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Health Promotion

Prof. Sulaiman Al-ShammariDepartment of Family & Community

Medicine , College of Medicine King Saud University , Riyadh, Saudi Arabia

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What is Health Promotion1?

• Concept was first introduced in USA 1979

• Has evolved to include the educational, organizational, procedural, environmental, social, and financial supports that help individuals and groups reduce negative health behaviors and promote positive change among various population groups in a variety of settings

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What Is Health Promotion2?

• Health promotion programs are designed to help people who are healthy, but engaging in– risky behaviors (i.e., smoking, drinking, risky

sexual behaviors)– or actions that increase their susceptibility to

negative health consequences (i.e., physical inactivity, unhealthy diets)

• to change their behaviors

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Behavior Change– Is It An Easy Task?

• Can we expect people to adopt a healthy lifestyle after they have been exposed to a health promotion program?

• Can we force people to participate in sport and physical activities because we believe they are good for their health and soul?

• No … Getting people to engage in health behavior change is a complex process that is very difficult even under the best of conditions..

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Effective Health Promotion1

• Does saying, “Just do it!” work?• No … Health promotion is not simply an

information campaign or just providing opportunities.– Information campaign is the easiest and most

common form of program, yet least effective– “Just do it!” sounds ‘good’, but doesn’t work.

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Effective Health Promotion2

• Effective health promotion programs– help people:

• modify behaviors, increase skills, change attitudes, increase knowledge, influence values, and improve health decision making

• maintain healthy lifestyles– provide:

• educational, organizational, environmental, financial, and social support

– e.g., worksite smoke cessation program

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Need for Health Promotion1

• Physical Inactivity is a Global Problem– In developed countries:

• Industrialization, modern technologies, automation, and a global food market have taken away the need and opportunity for physical exertion

– In developing countries:• Over crowding, poverty, crime, traffic, low air quality, plus

lack of parks, sports and recreation facilities, and sidewalks make physical activity a difficult choice

– Result: 60% ~ 85% global population fails to achieve 30 minute moderate intense physical activity daily

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Need for Health Promotion2

• Physical movement and activity are essential for the human organism to grow, develop, and maintain health.

• Consequences of physical inactivity

– increased levels of obesity, diabetes, cardiovascular disease (the leading cause of death in most countries)

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Need for Health Promotion4

• Physical inactivity:– second greatest threat to U.S. public health– a major public health problem affecting huge

numbers of people in all regions of the world• Effective health promotion programs are urgently

needed to promote physical activity and improve public health around the world.

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Physical activity

• A sedentary lifestyle increases the risk of• overall mortality (2 to 3-fold)• cardiovascular disease (3 to 5-fold)

• The effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, and even smoking.

Sources: Wei et al., JAMA 1999; Blair et al., JAMA 1996

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Need for Health Promotion3

• Chronic diseases associated with unhealthy behaviors, such as unhealthy diets, caloric excess, inactivity, and obesity are the greatest public health problems in most countries of the world– The increasing incidence of chronic diseases

• causing ~60% of the 56.5 million reported deaths globally

• contributing ~46% to the spread of disease worldwide

• These estimates are expected to rise to 73% and 60%, respectively, by 2020

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Deaths by broad cause group

Cardiovascular disease – heart disease, stroke

CancerChronic respiratory diseasesDiabetes

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60% of all deaths are due to chronic diseases

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What Has Been Done3?

• In the past three decades:– widespread interest in good health, wellness, and

health behaviors,– recognized for its potential to improve quality of

lives,longevity & adaptation healthy lifestyle, – programs to promote good health among general

population.

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What Has Been Done1?

• WHO Annual Global Move for Health initiative– to promote healthy diets and physical activity

among the world population, both male and female, of all ages and conditions including disabilities worldwide.

• WHO Global Strategy on Diet, Physical Activity and Health

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What Has Been Done2?

• In the United States, physical activity, overweight and obesity:– are the top two leading health indicators listed in the

government document, Healthy People 2010 - the U.S. National Goals and Objectives in Health Promotion and Disease Prevention

– are two of the six priority health behaviors used by the U.S. Centers for Disease Control and Prevention to monitor the population risk behaviors in the U.S.

– will lower life expectancy by 5 years unless obesity rate is reduced significantly by 2010.

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How Effective Have We Been1?

• Still increase in prevalence of obesity and overweight

• Obesity and overweight declared an epidemic in U.S.

• Adult onset diabetes now affecting more school age children

• CVD ,leading cause of death in developed and will be in the developing countries

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Overweight

Increasing weight associated with: risk of overall mortality (up to 2.5-fold in the

30-44 age group, less at older ages) risk of cardiovascular mortality (up to 4-fold

in the 30-44 age group, less at older ages) risk of diabetes (up to 5-fold) risk of hypertension risk of some cancers risk of gall bladder disease

Source: Willett et al., New Eng J Med, 1999

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Why Aren’t We Effective?

• Programs not based on sound health behavior theories or outcomes assessment

• The program planners may:– not have the necessary knowledge of health

promotion program planning, implementation, evaluation, and

– lack adequate training in health behavior theories.• Having good intentions and the knowledge in exercise

and sports are not enough.

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What Can Sport Do to Promote Health1

• Competitive sports events inspire and motivate people to participate.

• Non-competitive sports activities provide opportunities for mass participation and involvement.

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What can Sport do to Promote Health2?

• Participation help people become more physically active and develop healthier lifestyle habits, thus reduce :

– obesity, BP ,cholesterol– burden illness and premature death.

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What Can Sport Do to Promote Health3?

– build social bonds and social support,– reduce feelings of depression and anxiety,– promote psychological well-being, and – prevent risky behaviors, especially among

children and young people• tobacco, alcohol or other substance abuse• unhealthy diet or violence

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What Can Sport Do to Promote Health5?

– Detailed sport plans provide procedural support for behavioral change.

– Incentives eg discounted,free gym, reduced insurance premiums for regular exercise and healthy body weight = provide financial support for behavioral change.

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What Can Sport Do to Promote Health6?

– Building fields, sidewalks, bike lanes, and organize events = environmental support for behavioral change.

– Participating in sport, instill the value of sport in all aspect of our lives, and involve families, friends, and coworkers = social support for behavioral change.

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Plan Sport-Related Health Promotion Programs1

• Practitioners and scholars in sport field:– are experts in theories and skills of sports,– have a desire to help people live a healthier

life, and– already possess the basic program planning

and implementation skills.

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Plan Sport-Related Health Promotion Programs2

• Procedures that are similar to health promotion programming:– identifying a planning committee,– obtain support of decision makers,– develop goals and objectives,– design or select health intervention activities,– identify and allocate resources,– market the program, and– implement the program.

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Plan Sport-Related Health Promotion Programs5

– Health promotions:• conduct various forms of evaluations

throughout the implementation phase to ensure that the program is carried out as planned.

–Process evaluation - to control, assure, or improve the quality of program activities

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Plan Sport-Related Health Promotion Programs6

–Impact evaluation - to judge the immediate impact of the program:

»awareness of consequences of physical inactivity,

»knowledge of benefits of healthy body weight,

»attitudes toward exercise,»skills of certain sports, and»behaviors of healthy diet.

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Plan Sport-Related Health Promotion Programs7

–Outcome evaluation - to assess the ultimate goal of the program is achieved:

»improved BMI,»reduced CVD, »reduced deaths due to chronic disease.

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How Do We Change Culture?

• In some culture, “plump” used to be a sign of health and wealth.

• In the Middle East, “round” is seen as successful.

• Some Africans view “heavy” women as a sign of having rich husbands?

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WHO Global Strategy on Diet, Physical WHO Global Strategy on Diet, Physical Activity and Health (Activity and Health (DPAS) Goal

"Promote and protect health by guiding the development of an enabling environment for sustainable actions at individual, community, national and global levels, that, when taken together, will lead to reduced disease and death rates related to unhealthy diets and physical inactivity"

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Objectives of DPAS

• Reduce risk factors through essential public action actions, health-promoting and disease prevention measures

• Increase awareness and understanding of importance of diet and physical activity and health

• Develop, strengthen, implement global, regional, national policies, plans etc to improve diets, physical activity

• Monitor science and promote research

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Foundations of WHO Global Strategy on Diet, Physical Activity and Health

• Prevention of chronic, noncommunicable diseases (NCDs)

• Multisectoral action

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1.Integrated healthy lifestyle guide on healthy diet, PA and tobacco

2.Directed at the public in general

3.Transmitted by the health and education sectors

Activities in CHILE

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Activities in Spain

Spanish Strategy for Nutrition, Physical Activity and the Prevention of Obesity (NAOS)

• AIM:– To improve the diet and encourage the regular practice of physical activity by all citizens, with special emphasis on children

• Produced by:– Spanish Ministry of Health and Consumer Affairs (General Directorate of Public Health)– Coordinated by the Spanish Food Safety Agency

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Activities in Sweden

The Action Plan for Healthy Dietary Habits and Increased Physical activity

• Aim: – To introduce measures to improve the prerequisites for healthy

dietary habits and physical activity in order to contribute to the overall public health aim

– To create societal conditions which ensure good health on equal terms for the entire population

• Produced by: – The Swedish Government commissioned the National Food

Administration and the National Institute of Public Health to develop the national action plan.

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Germany – Platform for Diet and Physical Activity

• Partnership with public and private sector, NGO's, …

• Focus obesity prevention in preschool children

• Funding projects

• Use of the logo by initiatives that follow the established requisites

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ISSUES AND CHALLENGES:

The Global Evidence Debate in Health Promotion

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Issues in urbanization: major public health concern of an urbanizing world

• Population

• Pollution

• Degradation (environment)

• Migration

• Destruction

• Desertification

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Example

• Physical activity, sprawl, pollution, built environment and health consequences

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How might sprawl affect health? air pollution• climate change contribution car crashes pedestrian injuries

physical activity• water quantity and quality heat island effect

• mental health impact social capital

Related to automobile dependency

Related to land use

Related to social

processes

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Ozone health effects

• Respiratory effects (ozone > PM): Airway inflammation Decreased air flow Increased symptoms, ER visits, medication use,

hospitalizations

• Cardiovascular effects (PM > ozone) Increased mortality

• Immune effects Increased susceptibility to infection

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Ozone health effects

Susceptible subgroups include:

• Asthmatics

• Children

• The elderly

• Those with certain underlying diseases

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Sprawl and climate change

• Forest loss (350,000 acres in metro Atlanta over 30 years)

• CO2 emissions from motor vehicles

New York Times, Nov 27 2001

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Physical Activity population density employment density

trip distances vehicle trips walking

overweight obesity

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EvidenceEvidence Evaluation

Evaluation

EffectivenessEffectiveness

The three ‘Es’The three ‘Es’

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Evidence Iceberg in Health Promotion

RCT

Companion Studies

Observational Studies

Observational Studies

Participation Designs

Fugitive Literature

Hearsay

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Evidence Iceberg in Health Promotion

Less Formal Observational Studies

Participatory Studies

Fugitive Literature

Hearsay

Less Formal Observational Studies

Participatory Studies

Fugitive Literature

Hearsay

RCTs

Comparison Studies

Observational Studies

RCTs

Comparison Studies

Observational Studies

dvmcq 2001

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Physical Activity

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Intervention Characteristics

The interventions use policy instruments such as building codes, roadway design standards, and environmental changes

• Improved lighting• Ease and safety of street crossing • Sidewalk continuity• Presence of traffic calming structures• Making aesthetic enhancements

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Transportation Policies and Practices

Transportation policies and practices that encourage and facilitate walking and bicycling for transportation

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Intervention Characteristics

• Policy measures such as roadway design standards

• Expanding public transportation services

• Subsidizing public transportation

• Providing bicycle lanes and racks

• Increasing the cost of parking

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EWG Principles for Evaluation of Health Promotion Initiatives• Participation

• Multiple methods

• Capacity-building

• Appropriateness

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Key General Recommendations

1 Develop appropriate infrastructure for the development of successful health promotion programs

2 The impressive body of evidence in health promotion best practice needs to be made available widely and systematically updated

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EWG Threefold Approach

• Marshalling the evidence – an academic book

• Showing the practice – a practitioner’s guide

• Convincing those with resources – a policy document

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Conclusions I

• Implementation well underway in most regions, credible response but inadequate

• Global and national investment well short of requirements

• National strategies developed in various countries but not universal

• Commendable actions seen in the private sector, especially food and drink

• Physical activity programmes remain weak in many countries – capacity limited

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Conclusions II

• WHO will continue to develop and disseminate suitable tools and evidence-based guidelines in various areas e.g. monitoring framework.

• Member States are encouraged to fully utilize the opportunity created by DPAS to make progress and strengthen their national capacities for action to prevent and control chronic diseases and their common risk factors.

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ACCOMMULATION OF HAZARDS

Risk behavior• Unbalanced diet• Inactivity• Obesity• Smoking

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Successful Health Promotion

• Regular Exercise• Balanced Diet• Ideal Body Weight• No Smoking

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Thank youThank you