wk 2 chapters

Health Promotion

Definition = a social + political process focused on improving health and reducing health inequities by helping people gain greater control over their health and determinants of health. Goes beyond teaching healthy lifestyles and includes empowerment, advocacy, policy change, social/environmental conditions, equity, and community participation.

Biomedical Model of Health

Defines health mainly as the absence of disease and focuses on physical pathology only. Criticized because it ignores mental, emotional, social, spiritual, and environmental influences on health.

Modern/Holistic View of Health

Health is dynamic and multidimensional. Includes physical, mental, emotional, social, and spiritual well-being and is influenced by determinants of health.

WHO Definition of Health (1948)

“A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Important because it shifted focus from disease treatment to overall wellness.

WHO Definition of Health Promotion

“The process of enabling people to increase control over, and improve, their health.”

Importance of WHO Health Definitions

Influenced nursing, sociology, anthropology, and social work by emphasizing prevention, empowerment, and social conditions rather than just illness treatment.

Nursing Perspective on Health

Health is holistic, constantly evolving, and influenced by determinants of health such as income, housing, education, relationships, and environment.

Community Health Nursing View of Health

Health is viewed as a resource for daily living and is shaped by beliefs, social conditions, environment, culture, and access to resources.

Examples of Social Justice and Health

Safe housing, supportive relationships, freedom from discrimination/fear, access to education, healthcare, income, and community supports.

Health Promotion Focuses On

Prevention, empowerment, equity, healthy public policy, community participation, social justice, and addressing root causes of illness.

Difference Between Health Education and Health Promotion

Health education = giving information and encouraging behavior change (ex. teaching nutrition). Health promotion = broader process including advocacy, social action, environmental change, and policy reform.

Examples of Health Promotion Strategies

Tobacco laws, housing reform, advocacy campaigns, safer environments, policy changes, improving food access.

Goals of Health Promotion

Improve quality of life, reduce health disparities, improve living conditions, and help people gain control over determinants of health.

Indigenous Views of Health

Holistic and community-centered. Health is connected to land, culture, spirituality, relationships, body, mind, emotions, and spirit.

Factors Affecting Indigenous Health

Colonization, residential schools, systemic racism, discrimination, intergenerational trauma, and inequitable social conditions.

Nursing Activism Example – Cathy/Vathy Crowe

Advocated for people experiencing homelessness and highlighted housing as a determinant of health.

Nursing Activism Example – Cheryl Forchuk

Advocated for mental health community integration and better support systems.

Major Challenges in Health Promotion

Governments often prioritize acute care and illness treatment while failing to address poverty, housing insecurity, food insecurity, social exclusion, and inequities.

Neo-Liberal Policies

Policies that reduce government social services and supports, often worsening inequities and access to care.

Upstream Approach

Focuses on root social, environmental, and policy causes of disease before illness develops. Goal = prevention and structural change.

Examples of Upstream Interventions

Poverty reduction, education improvements, housing programs, fluoridated water, adding iodine to salt, vitamin D in milk, environmental regulation reform.

McKinlay’s River Story

Story showing difference between upstream vs downstream thinking. People became sick from contaminated river water. Health department focused downstream on boiling water advisories and antibiotics, but PHN identified upstream root cause = factory dumping and outdated environmental policies.

What McKinlay’s River Demonstrates

Treating illness alone is ineffective if root social/environmental causes are ignored.

Role of Public Health Nurse in Upstream Approaches

Conduct community assessments, environmental scans, advocacy, water testing, policy advocacy, and identify root causes of health problems.

Downstream Approach

Focuses on treatment after illness occurs. Mainly individual-focused tertiary care.

Examples of Downstream Care

Emergency departments, hospital care, surgeries, chronic illness management.

Problems with Downstream Care

Expensive, reactive, and does not solve root causes of illness.

Primary Health Care (PHC)

Essential healthcare that is scientifically sound, socially acceptable, accessible, affordable, community-based, and involves community participation.

Difference Between Primary Care and Primary Health Care

Primary care = direct point-of-entry medical services. PHC = broader system emphasizing prevention, equity, social justice, community participation, and determinants of health.

Tommy Douglas Contribution to Canadian Healthcare

Introduced Saskatchewan hospital insurance in 1948 to ensure poor people had access to care. Led to National Hospital Insurance (1957) and Medicare (1966).

Lalonde Report (1974)

“A New Perspective on the Health of Canadians.” Major Canadian health promotion report shifting focus away from purely biomedical care.

4 Health Field Concepts from Lalonde Report

Human biology, environment, lifestyle, and healthcare organization.

Importance of Lalonde Report

Recognized environmental and social conditions as major health influences and inspired health promotion initiatives like ParticipACTION.

ParticipACTION

Canadian initiative promoting physical activity and healthy lifestyles.

Alma-Ata Declaration (1978)

WHO declaration stating health is a fundamental human right and healthcare requires action beyond the healthcare system.

Key Ideas of Alma-Ata Declaration

Care should be practical, accessible, affordable, community-based, and participatory.

Epp Report (1986)

“Achieving Health for All.” Identified 3 mechanisms of health promotion: self-care, mutual aid/support, and healthy environments.

WHO 5 Components of PHC

Reduce health inequities; organize services around people’s needs; integrate health into all sectors; collaborative leadership; increase stakeholder/community participation.

Core Values of PHC

Equity, social justice, accessibility, and community participation.

Equity in PHC

Fair distribution of health resources with focus on disadvantaged groups.

Social Justice in PHC

Fair distribution of benefits/responsibilities and elimination of root causes of inequities.

Principles of PHC

Health promotion, public participation, intersectoral collaboration, appropriate technology, and accessibility.

Intersectoral Collaboration

Multiple professions/sectors working together to improve health outcomes.

Appropriate Technology

Affordable, effective, culturally acceptable interventions.

Elements of PHC

Health education, nutrition, safe water, sanitation, maternal-child health, immunization, disease prevention, treatment, and essential drugs.

Ottawa Charter for Health Promotion (1986)

WHO framework for global health promotion created at the first International Conference on Health Promotion.

Goal of Ottawa Charter

“Health for All by the Year 2000.”

5 Action Areas of Ottawa Charter

Build healthy public policy; create supportive environments; strengthen community action; develop personal skills; reorient health services.

Build Healthy Public Policy

Health should be considered in ALL government policies, not only healthcare policies.

Examples of Healthy Public Policy

Tobacco legislation, housing policies, environmental protections.

Create Supportive Environments

Healthy physical and social environments are necessary for health.

Examples of Supportive Environments

Safe workplaces, clean communities, supportive schools.

Strengthen Community Action

Communities participate in decisions and gain control over their health.

Develop Personal Skills

Increase knowledge, health literacy, coping skills, and life skills.

Reorient Health Services

Shift healthcare focus from disease treatment to prevention and promotion.

Meaning of Ottawa Charter Logo

Outer circle = healthy public policy. Three rings = integrated action areas. Broken wing = society constantly changes so policies must adapt. Inner circle = enabling, mediating, advocating.

Enabling

Creating equal opportunities for health.

Mediating

Coordinating between sectors and groups.

Advocating

Promoting social conditions that support health.

Social Determinants of Health (SDOH)

Conditions influencing health outcomes such as income, education, employment, housing, and social status.

Structural Determinants of Health

Large systems creating inequities including racism, wealth distribution, education systems, and gender norms.

Toronto Charter on SDOH (2002)

Developed at York University to analyze Canadian SDOH and promote health equity, social justice, and policy change.

Population Health Promotion

Taking action on determinants of health to improve outcomes for groups and populations.

Old Health Promotion Approach

Focused mainly on individual behavior and lifestyle education.

New Health Promotion Approach

Focuses on equity, justice, social/environmental conditions, and populations.

Population Health Promotion Model (PHPM)

Canadian model integrating health promotion, population health, and determinants of health.

Questions Asked by PHPM

What determines health? What should be done? How should action happen?

PHPM Cube Components

Determinants of health, levels of action, and Ottawa Charter strategies.

Levels of Action in PHPM

Individual, family, community, system/structure, and society.

Foundation of PHPM

Research, evaluation, experiential learning, values, and assumptions.

Population Health

Improving health outcomes for entire populations and reducing inequities.

Examples of Populations

Children, immigrants, older adults, geographic communities.

Population Health Indicators

Mortality rates, birth rates, life expectancy, disease incidence.

Social Marketing

Using commercial marketing strategies to promote healthy behaviors and social change.

Goal of Social Marketing

Change behaviors to improve population health, not just increase awareness.

Examples of Social Marketing

Anti-smoking campaigns, safe sex education.

When Social Marketing Works Best

People already considering change, people who tried before, and hard-to-reach groups.

When Social Marketing Fails

People resistant to change or uninterested in changing behavior.

Alternative to Social Marketing

Legislation (ex. seatbelt laws).

At-Risk Population

Group with higher likelihood of morbidity, mortality, or poor outcomes.

Problems with At-Risk Labeling

Can reinforce stigma, racism, sexism, ageism, classism, ableism, and discrimination.

Example of Bias Related to Social Assistance

Assuming people receiving social assistance are lazy.

Consequences of Bias in Healthcare

Discrimination in care planning and reduced access to trauma-informed care/resources.

Indigenous Peoples and Risk

Higher rates of diabetes, suicide, and disease-related deaths due to systemic racism, colonialism, and inequities—not racial inferiority.

MRFIT Study

Heart disease prevention study focusing on smoking reduction, diet, and blood pressure. Intervention group did not improve significantly, showing behavior change alone is insufficient.

Risk Communication

Sharing information about current/future health risks, severity, who is affected, and prevention actions.

Example of Risk Communication

Disease outbreak warnings.

Risk Management

Activities addressing shared risks in vulnerable groups.

Example of Risk Management

Smoking cessation programs for pregnant women.

Primordial Prevention

Prevents risk factors from developing at all through policy/environmental changes.

Example of Primordial Prevention

Removing tobacco use in public environments.

Primary Prevention

Prevent disease/injury before it occurs.

Examples of Primary Prevention

Immunizations, smoking cessation, STI education, safe car seats.

Pandemics and Primary Prevention

COVID-19 and the 1918 influenza pandemic highlighted importance of masking, quarantine, and public health restrictions.

Health Inequities During Pandemics

Indigenous populations and marginalized groups were disproportionately affected.

Secondary Prevention

Early detection and treatment to stop disease progression.

Examples of Secondary Prevention

Pap smears, cholesterol tests, diabetes screening, blood pressure checks.

Benefit of Secondary Prevention

Reduces morbidity and mortality through early treatment.

Tertiary Prevention

Reduces complications/disability after illness develops.

Examples of Tertiary Prevention

Stroke rehab, trauma counseling, chronic disease management.