Karolinska Institutet Department of Public Health Sciences Health
* Karolinska Institutet, Department of Public Health Sciences Health Promotion Introductory remarks Bo J A Haglund professor
Tasks for the presenation • 1 Critical issues on Health, Health Promotion and Health Promotion Evaluation • 2 Practice of Health Promotion
Tasks for the presenation • 1 Based on Jennie Naidoo and Jan Wills: Health Promotion. Foundations for Practice. (2000) London: Bailliére Tindall • 2 Comments on First section : Theory of Health Promotion
Critical Issues • What are the major health problems? • What are the causes of these problems? • What health promotion activities may reduce these problems? • How do we know whether we have been effective in solving these health problems?
Definitions of health • Physical health • Mental health • Emotional health
Definitions of health • Physical health • Mental health • Emotional health • Social health • Spiritual health • Societal health
Summary of theories of health adapted after See The theory that health is an ideal state Disease, illness and handicap and social problem absent Health is a personal strength or ability. . developed as personal tasks Health is the foundation for achievment of potentials Health is a commodity that can be bought or given Health is the physical and mental fitness to do socialized daily tasks an end for providers and means for receivers a means towards the end of normal social functioning
Seedhouse argue that Health as the foundation for human achievements and Working for health is thus to create the conditions • basic needs for food, drink, shelter, warmth • access to information about factors influencing health • skills and confidence to use that information
Determinants of health
Determinants of health
Determinants of health Three waves of Public Health Industrialism evolving Goal: environment and individual measures: health policy reforms Economical growth Goal: Individual and environment Measures: programmes Postindustrial society Goal: environment and individual Measure: Supportive environments for helath
The Rise of the new public health Public Health Movement (1840 s-1920 s) Health education (1920 s-1970 s) Health Promotion (1940 s-1990 s) New Public Health (1980 s-2000) after Bunton&Macdonald 1992 Health Promotion Discipline and Diversity
Factors influencing health Health Determinants in Mortality/Morbidity in Wellbeing Physiological Risk Factors • Hypertension • Hypercholesterolemi • Release of stress hormones • Elevated levels of fibrinogen Behavioural Risk Facors Risk Conditions Poverty(absolute and reative) Low social status Dangerous, stressful work(high demand/low control) Dangerous, polluted environment Natural resource depletion Greenhouse effect Ozone depletion Discriminations(e. g. sexism, racism, agism) Steep power hierarchy (incomen, weatlth, status, authority Individualism, competitiveness and meritocracy Psychosocial Risk Factors • Smoking • Poor nutrition • Physical inactivity • Substance abuses • (alcohol, drugs) • Isolation • Lack of social support • Poor social networks • Low self-esteem • High self-blame • Low perceived health, self-efficacy • Loss of meaning or purpose Labonté 199
Environment Socioeconomic strategies Farming & Food Traffic Living conditions Unemployment Narcots Education Sex & relations Leisure & culture Food habits Social networks Alcohol Tobacco Social Working support Conditions Socialinsurance Socialwelfare Physical exercise Age, sex heritage Chiled Adult contacts After Haglund and Svanström, KI, omarbetning, Beth Hammarström Sleep habits m. m. Heath care
Basic strategy • The basic strategy is thus how to find methods to influence determinants of health that are possible to take action towards !
The health promotion concept Definitions of health promotion fall into two clusters--clusters that are not mutually exclusive. The first cluster focuses on the environment--for example, "to improve social and environmental living conditions. . . " the second focuses on the individual, for example to "choose new lifestyles. . . ". Most however, recognize the need to focus on both the individual and the environment
7 Principles of Health Promotion • Empowering: Health promotion initiatives • • • should enable individuals and communities to assume more power over the personal, socioeconomic and environmental factors that affect their health. Participatory: Health promotion initiatives should involve those concerned in all stages of planning, implementing and evaluation. Holistic: Health promotion initiatives should foster physical, mental, social and spiritual health. Intersectoral: Health promotion initiatives should involve the collaboration of agencies from relevant sectors
7 Principles of Health Promotion • Equitable: Health promotion initiatives should be guided by a concern for equity and social justice. • Sustainability: Health promotion initiatives should bring about changes that individuals and communities can maintain one initial funding has ended. • Multi-strategy: Health promotion initiatives should use a variety of approaches, including policy development, organisational change, community development, legislation , advocacy, education and communication, in combination with one another
HP definitions • Various definitions of health promotion typically: • list types of actions that may be employed (educational, organisational, environmental, economic and political); • list adaptations or changes that occur as a result of these changes (attitudinal, behavioural, social and environmental); and • make reference to the goal of improving health.
Definition of Health Promotion based on Ottawa Charter altered by Stachtchenko and Jenicek (1990) with the adding of safety reads as follows: “the process of enabling [individuals and communities] to increase control over [the determinants of health and safety] and [thereby] improve their health. ”
Defintion of HP Staff in the Department of Health Promotion at Curtin University in Western Australia have agreed to adopt a description of health promotion that is based on the two most widely used definitions formulated by European and North American sources (Green and Kreuter 1999; WHO 1986; WHO 1997). The following definition of health promotion was adopted for the project: “Health promotion can be regarded as a combination of educational, organisational, economic and political actions designed with consumer participation, to enable individuals, groups and whole communities to increase control over, and to improve their health through attitudinal, behavioural, social and environmental changes”
Practice of Health Promotion
Is health promotion more like pool or water polo?
Pool or Water polo • One person, one • Team game multiple • • • opponent Level playing surface Highly defined playing strategy, predictable outcomes No background noise Action occurs above ground under spotlights • • • opponents Constantly changing playing environment Fast moving, constantly changing game plan Considerable background noise Much action occurs below the surface
Definition of Competencies are made up of attributes such as knowledge, abilities, skills and attitudes. They can be broad and complex or specific and simple
1. Följa (Monitor) hälsoläget för att identifiera samhällets hälsoproblem 2. Diagnostisera och undersöka hälsoproblem och hälsorisker i samhället (Samhällsanalyser) 3. Informera, utbilda, och maktmobilsera (empower) befolkningen om hälsofrågor 4. Mobilisera olika partner i samhället vilka kan identifiera och åtgärda hälsoproblemen. 5. Utveckla policies och planer som stöder individuella och samhälleliga ansträngningar som kan påverka hälsan 6. Förstärk lagar och regler som skyddar hälsa och förstärker säkerhet 7. Stöd människors behov av hälsoservice och försäkra att vård ges till alla behövande 8. Utveckla en kompetent arbetskraft för folkhälsoarbete och vård 9. Utvärdera effekter, tillgänglighet och kvalitet i vård och folkhälsoarbete. 10. Utveckla forskning som kan ge nya insikter och innovativa lösningar på folkhälsoproblem Nelson, J. Essien, J. , Loudermilk, R. and Cohen, D. (2002). The Public Health Competency Handbook: Optimizing Individual & Organization Performance for the Public’s Health. Atlanta, GA: Center for Public Health Practice of the Rollins School of Public Health. USA report (CDC) on Public Health Core Competencies
Framework for Health Promotion Activities, after Ewles & S
REVIEW OF COMPETENCIES FOR AUSTRALIAN HEALTH PROMOTION 2002
The study identifies broad consensus around a list of 82 competencies under the eight broad headings of: • Needs Assessment • Planning • Implementation • Communication • Knowledge • Organisation and management • Evaluation and research • Use of technology
The health promotion concept • health promotion is generally seen by those who have defined it as involving a diverse set of actions focused on the individual or environment which through increasing control, ultimately leads to improved health or well being (Rootman et al 2001).
The health promotion concept health promotion activities involve the process of enabling or empowering individuals or communities. Therefore, the absence of empowering activities should be a signal that an intervention does not fall within the rubric of health promotion. Attempts to encourage public participation are critical to the process of empowerment
Settings approach Health is created and lived by people within the settings of their everyday life: where they learn, work, play and love? It is in these settings - at school, at work, in our neighborhoods - that we live our lives and it is these contexts or settings, which need to be made more conducive to health
Settings approach c. • Healthy cities • Healthy workplaces • Healthy schools • Healthy universities • Healthy hospitals • Healthy prisons Underlying principle: equity and social ju
Appropriate evidence Given these complexities, there can be no single ”right” method or measure to evaluate effectiveness of programmes, and no ”absolute” form of evidence
Appropriate evidence Evidence of effectiveness is inextricably linked to the entry point (health issue, population or setting), method of health promotion intervention and measure of outcome used to judge ”sucess”
The meaning of “evidence” in health promotion • Four questions: Evidence for whom? – Defining “values” for different groups Evidence of what? – How to measure success in health promotion? Evidence from what? – What makes a good intervention? Evidence through what? – What is the best evaluation research method for health promotion interventions?
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