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• Health promotion:

  • Is the process of enabling people to increase control over and to improve their health 
  • It encompassess health, wellness, disease and illness

• Determinants of health: 

  • Broad range of personal, social, economic and environmental factors that determine individual and population health 
  • The main determinants of health include: 

1. Income and social status
2. Employment and working conditions 
3. Education and literacy 
4. Childhood experiences 
5. Physical environments 
6. Social supports and coping skills
7. Healthy behaviors
8. Access to health services 
9. Biology and genetic endowment 
   10. Gender 
   11. Culture 

Race / racism 

• Population health: 

  • Means health outcomes of a defined group along with the distribution of health outcomes within the group

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• Levels of prevention: 

  • Primordial:
  • Before risk factor 
  • Aimed at affecting health before at risk lifestyle behaviors are adopted 
  • Reflects policy level intervention 
  • Examples: healthy eating school based programs, creating bike/walking paths, reduction of sodium in food

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• Primary:

  • Interventions / education
  • The goal is to intervene before the disease process occurs 
  • The focus is to maintain/improve general individual, family and community healthy 
  • Example: administering immunizations

• Secondary:

  • Screening 
  • Focuses on early detection 
  • Example: pap tests

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• Tertiary: 

  • Focuses on restoration and rehabilitation 
  • Minimize long term sequelae of disease 
  • Restore function; prevent further injury / disease 
  • Example: cardiac rehab about MI

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• Approaches to health over time:

1. Medical: 

• Traditional approach

• Health equated with quality of medicine and number of acute care hospitals

• Very expensive system 

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1. Behavioral approach: 

• Lalonde 

• Epp report and ottawa charter

• Places responsibility for health on individuals 

• Social marketing and health education campaigns (anti-smoking campaigns)

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1. Socio Environmental approach:  

• Social context of health

• Social determinants of health

• Looks beyond the individual 

• Recognizes the complexity of health

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• Lalonde report: 

  • A new perspective on the health of canadians 
  • Response to 3 crises: 

1. Growth in expenditures did not match gains in life expectancy 

2. Sick care expenditures created budget problems 

3. Medicine not successful at curing chronic conditions 

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• Recognized dynamic nature of health
• 4 key areas: 

1. Human biology 

2. Environment 

3. Lifestyle

4. Health care organization

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• Started focusing on lifestyle

• Decreasing behavioral risk factors for chronic disease

• Entire population rather than individual 

• Recognized value of research 

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• The epp report: 

  • Achieving health for all: a framework for health promotion 
  • Identified 3 major challenges not met by current health care practice and policies

1. Disadvantaged groups have lower life expectancy, poorer health, higher disability 

2. Preventable disease continues to harm health of canadians

3. Chronic diseases/lack of community support   

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• Achieving health for all (epp report):
  • Three health challenges: 

1. Reducing inequalities

2. Increasing prevention 

3. Enhancing coping 

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• Three health promotion mechanism: 

1. Self care 

2. Mutual aid

3. Healthy environments 

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• Three implementation strategies: 

1. Fostering public participation

2. Strengthening community health services 

3. Coordinating healthy public policy 

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• The ottawa charter: 
  • Identified 5 strategies to achieve health for all by the year 2000:

1. Strengthen community action 
2. Build health public policy
3. Create supportive environments 
4. Develop personal skills 
5. Reorient health services 

• Milestone document in that it places responsibility for health on society as a whole 

• Enable people to increase control 

• Key concept: empowerment 

• Identified prerequisites for health (peace, shelter, income, food)

• Viewed health as dynamic and positive having both social and individual dimensions 

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• Health promotion and disease prevention:

  • Health promotion: 
  • Directed towards increasing the level of well-being 

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• Disease prevention: 

  • Action to avoid illness and disease 

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• Health disparities: 

  • Differences in health status among different population groups 

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• Health inequities: 

  • Differences in health between population groups-defined in social, economic, demographic terms that are unfair and avoidable
  • Common avoidable and unacceptable disparities: 
    • Lack of health insurance and high healthcare costs
    • Language barriers 
    • Lack of transportation 
    • Provider-patient communication 
    • Biased clinical decision making 
    • Patient’s mistrust and refusal 
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Social justice: 

• Social justice is the equitable, or fair, distribution of society’s benefits, responsibilities and their consequences 
• It focuses on the relative position of social advantage of one individual or social group in relation to others in society as well as on the root causes of inequalities and what can be done to eliminate them 
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Major social determinants generating health inequalities in canada: 

• Income 

• Housing 

• Food insecurity 

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Equality: 

• The assumption is that everyone benefits from the same supports 

• This is equal treatment 

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Equity: 

• Everyone gets the supports they need 

• This is the concept of affirmative action 

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Justice: 

• The causes of the inequity was addressed 

• The systemic barrier has been removed 

• (everyone can see the game without help)

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How can nurses provide care to vulnerable populations:

• Be comfortable with diversity 

• Understand client’s beliefs, values, practices 

• Be aware of barriers 

• Communication and caring practices

• Advocate on behalf of your clients 

• Not judge or evaluate beliefs in terms of nurse’s own culture 

  • Check your privilege 
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  • Strength based nursing 
    • An approach to care - promotes empowerment, self-efficacy and hope
    • The nurse focuses on inner and outer strengths 
    • Fosters the capacity for health and innate mechanisms of healing
    • Based on 8 core values: 

  1. Health and healthing

  2. Uniqueness

  3. Holism and embodiment

  4. Subjective reality and created meaning 

  5. Person and environment are integral

  6. Self-determination 

  7. Learning, timing and readiness

  8. Collaborative partnership 

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Reality inquiry: 

• Complex interplay of human life, the world and nursing practice 

• Aimed toward patient-well being, nurse well-being and system well-being 

• Essential components: 

  • Relational consciousness
  • Inquiry as a form of action

  \n Five Cs: 

1. Compassionate

2. Curious

3. Committed

4. Competence

5. Corresponding to ‘what is’

   \n Health belief model:

• Developed to explain individual decisions for health screening opportunities

• Designed to explain health behavior and health behavior change 

• Focuses on individual 

• Framework for motivating people 

• Negative consequences are the prime motivator 

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Health promotion model:

• Focus is on optimizing wellness versus avoiding disease 

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Social cognitive theory:

• Emphasizes the influence of efficacy beliefs on health behavior 

• Self-efficacy: individual’s belief in their ability to influence own health

• Includes roles of reinforcement and observational learning 

• Modeling: 

  • Parents model behavior for their child 

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Success depends on:

• Motivation 

• Client involvement 

• Identify pre contemplative stage

• Social support networks 

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Obstacles depend on:

• Values 
• Beliefs
• Life stressors 
• Goals
• Previous experiences