Health promotion Health promotion promotion

About Health

1. Health promotion
Prof. Janko Jankovic, MD, PhD




Faculty of Medicine University of Belgrade
Institute of Social medicine

2. Definition:
Health Promotion is the process of enabling people to increase
control over, and to improve their health (Ottawa Charter, 1986).
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, therefore, seen as a resource for everyday life, not the objective
of living

Health is a positive concept emphasizing social and personal resources, as
well as physical capacities.

Therefore, health promotion is not just a responsibility of the health
sector, but goes beyond healthy life-styles to well-being
Health Promotion

3. Health promotion

Health education
Health education methods
New public health

4. Peace
Shelter
Education
Food
Income
A stable eco-system
Sustainable resources
Social justice
Equity
Prerequisites for Health
(fundamental conditions and resources
for health)

5. Determinants of health
oMany factors combine together to affect the health of
individuals and communities.
oDifferent personal, social, economic and environmental
factors that influence the health status of the individual
and the population

The determinants of health include:
othe social and economic environment,
othe physical environment, and
othe person’s individual characteristics and behaviors.

6. Determinants which
Influence our health
1. Hereditary factors


2. Environmental factors
•Socioeconomic
•Physical (natural, built)
•Lifestyles (food, alcohol,
tobaco, sexual behavior)
WHO classification

7. Social determinants of health
o education
o income
o work
o unemployment
o social status
o poverty
o housing
o health care
services
o social support
o social exclusion
o social gradient
o addiction to alcohol, drugs
and tobacco
o food
o transport
o stress
o early life

8. Dahlgren and Whitehead:
layered influence
Source: Dahlgren & Whitehead, 1991

9. Wealth and health
Selection or
causation?

10. In response to growing expectations for a new public health
movement around the world
Built on the progress made through:
the Declaration on Primary Health Care at Alma Ata (1978)
WHO’s Targets for Health for All by the year 2000
Debate on intersectoral action for health

The 1
st
International Conference on Health Promotion, Ottawa, 1986

Ottawa CHARTER for action
Health Promotion

11. Importance of Health Promotion
The primary importance of health promotion is to prepare people to
constantly learn to overcome the challenges of diseases and injuries
The process should begin from childhood and continue through the
school system and in the places where people live and work

Health promotion activities contribute to:
oReducing inequalities in health
oPromotion of human rights
oProlongation of life expectancy
oReducing the differences between developed and developing
countries

12. The basic principles of
health promotion
Population approach
Orientation to health determinants
Comprehensive intersectoral initiatives
Effective community participation
Important role of health professionals
It is implemented in places where people live and
work

13. The basic values ​​of
health promotion
Empowerment (people have greater control over
decisions and actions that affect their health)
Social justice and equity (equal access to food,
income, employment, education, etc.).
Participation (inclusion) of marginalized groups
Respecting of different views , cultures and
perspectives of health and well-being

14. Where to perform activities
(healthy settings)
HOME SCHOOL WORKPLACE
HEALTH
INSTITUTIONS
COMMUNITY PRISONS...

15. ADVOCATE

ENABLE

MEDIATE
Health Promotion strategies

16. Good health is a major resource for social, economic and personal
development, and an important dimension of quality of life
Factors that can favour, or be harmful to health, are
Political
Economic
Social
Cultural
Environmental
Behavioral
Biological

Health promotion actions aims at making these conditions favorable
thorough advocacy for health.

Health Promotion strategies:
ADVOCATE

17. 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
Opportunities for making healthy choices

People cannot achieve their fullest health potential unless they are
able to take control of those things which determine their health. This
must apply equally to women and men.
Health Promotion strategies:
ENABLE

18. Health promotion demands coordinated action by all concerned:
by government
by health and other social and economic sectors
by nongovernmental and voluntary organizations
by local authorities
by industry
by the media
People are involved as individuals, families and communities.

Professional and social groups have a major responsibility to
mediate between differing interests in society for the pursuit of
health.

Health Promotion strategies:
MEDIATE

19. (1) Build Healthy Public Policy (WHO FCTC)

(2) Create Supportive Environments (Healthy cities)

(3) Strengthen Community Actions

(4) Develop Personal Skills (Peer education, Y-PEER)

(5) Reorient Health Services


Health Promotion Action means:

20. Health promotion puts health on the agenda of policy makers in all
sectors and at all levels, directing them to be aware of the health
consequences of their decisions and to accept their responsibilities for
health

Combines diverse but complementary approaches, including:
Legislation
Fiscal measures
Taxation
Organization change

Joint action contributes to ensuring safer and healthier goods and
services, healthier public services, and cleaner, more enjoyable
environments


(1) Build Healthy Public Policy

21. WHO Framework Convention on Tobacco Control (WHO FCTC),
2003, one of the most quickly ratified treaties in United Nations
history

Supranational agreement that seeks “to protect future generations
from the devastating health, social, environmental and economic
consequences of tobacco consumption and exposure to tobacco
smoke” by enacting a set of universal standards stating the dangers
of tobacco and limiting its use in all forms worldwide

Signed, ratified and legally bonded in 177 countries all around the
world

(1) Build Healthy
Public Policy: example

22. Topic Measure
Lobbying Call for a limitation in the interactions between lawmakers and
the tobacco industry.
Demand reduction Tax and other measures to reduce tobacco demand.
Passive smoking Obligation to protect all people from exposure to tobacco smoke
in indoor workplaces, public transport and indoor public places.
Regulation The contents and emissions of tobacco products are to be
regulated and ingredients are to be disclosed.
Packaging and labeling Large health warning (at least 30% of the packet cover, 50% or
more recommended); deceptive labels (mild, light, etc) are
prohibited.
Awareness Public awareness for the consequences of smoking.
Tobacco advertising Comprehensive ban, unless the national constitution forbids it.

Addiction Addiction and cessation programs.
Smuggling Action is required to eliminate illicit trade of tobacco products.
Research Tobacco-related research and information sharing among the
parties.

23. The inextricable links between people and their environment constitutes
the basis or socioecological approach to health

The overall guiding principle is the need to encourage reciprocal
maintenance - to take care of each other, our communities and our natural
environment.

The conservation of natural resources should be emphasized as a global
responsibility

Changing patterns of life, work and leisure have a significant impact on
health

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

(2) Create Supportive Environments

24. WHO Healthy Cities project, a global movement that engages local
governments in health development through a process of
political commitment,
institutional change,
capacity-building,
partnership-based planning, and
innovative projects

Healthy city is "one that is continually creating and improving those physical
and social environments and expanding those community resources which
enable people to mutually support each other in performing all the functions of
life and in developing to their maximum potential.”

About 90 cities are members of the WHO European Healthy Cities Network,
and 30 national Healthy Cities networks across the WHO European Region
have more than 1400 cities and towns as members.

(2) Create Supportive
Environments: example

25. Empowerment of communities - their ownership and control
of their own endeavors and destinies

Community development draws on existing human and
material resources in the community:
to enhance self-help and social support
To develop flexible systems for strengthening public
participation in direction of health matters

(3) Strengthen Community Actions

26. Through providing information, education for health, and
enhancing life skills
It increases the options available to people to exercise more
control over their health and over their environments
Learning through lifetime and preparing to cope with different
challenges (reproductive health, chronic illness…)

Example: Y-PEER network (Peer education network)




(4) Develop Personal Skills

27. The role of health sector must move increasingly in health
promotion direction, beyond its responsibilities for providing
clinical and curative services

(5) Reorient Health Services

28. Health
education
Health Promotion Model
(Downie, Fyfe & Tannahill's model)
Other measures/
Health protection Prevention

29. Prevention
Reducing the risk of pathological processes, illness, injury,
disability, handicap or other undesirable condition or
phenomenon.
(Downie, Fyfe, Tannahill, 1993)
Health education
Activity focused on health promotion, disease prevention or
reduction of their consequences for individuals and groups
through organized efforts on changing beliefs, knowledge,
attitudes and behavior.
(Downie, Fyfe, Tannahill, 1993)

30. Primordial (modification of social, political, economic and
other conditions that contribute to the basic measures of
primary prevention)

Primary (covering the period before the onset of diseases
and indicates the improvement and protection of health and
prevention of disease)

Secondary (relating to the early detection and timely
treatment of disease)
Tertiary (indicating rehabilitation)
Prevention levels

31. Other measures of
health promotion
Measures of legal or fiscal control, other regulations and policies
and voluntary codes of conduct in order to encourage positive
behavior and prevent disease.
(Downie, Fyfe, Tannahill, 1993)

32. Health Promotion Model
(7 promotion strategies)

33. Health promotion and disease
prevention - differences
Elements Promotion Prevention
Health concept Health is a multi-sectoral responsibility Biomedical concept of health - the
absence of disease
Target groups Population and environment Patient
Focus of action Health behavior Risk behavior
Strategies Combination of multiple strategies Only one strategy oriented at one
problem
Principle of action Information, skills development with
the right choice of mediators (media)
Advising without mediators
Program Program for protection of the
environment and measures to improve
the health of the community
Programs targeted to an
individual or group
Stakeholders NGOs, lay people, civic groups, local,
regional and national authorities,
medical professionals
Health care professionals from
diverse disciplines

34. 1.Diagnosis

2.Program development

3.Implementation

4.Evaluation
Health promotion program design

35. Thank you for attention!