1. Introduction to health promotion
Dr John Hubley

2. With acknowledgements to Dennis Burkitt

3. World Health Report 2002
Simple, cost effective public health measures could lengthen the average human life span by five to 10 years
The top 10 risk factors accounting for about 40% of the 56 million deaths in the world each year are underweight in children and mothers; unsafe sex; poor water, sanitation, and hygiene; indoor smoke from solid fuels; iron deficiency; high blood pressure; tobacco; alcohol; high cholesterol; and obesity. Two other factors are important in the developing world: zinc deficiency and vitamin A deficiency.

4. Health Field Model Human Biology (Genetics) Life style (Human Health
behaviour)
Health
Services
Environment

5. Primary Secondary Tertiary prevention prevention prevention
healthy onset of advanced disabilty
person symptoms symptoms death
(reversible) (not reversible )
Primary Secondary Tertiary
prevention prevention prevention
screening rehabilitation
case finding
early prevention

6. Primary prevention
Actions carried out with healthy people to maintain their health and prevent disease

7. Annual lung cancer death rates
Death rates from lung cancer (per 1000) by number of cigarettes smoked, British doctors,
Annual lung cancer death rates
per 1000
Average number of cigarettes smoked per day

8. Secondary prevention
Actions to promote early interventions when someone becomes ill to promote recovery and prevent the condition from becoming worse

9. A calendar from Cambodia promoting the DOTS approach to TB – essential to ensure adherance to prescribed doses
To ensure effectiveness of treatment and the prevent the emergence of antibiotic resistance

10. Types of behaviours
Decision-based behaviours – where a person goes through a conscious decision-making process before deciding to perform (or not to perform the behaviour)
One-time behaviour – a behaviour that a person is expected to do only a few times in their life. (also usually a decision-based behaviour).
Routine behaviour – something people do regularly - usually without a conscious decision (a behaviour might start as decision-based and then become a routine as it is integrated into their pattern of life)
Addictive behaviour – when there is some physiological reinforcement of the behaviour through a biological adaptation in the person who becomes dependent on regular use of the substance.

11. How realistic is this message?
Do people living in overcrowded housing have any choice?
This is an example of victim blaming health education that puts all the emphasis on individual behaviour change and ignores social and economic influences on the individual

12. This photograph of a poster in a village in Cambodia promoting iodized salt for the prevention of goitre.
One out every 4 –5 houses had stalls selling cigarettes – but iodized salt was not on sale.
It is not enough to do health education – you have to make the health choice the easier one!

13. An effective response should
Provide the information and power for the community to make decisions
Make the healthy choice the easiest one
Remove barriers to action

14. Ottawa Charter for Health Promotion
Health Promotion - the process of enabling people to increase control over, and to improve, their health.
Strengthen
Community
Action
Develop
Personal
Skills
Create
Supportive
Environments
Enable
Mediate
Advocate
Reorient
Health
Services
Policy
Build
Public
Healthy
Source: Canadian Public Health Association - An International Conference on Health Promotion - November 18

15. Promoting health Health Education Service Improvement Advocacy
Communication directed at individuals, families and communities to influence:
awareness/knowledge
decision-making
beliefs/attitudes
empowerment
individual and community action/behaviour change
community participation
Service
Improvement
improvements in
quality and quantity of services:
accessibility
case management
counselling
patient education outreach
social marketing
Advocacy
agenda setting and
advocacy for healthy public policy
policies for health
income generation
removal of
obstacles
discrimination
inequalities
gender barriers

16. HESIAD Exercise Take a health topic
In groups identify suitable actions that might be taken for each component of HESIAD - health education, service improvement and advocacy

17. Components of an intervention
Health Education
directed at individuals, families and communities
Service
improvement
improvements in
quality and quantity of services:
Advocacy
agenda setting and
advocacy for healthy public policy

18. Service Improvement
Improvement in capacity of staff – training and support
Development of new activities
Reorienting existing activities to make them more effective/acceptable
Strengthening communication/health education within services
Improved patient education
Outreach to schools, community, workplace
Involvement of personnel in supporting community health promotion

19. Advocacy
Influencing policy makers, leaders and media to raise profile of programmes
Addressing legal, financial and service obstacles to health action

20. Equivalent terms Health education
IEC (information, Education and Communication)
Behaviour Change Communication
Social marketing

21. Why is health education essential for promoting health?
Community action to change surroundings - includes community participation in health decision-making.
Adoption of healthy life style – e.g. diet, life style, child care, safety, stopping smoking, not taking drugs.
Utilization of health services especially preventive services e.g. ante-natal care, immunization, family planning, screening.
Recognition and prompt self referral on early symptoms eg for cancers, diabetes.
Following (adhering to) prescribed medicines, completing doses.
Support for health promoting policies e.g. seat belt wearing, traffic restrictions.

22. “any combination of learning opportunities designed to facilitate voluntary adaptation of behaviour which will improve or maintain health”
Larry Green

23. "A process with intellectual, psychological and social dimensions relating to activities that increase the abilities of people to make informed decisions affecting their personal family and community well-being. This process, based on scientific principles, facilitates learning and behavioural change in both health personnel and consumers, including children and youth
Helen Ross and Paul Mico

24. Levels for communication activities
individual
family
wider family
community
district
region
national
international
Each level has factors which influence peoples’ actions
Each level offers opportunities for different communication methods

25. Critical decisions in Public Health Education
Actions to be promoted
Target groups
Messages
Methods (settings, channels)
Delivery – timing

26. Some common settings for public education
school
household
Health facility
Schools
health facility
community

27. Programme planning for health promotion
Situation analysis
Dialogue with stakeholders
literature reviews
Surveys to determine:
Baseline situation
Needs/Problems
Influences on problem at different levels – community, service and policy/society level
Opportunities/resources available to support intervention
Plan health promotion
Strategy: mix of advocacy, service improvement and health education
Activities
Targets/objectives
Management
Timing
Costs
Implement health promotion
Monitor progress
Evaluate impact
Feedback from monitoring/evaluation