บทบาทของคณะแพทยศาสตร์ในการจัดการศึกษาด้าน การสร้างเสริมสุขภาพ

บทบาทของคณะแพทยศาสตร์�ในการ์จั�ดการ์ศ�กษาด�าน

การ์สร์�างเสร์�มส�ขภาพอาน�ภาพ เลขะก�ล

คณะแพทยศาสตร์� มหาวิ�ทยาล�ยสงขลา

นคร์�นทร์�

Scope of PresentationScope of Presentation

• Concept of health promotion

• Medical school and HP

Health Promotion in Medical Curriculum, PSU

Medical EducationMedical Education


Health Care System

Medical Service Medical Education

Concept of Health PromotionConcept of Health Promotion



สร้�างนำ�าซ่อมนำโยบายสร้�างเสร้�มส�ขภาพ

ใคร้ สร้�าง……ใคร้ ซ่อม……สร้�าง อยางไร้……


นำโยบายสร้�างเสร้�มส�ขภาพ

การ้สงเสร้�มส�ขภาพvs

การ้สร้�างเสร้�มส�ขภาพ


Health

Health CareOrganization

Lifestyle

Human Biology

Environment

Lalonde, 1974

PovertyFood poverty, Fuel poverty

Poor housing, Poor transportSocial isolation, Relative powerlessnessPoor access to recreation/social facilities

Physical Health EffectsLow birth weightsInfant deathsPoor growth in childrenRespiratory diseasesHeart diseaseAccidents

PsychologicalHealth EffectsStressAnxietyDepressionLow self-esteem

Behavioral changes

SmokingDrug abuseLow exercise levelsPoor diets

How How PP overty overty AA ffects ffects HHealthealth


1992(Blackburn, )

Maslow’s NeedsMaslow’s Needs

Physiological Needs

Safety Needs

Needs for Love & Care

Esteem Needs

Self Actualization

Health Promotion (WHO)Health Promotion (WHO)

• A process of enabling people to increase control over and improve their health• To reach a state of complete physical, mental, social and spiritual well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment


From disease prevention to health promotion


Levels of Disease Levels of Disease PreventionPrevention


Behavioralrisk factors• Tobacco• Alcohol• Physical inactivity• Diet

Physiologicalrisk factors• BMI (Obesity)• Blood pressure• Blood glucose• Cholesterol

Diseaseoutcomes• Heart disease• Stroke• Diabetes• Cancer• Accidents• COPD• Chronic diseases

Health Promotion (WHO)Health Promotion (WHO)

• A comprehensive social and political process • It not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environment and economic conditions so as to alleviate their impact on public and individual health


• Health is, therefore, seen as a resource of everyday life, not objective of living

• “…the health of populations will not be improved without the participation of

all groups with an interest in and an influence on health care..”


Health PromotionHealth Promotion

Three Basic Strategies Three Basic Strategies forfor

Health PromotionHealth Promotion• Advocacy Political, economic, social, cultural, environment,

behavioural and biological factors can all favour health or be harmful to it.

• Enabling To support people in communities to achieve

their full health potential and to reduce health inequalities

• Mediating To coordinate and collaborate all groups

concerned

Five Priority Actions for Health Promotion (The Ottawa Charter,

1986)

Five Priority Actions for Health Promotion (The Ottawa Charter,

1986)• Building a healthy public policy• Creating supportive environments• Developing personal skills• Strengthening community action• Reorienting health service (from tertiary to primary)


Five Priority Actions for 21st Century

Health Promotion (Jakarta Declaration,

1997)

Five Priority Actions for 21st Century

Health Promotion (Jakarta Declaration,

1997)• Promote social responsibility for health• Increase investments for health development• Expand partnerships for health promotion• Increase community capacity and empower the individual• Secure an infrastructure for health promotion


Key Issues in Health Promotion

Key Issues in Health Promotion

• Equity Being fair and just, not equality• Effectiveness and evidence-based practice• Collaborative working


Effectiveness and Effectiveness and- Evidence based Practice- Evidence based Practice

• Medical model RCT, challenged extensively in the literature• Educational model Ensure clients and patients have access to information• Behavioural model Promote behavioral changes linked to health lifestyles• Social model Modify people’s environment• Empowerment model Empowerment of individuals and communities


Collaborative Working Collaborative Working

• Identify the need for shared objectives• Innovative work• Commitment of time• Resources and energy• Regular review procedures• Importance of key players• Impact of different professional and organization culture• Impact of funding issues


Focus of Intervention Individual Collective

Mode of InterventionAuthoritative

Negotiated

Beattie’s Model of Beattie’s Model of Health Promotion Health Promotion


Focuses/Levels of Focuses/Levels of Health PromotionHealth Promotion

• An individual

• Organization level Healthy cities, villages,

islandsHealthy promoting schools,

hospitals, market placesHealthy workplaces

• Community level

Medical School and HPMedical School and HP


Medical Schools and Medical Schools and HPHP

• Health Promoting Hospital

• Health Promotion in Higher Education

• Health Promotion in Medical Curriculum

• Medical Schools and Communities






Health Promotion in Health Promotion in HospitalsHospitals

• Management Policy• Patient Assessment• Patient Information and Intervention• Promoting a Healthy Workplace• Continuity and Cooperation






Health Promotion in Health Promotion in Higher Education Higher Education

(ACHA)(ACHA)• Integration with the learning mission

of higher education• Collaborative practice• Cultural competence• Theory-based practice• Evidence-based practice• Continuing professional development

and service






Planning a Curriculum Planning a Curriculum

• Identifying the need• Establishing the learning outcomes• Analysing possible constraints (SWOT analysis) • Agreeing the content• Organising the content including the sequence• Deciding the educational strategy


Planning a Curriculum Planning a Curriculum

• Deciding the teaching methods• Preparing the assessment• Communication about the curriculum• Promoting an appropriate educational environment• Managing the curriculum


What to TeachWhat to Teach

• Cognitive (Knowledge)• Skills• Affective


Application of HP Components in Teaching


• Building a healthy public policy• Creating supportive environments Building environment in favor of staff and patient’s health• Developing personal skills Learning and skills development in communicating with patients and relatives




• Strengthening community action Empower community of decide, of their own, the right choices of their health• Reorienting health service (from tertiary to primary) Holistic approach for promotive, preventive and curative


Examples of Core ContentExamples of Core Content• Health behavior model• Determinants of health• Concept of healthy lifestyle and health promotion• Social aspect of health and diseases • Health promotion model and level : Individual, group/organization, community• Self-development and technique• Communication skills : counseling, group dynamics, social marketing


Examples of Core ContentExamples of Core Content• Health promotion : Individual level – life cycle approach

• Healthy eating• Oral health• Substance use – drug abuse, alcohol, tobacco• Physical activity and exercise• Stress reduction• Healthy sex• Healthy elderly


Examples of Core ContentExamples of Core Content• Health promotion : Organization level

• Healthy workplace• Healthy city• Health promoting hospital

• Health promotion : Community level• Health reform• People empowerment• Social movement• Civil society• Alternative medicine


• Health promotion : Community level• Health reform• People empowerment• Social movement• Civil society• Alternative medicine

HP in Preclinical teachingHP in Preclinical teaching• Topics related to health


Anatomy Musculoskeleton – Working posture Osteoarthritis

Accidents - fractureCardiovascular – Coronary heart diseaseRespiratory – Occupation lung disease Smoking, COPD



Physiology Blood pressure – HypertensionExerciseMenopause, Aging processBiochemistry Carbohydrate metabolism – DMLipid metabolism – DyslipidemiaCalcium metabolism – OsteoporosisNutrition - Obesity



Genetics Prenatal diagnosisGenetic counselingGMO

MicrobiologyAIDSHygienic controlInfection controlBiological terrorismParasitic infectionSARS, Avian flu



Pharmacology Rational use of drugsHerbal medicines

Pathology Pathogenesis of diseases

Miscellaneous Hazardous risk management in LabHealthy learning

Skills in Health PromotionSkills in Health Promotion• Social skills• Communication skills• Negotiation & empowerment skills• Research skills• Epidemiology skills• Professional (clinical) skills • Counseling skills• Education skills• …………………


How to TeachHow to Teach• Separate or integrated teaching• Issues of number of hour available, number of subjects taught• Educational strategies• Create learning environment Extra(supporting)-curricular activities• How to integrate with existing curricula• Start with students’ own lifestyle


ContentContent- based Education- based Education

Yr 1

Yr 2

Yr 3

Yr 4

Yr 5

Yr 6

Content 1

Content 2

Content 3

Content 4

.

Content nHealth Promotion in Medical Curriculum, PSU

- Outcome based Education- Outcome based Education

Yr 1

Yr 2

Yr 3

Yr 4

Yr 5

Yr 6

Competency 1

Competency 2

Competency 3

Competency 4

.

Competency nHealth Promotion in Medical Curriculum, PSU

Putting Health Promotion into the Curriculum


• Unfamiliar to medical students, as well as teachers• A hybrid/integrated discipline

Social sciences (Sociology, Social policy, psychology)

Medical sciences (Including Epidemiology, Biostatistic)• Not only function of Community Medicine• Inadequate body of knowledge/experiences




• Specialist (expert) can teach HP• Incorporate health-promotion principles in learning approaches• Use practical vignettes enables students to identify key characteristics of health promotion• Practical and concrete illustrations of the potential of health promotion


• Promote students’ healthStarts with their own needsEncourages collaborative workingDevelops their personal skillsProvide safe and secure environment in which to practise new skills and approaches




Improving HP TeachingImproving HP Teaching• Role of institution• Creating HP environment• Staff development/Role model• Multidisciplinary and multiprofessional approach• Concrete real-life experiences• Integrating HP into various clinical specialties • Research for body of knowledge



Documents

บทบาทของคณะแพทยศาสตร์ในการจัดการศึกษาด้าน การสร้างเสริมสุขภาพ