HEALTH EDUCATION and HEALTH PROMOTION OEDOJO SOEDIRHAM DEPARTMENT

HEALTH EDUCATION and HEALTH PROMOTION OEDOJO SOEDIRHAM DEPARTMENT OF HEALTH PROMOTION AND BEHAVIORAL SCIENCES FKM-UNAIR, SURABAYA 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 1

HEALTH EDUCATION and HEALTH PROMOTION • HEALTH EDUCATION AND HEALTH PROMOTION – introduction – Definitions and Concepts – Foundation for Practice – Others 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 2

INTRODUCTION OVERVIEW • Everyone engaged in the tasks of promoting health starts health with a view of what is. • However, there is a wide variety of these views, or concepts, of health. It is, important of the outset to be clear about the concepts of health which you personally adhere to, and to recognize where these differ from those of your colleagues and clients. Otherwise, you may find yourself drawn into conflicts about appropriate strategies and advice that are actually due to different ideas concerning the end goal of health. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 3

• This lecture does not discuss about health only, but also to present the process of attempting to promote health that may include a whole range of interventions including: – Those which foster healthy lifestyle – Those which encourage access to services and involvement in health decisions – Those which seek to promote an environment in which the healthy choice becomes the easier choice – Those which educate about the body and keeping healthy 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 4

• Until the 1980 s most of these interventions were referred to as “health education” and the practice was almost exclusively located within preventive medicine or, to a lesser extent, education. In recent years, the term health promotion has become widely used. This course considers whether this change in name signifies a difference in ideology, policy, and practice. Using typology first suggested by Bunton and Macdonald (1992), it describes the development of health education and health promotion, and shows their interdependent. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 5

• The 19 th century public health movement informed the health education of the earlier part of the 20 th century which, in turn, informed the development of health promotion. It shows how the debate about the meaning of health education and health promotion has stemmed from a growing awareness that achieving “Health For All” requires not just changes in individual behavior, but also, social and environmental change. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 6

• The development of health education – The origins of health education lie in the 19 th century when epidemic disease eventually led to pressure for sanitary reform for the overcrowded industrial towns. Alongside the public health movement emerged the idea of educating the public for the good of its health. The Medical Officers of Health appointed to each town under the Public Health legislation of 1848 frequently disseminated everyday health advice on safeguards against “contagion”. (Voluntary associations were also formed including the London Statistical Society, 1839; the Health of Towns Association, 1842; and the Sanitary Institute, 1876). 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 7

– The Temperance Movement held Band of Hope mass meetings, through schools and churches lectured to young people on the virtue of abstinence. By the 1920 s health education had become associated with diarrhoea, dirt, spitting and venereal disease. The evidence that between 10% and 20% of soldiers in the First World War had contracted venereal disease led to propaganda, one-off lectures and the first use of “shock-horror” techniques in which soldiers were shown lurid pictures of diseased genitals to dissuade them from having sex. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 8

• Changing patterns of morbidity and mortality shifted attention away from disease to personal behavior. The Central Council for Health Education was established in 1972, paid for by local authority public health departments and public health doctors formed the majority of its membership. An extract from some of the tasks listed as important reflects an emphasis on information, and education to bring about change in personal habits and behavior” 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 9

• • The provision of better and cheaper posters and leaflets The provision of exhibits for exhibition The production of readable monthly bulletin The provision of a panel of lectures who really could lecture and hold an audience 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 10

• The Central Council was principally concerned with propaganda and instruction. During the Second World War it delivered 3799 lectures on sex education and venereal disease which were attended by 340, 000 people. • But, according to Sutherland (1979) the two principal functions or aims of the Central Council for Health education were: 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 11

• First to promote and encourage education … in the science and art of healthy living [and, second], to coordinate the work of all statutory bodies in carrying out their powers and duties under the Public Health Acts … relating to the promotion … of Public Health. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 12

• Unfortunately, health education confined itself in the main to the first, largely lifestyle, function and neglected the second, largely structuralist, issue. Health promotion in the last 20 years or so has attempted to fill that gap. It is worth noting, however, that health in turn did not develop in a vacuum but emerged as a consequence of the public health measures of the late 19 th and early 20 th centuries. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 13

• This lecture does not to conclude which one come first, whether health education or health promotion. Rather, to give information about what is “inside” of those two. Is there any real different, both in concept and in practice? • What do you think about these two tables below, which one is more useful for you as public health worker? 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 14

TABLE 1: 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 15

TABLE 2: 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 16

Definitions and Concepts What is: HEALTH ? 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 17

Health in the River of Life 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 18

• The river as a metaphor of health development has often been used. According to Antonovsky, it is not enough to promote health by avoiding stress or by building bridges keeping people from falling into the river. Instead people have to learn to swim (Antonovsky 1987). 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 19

• The river of life is a simple way to demonstrate the characteristics of medicine (care and treatment) and public health (prevention and promotion) shifting the perspective and the focus from medicine to public health and health promotion towards population health. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 20

• Cure or treatment of diseases • The curative perspective on health means that we ‘save people from drowning’ using expensive high technology and well-educated professionals. Up stream thinking would offer people support and interventions at an earlier stage. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 21

• Health protection/disease prevention • This stage can be divided in two phases, i. e. the protective and the preventive. The protective perspective means that the interventions are limiting the risks of disease. The efforts and interventions are population-based and passive. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 22

• In the metaphor of the river, the interventions are aimed at preventing people from falling into the river by ‘building fences’. The preventive perspective aims at preventing diseases by active interventions characterized by an empowering attitude where people are actively involved. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 23

• People are here ‘supplied with a life vest’. The rationale is to reduce the negative effects and risks thus maintaining the health of the public. The interventions are both population-directed (protective) and individual-based (preventive). 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 24

• Health education/health promotion • This stage consists both of health education and health promotion. Health education has a long tradition in public health practice. Originally, it was a question of the professionals informing people of health risks and giving advice how people should live their lives. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 25

• Today it is based on a dialogue, involving people in their own lives, making their own decisions supported by the professionals. People are, in general, more actively involved than in the previous stages. The interventions are directed towards both individuals and groups. Improved health literacy is the key outcome of health education (Nutbeam, 2000). 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 26

• Returning to the river, the efforts here aim at ‘teaching people how to swim’. In health promotion, health is seen as a human right. The focus is on the co-ordination of activities between professions and professionals in societies. This is a positive concept emphasizing social and personal resources as well as physical capacities. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 27

• The responsibility of health promotion action extends far beyond the health sector and health behavior to wellbeing and Qo. L. It is a humanistic approach having the human being, human rights at focus again. The individual becomes an active and participating subject. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 28

• The task for the professionals is to support and provide options, enabling people to make sound choices, point out the key determinants of health, to make people aware of them and able to use them (Lindström and Eriksson, 2006). Health education is here replaced by learning about health referring to the reciprocity of a health dialogue. The salutogenic perspective can be applied in all these stages. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 29

• Improving health perception/wellbeing/quality of life • Going up-streams towards the source the last stage deals with health perception and Qo. L. The ultimate objective of health promotion activities is to create prerequisites for a good life. Perceived good health is a determinant for Qo. L. The salutogenic framework can create a fusion of the complexity of health and Qo. L development (Eriksson and Lindström, 2006, 2007). 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 30

• It is necessary to learn how to reflect on the options of ones life situation, such as what generates health, what improves Qo. L and what develops SOC. Traditionally, the difference between the biomedical model and public health has been described through a metaphor of a river moving from the down river approach where people already are struck by disease up streams through the stages described above. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 31

• However, to explain the shift of paradigm of the salutogenic framework, the metaphor of the river is different. This is Health in the River of Life. Here the river flows vertically across your view. Along the front side of the river, there is a waterfall continuously following the whole stretch of the river. This means the main flow and direction of the river is not down the waterfall. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 32

• At birth, we are dropped into the river and float with the stream. The main direction is life not death and disease in the waterfall. Some are born close to the opposite side of the river where one can float at ease and the opportunities for life are good and there are many resources at disposal, like in a welfare state. Some are born close to the waterfall, at dis-ease, where the struggle for survival is harder and the risk of going over the rim is much greater. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 33

• The river is full of risks and resources. However, the outcome is largely based on our ability to identify and use the resources to improve our options for health and life. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 34

Definitions and Concepts • BIOMEDICAL • PSYCHOLOGICAL • SOCIOLOGICAL (SOCIOCULTURAL) 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 35

Definitions and Concepts • BIOMEDICAL • Focuses solely on the individual’s physiological state • Health is defined simply as the absence of disease or physiological malfunction • It is NOT positive state; but the absence of a negative state 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 36

Definitions and Concepts • PSYCHOLOGICAL • Asserts that individual constantly make subjective evaluations of their own health • Originally, this assessment was assumed to focus solely on a general feeling of overall wellbeing • Psychological wellness includes – Pleasurable involvement – Long-term satisfaction – The absence of negative affect 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 37

Definitions and Concepts • SOCIOLOGICAL (SOCIOCULTURAL) • Emphasizes on the social and cultural aspects of health and illness • Focuses on the individual’s capacity to perform roles and tasks and acknowledges that there are social differences in defining health 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 38

Definitions and Concepts • 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, therefore, seen as a resource for everyday life, not the objective of living. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 39

Definitions and Concepts • 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 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 40

Definitions and Concepts • PREREQUISITIES FOR HEALTH § § § § § 1/3/2022 Peace Shelter Education Food Income A stable eco-system Sustainable resources Social justice Equity OEDOJO SOEDIRHAM (oedojo@yahoo. com) 41

Definitions and Concepts • HEALTH PROMOTION ACTION MEANS v. BUILD HEALTHY PUBLIC POLICY v. CREATE SUPPORTIVE ENVIRONMENTS v. STRENGTHEN COMMUNITY ACTION v. DEVELOP PERSONAL SKILLS v. REORIENT HEALTH SERVICES 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 42

Definitions and Concepts These actions are interdependent, but healthy public policy establishes the environment that makes the other four 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 43

Definitions and Concepts 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 44

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) 1. Healthy Public Policy v. Healthy public policy is a pre-requisite for successful health promotion. v. A Healthy Public Policy is characterized by a concern for health and equity and an accountability for health impact. v. Health should be made a priority item on the agenda of policy-makers in all sectors. v. Policy-makers should be made aware of the health consequences of their decisions. They should create pro-health policies, whether in the area of development, legislation, taxation etc. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 45

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) v Healthy public policy covers a combination of diverse but complementary measures and approaches such as legislation, taxation, fiscal incentives and disincentives, policy analysis and review, and organizational change v Joint action by all sectors will contribute to achieving safer and healthier goods and services, healthier public services, and cleaner and more healthy environment. v The aim is to make the healthier choice the easier choice for all people. v HPP should lead to the creation of a supportive environment to enable people to lead healthy live 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 46

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) v According to the Adelaide Conference (1988), “The main aim of HPP is to create a supportive environment to enable the people to lead healthy lives. Healthy choices are thereby made possible and easier for citizens”. v All relevant government sectors like agriculture, trade, education, industry and finance need to give important consideration to health as an essential factor during their policy formulation. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 47

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) 2. Create Supportive Environment v A supportive environment is essential for health. v Supportive environments cover the physical, social, economic, and political environment. v Supportive environments encompass where people live, work and play. This is what is envisaged by the “settings” approach. v Everyone has a role in creating supportive environments for health. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 48

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) 3. Strengthen Community Action: Community Participation v 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 better health”. v There are many ways of defining community. Factors used are geography, culture and social stratification. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 49

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) v Community action is any activity undertaken by a community in order to effect change (including voluntary and self-help services). v Community participation covers a spectrum of activities v At the low end, it may be token participation in the form of consultation or endorsing plans drawn up by the health authorities. 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 program. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 50

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) v Full community participation occurs when communities participate in equal partnership with health professionals as stakeholders in setting the health agenda. • A Definition (Rifkin et al. 1988) ÜCommunity 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 these needs 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 51

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) v 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 of health”. v Empowerment is an important strategy, based on the notion that health is significantly affected by the extent to which one has control or power over one’s life. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 52

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) 4. Develop Personal Skills v Strategies for empowering the community include leadership training, learning opportunities for health, and access to resources including material and funding v Empowerment helps people to identify their own needs and concerns, and gain the power, skills and confidence to act upon them. It is a bottom-up strategy which requires the health promoter to act as a facilitator and catalyst for change. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 53

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) v Skills which can promote an individual’s health include those pertaining to identifying, selecting and applying healthy options in daily life. v 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 and disabilities. v Health education should be conducted in all settings. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 54

THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER) 5. Reorient Health Services v Shift of emphasis from provision of curative services. v Health care system must be equitable and clientcentered. v 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 of services, 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 55

Health Promotion Theory • Why study health promotion theory? • Although it is clear why public health practitioners and students of public health should learn about how to devise and implement health promotion interventions, it may be less obvious why it is necessary to spend time learning about theory of health promotion. As this book makes clear, health promotion is far from straightforward. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 56

Health Promotion Theory • Why study health promotion theory? • Unless public health practitioners explore and understand theory underpinning health promotion, there is a real risk, at best, of establishing ineffective interventions and, at worst, of antagonizing and even harming the very people you are seeking to help. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 57

SECTION 1 Philosophy and theory of health promotion • Health promotion is probably the most ethical, effective, efficient and sustainable approach to achieving good health. It was defined initially by the World Health Organization in 1986, but the definition has since been refined to take account of new health challenges and a better understanding of the economic, environmental and social determinants of health and disease. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 58

• Health is the most sought after subject on the World Wide Web. The problem of definition is confusing because terms such as health (and education and promotion) are widely used in everyday language and, as such, are used to mean very different things in different contexts. These are essentially contested concepts, as they are used and abused, in the familial sense, in everyday language. 1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 59

1/3/2022 OEDOJO SOEDIRHAM (oedojo@yahoo. com) 60