Chapter 1 Part 1Introduction to Health Promotion © John Hubley & June Copeman 2008
Refocusing upstream "I am standing by the shore of a swiftly flowing river and hear the cry of a drowning man. I jump into the cold waters. I fight against the strong current and force my way to the struggling man. I hold on hard and gradually pull him to shore. I lay him out on the bank and revive him with artificial respiration. Just when he begins to breathe, I hear another cry for help. I jump into the cold waters. I fight against the strong current, and swim forcefully to the struggling woman. I grab hold and gradually pull her to shore. I lift her out on the bank beside the man and work to revive her with artificial respiration. Just when she begins to breathe, I hear another cry for help. I jump into the cold waters. Fighting again against the strong current, I force my way to the struggling man. I am getting tired, so with great effort I eventually pull him to shore. I lay him out on the bank and try to revive him with artificial respiration. Just when he begins to breathe, I hear another cry for help. Near exhaustion, it occurs to me that I'm so busy jumping in, pulling them to shore, applying artificial respiration that I have no time to see who is upstream pushing them all in...." A story told by Irving Zola - but is used in an article by John B. McKinlay in "A Case for Refocusing Upstream: The Political Economy of Illness" McKinlay, J.B. (1981)
healthy onset of advanced disability person symptoms symptoms death (reversible) (not reversible ) Primary Secondary Tertiary prevention preventionprevention screening rehabilitation case finding early prevention
Death rates from lung cancer (per 1000) by number of cigarettes smoked, British doctors, 1951-61 Annual lung cancer death rates per 1000 Average number of cigarettes smoked per day
Health Field Model Human Biology (Genetics) Lifestyle (Human behaviour) Health Services Environment
Human behaviours important for health promotion • Community action- actions by communities to change their surroundings include community participation in health decision-making • Health behaviours– actions people undertake to be healthy • Utilization behaviours– utilization of health services • Illness behaviours- recognition of symptoms and prompt self-referral • Compliance (adherence)– following course of prescribed medicines • Rehabilitation behaviours– what people need to do after an illness/surgery to recover
Saving Lives – Our Healthier Nation (1999)This White Paper from the Department of Health for England set the agenda for health policy for the next decade. Lifestyle and human behaviour was given a prominent role through its “Ten Tips for Better Health” • Don't smoke. If you can, stop. If you can't, cut down. • Follow a balanceddiet with plenty of fruit and vegetables. • Keep physicallyactive. • Managestress by, for example, talking things through and making time to relax. • If you drink alcohol, do so in moderation. • Cover up in the sun, and protect children from sunburn. • Practise safer sex. • Take up cancer screening opportunities. • Be safe on the roads: follow the Highway Code. • Learn the First Aid ABC - airways, breathing, circulation
Mortality from Coronary Heart Disease men aged 20-64 by social class, England and Wales, 1991-93 England and Wales = 100 Social Class Professional Managerial Non-manual skilled Manual skilled Partly skilled Unskilled Standardized mortality ratios Source: Office for National Statistics (ONS), Health Inequalities charts.ppt
Perinatal Mortality Rate By mother’s country of birth, England and Wales, 1997-99 combined Rate per 1,000 live & still births Pakistan Caribbean Bangladesh India E Africa UK
The Rainbow model - The main determinants of health Independent Inquiry into Inequalities in Health report Chairman: Sir Donald Acheson 1998
Jason’s story "Why is Jason in the hospital? Because he has a bad infection in his leg. But why does he have an Because he has a cut on his leg and it got infected. infection? But why does he have a cut Because he was playing in the junk yard next to his on his leg? apartment building and there was some sharp, jagged steel there that he fell on. But why was he playing in Because his neighbourhood is kind of run down. a junk yard? A lot of kids play there and there is no one to supervise them. But why does he live in that Because his parents can't afford a nicer place to neighbourhood? live. But why can't his parents afford Because his Dad is unemployed and his Mom is a nicer place to live? sick. But why is his Dad unemployed? Because he doesn't have much education and he can't find a job. But why ...?" Towards a Healthy future : second report on the health of the Canadians (1999)
Causes of poor health Inequality Social Injustice Alienation Lack of empowerment Tobacco use Anxiety Reckless risk- taking Poor education Low prestige Poverty Excess illness Low productivity Early death Proximal and distant causes of illness and premature mortality, JR Seffrin Journal of health education Sep – Oct 1997. Vol 28.No4.
An effective response should • Provide the information and power for the community to make decisions • Make the healthy choice the easiest option • Remove barriers to action
Health Promotion The process of enabling people to increase control over, and to improve, their health Ottawa Charter 1986
Ottawa Charter for Health Promotion Health Promotion - the process of enabling people to increase control over, and to improve, their health. Strengthen Community Action Develop Personal Skills Create Supportive Environments Enable Mediate Advocate Reorient Health Services Policy Build Public Healthy Source: Canadian Public Health Association - An International Conference on Health Promotion - November 17-21 1986
Promoting health Service improvement Improvements in quality and quantity of services: accessibility case management counselling patient education outreach social marketing • Health Education • Communication directed at individuals, families and communities to influence: • Behaviour change • Determinants of behaviour change: • awareness/knowledge • decision-making • beliefs/attitudes • empowerment • community participation Advocacy Agenda setting and advocacy for healthy public policy: policies for health income generation removal of obstacles discrimination inequalities gender barriers
Health education.‘A process with intellectual, psychological and social dimensions relating to activities that increase the abilities of people to make informed decisions affecting their personal, family and community well-being. This process, based on scientific principles, facilitates learning and behavioural change in both health personnel and consumers, including children and youth.’ (Ross and Mico, 1997) Service improvement.Promoting change in services to make them more effective, accessible or acceptable to the community. Advocacy.Activities directed at changing policy of organizations or governments.
Advocacy • Influencing policy makers, leaders and media to raise profile of health programmes • Addressing legal, financial and service obstacles to health action • Tackling discrimination and inequalities
Service Delivery • Improvement in capacity of staff – training and support • Development of new activities • Reorienting existing activities to make them more effective/acceptable • Strengthening communication/health education within services • Improved patient education • Outreach to schools, community, workplace • Involvement of personnel in supporting community health promotion
Define health promotion strategy • Mix of health education, service improvement and advocacy? • Health Education approach? • Methods? • Settings? • Persons/groups involved in delivery? • Timing? • Targets? Health promotion needs/situation analysis • Current situation? • Health needs? • Influences on health • Influences on health actions? • Target groups? Health Promotion Planning Cycle • Implement • How to put it all together? • How do we overcome barriers? • How to monitor activities? • Evaluate, reflect, learn • Were our targets achieved? • What lessons were learnt? • How can we make our programmes better?
The ten areas of competencies in public health identified by Faculty of Public Health • Surveillance and assessment of the population's health and wellbeing. • Promoting and protecting its health and wellbeing. • Developing quality and risk management within an evaluative culture. • Collaborative working for health. • Developing health programmes and services and reducing inequalities. • Policy and strategy development and implementation to improve health. • Working with – and for – communities to improve health and wellbeing. • Strategic leadership. • Research and development to improve health and wellbeing. • Ethically managing self, people and resources to improve health/wellbeing.