health, promotion, prevention, developing countries, health protection, health education, community medicine

1. Amany R.Abo-El-SeoudAmany R.Abo-El-Seoud
Prof. Of Community MedicineProf. Of Community Medicine
Zagazig University,EGYPTZagazig University,EGYPT
HEALTH PROMOTIONHEALTH PROMOTION

2. Health promotionHealth promotion
It is the science aiming at reaching optimal
(perfect) health
All activities aiming at increasing well-being,
prevention of disease and health hazards,
or control of disease are included under
health promotion. (it is the highest aim of CM)
Health promotion is to addHealth promotion is to add ‘‘life into thelife into the
yearsyears’’ and not just addand not just add ‘‘years onto lifeyears onto life’’

3. Definition of health promotionDefinition of health promotion
Is a process of activating communities,Is a process of activating communities,
policy makers, professionals and thepolicy makers, professionals and the
public in favor of health supportivepublic in favor of health supportive
policies, systems and ways of living.policies, systems and ways of living.
It is carried out through acts of advocacy,It is carried out through acts of advocacy,
empowerment of people and buildingempowerment of people and building
social support systems that enable peoplesocial support systems that enable people
to make healthy choices and live healthyto make healthy choices and live healthy
lives.lives.

4. The basic principles for health
promotion:
Promotion of health requires a secure foundation in
these basic prerequisites.
Sustainable
resources
Peace
Shelter
Education
Food
Income
A stable
ecosystem
Health
• Social justice & equity

5. Advocate for health:
- Good health gives better quality of life so it
necessitates advocacy (fighting for it).
- The following factors can favor health or can harm it:
- Health promotion aims at making these conditions
favorable for health.
Political conditions
Economic conditions
Social conditions
Cultural conditions
Environmental factors or conditions
Behavioral factors or conditions
Biological factors or conditions
Health

6. Approaches for health promotionApproaches for health promotion
How can we promote health?How can we promote health?
 Healthy population (infrastructure)Healthy population (infrastructure)
 Healthy lifestyleHealthy lifestyle
 Healthy environmentHealthy environment

7. 11--Healthy populationsHealthy populations
By targeting all life stages and groups.By targeting all life stages and groups.
Since the health needs of people varySince the health needs of people vary
according to their stage in the life cycle oraccording to their stage in the life cycle or
their gender, the healthy populationtheir gender, the healthy population
approach encourages initiatives that focusapproach encourages initiatives that focus
on the health needs and contributions ofon the health needs and contributions of
people at every life stage.people at every life stage.

8. 22--Healthy lifestylesHealthy lifestyles
This approach focuses more on theThis approach focuses more on the
behavior of individuals and how theirbehavior of individuals and how their
decisions and actions can lead to healthierdecisions and actions can lead to healthier
outcomes. This can be done throughoutcomes. This can be done through
health education, social mobilization andhealth education, social mobilization and
advocacy programs.advocacy programs.
No smoking, better nutrition and exerciseNo smoking, better nutrition and exercise
are examples of healthy lifestylesare examples of healthy lifestyles
approach.approach.

9. 33--Healthy settingsHealthy settings
Creating social, economic andCreating social, economic and
environmental conditions that areenvironmental conditions that are
favorable to good health. Healthfavorable to good health. Health
conditions in developing countries must beconditions in developing countries must be
viewed in a wider socio economic contextviewed in a wider socio economic context
because millions of people are trapped inbecause millions of people are trapped in
the vicious cycle of poverty, despair,the vicious cycle of poverty, despair,
disparity, illiteracy and diseasedisparity, illiteracy and disease

10. Other approach for healthOther approach for health
promotionpromotion
Prevention
Immuniz.
Environment
H.Services
Protection
Laws&policy
Health education
Appreciate health
Keen to keep healthy

11. Who promote health?Who promote health?
Individual role Governmental role
Legislation
Environmental health
Health services
Other ministries
Policy & budget
H.Conciousness
Life style
Genetic
Beliefs
Occupation

12. WHO PROMOTESWHO PROMOTES
HEALTHHEALTH??
 International organizationInternational organization
 Health authoritiesHealth authorities
 Non-Governmental OrganizationsNon-Governmental Organizations
 Primary health care teamPrimary health care team
 Private physician.Private physician.
 Other health professions: nurses,Other health professions: nurses,
professions allied to medicine.professions allied to medicine.
 Religious organizationsReligious organizations

14. Guiding Principles of HealthGuiding Principles of Health
PromotionPromotion
 EmpoweringEmpowering individuals and communities.individuals and communities.
 ParticipatoryParticipatory (involving all).(involving all).
 HolisticHolistic (all four dimensions of health).(all four dimensions of health).
 IntersectoralIntersectoral (collaboration of all agencies)(collaboration of all agencies)
 EquitableEquitable (equity and social justice)(equity and social justice)
 SustainableSustainable (changes are maintained)(changes are maintained)
 MultistrategyMultistrategy (variety of approaches)(variety of approaches)

15. Health promotion "23 years of
continuous development"
- Ottawa (Canada) 1986:
→ first international health promotion
conference as an extended application for the
Alma Ata declaration 1978 on primary health
care.
- Australia 1988:
→ Concept of healthy public policy being a
human right. gender dimension was given
specific attention.
- Sweden 1991:
→ Concept of supportive environments
conductive to health and the links with
sustainable development.

16. -Jakarta, Indonesia 1997:
Issues related to globalization (the potentials
and controversies around public-private
partnership) infra-structures and funding.
- Mexico city, Mexico 2000:
→ High level political commitment to health
promotion.
Positioning health promotion higher on the
political agenda and recognizing it as a priority
in local, regional, national, and international
programs.
- Bangkok (Thailand) 2005:
Identified major challenges, actions &
commitments needed to address the
determinants of health in the world by reaching
out to people, groups & organizations that are
critical to the achievement of health.

17. Ottawa Charter put five
action areas for promotion:
1- Develop healthy public policy.
2- Create supportive environment
for
health
3- Strengthen community action.
4- Develop personal skills i.e.
modifying their life style towards
healthy behaviors.
5- Reorient health services.

18. 11--Develop healthy public policyDevelop healthy public policy
health should be on the policy agenda in allhealth should be on the policy agenda in all
sectors, and at all levels of government.sectors, and at all levels of government.
Governments are ultimately accountable to theirGovernments are ultimately accountable to their
people for the health consequences of theirpeople for the health consequences of their
policies, or the lack of policies. A commitment topolicies, or the lack of policies. A commitment to
healthy public policies means that governmentshealthy public policies means that governments
must measure and report on their investmentsmust measure and report on their investments
for health, and the subsequent health outcomesfor health, and the subsequent health outcomes
of these investments and policies in a languageof these investments and policies in a language
that all groups in society readily understand.that all groups in society readily understand.

19. 2-Create supportive
environment:
(1) Protection and conservation of the
natural environment - as a natural
resource - must be addressed in
any health promotion strategy.
(2)We must create a healthy working
& living conditions and making
them safe, stimulating for health,
satisfying & enjoyable.

20. (3) Systematic assessment of the
health impact of any rapidly
changing environment as in Work
places, energy production areas
and rapidly urbanized areas.
(4)Encourage research studies for
detection of environmental hazards
on health and methods of
controlling them.

21. 3-Strengthen community
action
 Health promotion depends on concrete &
effective community action.
The community has to share in:
• Setting priorities
• Making decisions
• Planning strategies
• Implementing these strategies

22. This can be enhanced by:
 • Empowering the community
 • Create ownership
 • Control of their actions & efforts
This requires:
 • Continuous access to information.
 • Learning opportunities for health.
 • Funding support.

23. 44--Health promotion strategiesHealth promotion strategies
directed towards individualsdirected towards individuals
1.1. Increase individual awareness of disease andIncrease individual awareness of disease and
disability prevention actions.disability prevention actions.
2.2. Changing lifestyles to healthy onesChanging lifestyles to healthy ones
3.3. Encourage individuals to have check-ups andEncourage individuals to have check-ups and
to use health screening opportunities.to use health screening opportunities.
4. Early seeking for medical advice4. Early seeking for medical advice
5. Compliance to physician5. Compliance to physician
instruction and treatment scheduleinstruction and treatment schedule

24. 55--Reorient health servicesReorient health services
Health promotion requires reorientation of healthHealth promotion requires reorientation of health
systems from tertiary (curative strategies) tosystems from tertiary (curative strategies) to
primary and secondary prevention models. Thisprimary and secondary prevention models. This
reorientation is often be resisted by doctors, andreorientation is often be resisted by doctors, and
pharmaceutical companies and hospitals, thosepharmaceutical companies and hospitals, those
who adoptwho adopt ‘‘find it and fixfind it and fix itit’’ approach.approach.
Encourage health service providers to buildEncourage health service providers to build
opportunities for health education settings inopportunities for health education settings in
primary and secondary prevention of diseaseprimary and secondary prevention of disease
and disability when delivering services.and disability when delivering services.

25. Evaluation of Health promotionEvaluation of Health promotion
activities in a community:activities in a community:
By assessing:By assessing:
1.1. Quality of life indicators.Quality of life indicators.
2.2. Health knowledge, attitude, motivationHealth knowledge, attitude, motivation
and skills among population sectors.and skills among population sectors.
3.3. Social action and influence (communitySocial action and influence (community
participation & public opinion).participation & public opinion).
4.4. Legislation, regulation for public healthLegislation, regulation for public health

26. 5- Resource allocation for health in relation to5- Resource allocation for health in relation to
national budget.national budget.
6- improved health indicators as morbidity &6- improved health indicators as morbidity &
mortalitymortality
7- improved productivity, reduced absenteeism.7- improved productivity, reduced absenteeism.
8- decrease in medical care utilization8- decrease in medical care utilization
9- decrease in health care cost.9- decrease in health care cost.
H. Promotion = h.education x healthy public policyH. Promotion = h.education x healthy public policy

27. Problems facing health promotionProblems facing health promotion
in developing countriesin developing countries
 PovertyPoverty and consequently the poor livingand consequently the poor living
conditions (e.g. poor nutrition, poor housing,conditions (e.g. poor nutrition, poor housing,
environmental degradation) associated with itenvironmental degradation) associated with it
are major obstacle for improving health ofare major obstacle for improving health of
people in developing countries. Unlesspeople in developing countries. Unless
fundamental changes are made to this widerfundamental changes are made to this wider
context it will be difficult to make major advancescontext it will be difficult to make major advances
in health promotion.in health promotion. The challenge of reducing
poverty cannot be underestimated.

28. Decision makers must find answers forDecision makers must find answers for
these questions:these questions:
1-How to draw more resources from the1-How to draw more resources from the
community and individuals to meet thecommunity and individuals to meet the
health challenges they face?health challenges they face?
2-How to direct health expenditures? Either2-How to direct health expenditures? Either
for prevention or for control?for prevention or for control?

29.  Economic prioritiesEconomic priorities
Most developing countries have limited resources andMost developing countries have limited resources and
many competing demands for these resources. They aremany competing demands for these resources. They are
seeking to achieve rapid economic gains andseeking to achieve rapid economic gains and
development by industrialization and food productiondevelopment by industrialization and food production
that gives priority to foreign markets for earning foreignthat gives priority to foreign markets for earning foreign
exchange.exchange.
Insufficient attention is given to the needs of local citizensattention is given to the needs of local citizens
leading to low wages and poverty, poor nutrition andleading to low wages and poverty, poor nutrition and
worse environmental condition, all of which have seriousworse environmental condition, all of which have serious
health consequences. International donors tend tohealth consequences. International donors tend to
encourage activities that promote economicencourage activities that promote economic
development and have quick and visible outcomes.development and have quick and visible outcomes.
The challenge for health promotion is to convince policy-The challenge for health promotion is to convince policy-
makers thatmakers that good health is an economic asset rathergood health is an economic asset rather
than a cost and it is an essential component of socialthan a cost and it is an essential component of social
and economic empowermentand economic empowerment

30.  EducationEducation
Low levels of literacy specially health literacyLow levels of literacy specially health literacy
provide another challenge for the healthprovide another challenge for the health
promotion approach. This can be an obviouspromotion approach. This can be an obvious
problem when trying to promote better healthproblem when trying to promote better health
behavior among people. Poor levels ofbehavior among people. Poor levels of
knowledge is an important factor that contributeknowledge is an important factor that contribute
to almost all diseases. Efforts done to improveto almost all diseases. Efforts done to improve
illiteracy actually share in health promotionilliteracy actually share in health promotion

31. Political stabilityPolitical stability::
Where there is political instability,Where there is political instability,
internal conflict and war, it is extremelyinternal conflict and war, it is extremely
difficult to develop health-promotingdifficult to develop health-promoting
environments. Not only are the economicenvironments. Not only are the economic
resources and priorities of governmentsresources and priorities of governments
directed elsewhere, but also the regulatorydirected elsewhere, but also the regulatory
environment to create health supportiveenvironment to create health supportive
settings is lacking.settings is lacking.

32. Inter sectoral co-operationInter sectoral co-operation::
Decision-makers in all sectors (even inDecision-makers in all sectors (even in
areas that are indirectly related to healthareas that are indirectly related to health
as agriculture, commerce, education,as agriculture, commerce, education,
industry etc) must focus on the healthindustry etc) must focus on the health
implications of their policies, in fact, theirimplications of their policies, in fact, their
competing priorities may lead them tocompeting priorities may lead them to
disregard the health implications of theirdisregard the health implications of their
decisions.decisions.

33. Commercial interestsCommercial interests
Marketing does not necessarily considerMarketing does not necessarily consider
health of citizens of developing countrieshealth of citizens of developing countries
uppermost in their priorities. This is oftenuppermost in their priorities. This is often
result in poor health outcomes. For exampleresult in poor health outcomes. For example
marketing tobacco, and western food products.marketing tobacco, and western food products.
Commercial propaganda of unhealthy products andCommercial propaganda of unhealthy products and
lifestyles make it difficult for healthy choices to be thelifestyles make it difficult for healthy choices to be the
easiest or the attractive choiceseasiest or the attractive choices..
Regulation of the activities of these commercial interests isRegulation of the activities of these commercial interests is
required through political rules to introduce sufficientrequired through political rules to introduce sufficient
levels of regulation as the taxes gained from unhealthylevels of regulation as the taxes gained from unhealthy
products and used as an important source ofproducts and used as an important source of
governmental funds. Poor governments can find itgovernmental funds. Poor governments can find it
difficult to resist this source of revenue.difficult to resist this source of revenue.

34. The double burden of diseaseThe double burden of disease
One of the particular challenges that faceOne of the particular challenges that face
developing countries is that the epidemicdeveloping countries is that the epidemic
of non communicable disease isof non communicable disease is
developing before the burden ofdeveloping before the burden of
communicable (infectious disease) hascommunicable (infectious disease) has
been dealt with. The difficulty faced bybeen dealt with. The difficulty faced by
developing nations is to deal with thesedeveloping nations is to deal with these
dual sources of disease without adequatedual sources of disease without adequate
economic resources.economic resources.

35. The speed of changeThe speed of change
Populations in the developingPopulations in the developing
world are increasing at a muchworld are increasing at a much
faster rate than countries infaster rate than countries in
the developed world. It isthe developed world. It is
much easier for countries tomuch easier for countries to
adjust to gradual population transitions than toadjust to gradual population transitions than to
these rapid changes. Population increase atthese rapid changes. Population increase at
such a rate that all policy systems have not keptsuch a rate that all policy systems have not kept
pace. The speed of the transition and thepace. The speed of the transition and the
economic cost make it nearly impossible for d.economic cost make it nearly impossible for d.
countries to provide all needs of citizens.countries to provide all needs of citizens.

36. QUALITY OF LIFE QOLQUALITY OF LIFE QOL
 WHO defined QOL as the individualWHO defined QOL as the individual’’ss
perception of position in life in relation toperception of position in life in relation to
his goals, expectations, standards andhis goals, expectations, standards and
concerns.concerns.
 It is to live normal life, to feel happy,It is to live normal life, to feel happy,
achieve your goals and to be satisfied withachieve your goals and to be satisfied with
your self and your surroundings.your self and your surroundings.
 It is the sense of wellbeing.It is the sense of wellbeing.

37. Why measuring QOLWhy measuring QOL??
 To evaluate the effects of health (and other)To evaluate the effects of health (and other)
services on citizenservices on citizen’’s life. The higher the score ofs life. The higher the score of
QOL the better is the promotion services.QOL the better is the promotion services.
 To classify health hazards according to theirTo classify health hazards according to their
effect on QOL (in putting priorities)effect on QOL (in putting priorities)
 To evaluate the effects of different lines ofTo evaluate the effects of different lines of
treatment on patients.treatment on patients.
 To evaluate the rehabilitation methods used byTo evaluate the rehabilitation methods used by
handicapped.handicapped.

38. How to assess QOL?How to assess QOL?
By using questionnaires :By using questionnaires :
1- physical aspects1- physical aspects
2- psychological aspects2- psychological aspects
3- spiritual aspects3- spiritual aspects
4- social aspects4- social aspects
5- environmental aspects5- environmental aspects

39. Global burden of diseaseGlobal burden of disease
Using certain indicators as:Using certain indicators as:
 QALY= quality adjusted life yearsQALY= quality adjusted life years
 DALY=disability adjusted life yearsDALY=disability adjusted life years
 YLL= years of life lostYLL= years of life lost
 YLD=years lost due to disabilityYLD=years lost due to disability

40. Thank youThank you

41. Health educationHealth education
Definition:Definition:
Is planned opportunities for people to learnIs planned opportunities for people to learn
about health and make changes in theirabout health and make changes in their
behaviorbehavior
Steps: to know (knowledge)Steps: to know (knowledge)
to feel importance to health(attitude)to feel importance to health(attitude)
to changeto change (practice)(practice)

42. Era of health educationEra of health education
 Improvement of quality of lifeImprovement of quality of life
 Restore state of good healthRestore state of good health
 Make the best of remaining healthMake the best of remaining health
i.e. in health promotion, prevention ofi.e. in health promotion, prevention of
hazards, control of disease andhazards, control of disease and
complications and in rehabilitation.complications and in rehabilitation.
i.e. in physical, mental, social healthi.e. in physical, mental, social health
it is life long process.it is life long process.

43. Health educationHealth education
 Source or educator (doctor, nurse, T.V.,Source or educator (doctor, nurse, T.V.,
book, film)book, film)
 Message (knowledge, information body)Message (knowledge, information body)
 Channel (method): face-face or broad castChannel (method): face-face or broad cast
 Receiver : the target of the processReceiver : the target of the process
 Noise (barriers): factors decreasingNoise (barriers): factors decreasing
responseresponse

44. Health educationHealth education
Health education program:Health education program:
 What is the message?What is the message?
 Who will give it? Who is our target?Who will give it? Who is our target?
 How it will be given?How it will be given?
 Where?Where?
 When? How frequent?When? How frequent?
Evaluation of program.Evaluation of program.

45. Community participationCommunity participation
 People sharing the same culture, experience,People sharing the same culture, experience,
problems, place they live, language, religion.problems, place they live, language, religion.
 C. participation is important in:C. participation is important in:
1- success of health education program1- success of health education program
2- improving health services2- improving health services
3- giving power to people to solve health problems3- giving power to people to solve health problems
and criticize un-needed health servicesand criticize un-needed health services oror
health policy.health policy.
4- gaining a health responsibility4- gaining a health responsibility

46. Community participationCommunity participation
How?How?
 Involve representatives in planning andInvolve representatives in planning and
execution team. (in health education)execution team. (in health education)
 Population needs must be assessed inPopulation needs must be assessed in
health planning. They can evaluate alsohealth planning. They can evaluate also
 Help people to get knowledge, skills,Help people to get knowledge, skills,
information, fund.information, fund.
 Enable all population sectors to representEnable all population sectors to represent
themselves.themselves.

47. Behavioral scienceBehavioral science
How people think in health & diseaseHow people think in health & disease
 For health promotion & educationFor health promotion & education
 To improve doctor-patient relationshipTo improve doctor-patient relationship
 To solve health problems easily.To solve health problems easily.
People differ in behavior because ofPeople differ in behavior because of
demographic factors & psychologicaldemographic factors & psychological
factorsfactors

48. Health belief modelHealth belief model
Healthy individuals perceive risk, itsHealthy individuals perceive risk, its
severity, that heseverity, that he’’s susceptible, realizes susceptible, realize
the benefits of protection from risk,the benefits of protection from risk,
certain barriers prevent him fromcertain barriers prevent him from
taking action. He has motive fortaking action. He has motive for
change. He either decides to act atchange. He either decides to act at
once (with or without trigger) or cancelonce (with or without trigger) or cancel
the whole subject.the whole subject.

49. Health belief modelHealth belief model
Perception of disease
severity
motivation
personal
external
cancel
action relapse
Healthy
behavior

50. Behavior in illnessBehavior in illness
Disease
Do
nothing
Self
treatment
Go to
doctor
treatment
Not
adherent
compliance
cured

51. Factors affecting illness behaviorFactors affecting illness behavior
 Severe, prolonged or frequent symptom.Severe, prolonged or frequent symptom.
 Unusual symptomUnusual symptom
 Personal tolerance to symptomPersonal tolerance to symptom
 Culture and knowledge about symptomCulture and knowledge about symptom
 Stigma of diseaseStigma of disease
 Doctor-patient relationshipDoctor-patient relationship
 Availability of reliable health servicesAvailability of reliable health services
 Cost of service & ttt. Time wasteCost of service & ttt. Time waste

52. CommunicationCommunication
• Definition :it is a dynamic, continuous
and reciprocal sending, receiving and
comprehending messages, feelings &
ideas.
• Relation between communication&health
1. For history taking, counseling
2. For health education
3. Patient satisfaction & adherence to ttt

53. Steps of communicationSteps of communication
• Initiation of simple introduction
• Listening carefully to your client
• Probing to assure your care, observation
of non-verbal expressions
• Giving information: clear, concise,
summarize, in simple language etc..

54. Methods of communicationMethods of communication
• Verbal : spoken or written words
• Non-verbal: any other method except
words e.g.:
1. Body movement, posture, sitting, walking
2. Facial expressions
3. Touch ,shake hands
4. Personal appearance: cloths,hair
5. Voice interference.

55. Barriers to communicationBarriers to communication
• Environmental
• Pathological
• Language
• Personal : SE, values, belief, experience
• Psychological :stress, anger, tiredness