Strategies for promoting health

1. Health promotion aims to achieve better health for everyone. It is the process of preventing ill health and advancing the health of individuals and the community through planned interventions. The World Health Organization defines health promotion as ‘the process of enabling people to increase control over their health and improve their health’. This definition underpins a global approach to health promotion initiated by the World Health Organization. In 1986 this definition was incorporated in a document known as the Ottawa Charter for Health Promotion that was developed as part of the first International Conference for Health Promotion. Strategies for promoting health What is health promotion?

2. The Ottawa Charter outlines essential actions for effective health promotion and is based on the understanding that health is socially determined. It recognises the importance of a broad range of approaches to health promotion that assist people to gain greater control over their health and improve their health outcomes. These approaches need to: • focus on the prevention of ill health, not just on treating illness • provide resources and opportunities for individuals and groups to achieve positive health • include school and community health education • include resources to support healthy living and working environments • ideally, provide equal access to health and physical activity resources for everyone • include legislation, policies and economic conditions to protect people from harm. Health promotion therefore is more than teaching students the importance of good health or promoting lifestyle behaviours that reduce the chance of diseases developing in later life. It involves: • recognising the social, economic, behavioural, environmental and lifestyle factors that contribute to the lifestyle-related health problems that are currently prevalent • seeking to address these factors in order to support behavioural change. What is health promotion?

3. A wide range of people and groups have responsibility for promoting better health. These include: • individuals • community groups and schools • non-government organisations • various levels of government • international organisations. For health promotion to be effective, a coordinated approach by all people and organisations involved is needed to successfully plan, develop and deliver initiatives that address identified areas of concern. Responsibility for Health Promotion

4. Individuals play a key role in promoting their own health, because personal behaviour is the major determining factor of health status. Ill health can be prevented by making choices that promote health and leading a healthy lifestyle. However, the living conditions of some people limit their ability to easily make healthy choices and prevent them from taking control of their health, leaving them vulnerable to illness and disease. It is important to note, however, that an individual’s social, economic and cultural environments contribute to their health practices. Individual factors interrelate to impact on a person’s health. While individuals can develop their knowledge on health issues, which aim to impact on their behaviour, if an individual’s attitude is not supportive of the new knowledge they have gained, it is hard for their behaviour to change. For example, young people learn about the dangers of smoking and developing lung cancer in the future, however, young girls may think it is cool to smoke and that it can assist them with weight loss, therefore, their behaviour does not change, despite them knowing that smoking is bad for their health. Individuals

5. An individual’s motivation levels also affect their health choices. If a person is motivated to reduce their stress levels, then by choosing to implement effective time-management strategies such as checklists, completing tasks before due dates and organising relaxation sessions they will contribute to reducing their stress levels. However, a lack of motivation can negatively affect an individual’s health, for example, a person who is not motivated to exercise. By sitting on the couch watching television and eating chips they will put on weight, which can lead to obesity, cardiovascular disease or diabetes. While there are external factors that influence an individual’s health, there are certain factors for which, ultimately, the individual is responsible if they are to improve and promote their health and wellbeing. Individuals

6. An individual at risk Tamika is 21, unemployed and has little money. She dropped out of school in year 10 and has struggled to find regular full-time work. She has moved house many times in the past few years, even though she could live with her mother, who loves and cares about her but also expects her to take responsibility for her life. Tamika sleeps most of the day and eats a large, usually high-fat meal at night. She is overweight and has been warned by her doctor that she is at risk of developing diabetes if she does not change her lifestyle. She suffers from depression and feels no-one understands her. CASE STUDY INQUIRY: Empowering individuals to improve their health Read the case study about Tamika and answer the following questions. 1. Identify factors in Tamika's life that affect her ability to take actions to improve her health. 2. Propose people or groups who could play a role in supporting Tamika and empowering her to improve her level of health. Briefly describe how these people or groups could help to promote Tamika's health.

7. Communities play a significant role in supporting individuals to adopt health-promoting practices and ensure the environment in which people live is conducive to healthy living. Various community groups work towards improving the health of society. These include mobile playgroups, church groups, sporting groups and schools. These community groups can serve many purposes in supporting and enhancing an individual and their environment. Community groups and schools

8. School communities have an instrumental role in promoting opportunities for positive health behaviours. Providing activities for all the school community members allows a holistic approach towards health. Schools can offer health-promotion strategies for their communities through: • offer health-promotion strategies for their communities through: • teaching compulsory PDHPE lessons from kindergarten through to Year 10 • educating individuals about the risk factors of lifestyle diseases such as • smoking, inactivity and unhealthy eating choices • implementing school policies such as ‘no hat, no play’ to reduce skin cancer implementing anti-bullying policies to reduce mental health issues • bringing in guest speakers to raise the awareness of topics, such as domestic violence or ways in which to access health services • offering lunchtime sport competitions to improve physical activity levels • conducting peer support programs to ensure individuals feel connected • and supported • presenting seminars to parents on safe partying and how to assist their children with stress and coping • selling healthy foods in the canteen • holding multicultural days to highlight and accept diversity of the different • cultures within the school. Community groups and schools

9. Depending on the needs of a local community, support groups such as Alcoholics Anonymous, English-speaking courses for new migrants and health facilities, such as a baby health clinic, can assist a population to improve their health. Community groups, such as the Lions Club, fundraise for their local communities and assist in times of disaster, such as bushfires and floods. Communities have a significant role in improving the health status of their members. They help develop personal and social identities through common beliefs, values and norms, which assist people to live. Communities have a greater ability to empower people to take action towards changing their environment for the better. When groups of people are bound together for a common cause, there is a greater capacity to bring about change. Community groups and schools

10. Breakfast at school — benefits for health and learning Teachers in the Northern Territory have long been concerned about low attendance rates among indigenous schoolchildren and poor levels of concentration in class. A major concern was that many students were coming to school hungry, which caused them to be unsettled and lacking in energy. This in turn was affecting their ability to learn and enjoy school which had a long-term impact on their well-being and employment prospects. There are various reasons why children don't have breakfast at home; for example: • some parents leave very early for work and aren't able to supervise breakfast • many children have early transport pick-ups and often skipped breakfast • some families struggle financially to provide sufficient food for their children or make poor food choices • there might be a limited understanding of nutrition and its importance for good health. Health experts are clear about the benefits of a nutritious breakfast. It helps with children's physical and mental development and is essential to maintain energy levels and concentration skills. Skipping breakfast during childhood is also believed to be a factor in increasing obesity later in life. CASE STUDY

11. A school and community health initiative now operating in many schools across Australia, particularly in disadvantaged urban or regional communities, is the Good Start Breakfast Club. The program involves a team of volunteers who serve schoolchildren with cereal, fruit, toast and juice, and teach them healthy eating habits. The Australian Red Cross runs the program in partnership with Sanitarium Health Foods. Some schools report that indigenous students’ attendance has risen from 50 per cent to around 70 per cent and their overall health, behaviour and willingness to learn have improved significantly. The General Manager of Sanitarium Health Foods (www.sanitarium.com.au) states the program is about ‘nourishing the minds of growing bodies, and teaching kids positive habits that will stay with them for life, ensuring the brightest futures’. INQUIRY: Breakfast at school Read the case study about the breakfast program and answer the following questions. CASE STUDY 1. Identify the problems that led to the introduction of a school breakfast program. 2. Which organisations are working in partnership to make this health initiative possible? 3. Discuss the importance of school-based programs such as the Breakfast Club for the promotion of health, both now and in the future.

12. Non-government organisations Non-government organisations (NGOs) play a key role in promoting health. Specialised organisations that are independent from the government provide a greater focus on specific heath issues. Examples of non-government organisations include the following. Non-government organisations (NGOs)

13. Government The Commonwealth Government is responsible for: • planning and forming national health policies • identifying priority areas for action and coordinating health promotion campaigns to ensure national health priorities are addressed in an effective and efficient way • giving direction to state health policy making and influencing its delivery • allocating funding for health promotion, special projects and research to state and local government groups as well as NGOs • introducing regulations and legislation to ensure the maintenance of health. The Commonwealth Government is responsible for formulating and overseeing long-term programs and strategies that address Australia's health priorities. These programs seek to reduce the risk factors for chronic diseases suffered by many Australians in order to improve the general well-being of the nation and lessen the burden of chronic poor health.  Government

14. National programs often involve a collaborative partnership between federal and state governments and can also be supported by industry and other organisations with an interest in promoting good health. Organisations such as the Cancer Council, the National Heart Foundation and the Australian Medical Association are some of the groups that have collaborated on the National Tobacco Campaign. Research is used to inform the strategies developed and evaluation is undertaken to measure their effectiveness and determine changes in knowledge, behaviour and attitudes that may have taken place. Government

15. State government State governments have the primary responsibility for planning and delivering specific health promotion and disease prevention programs. These programs may be funded by Commonwealth grants, jointly funded by the federal and state government, or funded solely by the state itself. Each state has a department of health that includes health promotion personnel who develop and run health promotion programs. Local governments Local governments are given specific health roles for helping to implement state-controlled programs at a community level. For example, they ensure swimming pools are fenced and are responsible for carrying out inspections to ensure compliance with food handling, storage and preparation regulations by businesses selling food. However, a recent trend has seen local councils participating in a broader range of health promotion programs. For example, they have been responsible for developing lifestyle events and programs using community infrastructure and facilities, such as creating community gardens and holding ‘come and try’ workshops in local parks and halls. Such programs seek to address local issues and strengthen community involvement in actions that target these issues. Government

16. International organisations Global health issues affect everyone, regardless what country a person lives in. Health varies considerably from country to country. International collaboration is important to improve Australia’s health, as Australia is able to learn from and contribute to international and regional health issues. Working with health ministers in other countries, and with international organisations and health and medical institutes enables Australia to set health standards and structures of support for health promotion. International organisations can and do assist Australia in developing health policies and resources and in providing information on how Australia’s health is progressing in comparison with the health of other nations. United Nations The United Nations (UN) helps millions of people around the world. They aim to give people a voice to share their struggles and fears. The United Nations plays a crucial role in assisting countries to address issues that they cannot resolve on their own. The key focus of the United Nations includes issues relating to children, education, poverty, peace, health, HIV/AIDS, human rights, climate change, emergencies, and women. International Organisations

17. The World Health Organization A specialised branch of the United Nations, the World Health Organization aims to work with others to promote the health of all people. Conferences and forums allow discussions to take place around health issues that have a global impact. The main functions of the World Health Organization are: to give worldwide guidance in the field of health to cooperate with governments to strengthen the planning, management and evaluation of national health programs to develop and transfer appropriate health technology, information and standards for human health. International Organisations World Bank The World Bank focuses on the inclusion and sustainability of globalisation to developing countries. The assistance provided through financial and technical support enables developing countries to improve the health and infrastructure of their populations.

19. Lifestyle/behavioural approaches • Various programs target an individual’s lifestyle and behaviour in order to improve their health. These programs aim to develop individual skills to empower people to take control of their behaviour and attitudes. Lifestyle/behavioural approaches ensure that individuals: • Develop accurate knowledge about the health consequences of their • lifestyle behaviour, for example, knowing the short- and long-term effects • of obesity on the body. • Find personal meaning and relevance in changing their behaviour/lifestyle, • for example, realising that reducing their drinking habits will bring about • stronger family relationships. • Feel positive towards the outcomes of their behaviour change—feeling a • sense of achievement as they reach milestones. • Are empowered in their ability to make the behaviour change. • Are accepted by their peers and communities positively as a result of their • behaviour change. • Are equipped with skills to cope with difficult situations or relapses to • their previous lifestyle/behavioural patterns. Health promotion approachesand strategies

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22. Public health approaches are undertaken on a large scale. They seek to include a large number of people with maximum involvement. Usually these approaches endeavour to improve the health and safety of all individuals by addressing underlying risk factors. Public health approaches try to encompass whole communities to embrace positive behaviour change. A number of public health approaches have been used in Australia, such as health promoting schools and WorkCover. These approaches are implemented on a mass scale to ensure maximum involvement and coverage of individuals. Health-promoting schools Health-promoting schools are a key public health approach used in Australia. The approach focuses on the interaction between health and education sectors to improve the health of children and young people. It has an organised set of policies, practices, activities and structures, designed to protect and promote the health and wellbeing of students, staff and the wider school community members, while providing consistent messages to school, home and within the community. Public Health approaches

23. Health Promoting Schools A health-promoting schools’ approach is able to target many individuals at once: students, staff, families and the wider community. Through the provision of education, school organisation, ethos and environment, and improved partnerships within the community, this approach to health promotion can have positive impacts on the health of individuals.

24. WorkCoverNSW is a statutory authority that works in partnership with the NSW community to create safe workplaces, effective return-to-work procedures and security for injured workers. They administer and enforce compliance with occupational health and safety (OH&S), injury management, return-to-work and workers’ compensation legislation and manage the workers’ compensation system. They have access to all workplaces and are, therefore, able to target specific issues to enhance individuals’ health.WorkCover has undertaken a number of health promotion initiatives to improve safety and wellbeing in the workplace. The ‘Homecoming’ campaign uses a television commercial to highlight the affect of a worker potentially not returning from work because they might have had an accident and showing the effect on their family. The campaign also uses posters to remind individuals that workplace safety doesn’t just affect those at work. WorkCover