1. dr swe swe latt health promotion

Dr. Swe Swe Latt

M.B.,B.S, M.Med.Sc (Public Health)

LecturerCommunity Medicine Department

KOM

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At the end of this lecture, students should be able to:

1. Define health promotion

2. List the five principles of Ottawa charter

3. Describe the importance of HP

4. Describe and explain approaches used in health promotion

6. Correlate Islamic perspective on Health Promotion

7. HP activities in Malaysia

Health Promotion ( DRSSL)

HEALTH?

Dimensions of Health?

Factors influencing on Health?

Promotion, Protection, Prevention?

3Health Promotion ( DRSSL)

Factors Influencing on health

Human rights

Biological

Justice

Gender

Inf & com

Science &Tech

Aging of pop

Socio-cultural

Health system

Socio-economic

Environmental

Behavioral

communities

SocietiesFamilies

Individual

Health promotion Health protection Disease prevention

Developed in healthy people related to individual lifestyles (more healthy LS)Eg: 1.physical activity 2.Nutrition 3.Sexuality 4.Tobacco/ antismoking5.Alcohol and drug use6.Oral health 7.Mental health and mental disorders8.Violent and abusive behavior Actions: educational and community-based programs (encourages well-being)(health education and spe interventions)

Focus on Environmental and regulatory measures -Protection on large population groupsEg:1.unintentional injuries2.Occupational safety and health 3.Env health hazards4.Food and drug safety 5.Fluoridation of water for oral health 6.Industrial chemicals7.Exposure to lead8.Air pollutants9.Radon 10.Pesticide residues

(desire to avoid illness)

Avoidance of illness and agents of illness

Primary Secondary Tertiary

( take action to thwart the disease process)

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Period of Pre-Pathogenesis Period of Pathogenesis

DeathDisease Process

LEVELS OF PREVENTION

MODES OF INTERVENTION

PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION

Disability Limitation

RehabilitationEarly Diagnosis & Prompt Treatment

Health Promotion

Specific Protection

Before Man is Involved

Agent

Bring agent and host

Together or produce a Disease provoking stimulus

Host

Environment

In the Human Host

Interaction of host and stimulus

Host Reaction

Early Pathogenesis

Discernible early Lesion

Advance Disease Convalesence

RECOVERYStimulus or agent becomes established and increases by multiplication

Tissue & Physiologic changes

Immunity & Resistance

Disability

Defect

Chronic State

Signs & Symptoms

Illness

Clinical Horizon

The Course of disease in man


Definition

“Health promotion is the process of enabling people

to increase control over & to improve their health.” Ottawa Charter for HP (WHO, 1986)

‘Health promotion is any combination of

educational, organizational, economic and

environmental supports for actions conducive to

health” (Green & Kreuter, 1991) 7

A Framework for Health Promotion Activities

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Health Promotion Process



The Ottawa Charter for Health Promotion

First International Conference on Health

Promotion, meeting in Ottawa, 21 November

1986

•Uses Health Promotion to summarize new

approaches to Public health intervention

based on 5 principles


Principles of Ottawa Charter


1. Develop Personal Skills

• supports personal and social development through providing information, education for health, and enhancing life skills

• Enabling people to learn, throughout life• facilitated in school, home, work and community

settings• Action -through educational, professional,

commercial and voluntary bodies

institutions


2. Strengthen Community Actions

• empowerment of communities - their ownership and control of their own endeavours and destinies

• Community development to enhance self-help and social support

• strengthening public participation in and direction of health matters

• requires full and continuous access to information, learning opportunities for health, funding support


3. Create Supportive Environments• links between people and their environment

constitutes the basis for a socioecological approach to health

• Work and leisure should be a source of health for people.

• Creation of the society of healthy work organization

• Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable.

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4. Build Healthy Public Policy

• 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


5. Reorient Health Services• Reorienting health services also requires stronger

attention to health research as well as changes in professional education and training.

• lead to a change of attitude and organization of health services which refocuses on the total needs of the individual as a whole person

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Health Promotion Emblem

The main graphic elements of the HP logo are:

a. one outside circle,

b. one round spot within the circle, and

c. three wings that originate from this inner spot, one of which is breaking the outside circle.


The Health Promotion emblem and its interpretations in successive conferences

• Ottawa 1986• Adelaide 1988• Sundsvall 1991• Jakarta 1997• Mexico 2000• Bangkok 2005• Nairobi 2009

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1. UK: In equalities in health

overall health status – improved Inequalities in health still exist!

- Gap between less well – off vs. better – off social groups tend to increase

• People in the upper classes had a greater chance of avoiding illness & staying healthy than those in the lower class

• Gender differences: men vs. women

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Why do we need to do health promotion?


European Public Health Association•Inequalities in health exist in all European countries. In many cases, evidence that exists shows the gap between the rich and poor is increasing.

•Many European countries do not record deaths by socio- economic categories, but years in higher education is widely taken to be a proxy for social advantage.

•In Netherlands, if the risk of dying from a heart attack is 1.00 for people with a university education, the relative risk (RR) for Dutch people without a secondary school diploma is 2.40http://www.epha.org/a/547

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Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries


Economic Status and Health in Childhood: The Origins of the Gradient

• Children from lower-income households with

chronic health conditions have worse health than

do children from higher-income households.

http://www.nber.org/papers/w8344


2. Changing disease pattern eg: CD to NCD, emerging diseases

3. Rising health care cost - continuous rise of investments in research &

development - adoption of the latest technologies to deal with the rapid emergence of new & complicated illnesses


4. Role of population in improving health - Dengue, Typhoid

5. Limitation of medical services from health

threats – from environment (air/ water

pollution) , lifestyle

6. Shift in health care delivery

– wellness paradigm


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Treatment paradigm brings a person to the neutral point, where the symptoms of disease have been alleviated

Wellness paradigmwhich can be utilized at any point on the

continuum, helps a person to move toward higher level of wellness


FIVE APPROACHES TO HEALTH PROMOTION


Approaches to health promotion

• Medical or preventive Approach

• Behaviour change Approach

• Educational Approach

• Empowerment Approach

• Societal change Approach


Five Approaches to Health Promotion Summary and Example (smoking)

Approach Aim Health promotion

activity

Important values

Example - smoking

Medical Freedom from medically defined disease and disability such as infectious d/ss, Ca and heart d/s.

Eg. ImmunizationScreening for HTPAP smear

Promotion of medical intervention to prevent or improve ill health

Patient compliance with preventive medical procedures

Aim- freedom from lung d/s, heart d/s and other smoking –related disordersActivity- encourage people to seek early detection and treatment of smoking- related disorder

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Five Approaches to Health Promotion Summary and Example


activity

Important values

Example - smoking

Behaviour change

Individual behaviour conductive to freedom from disease

Attitude and behaviour change to encourage adoption of ‘healthier’ lifestyle

Healthy lifestyle as defined by health promoter

Aim-behaviour change from smoking to not smokingActivity- persuasive education to prevent non-smokers from starting and to persuade smokers to stop

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Approach Aim Health promotion activity

Important values

Example - smoking

Educational Individuals with knowledge and understanding enabling well-informed decisions to be made and acted upon

Information about cause and effects of health-demoting factors.Exploration of values and attitudes. Development of skills required for healthy living

Individual right of free choice. Health promoter’s responsibility to identify educational content

Aim-Clients will have understanding of the effects of smoking on health. They will make a decision whether or not to smoke and act on the decision.Activity- giving information to clients about the effects of smoking, help them to learn how to stop smoking

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activity

Important values

Example - smoking

Client-centered/ Empowerment Approach

Working with clients on their own terms

Working with health issues, choices and actions that clients identify. Empowering the client

Client as equals. Client’s right to set agenda. Self-empowerment of client

Anti-smoking issue is considered only if clients identify it as a concern. Clients identify what, if anything, they want to know and do about it.

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Approach Aim Health promotion activity

Important values

Example - smoking

Societal change

Physical and social environment that enables choice of healthier lifestyle

Political/ social action to change physical/socialenvironment

Right and need to make environment health-enhancing

Aim-Make smoking socially unacceptable, so it is easier not to smoke than to smokeActivity- no-smoking policy in all public places. Cigarette sales less accessible to children, promotion of non-smoking as social norm, banning tobacco advertising and sports’ sponsorship32

Health Promotion Means Changing Behavior at Multiple Levels

A Individual: knowledge, attitudes, beliefs, personality

B Interpersonal: family, friends, peers C Community: social networks,

standards, norms D Institutional: rules, policies, informal

structuresE Public Policy: local policies related to

healthy practices33


Health Promotion Tools• Mass media• Social marketing• Community mobilization• Health education• Client-provider interactions• Policy communication( edu tools: leaflets, videotapes, bulletin boards, overhead transpancies,

PPT material, chalk boards, other audiovisual support items, sms, TV,

Talk)

Source: Robert Hornik and Emile McAnany, “Mass Media and Fertility Change,” in Diffusion Processes and Fertility Transition: Selected Perspectives, ed. John Casterline (Washington, DC: National Academies Press, 2001): 208-39.

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A Flowchart for Planning and Evaluating Health Promotion

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Aims and Methods in Health promotion Aim Appropriate method

Health Awareness goal Raising awareness, or consciousness, of health issues

Talks/ Group work Mass media / Displays and exhibitions Campaigns

Improving knowledge Providing information

One-to-one teaching/ Displays and exhibitions Written materials/ Mass media (including internet)Campaigns/ Group teaching

Self-empoweringImproving self-awareness, self-esteem, decision-making

Group work / Practicing decision-makingValues clarification/ social skills trainingSimulation/ gaming and role playAssertiveness training/ counselling

Changing attitudes and behaviourChanging the lifestyles of individuals

Group work / skills training/ self-help groupsOne-to-one instruction/ Group or individual therapy Written material / Advice

Societal/ environmental changeChanging the physical or social environment

Positive action for under-served groups/ lobbying /Pressure groups/ community development/ community-based work / Advocacy schemes/ Environmental measures / Planning and Policy making/ organisational change/ enforcement of laws and regulations

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Important Elements in Health Promotion o Involves all sectors e.g other government

agencies, private sectors, NGOs not MOH M’sia alone

o Involves whole population, aims at public participation

o Addresses action on health determinantso Uses diverse, but complementary methods

or approaches


Who promotes health? Agents and Agencies of HP

National GovernmentEg. Dept of Health

Health Promotion Activities

International organisations eg. WHO

National and local media eg . TV, radio, newspaper, internet

National voluntary organisaations and pressure groups

Private preventive medical services Eg. Private health checks

Professional org and trade unions

Local government eg. Teachers, environmental health officers, social workers

National health Service eg. National health development agencies, local heath workers

Police, probation, firefighters Health and Safety Executive

Local community and voluntary groups eg. Youth groups, self-help gps

Workplace employers eg. Occupational health services, human resources managers

Local branches of national organizations

Commercial and industrial orgs, manufactures and retailers

Institutions of higher leaningEg. Universities and collages

Churches and religious orgs

Complementary health practitioners The informal network eg. Family, friends, neighbors

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Factors influencing effectiveness of HP

A) Group attributes• educational level• Knowledge• Channels of communication• Confidence to act• Infrastructure• Leadership -priority

B) Perception of disease• Susceptibility• Severity• Impact on finance, family

C) Perception of action• Socially acceptable• Safety• benefit> cost


Evaluation in health PromotionDifferent criteria to judge effectiveness of HP intervention

Effectiveness the extent to which aims and objectives

are met

Appropriateness the relevance of the intervention to

needs

Acceptability whether it is carried out in a sensitive

way

Efficiency whether time, money and resources are

well spent, given the benefits

Equity equal provision for equal need 40

Health Promotion at a glance Settings (Where?) – Schools - Work place

- Local community

Specific health issues (Which?) - Mental health - Communicable diseases - Non-communicable diseases - Violence and Accidents

Specific population groups (Whom?) – The poor - Young children - Young people - The elderly - Women

Health promotion activities (How?) - Supporting general condition - Education, training - Social mobilization

Participators/ Observers (Who?) - Politicians, financing [Cost, benefit (short term)] - Health promoting actors [Promising procedures of action,

keeping to HP principles (Ottawa,etc.)]

- Scientists [Measurement of results, evaluation of effects, process evaluation]

- Population [Orientation towards real needs, possibilities of participation] 41

Conclusion

•Health Promotion needs commitment and support from everybody

•Health workers alone is not enough to change the community behaviour


Religion and Health (The Salutogenic Effect)Religious dimensions

Pathways Mediating factors

Salutogenic mechanisms

Religious commitment

Health –related behavior and lifestyle

Avoidance of smoking, Alcohol, drug use, poor diet, unsafe sex, etc

Lower disease risk & enhanced well-being.

Involvement & fellowship

Social support & Networks

Relationshipsfriends & family.

Stress-buffering, coping and adaptation

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Religion and Health

Figure 1: Pathways of ‘Islamic Health Theory’

Quran & Ahadith

Five Pillars of Islam

Elements of Faith

Islamic Jurisprudence

Salutogenic Mechanism

Sense of coherence

Predisposing &Enabling factors

Behavior

Healthy Lifestyle 44

HEALTH PROMOTION

ACTIVITIES

IN

MALAYSIA


HEALTH PROMOTION ACTIVITIES IN MALAYSIA
















HP activities on Dengue Prevention



References1) Agency, P. H. (July 6). Health promotion theories and models.

from http://www.healthpromotionagency.org.uk/Healthpromotion/Health/section5.htm

2)Ewles, L., & Simnett, I. (2003). Promoting Health. A Practical Guide: Bailliere Tindall

3) Gorin, S. S., & Arnold, J. (2006). Health Promotion in Practice: Jossey Bass

4) WHO. Health Promotion. from http://www.who.int/healthpromotion/en/

5). Islam and health promotion By Aisha Omar Maulana, MPH.


For More Information

1. Cottrell, R. R., Girvan, J. T., & McKenzie, J.Health Promotion and Education (3

rd Edition ed.). Boston: Benjamin Cummings.

2. Tones, K., & Tilford, S. (2001). Health equity (3rd Edition ed.). Cheltenham: Nelson Thornes

3. Kiger, A.M (2004). 3. Kiger, A.M (2004). Teaching for health (3rd Edition ) Churchill Livingstone

4.Naido, J., &Wills, J. (2007). Health Promotion Foundations for Practice (2nd Edition) Royal College of Nursing

5. Elaine M. Murphy, “Promoting Healthy Behavior,” Health Bulletin 2 (Washington, DC: Population Reference Bureau, 2005). Available online at www.prb.org

http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index1.html• http://www.vichealth.vic.gov.au/Publications/VCE/Defining-health-promotion.aspx• uqu.edu.sa/.../Lecture%2053Models%20of%20Health%20Promotion.pp• https://www.google.com/search?

newwindow=1&site=&source=hp&q=caplan+and+holland+1990&oq=Caplan+and+Holland+&gs_l=hp.1.0.0l3j0i22i30l5.8022.16553.0.20230.19.14.0.5.5.0.238.1239.11j2j1.14.0....0...1c.1.32.hp..0.19.1304.7i1RYgF9Bpk

• (Health Promotion :Perspective of Malaysian Health Promotion Board • My Sihat)http://sehat.perkeso.gov.my/panelclinichtml/APS2013/lpkm.pdf

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Health & Medicine

1. dr swe swe latt health promotion