Health Promotion

Oxford Textbook of Public Health, Marcia Hills and Simon Carroll

By: Izzeldin F. Adam, BPEH, MPHDepartment of International Health, TMDU

contents

Concept and definitions Health education Beliefs and approaches in health

promotion Health promotion strategies and priority

actions Public health, social movement, health

inequity and millennium goals Canadian experience in health promotion Conclusion

concepts

health promotion is centered on the values and principles of equity, participation, and empowerment.

health promotion must be much more active in supporting the global efforts to address equity in health and development represented on

- the UN's MDGs - WHO's Commission on the Social Determinants

of Health

Definitions

‘the process of enabling people to increase control over, and to improve their health’ (WHO,1986)’.

‘Health promotion represents a comprehensive social and political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health (WHO 1998)’.

Health education: History and influences

Any intentional activity which is designed to achieve health or illness-related learning, that is, some permanent change in an individual's capability or disposition’ (Tones 2004: 7).

Freire proposes that the main strategy of empowerment education, critical dialogue, requires us to engage in a process of problem posing rather than a process of problem solving.

Beliefs underlying health promotion

All people have strengths and are capable of determining their own needs, finding their own answers, and solving their own problems.

Every person and family lives within a social-historical context that helps shape their identity and social relationships.

Diversity is positively valued. People without power have as much capacity as the powerful to assess their own

needs (people are their own experts). Relationships between people and groups need to be organized to provide an

equal balance of power (professional/client ). The power of defining health problems and needs belongs to those experiencing

the problem. The people disadvantaged by the way that society is currently structured must

play the primary role in developing the strategies by which they gain increased control over valued resources.

Empowerment is not something that occurs purely from within (only I can empower myself), nor is it something that can be done to others (we need to empower the group).

Shared power relations do not deny health professionals their specialized expertise and skills.

What is the ‘health’ in health promotion?Approach medical Behavioral Socio-ecological

Health concept

Biomedical; absence of disease or disability

Individualized; physical-functional ability; physical well-being

Positive state; connectedness; ability to do important things; psychological well-being

Health determinants

Disease categories, physiological risk factors (hyper.)

Behavioral risk factors (unsafe sex)

Psychological risk factors (isolation); socio-environmental risk condition (poverty)

Principle strategy

Surgery; drug therapy; illness care; medically managed behavioral change

Advocacy for healthy life style choices

Personal empowerment; small groups development; community organization ; coalition advocacy, political action

Program development

Professionally managed

Negotiated with individuals communities and professional

Managed by community in critical dialogue with supporting professionals and agencies

Ottawa Charter strategies for health promotion1. Advocacy for health to create the essential

conditions for health;

2. enabling all people to achieve their full health potential; and

3. mediating between the different interests in society in the pursuit of health

Priority action areas

Health promotion

Build healthy public policy

Create supportive

environments

Strengthen community

action Develop personal

skills

Re-orient health

services

3

2

1

4

5

1.Build healthy public policy

policy action must come from policy sectors other than health but the health sector would play a role in public policy action. how?

Healthy public policy requires the coordinated use of all policy levers available, including ‘legislation, fiscal measures, taxation, and organizational change.

Healthy public policy requires the identification and removal of obstacles to the adoption of healthy public policies in non-health sectors

National policies

National health policy for food and drugs

National health policy for protection of water and environment

National health policy for health care and health insurance.

National health policy for social insurance, equity and social justice.

National policy for socio-economic development.

National policy for health promotion National policy for ……etc.

2.Create supportive environments

Both the natural and built environments are inextricably linked with people's health.

It involves creating conditions that allow people to have ‘living and working conditions that are safe, stimulating, satisfying, and enjoyable.

both past endeavors and future prospects, one must take into account the lofty ambition of this programme of action (HIA, EIA)

Healthy environments healthy schools healthy cities

healthy life style healthy working envirnments

3.Strengthen community action

strengthening the capacity of people as active citizens through their community groups, organizations and networks to address and prioritize their problems, shape and determine change in their communities.

The foundational principles for community development are:

• Empowerment• Community competence• Participation• Issue selection• Creating ‘critical consciousness’

Examples for community actions

ToT for community health workers (CHWs)

Community health committees Training of community health promoter (CHPs)

Mobilizing communities (ACSM)

4.Develop personal skills

Supporting personal and social development through providing information, education for health, and enhancing life skills.

while we must be vigilant against the temptation and limitations of an individually focused, skills development approach, we must also re-engage with the most advanced and progressive elements in this area of work.

Testicular Self-ExaminationBreast Self-Examination

Digital measuring for blood pressure

5.Re-orient health services

universal access to health services (universality) and the removal of barriers to access such as, geographic, social, economic, or cultural (accessibility);

It demands community participation in planning, operation, and evaluation of health services (participation);

It requires integration across health and other sectors such as housing, education, and employment;

It recognizes the power of multi-disciplinary teams working as equal partners for the health of the community;

It focuses on a range of services, determined by the community, that include health promotion, primary prevention, rehabilitative, and curative (essentiality); and,

It demands a commitment to equity concerning issues of power and resources (equity and access

3 delays model

Public health, social movement and health promotion

The more recent emphasis on health in the context of globalization makes the necessity for health promotion to engage with larger social movements, particularly on the global development agenda, even more apparent.

Health promotion suspended between its constitutive desire to become one with the ‘community’ and its real position as a mediating professional fraction, often acting on behalf of formal public institutions.

Health promotion, health inequities, and social justice

Health Promotion Glossary describes what equity in health entails: ‘That all people have an equal opportunity to develop and maintain their health, through fair and just access to resources for health’.

Health promotion must fully engage with recent work in political philosophy, particularly in the arguments surrounding the concept of social justice

As health promoters, charged with the responsibility to advocate, enable, and mediate for equity in health, we should be armed with the very best arguments supporting our position.

Millennium development goals

(MDGs) adopted by all UN Member States in 2000, have become a universal framework for development and a vehicle by which low- and middle-income countries and their development partners can work together ‘in pursuit of a shared future for all.

In year 2005, the preventative health inequities reported are overwhelming and their impact is devastating. Even more discouraging is a call within the report for high-income countries to scale up their response if we are to have any hope of meeting these goals.

Health Care Reform in Canada

focus on health promotion, disease prevention and population health status

place greater emphasis on community-based rather than institutional care

decentralize and regionalize the health care system

emphasize primary care and move away from fee-for-service structures

place greater emphasis on self-care and personal responsibility for health maintenance.

Canadian health promotion

In year 1978,the federal Directorate of Health Promotion was created.

In the late 1980s and early 1990s, health promotion gained considerable acceptance within the academic community.

In the early 1990s, a new construct—entitled population health—began to replace health promotion in many government and health policy circles.

The “Healthy Community” and “Strengthening Community Health” Initiatives The “Healthy Cities/Communities” movement originated in Canada and was implemented in 1986.

The milestones in health promotion

Lalonde report1974

1st international conference on

health promotion(Ottawa,1986)

2nd international conference on

health promotion

(Adelaide,1988)

3rd international conference on

health promotion

(Sundsvall,1991)

4th international conference on

health promotion

(Jakarta,1997)

5th international conference on

health promotion(Mexico,2000)

6th international conference on

health promotion

(Bangkok,2005)

7th international conference on

health promotion(Nairobi,2009)

8th Where, when,

why?

Conclusion

Health promotion is a complex, often ambiguous concept and set of practices. It has an intimate connection with health education and has its roots in the deep history of public health.

The foundational principles of health promotion are equity, participation, and empowerment.

Health promotion must take its duty to enable people to control the determinants of their health seriously.

To achieve its goals health promotion must engage directly with political philosophy and it must be aware of the dynamics of the global political economy and its effect on health.

Thank you for attention