Introduction to Health Promotion and Disease Prevention

Prevalent patterns of disease and mortality in North America shifted from infectious diseases in the early nineteen hundreds to chronic conditions by the late nineteen fifties due to sanitation, penicillin, and vaccines for polio, diphtheria, and pertussis developed in the nineteen forties and early nineteen fifties.
Primary prevention concepts were first discussed by Hugh R. Lavelle and Edwin G. Clark in the nineteen forties.
Primary prevention prevents individuals and populations from becoming sick or injured by promoting health, protecting existing health, and disseminating information (e.g., sanitation, immunization).
Secondary prevention involves the early detection of disease before symptoms emerge (e.g., mammography, lipid profiles, papainicola test).
Tertiary prevention focuses on preventing complications when a disease is present (e.g., foot care education for newly diagnosed diabetes, proper inhaler instruction for chronic obstructive pulmonary disease).

Prevention approaches adapt as understanding evolves; for example, peptic ulcer disease was attributed to stress and excess gastric acid before 1982, until the discovery of Helicobacter pylori as a major risk factor altered management.
The 1974 Lalonde report highlighted limitations in curative care and initiated a shift in Canada toward lifestyle, human biology, and social environment considerations.
The 1978 Declaration of Alma Mater reaffirmed health promotion principles and encouraged shifting power from healthcare providers to consumers and communities.
The World Health Organization outlined five principles of health promotion in 1984, defining health promotion as enabling people to increase control over and improve their health.
The 1986 Ottawa Charter for Health Promotion established five action strategies for population health improvement.

Proportional influences on health outcomes:
- Social and economic factors: $50\%$
- Health care services: $25\%$
- Biology and genetics: $15\%$
- Built and natural environment: $10\%$
Social determinants defined by the Public Health Agency of Canada include income and social status, social support networks, education and literacy, employment working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender, and culture.
Disparities leading to avoidable health inequalities affect vulnerable Canadian groups:
- First Nations and limit peoples have shorter life expectancies and higher mortality rates from infectious diseases like tuberculosis.
- Temporary foreign workers, whose numbers doubled in Canada between 2004 and 2013, experience poor working and housing conditions in the agricultural sector.
- Undocumented immigrants and refugee claimants face significant barriers to accessing health care.

Developed in 1996 by Hamilton and Body as a three-dimensional cube resting on societal values, assumptions, and evidence-informed decision-making.
Structural faces of the model:
- Top face (Who): Continuum from individual to society.
- Side face (How): Five action strategies of the Ottawa Charter.
- Opposite face (What): Original nine social determinants of health.
Directs nursing assessment across individual, family, community, and population levels to address upstream causes through clinical encounters and public policy.

Patient Case Encounter (Randy):
- A 45 year old single man presenting with early morning insomnia (waking at 3AM), loss of five kilograms over the past month, reduced appetite, and recent loss of his chief engineer position four weeks ago.
- Contextual risk: Suicide rates in Canada are highest among men between ages 40 and 59; loss of employment role and social isolation increase risk for self-harm.
- Clinical plan: Screen for depression and suicidal ideation, identify physical health deviations, and co-create a supportive management plan.
Principles of Health Education:
- Represents one strategy of health promotion; it is not synonymous with health promotion.
- Must align with developmental level, readiness, local resources, and socioeconomic context (e.g., addressing injury prevention in Canadian men younger than 20 participating in sports).
- Utilized across primary, secondary, and tertiary prevention levels.