Approaches to Health Promotion. Puja Myles Puja.firstname.lastname@example.org. Learning Outcomes. To recognise the ethical and philosophical principles underpinning health promotion practice To categorise and describe various approaches to health promotion
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Approaches to Health Promotion Puja Myles Puja.email@example.com
Learning Outcomes • To recognise the ethical and philosophical principles underpinning health promotion practice • To categorise and describe various approaches to health promotion • To choose an appropriate health promotion approach in different contexts
Session Outline • The context of health promotion: individuals vs. population • Intervention ladder and ethical underpinnings • Approaches to health promotion • Social Marketing and Media Advocacy • Group exercise
Sick individual and sick populations (Rose) • Populations as a whole may be susceptible to a particular disease • Not all individuals belonging to a susceptible population get that disease • Determinants of illness (or health) are different depending on the level: individual or population Should health promotion practice focus on individual determinants of health or population determinants?
Ethical and philosophical principles underpinning health promotion practice
Why should you concern yourselves with ethics and philosophy? Does the choice of health promotion model and approach by an individual, organisation or government reflect particular individual and societal values?
Why is state intervention required? • Tension between autonomy and state paternalism • Does the state have a duty to protect its citizens and if yes, under what conditions? • The concept of ‘public goods’ • Beneficence • Non-maleficence • Respect for autonomy • Justice • Equity, equality
3 main approaches • Behavioural approaches • Self-empowerment approaches • Collective action or community development approaches These are not mutually exclusive!!
Other ways of approaching Health Promotion • Targeted versus universal approaches • Settings approach • Ecological or whole-systems approach
Targeted vs. Universal approaches • Targeted (high-risk) approach: Identify individual person or group of people at high risk, offer advice & treatment • Universal (population) approach: Lower the average level of risk in the population
A large number of people exposed to a small risk may generate many more cases than a small number exposed to high risk. A preventive measure that bringslarge benefits to the communityoffers little to each participating individual. Prevention Paradox
Settings From Ottawa Charter: • “Health is created & lived by people within the settings of their everyday life: where they learn, work, play and love”. • Schools • Workplaces • Homes • Communities • Cities
Settings WHO 1998 definition: • “…identified as having physical boundaries, a range of people with defined roles and an organisational structure …”
Settings Settings approach • Enables access to groups or individuals • Focus: whole ethos of the setting is health promoting (holistic approach) • Integration of health promotion into the daily activities of the setting • Example: ‘health promoting schools’ rather than ‘health promotion in schools’ • Creation of conditions for reaching out into the community
Settings • Who is left out? • Constrained to those within setting? • Possible solutions: • Go for novel settings • Demands organisational change & commitment • Balance between top-down and bottom-up approaches
Social Marketing • Included in behaviour change approaches • The adaptation of commercial marketing techniques to achieve specific behavioural goals for a social good. • “A social change campaign is an organized effort conducted by one group (the change agent) which attempts to persuade others (the target adopters) to accept, modify, or abandon certain ideas, attitudes, practices or behaviour.” --Kotler, Roberto, & Lee, 2002 • Consumer-oriented approach, but… • Contrast with commercial marketing: profit goal
Media Advocacy-1 • Not a health promotion approach per se but a means of getting an issue on the policy agenda • Kingdon’s policy model: Windows of opportunity when coupling of three streams occurs: problems, policy (technically feasible and sustainable solutions) and politics (commitment)
Media Advocacy-2 Media advocacy by ‘policy entrepreneurs (like you!!) could result in the recognition of an issue as a problem, create awareness of possible solutions and generate wide scale political commitment
Further reading-1 1. Nuffield Council on Bioethics (2007). Public Health: Ethical Issues http://www.nuffieldbioethics.org 2. Oxford Handbook of Public Health Practice 2nd ed. (2006): Chapter 1.7 (Pp. 64-70): Understanding ethics in Public Health (Angus Dawson) Chapter 4.7 (Pp. 348-353): Influencing governments via media advocacy (Simaon Chapman) Chapter 3.7 (Pp. 266-275): The public health response to ‘hard to reach’ populations
Further reading-2 3. Social Marketing- Big pocket guide (2007) http://www.nsms.org.uk 4. Rose, G. (2001). Reiteration: Sick Individuals and sick populations. International Journal of Epidemiology; 30: 427-432
Scenario 1:HIV/AIDS • Targeted (high-risk) or Universal (population) approach? • Behavioural/Self-empowerment/Community Development approach? • What are the values and assumptions underlying your choices?
Scenario 2: Obesity • Does the state or its agents (NHS/Public Health?!) have a duty to intervene? • Look at the intervention ladder- which rungs would you choose? • What approaches would you use: behavioural/self-empowerment/community development? • What values and assumptions underpin your choices?