives for Health Promotion

• Health promoting hospitals International
  Experience

28
Health Promoting Hospital

• Rationale
• Hospitals play an important role in promoting
  health, preventing disease and providing
  rehabilitation services.
• Life style related non-communicable diseases are
  increasing.
• Chronic patients require continuous support.
• Emerging infectious diseases- Avian influenza.
• Hospitals have impact on the local environment.

29
Health Promoting Hospitals International
Experience

• Very good initiatives at the European Region
• Western Pacific Region had established a
  framework for health promotion in the region
  2001-05
• Key Documents from the European Region include
• The Budapest Declaration on Health Promoting
  Hospitals- 1991
• Vienna Recommendations on Health Promoting
  Hospitals- 1997

30
Budapest Declaration on Health Promoting
Hospitals 1991

• Recognized a set of standards
• Provide opportunities through out the hospital to
  develop health-oriented perspectives.
• Develop a common corporate identity- Branding
• Raise awareness of the impact of environment of
  the hospital on the health of the patient.
• Encourage active and participatory role of
  patients according to their specific potentials.
• Create healthy working conditions for all
  hospital staff.

31
Budapest Declaration on Health Promoting
Hospitals 1991

• Recognized a set of standards
• Strive to make the Health Promoting Hospital a
  model for healthy services and workplaces.
• Maintain and promote collaboration between
  community based health promotion.
• Improve communication and collaboration with
  existing social and health services.
• Improve the range of support given to patients
  and their relatives.

32
Budapest Declaration on Health Promoting
Hospitals 1991

• Recognized a set of standards
• Identify and acknowledge specific target specific
  target groups with in hospital.
• Acknowledge difference in value sets, needs and
  cultural conditions for individuals and groups.
• Create supportive, humane and stimulating living
  environments with in the hospital.
• Improve the health promoting quality and the
  variety of food services in hospitals for
  patients and personnel.

33
Budapest Declaration on Health Promoting
Hospitals 1991

• Recognized a set of standards
• Enhance the provision and quality of information,
  communication and educational programmes and
  skill training for patients and relatives.
• Enhance the provision and quality of educational
  programmes and skills training for staff.
• Develop an epidemiological data base in the
  hospital specially related to the prevention of
  illness and injury and communicate this to policy
  makers.

34
Vienna Recommendations on Health Promoting
Hospitals 1997

• Adopted fundamental principles
• Promote human dignity, equity and solidarity.
• Be oriented towards quality improvement, well
  being of patients.
• Focus on health with a holistic approach and not
  only curative services.
• Use resources efficiently and cost effectively,
  and allocate resources.
• Form as closelinks as possible with other levels
  of the health care system.

35
Vienna Recommendations on Health Promoting
Hospitals 1997

• Strategies for Implementation
• Fostering participation and creating commitment.
• Improving communication, information and
  education.
• Use methods and techniques form organizational
  development and project management.
• Learning from experience.

36
Health Promoting Hospital WHO initiatives

• Set standards for health promotion in hospitals
  (2004)
• Demands that a hospital has a written policy on
  health promotion.
• Describes the organisations obligation to ensure
  the assessment of peoples need for health
  promotion.
• Organisation must provide the patient with
  information on significant factors concerning
  their disease or health condition.
• Management has the responsibility to establish
  conditions for the development of the hospital as
  a healthy workplace.
• Deals with continuity and cooperation , demanding
  a planned approach to collaboration with other
  health service sectors.

37
Responsibilities of Management to make Health
Promoting Hospital

• Develop written policies on health promotion and
  set standards by involving staff.
• Example baby-friendly hospitals.
• Organise training programme for the staff.
• Develop monitoring framework with staff
  involvement.
• Provide recognition to staff who perform well on
  health promotion activities.
• Review the progress regularly and provide
  feedback to the staff.

38
Responsibilities of Staff to make Health
Promoting Hospital

• Contribute to developing hospital policies and
  workplans on health promotion.
• Adhere to hospital health promotion policies.
• Promote health promotion, interaction with
  patients and relatives.
• Regularly gather information, analyse and provide
  feed back to management.
• Represent and share the patients perspective
  to the management.

39
Key Challenges for Health Promoting Hospitals

• Changing health burden and complex determinants
  of health.
• Increasing burden of non-communicable diseases.
• Emerging infectious diseases- SARS, Avian
  influenza..
• Inequity and health.
• Increasing costs and lack of access to treatment.
• Disparities on access to care on the basis of
  region, gender, economic status, ethnicity...
• Poverty.

40
Key Challenges for Health Promoting Hospitals

• Communication revolution.
• How to use effective communication methodology.
• How to overcome ill effects of unhealthy
  products- tobacco, alcohol
• How to increase access to information.
• Globalisation.
• Link between globalisation and health
• Trade and health, massive movements of people,
  migration