Approaches to Health Promotion

Puja Myles

Puja.myles@nottingham.ac.uk

Learning Outcomes

• To recognise the ethical and philosophical principles underpinning health promotion practice

• To categorise and describe various approaches to health promotion

• To choose an appropriate health promotion approach in different contexts

Session Outline

• The context of health promotion: individuals vs. population

• Intervention ladder and ethical underpinnings

• Approaches to health promotion

• Social Marketing and Media Advocacy

• Group exercise

The context of health promotion: individual vs.

population

Sick individual and sick populations (Rose)

• Populations as a whole may be susceptible to a particular disease

• Not all individuals belonging to a susceptible population get that disease

• Determinants of illness (or health) are different depending on the level: individual or population

Should health promotion practice focus on individual determinants of health or population determinants?

Ethical and philosophical principles underpinning health

promotion practice

Why should you concern yourselves with ethics and philosophy?

Does the choice of health promotion model and approach by an individual, organisation or government reflect particular individual and societal values?

Why is state intervention required?

• Tension between autonomy and state paternalism

• Does the state have a duty to protect its citizens and if yes, under what conditions?– The concept of ‘public goods’– Beneficence – Non-maleficence– Respect for autonomy– Justice– Equity, equality

Approaches to Health Promotion

3 main approaches

• Behavioural approaches

• Self-empowerment approaches

• Collective action or community development approaches

These are not mutually exclusive!!

Other ways of approaching Health Promotion

• Targeted versus universal approaches

• Settings approach

• Ecological or whole-systems approach

Targeted vs. Universal approaches

• Targeted (high-risk) approach: Identify individual person or group of people at high risk, offer advice & treatment

• Universal (population) approach: Lower the average level of risk in the population

Prevention Paradox

A large number of people exposed to a small risk may generate many more cases than a small number exposed to high risk.

A preventive measure that brings large benefits to the community offers little to each participating individual. 

Settings

From Ottawa Charter: • “Health is created & lived by people within

the settings of their everyday life: where they learn, work, play and love”.– Schools– Workplaces– Homes– Communities– Cities

Settings

WHO 1998 definition:

• “…identified as having physical boundaries, a range of people with defined roles and an organisational structure …”

Settings

Settings approach – Enables access to groups or individuals – Focus: whole ethos of the setting is health

promoting (holistic approach)– Integration of health promotion into the daily

activities of the setting– Example: ‘health promoting schools’ rather

than ‘health promotion in schools’– Creation of conditions for reaching out into the

community

Settings

• Who is left out?– Constrained to those within setting?

• Possible solutions:– Go for novel settings– Demands organisational change &

commitment– Balance between top-down and bottom-up

approaches

2 useful additions to your Health Promotion toolkit

Social Marketing

• Included in behaviour change approaches• The adaptation of commercial marketing

techniques to achieve specific behavioural goals for a social good.

• “A social change campaign is an organized effort conducted by one group (the change agent) which attempts to persuade others (the target adopters) to accept, modify, or abandon certain ideas, attitudes, practices or behaviour.” --Kotler, Roberto, & Lee, 2002– Consumer-oriented approach, but…– Contrast with commercial marketing: profit goal

Media Advocacy-1

• Not a health promotion approach per se but a means of getting an issue on the policy agenda

• Kingdon’s policy model:

Windows of opportunity when coupling of three streams occurs: problems, policy (technically feasible and sustainable solutions) and politics (commitment)

Media Advocacy-2

Media advocacy by ‘policy entrepreneurs (like you!!) could result in the recognition of an issue as a problem, create awareness of possible solutions and generate wide scale political commitment

Further reading-1

1. Nuffield Council on Bioethics (2007). Public Health: Ethical Issues

http://www.nuffieldbioethics.org

2. Oxford Handbook of Public Health Practice 2nd ed. (2006):

Chapter 1.7 (Pp. 64-70): Understanding ethics in Public Health (Angus Dawson)

Chapter 4.7 (Pp. 348-353): Influencing governments via media advocacy (Simaon Chapman)

Chapter 3.7 (Pp. 266-275): The public health response to ‘hard to reach’ populations

Further reading-2

3. Social Marketing- Big pocket guide (2007)

http://www.nsms.org.uk

4. Rose, G. (2001). Reiteration: Sick Individuals and sick populations. International Journal of Epidemiology; 30: 427-432

Scenario 1:HIV/AIDS

• Targeted (high-risk) or Universal (population) approach?

• Behavioural/Self-empowerment/Community Development approach?

• What are the values and assumptions underlying your choices?

Scenario 2: Obesity

• Does the state or its agents (NHS/Public Health?!) have a duty to intervene?

• Look at the intervention ladder- which rungs would you choose?

• What approaches would you use: behavioural/self-empowerment/community development?

• What values and assumptions underpin your choices?