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Page 1: Health promotion

Amany R.Abo-El-SeoudAmany R.Abo-El-Seoud

Prof. Of Community MedicineProf. Of Community Medicine

Zagazig University,EGYPTZagazig University,EGYPT

HEALTH PROMOTIONHEALTH PROMOTION

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Health promotionHealth promotion

It is the science aiming at reaching optimal (perfect) health

All activities aiming at increasing well-being,

prevention of disease and health hazards, or control of disease are included under health promotion. (it is the highest aim of CM)

Health promotion is to add Health promotion is to add ‘‘life into the life into the yearsyears’’ and not just add and not just add ‘‘years onto lifeyears onto life’’

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Definition of health Definition of health promotionpromotion

Is a process of activating communities, Is a process of activating communities, policy makers, professionals and the policy makers, professionals and the public in favor of health supportive public in favor of health supportive policies, systems and ways of living. policies, systems and ways of living.

It is carried out through acts of It is carried out through acts of advocacy, empowerment of people advocacy, empowerment of people and building social support systems and building social support systems that enable people to make healthy that enable people to make healthy choices and live healthy lives. choices and live healthy lives.

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The basic principles for health

promotion:

Promotion of health requires a secure foundation in

these basic prerequisites.

Sustainable resources

Peace

ShelterEducation

Food

Income

A stable ecosystem

Health

Social justice & equity

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Advocate for health:- Good health gives better quality of life so it

necessitates advocacy (fighting for it).- The following factors can favor health or can harm it:

- Health promotion aims at making these conditions favorable for health.

Political conditions

Economic conditions

Social conditions

Cultural conditions

Environmental factors or conditions

Behavioral factors or conditions

Biological factors or conditions

Health

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Approaches for health Approaches for health promotionpromotion

How can we promote health?How can we promote health? Healthy population Healthy population

(infrastructure)(infrastructure) Healthy lifestyleHealthy lifestyle Healthy environmentHealthy environment

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11 - -Healthy populationsHealthy populations

By targeting all life stages and groups. By targeting all life stages and groups. Since the health needs of people Since the health needs of people vary according to their stage in the vary according to their stage in the life cycle or their gender, the life cycle or their gender, the healthy population approach healthy population approach encourages initiatives that focus on encourages initiatives that focus on the health needs and contributions of the health needs and contributions of people at every life stage. people at every life stage.

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22-- Healthy lifestylesHealthy lifestyles

This approach focuses more on the This approach focuses more on the behavior of individuals and how their behavior of individuals and how their decisions and actions can lead to decisions and actions can lead to healthier outcomes. This can be done healthier outcomes. This can be done through health education, social through health education, social mobilization and advocacy programs. mobilization and advocacy programs.

No smoking, better nutrition and No smoking, better nutrition and exercise are examples of healthy exercise are examples of healthy lifestyles approach.lifestyles approach.

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33--Healthy settingsHealthy settings

Creating social, economic and Creating social, economic and environmental conditions that are environmental conditions that are favorable to good health. Health favorable to good health. Health conditions in developing countries conditions in developing countries must be viewed in a wider socio must be viewed in a wider socio economic context because millions of economic context because millions of people are trapped in the vicious people are trapped in the vicious cycle of poverty, despair, disparity, cycle of poverty, despair, disparity, illiteracy and diseaseilliteracy and disease

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Other approach for health Other approach for health promotionpromotion

PreventionImmuniz.

EnvironmentH.Services

Protection Laws&policy

Health educationAppreciate health

Keen to keep healthy

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Who promote health?Who promote health?

Individual role Governmental role

LegislationEnvironmental health

Health servicesOther ministriesPolicy & budget

H.ConciousnessLife styleGeneticBeliefs

Occupation

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WHO PROMOTES WHO PROMOTES HEALTHHEALTH??

International organizationInternational organization Health authoritiesHealth authorities Non-Governmental OrganizationsNon-Governmental Organizations Primary health care teamPrimary health care team Private physician.Private physician. Other health professions: nurses, Other health professions: nurses,

professions allied to medicine.professions allied to medicine. Religious organizationsReligious organizations

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Guiding Principles of Health Guiding Principles of Health PromotionPromotion

Empowering Empowering individuals and individuals and communities.communities.

ParticipatoryParticipatory (involving all). (involving all). HolisticHolistic (all four dimensions of health). (all four dimensions of health). IntersectoralIntersectoral (collaboration of all (collaboration of all

agencies)agencies) EquitableEquitable (equity and social justice) (equity and social justice) SustainableSustainable (changes are maintained) (changes are maintained) MultistrategyMultistrategy (variety of approaches) (variety of approaches)

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Health promotion "23 years of continuous development"

- Ottawa (Canada) 1986: first international health promotion conference as an extended application for the Alma Ata declaration 1978 on primary health care.

- Australia 1988: Concept of healthy public policy being a human right. gender dimension was given specific attention.

- Sweden 1991: Concept of supportive environments

conductive to health and the links with sustainable development.

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-Jakarta, Indonesia 1997:Issues related to globalization (the potentials and controversies around public-private partnership) infra-structures and funding.

- Mexico city, Mexico 2000: High level political commitment to health

promotion. Positioning health promotion higher on the

political agenda and recognizing it as a priority in local, regional, national, and international programs.

- Bangkok (Thailand) 2005: Identified major challenges, actions &

commitments needed to address the determinants of health in the world by reaching out to people, groups & organizations that are critical to the achievement of health.

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Ottawa Charter put five action areas for promotion:

1- Develop healthy public policy.2- Create supportive environment

for health3- Strengthen community action.4- Develop personal skills i.e.

modifying their life style towards healthy behaviors.

5- Reorient health services.

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11--Develop healthy public Develop healthy public policypolicy

health should be on the policy agenda in all health should be on the policy agenda in all sectors, and at all levels of government. sectors, and at all levels of government. Governments are ultimately accountable to Governments are ultimately accountable to their people for the health consequences of their people for the health consequences of their policies, or the lack of policies. A their policies, or the lack of policies. A commitment to healthy public policies means commitment to healthy public policies means that governments that governments must measure and report must measure and report on their investments for health, and the on their investments for health, and the subsequent health outcomessubsequent health outcomes of these of these investments and policies in a language that investments and policies in a language that all groups in society readily understand. all groups in society readily understand.

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2-Create supportive environment:

(1) Protection and conservation of the natural environment - as a natural resource - must be addressed in any health promotion strategy.

(2)We must create a healthy working & living conditions and making them safe, stimulating for health, satisfying & enjoyable.

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(3) Systematic assessment of the health impact of any rapidly changing environment as in Work places, energy production areas and rapidly urbanized areas.

(4)Encourage research studies for detection of environmental hazards on health and methods of controlling them.

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3-Strengthen community action

Health promotion depends on concrete & effective community action.

The community has to share in: Setting priorities Making decisions Planning strategies Implementing these strategies

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This can be enhanced by: Empowering the community Create ownership Control of their actions & efforts This requires: Continuous access to information. Learning opportunities for health. Funding support.

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44--Health promotion Health promotion strategies directed towards strategies directed towards

individualsindividuals1.1. Increase individual awareness of disease Increase individual awareness of disease

and disability prevention actions.and disability prevention actions.

2.2. Changing lifestyles to healthy onesChanging lifestyles to healthy ones

3.3. Encourage individuals to have check-ups Encourage individuals to have check-ups and to use health screening and to use health screening opportunities.opportunities.

4. Early seeking for medical advice 4. Early seeking for medical advice

5. Compliance to physician 5. Compliance to physician

instruction and treatment scheduleinstruction and treatment schedule

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55--Reorient health servicesReorient health servicesHealth promotion requires reorientation of Health promotion requires reorientation of

health systems from tertiary (curative health systems from tertiary (curative strategies) to primary and secondary strategies) to primary and secondary prevention models. This reorientation is often prevention models. This reorientation is often be resisted by doctors, and pharmaceutical be resisted by doctors, and pharmaceutical companies and hospitals, those who adopt companies and hospitals, those who adopt ‘‘find it and fixfind it and fix itit’’ approach. approach.

Encourage health service providers to build Encourage health service providers to build opportunities for health education settings in opportunities for health education settings in primary and secondary prevention of disease primary and secondary prevention of disease and disability when delivering services.and disability when delivering services.

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Evaluation of Health promotion Evaluation of Health promotion activities in a community:activities in a community:By assessing:By assessing:

1.1. Quality of life indicators.Quality of life indicators.

2.2. Health knowledge, attitude, motivation Health knowledge, attitude, motivation and skills among population sectors.and skills among population sectors.

3.3. Social action and influence (community Social action and influence (community participation & public opinion).participation & public opinion).

4.4. Legislation, regulation for public healthLegislation, regulation for public health

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5- Resource allocation for health in relation to 5- Resource allocation for health in relation to national budget.national budget.

6- improved health indicators as morbidity & 6- improved health indicators as morbidity & mortalitymortality

7- improved productivity, reduced 7- improved productivity, reduced absenteeism.absenteeism.

8- decrease in medical care utilization8- decrease in medical care utilization9- decrease in health care cost.9- decrease in health care cost.

H. Promotion = h.education x healthy public H. Promotion = h.education x healthy public policy policy

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Problems facing health Problems facing health promotion in developing promotion in developing countriescountries PovertyPoverty and consequently the poor living and consequently the poor living

conditions (e.g. poor nutrition, poor conditions (e.g. poor nutrition, poor housing, environmental degradation) housing, environmental degradation) associated with it are major obstacle for associated with it are major obstacle for improving health of people in developing improving health of people in developing countries. Unless fundamental changes countries. Unless fundamental changes are made to this wider context it will be are made to this wider context it will be difficult to make major advances in health difficult to make major advances in health promotion. promotion. The challenge of reducing poverty cannot be underestimated.

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Decision makers must find answers for Decision makers must find answers for these questions:these questions:

1-How to draw more resources from 1-How to draw more resources from the community and individuals to the community and individuals to meet the health challenges they meet the health challenges they face?face?

2-How to direct health expenditures? 2-How to direct health expenditures? Either for prevention or for control? Either for prevention or for control?

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Economic prioritiesEconomic prioritiesMost developing countries have limited resources Most developing countries have limited resources

and many competing demands for these and many competing demands for these resources. They are seeking to achieve rapid resources. They are seeking to achieve rapid economic gains and development by economic gains and development by industrialization and food production that gives industrialization and food production that gives priority to foreign markets for earning foreign priority to foreign markets for earning foreign exchange.exchange.

Insufficient attention is given to the needs of local attention is given to the needs of local citizens leading to low wages and poverty, poor citizens leading to low wages and poverty, poor nutrition and worse environmental condition, all of nutrition and worse environmental condition, all of which have serious health consequences. which have serious health consequences. International donors tend to encourage activities International donors tend to encourage activities that promote economic development and have that promote economic development and have quick and visible outcomes. quick and visible outcomes.

The challenge for health promotion is to convince The challenge for health promotion is to convince policy-makers that policy-makers that good health is an economic good health is an economic asset rather than a cost and it is an essential asset rather than a cost and it is an essential component of social and economic empowermentcomponent of social and economic empowerment

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EducationEducation

Low levels of literacy specially health Low levels of literacy specially health literacy provide another challenge for the literacy provide another challenge for the health promotion approach. This can be an health promotion approach. This can be an obvious problem when trying to promote obvious problem when trying to promote better health behavior among people. Poor better health behavior among people. Poor levels of knowledge is an important factor levels of knowledge is an important factor that contribute to almost all diseases. that contribute to almost all diseases. Efforts done to improve illiteracy actually Efforts done to improve illiteracy actually share in health promotionshare in health promotion

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Political stabilityPolitical stability::

Where there is political instability, Where there is political instability,

internal conflict and war, it is internal conflict and war, it is extremely difficult to develop health-extremely difficult to develop health-promoting environments. Not only promoting environments. Not only are the economic resources and are the economic resources and priorities of governments directed priorities of governments directed elsewhere, but also the regulatory elsewhere, but also the regulatory environment to create health environment to create health supportive settings is lacking.supportive settings is lacking.

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Inter sectoral co-operationInter sectoral co-operation::

Decision-makers in all sectors (even in Decision-makers in all sectors (even in areas that are indirectly related to areas that are indirectly related to health as agriculture, commerce, health as agriculture, commerce, education, industry etc) must focus education, industry etc) must focus on the health implications of their on the health implications of their policies, in fact, their competing policies, in fact, their competing priorities may lead them to disregard priorities may lead them to disregard the health implications of their the health implications of their decisions.decisions.

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Commercial interestsCommercial interests

Marketing does not necessarily consider Marketing does not necessarily consider health of citizens of developing countries health of citizens of developing countries uppermost in their priorities. This is oftenuppermost in their priorities. This is often result in poor health outcomes. For example result in poor health outcomes. For example marketing tobacco, and western food products.marketing tobacco, and western food products.Commercial propaganda of unhealthy products and Commercial propaganda of unhealthy products and

lifestyles make it difficult for healthy choices to lifestyles make it difficult for healthy choices to be the easiest or the attractive choicesbe the easiest or the attractive choices. .

Regulation of the activities of these commercial Regulation of the activities of these commercial interests is required through political rules to interests is required through political rules to introduce sufficient levels of regulation as the introduce sufficient levels of regulation as the taxes gained from unhealthy products and used taxes gained from unhealthy products and used as an important source of governmental funds. as an important source of governmental funds. Poor governments can find it difficult to resist this Poor governments can find it difficult to resist this source of revenue.source of revenue.

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The double burden of diseaseThe double burden of disease

One of the particular challenges that One of the particular challenges that face developing countries is that the face developing countries is that the epidemic of non communicable disease epidemic of non communicable disease is developing before the burden of is developing before the burden of communicable (infectious disease) has communicable (infectious disease) has been dealt with. The difficulty faced by been dealt with. The difficulty faced by developing nations is to deal with these developing nations is to deal with these dual sources of disease without dual sources of disease without adequate economic resources.adequate economic resources.

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The speed of changeThe speed of change

Populations in the developing Populations in the developing world are increasing at a muchworld are increasing at a much faster rate than countries in faster rate than countries in the developed world. It is the developed world. It is much easier for countries to much easier for countries to adjust to gradual population transitions than adjust to gradual population transitions than

to these rapid changes. Population to these rapid changes. Population increase at such a rate that all policy increase at such a rate that all policy systems have not kept pace. The speed of systems have not kept pace. The speed of the transition and the economic cost the transition and the economic cost make it nearly impossible for d. countries make it nearly impossible for d. countries to provide all needs of citizens.to provide all needs of citizens.

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QUALITY OF LIFE QOLQUALITY OF LIFE QOL WHO defined QOL as the individualWHO defined QOL as the individual’’s s

perception of position in life in perception of position in life in relation to his goals, expectations, relation to his goals, expectations, standards and concerns.standards and concerns.

It is to live normal life, to feel happy, It is to live normal life, to feel happy, achieve your goals and to be achieve your goals and to be satisfied with your self and your satisfied with your self and your surroundings.surroundings.

It is the sense of wellbeing. It is the sense of wellbeing.

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Why measuring QOLWhy measuring QOL??

To evaluate the effects of health (and To evaluate the effects of health (and other) services on citizenother) services on citizen’’s life. The higher s life. The higher the score of QOL the better is the the score of QOL the better is the promotion services.promotion services.

To classify health hazards according to To classify health hazards according to their effect on QOL (in putting priorities)their effect on QOL (in putting priorities)

To evaluate the effects of different lines of To evaluate the effects of different lines of treatment on patients.treatment on patients.

To evaluate the rehabilitation methods To evaluate the rehabilitation methods used by handicapped.used by handicapped.

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How to assess QOL?How to assess QOL?

By using questionnaires :By using questionnaires :

1- physical aspects1- physical aspects

2- psychological aspects2- psychological aspects

3- spiritual aspects3- spiritual aspects

4- social aspects4- social aspects

5- environmental aspects5- environmental aspects

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Global burden of diseaseGlobal burden of disease

Using certain indicators as:Using certain indicators as: QALY= quality adjusted life yearsQALY= quality adjusted life years DALY=disability adjusted life yearsDALY=disability adjusted life years YLL= years of life lostYLL= years of life lost YLD=years lost due to disabilityYLD=years lost due to disability

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Thank youThank you

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Health educationHealth education

Definition:Definition:

Is planned opportunities for people to Is planned opportunities for people to learn about health and make learn about health and make changes in their behaviorchanges in their behavior

Steps: to know (knowledge)Steps: to know (knowledge)

to feel importance to to feel importance to health(attitude)health(attitude)

to changeto change (practice)(practice)

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Era of health educationEra of health education

Improvement of quality of lifeImprovement of quality of life Restore state of good healthRestore state of good health Make the best of remaining healthMake the best of remaining health

i.e. in health promotion, prevention of i.e. in health promotion, prevention of hazards, control of disease and hazards, control of disease and complications and in rehabilitation.complications and in rehabilitation.

i.e. in physical, mental, social healthi.e. in physical, mental, social health

it is life long process.it is life long process.

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Health educationHealth education

Source or educator (doctor, nurse, T.V., Source or educator (doctor, nurse, T.V., book, film)book, film)

Message (knowledge, information Message (knowledge, information body)body)

Channel (method): face-face or broad Channel (method): face-face or broad castcast

Receiver : the target of the processReceiver : the target of the process Noise (barriers): factors decreasing Noise (barriers): factors decreasing

responseresponse

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Health educationHealth education

Health education program:Health education program: What is the message?What is the message? Who will give it? Who is our target?Who will give it? Who is our target? How it will be given?How it will be given? Where?Where? When? How frequent?When? How frequent?

Evaluation of program.Evaluation of program.

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Community participationCommunity participation

People sharing the same culture, People sharing the same culture, experience, problems, place they live, experience, problems, place they live, language, religion.language, religion.

C. participation is important in:C. participation is important in:

1- success of health education program1- success of health education program

2- improving health services 2- improving health services

3- giving power to people to solve health 3- giving power to people to solve health problems and criticize un-needed health problems and criticize un-needed health servicesservices or health policy. or health policy.

4- gaining a health responsibility4- gaining a health responsibility

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Community participationCommunity participation

How?How? Involve representatives in planning and Involve representatives in planning and

execution team. (in health education)execution team. (in health education) Population needs must be assessed in Population needs must be assessed in

health planning. They can evaluate health planning. They can evaluate also also

Help people to get knowledge, skills, Help people to get knowledge, skills, information, fund.information, fund.

Enable all population sectors to Enable all population sectors to represent themselves.represent themselves.

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Behavioral scienceBehavioral science

How people think in health & diseaseHow people think in health & disease For health promotion & educationFor health promotion & education To improve doctor-patient To improve doctor-patient

relationshiprelationship To solve health problems easily.To solve health problems easily.

People differ in behavior because of People differ in behavior because of demographic factors & demographic factors & psychological factorspsychological factors

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Health belief modelHealth belief model

Healthy individuals perceive risk, its Healthy individuals perceive risk, its severity, that heseverity, that he’’s susceptible, s susceptible, realize the benefits of protection realize the benefits of protection from risk, certain barriers prevent from risk, certain barriers prevent him from taking action. He has him from taking action. He has motive for change. He either motive for change. He either decides to act at once (with or decides to act at once (with or without trigger) or cancel the whole without trigger) or cancel the whole subject.subject.

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Health belief modelHealth belief model

Perception of disease severity

motivation

personal

external

cancel

action relapse

Healthybehavior

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Behavior in illnessBehavior in illness

Disease

Donothing

Selftreatment

Go to doctor

treatment

Not adherent

compliance

cured

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Factors affecting illness behaviorFactors affecting illness behavior

Severe, prolonged or frequent symptom.Severe, prolonged or frequent symptom. Unusual symptomUnusual symptom Personal tolerance to symptomPersonal tolerance to symptom Culture and knowledge about symptomCulture and knowledge about symptom Stigma of diseaseStigma of disease Doctor-patient relationshipDoctor-patient relationship Availability of reliable health servicesAvailability of reliable health services Cost of service & ttt. Time wasteCost of service & ttt. Time waste

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CommunicationCommunication

• Definition :it is a dynamic, continuous and reciprocal sending, receiving and comprehending messages, feelings & ideas.

• Relation between communication&health

1. For history taking, counseling

2. For health education

3. Patient satisfaction & adherence to ttt

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Steps of communicationSteps of communication

• Initiation of simple introduction

• Listening carefully to your client

• Probing to assure your care, observation of non-verbal expressions

• Giving information: clear, concise, summarize, in simple language etc..

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Methods of communicationMethods of communication

• Verbal : spoken or written words• Non-verbal: any other method except

words e.g.:1. Body movement, posture, sitting, walking2. Facial expressions3. Touch ,shake hands4. Personal appearance: cloths,hair5. Voice interference.

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Barriers to communicationBarriers to communication

• Environmental

• Pathological

• Language

• Personal : SE, values, belief, experience

• Psychological :stress, anger, tiredness

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