PowerPoint Presentation
Introduction
to Public Health XXXXXXXXXX
Bernard Saliba
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health.uts.edu.au
Lecture: Introduction to Health Promotion
mailto: XXXXXXXXXX
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Session Overview
Health Promotion
• Defining Health Promotion
• History of Health Promotion
• The Alma-Ata Declaration & the Ottawa Charte
• Health & Public Education
• Levels of Prevention
• Health promotion Strategies & Settings
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DEFINING HEALTH
PROMOTION
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Health Promotion
“The process of enabling people to increase control over,
and to improve, their health.” WHO
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“Health promotion is the science and art of helping people change their lifestyle to move
toward a state of optimal health. Optimal health is defined as a balance of physical, emotional,
social, spiritual, and intellectual health. Lifestyle change can be facilitated through a
combination of efforts to enhance awareness, change behavior and create environments that
support good health practices.”
Volume 29, Issue 4 (March/April 2015)
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Health Promotion
The WHO identifies Health promotion as encompassing
• Advocacy about Health - via agents of politics, economics, socio-cultural,
environments, behaviour and psychology.
• Achieving equity in health status between populations
• Fostering coordinated action between governments, Health, Social and
Economic organisations, Non-governmental and local authorities, industry and
the media
• Reference: WHO (2009) ‘Milestones in Health Promotion: Statements from the global conferences’ P2
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Health Promotion
• Health promotion involves the population as a whole in the context of their
everyday life, rather than focusing on people at risk for specific diseases
• Health promotion is directed towards action on determinants or causes of good
or poor health outcomes
• Health promotion combines diverse, but complementary, methods or
approaches
• Health promotion aims particularly at effective and concrete public participation
• Health professionals – particularly in primary health care – have an important
ole in nurturing and enabling health promotion – but they do not control it.
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Health Promotion:
• Has its roots in Education and Social Change
• Develops strategies to
• Create Knowledge
• Encourage attitudes
• Empower beliefs and practices amongst populations
• Improves behavioural choices conducive to health
• Goes hand in hand with changing environments and improvement of
choice in enhancing and improving health
• Reference Lin V James Smith and Sally Fawkes XXXXXXXXXXPp104-105
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Responsibility for health promotion
• Health promotion is not just the responsibility of the health secto
• The responsibility is shared among individuals, community
groups/schools, health professionals, health service institutions and
governments
• They must work together to provide a system that promotes health
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Processes and Systems
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Health
⇅
Result of factors
working togethe
Health
Promotion
⇅
Addresses these
factors through
a variety of
interventions
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Health Promotion is based on Health Promotion Theory
Focuses on
• Increasing capacity of individuals, communities and organisations
• Shaping and implement agendas for action
• Promoting better population health outcomes
Health Promotion Theory applies a capacity-strengthening approach:
• E.g. Behaviour Change Theories identify ten processes of change: Consciousness raising; Counter
conditioning; Dramatic relief; Environmental re-evaluation; Helping relationships; Reinforcement management;
Self-liberation; Self re-evaluation; Social liberation; and Stimulus control
• Reference: Lin V, James Smith, Sally Fawkes XXXXXXXXXXP345
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Health promotion encompasses a range of activities
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Framework for Health Promotion
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History of health
promotion
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Phases (Era’s) of Public Health Activity
• Era of indigenous control (estimated to be in excess of 40,000 years)
• Colonial era (from White invasion until 1890’s)
• National Building era (1890 – 1940s)
• Affluence, medicine and infrastructure (1950’s to early 1970’s)
• Lifestyle era (early 1960’s to mid 1980’s)
• New Public Health Era (mid 1980’s onwards) Alma-Ata and Ottawa
What were the approaches to public health in each of these eras?
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Australian Historical Developments
• 1973 Whitlam creates Community Health Programs (CHP)
• Delivered integrated health services (such as dental, mental, social work, rehabilitation,
education etc.)
• To complement Medibank (the newly introduced universal – and then controversial – health
insurance)
• 1980s Various Public Health Associations formed or re-organised to fit within the New Public
Health model.
• The Biomedically oriented Australian and New Zealand Society for Epidemiology and
Research into Community Health (ANZERCH)
• Re-oriented itself as an integrated body – the Australian Public Health Association (APHA)
• 1983 CHP revitalised under the Medicare agreement by Hawke government.
• Health Promotion agencies set up in Victoria, SA and WA funded by tobacco taxes
Fleming M L and Elizabeth Parker XXXXXXXXXXChapter 2
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Australian Historical Developments
• 1988 Hawke Government releases ‘Health for All Australians’ report after the Ottawa Charter.
• Although philosophically adhering to Ottawa principles, they still could not escape focusing on biomedical approaches
to achieve targets.
• 1990s Liberalisation of economy by Hawke and Keating governments
• leads to cu
ent economic prosperity
• but results in reductionist approaches to healthcare.
• Election of Howard Government leads to further erosions in commitment to public health.
• Evidence Based Medicine becomes dominant in health policy
• 2000s Explosion of chronic diseases points out the failures of cu
ent biomedical-only approaches to
healthcare
• Refocuses attention of both political persuasions to the importance of an integrated approach to public health policy.
Fleming M L and Elizabeth Parker XXXXXXXXXXChapter 2
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Australian Historical Developments
What about new methods of health promotion?
• Social media
• Technology
• Health and fitness Apps
• Work-from-home / train-from-home / learn-from-home etc.
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Evolution of Community Health Promotion
• Medical approach
• Behavioural change
• Educational change
• Empowerment (client-centred)
• Social Change Approach
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What are the advantages &
disadvantages of each approach?
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Medical Approach
• Focuses on disease and mo
idity
• Targets whole population
• Uses technology
• Adoption of scientific method – epidemiology
• Expert lead
• Passive conforming client
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Behavioural Model
• Encourage individuals to adopt healthy behaviou
• Views health as property of individual
• Use of health education as vehicle
• If inappropriately applied can have “victim blaming” ideology
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Educational Approach
• Provide knowledge & information to develop skills so informed choices
can be made
• Does not explicitly set out to persuade or to motivate change
• Encourages voluntary choice
• Based on assumption that increasing knowledge will change attitude,
leading to behavioural change
• May be expert led but may also involve client in negotiation of issue for
discussion
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Empowerment
• Aims to assist people in identifying their own health concerns & to gain the
skills and confidence to act upon them
• Involves advocacy, negotiation, networking & facilitation
• Based on bottom up type of intervention
• Requires health promoter to take the role as a facilitator – acting as a
catalyst, not an instigato
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Social Change
• Address socio-economic environmental influences on health
• Encourage change in physical, social & economic environments
• Focuses on policy development, legislation, lo
ying and fiscal comforts
• Entails social regulation and is top down
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Alma Ata Declaration
&
Ottawa Charte
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Alma Ata Declaration
• Adopted at the International Conference on Primary Health Care in Almaty
(formerly Alma-Ata), Kazakhstan (formerly Kazakh Soviet Socialist Republic) on
12th September 1978
• First international declaration underlining the importance of primary health care
• The primary health care approach has since then been accepted by member
countries of WHO as the key to achieving the goal of “Health for All”
• Declaration of Alma Ata informs the “new public health”
Ref: http:
www.who.int/hp
NPH/docs/declaration_almaata.pdf
http:
www.oxfordreference.com/view/10.1093/oi/authority XXXXXXXXXX
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http:
www.who.int/hp
NPH/docs/declaration_almaata.pdf
http:
www.oxfordreference.com/view/10.1093/oi/authority XXXXXXXXXX
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Alma Ata Declaration
Defines primary healthcare and lists ten points of required urgent actions for member states and draws together
the following ideas on health:
• Global cooperation and peace as important precursors to primary health care
• Adaptation of primary health care to particular circumstances of a country and communities within it
• Recognition that health status reflects
oader social and economic development
• Primary health care seen as the backbone of a country’s health strategy
• Achievement of equity in health status
• Participation in the planning, organisation, operation and control of primary health care, supported by
appropriate education
• Involvement of all sectors in the promotion of health
health.uts.edu.au
http:
www.euro.who.int/__data/assets/pdf_file/0009/113877/E93944.pdf
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Alma Ata Declaration
“Primary Health Care is based upon practical, scientific, solid and social
acceptance of methods and technology. It is fundamentally health care that is
generally accessible to the individual and Families in the community through
their participation and with a cost that the being of the community life and the
country can determine with sustainability in the spirit of self-confidence and
self-determination. Primary Health Care systems whose main areas of
concern are formed by the community, is dependent upon the general social
and economic development of the country.”
(Diesfeld, Gesundheitversogung in Entwicklungsländer, 1996)
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Ottawa Charte
The Ottawa Charter XXXXXXXXXXargues for:
• Advocacy for health
• Enabling people to achieve their
full health potential
• Mediation between different
interests in society for the
pursuit of health.
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Ottawa Charte
Five action areas for health promotion :
1. Building healthy public policy
• Environmental protection legislation
• Progressive taxation
• Welfare
• Occupational health and safety legislation and enforcement
• Land rights
• Legislation and control of the sale and distribution of substances such as alcohol and tobacco
2. Creating supportive environments – importance of:
• Social factors
• Economic factors
• Physical factors
• Environmental factors
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Ottawa Charte
Five action areas for health promotion :
3. Strengthening community action
• Activities that increase ability of communities to achieve change in their physical and social environments through
• Collective organisation
• Taking action
4. Developing personal skills
• Enhancing life skills
• Increases level of control over own health
• Make choices conducive to health
5. Re-orienting health care services
• Towards a health system which contributes to the pursuit of health
• Respect cultural needs
• Strong attention to health research
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Health and Public
Education
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The changing role of Health Education
• Historically a strategy for public health e.g. isolation for epidemics, using soap to
prevent disease transmission in 19th Century
• In recent times – Campaigns regarding Anti smoking, Driving safety, The
enefits of Vaccination, Dental care, Appropriate Use of alcohol