Week 1 + 2: Introduction to Health Promotion

health promotion

the process of enabling people to increase control over, and to improve, their health

Ottawa Charter 1986

Landmark document of health promotion
- Created at 1st ever International Health Promotion Conference by WHO
Intended for International use, whereas Achieving Health For All (EPP report) was intended only for Canadians

Key components of the Ottawa Charter

5 action areas and 3 strategies

5 Action areas of the Ottawa Charter

1. Building healthy public policy
2. Creating supportive environments
3. Strengthening community action
4. Developing personal skills
5. Reorienting health services

3 strategies of the Ottawa Charter

1. Advocate
2. Mediate
3. Enable

International union for health education (IUHPE)

Most important international non-governmental organization in the field. Promoted exchange of experience and information in a more scientific and systematic exchange

The Lalonde Report 1974

1st document by a central government of a major developed country that advocated for investing resources beyond health services to improve the health of the population
- introduced the term: health promotion
- Introduced 4 health population factors:
1. Human Biology
2. Environment
3. Lifestyle
4. Health Care Organization

Prior to 1974

Health education era - it was believed that educating the public was enough.
After 1974, Health education becomes health promotion
- WW11 sanitary reformers dominated the HE field (posters, newspapers)
1951: International Union for HE created
1950s-60s: Greater involvement of social scientists and communication
1970: Too much emphasis on individual behaviour

The population health era 1994-2007

- Support for health promotion began to weaken
- Shift away from a welfare state, meaning WHO lost a lot of influence while banks and private institutions gained influence.
- Population health focused on social determinants of population differences rather than individual differences in disease.
- Rise of population health
helped by the publication of the book: Why are some people healthy and others not?
- In 2007, leadership had shifted from government to academic sectors.

2007-2017 Health promotion

- 2008's economic crisis caused countries to cut funds in health promotion programs
- 2010's IUPHE conference led to the reinstatement of health promotion (Canada had the 2nd largest participants at the conference)
- WHO released the commission on social determinants of health report
- 5 graduate programs at Canadian Universities

Salutogenesis

Health enhancing rather than pathogenic (disease causing aspects of health)
- The salutogenic approach reduces entropy (chaos)
- lower chaos = better health
- Salutogenic model views health and disease as a continuum and focuses on conditions leading to wellness.
- emerged from Scandinavia

Health and empowerment

- having control is central to definitions of health
- to be healthy is to be empowered
3 key dimensions of empowerment:
1. Material
2. Psychosocial
3. Political
- women are at disadvantage
The empowerment model is a popular choice of many health promoters

7 key principles of the Perth charter for the promotion of mental health

1. Mental health is more than the absence of mental illness. Mental health promotion includes both preventing illness and increasing wellbeing

2. The foundations of social and emotional wellbeing develop in early childhood and must be sustained throughout the lifespan

3. Mental health promotion must be integrated with public health and requires a cross-sectoral approach

4. Mental health and illness are constructed, experienced and viewed as different to physical health and illness

5. Mental health and mental illness are a dynamic balance.

6. Destigmatization of mental illness and addressing discrimination are essential components of mental health promotion

7. Mental health promotion must take place at the individual and societal levels

3 main aspects of individual social health:

1. Independence
2. Interpersonal relationships
3. Responsibility

The Shanghai Declaration

Call to action:
We recognize that health is a political choice and we will counteract interests detrimental to health and remove barriers to empowerment especially for women and girls...We pledge to accelerate implementation of the sustainable development goals (SDG's) through increased political commitment and financial investment in health promotion.

Freedom of choice

A difficult concept in health promotion - e.g. An individual is free to choice to to smoke but not free with a drug of addiction, the option is only open at the beginning.
- Health promotion should uphold the principle of voluntarism however more coercive methods can be used on specific grounds

health education

Planned learning experience to facilitate voluntary change in behaviour. Concerned with health directed behaviour for disease prevention or progression

Health Education to Health Promotion

- HE was historically successful e.g. immunizations
- However concerns about HE ability to address lifetime habits (lifestyles)
- need for POSITIVE approaches in health ed

Lifestyle

- an enduring pattern of behaviour or socialization
- focus on determinants of health rather than measuring and explaining disease at sub-molecular units.

Sub-molecular level of health

- reduces health to sub-molecular levels = great for medicine but neglects the whole person
- incentives stacked in favour of high tech
- HP suffers in clinical settings

Equality vs. Equity

Equity is giving everyone what they need to be successful. Equality is treating everyone the equally
- recall the shorter picture of short vs tall people seeing over the fence

Health Promotion definition - Green and Kreuter 1999

The combination of educational and ecological supports of actions and conditions conductive to health

Health Promotion definition - Ottawa Charter 1986

Process of enabling people to increase control over, and to improve, their health

Without Health Education, Health Promotion would be a...

"manipulative social engineering enterprise"

9 assumptions of health promotion

1. Health status is changeable

2. Health and disease determined by interactions among bio, psych, beh, social factors

3. Behaviour can change, those changes influence health

4. individual beh, family interactions, community and work relationships all contribute to health and beh change

5. Interventions can teach HP-ing behaviours or attenuate risky ones

6. Determinants, nature & motivation for beh must be understood for health beh to change

7. Initiating & maintaining beh change is challenging!

8. Individual responsibility does not equal victim blaming!

9. For permanent health behaviour change, person must be motivated & ready.

Efficacious HP efforts follow a basic format:

approx. 6 steps (each step including more)
1. Understand & engage
2. Assess needs
3. Set goals & objectives
4. Develop Intervention
5. Implement Intervention
6. Evaluate results

Halifax Experience

Irwin tasked with finding a solution for people living in low income buildings in Halifax. After asking them (needs assessment), she found they wanted to revamp the clothing donation centre and increase their self esteem.
- residents didn't want to line up outside as their neighbours could see them in line and that was embarrassing.
- clothing was set up like a clothing store, mens, women, sizes
- cash register even added to make it feel more real (Like in Maid!!!!!)
- needs assessments are so important, Irwin had no idea this was what they wanted...

What report introduced the term health promotion?

A new perspective on the health of Canadians

better control of behavioural risk
factors alone could
prevent between _ -_% of ALL
premature deaths, ____ of ALL
acute disabilities, and ____
of chronic disabilities

40-70%
one third
two thirds

disease prevention vs health promotion: Health Promotion

Health = positive & multidimensional
Concerns a network of issues
Diverse & complementary strategies
Non-professional organizations, civic
groups, local, municipal, regional and
national governments necessary for
achieving the goal of health promotion

Disease prevention vs health promotion: Disease prevention

Health = absence of disease
medical model
Concerns a specific pathology
One-shot strategy
Preventive programs considered the affairs
of professional groups from health
disciplines

health education is a planned learning
experience to facilitate ______ ______ in behaviour

Voluntary change