[PT10120] [1T1S] [3] Health Promotion & Health Education

To teach and increase knowledge (understand) about health; building knowledge, enhancing skill

Health education

Wider scope on health (broader scope)

Health promotion

DEFINITIONS OF HEALTH EDUCATION

Who stated the following definition of health education:

• The process that bridges the gap between health information and health practice

Presidents Committee on Health Education (1976)

DEFINITIONS OF HEALTH EDUCATION

Who stated the following definition of health education:

• Bringing about behavioral changes in individuals, groups, and populations, shifting from detrimental behaviors to those conductive to health

Simmons (1976)

DEFINITIONS OF HEALTH EDUCATION

Who stated the following definition of health education:

• Any combination of learning experiences designed to facilitate voluntary adaptations of behavior conducive to health

Green (1980)

DEFINITIONS OF HEALTH EDUCATION

Who stated the following definition of health education:

• The process of assisting individuals, separately or collectively, to make informed decisions about matters affecting personal and others’ health

National Task Force on Preparation and Practice of Health Educators (1983)

DEFINITIONS OF HEALTH EDUCATION

Who stated the following definition of health education:

• Any combination of learning experiences designed to help individual and communities improve their health by increasing knowledge or influencing attitudes

WHO

• Action individuals engage in to maintain or improve their health and prevent illness encompass both subjective perceptions of what affects health and objective evaluation by experts of behaviors with a significant relationship to health outcomes.

• These behaviors are multidimensional and can vary significantly among individuals.

Health behavior

Three categories of health behavior 

1. Preventive ill behavior

2. Illness behavior

3. Sick role behavior

CATEGORIES OF HEALTH 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

• To prevent or detect illness in an asymptomatic state

Preventive ill behavior

CATEGORIES OF HEALTH BEHAVIOR

• An individual who perceives themselves to be ill

• To define their health state and find a suitable remedy

Illness behavior

CATEGORIES OF HEALTH BEHAVIOR

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

Sick role behavior

Three foundations of health education

1. Philosophical

2. Biomedical/biopsychosocial

3. Behavioral sciences

FOUNDATIONS OF HEALTH EDUCATION

• Why

• Guiding principles, beacon of light, that inform educators may be guided

• Focus of each health education program should be members of the org/population of concern

• Target population is the focus

Philosophical

FOUNDATIONS OF HEALTH EDUCATION

• What

• Content of subject matter of health education

Biomedical/biopsychosocial

FOUNDATIONS OF HEALTH EDUCATION

• How

• Theories and methods of bringing behavioral change

Behavioral sciences

Process of enabling people to increase control over, and to improve, their health (WHO, Ottawa Charter for ______, 1986)

Health promotion

LEVELS OF PREVENTION

• To prevent disease or injury before it ever occurs

• E.g. vaccines, scoliosis prevention programs, routine check ups

Primary prevention

LEVELS OF PREVENTION

• To reduce the impact of a disease or injury that has already occurred

• E.g. Diabetes, HTN — free lozartan, lifestyle changes, consulting an MD after fx

Secondary prevention

LEVELS OF PREVENTION

• To soften the impact of an ongoing illness or injury that has lasting effects

• E.g. Geriatric treatment, HIV (anti retroviral tx) – boosting immune system, rehab

Tertiary prevention

True or False: All levels of prevention should promote health education

True

True or False: Health promotion should span across the life time (various settings)

True

SETTINGS IN HEALTH PROMOTION

• Centers, clinics, hospitals, For patients, for families and the surrounding communities

• Provide training, seminars

Healthcare

SETTINGS IN HEALTH PROMOTION

• Community organization approach

• Involves a wider population = bigger risk involved = important to educate them

• Bigger, more stakeholders (investors, barangay leaders)

Community

SETTINGS IN HEALTH PROMOTION

• Starts here

• Where habit is developed

• Health teaching, supportive hygienic school environment, school health services, teachers training and training of health professionals

School

SETTINGS IN HEALTH PROMOTION

• If you take care of this population, you take care of the generations before & after them

• Industries, offices, and food establishments, hotel specific problems common to each group

• Health initiatives

Workplace

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Ayurvedic practices focused on personal hygiene, sanitation, water supply, and engineering

Indian (500 BC)

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Emphasis on hygiene, diet, hydrotherapy, massage and early forms of immunization

• Traditional acupuncture

Chinese (2700 BC)

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Community systems for rainwater collection, waste disposal, smallpox inoculation, plague control, mosquito nets, frequent bathing, and warnings against excess alcohol

• Known for their engineering processes or engineering controls

Egyptians (200 BC)

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Disease prevention, waste disposal, segregation of infectious persons (e.g., leprosy)

• ____ advocated weekly day of rest and recognized that eating pork could result in illness

Hebrew (Code of Hammurabi & Mosaic Law)

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Health as a function of physical and social environments, and human behavior

Greek Antiquity (460-136 BC) — Holistic View

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Emphasized harmony, equilibrium, and balance for health; promoted hygiene, moderation, self-control, and calmness

Greek Antiquity (460-136 BC) — Pythagoreans

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

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

Greek Antiquity (460-136 BC) — Plato

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

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

• Coined "endemic" and "epidemic.

Greek Antiquity (460-136 BC) — Hippocrates

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Evaluated environment, nutrition, and exercise; closely linked with trainers and educators

Greek Antiquity (460-136 BC) — Physicians’ Role

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Donations from the rich subsidized health for the poor; physicians were obliged to treat all equally

Greek Antiquity (460-136 BC) — Social Equity

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Temples of medicine in beautiful areas, integrating physical, psychological, social, and spiritual well-being.

Greek Antiquity (460-136 BC) — Asklepieions

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Focused on clean water, paved streets, street cleaning, and sanitary waste disposal

Roman Empire (27-476 AD) — Community Health

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Believed the state had the greatest influence on health, not the individual.

Roman Empire (27-476 AD) — State Influence

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

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

Roman Empire (27-476 AD) — Public Services

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

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

Roman Empire (27-476 AD) — Galen

HISTORY OF HEALTH PROMOTION

Who believed in this practice and from what year did this take place?

• Bubonic Plague (Black Death) and Pulmonary Anthrax

• Used quarantine to control spread; travelers from infested areas had to stop for two months

Medieval Pandemics (1000-1453 AD)

Six phases in the evolution of primary care prevention

1. Health protection era

2. Sanitary control era

3. Contagion central era

4. Preventive medicine era

5. Primary healthcare era

6. Health promotion era

SIX PHASES IN THE EVOLUTION OF PRIMARY CARE PREVENTION

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

Health Protection Era (until the 1830s)

SIX PHASES IN THE EVOLUTION OF PRIMARY CARE PREVENTION

• Response to Industrial Revolution's filthy conditions, unsafe water, poor drainage, and inadequate sewage

• Used modern epidemiological methods to track outbreaks

Sanitary Control Era (1840-1870)

SIX PHASES IN THE EVOLUTION OF PRIMARY CARE PREVENTION

• Influenced by Germ Control Theory (Robert Koch).

• Focus on infectious diseases (e.g., cholera), vaccination, and improved water filtration.

Contagion Control Era (1880-1930s)

SIX PHASES IN THE EVOLUTION OF PRIMARY CARE PREVENTION

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

• Targeted high-risk populations (e.g., pregnant women, elderly, factory workers).

• Clinical pathology advancements used for interventions

Preventive Medicine Era (1940-1960)

SIX PHASES IN THE EVOLUTION OF PRIMARY CARE PREVENTION

• 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

Primary Healthcare Era (1970-1980)

SIX PHASES IN THE EVOLUTION OF PRIMARY CARE PREVENTION

• Emphasis on advocacy, economic and political interventions to create supportive environments.

• Strengthening community action and developing personal skills.

• Shifted from individual lifestyle focus to social, cultural, political, economic, and environmental perspectives

Health Promotion Era (1990s-Present)

KEY ORGANIZATIONS AND DOCUMENTS

• Global Focus: Established in 1948 by the United Nations, it 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)

World Health Organization (1948-Present)

KEY ORGANIZATIONS AND DOCUMENTS

• Encourages attainment, monitoring, and enhancement of health and functioning.

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

• Highlights self-determination, autonomy, and personal/environmental factors in shaping healt

International Classification of Functioning, Disability and Health (ICF) (2001)

KEY ORGANIZATIONS AND DOCUMENTS

• 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

International Union for Health Promotion and Education (IUHPE) (1951-Present)

KEY ORGANIZATIONS AND DOCUMENTS

• First Policy Statement: The First authoritative policy to suggest health promotion was determined by factors beyond healthcare.

• Established Canada as a leader in health promotion policy.

The Lalonde Report (Canada, 1974)

KEY ORGANIZATIONS AND DOCUMENTS

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

• 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, potentialy leading to "victim blaming.

Health Field Model

KEY ORGANIZATIONS AND DOCUMENTS

• Major Milestone: Identified primary health care as the key to "Health for Al."

• 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

WHO: Declaration of Alma-Ata on Primary Health Care (1978)

KEY ORGANIZATIONS AND DOCUMENTS

• 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

WHO: Declaration of Alma-Ata on Primary Health Care (1978)

KEY ORGANIZATIONS AND DOCUMENTS

• 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.

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

Healthy People (United States, 1979-2030)

KEY ORGANIZATIONS AND DOCUMENTS

• 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

Healthy People (United States, 1979-2030)

KEY ORGANIZATIONS AND DOCUMENTS

• Iterations:

  • 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.

• Impact: Increased public awareness, engaged multiple sectors, identified research needs

Healthy People (United States, 1979-2030)

KEY ORGANIZATIONS AND DOCUMENTS

• Focus on 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: Advocated for reducing inequities, increasing prevention, and enhancing individual coping skills.

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

Achieving Health for All: The EPP Report (Canada, 1986)

KEY ORGANIZATIONS AND DOCUMENTS

• Definition of Health Promotion: "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

Achieving Health for All: The EPP Report (Canada, 1986)

KEY ORGANIZATIONS AND DOCUMENTS

• First International Conference: First WHO-sponsored international health promotion conference.

• Key Emphasis: Individuals need supportive environments and economic resources for healthy lives and wel-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

Ottawa Charter for Health Promotion (WHO, Canada, 1986)

KEY ORGANIZATIONS AND DOCUMENTS

• Definition: "Process of enabling individuals and communities to increase control over the 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

Ottawa Charter for Health Promotion (WHO, Canada, 1986)

KEY ORGANIZATIONS AND DOCUMENTS

• Second International Conference: Emphasized the necessity of supportive environments and caled for colaboration 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

Adelaide Recommendations on Healthy Public Policy (1988)

KEY ORGANIZATIONS AND DOCUMENTS

• Focused on physical and social aspects of supportive environments, including social, political, economic dimensions, and women's skills.

Sundsvall Statement on Supportive Environments for Health (1991)

KEY ORGANIZATIONS AND DOCUMENTS

• First in a developing country; emphasized poverty as the greatest threat to health, and called for a global health promotion alliance

Jakarta Declaration on Leading Health Promotion into the 21st Century (1997)

KEY ORGANIZATIONS AND DOCUMENTS

• Built on Ottawa Charter, adding focus on coherence of health policy, partnership, advocating for health based on human rights, and addressing health literacy

Bangkok Charter for Health Promotion (2005)

KEY ORGANIZATIONS AND DOCUMENTS

• 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

The New Public Health Movement (NPHM) (1980s)

THEORIES OF HEALTH PROMOTION

• Increasing knowledge prompts behavior change

• If you understand the body and condition it will eventually result into good practices

Rational Model/Knowledge, Attitudes, Practices (KAP) Model

THEORIES OF HEALTH PROMOTION

• Most commonly used

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

• Check the facilitators, the behavior, and what change can i do about it

Health Belief Model

THEORIES OF HEALTH PROMOTION

• Based on the health belief model

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

Extended Parallel Process Model

THEORIES OF HEALTH PROMOTION

• Behavior change progresses through 5 stages:

  • Precontemplation

  • Contemplation

  • Preparation

  • Action

  • Maintenance

Transtheoretical Model of Change

THEORIES OF HEALTH PROMOTION

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

• Give people the chance to choose

Theory of Planned Behavior

THEORIES OF HEALTH PROMOTION

• Three phases: Experiential, Awareness, Responsibility

Activated Health Education Model

THEORIES OF HEALTH PROMOTION

• Factors affecting behavior change include:

  • Self-efficacy, goals, and outcome expectancies

• Individuals with self-efficacy they can change their behavior despite obstacles

Social Cognitive Theory

THEORIES OF HEALTH PROMOTION

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

• Need tailored messaging to target audience

• Individual to community

Communication Theory

THEORIES OF HEALTH PROMOTION

• Identifies categories of people to customize strategies

  • Innovators, early adopters, early majority, late majority, laggards)

Diffusion of Innovation Theory

THEORIES OF HEALTH PROMOTION

Which category of people under Diffusion of Innovation Theory is described:

• Reason why there are changes

Innovators

THEORIES OF HEALTH PROMOTION

Which category of people under Diffusion of Innovation Theory is described:

• The person who does it

Early adopters

THEORIES OF HEALTH PROMOTION

Which category of people under Diffusion of Innovation Theory is described:

• Do it after getting sick

Late majority

THEORIES OF HEALTH PROMOTION

Which category of people under Diffusion of Innovation Theory is described:

• Don’t like change

  • Need intense education on why that action is needed

Laggards

ROLE OF PTS IN HEALTH PROMOTION & HEALTH EDUCATION

• Trained to deliver health services and adopt recommendations to community environments

Educational providers

ROLE OF PTS IN HEALTH PROMOTION & HEALTH EDUCATION

• Consider and account for social determinants of health economic stability, education, social context, healthcare, neighborhood in services

Social determinants

ROLE OF PTS IN HEALTH PROMOTION & HEALTH EDUCATION

• Integrate prevention, wellness, fitness, and health promotion with every patient

• Design and develop integrated clinical and community screening programs

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

• Use behavior change skills to promote healthy lifestyle

Prevention & wellness

ROLE OF PTS IN HEALTH PROMOTION & HEALTH EDUCATION

• Recognize chronic disease and factors and impact on QOL

• Facilitate collaborative patient centric relationship for self management

• Provide non surgical and non-pharmacological services

Disease & Disability Management

ROLE OF PTS IN HEALTH PROMOTION & HEALTH EDUCATION

• 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

Dynamic link

ROLE OF PTS IN HEALTH PROMOTION & HEALTH EDUCATION

• Support initiatives promoting regular physical activity and exercise.

• Advocate for physical education and wellness 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

Advocacy