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Human health, public health and
health’s promotion.
Considerations.
Human health
Health promotion
Public health
Marcio Ulises Estrada Paneque.
MD. PhD.
Human health.
• WHO 2001: … complete physical, mental and
social well-being state and not only absence of
disease or ailment.
• This medullary ideas conform the totality in
health, although there are differences between
ages, countries, cultures, classes and sorts that
prevent a homogenous consensus on this
definition.
• Physical and mental health, and wellbeing/social health, cannot exist independent .
• It belongs to interdependent dimensions.
Human health.
• Health is the base for well-being and the
effective life of an individual or a community.
• Health and disease can exist simultaneously
and are mutually exclusive only if the health is
defined restrictively.
• When recognizing health like a state of balance
of the own, the other and the enviroment, the
result is that individual and community look for to
improve it.
Human health.
• Health and disease are determined by many
factors that interact in social, psychological and
biological form, those that world-wide are
associate with indicators of poverty and low
levels of education.
• Association of poverty and bad health happens
in all societies, independent of its levels of
development.
• Factors like the insecurity, violence and changes
of articles of incorporation and styles of risk life,
increase the vulnerability and condition the
propensity to the development of diseases.
Public health.
• Public health is science and art to promote
health, to prevent diseases and to prolong the
life through organized efforts of the society.
• The gains in health have been obtained as a
result of improvements in the economic income,
education, water provision, nutrition, hygiene,
house, and health services.
• It are also result of new knowledge on the
causes, prevention and treatment of the
diseases.
Public health challenges.
• Demographic and epidemiologic changes,
environment deterioration, modern life conditions
in the great cities, accidents and chronic diseases
constitute sanitary challenges in this century.
• This scene requires to implement strategies of
public health that prevent the diseases appearance
and promote the total development of the health.
• These challenges exist due to the priority of
diseases treatment services by on promotion
programs and primary prevention of diseases.
Advances in the Public Health
• Implementation of policies that make
possible more accessible intervention
programs.
• Individual combination of structural
changes and actions.
• 21st century: What causes that the people
are healthful?
• Health genesis versus pathogenesis.
Stigmata for the global public health.
• Every six seconds, a boy dies of hunger and is
1000 million hungry people in the planet.
• Inequalities and lack of cover in the health.
• Increasing prices and the climatic change events
exacerbate this situation.
• Causes: marginalization, poverty, lack of earth
and employment and unjust international
economic order.
Prevention of diseases and health
promotion (HP).
• Prevention of diseases and health
promotion are different to each other, but
their objectives are superposed.
• Both interventions are complemented,
although but promotion and reach the
public to whom it goes directed are much
more ample
Prevention of diseases.
• Concept of prevention in health derives from the
classic paradigm of public health that
distinguishes three levels of prevention:
 Primary: Oriented to prevent diseases appearance
in susceptible populations. It uses as much
interventions of health promotion like specific
protection.
 Secondary: Its objective is to shorten the disease
duration once it has appeared, to reduce the
contagion probability, and to limit sequels, through
early diagnosis and opportune treatment.
Prevention of diseases.
• Tertiary: Directed to people with irreversible
diseases to which it is not had effective
treatments.
• It tries to preserve the functions, to diminish
incapacity, to diminish underlying disease
complications and to harness rehabilitation.
Preventive interventions.
• Preventive interventions must take into account
the diverse diseases causal factors, considering
its biological, psychological and sociocultural
components.
• Actions must focus, with preference, at the level
of public health instead of the individual level.
• If is difference in the disease incidence or
prevalence in comparable population groups,
exists the possibility of realizing primary
prevention.
Preventive interventions.
• Preventive actions have inevitable repercussions
in numerous health problems, besides specific
condition to which they are directed.
• Design of preventive interventions must be based
on an ample conceptual model with impacts in
diverse problems.
• It must consider human conduct like a crucial
factor. So that the prevention will be effective, it
requires of individuals changes in attitudes and
conducts at the same time as changes in the
systems.
Health and disease.
• Individual health is affected by individual factors,
social interaction, cultural structures and values
society resources
• Economic levels have implications in the familiar
health and mental health, social and conduct
interact problems and intensify those
implications. Substances abuse, mistreat and
violence are consequences and factors that
deepen those problems.
• Health and disease has multi-factor origin and
can exist of sequential and continuous form.
Differences in health concepts.
• Nonprofessional people consider to be healthful
when they do not have disease or they compare
health with vitality and autonomy.
• Majors adults define as an inner force and the
capacity to confront life’s challenges.
• Young people think about health like good
physical training conditions, energy and strength.
• Those that lives in prosperity think health about
the context to enjoy the life and those of less
resources think it like having the basic needs to
live.
Health promotion (HP).
• Health promotion, a still emergent field of action,
frequently is defined of indirect form, examining
primarily the health idea, when that term is
vague in itself, because it can talk about as
much to presentsstates show like disease or
incapacity absentees.
• Health can talk about a sufficiency state and
aptitude, or usable individual resources when it
are needed.
• Different conceptions exist on health and its
promotion, according to the diverse cultures and
experiences.
Textual definitions on PH.
• “Process that confer to the population means to
assure a greater control on its own health and
get it better“ (Ottawa Letter 1986); PAHO/OMS,
1996).
• Strategy directed to the profit of an integral
advance in life quality, every time in greater
degree, like the sum of population actions,
health services, sanitary authorities and other
social and productive sectors, directed to the
development of better conditions of individual
and collective health ". (PAHO/WHO, 1996).
Influential factors in HP
By his repercussion in theoretical and
pragmatic aspects of the HP, this
emphasize the following:
Little precision in the concept of health and
the responsibility that it infers.
Multicausalty of health and disease.
Little clarity in people in charge to develop
it (sectors, communities, family and
individual).
Insufficient evidence on its effectiveness.
Promotion and health theories.
• Unified theories of health, like the WHO
one, include individual and environmental
factors.
• It implies that health promotion must focus
so much to the individual as to
environment, and surpass the medicine
classic model centered in doctor and
patient, or the supplier and the user.
Promotion and health prevention.
• Promotion of health is action and law to
approach, to modify the health
determinants that are modifiable.
• Promotion and prevention are activities
that are related and superposed.
• First one takes care of determinants and
the second is concentrated in the diseases
causes.
Promotion and health determinants.
• Determinants are factors that improve or
threaten the individual or community health state
• It can be:
 of individual option (styles and habits),
 related to social, economic or environmental
characteristics outside the individual control
(class, sort, education and house)
 at communitarian level (social participation,
demand and/or labor availability and quality of
air and water)
Interventions in health promotion
• Interventions of any level (local/national), can
improve health.
• Intervention strategies were defined in Ottawa
letter (WHO 1986) with five strategies of action:
 To conform healthful public policies
 To fortify communitarian action
 To develop personal abilities
 Creation and protection of healthful atmosphere
 To reorient health services
Practice of health promotion.
• Diverse surroundings of health promotion
have common characteristics, based on
the collaboration - action and social
participation, and the functions of planning,
implementation and evaluation of the
programs.
• All promotion models agree in which
people potential is due to develop, to
control and to protect its own health and to
collaborate with others one
Health promotion models.
• These models include:
• Study of needs, resources, priorities,
communitarian structure and participation
“To make altogether instead of do for…”
• Plan of action in consensus, management of
resources, monitoring of action and changes
• Emphasis in the evaluation and dissemination
of best practices to improve the quality.
Evidence on health promotion.
• From 1998, WHO promoted use approaches
based on the evidence in the promotion actions.
• Generation of evidences on effectiveness in
health promotion is a challenge, since it is a
social action and it is difficult to control it.
• In order to measure its effectiveness, the
consensus is based on the methodological
triangulation, that allows to interpret evidences
convergence of different classes, in different
places and generated by different investigators.
Principle of prudence.
• It recognizes that all evidence can have
deficiencies, that never is possible to arrive to
say as much as to act with absolute certainty,
but that sufficient certainty on quality evidences
allows to make recommendations for the action.
• Evidence on effectiveness of health promotion
derives from the investigation based on the
community.
• It’s not possible to be trusted the quantitative
traditional measures totally. When including
qualitative methods, will exist a better
understanding of what it works and what no.
Force of the evidence in HP.
• In health promotion two medullary questions
with respect to the evidence exist:
 - The force that has and its implications for the
investigation, the practice
 - The design of policies.
• Evidence force is determined by the design of
interventions and methodological aspects like
validity and control of slants (falsificationprediction and repeatability). Evidence can be of
four types.
Types of evidence and HP.
• A: We knows what works, how it works
and its repetition is universal.
• B: We knows that it works, how it works
and its repetition is limited.
• C: Is known that it works, the repetition is
universal, but is not known how it works.
• D: Is known that it works, is not known
how and repetition is limited.
Investigation in health promotion.
• It works in an atmosphere where numerous
factors interact: economic, social, cultural and
political.
• This complexity very often not allows to obtain the
sufficient results to obtain evidences of type A.
HP strives in obtaining evidences of the B type,
which has implications for the practice.
• Effectiveness of an intervention for HP, not
always is guaranteed beforehand. Therefore
evaluation investigation must be combined with
the practice of HP.
Social capital and HP.
• Concept of “social capital” has been assumed to
reconstruct individual action in the investigation on
SHD means, it is more than qualification to improve
the individual productivity (capital human) and then
it projects itself to social organization (networks
and norms) that facilitates coordination and
cooperation for mutual benefit.
• Social capital is not a perception or individual
resource, is for collective action and promotes
growth, social and economic development. Relation
between social capital, health and health promotion,
is actually subjects of investigation and debates.
Social capital, risk and HP.
• Population health measures and risk factors are
considered like a sum of individual characteristics
in a population. Environmental association of one
or more factors and individual health.
• Social capital approach them like interaction
between environmental and social factors, and tie
groups of individuals (perspective of networks), it
explains the collective results variety, beyond the
explained thing by the individual results of health.
The social networks promote social cohesion,
informal attention, protection in crisis and better
education for health
Conceptual frame in HP action.
It must be concentrated in:
• Social and economic determinants of health
(social inclusion, absence of inequities &
discrimination and economic participation).
• To include all different methodologies from HP
that work concerning population.
• To involve to all and different sectors becoming
made responsible with HP.
Conceptual frame in HP action.
Health promotion practice must:
• Focus in the promotion of well-being
instead of the disease.
• To consider the population like a whole,
including those that present risk conditions.
• To orient itself towards action on health
determinants such as income and house,
rather on risk conditions and factors,
Conceptual frame in HP action.
• To include an ample rank of strategies,
such as communication, education,
organizational change, communitarian
development and local activities.
• To recognize and reinforce population
competitions.
• To include sanitary and social aspects at
the same time as medical services.
Health promotion components.
•
•
•
•
•
Social communication.
Social learning.
Intersectoral coordination.
Social participation.
Healthful surroundings.
• Promotion of effective health, produces
changes in health determinants.
Social communication and HP.
• Mass media are a vehicle to canalize educative
information, motivation and contents. In health
promotion and prevention it serve to harness
individual and collective conducts.
• Programs arise from determined population
evaluation of needs, susceptible to be boarded
by means of these strategies.
• It requires of problem knowledge and scientific
evidence on the promotional or preventive
interventions of greater effectiveness.
Social learning and HP.
• Is a interactive, reflective and critical process in
which participant people develop values,
knowledge and abilities, through its active and
experiential participation, to reinforce protective
factors (promotion) and to modify risk factors
(prevention).
• Results are obtained favoring expression of
creative capacity for construction of a collective
knowledge, where contribution and experience of
each participant contribute to the group learning.
Intersectoral coordination and HP.
• Intersectoriality is the agreement of political and
technical wills of diverse social sectors to
implement integral proposals destined to improve
the population health situation.
• It complements approaches of different scopes,
mobilizes resources and takes part jointly or
coordinated around health. Thus it is avoided to
duplicate to efforts and resources.
• Intersectoriality occurs in all society organizational
scopes, as much at national level as regional and
local, considering public and private institutions.
Social participation and HP.
• It is a real and effective capacity of people,
families or groups to indirectly influence or make
decisions on the health subjects that affects
them directly.
• It is a social process where all the actors identify
needs or health problems and are united in an
alliance to design and to put in practice solutions.
• Social participation in health acts of shared in
common form, evaluates and exerts a social
control on health system.
Healthful surroundings.
• People and communities environments formed
not only by a physical dimension, but talk about
social, economic, cultural and political aspects.
• It constitute communities life conditions and are
a great extent determining of people health.
• Labor districts, communities, towns, schools and
other centers are influential surroundings to
become healthful.
Interventions in HP.
• Directed to:
General population.
Vulnerable pre-school and babies.
Schools children.
Adults and majors adults in risk.
Individuals and groups with previous
health problems.
Special groups.
Challenges in HP.
• Health promotion is reduced and is confused
with the health education
• Family doctor roll in a the new vision of HP.
• Improvement of formation and major stimulation
by health promotion activities.
• Major participation of directive, managers of all
health centers and institutions.
• Improve infrastructure for health promotion
development in familiar medicine.
Conclusions.
• Medicine and public health advance together with
its styles of action.
• Satisfaction, well-being and quality of life
improvement of a person (ill, in risk or apparently
healthful) and their surroundings are fruit of a joint
work of health professionals and society.
• If yesterday we dedicated ourselves to patient and
risk, today is necessary to see people in his
integrity, with a human and holistic base,
harnessing his capacities, so that it can face the
challenges of environment.
Conclusions...
• If we yesterday saw the person in a clinical
frame today we must see it beyond its
surroundings: in the scope that lives,
studies or work, with a holistic and
integrating approach.
• Enable and to do participates person, the
community as far as health selfmanagement (Health promotion): this it is
defied that public health professionals
should face.