Health Promotion

By. Mr. Kailash Nagar

Assistant Professor
Dept. Community Health Nursing.
 Concept
Health promotion is directed towards action on the
determinants or causes of health promotion, therefore,
requires a close co-operation of sectors beyond health
services, reflecting the diversity of conditions which
influence health.
Government at both local and national levels has a
unique responsibility to act appropriately and in a timely
way to ensure that the ‘total’ environment, which is beyond
the control of individuals and groups, is conducive to health.
Concept 8
 What is Health Promotion? 9

Today Health Promotion is

more than personal and
population education.
Defined in a number of ways
“The process of enabling
people to increase control
over and improve their
health”(WHO 1986)
Phylosophy 10
Through the
Health promotion is any involvement of
combination of health, education, home, school and
community,
economic, political, spiritual or
including: the
organisational initiative designed physical,
to bring about positive attitudinal, intellectual,
behavioural, social or emotional,
social and
environmental changes conducive
moral
to improving development
the health of populations.
Definition 11

Health promotion is the process

of enabling people to increase control over, and to
improve, their health. It is a positive concept
emphasising personal, social, political and
institutional resources, as well as physical capacities.

WHO (1990), Health Promotion Glossary

THE PROCESS OF HEALTH PROMOTION
12
FOCUS STRATEGIES IMPACT OUTCOMES

Education Quality
couselling Behavioural
of life
educational
Individuals Economic change
change

Groups Legislative Better

change Social, Health
economic and
Population environment
Policy or
organisation change
change
A FRAMEWORK FOR HEALTH PROMOTION ACTIVITI E

Health education Preventive health

programmes services(Primary,
secondary, tertiary
Economic and
regulatory
activities
AREAS OF Community-based
HEALTH work
PROMOTION
ACTIVITY

Environmental
health measures
Organisation
Healthy development
Public Policy
A FRAMEWORK FOR HEALTH PROMOTION ACTIVITIES

Housing tenure
Nutrition
CLASS Environment
Smoking Cholesterol C
GENDER Regional
Physical Blood H
AGE location pressure
activity
D
ETHNICITY Access to Psychosocial Obesity
health services factors, e.g.
stress
Access to leisure
facilities
KEY SOCIAL ENVIRONMENT LIFESTYLE PHYSIOLOGICAL
STRATIFICATION FACTORS FACTORS FACTORS
FACTORS
Main approaches to health promotio 2n6
Medical or


 preventative



Behavioral
 change
Educational
Empowerment
Social change
The medical or preventative approach 27

Aims

Reduce
 morbidity and premature mortality

Target:
 whole populations or high risk groups
Promotion of medical intervention to prevent ill-health
Behavior change approach 28

Aims
Encourages individuals to adopt healthy behaviors which

improve health Views health as a property of individuals

People
 can make real improvements to their health by choosing
to
 change lifestyle It is people’s responsibility to take action to


look after themselves
Involves a change in attitude followed by a change in behavior
The educational approach 29

Aims
To enable people to make an informed choice about
their health behavior by
 providing knowledge and information
 developing the necessary skills

Not similar the behavioral approach, it does NOT try to
persuade or motivate change in a particular direction
OUTCOME is client’s voluntary choice which may be
different from the one preferred by health promoter
 Empowerment approach 30
Aims

 Helps people identify their own concerns and gain the skills and confidence
necessary to act upon them

This is the only approach to use a ‘bottom-up’ (rather than ‘top-down’)
 approach


Empowerment may involve both self-empowerment and community

empowerment

Self-empowerment:
Based
 on counseling Uses non-directive ways
Increase person’s control over his/her own live
Social change approach 32

Aims
Radical approach which aims to change society not


individual behavior
 Aims to bring changes in the

physical, economic and social environment

Healthy choice to become the easier choice in terms of cost,
availability and accessibility Targeted towards groups and
populations
TOP-DOWN VS. BOTTOM-UP 34


Priorities set by health
promoters who have the
power and resources to
 make decisions and
impose ideas of what
should be done
Priorities are set by
people themselves
identifying issues they
perceive as relevant
 35

THE FIVE APPROACHES

EXAMPLES RELATED TO SMOKING
Based on Ewles and Simnet (1992: 36)
The medical approach 36

 AIM: Free from lung disease, heart disease and other smoking
related disorders

 ACTIVITY: Encourage people to seek early detection and treatment

of smoking related disorders
Behavioral change approach 37

 AIM: Behavior changes from smoking to not smoking

 ACTIVITY: Persuasive education to

– prevent non-smokers from starting to smoke
– persuade smokers to stop
Educational approach 38

 AIM: Clients understand effects of smoking on health and will make

a decision whether to smoke or not and act on their decision

 ACTIVITY: Giving information to clients about effects of smoking

 Helping them explore their values and attitudes and come to a
decision
 Helping them learn how to stop smoking if they want to
The empowerment approach 39

AIM: Anti-smoking issue is considered only if clients identify it as a

concern

ACTIVITY: Clients identify what, if anything, they want to know and do

about it
Social change approach 40

AIM: Make

smoking socially unacceptable so it is easier not to
smoke than to smoke

ACTIVITY
–No smoking policy in all public places
–Cigarette sales less accessible
–Promotion of non-smoking as a social norm
–Limiting and challenging tobacco advertisements and sports
sponsorships
Alma Ata Declaration, 1978 43

 On Primary Health Care: Essential health care that’s practical,

scientifically sound and social acceptable methods and
technology made UNIVERSALLY accessible and affordable to
individuals and families in the community.
 It expressed the need for urgent action by all governments, all
health and development workers, and the world community to
protect and promote the health of all the people of the world.
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
49
2. Create Supportive Environment
 A supportive environment is essential for health.
 Supportive environments cover the physical, social, economic, and political
environment.
 Supportive environments encompass where people live, work and play. This
is what is envisaged by the “settings” approach.
 Everyone has a role in creating supportive
environments for health.
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
50
3. Strengthen Community Action: Community Participation

 According to the Ottawa Charter, “health promotion works through concrete and
effective community action in setting priorities, making decisions, planning
strategies and implementing them to achieve better health”.

 There are many ways of defining community. Factors used are geography, culture
and social stratification.

 Community action is any activity undertaken by a community in order to effect

change (including voluntary and self-help services).
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
51
3. Strengthen Community Action: Community Participation

 Community participation covers a spectrum of activities

 At the low end, it may be token participation in the form of consultation or
endorsing plans drawn up by the health authorities. At the high end, it may
be in the form of „people power‟ where they have full say in identifying needs,
setting priorities, planning strategies and activities and implementing the
programme.
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
52
3. Strengthen Community Action: community Participation

 Full community participation occurs when communities participate in equal

partnership with health professionals as stakeholders in setting the health
agenda.
 Community participation is a social process whereby groups with shared
needs living in a defined geographic area actively pursue identification of their
needs, take decisions and establish mechanisms to meet these needs
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
53
3. Strengthen Community Action: Community Participation

 According to the Jakarta Declaration (1997), “health promotion improves both

the ability of individuals to take action, and the capacity of groups,
organizations or communities to influence the determinants of health”.

 Empowerment is an important strategy, based on the notion that health is

significantly affected by the extent to which one has control or power over
one‟s life.
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
54
4. Develop Personal Skills

 Strategies for empowering the community include leadership training, learning

opportunities for health, and access to resources including material and
funding
 Empowerment helps people to identify their own needs and concerns, and gain
the power, skills and confidence to act upon them. It is a bottom-up strategy
which requires the health promoter to act as a facilitator and catalyst for
change.
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
55
4. Develop Personal Skills

 Skills which can promote an individual‟s health include those pertaining to

identifying, selecting and applying healthy options in daily life.
 Health education is life-long, so that people can develop the relevant skills to
meet the health challenges of all stages of life, and to be able to cope with
chronic illness and disabilities.
 Health education should be conducted in all settings.
THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
56

5. Reorient Health Services

 Shift of emphasis from provision of curative services.

 Health care system must be equitable and client-centered.

 May necessitate reengineering and organizational change, especially in

the areas of professional education and training, management, recruitment

and deployment of health personnel, and planning, development and

delivery of services,
IMPORTANT AREAS FOR CONSIDERATION IN HEALTH57
PROMOTION
Building a Creating
healthy public supportive
policy environments

Strengthening
community
action

Developing Reorientating
personal skills health services
Adelaide Recommendations on Healthy Public Policy 58
Second International Conference on Health Promotion, Adelaide, South Australia, 5-9 April 1988

Healthy Public Policy

The Conference strongly recommends that the World Health Organization
continue the dynamic development of health promotion through the five
strategies described in the Ottawa Charter. It urges the World Health
Organization to expand this initiative throughout all its regions as an
integrated part of its work.

Support for developing countries is at the heart of this process.

Sundsvall Statement on Supportive Environments
for Health 59
Third International Conference on Health Promotion, Sundsvall,
Sweden, 9-15 June 1991

The Sundsvall Conference has again demonstrated that the issues

of health, environment and human development cannot be
separated.
Development must imply improvement in the quality of life and
health while preserving the sustainability of the environment. Only
worldwide action based on global partnership will ensure the
future of our planet

Supportive environment for Health

Jakarta Declaration on Leading Health Promotion 60
into the 21st Century
The Fourth International Conference on Health Promotion: New
Players for a New Era - Leading Health Promotion into the 21st
Century, Jakarta, Indonesia, 21-25 July 1997

The Jakarta Declaration included Five Priorities for Health Promotion in

21st Century
1. “Promote Social Responsibility for health”
2. “Increase investments for health development”
3. “Consolidate and expand partnerships for health”
4. “Increase community capacity and empower the individual”
5. “Secure an infrastructure for health promotion”
 61
The participants endorsed the formation of a Global health promotion
alliance
Priorities for the alliance include:
• Raising awareness of the changing determinants of health
• Supporting the development of collaboration and networks for health
development
• Mobilizing resources for health promotion
• Accumulating knowledge on best practice
• Enabling shared learning
• Promoting solidarity in action
• Fostering transparency and public accountability in health promotion
Mexico Ministerial Statement for the
Promotion of Health: From Ideas to Action
Fifth Global Conference on Health Promotion,
Health Promotion: Bridging the Equity Gap,
Mexico City, 5-9 June 2000

The attainment of the highest possible standard of health is a

positive asset for the enjoyment of life and necessary for social
and economic development and equity.
 8 Statements and 6 Actions where signed by 88 Countries world
wide.
 63
The ‘Bangkok Charter for Health Promotion in a
globalized world’
It has been agreed to by participants at the 6th Global
Conference on Health Promotion held in Thailand from 7-11
August, 2005

1. Make the promotion of health central to the global development agenda.

2. Make the promotion of health a core responsibility for all of government.
3. Make the promotion of health a key focus of communities and civil society.
4. Make the promotion of health a requirement for good corporate practice.
Basic Strategies for Health Promotion 64

 Advocate

 Enable

 Mediate
Advocate 65

 Good health is a major resource for social,

economic and personal development and an
important dimension of quality of life. Political,
economic, social, cultural, environmental,
behavioral and biological factors can all favor
health or be harmful to it. Health promotion
action aims at making these conditions
favorable through advocacy for health.
Enable 66

Health promotion focuses on achieving equity in health.

Health promotion action aims at reducing differences in
current health status and ensuring equal opportunities
and resources to enable all people to achieve their
fullest health potential. This includes a secure foundation
in a supportive environment, access to information, life
skills and opportunities for making healthy choices.
People cannot achieve their fullest health potential
unless they are able to take control of those things which
determine their health. This must apply equally to women
and men.
Mediate 67

 The prerequisites and prospects for health cannot be ensured by

the health sector alone. More importantly, health promotion
demands coordinated action by all concerned: by governments,
by health and other social and economic sectors, by
nongovernmental and voluntary organization, by local authorities,
by industry and by the media. People in all walks of life are involved
as individuals, families and communities. Professional and social
groups and health personnel have a major responsibility to mediate
between differing interests in society for the pursuit of health.

 Health promotion strategies and programmes should be adapted

to the local needs and possibilities of individual countries and
regions to take into account differing social, cultural and economic
systems.
6 Major Elements 68

 Better Health policy.

 Physical environment.
 Social environment.
 Community relationships.
 Personal health skills.
 Health services
Prerequisites for Health 69

The fundamental conditions and resources for health are:

 peace,

 shelter,

education,

 food,

 income,

a stable eco-system,
sustainable resources,
 social justice, and equity.
 HEALTH PROMOTION: WHERE DO WE START? 70

 From disease/conditions.
 From issues eg. Safety, environment, tobacco control.
 From lifestyles.
 From settings eg. workplace
home
schools
clinics
 SETTINGS FOR HEALTH 71

 This approach to health promotion arose from the Ottawa Charter:

“Health is created and lived by people within the settings of their

everyday life; where they learn, work, play and love”.
 WHY SETTINGS? 72

 Human health behaviour is determined by the physical and social forces which are present and interacting
in any setting.

 Involves the target population as a whole in the context of their everyday life and in their unique
environment.

 Holistic and comprehensive approach.

SETTINGS FOR HEALTH 73

 The Settings For Health approach in concerned with creating health in our different settings.

 Examples of Healthy Setting are:

 Healthy Cities
 Healthy Villages
 Healthy Islands
 Health Promoting Hospitals
 Health Promoting Schools
 CONCLUSION 74

 The concept of health promotion is positive, dynamic and

empowering which makes it rhetorically useful and politically
attractive.
 By considering the recommended principles, subject areas,
policy priorities and dilemmas it is hoped that future activities in
the health promotion field can be planned, implemented and
evaluated more successfully.
 Further development work is clearly required and this will be an
ongoing task of the WHO Regional Office for Europe.
 References 75
Online
www.who.int/topics/health_promotion

www.healthpromotionjournal.com

www.iuhpe.org
 p ed.sagepub.co
m Books
1.A Text Book of Health Education (Philosophy and Principles) by Hari Bhakta Pradhan,
Educational Resources for Health, Kathmandu, Nepal.
2.Foundations and Principles of Health Education by Nicholas Galli, University of Illinois,
Illinois
3. Education For Health A Manual.. WHO
4. Theory in a Nutshell : A practical guide to HP Theories…Don Nutbeam and Elizabeth Harris
5. HP.. Bedworth
 76

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