Health promotion

Health promotion Community health nursing

1. PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD

2. Concept
•Healthpromotionisdirectedtowardsactiononthe
determinantsorcausesofhealthpromotion,therefore,
requiresacloseco-operationofsectorsbeyondhealth
services,reflectingthediversityofconditionswhich
influencehealth.
•Governmentatbothlocalandnationallevelshasa
uniqueresponsibilitytoactappropriatelyandinatimely
waytoensurethatthe‘total’environment,whichisbeyond
thecontrolofindividualsandgroups,isconducivetohealth.

3. Concept

4. What is HealthPromotion?
Today Health Promotion is
more than personal and
populationeducation.
Defined in a number ofways
“The process of enabling
people to increase control
over and improve their
health”(WHO1986)

5. Phylosophy
Through the
involvement of
home, school and
community,
including: the
physical,
intellectual,
emotional,
social and
moral
development
Healthpromotionisany
combination ofhealth,
education, economic,
political,spiritual or
organisational initiative
designed
tobringaboutpositive
attitudinal, behavioural,
socialorenvironmental
changes conduciveto

6. Definition
Healthpromotionistheprocess
ofenablingpeopletoincreasecontrolover,
andtoimprove,theirhealth.Itisapositive
concept emphasisingpersonal,social,
politicalandinstitutionalresources,aswell
asphysicalcapacities.
WHO (1990), Health PromotionGlossary

7. THE PROCESS OF HEALTH
PROMOTION
FOCU
S
STRATEGI
ES
IMPAC
T
OUTCOME
S
Individuals
Groups
Population
Education
couselling
Economic
change
Legislativ
e change
Policy or
organisation
change
Behavioural
educational
change
Social,
economicand
environment
change
Better
Health
Quality
oflife

8. A FRAMEWORK FOR HEALTH PROMOTION
ACTIVITI
AREAS OF
HEALTH
PROMOTIO
N ACTIVITY
Preventive health
services(Primary,
secondary,tertiary
Community-based
work
Organisation
developmentHealthy
PublicPolicy
Environmental
healthmeasures
Economicand
regulatory
activities
Healtheducation
programmes

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

10. Main approaches to health promotio





Medical or
preventative
Behavioral
change
Educational
Empowerment
Social change

11. Aims



Reduce morbidity and premature mortality
Target: whole populations or high riskgroups
Promotion of medical intervention to preventill-health
The medical or preventativeapproach

12. 




Aims
Encourages individuals to adopt healthy behaviors which
improve health Views health as a property ofindividuals
People can make real improvements to their health by choosing to
change lifestyle It is people’s responsibility to take action to look
afterthemselves
Involves a change in attitude followed by a change inbehavior
Behavior changeapproach

13. Aims



To enable people to make an informed choice about
their health behaviorby
providing knowledge andinformation
developing the necessaryskills
Not similar the behavioral approach, it does NOT try to
persuade or motivate change in a particulardirection
OUTCOME is client’s voluntary choice which may be
different from the one preferred by healthpromoter
The educationalapproach

14. Empowermentapproach
Aims




Helps people identify their own concerns and gain the skills and confidence
necessary to act uponthem
This is the only approach to use a ‘bottom-up’ (rather than ‘top-down’)
approach
Empowerment may involve both self-empowerment and community
empowerment Self-empowerment:


Based on counseling Uses non-directiveways
Increase person’s control over his/her ownlive

15. Aims




Radicalapproachwhichaimstochangesocietynot
individualbehaviorAimstobringchangesinthe
physical,economicandsocialenvironment
Healthychoicetobecometheeasierchoiceintermsofcost,
availabilityandaccessibilityTargetedtowardsgroupsand
populations
Social changeapproach

16. TOP-DOWN VS.BOTTOM-UP


Priorities set by health
promoters who have the
power and resources to
make decisions and
impose ideas of what
should be done
Priorities are set by
people themselves
identifying issues they
perceive asrelevant

17. THE FIVE APPROACHES
EXAMPLES RELATED TO
SMOKINGBased on Ewles and Simnet (1992:
36)

18. The medicalapproach
AIM: Free from lung disease, heart disease and other smoking
relateddisorders
ACTIVITY: Encourage people to seek early detection and treatment of
smoking relateddisorders

19. Behavioral changeapproach
AIM: Behavior changes from smoking to notsmoking
ACTIVITY: Persuasive educationto
–prevent non-smokers from starting tosmoke
–persuade smokers tostop

20. Educationalapproach
AIM: Clients understand effects of smoking on health and will make a
decision whether to smoke or not and act on theirdecision
ACTIVITY: Giving information to clients about effects ofsmoking


Helping them explore their values and attitudes and come to a
decision
Helping them learn how to stop smoking if they wantto

21. The empowermentapproach
AIM: Anti-smoking issue is considered only if clients identify it as a
concern
ACTIVITY: Clients identify what, if anything, they want to know and do
aboutit

22. Social changeapproach

AIM: Make smoking socially unacceptable so it is easier not to
smoke than tosmoke

ACTIVITY
–No smoking policy in all publicplaces
–Cigarette sales less accessible
–Promotion of non-smoking as a socialnorm
–Limiting and challenging tobacco advertisements and sports
sponsorships

23. Alma Ata Declaration,
1978


On Primary Health Care: Essential health care that’s practical,
scientifically sound and social acceptable methods and technology
made UNIVERSALLYaccessibleandaffordable to
individuals and families in thecommunity.
It expressed the need for urgent action by all governments, all health
and development workers, and the world community to protect and
promote the health of all the people of theworld.

24. Supportive environments cover the physical, social, economic, and political
environment.
Supportive environments encompass where people live, work and play. This
is what is envisaged by the “settings”approach.
Everyone has a role in creating supportive
environments forhealth.
2. Create SupportiveEnvironment
A supportive environment is essential forhealth.
THE FIVE MAJORAREAS/STRATEGIES INHEALTH PROMOTION (OTTAWA CHARTER)

25. According to the Ottawa Charter, “health promotion works through concrete and
effective community action in setting priorities, making decisions, planning
strategies and implementing them to achieve betterhealth”.
There are many ways of defining community. Factors used are geography, culture
and socialstratification.
Community action is any activity undertaken by a community in order to effect
change (including voluntary and self-helpservices).
3. Strengthen Community Action: CommunityParticipation
THE FIVE MAJORAREAS/STRATEGIES INHEALTH PROMOTION (OTTAWA CHARTER)

26. Community participation covers a spectrum of activities
At the low end, it may be token participation in the form of consultation or
endorsing plans drawn up by thehealthauthorities.At the high end, it may
be in the form of ‘people power’ where they have full say in identifying needs,
setting priorities, planning strategies and activities and implementing the
programme.
THE FIVE MAJORAREAS/STRATEGIES INHEALTH PROMOTION (OTTAWA CHARTER)
3. Strengthen Community Action: CommunityParticipation

27. 3. Strengthen Community Action: communityParticipation
Full community participation occurs when communities participate in equal
partnership with health professionals as stakeholders in setting the health
agenda.
Community participation is a social process whereby groups with shared
needs living in a defined geographic area actively pursue identification of their
needs, take decisions and establish mechanisms to meet theseneeds
THE FIVE MAJORAREAS/STRATEGIES INHEALTH PROMOTION (OTTAWA CHARTER)

28. 3. Strengthen Community Action: CommunityParticipation
According to the Jakarta Declaration (1997), “health promotion improves both
the ability of individuals to take action, and the capacity of groups,
organizations or communities to influence the determinants ofhealth”.
Empowermentisanimportantstrategy,basedonthenotionthathealthis
significantlyaffectedbytheextenttowhichonehascontrolorpowerover
one’slife.
THE FIVE MAJORAREAS/STRATEGIES INHEALTH PROMOTION (OTTAWA CHARTER)

29. Strategies for empowering the community include leadership training, learning
opportunities for health, and access to resources including material and
funding
Empowerment helps people to identify their own needs and concerns, and gain
the power, skills and confidence to actuponthem.It is a bottom-up strategy
which requires the health promoter to act as a facilitator and catalyst for
change.
4. Develop PersonalSkills
THE FIVE MAJORAREAS/STRATEGIES INHEALTH PROMOTION (OTTAWA CHARTER)

30. 


Skills which can promote an individual’s health include those pertaining to
identifying, selecting and applying healthy options in dailylife.
Health education is life-long, so that people can develop the relevant skills to
meet the health challenges of all stages of life, and to be able to cope with
chronic illness anddisabilities.
Health education should be conducted in allsettings.
THE FIVE MAJORAREAS/STRATEGIES INHEALTH PROMOTION (OTTAWA CHARTER)
4. Develop PersonalSkills

31. Shift of emphasis from provision of curativeservices.
Health care system must be equitable andclient-centered.
May necessitate reengineering and organizational change, especially in
the areas of professional education and training, management,recruitment
and deployment of health personnel, and planning, development and
delivery ofservices,
5. Reorient HealthServices
THE FIVE MAJORAREAS/STRATEGIES INHEALTH PROMOTION (OTTAWA CHARTER)

32. 57
Buildinga
healthy public
policy
Creating
supportive
environments
Developing
personalskills
Strengthening
community
action
Reorientating
healthservices
IMPORTANT AREAS FOR CONSIDERATION INHEALTH
PROMOTION

33. Adelaide Recommendations on Healthy PublicPolicy
Second International Conference on Health Promotion, Adelaide, South Australia, 5-9 April1988
Healthy PublicPolicy
The Conference strongly recommends that the World Health Organization
continue the dynamic development of health promotion through the five
strategies described in the Ottawa Charter. It urges the World Health
Organization to expand this initiative throughout all its regions as an integrated
part of itswork.
Support for developing countries is at the heart of this process.

34. Sundsvall Statement on Supportive
Environments forHealth
Third International Conference on Health Promotion, Sundsvall,
Sweden, 9-15 June 1991
The Sundsvall Conference has again demonstrated that the issues of
health, environment and human development cannot be separated.
Development must imply improvement in the quality of life and health
while preserving the sustainability of the environment. Only worldwide
action based on global partnership will ensure the future of ourplanet
Supportive environment forHealth
59

35. Jakarta Declaration on Leading Health Promotion
into the 21stCentury
The Fourth International Conference on Health Promotion: New
Players for a New Era -Leading Health Promotion into the 21st
Century, Jakarta, Indonesia, 21-25 July1997
The Jakarta Declaration included Five Priorities for Health Promotion in 21
st
Century
1.“Promote Social Responsibility forhealth”
2.“Increase investments for healthdevelopment”
3.“Consolidate and expand partnerships forhealth”
4.“Increase community capacity and empower theindividual”
5.“Secure an infrastructure for healthpromotion”

36. The participants endorsed the formation of a Global health promotion alliance
Priorities for the allianceinclude:
•Raising awareness of the changing determinants ofhealth
•Supporting the development of collaboration and networks for health
development
•Mobilizing resources for healthpromotion
•Accumulating knowledge on best practice
•Enabling sharedlearning
•Promoting solidarity inaction
•Fostering transparency and public accountability in healthpromotion

37. Mexico Ministerial Statement for the
Promotion of Health: From Ideas to Action
Fifth Global Conference on Health Promotion, Health
Promotion: Bridging the Equity Gap, Mexico City, 5-9
June2000
The attainment of the highest possible standard of health is a
positive asset for the enjoyment of life and necessary for social and
economic development andequity.
8 Statements and6Actionswhere signed by 88 Countries world
wide.

38. The ‘Bangkok Charter for Health Promotion in a
globalizedworld’
It has been agreed to by participants at the 6th Global Conference on
Health Promotion held in Thailand from 7-11 August,2005
1.Make the promotion of health central to the global developmentagenda.
2.Make the promotion of health a core responsibility for all ofgovernment.
3.Make the promotion of health a key focus of communities and civilsociety.
4.Make the promotion of health a requirement for good corporatepractice.

39. Basic Strategies for HealthPromotion
Advocate
Enable
Mediate

40. Advocate
Good health is a major resource for social,
economic and personal development and an
important dimension of quality of life. Political,
economic, social, cultural, environmental,
behavioral and biological factors can all favor
health or be harmful to it. Health promotion action
aims at making these conditions favorable through
advocacy forhealth.

41. Enable
Health promotion focuses on achieving equity in health.
Health promotion action aims at reducing differences in
current health status and ensuring equal opportunities and
resources to enable all people to achieve their fullest health
potential. This includes a secure foundation in a supportive
environment, access to information, life skills and
opportunities for making healthychoices.
People cannot achieve their fullest health potential unless
they are able to take control of those things which determine
their health. This must apply equally to women andmen.

42. Mediate
The prerequisites and prospects for health cannot be ensured by the
health sector alone. More importantly, health promotion demands
coordinated action by all concerned: by governments, by health and other
social and economic sectors, by nongovernmental and voluntary
organization, by local authorities, by industry and by the media. People in
all walks of life are involved as individuals, families and communities.
Professional and social groups and health personnel have a major
responsibility to mediate between differing interests in society for the
pursuit ofhealth.
Health promotion strategies and programmes should be adapted to the
local needs and possibilities of individual countries and regions to take
into account differing social, cultural and economic systems.

43. 6 MajorElements






Better Health policy.
Physical environment.
Socialenvironment.
Communityrelationships.
Personal healthskills.
Healthservices

44. Prerequisites for
Health
The fundamental conditions and resources for healthare:
peace,
shelter,
education,
food,
income,
a stableeco-system,
sustainableresources,
social justice, andequity.

45. HEALTH PROMOTION:
WHERE DO WESTART?




Fromdisease/conditions.
From issues eg. Safety, environment,
tobacco control. Fromlifestyles.
Fromsettingseg. workplace
hom
e
scho
ols
clinic
s

46. SETTINGS
FOR
HEALTH
This approach to health promotion arose from
the OttawaCharter:
“Health is created and lived by people within the settings of their
everyday life; where they learn, work, play andlove”.

47. WHY
SETTING
S?
Human health behaviour is determined by the physical and social forces
which are present and interacting in anysetting.
Involves the target population as a whole in the context of their
everyday life and in their unique environment.
Holistic and
comprehensiveapproach.

48. SETTINGS
FOR
HEALTH
The Settings For Health approach in concerned with creating
health in our differentsettings.
Examples of Healthy
Settingare:
HealthyCities
HealthyVillages
HealthyIslands
Health Promoting
Hospitals
Health Promoting
Schools

49. CONCLUSION
The concept of health promotion is positive, dynamic and
empowering which makes it rhetorically useful and politically
attractive.
By considering the recommended principles, subject areas, policy
priorities and dilemmas it is hoped that future activities in the health
promotion field can be planned, implemented and evaluated more
successfully.
Further development work is clearly required and this will bean
ongoing task of the WHO Regional Office forEurope.

50. Thankyou