Basic and Fundamental Principles of Health

Promotion

Prof. Elba N. Ortiz MSN FNP-BCCatedrática AuxiliarPrograma de FNP, RCM, UPR

Objectives

Recognize the health care trends and facts in the population.

Discuss basic and fundamental concepts and principles related to health promotion.

Compare theories related to the health promotion on individuals, family and community.

Health Promotion and FNP Certification Exam:

Knowledge of: 1. Health promotion concepts

Skill in: 2. Making appropriate

health promotion recommendations (considering age, developmental level, health status, current guidelines, primary, secondary, and tertiary prevention strategies)

Health Care Trends

Changes in causes of infant mortality: Infectious and nutritional problems no

infectious problem, congenital anomalies, perinatal events.

Resurgence of previously controlled infection, as TB and the emergency of newer infections as HIV

Concern on monitoring for biological agents of terrorism

Emphasis on disease prevention and health promotion

Facts

Major causes of morbidity and mortality 50% of illness related to lifestyle and unhealthy

decisions. Healthy People 2020

Preventive health services Well baby care, immunizations, birth control

Health protection activities Fluoridation, injury prevention, occupational safety

Health promotion behaviors Smoking cessation, exercise, stress reduction, diet

Visit website for Health People 2020 http://www.hhs.gov.healthypeople2020

Healthy People 2020 Vision

A society in which all people live long, healthy lives. Mission Healthy People 2020 strives to:

Identify nationwide health improvement priorities. Increase public awareness and understanding of the determinants of

health, disease, and disability and the opportunities for progress. Provide measurable objectives and goals that are applicable at the

national, State, and local levels. Engage multiple sectors to take actions to strengthen policies and

improve practices that are driven by the best available evidence and knowledge.

Identify critical research, evaluation, and data collection needs.

Overarching Goals Attain high-quality, longer lives free of preventable

disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve

the health of all groups. Create social and physical environments that promote

good health for all. Promote quality of life, healthy development, and healthy

behaviors across all life stages.

Healthy People 2020

Four foundation health measures will serve as an indicator of progress towards achieving these goals: General Health Status Health-Related Quality of Life and Well-Bein

g

Determinants of Health Disparities

Healthy People 2020

Epidemiologic Principles Natural history of disease

Stages: susceptibility (prepathological) presymptomatic disease (subclinical) clinical disease disability (or death)

Etiology of disease: defines cause of a disease Prevalence rates: describes the number of persons

in a defined group that have a disease at a certain point in time

Incidence rates – rate of development of a disease in a group over a period of time.

Human Rights Human rights are universal legal guarantees protecting

individuals and groups against actions that interfere with fundamental freedoms and human dignity. Some of the most important characteristics of human rights are that they:

guaranteed by international standards; are legally protected; focus on the dignity of the human being; oblige states and state actors; cannot be waived or taken away; are interdependent and interrelated; and are universal.

Source: The United Nations system and human rights: guidelines and information for the Resident Coordinator System, March 2000

Social determinants of health

The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system.

These circumstances are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices.

The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries.

Social determinants of health

Responding to increasing concern about these persisting and widening inequities, WHO established the Commission on Social Determinants of Health (CSDH) in 2005 to provide advice on how to reduce them.

The Commission's final report was launched in August 2008, and contained three overarching recommendations:

1. Improve daily living conditions 2. Tackle the inequitable distribution of power, money, and r

esources

3. Measure and understand the problem and assess the impact of action

Social determinants of health

Health promotion (WHO, 2011)

Health promotion is the process of enabling people to increase control over, and to improve, their health.

It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.

“Health promotion approaches do not focus on illness experiences or optimal use of medical services. In health promotion the focus usually is much broader and emphasizes healthy general living conditions and people’s chances to live healthy lives. Moreover, health promotion calls for improving the resources people need in order to be active for their health, their own personal health, the health of their families and communities, including the power to change things for the better”.

Health promotion (WHO, 2011)

Health literacy includes the skills to obtain and use appropriate knowledge about health and its determinants. Emphasizing the empowerment component in health promotion, … health literacy approaches should also address people’s knowledge and skills necessary to work on and change those factors that constitute their health chances: In health promotion practice, health literacy means to understand the conditions that determine health and to know how to change them’.

Health promotion (WHO, 2011)

Levels of Diseases

Prevention

Primary Prevention:

Stage of susceptibility

Secondary Prevention:

Stage subclinical

Tertiary Prevention:Stage clinical

Aimed at preventingdesease: exercise,

nutrition, education, Pollution control

Mammogramscreening, cholesterol

screening, smokingcessation program

Use of inhaled steroidsin the management ofasma, use of penicillin

prophylaxis in pct. sickle cell anemia

Prevention is more than education and goes beyond the individual

Spectrum of PreventionLevel of Spectrum Definition of Level

1. Strengthening Individual Knowledge and Skills

Enhancing an individual's capability of preventing injury or illness and promoting safety

2. Promoting Community EducationReaching groups of people with

information and resources to promote health and safety

3. Educating ProvidersInforming providers who will transmit

skills and knowledge to others

4. Fostering Coalitions and NetworksBringing together groups and individuals

for broader goals and greater impact

5. Changing Organizational Practices Adopting regulations and shaping norms

to improve health and safety

6. Influencing Policy Legislation Developing strategies to change laws

and policies to influence outcomes

A risk factor is any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury. Some examples of the more important risk factors are underweight, unsafe sex, high blood pressure, tobacco and alcohol consumption, and unsafe water, sanitation and hygiene. (WHO, 2011)

Risk Factors

Risk Factors Age, sex, social, cultural, familial,

occupational, lifestyle history represent potential sources of problem.

Modifiable / no modifiable

Risk reduction programs are established to reduce vulnerability of individuals to problems.

Communicable/Infectious Disease

Patterns in which organisms attack and invade vulnerable individuals

Reservoirs of infection Cases and carriers

Mechanisms of Transmission of infection Direct (touching, kissing, intercourse Indirect – air vector, water, food

Control Measures isolation, insect spraying (reservoirs) Water purification (interrupt transmission) Immunization (reduce susceptibility)

Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system.

Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Primary Care

The World Health Organization attributes the provision of essential primary care as an integral component of an inclusive primary health care strategy.

Primary care involves the widest scope of health care, including all ages of patients, patients of all socioeconomic and geographic origins, patients seeking to maintain optimal health, and patients with all manner of acute and chronic physical, mental and social health issues, including multiple chronic diseases.

Primary Care

Consequently, a primary care practitioner must possess a wide breadth of knowledge in many areas.

Continuity is a key characteristic of primary care, as patients usually prefer to consult the same practitioner for routine check-ups and preventive care, health education, and every time they require an initial consultation about a new health problem.

Collaboration among providers is a desirable characteristic of primary care.

Primary Care

Primary Care

Health care should be effective and safe. Professionals as well as the general public often over-rate the performance of their health services.

The emergence of evidence-based medicine in the 1980s has helped to bring the power and discipline of scientific evidence to healthcare decision-making, while still taking into consideration patient values and preferences.

Primary care brings promotion and prevention, cure and care together in a safe, effective and socially productive way at the interface between the population and the health system.

In short, what needs to be done to achieve this is “to put people first”: to give balanced consideration to health and wellbeing as well as to the values and capacities of the population and the health workers.

Features of health care: effectiveness and safety, are essential in ensuring improved health and social outcomes.

Primary Care

Primary health care, often abbreviated as “PHC”, has been defined as "essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination".

Primary health care

In other words, PHC is an approach to health beyond the traditional health care system that focuses on health equity-producing social policy.

This ideal model of health care was adopted in the declaration of the International Conference on Primary Health Care held in Alma Ata in 1978 (known as the "Alma Ata Declaration"), and became a core concept of the World Health Organization's goal of Health for all.

Primary health care

Primary health care The ultimate goal of primary health care is better

health for all. WHO has identified five key elements to achieving that goal:

reducing exclusion and social disparities in health (universal coverage reforms);

organizing health services around people's needs and expectations (service delivery reforms);

integrating health into all sectors (public policy reforms); pursuing collaborative models of policy dialogue (leadership

reforms); and increasing stakeholder participation.

Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978

The World Health Report 2008 - primary Health Care (Now More Than Ever)

Primary health care

Models of Health Promotion

Health Belief Model The Health Belief Model is a health behavior change and

psychological model developed by Irwin M. Rosenstock in 1966 for studying and promoting the uptake of health services.

The model was furthered by Becker and colleagues in the 1970s and 1980s. Subsequent amendments to the model were made as late as 1988, to accommodate evolving evidence generated within the health community about the role that knowledge and perceptions play in personal responsibility.

Originally, the model was designed to predict behavioral response to the treatment received by acutely or chronically ill patients, but in more recent years the model has been used to predict more general health behaviors.

The original model included these four constructs: Perceived susceptibility (an individual's assessment of their risk

of getting the condition) Perceived severity (an individual's assessment of the

seriousness of the condition, and its potential consequences) Perceived barriers (an individual's assessment of the influences

that facilitate or discourage adoption of the promoted behavior) Perceived benefits (an individual's assessment of the positive

consequences of adopting the behavior). A variant of the model include the perceived costs of adhering

to prescribed intervention as one of the core beliefs.

Health Belief Model: Constructs

Constructs of mediating factors were later added to connect the various types of perceptions with the predicted health behavior:

Demographic variables (such as age, gender, ethnicity, occupation) Socio-psychological variables (such as social economic status,

personality, coping strategies) Perceived efficacy (an individual's self-assessment of ability to

successfully adopt the desired behavior) Cues to action (external influences promoting the desired behavior,

may include information provided or sought, reminders by powerful others, persuasive communications, and personal experiences)

Health motivation (whether an individual is driven to stick to a given health goal)

Perceived control (a measure of level of self-efficacy) Perceived threat (whether the danger imposed by not undertaking a

certain health action recommended is great)

Health Belief Model: Constructs

The Health Belief Model.

Social Cognitive Theory

Social cognitive theory, used in psychology, education, and communication.

The theorists most commonly associated with social cognitive theory are Albert Bandura and Walter Mischel.

Social cognitive theory is a learning theory based on the ideas that people learn by watching what others do and that human thought processes are central to understanding personality.

While social cognitists agree that there is a fair amount of influence on development generated by learned behavior displayed in the environment in which one grows up, they believe that the individual person (and therefore cognition) is just as important in determining moral development.

Social Cognitive Theory

People learn by observing others, with the environment, behavior, and cognition all as the chief factors in influencing development. These three factors are not static or independent; rather, they are all reciprocal.

For example, each behavior witnessed can change a person's way of thinking (cognition). Similarly, the environment one is raised in may influence later behaviors, just as a father's mindset (also cognition) will determine the environment in which his children are raised.

Social Cognitive Theory

Health Promotion Model The health promotion model (HPM) proposed by

Nola J Pender (1982; revised, 1996) was designed to be a “complementary counterpart to models of health protection.”

It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a client’s level of well being.

The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health.

The model focuses on following three areas: · Individual characteristics and

experiences · Behavior-specific cognitions and affect · Behavioral outcomes

Health Promotion Model

The health promotion model notes that each person has unique personal characteristics and experiences that affect subsequent actions.

The set of variables for behavioral specific knowledge and affect have important motivational significance.

These variables can be modified through nursing actions.

Health Promotion Model

Health promoting behavior is the desired behavioral outcome and is the end point in the HPM.

Health promoting behaviors should result in improved health, enhanced functional ability and better quality of life at all stages of development.

The final behavioral demand is also influenced by the immediate competing demand and preferences, which can derail an intended health promoting actions.

Health Promotion Model

Health Promotion Model