Health Promotion

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

What isHealth Promotion?
Today Health Promotion ismore than
personal and population education.
Defined in a number of ways
“The process of enabling people to
increase control over and improve their
health”
(World Health Organisation 1986)
Health Promotion = health education x
healthy public policy.
(Tones and Tilford,1994)

Phylosophy
Through the involvement of
home, school and
community,
including: the physical,
intellectual, emotional,
social and moral
development
Health promotion is any
combination of health, education, economic,
political, spiritual or organisational initiative
designed
to bringaboutpositiveattitudinal,
behavioural,socialor environmental changes
conduciveto improving
thehealth of populations.

Definition(learnthis one)
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
FOCUS STRATEGIES I
MPACT OUT
COMES
Individuals
Groups
Population
Education
couselling
Economic
change
Legislative
change
Policy or
organisation
change
Behavioural
educational
change
Social,
economic and
environment
change
Better
Health
Quality
of life

Frameworks and Models are tools that help explain phenomena.
Many tools developed to explain the scope of health promotion.
1.Beattie’s (1991) model of health promotion
2.Tones and Tilford’s (1994) empowerment model of health promotion
3.Caplan and Holland’s (1990) Four perspectives on health promotion
4.Naidoo and Wills (2000) typology of health promotion
The scope ofhealth promotion activity

AREAS OF
HEALTH
PROMOTION
ACTIVITY
Preventive health
services(Primary,
secondary, tertiary
Community-based
work
Organisation
development
Healthy
Public Policy
Environmental
health measures
Economic and
regulatory
activities
Health education
programmes
A FRAMEWORK FOR HEALTH PROMOTION
ACTIVITIES

A FRAMEWORK FOR HEALTH PROMOTION
ACTIVITIES
CLASS
AGE
GENDER
ETHNICITY
Housing tenure
Environment
Regional location
Access to health
services
Access to leisure
facilities
Nutrition
Smoking
Physical
activity
Psychosocial
factors, e.g.
stress
Cholesterol
Blood
pressure
Obesity
KEY SOCIAL
STRATIFICATION
FACTORS
ENVIRONMENT
FACTORS
LIFESTYLE
FACTORS
PHYSIOLOGICAL
FACTORS
C
H
D

The five key principles of health promotion as
determined by WHO are as follows:
1.Health promotion involves the population as a whole
in the context of their everyday life, rather than
focusing on people at risk from specific diseases.
2.Health promotion is directed towards action on the
determinants or causes of health therefore, requires
a close co-operation of sectors beyond health
services, reflecting the diversity of conditions which
influence health
PRINCIPLES OF HEALTH PROMOTION

PRINCIPLESOFHEALTH PROMOTION contd
3.Health promotion combines diverse, but complementary methods
or approaches
including communication, education, legislation, fiscal measures,
organisational change, community change, community
development and spontaneous local activities against health
hazards.
4.Health promotion aims particularly at effective and concrete
public participation. This requires the further development of
problem-defining and decision-making life skills, both individually
and collectively, and the promotion of effective participation
mechanisms.
5.Health promotion is primarily a societal and political venture and
not medical service, although health professionals have an
important role in advocating and enabling health promotion.

Medical or preventative
Behavioral change
Educational
Empowerment
Social change
Main approaches to health promotion

Aims
Reduce morbidity and premature mortality
Target: whole populations or high risk groups
Promotion of medical intervention to prevent ill-health
The medical or preventative approach

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
Behavior change approach

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
The educational approach

Empowerment approach
WHO defined health promotion as “enabling people to gain control over their lives” (empowerment)
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

Aims (Cont.)
For people to be empowered they need to:
1. Recognize and understandtheir powerlessness
2. Feel strongly enough about their situation to want to change it
3. Feel capable of changing the situation by having information,
support and life skills

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
Social change approach

These approaches have different
objectives
To prevent disease
To insure that people are well informed and are able to make
health choices
To help people acquire the skills and confidence to take greater
control over their health
To change polices and environments in order to facilitate healthy
choices

TOP-DOWN VS. BOTTOM-UP
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 issuesthey
perceive as relevant

THE FIVE APPROACHES
EXAMPLES RELATED TO SMOKING
Based on Ewles and Simnet (1992: 36)

The medical approach
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
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
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
AIM: Anti-smoking issue isconsidered only if clients identify it asa
concern
ACTIVITY: Clients identify what, if anything, they want to know and do
about it

Social change approach
AIM: Make smoking socially unacceptable so it iseasier 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

Building a
healthy public
policy
Creating
supportive
environments
Developing
personal skills
Strengthening
community
action
Reorientating
health services
IMPORTANTAREAS FOR CONSIDERATION IN HEALTH
PROMOTION

Basic Strategies for Health Promotion
Advocate
Enable
Mediate

Advocate
Good health isa 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
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. Thisincludes 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
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
1. Better Health policy.
2. Physical environment.
3. Social environment.
4. Community relationships.
5. Personal health skills.
6. Health services

References
Online
• www.who.int/topics/health_promotion
• www.healthpromotionjournal.com
• www.iuhpe.org
• ped.sagepub.com
Books
• A Text Book of Health Education (Philosophy and
Principles) by Hari Bhakta Pradhan, Educational Resources for Health, Kathmandu,
Nepal.
• Foundations and Principles of Health Education by Nicholas Galli, University of Illinois,
Illinois
• Education For Health A Manual.. WHO
• Theory in a Nutshell : A practical guide to HP Theories…Don Nutbeam and Elizabeth Harris
• HP.. Bedworth

Break
… BACK TO THE ‘BACK’…..AGAIN

Immunization (Vaccines)

Immunization (Vaccines)
•
Immunization: Immunization is the cornerstone of public
health. It is a way to protect people from infectious diseases.
•
Vaccines: A vaccine contains dead or weakened bacteria or
viruses (they are not capable of causing a disease) that are
administered to individuals to encourage the immune system
to recognize them and to consequently produce antibodies
that can identify the germ early on. This allows the individual
to fight the germ if it encounters it again, therefore preventing
disease. Vaccines are an easy and safe way to protect
everyone since they are subject to safety tests before they are

Target segments:
• Infants
• Children
• Pregnant women
• The elderly
• People with weakened immune systems due to cancer treatments
• People with chronic illnesses
• Pilgrims
• Travelers heading to infected areas
Other names:
Shots

Types of vaccines:
There are several types of vaccines and each type helps the immune
system fight a certain type of germs and the diseases they cause.
They include:
• Live-attenuated vaccines: They use an attenuated (or weakened)
form of the germ that causes a disease. These vaccines are very
similar to the natural infection and therefore help protect against the
infection by creating a strong and long-lasting immune response. Just
1 or 2 doses (of most live vaccines) can provide a lifetime of
protection against a germ and the disease it causes. E.g.: MMR
combined vaccine (measles, mumps, rubella), Rotavirus, Smallpox,

• Inactivated vaccines They use the dead version of the germ that causes a disease.
The immunity (protection) they provide is usually not as strong as that provided by
live vaccines. Therefore, several doses may be needed over time to gain ongoing
immunity against diseases. E.g.: Hepatitis A, Influenza, Polio, Rabies
• Subunit/conjugate vaccines They use specific parts of the germ (e.g. protein,
sugar, or the casing around the germ). This type of vaccine can be used on almost
everyone who needs it, including people with weakened immune systems and
chronic health problems. However, one of their disadvantages is that booster shots
may be necessary to get ongoing protection against diseases. E.g.: Hib
(Haemophilus influenzae type b) disease, Hepatitis B, HPV (Human papillomavirus),
Whooping cough, Pneumococcal disease, Meningococcal disease
• Toxoid vaccines They use the harmful product (toxin) made by the germ that
causes a disease so that the immune system can fight this toxin rather than the
germ. Like other vaccines, booster shots may be necessary to get ongoing
protection against diseases. E.g.: Diphtheria, Tetanus

Why are vaccines important?
• They give newborns a chance to grow healthily and to have a better life.
• They eliminate infectious diseases that were once widespread or that can cause
severe complications or death.
• Vaccines not only protect the vaccinated individuals but entire communities as
well.
• They help reduce mortality rates.
• They help prevent infectious diseases.
• They stop the development of antibiotic resistance by reducing the use of
antibiotics.
• They help you travel safely and comfortably.
• They provide economic benefit by saving on the costs of treating diseases.

What to expect when giving a child his/her first vaccine?
You can help the child by making the vaccination experience
more positive and explaining to the child what is about to
happen.
Before vaccination:
Remember to take the child’s immunization record card when
visiting the doctor or the public health office. If your child
doesn’t have a record, make sure to enquire about it at your
healthcare provider.

During vaccination:
The doctor or nurse may ask you some questions about the child’s health
such as if he/she suffers from allergies or health problems. Here are some
tips to help the child during vaccination:
• Relax: Children interact to their parents’ emotions and will be happier
and more positive when the parents are relaxed.
• Affection: It is advised to hold the child and speak to him/her during the
administration of the vaccine. Studies have found that children who are
hugged and held scream less during an injection.
• Breastfeeding: Breastfeeding a child before, during or after vaccination
helps him/her stay comfortable.
• Distraction: A sweet voice or a calming touch can help calm a child. You
can also hand the child his/her favorite toy or read him/her a story.

After vaccination:
• Before you go home, remember to schedule the next appointment.
• The first dose of immunization may be administered at birth with another
dose given after two months. The child’s immunization record (vaccination
card) should be received at the first appointment.
• Remind the healthcare provider if they forget to hand you the record.
• Record the date of the next appointment in your mobile phone or calendar
as soon as possible before you forget it.
• Keep the child’s immunization record in a safe place to find it when
necessary.
• Bring the immunization record with you to every appointment to update it
every time the child receives a vaccine.
Vaccines are a routine part of childcare. Their dates should be respected to
protect your child’s health.

•
Side effects after vaccination:
Most children feel fine after vaccination and may not exhibit any reaction at all. Some may
exhibit some side effects based on the type of vaccine. However, the benefits of vaccines
far outweigh these mild and temporary side effects that often don’t require treatment.
Side effects include:
• High temperature
• Pain, redness or swelling around the injection area
• Sleeping more than usual
• Itchiness around the injection area
• Mild rash
• Headache
• Nausea
• In rare cases, a severe allergic reaction may occur within a few minutes after
vaccination.
All of these reactions are considered normal and usually last 12 to 24 hours.

•
Consequences of delayed vaccination:
Any delay in vaccination may put the child at risk of developing
the targeted diseases. The effect of a vaccine is optimal when it is
taken on time and the timely administration of vaccines is one of
the parents’ key responsibilities. Vaccines provide children with
lifelong protection from dangerous diseases.

•
Postponing vaccination:
Vaccination can be postponed in the following cases:
• High temperature
• Severe illness
• For children receiving immunosuppressive drugs or treatments
(chemotherapy, radiotherapy)
However, a child can be vaccinated if he/she is suffering from a
mild illness, has a mild fever, or is taking antibiotics. It is advised
to speak to the child’s doctor if you have any questions.

•
If vaccination is forgotten:
Sometimes, parents may forget to schedule a vaccination
appointment. It is essential to check the immunization record
and schedule an appointment with a healthcare provider as soon
as possible.
Children depend on their parents to be immunized.

•
When to consult a doctor:
• Before vaccination
• Severe allergic reaction to a previous vaccination
• Severe allergic reaction to one of the vaccine’s components
• Individuals with immunodeficiency problems cannot be vaccinated before consulting with a doctor
• Neurological disorders such as spasms or epilepsy
• After vaccination:
• If the side effects are severe
• If the side effects don’t disappear
• If the child has spasms due to a fever
• If the child continues to cry for more than 3 hours
• If the child shivers or trembles
• If the child’s activity level significantly decreases
• If the swelling and redness in the injection area lasts more than 24 hours

Immunization when traveling:
When traveling to another country, everyone is at risk of
contracting diseases that can be prevented with vaccines. These
could include diseases for which vaccines are not routinely
administered. Therefore, it’s important to consult with a
healthcare provider or to visit a travel health clinic six weeks
before traveling. Certain vaccines may be recommended based
on age, destination and travel plans.

•
Immunization for pregnant women:
Vaccines can help protect both mother and baby from preventable diseases. The immunity gained
by a mother who is vaccinated during pregnancy is passed on to the fetus and consequently
protects
the infant against certain diseases during the first months of his/her life before any
vaccines can be administered. They also help protect the mother throughout the pregnancy. All
vaccines
recommended to pregnant women are also safe for breastfeeding women.
Before pregnancy, it is important for all members of the household to receive their vaccines on time
because the newborn can easily catch infections. Infections can also be severe during the first few
months of an infant’s life, especially because some vaccines can only be administered between 9-12
months of age (e.g. measles). Vaccines protect mother and baby from some diseases that may
cause:
• miscarriages
• Preterm births
• Birth defects
• Death

Necessary vaccines for pregnant women:
The necessary vaccines should be taken before pregnancy as
long as they are suitable and administered at the right time
after consulting with a doctor, as they can help protect mother
and baby. There are various vaccines recommended during
pregnancy:

Guidelines after vaccination:
• Some side effects such as loss of appetite or trouble sleeping don’t need treatment and
disappear within 1 or 2 days.
• Some children may need to rest more after vaccination.
• Paracetamol drugs may be used (e.g Fevadol or Panadol) if a fever is detected.
Instructions must be followed when administering the drug.
• Avoid giving aspirin to children.
• Regularly move the arm or leg (where the injection ).
• Consume lots of fluids and wear light and baggy clothes in case of a fever. • Avoid
bathing the child in cold water.
• Place cold, damp and clean compresses on the injection area to reduce swelling and
redness.

Frequently Asked Questions:
Are vaccines safe? The WHO has confirmed that vaccines are accurately
tested to check their safety and are continuously monitored even after
production.
If these diseases are rare, why does the child need to be vaccinated?
Diseases that were once common have now become rare thanks to vaccines
but they still exist. Even one case of measles can spread quickly if vaccines
aren’t given. It is difficult to identify who is carrying the germ and if a child is
at risk. Many of the diseases that can be prevented with vaccines have no
cure. In some cases, children may die as a result of complications from the
disease. The best protection is to immunize a child at the right time.

How are vaccines approved?
Like all medicines, vaccines undergo a series of tests before they
can be used in the Kingdom of Saudi Arabia. Several regulations
have been established to monitor the supply, use and safety of
vaccines. Side effects are reported by health care providers to
public health officers at the Ministry of Health to streamline the
handling of any unusual or unexpected side effects.

Are vaccines safer than the actual disease?
• Yes. A child’s natural immune system can handle the weakened or dead germs contained
in vaccines.
• A child can experience a mild fever or some pain in the arm after vaccination but these
side effects only last a few days and do not hinder daily activities.
• However, if an unvaccinated child contracts the actual disease, the result could be
dangerous or even deadly because active germs multiply rapidly and the child’s immune
system is not prepared to defend against them.
• Children need to receive vaccines at the specified time.
• Vaccines work best when they are given at the specified times starting from birth.
Routine vaccination is provided free of charge across the Kingdom.
• A person needs to make sure that their vaccination is regularly up to date. This is a life-
long process.

Why should children be vaccinated at such a young age?
Vaccination schedules were designed to protect children from preventable
diseases. They are given to children at a young age because it is during this
early stage in their lives that they are vulnerable to diseases with potentially
dangerous consequences. However, if the vaccines are given on time, the
child will benefit from the best protection as quickly as possible.
When should children be vaccinated?
Children need to be vaccinated at different stages to provide them with
complete protection. Some vaccines should be given more than once to
build-up the child’s immunity.

Can a child receive more than one vaccine at the same time?
Yes. Some vaccines are administered together to protect the child from several diseases at the
same time. A child’s immune system is fascinating and can easily, safely and effectively, handle more
than one vaccine at the same time. The healthcare provider will provide parents with information
on the vaccines their child needs at every visit.
Where can someone get vaccinated?
Vaccines are available at all health centers affiliated with the Ministry of Health and with the
private sector.
What is the benefit of keeping a child’s vaccination up to date?
Up to date vaccination is required by schools. Children should have all of the required vaccines
before starting school or kindergarten. This is important to help stop the spread of dangerous
diseases. A child’s immunization record is also useful when visiting a new doctor or when traveling.

Thanks…