Health Promotion and Health Inequalities
Health Promotion & Health Inequalities
Definitions
Health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions (WHO, 2018).
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1948).
Shift from Disease Treatment to Prevention
Traditional healthcare focuses on curing illness.
Health promotion aims to prevent disease and improve well-being.
Concepts
Life prolongation: Extending the length of life.
Health promotion: Improving overall well-being.
Ill health prevention: Reducing the occurrence of diseases.
Morbidity compression: Reducing the period of illness and disability, especially at the end of life.
Prolonged disability in ageing: A state to be avoided, where disability extends for a long period during old age.
Ottawa Charter for Health Promotion (1986)
The Ottawa Charter for Health Promotion was developed by WHO in 1986
provides a framework for improving health focusing on prevention, empowerment, and community involvement.
The charter identifies five key action areas for effective health promotion:
Build Healthy Public Policy
Integrate health into all sectors of policy-making (e.g., education, transport, labor).
Policies should support health, reduce inequalities, and discourage unhealthy behaviors.
Ireland’s smoking ban (2004) and Sugar tax on soft drinks (2018)
Create Supportive Environments
Health promotion should focus on where people live, work, and play.
Addresses environmental, social, and economic factors affecting health.
Development of smoke-free public spaces and Cycle-friendly cities to promote physical activity.
Strengthen Community Action
Encourages community participation in health promotion initiatives.
Community-based mental health programs in disadvantaged areas and Active School Flag initiative in Ireland, promoting physical activity in schools.
Develop Personal Skills
Focuses on education and skill-building to help people make healthier choices.
Provides information and tools to improve health literacy.
Example:
QUIT smoking campaign – Provides education and resources for smoking cessation.
Sexual health education in schools – Helps young people make informed decisions.
Reorient Health Services
Shifts focus from curative (treatment-focused) healthcare to preventive care.
Encourages healthcare providers to work on prevention and health promotion.
Example:
Sláintecare initiative – Aims to strengthen primary care and reduce hospital admissions.
Free GP care for children under 8 – Encourages early health intervention.
7 Health Promotion Principles
Initiatives should be…
Empowering: Enabling individuals and communities to have more power over the personal, socioeconomic and environmental aspects of their health.
Participatory: Involving all concerned at all stages of the process.
Holistic: Fostering physical, mental, social and spiritual health.
Intersectional: Involving the collaboration of relevant agencies.
Equitable: Guided by a concern for equity and social justice.
Sustainable: Bringing about changes that individuals and organizations can maintain once initial funding has ended.
Multi-strategy: Using a variety of approaches in combination.
Healthy Ireland
Healthy Ireland is a government-led initiative in Ireland aimed at improving the health and well-being of the Irish population.
Launched in 2013 by the Department of Health, it is a national framework designed to promote healthier lifestyles, prevent illness, and address health inequalities.
The goal is to create an environment where everyone can enjoy a healthy life, regardless of age, social status, or background.
This is a government-led initiative aimed at improving public health across all age groups in Ireland. It encourages people to take small, positive steps towards healthier living, including better nutrition.
Key Objectives
Encourage healthier choices in terms of diet, physical activity, and mental well-being.
Tackle lifestyle-related diseases like obesity, heart disease, diabetes, and mental health issues.
Key Focus Areas
Healthy Eating:
Promotes awareness of a balanced diet and reducing the intake of unhealthy foods. The campaign encourages people to consume more fruits, vegetables, and whole grains while reducing sugar, salt, and fat.
Provides guidelines like the updated Food Pyramid, which reflects current dietary recommendations.
Physical Activity:
Encourages people of all ages to engage in regular physical activity. The "Get Ireland Active" sub-campaign promotes walking, cycling, and community sports to increase participation in physical exercise.
Expanding facilities for exercise and sports in communities.
Mental Health:
Raising awareness around mental health and emotional well-being.
Encouraging open conversations about mental health and breaking the stigma.
Tobacco Control:
Reducing smoking rates by providing cessation support and promoting smoke-free environments.
Running campaigns to highlight the harmful effects of tobacco use.
Encouraging smoke-free homes and workplaces.
Alcohol Moderation:
Promoting responsible drinking and raising awareness about the risks of alcohol abuse.
Supporting programs to reduce harmful alcohol consumption.
Healthy Communities:
Encouraging local communities to make health-promoting changes to their environment.
Key Strategies
Public Awareness Campaigns: Mass media campaigns, including TV ads, social media, and posters, spread information about healthy eating, mental health, and physical activity.
Partnerships: Healthy Ireland collaborates with schools, workplaces, and community organizations to reach diverse populations. For example, schools participate in the Healthy Ireland Smart Start program to promote early health education.
Healthy Ireland is an excellent example of a comprehensive, multi-faceted health promotion campaign in Ireland that targets the prevention of chronic diseases and promotes healthier living across all age groups.
START Campaign
Another example of a preventative nutrition campaign in Ireland is the "START" campaign, a collaborative initiative between Safefood, the Health Service Executive (HSE), and Healthy Ireland.
The Safefood START Campaign is a public health initiative in Ireland designed to help parents and families make healthier lifestyle choices, specifically focusing on nutrition and physical activity to prevent childhood obesity.
Key Goals of the START Campaign
Prevent Childhood Obesity: The primary goal is to address the rising levels of childhood obesity in Ireland by encouraging parents to adopt healthier dietary and lifestyle habits for their children.
Empower Families: The campaign aims to provide practical, achievable advice for parents, helping them take small, sustainable steps towards healthier eating and increased physical activity.
Main Messages
“One daily win is a good start”: The campaign promotes the idea that making small, manageable changes—like adding more vegetables to a meal or replacing sugary drinks with water—can lead to significant health improvements over time.
Positive Lifestyle Changes: Encourages simple steps, such as reducing screen time during meals, preparing home-cooked meals, and engaging in physical activity as a family.
Reducing Sugary Foods and Drinks: Key message is to reduce or replace sugary snacks with healthier options like fruit, yogurt, or wholegrain foods.
What does START encourage parents to do?
The START campaign looks at seven ways that can help maintain a healthy weight for our children:
Eat fewer treat foods
Drink water and milk as regular drinks
Give the right portion size for children
Eat more fruit or vegetables.
Be more physically active
Limit screen-time
Increase sleep-time
Key Strategies
Media Campaigns: The campaign uses television, radio, and social media to reach parents with relatable scenarios and practical tips. These ads typically feature families making small but meaningful changes to their daily habits.
Online Resources: The START campaign website provides a wealth of resources for parents, including:
Healthy meal planners and recipes.
Tips on reducing sugar, portion control, and increasing physical activity.
Guidance on building healthy eating habits for children.
Community Involvement: The campaign partners with schools, healthcare providers, and community groups to spread its message and provide support for families in making healthier choices.
The START campaign is an example of a targeted, preventive nutrition initiative in Ireland aimed at addressing childhood obesity by promoting small, sustainable dietary changes within families.
Folic Acid Awareness Campaign
The Folic Acid Awareness Campaign, driven by the HSE, promotes the importance of taking folic acid supplements, particularly for women of childbearing age.
Key factors for a successful campaign
Clear Objectives and Goals
A successful campaign starts with well-defined, measurable objectives.
The goals should be specific, achievable, and time-bound to ensure they guide the campaign's focus and help evaluate its success.
Target Audience Identification
Understanding the target audience is critical to tailor messages and interventions effectively.
Evidence-Based Approach
Successful campaigns are built on scientific evidence and best practices. Using research and data ensures that the campaign focuses on the most critical health issues and uses proven interventions
Effective Communication and Messaging
Clear, consistent, and culturally relevant messaging is vital to any health campaign
Channels of communication (such as social media, TV, radio, print, or face-to-face interaction) should be chosen based on the preferences and habits of the target group.
Multimedia Strategies
Utilizing multiple communication platforms helps to reach a broader audience.
Partnerships and Collaboration
Successful public health campaigns often involve collaborations between different stakeholders, including:
Government agencies.
Non-governmental organizations (NGOs).
Healthcare providers.
Community Engagement and Participation
Community-based activities such as, workshops, and support groups also promote active participation.
Monitoring and Evaluation
Ongoing monitoring ensures that the campaign stays on track and can be adjusted if needed. Evaluation at the end of the campaign allows for an understanding of the campaign's effectiveness and provides insights for future initiatives.
Importance of Evaluating Health Promotion
Evaluation is a critical component of health promotion as it ensures that initiatives are effective, efficient, and impactful.
Without proper evaluation, resources may be wasted on strategies that do not work, and opportunities for improvement may be missed.
Evaluating Health Promotion campaigns
Measures Effectiveness – Ensures that programs achieve their goals, such as reducing smoking rates or improving physical activity.
Accountability & Funding – Justifies the use of public funds and ensures resources are allocated effectively.
Identifies Areas for Improvement – Helps refine strategies and adapt programs to better serve populations.
Demonstrates Long-Term Impact – Tracks changes in health outcomes over time and supports evidence-based policymaking.
How to evaluate Health Promotion Campaigns
Define Objectives & Goals
Identify the campaign’s aims (e.g., increase awareness, change behavior, improve health outcomes).
Use SMART goals (Specific, Measurable, Achievable, Relevant, Time-bound).
Identify Key Performance Indicators (KPIs)
Reach: How many people engaged with the campaign (e.g., website visits, social media shares)?
Engagement: How actively people participated (e.g., event attendance, comments, survey responses)?
Behavior Change: Did the target audience adopt healthier behaviors (e.g., increased exercise, smoking cessation)?
Health Outcomes: Long-term impact on health indicators (e.g., reduced disease rates, improved nutrition).
Choose Evaluation Methods
Quantitative Methods:
Surveys & questionnaires (pre/post-campaign)
Website and social media analytics
Health data analysis (hospital records, public health stats)
Qualitative Methods:
Focus groups & interviews
Compare Data & Analyze Results
Compare pre- and post-campaign data to measure changes.
Identify Successes & Challenges
What worked well? (E.g., high engagement in social media campaigns)
What needs improvement? (E.g., low participation in in-person events)
Make Recommendations for Future Campaigns
Adjust strategies based on findings (e.g., focus more on digital outreach).
Improve messaging, delivery channels, or partnerships.
Health Inequalities
Health inequities are systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies (WHO, 2017).
The determinants of health are the conditions and factors that have a positive or negative influence on the health of an individual.
Socio-economic status
Gender
Occupation
Economic conditions
Individual lifestyle choices
Education
Geographical location
Ethnic grouping
Some of these factors are under the control of the individual while others are structural and some are unchangeable.
Health inequalities are differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age.
Health inequalities are unfair and could be reduced by the right mix of government policies.
Every day 16000 children die before their 5th birthday. They die of pneumonia, malaria, diarrhoea and other diseases. They are 14 times more likely to die in sub- Saharan Africa than the rest of the world.
Developing countries account for 99% of the annual world deaths in the world. A woman in chad has a maternal death risk of 1 in 16, while a women in Sweden has a risk of less than 1 in 10,000
Health Inequalities Ireland
Health and wellbeing are not evenly distributed across Irish society.
Health inequalities exist when a subgroup of the population suffers a disproportionate burden of ill health and premature death compared to the community as a whole.
Many of the risk factors for chronic disease, such as smoking and obesity, are more common in lower socio-economic groups or among people living in more deprived areas.
The 2018 Healthy Ireland survey highlights how those in more deprived areas:
are less likely to rate their health as good or very good,
are more likely to have a long-term health problem; and
are more likely to smoke and binge drink
Lower socio-economic groups
Almost one in ten (9%) of 3 year olds in lower socio-economic groups are obese compared with one in twenty (5%) in higher socio-economic groups.
Almost four in ten (37%) of 13 year olds in the lowest socio-economic groups never participated in organised sports compared with less than two in ten (17%) in the highest socio-economic groups.
Body mass index (BMI), cholesterol and blood pressure levels are persistently higher among lower socio-economic groups.
Poorer individuals and those with lower levels of education have the highest levels of obesity
Geographic Health Inequalities
Rural areas have fewer healthcare facilities, leading to longer travel times and limited access to specialist care compared to urban areas.
Differences in air quality and environmental conditions also impact health outcomes.
Refugees
A refugee is someone who has been forced to flee conflict or persecution and has crossed an international border to seek safety.
Minority ethnic groups often face barriers to healthcare due to language differences and discrimination.
Direct Provision (DP) in Ireland
Established in 2000 by the State to provide accommodation and basic needs to people seeking international protection.
DP centres are comprised of hostels, hotels, and other accommodation rented by the Government from private providers.
Originally designed as a short-term solution, but people often stay for longer periods while waiting for asylum application outcomes.
Key Issues
Length of time: The average length of stay in Direct Provision is 24 months, with some residents having spent up to 10 or 12 years living in these conditions.
Privacy & overcrowded living conditions: Residents live in shared accommodation, with single adults sharing rooms with up to eight people of different backgrounds and nationalities.
Food: Three meals are provided at set times each day; limited cooking facilities are available in a small number of centres. Complaints have been made regarding lack of variety and lack of nutritional options in the centres.
Health: Physical and mental health issues among residents are very common. Asylum seekers are 5 times more likely to experience mental health issues and psychiatric conditions.
Children: 30% of Direct Provision residents are children. Children have been born and raised living in these conditions, the long-term developmental effects of which are still unknown.
Homelessness
sleep deprivation due to situation
severe material deprivation, psychological distress, insecurity and low self-esteem (DoHC 2001).
burden of coping and managing on a restricted budget is extremely difficult (Stitt et al. 1994).
inadequate diets and poorer nutritional status than housed populations
rely heavily on shelters, day centres, and soup kitchens as their main food source.
Rubbish bins are the chief source of food for some street homeless people (Crane and Warnes 2000).
Limited Access to Affordable and Healthy Food
Cost of Food
Homeless individuals often have limited financial resources, making it difficult to afford nutritious food.
Lack of Cooking and Storage Facilities
Irregular Meal Patterns
Nutrient Deficiency: Irregular meals, combined with a lack of nutritious food, can contribute to nutrient deficiencies, particularly in iron, calcium, vitamin D, and protein, which are critical for overall health.
Diet-Related Health Issues
Impact on Immunity and Healing
Children and Family Nutrition Challenges
children have higher nutritional needs for growth and development
Traveller Community Inequalities
life expectancy 15 years lower than the general population.
Lower levels of health literacy and lack of permanent addresses can make it difficult to access health services.
Many Travellers face discrimination and barriers in healthcare settings.
suicide rate men is 6-7 times higher
Conclusion
Health promotion is crucial in tackling health inequalities. By focusing on the root causes of health inequities and promoting equal access to health resources, public health efforts can help bridge the gap between different population groups.