Presented by Dr/Amira Yahia HEALTH PROMOTION Presented by Dr/Amira Yahia

Learning outcomes To define health promotion To identify the Principles of Health Promotion To discus the Concerns of health promotion To describe the Health Promotion Values To enlist the Components of Health Promotion To identify the basic charactristics of health promotion To enoumrate the Health Promotion Triad To discuss the health promotion program To apply the community health nurses roles

What is Health Promotion all about? It is the process of enabling people to increase control over and improve their health. (Ottawa H.P. Charter). It is a process which empowers families and communities to improve their quality of life, and achieve and maintain health and wellness. It emphasizes not only prevention of disease but the promotion of positive good health.

What is Health Promotion all about? It is a positive concept emphasizing personal, social, political and institutional resources, as well as physical capacities. Health promotion is any combination of health, education, economic, political, spiritual or organizational initiative designed to bring about positive attitudinal, behavioral, social or environmental changes conducive to improving the health of populations.

What is Health Promotion all about? Health promotion is directed towards action on the determinants or causes of health Health promotion, therefore, requires a close co-operation of sectors beyond health services, reflecting the diversity of conditions which influence health. Government at both local and national levels has a unique responsibility to act appropriately and in a timely way to ensure that the ‘total’ environment, which is beyond the control of individuals and groups, is conducive to health.

Definitions of health promotion “Any combination of health education and related organizational, economic and political interventions designed to facilitate behavioral and environmental changes conductive to health”. (Green LW 1979) "Health promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health. 

Definitions of health promotion (cont.) “the process of enabling people to increase control over, and to improve, their health: (WHO, 1984, 1986; Epp, 1986) “the process of enabling [individuals and communities] to increase control over [the determinants of health] and [thereby] improve their health” (Nutbeam, 1985) 7

Definitions of health promotion (cont.) “the maintenance and enhancement of existing levels of health through the implementation of effective programs, services, and policies” (Goodstadt, et al.,1987) “the advancement of wellbeing and the avoidance of health risks by achieving optimal levels of the behavioral, societal, environmental and biomedicial determinants of health” (Kar, 1987) 8

Cont… Optimal health is defined as a balance of physical, emotional, social, spiritual, and intellectual health.  Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behavior and create environments that support good health practices.  Of the three, supportive environments will probably have the greatest impact in producing lasting change".  (American Journal of Health Promotion, 1989,3,3,5)

Health Promotion Process enabling individually acollectivelly increase control over determinants of their health, and improve health status. (WHO, 1998) It does not mean only responsibility of the health care system, but also individual responsibility for health expressed via life style. (Kebza, 2005)

Principles of Health Promotion Involves population as a whole Acts on the determinants of health Combines diverse approaches Aims at public participation Health professionals have enabling role 11

Concerns of health promotion Health education programmes - to raise awareness of health risk and to encourage behaviour change Primary health education - to prevent ill health developing (e.g. diet, hygiene, social skills, etc)

Concerns of health promotion Preventive health services - e.g. family planning, immunisation and well person clinics Community-based work - local communities identify health problems and address them Healthy public policies - housing, employment, transport, etc

Concerns of health promotion Environmental health issues - making the physical environment safer - e.g. tackling pollution. Economic and regulatory activities - e.g. trying to get the government to raise tax on tobacco, etc

Health Promotion Values Empowerment Participation Social Justice/Equity Respect Priority to common good Choice Positive health 15

Components of Health Promotion Health protection implemented by public health policy Health education Intervention programmes

BASIC CHARACTERISTICS OF HEALTH PROMOTION Enabling people to take control over, and responsibility for, their health as an important component of everyday life. Requiring the close cooperation of sectors beyond the health services. Combining diverse, but complimentary, methods or approaches. Encouraging effective and concrete public participation. Media, newspapers, for a Participation from day 1 17

THE TRIAD OF HEALTH PROMOTION HEALTH EDUCATION HEALTH PROTECTION DISEASE PREVENTION Define Which is more difficult 18

The Health Promotion Triad Health Education Health Protection Prevention

Health Promotion Programs – Priorities Life style Nutrition Physical activity Tobacco Alcohol Accidents HIV/AIDS Noncommunicable diseases (NCD) Prevention of CVD Prevention of cancer diseases Prevention of metabolic diseases (obesity, diabetes)

Health Promotion includes … Promoting healthy lifestyles. Getting people involved in their own health care. Creating an environment that makes it possible to live a healthy life. Recognition of lifestyle diseases as major causes of illness and death. Strengthening community participation.

The Phases of Prevention in relation to natural history of disease Primary Prevention Secondary Prevention Tertiary Prevention Cure Chronic disease Healthy individual Biological onset of disease Clinical Course of disease Disability Death Functional Status Risk Factors Asymptomatic signs Symptoms and signs Predisposition/susceptibility Preclinical/presymptomatic Clinical/symptomatic Outcome- cure, permanent/temporary-partial disability/death Rehabilitation Support Immunization Health Education Prophylaxis Screening Surveillance Diagnosis Treatment Compliance Adherence The Phases of Prevention in relation to natural history of disease 22

Examples of preventable health problems related to lifestyle Chronic non-communicable diseases such as diabetes and hypertension. These are major causes of illness and death. They are related to… Overweight and obesity. Unhealthy diet. Insufficient physical activity. HIV/AIDS is related to unsafe sexual lifestyle, and causes many deaths.

- Action taken to avert the occurrence of disease PRIMARY PREVENTION - Action taken to avert the occurrence of disease Interventions: o Medical o Legislative o Societal o Educational o Individual efforts Nip in the bud 24

PRIMARY PREVENTION - The more directly a behavior is linked to a health problem as a risk factor, the better candidate it is for primary prevention efforts

SECONDARY PREVENTION Action taken to identify diseases at their earliest stages and to apply appropriate treatments to limit their consequences and severity.

TERTIARY PREVENTION Specific interventions to assist diseased or disabled persons in limiting the effects of their diseases or disabilities; also may include activities to prevent recurrences of a disease.

HEALTH EDUCATION Planned process, Combines a variety of educational experiences, and Facilitates voluntary adaptations or establishment of behaviour conducive to health

HEALTH EDUCATION Aims primarily at the voluntary actions people can take on their own part, individually or collectively, for their own health or the health of others and the common good of the community

Learning Domains Health Education Cognitive Psychomotor Affective Each learning domains are related and cannot be separated from one another. Example: Management of Diarrhea Cognitive: Acquired due lack of proper sanitation, causes dehydration Psychomotor: fluid and salt replacement Affective: hand washing 30

Cognitive Domain Aspect of health education that comprises information and knowledge Information gained from health education can be A new information A reinforcement

Psychomotor Domain Aspect of health education that deals with skill acquisition and reinforcement

Affective Domain Aspect of health education that is mainly concerned in Habit formation Behavior change New practice

THREE MAIN PURPOSES OF HEALTH PROMOTION/EDUCATION IN TERMS APPLICABLE TO THE THREE LEVELS OF PREVENTION Promotion of health and illness prevention Restoration of health when one becomes ill Maintenance of health while coping with chronic, long-term conditions

Intersectoral approach Health Promotion brings together many sectors to work towards the achievement and maintenance of health and wellness. The Health sector alone cannot achieve a healthy society. All sectors, both government and non-government, need to work together. Health Promotion can provide the link between the various sectors. Within Health the various disciplines also need to work together towards wellness.

Some non-health sectors with an input into Health Promotion… Education/ schools Agriculture Community Services Sport Media Non-Governmental Organizations (NGO’s) Community groups Youth Private sector

Health sectors with an input into Health Promotion Environmental Health Nutrition Community nursing Mental Health Dental Epidemiology Hospital (secondary) care School of Nursing Occupational therapy

Formulating healthy public policy Promotes healthy policies in all sectors , eg healthy workplaces, schools, homes, buildings, villages and communities. Health aspect should be thought of and included in the policies of the various sectors. Health Policies should also emphasize the prevention and promotion.

Reorienting health services Since lifestyle is linked to many of today’s health problems, prevention and promotion should decrease the burden on secondary (curative) health care. Greater emphasis and resources placed on health promotion and primary health care. Less emphasis on purchase of high tech equipment for secondary health care. Equity in health care.

Empowering communities to achieve well-being Involvement of the community in health decisions, a multisectoral and participatory approach. Provide communities with the information and tools to take actions to improve health and well-being.

Creating supportive environments Healthy physical, social and economic environment. All development activities should aim for a healthy environment – healthy buildings, roads, workplaces, homes, surroundings and schools.

Developing /increasing personal health skills Information and education for personal and family health. Take account of values, beliefs and customs of the community. Continuous process at all stages of life. Guided and supported in developing skills (not imposed on them). Build on existing knowledge and attitudes.

Building alliances with special emphasis on the media Media key players, influence on health of people. Partnership with media ensures their collaboration and that correct information is passed on. Free flow of information both ways, on matters vital to health.

CHN roles The role of nurses has included clinical nursing practices, consultation, follow-up treatment, patient education and illness prevention. This has improved the availability of health-care services, reduced symptoms of chronic diseases, increased cost-effectiveness and enhanced customers' experiences of health-care services.

Cont…. Health promotion by nurses can lead to many positive health outcomes including adherence, quality of life, patients' knowledge of their illness and self-management

THANK YOU VERY MUCH