Lecture Two: Basic Concepts in Health Promotion Dr J. Sitali MPH 541 Lecture Two: Basic Concepts in Health Promotion Dr J. Sitali

Lecture Outline Introduction Concept of health Measuring health Defining health promotion Equity in health Health inequalities Ethics in health promotion

Introduction What does health mean to you? Health comes from Latin word ‘hale’ meaning whole. More complex and elusive to define. Wide range of meanings. Need to clarify everyone’s view.

Concept of Health No single definition of the concept of health. Health is increasingly defined as a social construct. Disease: uneasiness or discomfort. Illness: causing harm or pain. Ill health: experience of disease + illness. Subjective Vs Objective?

Definitions of Health Western medical model Dominant model. Views the body as a machine Does not acknowledge social cause of disease. This view is curative. Negative sense of health – absence of disease. Monitored by data on disease incidence and death rates.

Definitions of Health Holistic Model of Health: WHO Definition. Health is not merely the absence of disease but a state of complete physical, mental and social well being (WHO, 1964). Derived from the Holistic model. Health is viewed in positive terms with acknowledgement of the negative sense.

Definitions of Health The Wellness model. Developed through the WHO health promotion initiative. Move away from “state” to view health as a “process or a force”. “Health is the extent to which an individual or group is able to realize aspirations and satisfy needs and change or cope with the environment. Health is the resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities.” (WHO, 1984)

Definitions of Health Salutogenesis and quality of Life Aaron Antonovsky father of Salutogenesis. In contrast to the medial term pathogenesis salutogenesis focuses on factors supporting health. A theory to guide health promotion. “Health is not a condition that one introspectively feels in oneself. Rather, it is a condition of being involved, of being in the world, of being together with one’s fellow human beings, of active and rewarding engagement in one’s everyday tasks”

Note: Although by no means inclusive, the four models of health outlined above are generally accepted as major discourses on health promotion. Throughout their development, one thing is consistent: the underlying philosophy that health is more than the absence of disease.

Other Key Points on Defining Health Lay concepts of health. Differences according to: Culture Age Social class Gender

Measuring Health Why measure health? To establish priorities. To assist planning. To justify resources. To assist the development of the professional development of health promoters.

Ways of Measuring Health Depend: Primarily on the view of health which is held. On the purpose.

Epidemiology and Measuring Health Epidemiology will tell you: Scale of the problem. Natural history and aetiology of a condition. Causation and association. Risk. Effectiveness.

Class Discussion Points What are the pros and cons of using epidemiology to define health? Why is it that as opposed to mortality statistics, the use of morbidity data is more complex. What are proxy measures of health and how do they help define the health of a population?

Introducing Health Promotion Health promotion is the cornerstone of PHC. It is effective in reducing the burden of disease. It is a core function of public health. Helps mitigate the social and economic impact of disease.

Defining Health Promotion “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. 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”. (WHO, 1986)

Prerequisites for Health Peace Shelter Education Food Income A stable eco-system Sustainable resources Social justice and equity

Strategies for Health Promotion Building healthy public policy. Creation of supportive environments. Strengthening community action. Developing personal skills. Reorienting health services.

Ways of Promoting Health Advocacy. Enablement. Mediation.

Equity in Health Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that none should be disadvantaged from achieving this potential, if it can be avoided. Equity is therefore concerned with creating equal opportunities for health, and with bringing health differentials down to the lowest level possible

Health Inequalities Basic concept describing the opposite of equity. Social inequalities are seen to be the drivers of health inequalities. Most disease burden is seen among the worlds poor and yet access to healthcare is mostly by the rich.

Explaining Health Inequalities Health inequalities as an artifact. Health inequalities as a selection process. Health inequalities as a result of lifestyles. Health inequalities and cultural explanations. Health inequalities as a result of material disadvantage.

Tackling Inequalities in Health Strengthening individuals. Strengthening communities. Improving access to health facilities and services. Encouraging a Healthy public policy.

…ethical theories… Deontological: from Greek word “deonto” meaning duty. We have a duty to act in accordance with certain universal moral rules. Consequential: whether an action is right or wrong depends on its end result.

Ethics and Health Promotion Respect for autonomy: a respect for the rights of individuals and their right to determine their lives. Beneficence: doing good. Non - maleficence: doing no harm. Justice: being fair and equitable.

The end!