Health Promotion

1. Health Promotion What is it? University of Aberdeen edited Y Letson 2008

2. Health Promotion Origins • Focus of this health improvement • effort has shifted from • environments, systems and • populations to individual based • approaches and back again. • Improving the health of individuals, communities and populations is a long standing societal issue. • First legislative action re health improvement went beyond the individual and sought to address the socio-economic conditions that people found themselves in. (1796) University of Aberdeen edited Y Letson 2008

3. Contemporary Health Promotion Origins • World Health Organisation (WHO) Declaration of Alma Ata (Russia) 1978 • Improvements in health could not be determined by investments in the health care systems alone – prevailing view since the end of the 2nd WW. • Needed to enrol other sectors in health improvement efforts. • The WHO’s Global Strategy for Health for All by the Year 2000 (1981) • Health Promotion: Concepts and Principles (WHO, 1984) • Ottawa Charter for Health Promotion (1986) University of Aberdeen edited Y Letson 2008

4. Health Promotion Definition “Health promotion is the process of enabling people to increase control over and to improve their health.…. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to well-being.”Ottawa Charter for Health Promotion (1986) University of Aberdeen edited Y Letson 2008

5. 5 Health Promotion Actions • Developing public policy. • Developing personal skills. • Strengthening community action. • Creating supportive environments. • Reorienting health services University of Aberdeen edited Y Letson 2008

6. 5 approaches to health promotion • Medical or preventive • Behaviour change • Educational • Empowerment • Social change Naidoo and Wills (2000) University of Aberdeen edited Y Letson 2008

7. 1. Medical or Preventive Approach • This approach is aimed at reducing premature deaths (mortality) and avoidable diseases (morbidity). • Actions are targeted at whole populations (eg. immunisation) or so called high risk groups. • Some argue this approach seeks to increase the use of medical interventions to promote health. University of Aberdeen edited Y Letson 2008

8. 1. Medical or Preventive Approach Primary prevention – prevention of the onset of disease through risk education. – smoking cessation, cholesterol reduction. Secondary prevention – preventing the progression of disease – screening and other methods of early diagnosis. Tertiary prevention – reducing further disability or, preventing the recurrence of illness, patient education, palliative care. tertiary healthcare is specialized consultative care, usually on referral from primary or secondary medical care personnel, University of Aberdeen edited Y Letson 2008

9. 1. Medical or Preventive Approach: Characteristics Is popular as it has high status, using scientific methods – epidemiology. In the short term, this approach is cheaper than the treatment of people who have become ill. (May not be the case in the longer term as people live longer and suffer from degenerative disease). It is top down and expert led, medical and health professionals and recognised as having expert status. University of Aberdeen edited Y Letson 2008

10. 2.Behaviour Change Approach • This approach aims to encourage individuals to adopt “healthy” behaviours that are regarded as key to improving health. • This approach is popular - views health as the property of the individual. University of Aberdeen edited Y Letson 2008

11. 2. Behaviour Change Approach Assumptions • People can make real improvements to their health by changing their lifestyle. • If people don’t take responsibility for their actions they are to blame for the consequences -victim blaming approach. University of Aberdeen edited Y Letson 2008

12. 2. Behaviour Change Approach However, it has become acknowledged that the complex relationship exists between individual behaviour, social and environmental factors. Behaviour - it is now recognised may be a response to the conditions people live in and the causes of these conditions may be out of individual control. But - the behaviour change approach remains popular with health promotion agencies! University of Aberdeen edited Y Letson 2008

13. Media and behaviour change.Pause for thought!! One of strategies used to encourage behaviour change (and popular with health promotion agencies) is the use of multi media campaigns. Can you think of any mass media campaigns that you have noticed that have been concerned with encouraging behaviour change? University of Aberdeen edited Y Letson 2008

14. 3. Educational Approach • Strongly linked to health education • Seeks to provide knowledge and information, and to develop the necessary skills so that people can make informed decisions about their behaviour. University of Aberdeen edited Y Letson 2008

15. 3. Educational Approach Assumption • Increasing knowledge may change in attitudes, that mayresult in changed behaviour. • It is argued that this approach does not necessarily set out to persuade or motivate change in a specific direction! University of Aberdeen edited Y Letson 2008

16. 4. Empowerment Approach • So-called bottom up approach - idea is premised on helping people or communities to identify their own health concerns, gain the skills and make changes to their lives accordingly . • This approach reflects the general principles of the Ottawa Charter definition. • Professional acts as a facilitator rather than expert University of Aberdeen edited Y Letson 2008

17. 4. Empowerment Approach • Approach described as a way of working which increases people’s ability to change their social reality. • Community development is a similar way of working. • Some statutory UK health agencies employ health promoters to engage in community development work – often in tandem with local authorities. University of Aberdeen edited Y Letson 2008

18. 4. Empowerment Approach Can you think of any difficulties or tensions that may exist for health professionals engaged in this type of work? University of Aberdeen edited Y Letson 2008

19. 5. Social Change Approach • Targets groups and populations, top down method of working. • Sometimes known as radical health promotion and is underlined by a belief that socio-economic circumstances determine health status. • Its focus is at the policy or environmental level. • Aims is to bring about physical, social, economic, legislative and environmental changes. University of Aberdeen edited Y Letson 2008

20. 5. Social Change Approach • Approach is based on the notion that to promote positive health it is necessary to tackle and diminish social and health inequalities. • “Make the healthy choice the easier choice”. • Healthy choices may be available, but this may require major structural changes. University of Aberdeen edited Y Letson 2008

21. Structural inequalities • DoH Nutrition Task Force 1996 – survey showed that a healthy diet which includes fruit, vegetables, high fibre foods and less fat can cost up to a third more than a typical diet of a low income family. University of Aberdeen edited Y Letson 2008

22. References • Naidoo and Wills. 2000 Health Promotion Foundations for Practice. Balliere Tindall: London • Breslow, L. 1999 From Disease Prevention to Health Promotion. JAMA 281 (11): 1030-1033. • Green, J. and South, J. 2006 Evaluation Open University Press, Maidenhead • Tones, K. & Green, J. 2004. Health Promotion: Planning and Strategies. Sage Publications:London. • Nutbeam, D and Harris, E. 1999. Theory in a Nutshell. A Guide to Health Promotion Theory. McGraw-Hill: Australia. • Egger, G. Spark and Lawson. 2005. Health Promotion: Strategies and Methods. (2nd Edition) McGraw-Hill: Australia. • Ashton, J. and Seymour, H. 1988. The New Public Health. Open University Press: Milton Keynes. • Glanz, K. Lewis, F. M. , Rimer, B. K. (Eds) 1997. Health Behaviour and Health Education: Theory, Research and Practice. (2nd Edition) Jossey-Bass: San Francisco. • Lucas, K & Lloyd, B. 2005. Health Promotion: Evidence and Experience. Sage Publications: London. • Lalonde, M. 1974 A New Perspective on the Health of Canadians. Government of Canada: Ottawa. University of Aberdeen edited Y Letson 2008

23. References • Scriven, A., Orme, J. 1996, Health Promotion: Professional Perspectives, .Macmillan & Open University Press: Basingstoke. • Seedhouse, D., 2001, Health: The Foundation of Achievement (2nd edition), Chichester: Wiley. • Tones, K. & Tilford, S. 1994, Health Education: Effectiveness, Efficiency and Equity. Chapman Hall: London. • Skinner, H.A. 2002, Promoting Health Through Organisational Change. Ben Cummings: San Francisco. • Amos, L., M. & Munro, J., 2002, Promoting Health: Politics and Practice. Sage Publications: London. • Bunton, R & Macdonald, G., 1992, Health Promotion: Disciplines & Diversity. Routledge: London. • Seedhouse, D., 1997, Health Promotion: Philosophy, Prejudice & Practice. Wiley:Chichester. • (WHO) 1946, Constitution, Geneva: World Health Organisations University of Aberdeen edited Y Letson 2008

24. Other information Policy Documents • Improving Health in Scotland: The Challenge, 2003, Scottish Executive. • Towards a Healthier Scotland, 1999, Scottish Executive. Health Promotion: Concepts and Principles (WHO, 1978) http://whqlibdoc.who.int/euro/-1993/ICP_HSR_602__m01.pdf Ottawa Charter (WHO, 1986) http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ Bangkok Charter (WHO, 2005) http://www.who.int/healthpromotion/conferences/6gchp/bangkok_charter/en/ University of Aberdeen edited Y Letson 2008