Transcript Health Promotion - Distance Learning Centre

Health Promotion
What is it?
University of Aberdeen
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edited
Health Promotion Origins
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Improving the health of
individuals, communities and
populations is a long standing
societal issue.
First legislative action re
health improvement went
beyond the individual and
sought to address the socioeconomic conditions that
people found themselves in.
(1796)
•Focus of this health improvement
effort has shifted from
environments, systems and
populations to individual based
approaches and back again.
University of Aberdeen
Y Letson 2008
edited
Contemporary Health
Promotion Origins
World Health Organisation (WHO) Declaration of Alma Ata
(Russia) 1978
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Improvements in health could not be determined by
investments in the health care systems alone – prevailing view
since the end of the 2nd WW.
Needed to enrol other sectors in health improvement efforts.
The WHO’s Global Strategy for Health for All by the Year
2000 (1981)
Health Promotion: Concepts and Principles (WHO, 1984)
Ottawa Charter for Health Promotion (1986)
University of Aberdeen
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Health Promotion Definition
“Health promotion is the process of enabling
people to increase control over and to improve
their health. …. Health is a positive concept
emphasizing social and personal resources, as well
as physical capacities. Therefore, health promotion
is not just the responsibility of the health sector,
but goes beyond healthy lifestyles to well-being.”
Ottawa Charter for Health Promotion (1986)
University of Aberdeen
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edited
5 Health Promotion Actions
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Developing public
policy.
•Creating supportive
environments.
Developing personal
skills.
•Reorienting health
services
Strengthening
community action.
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edited
5 approaches to health
promotion
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Medical or preventive
Behaviour change
Educational
Empowerment
Social change
Naidoo and Wills (2000)
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edited
1. Medical or Preventive
Approach
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This approach is aimed at reducing premature
deaths (mortality) and avoidable diseases
(morbidity).
Actions are targeted at whole populations
(eg. immunisation) or so called high risk
groups.
Some argue this approach seeks to increase
the use of medical interventions to promote
health.
University of Aberdeen
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edited
1. Medical or Preventive
Approach
Primary prevention – prevention of the onset of
disease through risk education. – smoking
cessation, cholesterol reduction.
Secondary prevention – preventing the progression of
disease – screening and other methods of early
diagnosis.
Tertiary prevention – reducing further disability or,
preventing the recurrence of illness, patient
education, palliative care. tertiary healthcare is
specialized consultative care, usually on referral
from primary or secondary medical care personnel,
University of Aberdeen
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edited
1. Medical or Preventive
Approach: Characteristics
Is popular as it has high status, using scientific methods
– epidemiology.
In the short term, this approach is cheaper than the
treatment of people who have become ill. (May not be
the case in the longer term as people live longer and
suffer from degenerative disease).
It is top down and expert led, medical and health
professionals and recognised as having expert status.
University of Aberdeen
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edited
2.Behaviour Change Approach
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This approach aims to encourage
individuals to adopt “healthy” behaviours
that are regarded as key to improving
health.
This approach is popular - views health
as the property of the individual.
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2. Behaviour Change Approach
Assumptions
People can make real improvements to their
health by changing their lifestyle.
• If people don’t take responsibility for their
actions they are to blame for the
consequences -victim blaming approach.
•
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2. Behaviour Change Approach
However, it has become
acknowledged that the
complex relationship exists
between individual
behaviour, social and
environmental factors.
Behaviour - it is now
recognised may be a
response to the conditions
people live in and the
causes of these conditions
may be out of individual
control.
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But - the behaviour change
approach remains popular
with health promotion
agencies!
edited
Media and behaviour change.
Pause for thought!!
One of strategies used to encourage behaviour
change (and popular with health promotion
agencies) is the use of multi media campaigns.
Can you think of any mass media campaigns that
you have noticed that have been concerned
with encouraging behaviour change?
University of Aberdeen
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edited
3. Educational Approach
Strongly linked to health education
 Seeks to provide knowledge and
information, and to develop the
necessary skills so that people can make
informed decisions about their
behaviour.
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3. Educational Approach
Assumption
 Increasing knowledge may change in
attitudes, that may result in changed
behaviour.
 It is argued that this approach does not
necessarily set out to persuade or
motivate change in a specific direction!
University of Aberdeen
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edited
4. Empowerment Approach
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So-called bottom up approach - idea is premised
on helping people or communities to identify their
own health concerns, gain the skills and make
changes to their lives accordingly .
This approach reflects the general principles of
the Ottawa Charter definition.
Professional acts as a facilitator rather than
expert
University of Aberdeen
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4. Empowerment Approach
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Approach described as a way of working which
increases people’s ability to change their social
reality.
Community development is a similar way of
working.
Some statutory UK health agencies employ health
promoters to engage in community development
work – often in tandem with local authorities.
University of Aberdeen
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edited
4. Empowerment Approach
Can you think of any difficulties or
tensions that may exist for health
professionals engaged in this type
of work?
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5. Social Change Approach
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Targets groups and populations, top down method
of working.
Sometimes known as radical health promotion and
is underlined by a belief that socio-economic
circumstances determine health status.
Its focus is at the policy or environmental level.
Aims is to bring about physical, social, economic,
legislative and environmental changes.
University of Aberdeen
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edited
5. Social Change Approach
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Approach is based on the notion that to
promote positive health it is necessary to
tackle and diminish social and health
inequalities.
“Make the healthy choice the easier choice”.
Healthy choices may be available, but this may
require major structural changes.
University of Aberdeen
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edited
Structural inequalities
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DoH Nutrition Task Force 1996 – survey
showed that a healthy diet which
includes fruit, vegetables, high fibre
foods and less fat can cost up to a third
more than a typical diet of a low income
family.
University of Aberdeen
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edited
References
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Naidoo and Wills. 2000 Health Promotion Foundations for Practice. Balliere Tindall:
London
Breslow, L. 1999 From Disease Prevention to Health Promotion. JAMA 281 (11): 10301033.
Green, J. and South, J. 2006 Evaluation Open University Press, Maidenhead
Tones, K. & Green, J. 2004. Health Promotion: Planning and Strategies. Sage
Publications: London.
Nutbeam, D and Harris, E. 1999. Theory in a Nutshell. A Guide to Health Promotion
Theory. McGraw-Hill: Australia.
Egger, G. Spark and Lawson. 2005. Health Promotion: Strategies and Methods. (2nd
Edition) McGraw-Hill: Australia.
Ashton, J. and Seymour, H. 1988. The New Public Health. Open University Press:
Milton Keynes.
Glanz, K. Lewis, F. M. , Rimer, B. K. (Eds) 1997. Health Behaviour and Health Education:
Theory, Research and Practice. (2nd Edition) Jossey-Bass: San Francisco.
Lucas, K & Lloyd, B. 2005. Health Promotion: Evidence and Experience. Sage
Publications: London.
Lalonde, M. 1974 A New Perspective on the Health of Canadians. Government of
Canada: Ottawa.
University of Aberdeen
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References
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Scriven, A., Orme, J. 1996, Health Promotion: Professional
Perspectives, .Macmillan & Open University Press: Basingstoke.
Seedhouse, D., 2001, Health: The Foundation of Achievement (2nd
edition), Chichester: Wiley.
Tones, K. & Tilford, S. 1994, Health Education: Effectiveness,
Efficiency and Equity. Chapman Hall: London.
Skinner, H.A. 2002, Promoting Health Through Organisational
Change. Ben Cummings: San Francisco.
Amos, L., M. & Munro, J., 2002, Promoting Health: Politics and
Practice. Sage Publications: London.
Bunton, R & Macdonald, G., 1992, Health Promotion: Disciplines &
Diversity. Routledge: London.
Seedhouse, D., 1997, Health Promotion: Philosophy, Prejudice &
Practice. Wiley: Chichester.
(WHO) 1946, Constitution, Geneva: World Health Organisations
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Other information
Policy Documents
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Improving Health in Scotland: The Challenge, 2003, Scottish Executive.
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Towards a Healthier Scotland, 1999, Scottish Executive.
Health Promotion: Concepts and Principles (WHO, 1978)
http://whqlibdoc.who.int/euro/-1993/ICP_HSR_602__m01.pdf
Ottawa Charter (WHO, 1986)
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
Bangkok Charter (WHO, 2005)
http://www.who.int/healthpromotion/conferences/6gchp/bangkok_charter/en/
University of Aberdeen
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edited