Introduction to health promotion

Dr John Hubley

www.hubley.co.uk

With acknowledgements to Dennis Burkitt

World Health Report 2002

• Simple, cost effective public health measures could lengthen the average human life span by five to 10 years

• The top 10 risk factors accounting for about 40% of the 56 million deaths in the world each year are underweight in children and mothers; unsafe sex; poor water, sanitation, and hygiene; indoor smoke from solid fuels; iron deficiency; high blood pressure; tobacco; alcohol; high cholesterol; and obesity. Two other factors are important in the developing world: zinc deficiency and vitamin A deficiency.

Health Field Model

Human Biology(Genetics)

Environment

HealthServices

Life style(Human

behaviour)

healthy onset of advanced disabiltyperson symptoms symptoms death

(reversible) (not reversible )

Primary Secondary Tertiaryprevention prevention prevention

screening rehabilitation case finding early prevention

Primary prevention

Actions carried out with healthy people to maintain their health and prevent disease

Average number of cigarettes smoked per day

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Death rates from lung cancer (per 1000) by number of cigarettes smoked, British doctors, 1951-61

Secondary preventionActions to promote early interventions when someone becomes ill to promote recovery and prevent the condition from becoming worse

A calendar from Cambodia promoting the DOTS approach to TB – essential to ensure adherance to prescribed doses

To ensure effectiveness of treatment and the prevent the emergence of antibiotic resistance

Types of behaviours• Decision-based behaviours – where a person goes through a

conscious decision-making process before deciding to perform (or not to perform the behaviour)

• One-time behaviour – a behaviour that a person is expected to do only a few times in their life. (also usually a decision-based behaviour).

• Routine behaviour – something people do regularly - usually without a conscious decision (a behaviour might start as decision-based and then become a routine as it is integrated into their pattern of life)

• Addictive behaviour – when there is some physiological reinforcement of the behaviour through a biological adaptation in the person who becomes dependent on regular use of the substance.

How realistic is this message?

Do people living in overcrowded housing have any choice?

This is an example of victim blaming health education that puts all the emphasis on individual behaviour change and ignores social and economic influences on the individual

This photograph of a poster in a village in Cambodia promoting iodized salt for the prevention of goitre.

One out every 4 –5 houses had stalls selling cigarettes – but iodized salt was not on sale.

It is not enough to do health education – you have to make the health choice the easier one!

An effective response should

• Provide the information and power for the community to make decisions

• Make the healthy choice the easiest one• Remove barriers to action

Ottawa Charter for Health Promotion

Source: Canadian Public Health Association - An International Conference on Health Promotion - November 17-21 1986

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

EnableMediateAdvocate

Build Healthy PublicPolicy

StrengthenCommunityAction

DevelopPersonalSkills

Create Supportive Environments

ReorientHealth Services

Promoting health

Health Education

Communication directed at individuals, families and communities to influence:

awareness/knowledgedecision-makingbeliefs/attitudesempowermentindividual and community action/behaviour changecommunity participation

Service Improvement

improvements in quality and quantity of services:

accessibility case managementcounselling patient education outreachsocial marketing

Advocacy

agenda setting andadvocacy for healthy public policy

policies for healthincome generationremoval of obstaclesdiscriminationinequalitiesgender barriers

HESIAD Exercise

• Take a health topic

• In groups identify suitable actions that might be taken for each component of HESIAD - health education, service improvement and advocacy

Components of an intervention

Health Education

directed at individuals, families and communities

Service improvement

improvements in quality and quantity of services:

Advocacy

agenda setting andadvocacy for healthy public policy

Service Improvement• Improvement in capacity of staff – training and support• Development of new activities• Reorienting existing activities to make them more

effective/acceptable• Strengthening communication/health education within

services• Improved patient education• Outreach to schools, community, workplace• Involvement of personnel in supporting community health

promotion

Advocacy

• Influencing policy makers, leaders and media to raise profile of programmes

• Addressing legal, financial and service obstacles to health action

Equivalent terms

• Health education

• IEC (information, Education and Communication)

• Behaviour Change Communication

• Social marketing

Why is health education essential for promoting health?

• Community action to change surroundings - includes community participation in health decision-making.

• Adoption of healthy life style – e.g. diet, life style, child care, safety, stopping smoking, not taking drugs.

• Utilization of health services especially preventive services e.g. ante-natal care, immunization, family planning, screening.

• Recognition and prompt self referral on early symptoms eg for cancers, diabetes.

• Following (adhering to) prescribed medicines, completing doses.• Support for health promoting policies e.g. seat belt wearing,

traffic restrictions.

“any combination of learning opportunities designed to facilitate voluntary adaptation of

behaviour which will improve or maintain health”

Larry Green

"A process with intellectual, psychological and social dimensions relating to activities that increase the abilities of people to make informed decisions

affecting their personal family and community well-being. This process, based on scientific

principles, facilitates learning and behavioural change in both health personnel and consumers,

including children and youth

Helen Ross and Paul Mico

individualfamily

wider familycommunity

districtregion

nationalinternational

Levels for communication activities

Each level has factors which influence peoples’ actions

Each level offers opportunities for different communication methods

Critical decisions in Public Health Education

• Actions to be promoted• Target groups• Messages• Methods (settings, channels)• Delivery – timing

Some common settings for public education

Health facilitySchools

household

health facility community

school

Situation analysis

Dialogue with stakeholders literature reviewsSurveys to determine:

Baseline situationNeeds/ProblemsInfluences on problem at different levels – community, service and policy/society levelOpportunities/resources available to support intervention

Plan health promotion

Strategy: mix of advocacy, service improvement and health education

ActivitiesTargets/objectives ManagementTimingCosts

Implement health promotion

Monitor progress Evaluate impact

Feedback from monitoring/evaluation

Programme planning for health promotion