The Need for Health Promotion. Understanding Key Terms/Concepts HEALTH: “the state of complete mental, physical and social well being not merely the absence

The Need for Health Promotion

Understanding Key Terms/Concepts

• HEALTH: “the state of complete mental, physical and social well being not merely the absence of disease or infirmity.” (WHO, 1947)– Physical: the absence of disease and disability;

functioning adequately from the perspective of physical and physiological abilities; the biological integrity of the individual

– Mental: may include emotional health; the subjective sense of well-being

– Social: the ability to interact effectively with other people and the social environment; satisfying the interpersonal relationships; role fulfillment


• COMMUNITY HEALTH: “The health status of a defined group of people and the actions and conditions to protect and improve the health of the community” (Green & McKenzie, in press)

• HEALTH EDUCATION: “any combination of planned learning experiences based on sound theories that provide individuals, groups and communities the opportunity to acquire information and the skills needed to make quality health decisions (Joint Committee, 2001)

• HEALTH PROMOTION: “any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to the health of individuals, groups, and communities (Joint Committee, 2001)

Relationship between Health Education and Health Promotion

Health Education

RegulatoryOrgani-zational

Policy Social

EconomicPolitical

HEALTH PROMOTION

HEALTH PROMOTION

Environmental

Environmental

Environmental Environmental

Environmental Environmental


• DISEASE PREVENTON: “The process of reducing risks and alleviating disease to promote, preserve, and restore health and minimize suffering and distress” (Joint Committee, 2001)

• PUBLIC HEALTH: “The sum of all official (governmental) efforts to promote, protect, and preserve the people’s health” (McKenzie et al., 1995)

• WELLNESS: “an approach to health that focuses on balancing the many aspects, or dimensions, of a person’s life through increasing the adoption of health-enhancing conditions and behaviors rather than attempting to minimize conditions of illness” (Joint Committee, 2001)


• PREVENTION: the planning for and the measures taken to forestall the onset of, a disease or other health problem before the occurrence of undesirable health events” (Cottrell et al., 2000)

– Primary prevention: – Secondary prevention: – Tertiary prevention:

Levels of PreventionHealth Status Levels of PreventionHealthy; without signs and symptoms of disease, illness, or injury

Disease, illness, or injury

Disability, impairmentor dependency

Death

Primary prevention – preventive measures that forestall the onset of illness or injury during the prepathogeneisis period

Secondary prevention – preventive measures that lead to early diagnosis and prompt treatment of a disease, illness, or an injury to limit disability, impairment, or dependency and prevent more severe pathogenesis

Tertiary prevention – preventive measures aimed at rehabilitation following significantpathogenesis

• Examples of Primary prevention:– Wearing a safety belt, using rubber gloves when there

is potential for the spread of disease, immunizing against specific diseases, exercising

• Examples of Secondary prevention:– Personal and clinical screenings and examines such

as blood pressure, cholesterol, hemocult (hidden blood) screenings; breast self-examines, testicle self-exams

• Examples of Tertiary prevention: – Educating a patient after lung cancer surgery, working

with an person who has diabetes to ensure that the daily insulin injections are taken

Levels of Prevention

WHY HEALTH PROMOTION?

• History– Public health revolution in the U.S. started in

the late nineteenth century, aimed at controlling for the harm (morbidity and mortality) that came from infectious diseases.

• By the mid-50’s infectious diseases were under control

• Reduced # children who were contracting childhood diseases, death rates, and increased life expectancy

Infectious and Chronic Disease Death Rates in the United States,

1990-2000

0100200300400500600700800900

100011001200130014001500

1900 1920 1940 1960 1980 2000

Year

Rat

e p

er 1

00,0

00 p

op

ula

tio

n

Infecitous disease

Chronic diseases

Source: Armstrong et al., (1999, JAMA)

Past and projected female and male life expectancy at birth, United States, 1900–2050.

Life Expectancy at Birth

* Death registration area only. The death registration area increased from 10 states and the District of Columbia in 1900 to the entire United States in 1933. Source: U.S. Department of Commerce, Bureau of the Census.


• Process check– By the mid-70s, the greatest potential for

reducing morbidity, saving lives, and reducing health care costs in America was to be achieved through health promotion and disease prevention

– At the core of this approach was health education.


• Major epidemic diseases, however, remain threats to public health – e.g., heart disease, cancer,

overweight/obesity, diabetes, etc.

• Costs, both direct and indirect, related to health care, such as delivery and insurance, have risen steadily


• Heart Disease – Morbidity: Number of noninstitutionalized adults with

diagnosed heart disease: 23.0 million (2002); Percent of noninstitutionalized adults with diagnosed heart disease: 11.2 (2002) (CDC, 2005)

– Mortality: Number of deaths: 696,947 (2002); Deaths per 100,000 population: 241.7 (2002); Cause of death rank: 1 (2002); % of hospital inpatient deaths from heart disease: 21.0 (2000)

WHY HEALTH PROMOTION?• Cancer

– Morbidity: % of noninstitutionalized adults who have ever been diagnosed with cancer: 7.0 (2002)

– Mortality: Number of deaths: 557,271 (2002); Deaths per 100,000 population: 193.2 (2002); Cause of death rank: 2 (2002)


• Overweight (BMI 25-29.9) and obesity (BMI of 30 or greater) – An estimated 30 percent of U.S. adults aged 20 years and older

- over 60 million people - are obese. – An estimated 65 percent of U.S. adults aged 20 years and older

are either overweight or obese (a BMI of 25 or higher).

• Health Consequences: Hypertension; Dyslipidemia (e.g., high total cholesterol or high levels of triglycerides); Type 2 diabetes; Coronary heart disease; Stroke; Gallbladder disease; Osteoarthritis; Sleep apnea and respiratory problems; Some cancers (endometrial, breast, and colon)

WHY HEALTH PROMOTION?• Economic Consequences

– Overweight and obesity and their associated health problems have substantial economic consequences for the U.S. health care system. The increasing prevalence of overweight and obesity is associated with both direct and indirect costs. Direct health care costs refer to preventive, diagnostic, and treatment services related to overweight and obesity (for example, physician visits and hospital and nursing home care). Indirect costs refer to the value of wages lost by people unable to work because of illness or disability, as well as the value of future earnings lost by premature death (The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity, 2001).

– In 1995, the total (direct and indirect) costs attributable to obesity amounted to an estimated $99 billion. In 2000, the total cost of obesity was estimated to be $117 billion ($61 billion direct and $56 billion indirect). Most of the cost associated with obesity is due to type 2 diabetes, coronary heart disease, and hypertension.

WHY HEALTH PROMOTION?• Diabetes

– Morbidity: Number of noninstitutionalized adults with diagnosed diabetes: 13.4 million (2002); % of noninstitutionalized adults with diagnosed diabetes: 6.6 (2002)

– Mortality: Number of deaths: 73,249 (2002); Deaths per 100,000 population: 25.4 (2002); Cause of death rank: 6 (2002)

The Current State of Public Health In China

• Past 50 yrs, achievements in controlling infectious diseases and improving the public’s health and hygiene

• In the 21st century, owing to the negative effects brought on by aging of the population and the burdens of diseases, urbanization, industrialization, and globalization, China is encountering greater difficulties than ever

Liming Lee, Annu. Rev. public Health 2004, 25:327-39

The Current State of Public Health In ChinaProblems:

• poor capacity to respond to public health emergencies

• Severe inequality of health care services

• lagging development of public health information systems

Needs

• build a public health information system

• interventional exchange (globalization)

• high technology

• health education and health consultation

Increasing Awareness• Although a great deal of progress has been

made in public health, there is still a need for health promotion activities to improve the health and reduce costs.

• Healthy People 2010 – 467 objectives in 28 focus areas, making this

blueprint an encyclopedic compilation of health improvement opportunities for the next decade.

– 2 Goals, reflecting the Nation’s changing demographics

• Goal 1: Increase Quality and Years of Healthy Life • Goal 2: Eliminate Health Disparities

Note: http://www.healthypeople.gov/Publications/

Increasing Awareness

• Healthy People 2010

• Proposing a multiple level approach to reduce health risks and increase chances for good health

• Setting a set of health goals and objectives for the nation

• emphasizing the merit of developing and implementing strong, results-oriented health promotion programs that address public health issues.

Note: http://www.healthypeople.gov/Publications/

Impetus• The focus on good health has given many

people, agencies, organizations, communities, and workplaces in the U.S. a desire to do something about their health

• This desire, in turn, has created a greater need for good health information that can be easily understood by the general community

• Because of the increased interest in health, health professionals are now faced with providing the public with the information and the skills needed to make quality health decisions.

Documents

The Need for Health Promotion. Understanding Key Terms/Concepts HEALTH: “the state of complete mental, physical and social well being not merely the absence