HEP1SL3: HEALTH EDUCATION AND HEALTH PROMOTION

Health Education

• The PROCESS that bridges the gap between health information and health practice -President's Committee on Health Education, 1976

  • Process has to be structured

Health Education

• Bringing about BEHAVIORAL CHANGES in individuals, groups, & larger populations from behaviors that are presumed to be detrimental to health, to behaviors that are conducive to present & future health  -Simmons, 1976

  • It takes 2wks (14 days) to develop a habit; similar with behavioral changes

Health Education

• Any COMBINATION OF LEARNING EXPERIENCES designed to facilitate voluntary adaptations of behavior conducive to health -Green, 1980

  • You don’t just learn at one time, naintindihan mo pero that does not mean na apply mo na sa sarili mo—it takes time and a lot of experiences

Health Education

The process of assisting individuals, acting separately or collectively, TO MAKE INFORMED DECISIONS ABOUT MATTERS AFFECTING THE PERSONAL HEALTH AND THAT OF OTHERS’ HEALTH -National Task Force on Preparation and Practice of Health Educators, 1983

Health Education

Any COMBINATION OF LEARNING EXPERIENCES designed to help individuals & communities improve their health by increasing knowledge & influencing attitudes -WHO, 1980

Health Behavior

• Actions individuals engage in to maintain or improve their health and prevent illness encompass both subjective perceptions of what affects health and objective evaluations by expert of behaviors with significant relationship to health outcomes

  • These behaviors are multidimensional and can vary significantly among individuals

Categories of Health Behavior

• Preventive Ill Behavior

• Illness Behavior

• Sick Role Behavior

Preventive Ill Behavior

• Any activity undertaken by an individual who believes himself to be healthy for the purpose of preventing or detecting illness in an asymptomatic state

• E.g when we take vitamins, exercise to prevent getting sick, handwashing, wearing mask

Illness Behavior

• Any activity undertaken by an individual perceives himself to be ill to define the state of his health and to discover suitable remedy

• E.g. taking rests & drink meds (w what u feel)

Sick Role Behavior

• An individual who considers themselves ill for the purpose of getting well, which may involve dependent behaviors and some exemption from usual responsibilities.

• Rely on professional to treat you

• Can’t do social roles and responsibilities bc sickness hinders you from doing it

Foundations of Health Promotion

• Philosophical

• Biomedical/Biopsychosocial

• Behavioral

Philosophical

• The guiding principles “beacon of light” that inform educators; 

• Foundation of the health education

• Core values/guiding principles in the program

Biomedical/Biopsychosocial

• (subject matter)

  • The content of subject matter of health education

The WHAT  

Behavioral Science

• The HOW (are you going to deliver)

• Theories and methods of bringing behavioral change 

Health Promotion

• Issued by WHO in 1984

• The PROCESS of enabling people to increase control over, and to improve their health

  • All components/aspects are being addressed (aligned with SDGs)

• Also building social and community factors to carry out health education 

• Operates at all levels of prevention 

Settings in Health Promotion

• Allows health promotion to reach the people through:

  • HEALTHCARE (not only confined in this setting)

  • SCHOOL: where health promotion can start, develop habits in children

  • COMMUNITIES: wider population, they are at bigger risk, diverse stakeholders

    • approaches could be different

History of Health Promotions

• Ancient Practices

• Greek Antiquity

• Roman Empire

• Medieval Pandemics

Ancient Practices

• INDIAN (5000 BC): Ayurvedic practices focused on personal hygiene, sanitation & even engineering practices

• CHINESE (2700 BC): Emphasis on hygiene, diet, hydrotherapy, massage, and early immunization

• EGYPTIANS (200 BC): Community systems for rainwater collection, waste disposal, smallpox inoculation, plague control, mosquito nets, frequent bathing, and warnings against excess alcohol

  • First to build a proper system after several plagues

• HEBREW (CODE OF HAMMURABI & MOSAIC LAW): Disease prevention, waste disposal, segregation of infectious persons

MOSAIC LAW advocated weekly day of rest and recognized that eating pork = illness

Greek Antiquity

• HOLISTIC VIEW: Health as function of physical and social environments and human behavior 

• PYTHAGOREANS: emphasized harmony, equilibrium and balance for health; promoted hygiene, moderation, 

• PLATO: Health is a state of harmony with the universe, experiencing completeness and contentment

• HIPPOCRATES: Defined health as equilibrium between environmental factors (e.g., climate, water, food) and individual habits (e.g., diet, exercise, alcohol). 

  • Coined "endemic" and "epidemic."

• PHYSICIANS’ ROLE: Evaluated environment, nutrition, and exercise (closely linked c trainers and educators)

• SOCIAL EQUITY: Donations from the rich subsidized health for the poor; 

  • Physicians were obliged to treat all equally 

ASKLEPIEIONS: Temples of medicine in beautiful areas integrating physical, psychological, social, and spiritual well-bein

Roman Empire

• COMMUNITY HEALTH MEASURES: Focused on clean water, paved streets, street cleaning, and sanitary waste disposal 

• STATE INFLUENCE: Believed the state had the primary role or greatest influence on health, not the individual

• PUBLIC SERVICES: Provided public baths, used census data for health planning, and mandated ventilation/central heating in buildings.

GALEN: Defined health as the absence of pain and hindrance in daily functions; disease caused by predisposing, exciting, and environmental factors.

Medieval Pandemics

• MAJOR DISEASES: Bubonic Plague (Black Death) and Pulmonary Anthrax

QUARANTINE: used to control spread; travelers from infested areas had to stop for two months

Six Phases in the Evolution of Primary Care/Prevention

• Health Protection Era

• Sanitary Control Era

• Contagion Control Era

• Preventive Medicine Era

• Primary Healthcare Era

• Health Promotion Era

Health Protection Era

> Relied on religious/cultural rules, spiritual practices, community, taboos, and quarantine (e.g. leprosy, Black Death)

Sanitary Control Era

> Response to industrial revolution’s filthy conditions, unsafe water, poor drainage, and inadequate sewage

> Used modern epidemiological methods to track outbreaks

> developing epidemiological methods to track outbreaks

Contagion Control Era

> Influenced by Germ Control Theory 

> Focus on infectious diseases (e.g. cholera in Europe) vaccination and improved water filtration

Preventive Medicine Era

> Awareness of disease vectors, understanding of beneficial microbes, and impact of nutritional deficiencies 

> Targeted high-risk populations (e.g. preg, elderly, factory workers)

> Clinical pathology advancements used for intervention

Primary Healthcare Era

> Focus on preventive health care, equity, community participation, and access to services 

> Understanding of social determinants of health and links between healthcare and socioeconomic development

> Prioritized multicultural, participatory, community-based interventions

Health Promotion Era

> Emphasis on advocacy, economic and political interventions to create environments that support health 

> Strengthening community action and developing personal skills.

> Shifted from individual lifestyle focus to social, cultural, political, economic, and

environmental perspectives.

> Focused on strengthening community and empowering individuals to make changes for their own health

WHO

• GLOBAL FOCUS: Established in 1948 by the united nations

  • Focuses on global health promotion 

• ADVOCACY: Advocates for legislation, fiscal change, and organizational/community efforts to promote health

• DEFINITION OF HEALTH PROMOTION: In 1984, defined as "the process of enabling people to take control over maintaining and improving their health."

• Shifted focus from lifestyle to structural factors (income, housing, food security, employment, working conditions)

International Classification of Functioning, Disability & Health

• Encourages attainment monitoring and enhancement of health and functioning

• Focuses on functional abilities, activities, participation levels and environmental factors

Highlightsself-determination, autonomy, and personal/environmental factors in shaping health

International Union For Health Promotion and Education

• GLOBAL NGO: A professional, non-governmental organization dedicated to advancing health promotion globally.

• MISSION: Promote global health and equity within and between countries

• KEY INTERESTS: Globalization, transboundary health influences, urbanization, consumerism, environmental threats, and population growth.

• ACTIVITIES: Publishes research (e.g., Health Education Research), sponsors conferences, maintains a website, and lobbies for social clauses in trade agreements. 

• SPECIFIC FOCUS: Health impact assessment and evaluating the effectiveness of health promotion programs. 

• COLLABORATION: Coordinates the Global Programme for Health Promotion Effectiveness (GPHPE) with WHO.

• They evaluate health promotion programs; they collaborate with WHO

THE LALONDE REPORT (CANADA, 1974)

• FIRST POLICY STATEMENT: First authoritative policy to suggest health promotion was determined by factors beyond healthcare

  • They saw that the inc. of incidents of child death were the MVAs → prompts them to establish Seatbelt law

• Established Canada as a leader in health promotion policy

• Landmark document recognizes the first authoritative statement that broaden the understanding of health determinants beyond the healthcare system

LALONDE: HEALTH FIELD MODEL

• Introduced a model where lifestyle/behavior, biology, environment and healthcare organizations all impact health. 

  • Encourage individuals to take responsibility

• ADVOCACY: Advocated for preventive care and prompting individuals to accept more responsibility for their health. 

• IMPACT: Influenced public policy shifts in Canada from disease treatment to health promotion (e.g., decreasing auto accidents, drunk driving, increasing seat belt use). 

• INFLUENCE ON WHO: Used as a rationale for expanding health promotion definition to include environmental and lifestyle factors. 

CRITICISM:Criticized for emphasizing lifestyle issues more than environmental, economic, social, and health system influences, potentially leading to "victim blaming."

WHO: DECLARATION OF ALMA-ATA ON PRIMARY HEALTH CARE (1978)

• ALMA ALTA = HEALTH CARE LAW

• Similar to universal healthcare law; foundation of all

• MAJOR MILESTONE: identified primary health care as the key to “Health for All”

• BROADENED SCOPE: Emphasized the need for health promotion, curative, and rehabilitative services. 

KEY TENETS

Global cooperation and peace are vital. Local and community needs must drive health promotion. Economic and social needs shape health. Prevention must be integral to healthcare. Equity in health status is needed. Multiple sectors and players must be involved

• CRITIQUE OF CENTRALIZED CARE: argued that healthcare resources were too concentrated in centralized high-tech institutions limiting local care 

• INFLUENCED THE OTTAWA CHARTER: Many ideas later appeared in the Ottawa Charter. 

DEVELOPING COUNTRIES FOCUS: Highlighted issues like food security, affordable healthcare, safe water, nutrition, and family planning for developing nations.

HEALTHY PEOPLE (US, 1979-2030)

• COMPREHENSIVE U.S. POLICY: Developed by the U.S. Surgeon General, initiated in 1979. 

• GOALS: Comprehensive 10-year prevention strategies and outcome targets to decrease mortality and morbidity. 

  • Separated Health Promotion and Disease Prevention, giving both priority

  • GOAL: to improve mortality

  • 10 yr prevention strategies and outcome 

• ROADMAP: Served as a national roadmap for public health activities and prevention strategies

ITERATIONS

1979: Emphasized unhealthy behavior/lifestyle (50% of mortality), environmental factors (20%), biology (20%), and healthcare inadequacies (10%).  1990: Focused on reducing mortality across the lifespan, identified subpopulations with greater health disparities.  2000: Goals: Increase healthy life years, reduce health disparities, increase access to preventative services.  2010: Same goals as 2000, with added focus on health communication, public health infrastructure, and eliminating disparities. Introduced MAP-IT (Mobilizing, Assessing, Planning, Implementing and Tracking) for community-level change 2020: Priorities: Eliminate preventable disease/disability/injury, achieve health equity, create health-promoting environments, support healthy development across lifespan. Incorporated new digital communication strategies (apps, social media, e-learning). 2030: Fifth iteration, building on past knowledge, focusing on health equity, social determinants of health, and health literacy, with a new emphasis on well-being.

• CRITICISMS: Excessive focus on individual responsibility, less credence to ethnic/gender/environmental/socioeconomic factors; concerns about data measurability and impact dilution

  • But kahit ganon, it’s the the roadmap for health promotion in US

• IMPACT: Increased public awareness 

ACHIEVING HEALTH FOR ALL: THE EPP REPORT (CANADA, 1986)

• FOCUS IN INEQUITIES: Documented that disadvantaged groups had lower life expectancies and poorer health.

• INFLUENCES ON HEALTH PROMOTION:  Identified self-care, mutual aid from others, and healthy environments as major influences. 

  • Mutual aid: Emotional support, sharing ideas/information/experience within social groups. 

• ADVOCACY: Advocates for reducing inequalities increasing prevention and enhancing individual coping skills 

• INTERSECTORAL POLICY: Stressed the importance of considering all policies impacting health (income, employment, education, housing, transportation, etc.). 

• DEFINITION OF HEALTH PROMO: a strategy that synthesizes personal choice social responsibilities and an environmental focus to create a healthier future

WARNING:  Admonished against "blaming the victim" and underestimating social/economic determinants

OTTAWA CHARTER FOR HEALTH PROMOTION (WHO, CANADA, 1986)

• FIRST INTERNATIONAL CONFERENCE: First WHO-sponsored international health promotion conference 

• KEY EMPHASIS: Individuals need supportive environments and economic resources for healthy lives and well-being.

  • Addressed health inequalities and political, economic, social influences

• EXPANDED FOCUS: Moved health promotion beyond health education alone

FIVE PRIORITY AREAS FOR ACTION

Building healthy public policy Creating supportive environments  Strengthening community action  Developing personal skills Reorienting health services

• DEFINITION: process of enabling individuals and communities to increase control over determinants of health thereby improving health to live an active and productive life." 

• IMPACT: Shifted health promotion's fulcrum from individual to a social, cultural, political, economic, and environmental perspective. 

CORE VALUES: Caring, holism, advocacy, and mediation of differing social priorities.

ADALAIDE RECOMMENDATIONS ON HEALTH PUBLIC POLICY (1988

• SECOND INTERNATIONAL CONFERENCE: Emphasized the necessity of supportive environments and called for collaboration across governmental and private sectors. 

PRIORITY AREAS FOR ACTION

Supporting the health of women Improving food security, safety, and nutrition Reducing tobacco and alcohol use Creating supportive environments for health

ADVOCACY: Argued for equal healthcare access for indigenous peoples, ethnic minorities, and immigrants, and for policies considering education levels and literacy.

OTHER SIGNIFICANT WHO CHARTERS

• SUNDSVALL STATEMENT ON SUPPORTIVE ENVIRONMENTS FOR HEALTH (1991): Focused on physical and social aspects of supportive environments, including social, political, economic dimensions, and women's skills.

• JAKARTA DECLARATION ON LEADING HEALTH PROMOTION INTO THE 21ST CENTURY (1997): First in a developing country; emphasized poverty as the greatest threat to health, and called for a global health promotion alliance. 

BANGKOK CHARTER FOR HEALTH PROMOTION (2005): Built on Ottawa Charter, adding focus on coherence of health policy, partnership, advocating for health based on human rights, and addressing health literacy.

THE NEW PUBLIC HEALTH MOVEMENT (1980s)

• INSPIRATION: Inspired by the Ottawa Charter and the growth of population health. 

  • SOCIOECOLOGICAL APPROACH: Emphasizes a socioecological rather than a biomedical approach to health. 

• ROOT CAUSES: Focuses on preventing disease by examining root causes like economic inequalities, social problems, and environmental issues. 

• SHIFT IN FOCUS: Represents a shift from the "lifestyle" era (individual behaviors) to a "public health" era (population-level social, cultural, and environmental factors). 

PROACTIVE POLICY: Priority on establishing health policy, services, and educational programs before disease occurs.

[1] RATIONAL MODEL/ KNOWLEDGE, ATTITUDES/PRACTICES (KAP)

• Increasing knowledge prompts behavior change

  • If you understand your body/condition, hopefully it will result to good practices

[2] HEALTH BELIEF MODEL

• Explains decision-making based on perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy

  • “Ano yung mga facilitators? Ano behavior ko? Ano eventually yung pwede kong gawing change bc of it?”

[3] EXTENDED PARALLEL PROCESS MODEL

• When presented with risk people appraise threat (susceptibility, severity) and efficacy (response efficacy, self-efficacy)

  • Able to manage to sudden occurrence of disease

[4] TRANSTHEORETICAL MODEL OF CHANGE

Behavior change progresses through 5 stages: Pre contemplation → Contemplation → Preparation → Action Maintenance

[5] THEORY OF PLANNED BEHAVIOR

• Intent is influenced by attitude towards behavior, perceived social norms, and perceived behavioral control

  • You give people the chance to choose

6] ACTIVATED HEALTH EDUCATION  MODEL

• 3 phases: Experiential → Awareness → Responsibility

[7] SOCIAL COGNITIVE THEORY

• Factors affecting behavior change include self efficacy, goals and outcome expectancies

• Individuals with self efficacy can change behavior despite obstacles

[8] COMMUNICATION THEORY

Utilizes multilevel strategies (tailored, targeted, social marketing, media advocacy, mass media) based on the target audience

[9] DIFFUSION OF INNOVATION THEORY

• Identifies categories of people to customize strategies for different groups

• CATEGORIES OF PEOPLE:

  • INNOVATORS: the reason why there’s changes

  • EARLY ADOPTERS: e.g. if there’s a new announced disease, they’ll be the first one to act (wear facemask, etc.)

  • EARLY MAJORITY

  • LATE MAJORITY: Nagkasakit muna before they act upon the disease

LAGGARDS: They don’t want change at all

ROLES OF PTs IN HEALTH PROMOTION

• EDUCATED PROVIDERS: Trained to deliver health services & adapt recommendations to community environment

• SOCIAL DETERMINANTS: Consider and account for social determinants of health (economic stability, education, social context, healthcare, neighborhood) in services

• PREVENTION & WELLNESS

  • Integrate prevention, wellness, fitness, and health promotion with every pt.

  • Design and develop integrated clinical and community screening programs

  • Apply evidence-based exercise prescriptions for prevention and optimal function

  • Use behavior change skills to promote healthy lifestyles

• DISEASE & DISABILITY Mx

  • Recognize chronic disease risk factors and impact on quality of life 

  • Facilitate collaborative patient-centric relationships for self-management

  • Provide nonsurgical and nonpharmacological services 

• DYNAMIC LINK: adapt expertise in exercise/physical activity from clinical to home/community settings

  • Function as part of interprofessional teams to reduce disease risk and improve quality of life 

• ADVOCACY

  • Support initiatives promoting regular physical activity and exercise

  • Advocate for physical education and well instruction at all levels

  • Advocate for community design supporting safe physical activity and active transportation

Advocate for strategies reducing inequities related to social determinants of health

BARRIERS OF HEALTH PROMOTION

• Lack of interest/awareness from pt/clients, the public, and other healthcare providers regarding PTs’ roles in health promotion

• The prevalent focus on secondary and tertiary prevention within PT practice

• The perception that the PT work environment is not suitable for health promotion

• Lack of education or knowledge in health promo for PTs

• Lack of reimbursement for health promotion services provided by PTs

• Lack of resources to implement health promo initiatives

• Lack of involvement of PTs in research, policy, and action related to health promo

APPROACHES FOR INCORPORATING HEALTH PROMOTION & WELLNESS INTO PT PRACTICE

APPROACHES FOR INCORPORATING HEALTH PROMOTION & WELLNESS INTO PT PRACTICE
INDIVIDUAL	ORGANIZATIONS (APTA, Chapters, Sections)	PROFESSIONAL PT EDUC PROGRAMS
Shift from a biomedical paradigm → biopsychosocial paradigm	Seek opportunities for members to engage in national & local discussions about NCDs	Include content on the definitions of health, wellness, and health promo
Build awareness of current public health priorities and causes of morbidity & mortality	Engage in educ of other healthcare providers about the role of PTs in 1º prevention	Include content on health behavior change theories
Discuss healthy behaviors with patients & clients and provide info and educ about health-causing behaviors	Create resources to educate PTs and facilitate the integ of health promo & wellness into PT practice	Include content o counseling skills (i.e. motivational interviewing)
Gain knowledge & skills in health behavior change & counseling	Educate the public about the role of the PT in health promo & wellness	Include content on ecological approaches to health promo & wellness
Partner with other providers to coordinate support for and reinforce health-causing behaviors	Advocate for changes to state and federal laws and regulations to support the provision of and payment for 1º care services by PTs	Integrate health & wellness content into and across curric
Engage in private and public community health promotion efforts	Support PTs to participate in local and federal gov’t initiatives/roles that promote health	Provide 1º care and community-based clinical educ experiences beyond service learning

NCD = Non-communicable Diseases; 1º = primary