Transcript Monday May 3 1999

HEALTH PROMOTION
An Interdisciplinary
Perspective
Change is one thing, progress is another;
change is scientific, progress is ethical
Bertrand Russell
Overview of Presentation

Definitions & Concepts

Strategies for Promoting Health

Implications of Adopting a Health Promotion
Perspective

Recommendations
Definitions of Health Promotion

“Health promotion is the process of enabling people
to increase control over, and to improve their health”
(WHO, 1986)

“Health promotion is any combination of educational,
organizational, economic and environmental supports
for actions conducive to health” (Green & Kreuter,
1991)
Key Concepts and Issues





Defining Health and Health Promotion
Types of Health Promotion
The Evolution of Health Promotion
Distinguishing Health Promotion & Population Health
Risk vs Protective Factors
Health Definitions

Health is a complete state of mental, physical & social
well-being, not merely the absence of disease (WHO,
1986)

Optimal health is a balance of physical, emotional, social,
spiritual & intellectual health. (O’Donnell, 1989)

Health is seen as a resource for everyday life, not the
objective of living. (WHO, 1986)
Our Definition of Health

“We define health as the capacity of people to adapt
to, respond to, or control life’s challenges and
changes”

Adapted from Frankish et al., 1997
A "Canadian” Definition of Health Promotion

"Health as perceived in the context of Canadian
health promotion has to do with the bodily, mental,
and social quality of life of people as determined in
particular by psychological, societal, cultural and
policy dimensions. Health is seen by Canadian health
promoters to be enhanced by sensible lifestyles and
the equitable use of public and private resources to
permit people to use their initiative individually and
collectively to maintain and improve their own wellbeing, however they may define it." (Rootman &
Raeburn, 1994)
Canadian Health Promotion

There is a strong social, community, and self-reliance
element, given that the overall model of health
promotion is centered around the concepts of selfhelp, mutual aid and citizen participation.

The history of Canadian health promotion comes
from the Lalonde Report so that there are overtones
of lifestyle and behavior. However, this emphasis on
lifestyle, has of more recent times, been balanced by
the influential social model of the Ottawa Charter.
Canadian Health Promotion

There is a strong implicit element of empowerment and
efforts have focussed on high priority sectors such as
youth, women, disabled, aboriginal populations.

The health concept has a non-medical tone, the biological
component of health is not prominent.

The concept of quality of life is at the foundation of
Canadian health promotion. Adapted from Pedersen,
O'Neill & Rootman (1994) Health Promotion in Canada
How Canadian/European Health Promotion
Contrast with the United States






Social Focus
Collective Responsibility
Risk Conditions
Blame Society
Excuse the Victim
Green. L. (1994). Canadian Health
Promotion: An Outsider's View From the
Inside, in Pedersen et al., Health Promotion
in Canada





Individual Focus
Personal Responsibility
Risk Factors
Blame the Victim
Excuse Society
Three Types of Health Promotion

Public health/ preventive medicine

Lifestyle/behavioral

Socio-environmental or determinants of health
(population health)
Potential Impact of Policies & Programs
(Health or Non-health)
Environmental
Impact
Health
Impact
Social
Impact
Economic
Impact
Eras In the Evolution of Health Promotion

The Public Health Era

Entrenching the Medical Model

Lifestyles - Behavioral Health Education &
Social Marketing

Shifting the Paradigm -Health Promotion as
Self-Responsibility?
Characterizing Population Health




Concerned with whole communities or populations, not
just individuals
Concerned more with distal rather than proximal
determinants of health
Concerned with intersectoral action, not just the health
sector
Seeks to make populations more self-sufficient, less depend
on health services & professionals
Contrasting Individual vs
Population Health






Proximal Determinants
Individual as Focus
Health Sector
Behavioral Change
Educational & Behavior
Modification
Quality of Life as Outcome






Distal Determinants
Whole Populations
Intersectoral
Environmental Change
Policy/Organizational
Levers
Social Conditions as
Ultimate Outcomes
Implications of a Health Promotion Approach









Redirection of resources
Need to adopt new or different roles
New stakeholders from diverse sectors
New forms of management
New or refocused functions to address new targets
New foci for evaluation
New partnerships and intersectoral collaboration
May need to develop new capacities and skills
A new "culture" in the health system
Risk Conditions & Health Promotion










Unemployment, Inadequate Housing
Minority Status Racial Discrimination
Cultural and Language Barriers
Low Educational Levels
Abuse and Neglect
High Levels of Family Stress
Social Isolation
Constitutional Vulnerability
Marital Status
Adapted from Brown (1995). Urban ecological model of subjective wellbeing among the elderly. Gerontologist, 35(4), 541.
Population Attributable Risks
(4 health indicators + 10 socio-demographic characteristics)
PAR (%)
100
80
60
40
20
0
long-term disabilities
self-rated health
long-term disorders
mortality
Source: Dutch Public Health
Status and Forecasts, 1997
Protective Factors & Health Promotion







Middle or upper class, low unemployment
Adequate housing, pleasant neighborhood
High-quality health care
Easy access to adequate social services
Multigenerational kinship network
Non-kin support network
Family stability and cohesiveness
Core Strategies for Health Promotion

Create Supportive Environments

Develop Personal Skills

Reorient Health Services

Building Healthful Public Policy

Strengthen Community Action
From the Ottawa Charter for Health Promotion, 1986
Population Health Promotion
Nancy Hamilton &
Tariq Bhatti
Health Promotion
Development Division
February 1996
Program & Policy Influences on Health
Policies & Programs
(Health or Non-health)
Determinants
of Health
Health Impact
(Outcomes)
Quality of Life
Reorienting Health Services for Health Promotion

Ottawa Charter stated: "the health sector must move
increasingly in a health promotion direction, beyond
its responsibility for providing clinical/curative
services"

HPPB has a mandate to improve the health of
Canadians and to contribute to a sustainable, high
quality health care system" (Health Canada, 1998)

It is important that the Government provide national
leadership by highlighting how health promotion has
contributed to sustainable, quality health services
DETERMINANTS OF POPULATION HEALTH
Social
Physical
Biological
Environment
Environment
Endowment
Individual
Response
Illness
Health Status
& Function
Productivity
& Wealth
Canadian Inst.for Advanced Research
Health
Care
+
Evidence Regarding The Determinants of Health

Illness Care System (20-25%)

Biological Endowment (10-15%)

Physical Environment (10-15%)

Social & Economic Environment (50-60%)

Adapted: Canadian Institute of Advanced Research,
Why Some People are Healthy & Others Are Not
Projects Focussing on
Reorientation of Health Services













Review of Hepatitis C Services in Canada
Prevention Strategy for Hepatitis C in Canada
Survey of Multicultural Needs and Use of Crisis Intervention Services
Crisis Intervention Training for Multicultural Community Workers
Evaluation of Services for Stroke Survivors in British Columbia
Evaluation of Mental Health Education & Health Promotion Resources
Experiences of Mental Health Patients as Members of Community Boards
and Committees
Homelessness in Greater Vancouver
Implications of a Population Health Approach for Mental Health System
Predictors of Ritalin Use in ADHD Children
Role of Community Pharmacies in Health Promotion
The Role of Health Promotion in Primary Care
Use Population Health Research by Regional Health Authorities
Strengthening Community Action
for Health Promotion

Theoretical reasons include: increased responsiveness or
accountability so health needs & services are matched; the notion
that people have the right to participate in planning, implementing,
& evaluating services; the view that community empowerment can
lead to a sense of contribution/power in the system.

Practical reasons include: appreciation of untapped community
resources and energy; provision of a broader range of inputs to
decisions; notions that such participation may lead to more costeffective decisions; and the belief that lay participation may
contribute to more efficient delivery of services.

Political reasons include: loss of faith in the legitimacy and
superiority of professional knowledge in decision making; a means
of gaining support and the efforts of volunteers; greater awareness
of health problems, more appropriate use of health services.
Three Worlds of Planning
“Actual
needs”
C
Public’s
perceived needs,
A
A
priorities
D
B
Resources,
feasibilities,
policy
From Green &
Kreuter, 1991
Projects Focussing on
Strengthening Community Action











Community Workbook for Participatory Health Promotion Research
Community Survey of Attitudes toward Adolescent Drug Use
Community Participation in Health Care Decision-making
Development of Measures of Community Health for the Canadian
Community Health Survey
Health Impact Assessment as a Tool for Health Promotion and Healthy
Public Policy
Health-Care Decision-Making and Community Health Councils
Lay Report of Injury Prevention Projects with Native Populations
Lifestyle Services for Low-Income Women
Measuring the Health of Communities
Measurement of Mental Health in the NPHS
Royal Society of Participatory Research in Health Promotion
Projects Focussing on Development
of Supportive Environments













Environmental Scan & Needs Assessment of Persons with Spinal Injuries
A Review & Evaluation of Smoking Cessation Strategies
Analysis of Community Health Plans
Analysis of Tobacco Advertising and Health Impacts
Community-Based Programs & Policies Dealing With Septic Field Failure
Counter-Advertising and Health Messages
Evaluation Strategy for the BC Heart Health Promotion Project
Literature Review of Injury Prevention Projects with Native Populations
Risk Behaviour Prevention Projects with Adolescent Populations
Mental Health, Active Living & the Determinants of Health
Pediatric Antibiotic Resistance
School, Community & Nutrition Project
Study of Health Empowerment in West End Youth Project
Projects Focussing on Development of Personal Skills












Adolescent depression and suicide; the role of social inadequacy
Assessment & Treatment Program for Heart Surgery and Patients
Assessment Protocol for Evaluation of the Back Injury Prevention Project
Assessment of Needs of Single Parents Survey
Attitudes to Health Promotion and Illness Prevention Questionnaire
Cardiovascular Psychophysiology, Psychosocial Factors in Heart Disease
Dance/Music Therapy on Quality of Life in a Disabled Population
Dietary Screening as a Predictor of Anaemia
Effect of Weight Training on Bone-Density in Adolescent Girls
Pre-Admission Education on Anxiety and Hospitalization in Heart Patients
Health Promotion Behaviours and Adherence to Exercise Prescriptions
Health Promotion in a Hearing-impaired Adult Population
Projects Focussing on Development of Personal Skills







Hyperventilation Treatment for Panic Disorder
Injury Prevention Skills for Parents
Psychosocial Factors in Coping and Health Outcomes among Disabled
Social Assertiveness and Psychopathology
Stress and Coping in Student Mothers
Survey of Measures of Health and Well-Being
Test Anxiety and Performance in Statistics
Projects Focussing on Building
Healthful Public Policy





Barriers to Health Policy: Evaluation of Smoking Bylaws in BC
National Study of the Implementation of Provincial Health Goals
Policy Regarding the Use of Retail Warning Signs for the Tobacco
Reduction Strategy
Development of a Policy Document for the BC Tobacco Reduction
Strategy
Case Study of the Development of BC's Health Goals
STEP 1: Creating the Motive

What have we done so far:
Heightened public awareness, changes in beliefs, changes in
knowledge

What remains to be done:
Continued public and professional education
Education of policymakers
Building the public and political will
STEP 2: Enabling the Change

What have we done so far:
Developed educational resources, some enhanced skills, some
changes in the environment

What remains to be done:
Increased availability/accessibility of resources for health
promotion and disease prevention
Creating supportive environments
STEP 3: Reinforcing the Effort

What have we done so far:
Not enough, limited, unclear incentives for engaging in
prevention for individuals, businesses, health professionals

What remains to be done:
Creation of clearer incentives and rewards for engaging in
health promotion/disease prevention
Development of supportive structures, policies and legislation
Summary Recommendations

Short-Term: development of educational resources
for the general public, patients, volunteers, health
professionals and service providers

Intermediate: creation of resources for use by policy
makers and planners, development and rigorous
evaluation of pilot demonstration projects

Long-Term: advocacy for policy, structural changes,
and allocation of resources toward health promotion,
disease prevention and population health