Health Promotion 1

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Health Promotion 1

• Introduction to Health Promotion
• Denise Gray

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Lecture overview

• Health promotion definitions and concepts
• Definition of Health Promotion
• Health Promotion Features
• Historical milestones and the development of
  health promotion strategies and policies
• Late 1800s, early 1900s
• Late 1900 onwards
• Approaches used in health promotion
• Perspectives on Health
• Exploring different ways of looking a a health
  issue

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What is Health Promotion?

• What is Health Promotion?
• What does it mean to you?
• Educating people
• Changing health behaviour and lifestyle
• Preventing disease and illness
• Improving population health
• Any other ideas?

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Definition of Health Promotion

• Health Promotion is the process of enabling
  people to increase control over and to improve
  their health Ottawa Charter for Health Promotion
  (1986)
• Health Promotion has emerged as a new way of
  thinking about the root causes of health and
  well-being
• Has triggered the development of new approaches
  to improving the health of individuals and
  communities
• http//www.who.int/hpr/NPH/docs/ottawa_charter_hp.
  pdf

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Health Promotion Features

• We can better understand the definition of HP by
  looking at the key features and values that guide
  HP practice
• HP has unique features to ensure the health and
  well-being of individuals and communities
• These features distinguish HP from other
  approaches such as population health and disease
  prevention
• http//www.ohprs.ca

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Health Promotion Features

• The features include
• A holistic view of health
• A focus on participatory approaches
• A focus on the determinants of health, social,
  behavioural, economic and environmental
  conditions that are the root causes of health
  and illness
• Building of existing strengths and assets, not
  just addressing health problems and deficits
• Using multiple, complementary strategies to
  promote health at the individual and community
  level

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Health Promotion Features

• A Holistic View of Health
• HP adopts the WHO definition of health as a
  state of complete physical, mental and social
  well-being rather than a mere absence of disease
  or infirmity
• This definition regards health as a resource for
  everyday life
• Health is therefore viewed as a positive concept
  which emphasises social and personal resources as
  well as physical capabilities (WHO, 1984)

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Health Promotion Features

• A focus on Participatory Approaches
• Addressing health issues by doing things with
  people rather than for them
• Enabling people to take more control over
  conditions affecting their health is an important
  feature of HP
• Key health promotion values are
• Empowerment
• Social justice and equity
• Inclusion
• Respect

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Participatory Approaches

• Empowerment
• A process through which people gain greater
  control over the decisions and actions that
  affect their health (Nutbeam, 1998)
• Evidence shows that people who are able to
  exercise greater control and decision making over
  factors which affect their health enjoy greater
  health status
• Social Justice and Equity
• Poverty and income inequality are determinants of
  health status
• HP practice reflects a concern with social
  justice to ensure that everyone has equitable
  access to food, income, employment, shelter,
  education and other factors needed to maintain
  good health

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Participatory Approaches

• Inclusion
• Ensuring that everyone has access to the
  resources they need to maintain good health
• Also a voice in the decisions affecting their
  health
• Inclusion is emphasised in HP by working with
  members of marginalised groups in the community
  who face systematic barriers to good health
• Respect
• HP embodies and respects a diverse range of
  viewpoints, cultures and perspectives on health
  and wellness

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Health Promotion Features

• Determinants of Health
• Range of social, economic and environmental
  factors which determine the health status of
  individuals or populations (Nutbeam, 1998)
• Examples
• Social and physical environments
• Education, employment and working conditions
• Biological and genetic endowment
• Health care
• Multiple and inter-related and combined determine
  health status at the individual and community
  level

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Health Promotion Features

• Building on Strengths and Assets
• Examples are
• Community leaders
• Existing programmes and services
• Strong social networks
• Institutions and community events that bring
  people together
• HP practice builds on these positive factors when
  promoting the health of individuals and
  communities

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Health Promotion Features

• Using Multiple, Complementary Strategies
• Focused on individuals, families, groups,
  communities and entire populations
• Ottawa Charter for HP identified 5 strategies for
  HP practice
• Building healthy public policy
• Creating supportive environments
• Strengthening community action
• Developing personal skills
• Re-orienting health services
• These strategies are crucial in shaping the
  boundaries of HP practice over time

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How does HP differ from other approaches?

• Population Health
• Aims to improve health inequalities by examining
  and acting upon a broad range of factors and
  conditions that determine health (Hamilton and
  Bhatti, 1996)
• Does not place as much emphasis on strategies
  promoting individual and community level change
  e.g.
• Education
• Organisational change
• Community mobilisation

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How does HP differ from other approaches?

• Disease prevention
• Branch of public health practice concerned with
  prevention of chronic diseases which contribute
  to premature mortality e.g. Heart disease,
  cancer, stroke and diabetes
• Three levels of prevention
• Primary preventing the onset of disease e.g.
  immunisation focus on risk factors
• Secondary preventing the progression of disease
  e.g. screening
• Tertiary preventing the recurrence of illness
  or reducing further disability e.g. patient
  education, palliative care
• HP also does this but in addition, is committed
  to participatory approaches and has greater focus
  on social, economic and environmental causes of
  health and illness

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Origins of Health Promotion

• 1800s - Public Health Movement
• John Snow Cholera, Broad St pump
• Epidemic disease ? improved sanitation
• 1900s Health Education and Health Promotion
• 1920 Propaganda and instruction
• Health education to prevent VD
• TB and danger of spitting
• 1970 High profile mass-media campaigns
• Vaccination, Smoking, HIV and AIDS
• 1980 Black Report Health inequalities linked
  to poverty
• 1986 WHO 1st National Conference on Health
  Promotion Ottawa Charter

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History of Health Promotion

• 1990 Strategies and Policies
• 1997 WHO, Jakarta Declaration
• 1998 - Working Together for a Healthier Scotland
• Health Promoting Schools
• Health Promoting Workplaces
• 2006 - Smoking Ban (2004-2007)
• 2007 - Healthy Working Lives building on
  success of SHAW (1996)
• Health promotion continues to evolve, with
  increased use of multi-media campaigns and more
  recently, the Internet as tools for education

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Media campaigns

• 1920s 1960-70s

http//www.nlm.nih.gov/exhibition/visualculture/vc
home.html
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Media campaigns

• 1980s 1998

http//www.nlm.nih.gov/exhibition/visualculture/vc
home.html
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Media campaigns
2004 and 2006
http//www.refuge.org.uk/page_l1-3_l2-426_l3-270_l
4-1439_.htm
http//www.knowyourlimits.gov.uk/further_informati
on.html
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Approaches to Health and Health Promotion

• Perspectives on Health
• What causes heart disease? Ask three different
  health professionals and you may get three
  different answers!
• Cardiologist may say Hypertension, family
  history and a build-up of arterial plaque
• Public health nurse may say smoking, physical
  inactivity, excess alcohol consumption and a high
  fat diet
• Social worker may say stress, poverty,
  unemployment and social isolation

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Models of Health

• These models influence the definition of health
  issues and the choice of strategies and actions
  for addressing them

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Approaches to Reducing Health Disease
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Challenges

• Policy
• Who decides what health policy should be?
• How do you implement it?
• Will everyone benefit equally?
• Practice
• Depends upon who is providing health care
• What perspective they take
• What is best practice?
• Individual
• Behaviour often in response to other conditions
  hard to change in isolation and danger of
  victim blaming
• Education where, when and how?

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Summary

• Many different meanings attached to the concept
  of health
• Heath Promotion considers the root causes of
  health and well-being
• Multiple strategies are the most effective
• HP approaches and practice differ depending on
  perspective
• HP will continue to evolve as our society and
  environment changes
• HP is complex and challenging!

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Health Promotion 2

• How does a Policy become an Intervention?
• Health Promotion Initiatives in Scotland
• Objectives
• Activities
• Outcomes
• Effectiveness
• How do we know if they worked or not?

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References and Links

• Naidoo Wills (2000) Foundations for Practice.
  Balliere Tindall London
• Naidoo Wills (2001) Health Studies An
  Introduction. Balliere Tindall London
• Nutbeam, D. (1998) Health promotion glossary.
  Health Promotion International, 13, 349364
• Hamilton, N. Bhatti, T. (1996) Population
  Health Promotion An integrated model of
  population health and health promotion. Ottawa
  Health Promotion Development Division
• http//www.who.int/hpr/NPH/docs/ottawa_charter_hp
  .pdf
• http//www.who.int/hpr/NPH/docs/jakarta_declarati
  on_en.pdf