N

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NÂNG CAO S?C KH?E
GS TS BS Lê Hoàng Ninh
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Ð?nh nghia nâng cao s?c kh?e

• A planned combination of educational, political,
  regulatory, and organizational supports for
  actions and conditions of living conducive to the
  health of individuals, groups, or communities.

Green Kreuter, 1999
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Ð?nh nghia nâng cao s?c kh?e
WHO, 1986

• The process of enabling people to increase
  control over and improve their health
• a commitment to dealing with challenges of
  reducing inequities, extending the scope of
  prevention, and helping people to cope with their
  circumstances
• creating environments conducive to health, in
  which people are better able to take care of
  themselves

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NH?NG Ð?C TRUNG CO B?N C?A NÂNG CAO S?C KH?E

1. Enabling people to take control over, and
   responsibility for, their health as an important
   component of everyday life.
2. Requiring the close cooperation of sectors beyond
   the health services.
3. Combining diverse, but complimentary, methods or
   approaches.
4. Encouraging effective and concrete public
   participation.

The Working Group on Concepts and Principles in
Health Promotion, 1987
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THE TRIAD OF HEALTH PROMOTION
HEALTH EDUCATION HEALTH PROTECTION DISEASE
PREVENTION
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The Health Promotion Triad
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PHÒNG NG?A B?NH T?T
BA C?P Ð? C?P I (Primary) C?P
II(Secondary) C?P III (Tertiary)
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Phòng ng?a c?p I
Phòng ng?a c?p II
Phòng ng?a c?p III
Cure
Chronic disease
Healthy individual
Biological onset of disease
Clinical Course of disease
Disability
Death
Functional Status
Risk Factors
Asymptomatic signs
Symptoms and signs
Rehabilitation Support
Immunization Health Education Prophylaxis
Sàng l?c b?nh
Diagnosis Treatment Compliance Adherence
Các giai do?n phòng ng?a b?nh theo ti?n trình t?
nhiên c?a b?nh
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Phòng ng?a c?p I(PRIMARY PREVENTION)

• - Action taken to avert the
• occurrence of disease

• Interventions
• o Medical
• o Legislative
• o Societal
• o Educational
• o Individual efforts

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PRIMARY PREVENTION

• - The more directly a behavior is
• linked to a health problem as a
• risk factor, the better
• candidate it is for primary
• prevention efforts

Simons-Morton, Greene, Gottlieb, 1995
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Phòng ng?a c?p II(SECONDARY PREVENTION)

• Action taken to identify
• diseases at their earliest stages
• and to apply appropriate
• treatments to limit their
• consequences and severity.

J. Thomas Butler, 2001
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Phòng ng?a c?p III(TERTIARY PREVENTION)

• Specific interventions to assist
• diseased or disabled persons in
• limiting the effects of their
• diseases or disabilities also may
• include activities to prevent
• recurrences of a disease.

J. Thomas Butler, 2001
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Prevention
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GIÁP D?C S?C KH?E(HEALTH EDUCATION)

• Planned process,
• Combines a variety of educational
• experiences, and
• Facilitates voluntary adaptations
• or establishment of behaviour
• conducive to health

J. Thomas Butler, 2001
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GIÁO D?C S?C KH?E(HEALTH EDUCATION)

• Aims primarily at the voluntary
• actions people can take on their
• own part, individually or
• collectively, for their own health
• or the health of others and the
• common good of the community

Greene Kreuter, 1999
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Learning Domains
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Cognitive Domain

• Aspect of health education that comprises
  information and knowledge
• Information gained from health education can be
• A new information
• A reinforcement

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Psychomotor Domain

• Aspect of health education that deals with skill
  acquisition and reinforcement

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Affective Domain

• Aspect of health education that is mainly
  concerned in
• Habit formation
• Behavior change
• New practice

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BA M?C ÐÍCH CHÍNH C?A GIÁO D?C, NÂNG CAO S?C
KH?E TUONG ?NG V?I BA C?P Ð? D? PHÒNG

• Promotion of health and illness
• prevention
• Restoration of health when one
• becomes ill
• Maintenance of health while
• coping with chronic, long-term
• conditions

Potter Perry, 1993
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HEALTH PROMOTION MODELS

• THREE SPHERES
• Health Education
• Prevention
• Health Protection
• SEVEN DOMAINS
• Prevention
• Lifestyle
• Preventive Policies
• Policy Maker
• Education
• 5. Health Education
• 6. Health Protection
• 7. Policy Support

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Prevention(Preventive Services)

• This domain includes primary preventive measures,
  such as immunization and exercise programs, and
  secondary preventive measures, such as pap
  smears, hypertension case-finding, and smoking
  cessation programs.

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Lifestyle(Preventive Health Education)

• This includes education efforts to influence
  lifestyle to prevent health-related problems and
  to encourage the uptake of preventive services.

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HEALTH PROMOTION MODELS

• THREE SPHERES
• Health Education
• Prevention
• Health Protection
• SEVEN DOMAINS
• Prevention
• Lifestyle
• Preventive Policies
• Policy Maker
• Education
• 5. Health Education
• 6. Health Protection
• 7. Policy Support

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Preventive policies(Preventive Health
Protection)

• This sphere represents health protection,
  including fluoridation of public water supplies
  and inspections of restaurants.
• It can be viewed as a policy commitment to the
  provision of preventive services such as those
  described under domain 1.

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HEALTH PROMOTION MODELS

• THREE SPHERES
• Health Education
• Prevention
• Health Protection
• SEVEN DOMAINS
• Prevention
• Lifestyle
• Preventive Policies
• Policy Maker
• Education
• 5. Health Education
• 6. Health Protection
• 7. Policy Support

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Policy maker education(Health Education for
Preventive Health Protection)

• Given that health protection measures do not
  emerge spontaneously, education of policy makers
  is important.
• Example of this is the lobbying by
  safety-conscious groups to encourage mandated use
  of automobile seat belts in the face of much
  public apathy.

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• Efforts to stimulate a social environment that
  demands or accepts preventive health protection
  measures are also part of this domain (Downie,
  Tannahill, Tannahill, 1996),
• As is a policy commitment to preventive health
  education.

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HEALTH PROMOTION MODELS

• THREE SPHERES
• Health Education
• Prevention
• Health Protection
• SEVEN DOMAINS
• Prevention
• Lifestyle
• Preventive Policies
• Policy Maker
• Education
• 5. Health Education
• 6. Health Protection
• 7. Policy Support

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Health education(Positive Health Education)

• This domain comprises all aspects of positive
  health education, including influencing behavior
  by helping individuals, groups, or whole
  communities develop positive health attributes,
  such as life skills and self-esteem.

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• Health promotion encompasses
• health education...and is aimed at
• the complementary social and
• political actions that will facilitate
• the necessary organizational,
• economic, and other
• environmental supports for the
• conversion of individual actions
• into health enhancements and
• quality of life-gains.

Greene Kreuter, 1999
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Health protection(Positive Health Protection)

• This domain includes implementation of a
  workplace policy forbidding smoking, graduated
  drivers licenses, and commitment of public funds
  to provide safe-walking areas and bicycles paths.

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Policy support(Health Education Aimed At
Positive Health Protection)

• This domain embraces raising awareness of, and
  securing support for, positive health protection
  measures among the public and policy makers.
• It includes a policy commitment to positive
  health.

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HEALTH PROMOTION MODELS

• THREE SPHERES
• Health Education
• Prevention
• Health Protection
• SEVEN DOMAINS
• Prevention
• Lifestyle
• Preventive Policies
• Policy Maker
• Education
• 5. Health Education
• 6. Health Protection
• 7. Policy Support

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HEALTH PROTECTION

• Comprises legal or fiscal controls,
• other regulation policies, and
• voluntary codes of practice, aimed
• at the enhancement of positive
• health and the prevention of ill-
• health

J. Thomas Butler, 2001
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HEALTH PROTECTION
MISSION reduce the likelihood that people
will encounter environmental hazards or behave
in unsafe or unhealthy ways.
Downie, Tannahill, Tannahill, 1996
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Health Protection

• Philippine Medical Act of 1959
• PHILHEALTH
• Generics Law National Drug Policy and Formulary
• Dangerous Drugs Act
• Cheaper Medicine Bill
• Code of Sanitation of the Philippines

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Health Protection

• Disability Act
• Senior Citizens Law
• Child Protection Laws and Policies
• Clean Air Act
• MMDA Waste Management Policies

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HEALTH PROMOTION
Strategies
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Strategies

• Educational Interventions
• Organizational Interventions
• Political/ Legislative Interventions
• Community and Social Interventions
• Economic Interventions

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Educational Interventions

• Stress management classes for middle-management
  employees in the workplace
• Mail-outs to the public describing positive steps
  a person can take to reduce exposure to HIV
• Educational programs designed to reduce personal
  vulnerability to crime
• Primary school programs to develop the skills to
  cope with peer pressure

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Organizational Interventions

• Annual hearing and vision screening in schools
• Automobile, bicycle, and firearm safety programs
  conducted by law enforcement agencies
• Identification of designated smoking areas and
  development of a smoking policy in a worksite
• Official recognition by business management of
  alcoholism as a disease and not a weakness in
  character
• Development of support groups by nonprofit
  organizations and facilities that provide
  services to people with special needs

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Political/ Legislative Interventions

• Passage of laws requiring use of helmets while
  riding motorcycles and bicycles
• Legislation requiring environmental polluters to
  measure their pollution and implement effective
  plans to reduce the pollution
• Fluoridation of the water supply
• Regulations requiring agencies and companies to
  monitor air pollution and governmental actions to
  reduce it
• Regulations aimed at reducing youth access to
  tobacco products and alcohol

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Community and Social Interventions

• Organization and training of out of school youth
  to reduce vulnerability to sex or drug crimes
• Formation of neighborhood walking clubs
• Health fairs at shopping malls

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Economic Interventions

• Tax incentives to landlords of low-income housing
  to encourage maintenance of property and
  reduction of pest infestation
• Incentives from insurance companies to those who
  practice healthy lifestyles
• Incentives from employers to employees who stay
  healthy and do not miss work