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Concept of Health Promotion

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Concept of Health Promotion

  1. 1. Concept of Health Promotion Rakesh Singh BPH, MPH, DGH Nepal Bidhya Bhusan Lecturer School of Public Health Patan Academy of Health Sciences 6/1/18 Concept of HP - Rakesh Singh
  2. 2. Nowadays we hear a lot about Health Promotion (HP).... People refer to it in workshops and meetings.... Directors in DOHS use this term to describe nature of their work and development workers discuss HP in relation to health campaigns... But what is HP? What does it aim to do? What ideas underpin HP? 6/1/18 Concept of HP - Rakesh Singh
  3. 3. TASK 1 - Identify common features of Health Promotion projects/programmes What examples of Health Promotion projects or campaigns do you know of, either at a national level or in your local district or region or state? What do all these projects/programmes have in common? 6/1/18 Concept of HP - Rakesh Singh
  4. 4. National HP projects What they have in common Open Defecation Free Campaign § They raise awareness and promote skills to assist people/groups to change behaviour that is detrimental to their health. § They develop supportive environments in which healthier choices are easier choices. § They … improve health GBV: Zero Tolerance Red Ribbon HIV/AIDS Awareness Campaign Child Abuse Helpline Health promoting settings, e.g. Health Promoting Schools Health warnings on tobacco advertisements 6/1/18 Concept of HP - Rakesh Singh
  5. 5. Feedback • .....HP programmes are often not flagged or labelled as such. • Instead, they are often found embedded within the broad activities of health and developmentorganisations. • They are also found in a variety of different settings, and assume different approaches. • HP activities are likely to be hidden within comprehensive integrated health activities of inter-sectoral action. 6/1/18 Concept of HP - Rakesh Singh
  6. 6. Other common features of HP programmes • Provide information about health enhancing initiatives, health issues or a particular behaviour that has a negative effect on health e.g. no smoking campaigns. • Refer the public to other supportive structures or organisations that provide additional support to the particular issue e.g. a Childhelplinecounsellingservice. 6/1/18 Concept of HP - Rakesh Singh
  7. 7. Contd… • Encourage the development of working partnerships across different sectors e.g. between health and transport, housing, engineering and planning. • Contain health promoting messages that are targeted at specific audiences and sometimes, developed in consultation with the target audience. • Contribute towards the development or implementation of healthy publicpolicy. 6/1/18 Concept of HP - Rakesh Singh
  8. 8. Before exploring these Health Promotion features further, let us look more closely at what we mean by the concept Health Promotion. 6/1/18 Concept of HP - Rakesh Singh
  9. 9. • Looking at any complex society, one can identify three overlapping sectors of health care: 1. the popular sector i.e. the lay or non-professional sector; 2. the folk sector i.e. the traditional or sacred sector 3. the professional sector i.e. the legally-sanctioned sector such as western scientific medicine. • Each sector contributes to how one might experience and interpret what being healthy or sick means. 6/1/18 Concept of HP - Rakesh Singh
  10. 10. • For example, under popular sector, one might start constructing one’s idea about health and illness from personal experience. q Experience of being sick, or taking care of family who is sickly. q Listening to neighbourhood or community beliefs or advice about how to keep away colds in winter or how important it is to eat certain foods to combat a particular illness. 6/1/18 Concept of HP - Rakesh Singh
  11. 11. • Under folk sector, one construct ideas about health and illness from a traditional healer, a diviner or a spiritualist. q Health and illness is viewed by many in this sector as holistic with all aspects of life being equally important. q In other words, one’s relationship with others, the natural environment, supernatural forces and any physical and/or emotional symptoms would all be considered in a consultationwith such a healer. 6/1/18 Concept of HP - Rakesh Singh
  12. 12. • Professional sector - western scientific medicine or allopathy, includes medical practitioners. This sector holds a dominant positionin our society. • People’s ideas about health and illness will not be constructed from any sector alone – nor will they necessarily seek relief from illness from a single health practitioner or healer. • A health worker need to move between the popular, the folk and the professional sector. 6/1/18 Concept of HP - Rakesh Singh
  13. 13. Understanding the Perception regarding these differences ? 6/1/18 Concept of HP - Rakesh Singh
  14. 14. DIFFERENT CONCEPTS OF HEALTH • Difficult to define as everyone has a different concept of health • But it can be conceptualised or understoodmentally • In other words, you can describe your concept of health but not necessarily define it. • The important thing is to think about your concept of health and to be able to articulate and communicate it to others. 6/1/18 Concept of HP - Rakesh Singh
  15. 15. Contd… • Equallyneed to respect other’s concepts of health. • If to my neighbour or my colleague, being healthy means being fit and never being ill, whereas to me health means to have a sense of wholeness, well-being and peace – one should acknowledge and respect this difference in opinion. 6/1/18 Concept of HP - Rakesh Singh
  16. 16. Contd.. • Many researchers and writers have explored different definitionsor concepts of health. • Discussed in terms of lay and health professional concepts or definitionsof health. • For example, a British Sociologist, Mildred Lillington Blaxter (1990) working from a British sample of 9000 people, grouped their lay definitions of health into a number of different perspectives. It included: 6/1/18 Concept of HP - Rakesh Singh
  17. 17. Contd… • Health as not ill or diseased i.e. the absence of disease. • As individual behaviour e.g. if someone lives in a healthy way, does exercise and or does not drink or smoke. • Physical fitness e.g. being fit or strong, or lookinghealthy. • Energy e.g. having energy and enthusiasm to do things. • Social relationships e.g. health in terms of relationships with other people. • Function e.g. being able to carry out normal routines or having the ability to do things. • Psycho-social well being e.g. being in a state of good mental health. 6/1/18 Concept of HP - Rakesh Singh
  18. 18. Contd.. • Consider how important it would be if you were developing a national HP campaign (for example with the 9 000 individuals that Blaxter included in her sample), to bear in mind just how diverse people’sideas about health are. • Also important to bear in mind the influence that the popular, folk and professional sectors have on influencing your audience’s interpretationof health. 6/1/18 Concept of HP - Rakesh Singh
  19. 19. • Discussing professional as opposed to lay perceptions of health, it is notable that perceptions are influenced by particular model of health or illness to which they subscribe. • In HP literature there are often references to two opposing views of health: the bio-medical model and social model of health. 6/1/18 Concept of HP - Rakesh Singh
  20. 20. Medical and Social Models – two views of health • Bio-medical- “the absence of disease” ....Assumption-disease is generated by specific agents- changes in the body... Emphasises the importance of alleviating symptoms or curing diseases. • Define health “… more by what it is not than what it is”. • This model halts its analysis at the actual disease – exploring other determinants (apart from specific agent). • Limited emphasis on preventionof disease. 6/1/18 Concept of HP - Rakesh Singh
  21. 21. Social Model • Views health and ill health as being caused not by diseases alone but by social conditions(poverty, gender, violence.....) • Emphasises positive side of health...Defines-in terms of a state of well-being. • The link between the physical, psychological and social processes also suggests that health is more holistic in nature, as is illustrated by WHO Definition. 6/1/18 Concept of HP - Rakesh Singh
  22. 22. • Health Promotion: A Discussion Document on the Concept and Principles, WHO – health as a human right and something which requires prioritisation and social investment by all, including governments, organisations, business and others. • “The extent to which an individual or group is able,...to realise aspirations (desire) and satisfy needs, and...to change or cope with the environment. Health, therefore, is seen as a resource for everyday life, not an object of living; it is a positive concept emphasising social and personal resources, as well as physical capacities” (WHO, 1984). 6/1/18 Concept of HP - Rakesh Singh
  23. 23. TASK 2 - Classify different perceptions of health Responses to “What is needed in order to feel healthy and live a healthy life?. Classifythese responses accordingto the two different models ofhealth. Having money No natural disasters (e.g. floods) Having interesting, challenging work Having a flushing toilet Good roads Feeling secure from danger or threat Not to have diseases I can’t easily cope with Not to have TB Not smoking Protected from discrimination Having good friends Having a job Having a house No violence Feeling happy Having enough food Feeling well, happy, stimulated by life and spiritually content A clean environment Feeling spiritually fulfilled Being fit and lean To feel strong and keen to take on new challenges 6/1/18 Concept of HP - Rakesh Singh
  24. 24. a. Different ways of classifying these responses. b. Being healthymeans different things to different people.Influenced by: q The context in which they are living e.g. geographical or physical location, housing,income,employment status. q Current health status. q Knowledge,experiences and beliefs about health. As a health promoter, it is always important to reflect on what being healthy means to you and what it means to your clients, .... important influence on the approach to HP. c. As a health promoter there will invariably be things that you cannot directly help your clients with. For example, ensuring that there is an accessible, well maintained and safe public transport system falls outside of health service’s responsibility. However, a health worker.....start lobbying...to put more traffic officers on duty around schools and parks, or to run educational campaigns about road safety at primary schools.....HW begin to work inter-sectorally to reduce the high rate of traffic accidents or to increase road access to rural villages. Professional skills or experience Broader developmental issues 6/1/18 Concept of HP - Rakesh Singh
  25. 25. BIO-MEDICAL MODEL OF HEALTH INDIVIDUAL COMMUNITY §Not to have diseases I can’t easily cope with §Not to have TB §To quit smoking §To be fit and lean §To feel strong and keen to take on new challenges §Having money §Having a job §To be happy §Protection from discrimination §Having good friends §No violence §Good roads §A clean environment §Having a house §Feeling secure from danger §Having a flushing toilet §Having enough food §No natural disaster (e.g. floods) §Having interesting work §Feeling spiritually fulfilled §To feel well, happy and stimulated in my life, and to be spiritually content SOCIAL MODEL OF HEALTH6/1/18 Concept of HP - Rakesh Singh
  26. 26. Dimensions of health • When people speak about being healthy, they refer to a number of different areas of their daily lives. • These different areas have been conceptualised as different dimensions of health. 6/1/18 Concept of HP - Rakesh Singh
  27. 27. PHYSICAL MENTAL EMOTIONAL SOCIAL SPIRITUAL SEXUAL ENVIRONMENTAL SOCIETAL Dimensions of Health 6/1/18 Concept of HP - Rakesh Singh Individual D Broader/Societal D Health interrelated to all aspects “Holistic Concept of H”
  28. 28. TASK 3 – Define (Health) Promotion a) What does promote or promotion mean to you? b) Given your concept of health, what does Health Promotion mean to you? c) In order to promote health what information do we first need to understand? 6/1/18 Concept of HP - Rakesh Singh
  29. 29. Feedback a) To promote means to advance, assist, encourage, lend support to, market, publicise, help the progress of something, push for. b) Health Promotion means to advance, to assist or to push for a better healthier life for people. To use an analogy: health and development workers often feel like they spend all their time standing on the banks of fast flowing river lifting people to safety. The health promoter works upstream and tries to find out why people are falling into the river from the beginning and how one can work together in preventing such things from happening in the future. c) In order to promote health effectively with individuals and communities, first need to understand the causes or determinants of ill-health. 6/1/18 Concept of HP - Rakesh Singh
  30. 30. Determinants of Health • Two other factors which affect our way of seeing or conceptualisingHP: 1. Determinants or causes of health and ill health 2. Inequity and explore how these factors impact on definition and understandingof HP. 6/1/18 Concept of HP - Rakesh Singh
  31. 31. • Like your definition of health, what you view as the determinants or causes of health also influences your interpretationof HP. • They affect the way you view the purpose of HP and the kinds of interventionsthat you choose to make. 6/1/18 Concept of HP - Rakesh Singh
  32. 32. TASK 4 - Identify some of the determinants of health and ill- health Jot down categories of determinants or causes of health or ill- health and rank them according to which ones you think are the most important or have the most influence. 6/1/18 Concept of HP - Rakesh Singh
  33. 33. 1. Genetic factors - determine individual’s predispositionto disease. 2. Biological factors - diseasecaused by bacteria or viruses. 3. Individual behavioural factors - contribute to disease, such as smoking, drinking, lack of exercise. 4. Socio-culturalfactors,such as traditional,religious beliefs and practices. 5. Factors around work and living conditions, such as housing, sanitation, transport, access to health services, income, adequate nutrition and employmentopportunities. 6. Environmentalfactors,such as pollution, level of violence. 7. Broader political, economic and social factors, such as a country’s constitution and laws, prevailing economic system, the available resources and how these are distributed. These factors affect the way in which a society is structured or stratified, e.g. in terms of class, gender, race, age. They also impact upon the other factors. DETERMINANTS 6/1/18 Concept of HP - Rakesh Singh
  34. 34. Ranking of Determinants • Influenced by your view of health and in turn influence where you, as a health promoter,place your efforts. • Depend on your judgement of the issues, but also the perspectives of those you work with and the feasibilityofanyintervention. • For example, if you were working with a group of youth and believed that individual behavioural factors as the most important determinant to tackle, you might focus on individual skills building session. These could include discussion sessions on how youth could stop smoking or taking drugs or how they should practise safer sex or encourage youth to take up some form of sport. • However, if environmental factors such as the high levels of violence or factors associated with poor living conditions were seen as priorities, you might focus on advocating for the development of community safety programmes, or for changes to be made in the design and layout of low-cost housing schemes, and you might work with the local communities to become involved in lobbying for stricter legislation regardinggender-based violence. 6/1/18 Concept of HP - Rakesh Singh
  35. 35. How the categories interact • Political, economic and social factors - affects the other categories in various ways. • For instance, consider how the following government laws and policies could determine and change economic and social conditions and how those changes would impact on other levels of health: q Providinghousingsubsidies for the poor. q Expandinglocal health facilities to rural areas. q Ensuring equal work opportunities for men, women and the physically challenged. q Restrictingthe levels of industrialpollution. q Assertingthe propertyand inheritance rights of women . q Supportingthe right of women to terminationofpregnancy. q Banningsmokingin publicplaces and prosecutingdrunken drivers. 6/1/18 Concept of HP - Rakesh Singh
  36. 36. Contd… • This intervention could improve the environment as well as the working and living conditions. It could also challenge unhealthy cultural and social practices, and reduce the negative effects of these factors, particularly on the health status of disadvantaged or vulnerable groups. • These broad determinants all have a major impact on the health of the population. 6/1/18 Concept of HP - Rakesh Singh
  37. 37. TASK 4 – Classifying the determinants of HIV/AIDS In the first column of the diagram below, jot down all the determinants that you can think of in relation to women’s experience of HIV/AIDS. Classify each of your determinants by ticking the category of determinants, into which it fits (provided two examples of determinants to guide you). Think of ways in which any of these categories of determinants are linked? Categories of determinants Determinants Genetic & biological Individual beliefs Socio- cultural Work & living conditions Environ- mental Political, economic,s ocial Anatomically, women are more at risk of HIV infection than men. √ Some religions forbid the use of condoms, thereby increasing the risk of HIV transmission. √ Include further determinants here. ê Classifying the Determinants of HIV 6/1/18 Concept of HP - Rakesh Singh
  38. 38. • What we are trying to illustrate here is the complexity of the situation and the fact that many different factors contributeto this/any health problem. • Addressing it as health promoters therefore requires you to be aware of the complexity of the determinants and their inter-connectedness. 6/1/18 Concept of HP - Rakesh Singh
  39. 39. Determinants Discussion of the interconnections between determinants Genetic & biological factors HIV, a virus, passes from one person to another through vaginal fluids and semen, during sexual intercourse, through blood, during childbirth, infected blood, through a needle stick injury or through IDUs. Anatomically women at more risk, as larger exposed surface area of the vagina and labia. In addition, mucosal surfaces in vagina are more susceptible to be affected compared to hardened penile skin. It is well documented that co-existing STDs increase the risk of HIV transmission – 9 times greater where one partner is HIV+. Women are particularly vulnerable in relation to this risk, as their symptoms are often non-specific or asymptomatic or might not be perceived to be serious enough to seek treatment. STDs in women thus often go undetected, thereby increasing women’s risk of HIV and giving rise to infections. INTER-CONNECTEDNESS OF, DETERMINANTS OF HIV/AIDS EPIDEMIC IN RELATION TO WOMEN’S EXPERIENCE 6/1/18 Concept of HP - Rakesh Singh
  40. 40. Determina nts Discussion of the interconnections between determinants Individual behavioural factors Men and women who have many sexual partners and do not use condoms, IDUs who share needles and syringes and HW who do not practise universal precautions are placing themselves and others at risk of HIV transmission. The use of alcohol and drugs... rational decisions about safer sex practices... in relation to the HIV epidemic. For example, ... Decisions regarding using a condom, having safer sex or in fact deciding not to have sex. Alcohol level of violence, including sexual violence, which would then place women in a position of risk. 6/1/18 Concept of HP - Rakesh Singh
  41. 41. Determinants Discussion of the interconnections between determinants (continued) Socio-cultural factors The practice of dry sex places women at increased risk of HIV infection due to vaginal tearing. Religious beliefs that forbid the use of condoms might place some women at risk of HIV infection. Women are often blamed or stigmatised for having a STD and thus might not seek early treatment for the infection. Traditional beliefs and perceptions about masculinity, to demand sex from his partner whenever he desires, or that wearing a condom reduces a male’s sexual power, also place women at risk of HIV. 6/1/18 Concept of HP - Rakesh Singh
  42. 42. Determinants Discussion of the interconnections between determinants (continued) Factors around work and living conditions In some communities, women do not have equal access to on-going training and tend to be excluded from the formal economy. Where women have been able to access skills and training, they have not always had the power to negotiate equivalent work positions or conditions as their male colleagues. Having had less choice around what work they are able to do, women have often had to explore other work options, such as sex work, or in some cases, accepting gifts, favours or a place to stay, in return for sex. In these situations, where women are economically dependant on their clients/men, they are likely to be placed in a situation where they accept money for sex without using a condom, or have to suffer abusive sexual situations. The level of sexual violence is increasing thereby increases their vulnerability to HIV infection. Environmental factors General degradation of environment, for example, lack of street lighting creates an environment which is not safe for women to walk in. 6/1/18 Concept of HP - Rakesh Singh
  43. 43. Determinan ts Discussion of the interconnections between determinants (continued) Gender In general, women have less power, not in a position to talk about and negotiate safer sex practices. A woman is also more at risk of violence, abuse or rejection by her partner if she asks him to use a condom . Women have less power to negotiate equal salaries and employment opportunities....more economically dependent on men. This has had grave consequences for women when they have informed their partner that they are HIV+, as often the partners have literally chased the women out of their homes. Women have in many cases had to leave all their possessions and find accommodation elsewhere, which in turn has increased their vulnerability to further discrimination. Lack of appropriate information places women in a less informed position, where they are unable to anticipate or identify risky HIV practices. Information about human rights and the rights of women has also not been conveyed to young people.......domestic violence and customary marriage law of. 6/1/18 Concept of HP - Rakesh Singh
  44. 44. Determinan ts Discussion of the interconnections between determinants (continued) Broader political, economic, and social factors Migrant labour system....men often had multiple sexual partners, which placed their primary partner at risk of HIV infection when he returned home. Women were left to work at home....suffer considerable hardship and poverty. In case of husbands falling ill or dying, women are left in an even more vulnerable position. ...to have sex in exchange for food, shelter and support for their children. People are not aware of laws which protect people in the workplace and support anti-discriminatory HIV/AIDS. A lack of knowledge about these laws is disadvantageous to women, particularly in the workplace. For instance, a woman living with HIV/AIDS might face discrimination in relation to how her colleagues treat her....affect opportunities for promotion or to receiving benefits that she would normally receive ..... potentially at risk of experiencing different levels of discrimination in terms of their access to treatment, care and support. 6/1/18 Concept of HP - Rakesh Singh
  45. 45. Determinants Discussion of the interconnections between determinants (continued) Conflict, community instability, mass migration, breakdown in family relationships Years of conflict .... instability within communities....disintegration of support networks within the community, the separation of families and increasing numbers of orphans and street children. Increased poverty level and broken relationships place them at risk of HIV infection. Discriminatio n on the basis of race/caste/et hnicity Women from low caste and ethnic groups have limited power, access to skills development and the opportunity to make and act on decisions that impact on their own lives, including their health. 6/1/18 Concept of HP - Rakesh Singh
  46. 46. • Broader political, economic and social factors are linked to other determinants and have an influence,either negativelyor positively. • For example: q Migrant labour system. q The laws did not support the principle of equity or protect against discrimination. q Affected the working and livingconditions ofwomen. • Women were (and still are) not afforded the same status as men and not given equal access to formal employment and ongoing training opportunities. Their earning power is thus reduced, and until recently, they have not had adequate legal protection against gender discrimination in the workplace,or gender violence at home or in the broader community. 6/1/18 Concept of HP - Rakesh Singh
  47. 47. • Further example illustrate the link between socio-cultural, gender factors and biological factors. In a situation where a woman is placed at risk of HIV transmission for instance, when she is having sex with her partner, she might not have the confidence, the skills, the economic self-sufficiency or even the choice to insist that she is protected from the risk of HIV transmission. Coupled with her biological susceptibility, a woman is thus placed in a significantly more vulnerable position. • Another example is the situation of HIV+ woman who has to make complex decisions about motherhood. For instance, if she decides to have a child, she risks transmitting HIV to her child and then has to live with the consequences of this decision if her child is HIV+. If she decides not to have a child, she might face rejection and even potential abuse from her partner and her family. Mother-to-child transmission also inadvertently carries with it a stigma, as women are seen as the carriers of the disease. This reinforces a commonly held belief that women are in fact to blame for the epidemic. 6/1/18 Concept of HP - Rakesh Singh
  48. 48. • Ultimately all these determinants have a role to play in determining the level or health status ofthe individualor community. • Because of the relationship between all these factors, people working in the area of Health Promotion need to consider all of the determinants when developing and implementing an intervention in relation to women and HIV/AIDS (any health problem), whether targeted at the general public,at men, at the youth or at women. 6/1/18 Concept of HP - Rakesh Singh
  49. 49. LEVELS OF DETERMINANTS • National or global levels: Related to broader economic, political and social causes, such as the system, laws and regulations. • Environmental levels: Related to the living and working environments, and the natural environment. • Community levels: Related to community practices, attitudes and norms. • Individual levels: That are close to or part of an individual, like those relating to genetic, biological and physical causes and individual behaviour. 6/1/18 Concept of HP - Rakesh Singh
  50. 50. 6/1/18 Concept of HP - Rakesh Singh
  51. 51. • In HP, recognising how determinants are inter-linked, try to tap into and work with the different levels. • For example, with HIV, try to encourage young women to delay practising sex, or to ensure that they seek immediate treatment for STDs. This is an intervention that taps into the most individual or local level of determinants. • However, working with only one level of determinants could be detrimental to our health development workin the longterm. • For example, whilst we may be ensuring that women receive early treatment for their STDs, we have not adequately dealt with the fact that women also need to be provided with the skills to prevent STD infection. For instance, they need easy access to condoms and to be able to communicate effectivelywith their partners. 6/1/18 Concept of HP - Rakesh Singh
  52. 52. • As health promoters, different levels of determinants need to be looked upon so that development of realistic health promotion interventions can be done. Take for example the issue of the large numbers of children with scalds and burns. • As a health promoter working in such an institution, one would begin to think about what role the team could play or what would be an appropriate intervention to assist in reducing such accidents. 6/1/18 Concept of HP - Rakesh Singh
  53. 53. Perhaps asking the question “Why?” could begin such a brainstorm session: • Why are we seeing so many children with burns and scalds? • Is it because families are living in crowded, informal houses without adequate cooking and cleaning facilities? • Is it because adults are unaware of the care and precautions that need to be taken when using paraffin, gas or hot water near children? • Is it because children are being left at home unsupervised – without adequate adult supervision? • Is it because the accident prevention campaigns have been inadequate? • Is it because parents have no choice but to leave their children at home as they need to go out and work and are unable to afford regular childcare? 6/1/18 Concept of HP - Rakesh Singh
  54. 54. • By asking the question “why?”, focus on the cause upstream and then begin to consider how one might plan an intervention that focuses on both those determinants that are close to the individual (like educating parents and care-givers about safety in the home) and broader determinants like housing regulations,access to electricity and water and economicopportunities. • In planning an intervention, the HP team might consider setting up a joint project with the concerned stakeholders to host an awareness raising workshop. • Also consider advocating small business initiative to establish child care so that working parents can leave their children in safety. • The team might also consider working with local businesses that are selling gas, paraffin and cooking utensils to support a child safety campaign. For example, they could ask shop owners to display posters about safety and to stock and sell paraffin safety caps - a campaign which could be supported by a local community-based radiostation. 6/1/18 Concept of HP - Rakesh Singh
  55. 55. Health Promotion intervention Level of determinant Advocate that workplaces offer adequate opportunities for workers to be supported in taking their TB treatment. Establish a community-based condom distribution and education programme. Encourage TB patients to join a directly observed treatment shortcourse (DOTS) programme. Encourage family and household members ofTB patients to come to the clinics for screening. Advocate for the introduction oflegislation which ensures thatpeople living with HIV/AIDS are not discriminated againstin the workplace or within the health services. Encourage young adolescentwomen to delay practising sex. Produce preventive HIV educational materials and facilitate lifeskills sessions for youth. Educate children abouthow to clean their teeth regularly and correctly. Implementan inter-sectoral programme thatencourages other developmentprojects and organisations to work in collaboration with the health services in informing their clients abouthow to preventTB, the signs and symptoms of TB and how to access treatment. Advocate for an optimal level of fluoride to be maintained in the local water supply. Ensure that men and women seek immediate treatment for STDs. Advocate for improved quality in housing construction,so as to reduce overcrowding and improve ventilation. Run educational workshops on gender and violence for local councillors. Encourage parents to adopthealthy eating routines for their children e.g.less sugar and less frequently. TASK 6 – Identify levels of HP interventions Listed below are some HP interventions that have commonly been used in relation to the three health issues HIV/AIDS, TB and tooth decay. Identify which level of determinants each intervention tries to address. 6/1/18 Concept of HP - Rakesh Singh
  56. 56. Determinants close to the individual • Encourage youngadolescent women to delaypractisingsex. • Ensure that men and women seek immediate treatment for STDs. • Encourage TB patients to join a directly observed treatment shortcourse (DOTS) programme. • Encourage family and household members of TB patients to come to the clinics for screening. • Educate children about howto clean their teeth regularlyand correctly. • Encourage parents to adopt healthy eating routines for their children i.e. less sugar and less frequently. • Produce preventive HIV educational materials and facilitate lifeskills sessions for youth. • Establish a community-based condom distribution and education programme. 6/1/18 Concept of HP - Rakesh Singh
  57. 57. Determinants that relate to living and working conditions and the natural environment • Implement an inter-sectoral programme that encourages other development projects and organisations to work in collaboration with the health services in informing their clients about how to prevent TB, the signs and symptoms ofTB and howto access treatment. • Advocate that workplaces offer adequate opportunities for workers to be supported in takingtheir TB treatment. 6/1/18 Concept of HP - Rakesh Singh
  58. 58. Determinants that relate to broader economic, political and social causes, such as systems, laws and regulations • Advocate for the introduction of legislation which ensures that people living with HIV/AIDS are not discriminated against in the workplace or within the health services. • Advocate for an optimal level of fluoride to be maintained in the local water supply. • Advocate for improved quality in housing construction, so as to reduce overcrowdingand improve ventilation. 6/1/18 Concept of HP - Rakesh Singh
  59. 59. • A single HP intervention, whilst it might be aimed at a particular set of causes or level of determinants, might also have an impact on the other levels of determinants. • For example, running an educational workshop on gender and violence for local councillors (activist/leaders) in a community is a HP intervention aimed at increasing awareness about the issue....thus aimed at determinants close to individual. However, it might also encourage the participants to reflect on how safe their communityis for women. 6/1/18 Concept of HP - Rakesh Singh
  60. 60. • They might then lobby for changes in their environment and in local government regulations, which try to reduce the current level of gender violence.Such intervention might include: q Advocatinglife-skills programmesbe run in all schools. q Installingmore street lights in each neighbourhood. q Training the local health workers and police force on gender issues and gender violence. q Increasing the allocation of resources to the police service in order that more communitypolice officers can be employed at local police stations. q Introducing new regulations on the handling of domestic violence by the police. 6/1/18 Concept of HP - Rakesh Singh Individual L & W EnvBroader
  61. 61. • Dividing determinants into categories is a useful analytical tool that helps to recognise the importance of addressing the different levels of causes of ill health. • It is important in the process of planninga HP intervention to consider: q firstly, how the different levels of determinants interact with one another in causingill health or a disease,and q secondly, how HP interventions aimed at different levels of determinants could work alongside and complement one another. • Generally, an intervention aimed at only one level of determinant will have less chance of success than a Health Promotion intervention that recognises the different levels of determinants. 6/1/18 Concept of HP - Rakesh Singh
  62. 62. INEQUITY AND HEALTH PROMOTION • Talking about health determinants,inevitablyraises the issue ofinequity. • Individuals, communities and countries with the least resources unfairly carry the burden of ill-health and mortality. • The link between poverty and ill health is apparent where differences exist between the different sectors of our society. • The distribution of inequity generally reflects or falls along the lines of race, class, gender and age. 6/1/18 Concept of HP - Rakesh Singh
  63. 63. • When working in the field of HP, it is important to clarify what you and others understand health to mean, and what the causes or determinants of ill-health are. • It affects the way you and others view the purpose of HP, the ideals and values upon which HP activities are based and the choices made in developingHP interventions. • People’s definitions ofHP embodythese ideas. 6/1/18 Concept of HP - Rakesh Singh
  64. 64. TASK 7 - Summarise the factors which affect your understanding of HP Take some minutes to make a mindmap of your understanding thus far of the factors which affect your understandingofHealth Promotion e.g. inequity. So far we have looked at definitions, perceptions and determinants of health, including the issue of inequity. These ideas helped us to clarify what we mean by health. They are also crucial to understanding what we mean by Health Promotion. 6/1/18 Concept of HP - Rakesh Singh
  65. 65. TASK 8 - Analyse definitions of Health Promotion Read the six definitions of HP below. What concept and model of health and what determinants of health is each one likely to be based on? 1. “Health Promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, Health Promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being” (Ottawa Charter for Health Promotion, 1986). 2. “Health promotion is health education and related organisational, political and economic interventions that are designed to facilitate behavioural and environmental changes to improve health” (Green in Wass, A. 1994: 39). 3. “The terms health promotion and health education are not interchangeable. Health promotion covers all aspects of those activities that seek to improve the health status of individuals and communities. It therefore includes both health education and all attempts to produce environmental and legislative change conducive to good health. Put another way, health promotion is concerned with making healthier choices easier choices” (Dennis et al, in Naidoo & Wills, 1994: 77). 4. “Health Promotion work has to recognise the prevailing social, economic, political and cultural context in which we all live. In recognising the powerful links between personal and political issues, we assert the need to challenge inequalities and oppression wherever they may arise. Health promotion work seeks to oppose inequity and oppression based on race, ethnicity, age, gender, disability, class, sexual orientation and religious belief. The task of health promotion is to enable, facilitate and empower individuals, groups and communities in order that they gain and maintain control of their lives and their health. Education and training for health promoters must be compatible with these aims” (Dr Rachael Dixey, Leeds Metropolitan University, UK). 5. “Health promotion is the art and science of helping people change their lifestyle to move towards a state of optimal health” (O’Donnell ,M. in Reddy & Tobias, 1994: 23). 6. “Health promotion is a set of activities that aim to promote healthy living and to prevent disease through information, skills building and the provision of health care” (South African health and development worker). 6/1/18 Concept of HP - Rakesh Singh
  66. 66. • Definitions (1) to (4) emphasise the Social Model of health. They support the idea that health is a positive, holistic concept and that the health of individuals and communities is affected by a range of determinants (social, political, economicand cultural). • Whilst it is generally accepted that the Ottawa Charter is strongly based within a Social Model of Health framework, some people have interpreted the first line of the Charter as being conservative. In other words they believe that whilst one might be able to increase the level of control one has over one’s health, that does not necessarily mean that one is assured of being able to live in a good social environment. • Definitions (5) and (6) are somewhat narrower and seem to imply a focus on promoting the health of individuals. They emphasise biological and individual behavioural determinants. 6/1/18 Concept of HP - Rakesh Singh
  67. 67. Some of the common themes which underpin the first three definitions are: • HP is a process - it does not happen overnight, but is rather a longer-term set of sustained activities and interventions. • HP aims to improve the health status of individuals and communities and enable them to gain increased control over their health. • Based on the philosophyofself-empowerment. • Entails different strategies, such as providing information and building skills, to developingpolicyand legislation. • HP is not equivalentto health education,but encompasses it. • Involves inter-sectoral action and workingin partnershipwith other sectors. 6/1/18 Concept of HP - Rakesh Singh
  68. 68. • The last two definitions of HP are considerably more individualistic in their emphasis and would most likely be focused on working towards attitude and behaviour change within a health care setting. • They assume that individuals have considerable influence over their environment, and that a healthy outcome would automatically result from the changes made in behaviour. 6/1/18 Concept of HP - Rakesh Singh
  69. 69. • One of the challenges that a health promoter may be faced with is working in an environment where different parties hold different understandings ofHP. • Our conceptualisations affect our responses to health problems and strategies for HP; health promoters need to develop a way of dealing with these differences. The next task offers you an opportunity to prepare yourself for this problem. 6/1/18 Concept of HP - Rakesh Singh
  70. 70. TASK 9 – Managing different understandings of Health Promotion Imagine that you are going to set up a HP project involving health colleagues, other professionals (such as teachers and engineers) and community members. It is likely that everyone does not share the same understanding of health and of the role that determinants play in influencing health or ill health. People are also likely to have had different experiences, and thus have different levels of familiaritywith the concept of HP. a) How would this affect the project? b) How would you cope with this situation? c) What would you do at the start of the project? 6/1/18 Concept of HP - Rakesh Singh
  71. 71. Feedback • Universally, it is unlikely that a single concept of health, which is acceptable to all, will ever be developed. • Instead,diverse and competingdefinitions are inevitable. • This can lead to confusion, misunderstanding and lack of true co-operation when settingup a HP project. • Ultimatelythis can undermine the success of the project. • To address these problems and to work successfully with colleagues and the community, it is important for everyone involved to share their understandingofhealth and HP. 6/1/18 Concept of HP - Rakesh Singh
  72. 72. Contd.. • You could suggest that this be done as part of an ice-breaker or introductory exercise in your first meeting or workshop. • You could then reach consensus on the main elements of these definitions through group discussion. • This awareness-raising exercise could be the first step towards establishing a good working relationship and forging a closer understanding of what HP means for your team members. • It might also allow the group to start thinking about the appropriate level of determinants to target the HP intervention. 6/1/18 Concept of HP - Rakesh Singh
  73. 73. AIM GOAL Health Promotion A process of enabling people to increase control over the determinants of Health and thereby improve health It embraces actions •Directed at strengthening the skills & capacities of individuals so that they can change and cope with the environment. •Directed towards changing social, environmental & economic conditions to alleviate their negative impact on public or collective health and individual health. PRINCIPLES & METHODS •Participation is essential to sustain health promotion •Health Promotion action is not the responsibility of the health sector alone-it involves all sectors, systems and structures that govern our social, economic and physical environment. 6/1/18 Concept of HP - Rakesh Singh
  74. 74. TASK 10 – Reflect on your initial definitionof Health Promotion Look back at your definition of health promotion in Task 2. Are you still comfortable with this definition? If you are, that’s fine! However, if you feel that you have a different understanding of Health Promotion now, try rewriting your original definition to fit with your new thinking. 6/1/18 Concept of HP - Rakesh Singh
  75. 75. • By now, you probably have a fairly strong sense of how our values, experiences and our own critical perspectives influence the way we conceptualise Health Promotion,and therefore the strategies we use. • In order to develop our understanding even further, we need to look at the history of the Health Promotion Movement to find out where Health Promotion originated. 6/1/18 Concept of HP - Rakesh Singh
  76. 76. Forerunners of Health Promotion 6/1/18 Concept of HP - Rakesh Singh
  77. 77. AN OVERVIEW OF THE HISTORY OF HEALTH PROMOTION TASK 11 – Clarify some terms Historical accounts often describe particular events, gatherings of people, documents, laws etc as landmarks, milestones and watersheds. What do each of these three terms mean, in their original usage or literally and in everyday usage? 6/1/18 Concept of HP - Rakesh Singh
  78. 78. • A landmark literally means an object that is easily seen in a landscape. In everydayuse it means an important historicalevent. • A milestone literally referred to a stone that used to be placed beside the road to mark the distance between towns. In everyday use it also means an importantevent in life or history. • A watershed literally describes a line of high land from which streams flow down on all sides. In everyday use it means a turning point in the course of events. 6/1/18 Concept of HP - Rakesh Singh
  79. 79. TASK 12 – Think about the history and forerunners of Health Promotion a)What do you know about the history of Health Promotion? Where, when, how and why did it start? What were the landmark or watershed dates, events and documents associated with it? Jot down any knowledge you have in a mind map like the one below. b)The origins of the term Health Promotion is linked to activities that took place around the 19th centuryin Europe.Whyis this? c)Can you think of any examples of health promoting activities which took place earlier in history,and in places other than Europe? History of Health Promotion 6/1/18 Concept of HP - Rakesh Singh
  80. 80. a) Your mind map will be helpful in reminding you that you already have some prior knowledge about the topic b) 1. The term Health Promotion is associated with 19th century Europe because this was the first time in more recent history when public health concerns were officiallyrecognised and seen to be of national importance. 2. It is interesting to note that many of the popular Health Promotion texts start discussing the history of Health Promotion from this period (i.e. the 19th century) onwards and focus exclusively on public health legislation and reform that was implemented in Europe,Britain or North America. 6/1/18 Concept of HP - Rakesh Singh
  81. 81. Contd… 3. Very few writers begin discussing the history of Health Promotion by using examples of Health Promotion interventions from earlier centuries or describing traditional indigenous practices or beliefs about health and disease. 4. It is an interesting bias and reflects the focus of the authors on documenting events in their own countries for the interest of their first world readers. 5. It is also perhaps a reflection on the lack of documentation about indigenous health practices which were considered by many in the colonial era to be unscientific. 6. This was partly because practices were transferred from one generation to the next through oral tradition and oral communication rather than the written word. 6/1/18 Concept of HP - Rakesh Singh
  82. 82. Contd… c) However, histories of Public Health show that some form of collective public health measures have always been implemented by societies. Strategies to promote health would have inevitably formed a part of these measures, although these would not have been called HP. Examples include: -The Roman publicbaths. -Roman laws governing burial of the dead and regulating dangerous animals and unsound goods. -The regulation ofprostitution in Ancient Rome and Greece. -Inoculation against smallpoxin India and China before the Christianera. -The isolation of people with leprosy in Europe in the Middle Ages (5-15th Century. -The quarantiningofships by the Venetians (Italy). 6/1/18 Concept of HP - Rakesh Singh
  83. 83. • Western concept of public health and concepts of health and disease would have had little relevance or significance to the indigenous people as hunter gatherers they did not have the Public Health problems associated with permanent settlements. • Traditional healers use of natural products for healing was part of the indigenous practice which had little connection to European concepts of Public Health. • The world including developing nations have a rich history of indigenous healing. To what extent has this indigenous practice been incorporated into the recordingof our local Health Promotion history? 6/1/18 Concept of HP - Rakesh Singh
  84. 84. Health Promotion Era Milestones in the development of health promotion 6/1/18 Concept of HP - Rakesh Singh
  85. 85. The Health Promotion Movement The four key movements or eras affecting HP: 1. Early Public Health Movement i.e. the concern with environmental conditions. 2. Medical Era i.e. the belief that medicine had all the answers. 3. Health Education Era i.e. that medicine does not have all the answers. 4. New Public Health Movement/Health Promotion Era i.e. that Health Education does not solve everything and can result in blaming the victim. 6/1/18 Concept of HP - Rakesh Singh
  86. 86. DIFFERENTIATING HEALTH EDUCATION AND HEALTH PROMOTION • Since the mid-1980’s, there has been considerable debate about the difference between Health Promotion and Health Education. 6/1/18 Concept of HP - Rakesh Singh
  87. 87. TASK 12 – List the differences between Health Education and Health Promotion Jot down the main differences between Health Education and Health Promotion in terms of their •Aims. •Activities and strategies. 6/1/18 Concept of HP - Rakesh Singh
  88. 88. • Both have the same aim, “to improve or protect health”. However, the scope of their activity varies. • In the case of HE, most activity centres on providing learning opportunities for individuals and communities so that they are able to voluntarily change their behaviour. • They acquire information and skills to help them initiate a change that enhances their well-beingand their health. • HP activity is much broader and includes both HE And: 1. The provisionofpreventative healthservices. 2. Measures to protect the physical environment and make it conducive to health 3. The mobilisationofcommunityresources. 4. The implementationoforganisational policies which promote health. 5. Economicand regulatoryactivities. 6/1/18 Concept of HP - Rakesh Singh
  89. 89. HP Vs HE • The two concepts,HE and HP are symbioticstrategies. • A key feature that distinguishes HP from HP is that HP involves environmental and political action. • Similarly, Tones and Tilford (2001) have suggested that it is possible to distil the concept of HP into an essential formula: Health Promotion = Health Education x HealthyPublicPolicy • HP is the product of both HE and HPP. • The multiplication sign x literally means to add a given amount several times over. • Here the given amount is HE which is added as manytimes over as HPP. • In other words, when HE and HPP are multiplied, they produce a far greater effect than just the sum of the two. HE and HPP - if implemented together produce an effect that is far greater than the individual parts. • This formula serves to illustrate how central both Health Education and policy are to the achievement of individual, community and national health status, and how symbiotic or inter-connected the relationship is between Health Education and the broader activityofHealth Promotion. 6/1/18 Concept of HP - Rakesh Singh
  90. 90. Contd.. • Some people viewed HE in a rather stereotypical way, reflecting a narrow field of activityand focusingon the individual. • HP, on the other hand has been positioned as the more politically correct approach to challenginghealth status. 6/1/18 Concept of HP - Rakesh Singh
  91. 91. Health Promotion is thus seen as the umbrella term that includes a whole range of activities, such as policy development, environmental or social action and organisational development. 6/1/18 Concept of HP - Rakesh Singh
  92. 92. Approaches to Health Education • HE is seen as a way of providing the public and in many cases risk groups with information; this information is intended to motivate them to change the behaviour that placed them at risk of developing a particular disease or set of diseases. • Diverse approaches to HE have emerged over the last century: q The two most common- preventive approach and the educational approach. q A third approach has also been implemented - the empowerment approach. 6/1/18 Concept of HP - Rakesh Singh
  93. 93. The Preventive Approach • Aims to provide individuals with knowledge, facilitate a change in attitude and, if successful, to galvanize the individual into action or into the practice of preventive behaviours. • The approach supports the use of a variety of persuasive communication strategies, for example, mass media campaigns, or individual educational sessions at a local clinic, to influence behaviour change. • This approach has been criticised for assuming that knowledge leads to a change in attitude. Take the issue of a healthy diet for example: whilst I know that cream cakes and donuts are unhealthy for me, I have not eliminated them from my diet. The same could be said for smoking. As a health worker, I know smoking is bad for me and that it has a negative impact on my health. However I am not planning to give up smoking. Both examples illustrate that the relationship between knowledge, attitude and behaviour change is not straightforward. 6/1/18 Concept of HP - Rakesh Singh
  94. 94. The Educational Approach • Aims to provide individuals with understanding and knowledge, facilitate a process of belief and value clarification, and develop and practise the skills to make informed decisions. • A key component of this approach is the recognition given to the value of voluntarism, i.e. that individuals should be free to make their own decisions, either now or at some future time, about their choice of action. • This kind of approach would be suitable as a basis for running workshops where individuals are or will be faced with havingto make a choice. • For example, the approach could be used in the various stages of a smoking cessation programme or in a dieting programme. It often includes a series of value clarification workshops. 6/1/18 Concept of HP - Rakesh Singh
  95. 95. The Empowerment Approach • This approach supports the idea of providing individuals with an opportunity to critically reflect upon their environment, as they acquire knowledge, to clarify their values and develop skills. • This enables them to maximise their chances of managing the environmental constraints - constraints over which individuals might find it difficult to exercise some degree of control, if they did not have adequate life skills. • This approach is very much a bottom-up approach and is like the process of communitydevelopment -with the health promoter as facilitator. • An example- health promoter working with teachers to develop programmes aimed at building the self-esteem of young girls, so that they are able to actively participate in their studies and to enter into relationships with greater self-confidence. 6/1/18 Concept of HP - Rakesh Singh
  96. 96. • HE models have been subject to a considerable amountofcriticism. • Concerns have been raised about their individualistic approach and their tendencytowards blamingthe victim. • For instance, how empowered are individuals to receive and to act on health education messages, when the context in which they live does not support or allowfor the necessarybehaviour change? • For example, it might be difficult for a teenager to stop smoking when adverts glamorise smoking and there is pressure on young people to smoke in order to fit into their peer group. 6/1/18 Concept of HP - Rakesh Singh
  97. 97. • Although HE has achieved some success in changing lifestyle, it has been realised that changes in individual behaviour would not bring about the necessary improvements or changes that are required to change patterns of ill health or disease. • Many of the changes that were required were beyond the power of the individual. • This is where the ideas of the New Public Health and Health Promotion arose. • Let us now take a few steps back and consider how this transition came about and what other influences have shaped the course of Health Promotion as we know it today. 6/1/18 Concept of HP - Rakesh Singh
  98. 98. HISTORY OF THE HEALTH PROMOTION 6/1/18 Concept of HP - Rakesh Singh
  99. 99. The Early Public Health Movement in Europe • In Northern Europe, the Industrial Revolution (late 18th century in Britain), and the growing popularity and attraction of cities resulted in massive changes in population patterns and in the physical environment in which people lived. • However, this rapid industrialisation also brought with it disease and social dislocation – the disintegration of family and social structures. • In Britain, the overcrowded and unsanitary living conditions of the poor, coupled with the rise of cholera and typhoid as major causes of death, placed pressure on the government to introduce reforms or legislation to promote public health. 6/1/18 Concept of HP - Rakesh Singh
  100. 100. Contd… • In 1842, Edwin Chadwick, responsible for leading a “Health of Towns Commission” and advocating for the first public health reforms, suggested that the ill health experienced by the poor was a result of poor housing, sanitation and unclean water. • His efforts resulted in the 1848 Public Health Act, which gave local authorities the powers to remedy unsanitary conditions and to require adequate drainage and sanitation in towns. • It was around this time (1854), John Snow discovered that cholera was a waterborne disease, by tracing an outbreak to a water pump in Broad Street, Soho, London. When use of the water pump was stopped, the outbreak stopped. • Experiences such as these, together with public health legislation led to the appointment of Medical Officers of Health by local authorities, to enforce public health legislation and advise on appropriate measures. 6/1/18 Concept of HP - Rakesh Singh
  101. 101. • Opinions differ about whether this early public health movement evolved out of a “desire to control disease and the poor who were seen to be the cause of it, rather than by a more altruistic desire to make a society a fairer place”. • Some theorists believe that the sanitary reforms that were introduced during this time were more about ensuring that the workforce was economically active and could support an efficient capitalist economy than about the redistribution of resources and better living conditions for the poor. • Altruism or control of the poor??? 6/1/18 Concept of HP - Rakesh Singh
  102. 102. The rise in popularity of the Medical Model • Motivations aside, at the end of the nineteenth century, the emphasis on improving environmental and social conditions in order to prevent ill- health was overshadowed by the rising popularity and investment in a medical (or curative) approach to tackling ill-health. • “As the most pressing environmental problems were brought under control, action to improve the health of the population moved on first to personal preventative medical services, such as immunization and family planning, and later to a range of other initiatives including the development of community and school nursing and school health services”. 6/1/18 Concept of HP - Rakesh Singh
  103. 103. Contd.. • Public health activity then entered a therapeutic era from the 1930’s, with the advent of insulin (which treats diabetes) and simple antibiotics. • Historically, this period was also characterised by “a weakening of departments of public health and a shift of power and resources to hospital-based services and particularly those based in teaching hospitals”. • Underlying this therapeutic orientation was an “… implicit assumption that magic bullets could be provided by the pharmaceutical industry for all conditions” 6/1/18 Concept of HP - Rakesh Singh
  104. 104. Contd… • This trend – that of placing greater emphasis and value on scientific medicine rather than on social, political and environmental measures to treat and prevent ill-health continued until the early 1970’s. • You will recall that this is a medical model approach as opposed to a social or Public Health model approach. • During this era, medical advances claimed much of the credit for extending life expectancy. • After the Second World War “medical progress seemed to promise that it would eventually be able to cure most diseases”. 6/1/18 Concept of HP - Rakesh Singh
  105. 105. Questioning the Medical Model • The social climate of the 1960s and 1970s was characterised by protest, activism and challenging of the status quo or existing conditions. • Examples are the Vietnam War, issues of gender equality and the Women’s Movement which were raised and protested about in public. • In addition, during the early 1970s, many countries were experiencing a crisis in health care costs. • People began to consider that whilst medicine might be good against acute illnesses like TB or pneumonia, it did not appear to have much to offer in other areas such as cancer. • The rates of cancer were still the same and there was still no cure for the disease. • Thus, value or returns from the investment in medical technology appeared to be decreasing. 6/1/18 Concept of HP - Rakesh Singh
  106. 106. Contd… • Studying the growth of the population in England and Wales, showed that, apart from the smallpox vaccination, immunisation or medical therapies were unlikely to have had a significant impact on mortality in the 19th and 20th centuries. • Further, mortality was in fact declining before effective medical interventions were available. • When ranked the major contributing factors to improvements in health in order of importance.... “…limitation in family size (a behavioural change), increase in food supplies and a healthier physical environment (environmental influences) and specific preventive and therapeutic measures”. 6/1/18 Concept of HP - Rakesh Singh
  107. 107. Contd… • Interventions from government authorities were critical in enabling health to be improved. • Collectively, it was established that there was importance of general standards of living and of state intervention in improving the health of populations - crucial ideas underpinning the new Public Health Movement. 6/1/18 Concept of HP - Rakesh Singh
  108. 108. The New Public Health Movement • The Lalonde Report is the first major landmark in what came to be known as the New Public Health era. • In 1974, the Canadian Minister of National Health and Welfare, Marc Lalonde,publisheda report entitled A New Perspective on the Health. • This report suggested that greater emphasis should be attributed to the environment and to behavioural factors as causes of disease and death, rather than biophysical characteristics. • This was a major change from the Medical Model:in what way did it differ? 6/1/18 Concept of HP - Rakesh Singh
  109. 109. Contd… • The Lalonde report described four health fields as having an influence on health and illness: 1. Medicine and health care services. 2. Lifestyle or behavioural factors. 3. The environment. 4. Human biology. 6/1/18 Concept of HP - Rakesh Singh
  110. 110. Contd… • Also proposed that critical improvements within the environment, combined with changes in behaviour could lead to significant reductions in morbidityand mortality. • This report is viewed by some as a highly significant watershed in that it “… signalled the turning point in efforts to rediscover public health in developed countries”. It did so by proposing that policies focus more on the preventionofillness than on treatment and cure. • Many people consider this report as marking the beginning of the New Public Health Movement. 6/1/18 Concept of HP - Rakesh Singh
  111. 111. A focus on lifestyle • Even though the Report broke with the Medical Model, the particular focus on individual behaviour or lifestyle was seen by some as cause for concern. • The focus was criticised because it was seen as narrow, failing to take into account the impact of social forces (e.g. peer influences, commercial marketing and the price of commodities)on behavioural choices. • As a result, the approach tended to ignore an individual’s social environment,or the context in which decisions were being made. • Greater emphasis was placed on individual responsibility. This led to the idea of self-imposed risk in relation to health. • In other words, people placed themselves at risk of ill-health through their choice of behaviour, e.g. drinking alcohol, taking drugs, getting pregnant unintentionallyand catchingSTDs. Contd… 6/1/18 Concept of HP - Rakesh Singh
  112. 112. Contd… • HP programmes based on the approach of the Lalonde Report would have focused on persuading people to change their health-related behaviour, which placed them at risk of disease. • This focus on lifestyle was characteristic of the 1970s and brought about different approaches to creating change in individual behaviours. • These approaches drew almost exclusively on psychological theory, with little regard for the individual’s social and economic circumstances. • Well known behaviour change models such as the Health Belief Model, the Theory of Reasoned Action and the Social Learning Theory were developed during this time. 6/1/18 Concept of HP - Rakesh Singh
  113. 113. Contd… • Parallel with this behavioural approach to Health Promotion, there was an increasing understanding of the structural causes of illness and health: in other words, those who did not subscribe to the ideas of Lalonde’s approach were developing one which took account of those causes that fell outside the control ofthe individual. • In line with this understanding, two significant WHO events occurred in the late 1970’s, which shaped the development ofHealth Promotion. q World Health Organisation: Global Strategy for Health for All by the Year 2000 (1977), and the International Conference on Primary Health Care, Alma-Ata (1978) 6/1/18 Concept of HP - Rakesh Singh
  114. 114. Contd… • In 1977, 30th WHA decided that the main health-related goal of governments and WHO in the coming decades should be directed at ensuring that all the people of the world attain a level of health that would permit them to lead socially and economically productive lives (Global Strategyfor Health for All by the Year 2000 -HFA 2000). • This global strategy was adopted in 1981 by 34th WHA and thereby accepted as WHO policy. • Member states of the WHO were invited to formulate their national policies, strategies and plans of action for attaining this goal and to act collectivelyin formulatingregional and global strategies. 6/1/18 Concept of HP - Rakesh Singh
  115. 115. Contd… • The significant feature of HFA 2000 was the recognition that the main determinants of health lay outside the health sector - namely food, water, sanitation,housing,employment etc. • This implied a global movement in which inequities between as well as within countries could be reduced. 6/1/18 Concept of HP - Rakesh Singh
  116. 116. Contd… • In 1978, the International Conference on Primary Health Care at Alma-Ata defined the key to achievingthe goal of HFA 2000 as Primary Health Care. • The Declaration on Primary Health Care at Alma-Ata was an important milestone in the development ofcurrent concept of Health Promotion. • In the early 1980’s, some of the key principles of the Primary Health Care approach such as equity, community participation, a focus on prevention and the need for multi-sectoral activity, were being incorporated into international discussions about a new concept – that of Health Promotion. • Community participation or community involvement in health development is central to any discussion which focuses on Health Promotion. 6/1/18 Concept of HP - Rakesh Singh
  117. 117. Principles of HP • The WHO later convened two working groups that focused on Health Promotion. • First, in 1984, a WHO working group met in Copenhagen and drew up an outline of the most important issues facing the development of Health Promotion policies and programmes. Arising from this, the WHO made explicit five key principles for Health Promotion: 1. Involves the population as a whole in the context of their everyday lives, rather than focusing on people at risk of specific diseases. 2. Directed towards action on the causes or determinants of health, to ensure that the total environment, which is beyond the control of individuals, is conducive to health. 6/1/18 Concept of HP - Rakesh Singh
  118. 118. Contd… 3. Combines diverse but complementary methods or approaches, including communication, education, legislation, fiscal measures, organisational change, community development and spontaneous local activities against health hazards. 4. Aims particularly at effective public participation, supporting the principle of self-help movements and encouraging people to find their own ways of managing the health of their community. 5. While Health Promotion is basically an activity in the health and social fields and not a medical service, health professionals, particularly in Primary Health Care have an important role in nurturing and enabling Health Promotion. 6/1/18 Concept of HP - Rakesh Singh
  119. 119. Contd… • In relation to these principles, the WHO noted that improvements in lifestyles, environmental conditions and health care will have little effect if fundamentalconditions are not met. • These conditions include peace or freedom from war, equality, satisfaction of basic needs,political commitment and publicsupport. 6/1/18 Concept of HP - Rakesh Singh
  120. 120. International Conference on Health Promotion, Ottawa, Ontario, Canada (1986) • Conference produced a critical document - the Ottawa Charter for Health Promotion. • Many of the principles outlined by the WHO in their earlier working group were developed further in the Ottawa Charter. 6/1/18 Concept of HP - Rakesh Singh
  121. 121. 6/1/18 Concept of HP - Rakesh Singh
  122. 122. • The Ottawa Charter outlined five areas in which Health Promotion action should be directed: 1. Buildinghealthypublicpolicy. 2. Creatingsupportive environments. 3. Strengtheningcommunityaction. 4. Developingpersonal skills. 5. Re-orientinghealth services. • It identified three ways (or strategies) in which health could be promoted, namelythrough: 1. Advocacy 2. Enablement 3. Mediation 6/1/18 Concept of HP - Rakesh Singh
  123. 123. Contd… • The Charter notes that HP strategies and programmes should be adapted to the local needs and that the differing social, cultural and economic systems within countries and regions should be taken into account when developingprogrammes. • The Conference tended to focus more on the needs of the industrialised countries,rather than developingcountries. • Alma Ata had a sense of abundance about it, Ottawa was characterised by restraint, reflecting the climate of the times in which the Charter was drafted. • The Charter has however been used worldwide as the basic framework around which Health Promotion activities are planned and is regarded as “...something of a mantra [or a set of guidelines] for health promotion workers”. 6/1/18 Concept of HP - Rakesh Singh
  124. 124. Pre-requisites of Health (Promotion) 1. Peace 2. Shelter 3. Education 4. Food 5. Income 6. A stable eco-system 7. Sustainable resources 8. Social justice 9. Equity 6/1/18 Concept of HP - Rakesh Singh
  125. 125. TASK 13 – Based on Ottawa Charter for Health Promotion a) Why is it important for health workers in developing countries to be aware of the prerequisites for health? b) How are these prerequisites for health linked to the principle of inter-sectoral collaboration proposed in the declaration of Alma Ata? c) What do the verbs to “advocate”, “enable” and “mediate” mean? d) What are some practical everyday examples of these three strategies or tools of Heath Promotion – “advocacy”, “enablement” and “mediation”? 6/1/18 Concept of HP - Rakesh Singh
  126. 126. Feedback • The Charter is based on the belief that a secure foundation in society- the fundamental conditions of “peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice and equity” - are prerequisites for health improvement. • Working in the context of a developing country, it is important for HP workers to reflect on the extent to which such prerequisites exist, and how these might affect the success or the outcome of HP interventions. • These prerequisites are linked to the principle of inter-sectoral collaboration, which is a way of helping to secure these conditions. This connection is summarised in the followingquote: “Health cannot be achieved by the health sector alone. In developing countries in particular, economic development, anti-poverty measures, food production, water, sanitation, housing, environmental protection and education all contribute to health and have the same goal of human development”(WHO-UNICEF, 1978: 40). 6/1/18 Concept of HP - Rakesh Singh
  127. 127. Contd… • To advocate means to speak in favour of something or to recommend it. • To enable means to provide the means or the ability to do something. • To mediate means to negotiate between opposing sides. 6/1/18 Concept of HP - Rakesh Singh
  128. 128. Contd… Examples of advocacy include: • Petitions drawn up by groups of people in response to a particular issue e.g. the lack of adequate protection provided to a community by the police service or the number of rapes occurring within a region or country. • Demonstrations e.g. a group of bus drivers and owners protesting outside of parliament about current transport legislation that restricts their business. 6/1/18 Concept of HP - Rakesh Singh
  129. 129. Contd… Examples of enablement include: • Trainingprogrammes and workshops. • Representative meetings e.g. all stakeholders involved in running a health clinic. Examples of mediation include: • Reaching agreement around co-ordinated action e.g. where the Health and Education Departments work together to develop health promoting schools within a local district. • Two parties coming to an agreement whereby individual interests are set aside in the interests of the health of a community e.g. after a meeting with the health department, a trucking company agrees to review their policy around the length of time drivers spend away from home and agrees to support an educational intervention for their long-distance drivers. 6/1/18 Concept of HP - Rakesh Singh
  130. 130. Strategies of health promotion Advocacy • Involves a process of pressurisingor pushingfor change. • Usually aimed at changing policies, laws or regulatory measures that either work against the development of optimal health or fail to protect the health of individuals and communities. • Often seen as a process of representing the rights or needs of marginalised groups such as street children, sex workers, people suffering from a particular health condition,or poor communities. • Collaborative process, gives a voice to the needs of a community and brings these needs to the attention of appropriate decision-makers, or those that have the power to change the unhealthy policies. 6/1/18 Concept of HP - Rakesh Singh
  131. 131. Contd… • Communication is an important component ofthe advocacy process. • Communication strategies include: 1. Interacting and engaging with the mass media, so as to profile the campaign and shape public debate around the problem that the campaign is addressing. 2. Producing and distributing educational media about the issue or the problem. 3. Networking with others in order to develop support for the campaign which often gives rise to the development ofcoalitions. 6/1/18 Concept of HP - Rakesh Singh
  132. 132. ADVOCACY VS LOBBYING??? 6/1/18 Concept of HP - Rakesh Singh
  133. 133. Advocacy VS Lobbying • Advocacy is generally used to describe the broad range of activities that one would do to influence change. • Lobbying refers to the specific work one would do to influence key decision-makers (like parliamentarians and local councillors). • It is suggested that the word lobbying came to be used like this because advocates would spend many an hour waiting in the parliamentary lobby in order to catch up and meet with parliamentarians! 6/1/18 Concept of HP - Rakesh Singh
  134. 134. Enablement • Enablement is a wayof workingwith others in a participative manner. • It is a process that encourages people to reflect on their own experiences and facilitates a process of learning and skills-building, which people can applyto their everydaylives. • The Ottawa Charter links enablement with equity(or fairness)in health. • For example, if we develop capacity or increase the skills of individuals or groups, be they health workers or members of the community, they will have more power to control the factors that determine their health. 6/1/18 Concept of HP - Rakesh Singh
  135. 135. Mediation • Mediation is a way of coming to an agreement, of seeking reconciliation, of settingaside individualinterestsand negotiatinga common goal. • The Charter links the term mediation to co-ordinated action between different players – a concept that is often referred to when we talk about inter-sectoral action. • The motivation behind working together is that co-operation produces greater output than competition. 6/1/18 Concept of HP - Rakesh Singh
  136. 136. 6/1/18 Concept of HP - Rakesh Singh
  137. 137. ASSIGNMENT 1 – Analyse HP projects in terms of the Ottawa Charter Look at the five areas of action and the three strategies in the Ottawa Charter. Think about a project in your own context, and analyse and Classify each project or initiative intothe five areas of action and the three strategies. 6/1/18 Concept of HP - Rakesh Singh
  138. 138. Feedback • In reality, it is difficult to distinguish into which particular action area a Health Promotion project falls or which particular strategy you are using or working with as a health promoter. • Inevitably the processes involved in one action area overlap with the work we do in another other area. • Very often we find we are working with all three strategies. • For example, in the process of developing a community campaign (advocacy), we often have to develop people’s skills or capacity in a particular area (enablement) and to facilitate agreement between the different parties involved in the campaign issue (mediation). • The important point in this exercise is to realise that for a Health Promotion project to be successful, it cannot work exclusively in one action area alone. There is a greater chance of change occurring if consideration is given to working across a range of areas of action. 6/1/18 Concept of HP - Rakesh Singh
  139. 139. • Following the development of the Ottawa Charter, the WHO convened a second Working Group on Health Promotion in Developing Countries in Geneva in October 1989. • The task of this group was to explore the application of Health Promotion concepts and strategies to developing countries and to recommend specific steps for translatingthese into action. 6/1/18 Concept of HP - Rakesh Singh
  140. 140. A CALL FOR ACTION • The summary statement produced by the working group meeting (convened by the WHO in 1989) for developing countries is called A Call for Action: Promoting Health in Developing Countries (WHO, 1991). It focuses on four main themes: 1. Issues (which are often in the form of challenges), that need to be considered in the field of Health Promotion. 2. The importance ofworking together to develop healthypublicpolicies. 3. Supportinggrass-roots strategies. 4. Strengthening political commitment to and national capability for Health Promotion. • The statement proposed that: “Immediate and sustained action is called for now in all nations,to move health promotion from concept to reality”. • Although developed over two decades ago, this document still provides a useful overview of some of the key issues that need to be considered in relation to Health Promotion in a developingcontext. 6/1/18 Concept of HP - Rakesh Singh
  141. 141. 6/1/18 Concept of HP - Rakesh Singh
  142. 142. The HP Emblem • Represents a circle with 3 wings • The main graphic elements of the HP logo are: 1. one outside circle, 2. one round spot within the circle, and 3. three wings that originate from this inner spot, one of which is breaking the outside circle. a. The outside circle, originally in red colour, is representing the goal of “Building Healthy Public Policies”, therefore symbolising the need for policies to “hold things together”. This circle is encompassing the three wings, symbolising the need to address all five key action areas of health promotion in an integrated and complementary manner. b. The round spot within the circle stands for the three basic strategies for health promotion, “enabling, mediating, and advocacy” c. The three wings represent the five key action areas for health promotion that were identified in the Ottawa Charter for Health Promotion in 1986 and were reconfirmed in the Jakarta Declaration on Leading Health Promotion into the 21st Century in 1997. 6/1/18 Concept of HP - Rakesh Singh
  143. 143. Contd… More specifically: • The upper wing represents that action is needed to “strengthen community action” and to “develop personal skills”. This wing is breaking the circle to symbolise that society and communities as well as individuals are constantly changing and, therefore, the policy sphere has to constantly react and develop to reflect these changes: a “HealthyPublic Policy” is needed; • The middle wing represents that action is needed to “create supportive environmentsfor health” • The bottom wing represents that action is needed to “reorient health services” towards preventingdiseases and promotinghealth. • Overall, the logo visualises the idea that HP is a comprehensive, multi- strategyapproach. 6/1/18 Concept of HP - Rakesh Singh
  144. 144. Recent Developments in Health Promotion 6/1/18 Concept of HP - Rakesh Singh
  145. 145. The Second International Health Promotion Conference • Held in Adelaide, Australia (1988). • Focused on the theme of healthy public policy. • At this conference, the DG of the WHO at that time explained that the main aim of developing healthy public policies was to create the preconditions for healthy living through: q closing the gap between social groups and between nations; q broadening people’s choices to make healthy their choices the easiest and most possible, and q ensuring supportive social environments. • The importance of community participation and collaboration between all sectors of government were emphasised as crucial aspects of healthy public policy. 6/1/18 Concept of HP - Rakesh Singh
  146. 146. The Third International Health Promotion Conference • Held in Sundsvall,Sweden in 1991. • Focused on linkingenvironmentalissues directlyto human health. • Emphasised that Health Promotion has been, and should be concerned with preservingand protectingnatural environments. • An important link was thus made at this international conference between those activities concerned with the promotion of health within communities and those activities that focus on protecting the natural environment. 6/1/18 Concept of HP - Rakesh Singh
  147. 147. United Nations Conference on Environment and Development (The Earth Summit) • Held in Rio de Janeiro,Brazil in 1992. • One of the outcomes of this conference was the development of a detailed action plan outlining how member states could work towards sustainable development. • By sustainable development they meant development which meets the needs of the present without compromising the ability of future generations to meet their own needs. • The action plan specifically highlights the role of local government in achievingthis sustainability. 6/1/18 Concept of HP - Rakesh Singh
  148. 148. The Fourth International Health Promotion Conference • Held in Jakarta,Indonesia in 1997. • First time it had been held in a developingcountry. • Focused on identifying directions and strategies to address the challenges of promotinghealth in the 21st Century. • The main outcome of the conference was the Jakarta Declaration. • In the Declaration, emphasis was placed on the importance of developing new alliances and partnerships, for example between private and public, and within government and non-government agencies. • In addition,the declaration adopts a settings approach to Health Promotion. • Settings refers to an approach to Health Promotion that focuses on a place or a setting in which people gather, such as a school or a workplace, as opposed to an illness or symptom. • Health promoters were urged to build new alliances for health, including private sector partnerships. 6/1/18 Concept of HP - Rakesh Singh
  149. 149. Contd… • In practice, this could mean that the local government structure, in collaboration with the local community, identifies the major social, economic and environmental issues that are going to pose substantial risks to the environment and to publichealth. • They then develop an integrated action plan to address the key issues, both in the short and long term. • Another approach might be for all stakeholders to identify key environmental and public health goals that they would want incorporated into the local government management plans, such as accessing affordable housing, improving public transport, and ensuring community safety. 6/1/18 Concept of HP - Rakesh Singh
  150. 150. Priorities identified by JD 1. Promote social responsibilityfor health 2. Increase investments for health development 3. Consolidate and expand partnerships for health 4. Increase communitycapacityand empower the individual 5. Secure an infrastructure for health promotion 6/1/18 Concept of HP - Rakesh Singh
  151. 151. The Fifth Global Conference on Health Promotion • Took place in Mexico City from the 5-9th June 2000. • It was entitled Bridging the Equity Gap. • It had the followingobjectives: q To show how Health Promotion makes a difference to health and quality of life, particularlyfor those livingin adverse conditions. q To place health high on the development agenda within international, national and local agencies. q To stimulate partnerships for health between different sectors and at all levels of society. 6/1/18 Concept of HP - Rakesh Singh
  152. 152. Brainstorm • In terms of the June 2000 HP conference,what is the significance of: a) The switch to calling it a “global” rather than an “international” conference? b) The conference objectives and what they suggest about the future direction ofHP? 6/1/18 Concept of HP - Rakesh Singh
  153. 153. Feedback a) The term “global” signifies that the conference is now bigger in scope, involvingcountries from all over the world,rather than just some nations. b) The conference objectives do not, however, introduce an entirely new agenda for HP. Instead theystress new priorities: • The role of HP in promoting development at all levels, particularly with regard to poor countries. • CollaborationaroundHP at all levels. 6/1/18 Concept of HP - Rakesh Singh
  154. 154. • The Bangkok Charter for HP (Thailand), 2005: New Context, Globalization (advocate for health based on human rights, invest in sustainable policies, actions and infrastructure, build capacity for policy development, leadership, HP practice, knowledge transfer and research, and health literacy; regulate and legislate to ensure a high level of protection, partner and build alliance to create sustainable actions). • Nairobi, 2009: Bridging the implementation gap (multiple participatory processes, urgency to close the implementation gap in health and development through HP, importance of HP as an integrative, cost- effective strategy, and as an essential component of health systems primed to respond adequatelyto emergingconcerns). 6/1/18 Concept of HP - Rakesh Singh Further Discourse in HP
  155. 155. Contd… • Helsinki, Finland, 2013: Theme: Health in all policies (Inter-sectoral action – action beyond health sector; its focus was on implementation, the “how- to”). • Shanghai, 2016: (health and wellbeing are essential to achieving sustainable development, Good governance is crucial for health, Cities and communities are critical settings for health, Health literacy empowers and drives equity, accelerate the implementation of the SDGs through increased political commitment and financialinvestment in HP) 6/1/18 Concept of HP - Rakesh Singh
  156. 156. ASSIGNMENT 2 – Assess the role of the private sector as outlined in the Jakarta Declaration Read the Jakarta Declaration on Health Promotion into the 21st Century: a) What role you think the private sector or the sector which works for profit could playin a Health Promotion project at a local or district level? b) What do you think some of the difficulties might be in working with the private or business sector at a local level? 6/1/18 Concept of HP - Rakesh Singh
  157. 157. Feedback • If you are developing or managing a Health Promotion project at a local level, it is likely that you would set up a steering committee or an inter-sectoral team to co-ordinate the project. • Like other role players in the district, a representative from the private sector or business sector would be a member of this committee. • Together the team would develop the vision for the project and start defining project objectives and activities. A private sector representative might be able to contribute to the project by: q Providing resources such as a meeting space for the group and a venue for workshops, covering the costs of printing materials or minutes of the meetings. q Providing skills and training in relation to project design and development, such as strategicplanningprocesses or budgeting. q Providing contacts and links with other businesses or private sector institutions or networks. q Supporting the implementation of the project on the ground e.g. by providing the commitment and resources to implement the Health Promotion project within their respective workplaces. 6/1/18 Concept of HP - Rakesh Singh
  158. 158. Contd… • Some of the potential problems might be that private sector representatives: q Have less time to commit to the development ofthe project. q Stipulate that there are specific requirements attached to the resources they contribute to the project or the development process. q Might have a different understandingofthe concept of Health Promotion. q Might be pressurised to produce noticeable or tangible results from the project early on in the process, thus reducing the level of community involvement. 6/1/18 Concept of HP - Rakesh Singh
  159. 159. A Framework for Health Promotion Activities 6/1/18 Concept of HP - Rakesh Singh
  160. 160. Preventive Health Services • These include medical services, which aim to prevent ill-health through immunization, family planning and personal health checks, as well as wider preventive health services such as child protection services for children at risk of child abuse. 6/1/18 Concept of HP - Rakesh Singh
  161. 161. Community-based work • This is a “bottom up” approach to Health Promotion, working with and for people. • It involves communities in health works such as local campaigns for better facilities. • It includes community development, which is essentially about communities identifying their own health needs and taking action to address them. 6/1/18 Concept of HP - Rakesh Singh
  162. 162. Organizational development • This is about developing and implementing policies within organisations to promote the health of staffand customers. • Examples include implementing policies on equal opportunities or providinghealthyfood choices in staffdiningrooms. 6/1/18 Concept of HP - Rakesh Singh
  163. 163. Healthy public policies • This involves statutory and voluntary agencies, professionals and the publicworkingtogether to develop changes in the conditions ofliving. • It is about seeing the implication for health in policies associated with housing,employment,transport and leisure. 6/1/18 Concept of HP - Rakesh Singh
  164. 164. Environmental health measures • This is about making the physical environment conducive to health, whether at home, work or in publicplaces. • It includes traditional public health measures such as providing clean food and water, controlling pollution, as well as working on newer issues such as providing smoke free areas in pubs or taverns and controlling the use of environmentallydamagingchemicals. 6/1/18 Concept of HP - Rakesh Singh
  165. 165. Economic and regulatory activities • This includes political and educational activity directed at politicians, policymakers and planners. • It involves lobbying for and implementing legislative changes, such as food labelling regulations and advocating for financial measures such as an increase in tobacco legislation. 6/1/18 Concept of HP - Rakesh Singh
  166. 166. Health education programmes • These are planned opportunities for people to learn about health and to undertake voluntarychanges in their behaviour. • Such programmes may include providing information, exploring values and attitudes, making health decisions and acquiring skills to enable behaviour change to take place. • They involve developing self-esteem and self- empowerment so that people are enabled to take action about their health. • They can happen on a one-to-one level such as health worker to client sessions, in a group, or by means of reaching large audiences through the mass media and health exhibitions. 6/1/18 Concept of HP - Rakesh Singh