Health Promotion

What is the difference between health promotion and disease prevention?

Health promotion is the process of empowering people, increasing control over and improving health.

Disease prevention is a reverse activity taken by the health care sector, to prevent the reoccurrence of disease , to defect and stop development and to reduse the negative effects once a disease is established.

How does the World Health Organization (WHO) define health?

"Health is not an end in itself but rather a resource for living and the concept can be applied to individuals, groups of individuals, communities, whole populations."

*resource of living not an object, it is a positive concept*

How does WHO define health promotion?

"The Ottawa Charter (1986) defined it as "enabling people to increase control over and to improve their health."

*This was the beginning of conceptualization of empowerment as a component of health promotion*

Why is health promotion important to Canada and the world in general?

Nurses are the front lines of the health care system, we see the impact of social detriments everyday. We see people with a lower socioeconomic status they're more susceptible to diseases processes. They have more complications and a longer recovery time.

To reach a state of complete physical, social and mental well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment.

What are the prerequisites for health, according to the Ottawa Charter?

The Government of Canada has identified 12 detriments to health which were developed from:

The Lalonde Report (1974)

The Epp Report (1986)

Ottawa Charter of Health Promotion (WHO, 2006)

Social Determinants of Health

Social Determinants of Health Definition:

The economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole. "The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience". (Social Determinants of Health: The Canadian Facts Mikkonen and Raphael, 2010:7)

Fundamental conditions and resources for health Prerequisites for Health

Peace, Shelter, Education, Food, Income, Stable ecosystem use,

Sustainable resources, Equality,

Empowerment of women, Social security, Respect for human rights, Social relations, Social justice

What are the determinants of health according to Health Canada?

Income and social status

Social support networks

Education and literacy

Employment and working conditions

Social environments

Physical environments

Personal health practices and coping skills

Healthy child development

Biology and genetic endowment

Health services

Gender

Culture

The most influential determinant of health is:

socioeconomic status.

Factors of socioeconomic status include:

- Gender

- Income

- Social position

- Education

-Employment

-Working conditions

What does the Ottawa Charter (1986) say about?

Directs them to be aware of health consequences and their decisions to accept responsibility for people's health.

Building Healthy Public Policy- Models, At present, three frameworks help in understanding healthy public policy:

1. Milo's framework for the development of healthy public policy

2. Weiss's framework on the relationships between evidence and policy

3. Impact assessment and health impact assessment (HIA) on policy development and implementation

Healthy public policy:

Policy that has a positive effect on or promotes health

Building healthy public policy:

Creating environments that support health and reduce inequities in health and social policies

ii. Creating supportive environments

The need to encourage reciprocity maintenance, to take care of each other in our communities and our natural environment, and the conservation of natural resources throughout the world.

Requires attention to the Determinants of Health,

The Determinants of Health:

Have a direct impact on the health of individuals and populations

Are the best predictors of individual and population health

Structure lifestyle choices

Interact with each other to produce health

iii. Strengthening community action

It said that at least that the heart of this process is the pyramid of communities: their ownership and control of their endeavours and destinies, make communities in charge, not somebody at the top.

Community development:

A process whereby community members identify health problems or issues impacting their community that require the development of capacity-building skills to bring about change.

Capacity building:

Recognizing and utilizing strengths (rather than deficits) such as available services, resources, and programs in order to assist communities, individuals, or organizations to resolve their health issues.

Asset mapping serves as the starting point for determining the resources and assets available in the community.

Community mobilization:

Individuals in a community working together as a group to influence healthy public policy and to bring about change regarding a health issue.

Community-based strategies vs. community development strategies:

Community-based strategies:

Connect programs and services to community groups

Decision-making power usually rests with the sponsoring organization or professional, and not with community participants.

Community development strategies:

Involve a health concern or issue defined by community residents, rather than by a sponsoring organization or professional

Decision-making power rests primarily with community residents.

Empowerment:

A key concept in health promotion

Refers to an active process whereby individuals, groups, and communities are able to state their health requirements and be involved in and take charge of the strategies required to achieve improved health.

Develop personal skills

Literacy refers to nine skills essential to achieving success and safety in work, learning, and life:

Reading

Writing

Oral communication

Numeracy

Thinking

Document use

Working with others

Computer use

Continuous learning

Health literacy:

The ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in a variety of settings across the lifespan

Illiteracy can prove to be a barrier to accessing health services.

Literacy can be related to the following, and is therefore linked to the Determinants of Health:

Overall health status

Co-morbidity burden

Life expectancy

Lifestyle practices

Culture

Income and socioeconomic status

Living and working conditions

Educational attainment

Gender

Early life

Health education is a strategy for the development of personal health skills, for example:

Stress management

Healthy eating

Physical activity

Improved literacy

Various teaching methods are used, for example, lectures, demonstrations, small groups, and health fairs.

Reorienting health services

-Outlined in the Ottawa Charter

-Refers to reforming health services/sectors to include a health promotion focus

-Work with community partners

-Common strategy include health communication and social marketing

Social determinants:

10 New tips for better health

-Don't be poor

-Don't have poor parents

-Own a car

-Don't work in a stressful, low-paid job

-Don't live in damp, low quality housing

-Be able to sunbathe on vacation

-Practice not losing your job

-Take all benefits you're entitled to

-Don't live next to a major road or factory

-Learn how to fill in complex housing forms

How does socioeconomic status influence health? Social, environmental, political, and economic determinants of health can be considered related to:

-Living and working

-Social support can lead to stress & illness

-Individual behaviour

-Genetic make-up

*Social Economic Status = SES

How does SES influence health?

-Consistent & persistent relationship whether measured with mortality/morbidity or perceived health

-Indicates that a person's sense of well-being is related to their social status

-Direct correlation: Greater wealth = greater health

What are some of the health challenges of those with low income?

More addictions to drugs and alcohol, face homeslessness, food insecurity, increased mental health issues.

Stress:

-Low income → more likely to be exposed to socioecological stresses

-Also, may experience more psychological distress

-May have fewer resources to cope with stress

-Coping strategies used may be harmful to health

-May have ↓ social support

-Chronic stress compromises immune system

-Many lead to cardiac complications

Why is the issue important to nurses? Health care utilization

-Low-income Canadians are more likely to contact health care providers

-Also, more likely to be hospitalized & use ER

-May have ↓ access to preventive health care

Health behaviours

-Limited income → may be more likely to engage in health-limiting behaviours

-Unable to comply with medication regime without finances to pay for treatment

Implications for nurses?

-Front line workers of the healthcare system

-Work to change health-limiting conditions rather than focus only on behaviours (social advocates)

-During assessment ask the right questions to find links between illness and social factors

-Our system is really about sick care, not health care

-Structural (violence) problems (CAN Backgrounder 2005:6)

Explain the principles of primary health care.

-Accessibility

-Public participation

-Intersectoral interdisciplinary collaboration

-Appropriate technology

-Increased health promotion and illness prevention

Five principles of primary health care were adopted at Alma-Alta in 1978:

1. Equitable distribution of essential health services to all populations.

2. Increased emphasis on services that are preventive and promotive rather than curative only. (increase health promotion and disease prevention)

3. Maximum individual and community involvement in the planning and operation of health care services. (public participation)

4. The integration of health development with social and economic development. (inter-sectoral and interdisciplinary collaboration)

5. The use of appropriate technology.

1. Equitable distribution of essential health services to all populations.

-Accessibility

-Regardless of geographical location, culture, and income

-Does not mean equal

2. Increased emphasis on services that are preventive and promotive rather than curative only. (increase health promotion and disease prevention)

-Such as health education and immunization

-Focus on promotion health and preventing disease to maintain health

-Eg) teaching low-income people to eat healthily n restricted budgets

3. Maximum individual and community involvement in the planning and operation of health care services. (public participation)

-Often referred to as public participation in decision making

-Communities need to be encouraged in managing their health care

-Eg) school breakfast program, heart health, and safe walking

4. The integration of health development with social and economic development. (inter-sectoral and interdisciplinary collaboration)

-Intersectional collaboration

-Involves interdisciplinary teams working together

-Work with agriculture, food, industry, housing

-Eg) decrease smoking in all public places

5. The use of appropriate technology.

-Finding the most cost-effective way to provide appropriate health care to everyone in the community

-Eg) telehealth technology

7. What is "downstream thinking?"

Downstream Thinking - Solving the problem and not looking for where it originates (band-aid solution)

8. What is "upstream thinking?"

Upstream Thinking - Finding where a problem originates and trying to solve the problem

9. What are some of the barriers to providing culturally sensitive care?

Ethnocentrism

Cultural blindness

Biassed

Culture shock

Stereotyping

Prejudice

Racism

Cultural awareness and cultural sensitivity are steps toward cultural safety:

-Cultural awareness = An initial understanding that variations exist

-Cultural sensitivity = Showing respect and valuing cultural diversity

-Cultural safety represents a way of working in highly diverse communities to help remove the barriers of "power" and "authority" and promote equality.

"Believing you can do it" &

"How the other half feels"

Self-Efficacy Model (Bandura)

Della Faulkner article

Describe Model:

A person's belief about their capability of performing a certain action.

Sources:

1) Performance

2) Vicarious experience

3) Verbal persuasion

4) Physiological state

Characteristics:

1. Magnitude

2. Strength3. Generality

Uses for Self-Efficacy Model (Bandura)

Della Faulkner article

Used to predict behavior change

Transtheoretical Model (stages of change)

Describe Model:

5 stages of change:

1) Precontemplation - Not considering change in next 6 months

2) Contemplation - Thinking about change in next 6 months

3) Preparation (Resolutions) - Identifies start date within the next month

4) Action - Implementing change builds self-efficacy - reinforce behaviour

5) Maintenance - Continues new behaviour - no temptation, increased self efficacy (how long can we keep going?)

* A sixth stage, termination, is associated with changing addictive behaviour.

Uses for Transtheoretical Model (stages of change):

This will assess how long it will take someone to make a change based on the five stages. The process of changing health behaviors.

Diffusion of Innovation Theory

Describe Model:

5 Categories:

Individuals adopt innovations at different rates and are classified into one of these five categories:

1. Innovators (quick adopters)

2. Early adopters (keeners)

3. Early majority - 30-35% of general population

4. Late majority - 30-35% of general population

5. Laggards (resistant to adopting the innovation)

Six Conditions:

Patients are more likely to adopt health-related practices if the following conditions exist:

Compatibility, flexibility, reversibility, simplicity, advantageousness, and cost-efficiency

Use of Innovation Theory Model

-Community health nursing who are developing and implementing new health promotion ideas and practices need to consider the types of responders to innovation and the six conditions influencing adoption.

-It provides guidance on effective ways to encourage people to adapt new ideas to marketers, telemarketers, and big companies.