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HEALTH EDUCATION and HEALTH PROMOTION

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1 HEALTH EDUCATION and HEALTH PROMOTION
OEDOJO SOEDIRHAM DEPARTMENT OF HEALTH PROMOTION AND BEHAVIORAL SCIENCES FKM-UNAIR, SURABAYA 4/6/2017 OEDOJO SOEDIRHAM

2 HEALTH EDUCATION and HEALTH PROMOTION
introduction Definitions and Concepts Foundation for Practice Others 4/6/2017 OEDOJO SOEDIRHAM

3 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
INTRODUCTION OVERVIEW Everyone engaged in the tasks of promoting health starts with a view of what health 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. 4/6/2017 OEDOJO SOEDIRHAM

4 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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 4/6/2017 OEDOJO SOEDIRHAM

5 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
Until the 1980s 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. 4/6/2017 OEDOJO SOEDIRHAM

6 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
The 19th century public health movement informed the health education of the earlier part of the 20th 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. 4/6/2017 OEDOJO SOEDIRHAM

7 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
The development of health education The origins of health education lie in the 19th 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). 4/6/2017 OEDOJO SOEDIRHAM

8 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
The Temperance Movement held Band of Hope mass meetings, through schools and churches lectured to young people on the virtue of abstinence. By the 1920s 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. 4/6/2017 OEDOJO SOEDIRHAM

9 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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” 4/6/2017 OEDOJO SOEDIRHAM

10 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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 4/6/2017 OEDOJO SOEDIRHAM

11 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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: 4/6/2017 OEDOJO SOEDIRHAM

12 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

13 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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 19th and early 20th centuries. 4/6/2017 OEDOJO SOEDIRHAM

14 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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? 4/6/2017 OEDOJO SOEDIRHAM

15 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
TABLE 1: 4/6/2017 OEDOJO SOEDIRHAM

16 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
TABLE 2: 4/6/2017 OEDOJO SOEDIRHAM

17 Definitions and Concepts
What is: HEALTH ? 4/6/2017 OEDOJO SOEDIRHAM

18 Health in the River of Life
4/6/2017 OEDOJO SOEDIRHAM

19 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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). 4/6/2017 OEDOJO SOEDIRHAM

20 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

21 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

22 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

23 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

24 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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). 4/6/2017 OEDOJO SOEDIRHAM

25 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

26 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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). 4/6/2017 OEDOJO SOEDIRHAM

27 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

28 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
The responsibility of health promotion action extends far beyond the health sector and health behavior to wellbeing and QoL. It is a humanistic approach having the human being, human rights at focus again. The individual becomes an active and participating subject. 4/6/2017 OEDOJO SOEDIRHAM

29 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

30 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
Improving health perception/wellbeing/quality of life Going up-streams towards the source the last stage deals with health perception and QoL. The ultimate objective of health promotion activities is to create prerequisites for a good life. Perceived good health is a determinant for QoL. The salutogenic framework can create a fusion of the complexity of health and QoL development (Eriksson and Lindström, 2006, 2007). 4/6/2017 OEDOJO SOEDIRHAM

31 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
It is necessary to learn how to reflect on the options of ones life situation, such as what generates health, what improves QoL 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. 4/6/2017 OEDOJO SOEDIRHAM

32 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

33 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

34 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

35 Definitions and Concepts
BIOMEDICAL PSYCHOLOGICAL SOCIOLOGICAL (SOCIOCULTURAL) 4/6/2017 OEDOJO SOEDIRHAM

36 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 4/6/2017 OEDOJO SOEDIRHAM

37 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 well-being Psychological wellness includes Pleasurable involvement Long-term satisfaction The absence of negative affect 4/6/2017 OEDOJO SOEDIRHAM

38 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 4/6/2017 OEDOJO SOEDIRHAM

39 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. 4/6/2017 OEDOJO SOEDIRHAM

40 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 4/6/2017 OEDOJO SOEDIRHAM

41 Definitions and Concepts
PREREQUISITIES FOR HEALTH Peace Shelter Education Food Income A stable eco-system Sustainable resources Social justice Equity 4/6/2017 OEDOJO SOEDIRHAM

42 Definitions and Concepts
HEALTH PROMOTION ACTION MEANS BUILD HEALTHY PUBLIC POLICY CREATE SUPPORTIVE ENVIRONMENTS STRENGTHEN COMMUNITY ACTION DEVELOP PERSONAL SKILLS REORIENT HEALTH SERVICES 4/6/2017 OEDOJO SOEDIRHAM

43 Definitions and Concepts
These actions are interdependent, but healthy public policy establishes the environment that makes the other four 4/6/2017 OEDOJO SOEDIRHAM

44 Definitions and Concepts
4/6/2017 OEDOJO SOEDIRHAM

45 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
1. Healthy Public Policy Healthy public policy is a pre-requisite for successful health promotion. A Healthy Public Policy is characterized by a concern for health and equity and an accountability for health impact. Health should be made a priority item on the agenda of policy-makers in all sectors. 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. 4/6/2017 OEDOJO SOEDIRHAM

46 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
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 Joint action by all sectors will contribute to achieving safer and healthier goods and services, healthier public services, and cleaner and more healthy environment. The aim is to make the healthier choice the easier choice for all people. HPP should lead to the creation of a supportive environment to enable people to lead healthy live 4/6/2017 OEDOJO SOEDIRHAM

47 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
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”. 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. 4/6/2017 OEDOJO SOEDIRHAM

48 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
2. Create Supportive Environment A supportive environment is essential for health. 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 for health. 4/6/2017 OEDOJO SOEDIRHAM

49 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
3. Strengthen Community Action: Community Participation 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”. There are many ways of defining community. Factors used are geography, culture and social stratification. 4/6/2017 OEDOJO SOEDIRHAM

50 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
Community action is any activity undertaken by a community in order to effect change (including voluntary and self-help services). 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 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. 4/6/2017 OEDOJO SOEDIRHAM

51 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
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) 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 these needs 4/6/2017 OEDOJO SOEDIRHAM

52 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
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”. 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. 4/6/2017 OEDOJO SOEDIRHAM

53 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
4. Develop Personal Skills 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 act upon them. It is a bottom-up strategy which requires the health promoter to act as a facilitator and catalyst for change. 4/6/2017 OEDOJO SOEDIRHAM

54 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
Skills which can promote an individual’s health include those pertaining to identifying, selecting and applying healthy options in daily life. 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. Health education should be conducted in all settings. 4/6/2017 OEDOJO SOEDIRHAM

55 THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH PROMOTION (OTTAWA CHARTER)
5. Reorient Health Services Shift of emphasis from provision of curative services. Health care system must be equitable and client-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 of services, 4/6/2017 OEDOJO SOEDIRHAM

56 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 the theory of health promotion. As this book makes clear, health promotion is far from straightforward. 4/6/2017 OEDOJO SOEDIRHAM

57 Health Promotion Theory
Why study health promotion theory? Unless public health practitioners explore and understand the 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. 4/6/2017 OEDOJO SOEDIRHAM

58 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. 4/6/2017 OEDOJO SOEDIRHAM

59 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
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. 4/6/2017 OEDOJO SOEDIRHAM

60 OEDOJO SOEDIRHAM (oedojo@yahoo.com)
thank you 4/6/2017 OEDOJO SOEDIRHAM


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