HEALTH PROMOTION

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The first International Conference on Health Promotion took place in Ottawa, Canada in 1986. The conference was a response to growing expectations for a new public health movement around the world. Out of this conference came the Ottawa Charter for Health Promotion, a framework for action to achieve 'Health For All by the Year 2000' and beyond.(Reference: Health Promotion Bush Book Northern Terirtory Governement Vol.1)

From the Ottawa Charter Health promotion is the process of enabling people to increase control over, and to improve, their health.
WHO 1986 Health promotion makes a difference
Research and case studies from around the world provide convincing evidence that health promotion works. Health promotion strategies can develop and change lifestyles, and the social, economic and environmental conditions which determine health. Health promotion is a practical approach to achieving greater equity in health.
WHO 1997:3





The Ottawa Charter identifies three approaches for health promotion. These are:
  • advocacy for health to create the essential conditions for health
  • enabling people to take control of the determinants of health in order to achieve their fullest potential
  • mediating between different interests in society in the pursuit of health (WHO 1986)

The Charter outlines five areas for health promotion action under the new public health:
  • build healthy public policy
  • create supportive environments
  • strengthen community action
  • develop personal skills
  • reorient health services

The five action areas for health promotion

In the following section, there is an explanation of each of the five action areas taken directly from the Ottawa Charter (1986). Following each statement, there are some examples of what community health teams can do, and are doing, to improve health within each of the action areas.

Build healthy public policy

"Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health."
Community health teams can:
  • assist the community to develop a community policy on alcohol availability
  • support the formation of a local store committee and development of a healthy food policy
  • observe whether the law that prohibits the selling of tobacco products to youth under 18 years of age is being followed and report to the council and local police if not

Create supportive environments

"Our societies are complex and interrelated. Health cannot be separated from other goals… the overall guiding principle for the world, nations, regions and communities alike is the need to encourage reciprocal maintenance - to take care of each other, our communities and our natural environment…".
Community health teams can:
  • support activities that enable Aboriginal people to maintain their links to the land
  • organise for improved occupational health and safety standards in the workplace and in public facilities
  • support local income generating projects such as market gardens

Strengthen community action

"Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. At the heart of this process is the empowerment of communities, their ownership and control of their own endeavours and destinies.
Community development draws on existing human and material resources in the community to enhance self-help and social support, and to develop flexible systems for strengthening public participation and direction of health matters. This requires full and continuous access to information, learning opportunities for health, as well as funding support."
Community health teams can:
  • provide statistics to support the community's submission for alcohol reform to the NT Liquor Commission
  • work with the women's centre to budget, plan, purchase and cook meals for school children and old people
  • support the development of an action plan and funding submission for a dust suppression project

Develop personal skills

"Health promotion supports personal and social development through providing information, education for health and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health. Enabling people to learn throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential…".
Community health teams can:
  • support health team members to attend relevant professional development activities such as Aboriginal Cultural Awareness Program (ACAP) and public health skills training
  • encourage responsible self-care by teaching mothers and carers to use the scales and Road To Health Chart, to enable them to monitor their babies' growth
  • conduct store tours to educate people about healthy foods, thereby enabling them to make healthier food choices

Reorient health services

"The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services. Health services need to embrace an expanded mandate which is sensitive and respects cultural needs. This mandate should support the needs of individuals and communities for a healthier life, and open channels between the health sector and broader social, political, economic and physical environmental components.
Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organisation of health services, which refocuses on the total needs of the individual as a whole person."
Community health teams can:
  • base work plans on the Aboriginal Public Health Strategy and the Aboriginal Employment and Career Development Strategy
  • offer a service where there is more balance between health promotion and treatment services
  • include brief intervention processes in day to day work practices

The Jakarta Declaration on Health Promotion into the 21st Century

Participants, at the 4th International Conference on Health Promotion held in Jakarta in July 1997, confirmed the Ottawa Charter approaches and action areas.

To take Health Promotion into the 21st Century and meet the new challenges, the conference participants prioritised five 'new forms of action':
  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

The health promoting way of working

There are a number of things that community health teams, support workers and public health staff can do to support a community and enable community action. These include:
  • identify community priorities
  • support local initiatives that make community residents more able to control and improve their situation
  • find out what people know and what they think is important
  • share information
  • assist with skills development
  • assist with research and information collection
  • help to plan community action
  • provide or help to locate resources if needed

Health promotion strategies include a whole range of possibilities - from an individually focused brief intervention through to the development of a national health promoting policy. Strategies are "the method or range of methods you are going to use in the program [project] to achieve the objectives; that is, how you will do it (Abbott 1990:9)."
Health promotion uses strategies focused on individuals, groups and communities to bring about behavioural and environmental changes which lead to better health. These strategies are illustrated in the following diagram.
Promotion
Promotion


Things to think about when choosing strategies

  • All strategies are potentially useful but combinations of strategies are likely to produce the best results
  • The strategy has to match the objective. The strategy selected will depend on what the project is trying to achieve and with whom
  • Some knowledge about current health issues (content) and knowledge about the best ways to approach them (process) are both important. Libraries and other health professionals are valuable resources
  • An understanding of team members' potential and limitations should be considered when choosing strategies. Additional training may be necessary
  • Strategies for lessening individual risk are important. Use them to complement strategies which lower average risk in a whole community (Egger et al 1990:113)


Precede-proceed model
If we want more evidence-based practice, we need more practice-based evidence

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The Precede-Proceed framework for planning is founded on the disciplines of epidemiology; the social, behavioral, and educational sciences; and health administration. Throughout the work with Precede and Proceed, two fundamental propositions are emphasized: (1) health and health risks are caused by multiple factors and (2) because health and health risks are determined by multiple factors, efforts to effect behavioral, environmental, and social change must be multidimensional or multisectoral, and participatory

http://www.courseweb.uottawa.ca/epi6181/images/PRECEDE.pdf
http://www.courseweb.uottawa.ca/epi6181/course_outline/Behaviour2.htm
http://www.lgreen.net/precede.htm



Reference:

Health Promotion Bush Book Northern Terirtory Governement Vol.1
http://www.nt.gov.au/health/healthdev/health_promotion/bushbook/volume1/promotion.html
Health Promotion strategies and Best Practice
http://www.bestpractices-healthpromotion.com/page3.php
Blog Michael Goodstadt Drupal on Intervention
http://interventionmapping.com/index.php?q=node/43

Literature/ Resource Material





Australia and types of Health Promotion Planning



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Illustration: 2002; Victorian Department of Human Services, 1999, Building Capacity for Effective Health Promotion Action,
Available online

ACT Community Care, Health Promotion Planning, 2002

Produced by the former Community Health Promotion section of ACT Community Care (now ACT Health), the Health Promotion Puzzle Solver booklet and related planning forms were used as tools to conduct best practice needs assessment, program and activity planning, budgeting and evaluation.

Ref:
Health Promotion Puzzle Solver (PDF File - 360k) ACT Community Care Health Promotion Planning Forms (PDF File - 302k)
Overview Health promotion uses a range of strategies focused on individuals, groups and communities to bring about changes in behaviour and environments that improve health. It is recognised that effective health promotion initiatives generally use a combination of strategies.

Strategy examples

  • Capacity Building
  • Community development
  • Economic, regulatory and policy initiatives
  • Health education, counselling and skills development
  • Health information
  • Screening, individual risk assessment and immunisation
  • Social marketing

Ottawa Charter strategies

The Ottawa Charter also identifies strategies for health promotion in its 5 key action areas. They are:
  • Build Healthy Public Policy
  • Create Supportive Environments
  • Strengthen Community Actions
  • Develop Personal Skills
  • Reorient Health Services

Strategy examples:

Capacity building

Capacity building is "The development of sustainable skills, organisational structures, resources and commitment to health improvement in health and other sectors, to prolong and multiply health gains many times over". (P Hawe et al, 1999). The five key elements of capacity building are:
  • Organisational development
  • Workforce development
  • Resource allocation
  • Partnerships
  • Leadership
For more information and resources on capacity building, visit the NSW Health capacity building website, or search the web links directory.

Community development

Community development is a range of activities dedicated to increasing the strength and effectiveness of communities, improving local conditions (especially for people in disadvantaged situations) and enabling people to participate in public decision-making and to achieve greater long-term control over their circumstances.
Community development aims to:

  • empower and facilitate communities to improve their social and physical environments
  • address disadvantage and overcome social exclusion
  • link empowerment with building civil society and social capital
  • involve communities in decision-making and problem solving processes in order to influence their local conditions
  • target structural change of the environment rather than the individual
  • improve equity and social justice in health
More information about community development can be found in the web links directory.

Economic, regulatory and policy initiatives

Economic, regulatory and policy initiatives involve putting in place incentives and/or disincentives to encourage either individuals, groups or organisations to adopt healthier practices or make healthier choices.
Examples include restrictions on the sale of alcohol, food safety requirements and restrictions on tobacco advertising.

Health information

Health information aims to improve knowledge and understanding about the causes of health and illness and to give health advice and support to help people manage their own health. Improving people's ability to access health information will increase their capacity to make informed choices about their health-related behaviours. Empowering individuals and groups through knowledge is an important health promotion objective.

Health education, counselling and skills development

Health education is not only concerned with the communication of information, but also with fostering the motivation, skills and confidence (self-efficacy) necessary to take action to improve health. Health education includes the communication of information concerning the underlying social, economic and environmental conditions impacting on health, as well as individual risk factors and risk behaviours and use of the health system. Health education, counselling and skills development includes providing education and skills development to individuals (e.g. through clinical consultations) as well as groups. Education may be offered pro-actively as part of a planned program, opportunistically, or reactively in response to client requests. This action can also include training in prevention and health promotion for professional groups and educators.

Screening, individual risk assessment and immunisation

Screening and individual risk assessment refers to testing people considered to be at high risk of developing a health problem even through the symptoms aren't yet evident. Risk assessment of heart, stroke and vascular disease is generally undertaken by evaluating all risk factors, often by general practitioners or allied health professionals. Appropriate follow-up includes personal counselling and monitoring for individuals to adopt healthy lifestyles, with supportive management by health professionals where necessary.
Screening and individual risk assessment aims to influence how people think and behave by using social marketing techniques and skill development.

Social marketing

Social marketing is a technique which aims to raise public awareness and provide advice on health issues. By providing information through channels such as literature, pamphlets, advertising and other media, it aims to trigger changes in behaviour that will lead to improvements in the health of society. This type of awareness raising also provides communities with a medium to drive change at a local, state and national level.
Social marketing aims to:

  • influence how people think and behave by using marketing techniques
  • put the media to better use in effecting policy (referred to as 'media advocacy' by Professor Simon Chapman, Dept of Public Health & Community Medicine, University of Sydney)
The following are some of the processes that can be used in developing a campaign:

  • define the target audience
  • develop the concepts for the intervention
  • develop and test a message based on the concepts
  • identify potential mechanisms or channels for communication
  • develop marketing objectives and strategies
  • implement the marketing campaign
  • evaluate the process and outcomes of the campaign
Challenges for marketing health promotion messages:

  • health messages can be difficult to define
  • target audiences for health messages are those usually least interested in them
  • benefits of adopting a health message are long-term and do not demonstrate instant results
  • adopting a health message often involves people giving up something they value or enjoy
  • changing health behaviour is a complex process that requires multiple strategies
Social marketing focuses on raising public awareness. Effective health promotion programs require the use of additional strategies in conjunction with social marketing.

ACT HP Model Intervention mapping

http://www.healthpromotion.act.gov.au/c/hp?a=sp&pid=1154065265

APE model

Reference: South West Sydney Area Health Service, 2002. Introduction to Health Promotion Training manual, originally developed by Wentworth Area Health Service.
The APE model shows the links between analysis (health issue, risk factors), planning (goals, objectives, strategies) and evaluation (outcome, impact, process).

Click here for
APE model (PDF File - 7k)



References....

The Community Development Foundation, What is Community Development, [Online], Available: www.cdf.org.uk/bfora/systems/xmlviewer/default.asp?arg=DS_CDF_ABOUTART_49/_page.xsl/62 [19 Sept 2006]
Green, L., Keynote presentation at Australian HP Association Conference, Sydney, June 2002.
Hawe, P., King, L., Noort, M., Jordens, C., Lloyd L. (1999) . Indicators to help with capacity building in health promotion. NSW Health, Sydney.
Nutbeam, D. 1999, Theory in a Nutshell: A practitioner's guide to commonly used theories and models in health promotion, McGraw Hill, Australia.
South West Sydney Area Health Service, 2002. Introduction to Health Promotion Training manual, originally developed by Wentworth Area Health Service.
Victorian Department of Human Services, 1999, Building Capacity for Effective Health Promotion Action, [Online], Available: www.dhs.vic.gov.au/phd/9907059/ [Aug 20, 2002].
Wass, A. 1994, Promoting Health - The Primary Health Care Approach, W.B Saunders Publishers, Sydney.
World Health Organisation, The Jakarta Declaration on Leading Health Promotion into the 21st Century, [Online], Available: www.who.int/healthpromotion/conferences/previous/jakarta/declaration/en/index1.html [19 Sept 2006]
World Health Organisation, Ottawa Charter for Health Promotion, [Online], Available: www.euro.who.int/AboutWHO/Policy/20010827_2 [19 Sept 2006]

Health promotion

Visit University of Southern Denmark to access Master in Health Science program

Session 1 and 2:

Write a paper in group work to describe health promotion with focus on your country/ continent. Use the following questions as main topics to answer in your paper (read in detail in the module book, pag


What is health promotion?
What are the aims of health promotion in your country/ on your continent?
What kind of health promotion is used in your country/ on your continent?

Session 3:
You will work with a case scenario and are asked to complete a PowerPoint draft of the Precede model to conduct a needs assessment. Please explain your draft in the end by using either the PowerPoint option Notice or provide a separate word file (read in detail in the module book, pages 5 and 6).





https://optima.oulu.fi/learning/id4/bin/user?rand=32400

Mental Health Peter Bjerregaardd