Introduction to Health Studies Health Promotion I Dennis Raphael School of Health Policy and Management York University, Toronto, Canada

Overview of Today’s Presentation Differing Concepts of Health Promotion Canadian Contributions The Ottawa Charter for Health Promotion Current Approaches to Health Promotion Reflection: The Role of Values Class Exercise: How Should We Reduce the Incidence of Heart Disease?

Defining Health: The Medical Definition The normal physical state, i.e., the state of being whole and free from physical and mental disease or pain, so that the parts of the body can carry on their proper function.

Defining Health: The World Health Organization Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. Health is a positive concept emphasizing personal resources, as well as physical capacities.

Three Broad Concepts of Health Medical (Traditional) Behavioural (Lifestyle) Socio-Environmental (Structural) These approaches lead to different definitions of problems, different strategies, different target groups, and different people responsible for the activities of promoting health.

Concepts of Health Promotion: Medical Approach I (Traditional, Biomedical) Health Concept is biomedical, absence of disease and/or disability Leading Health Problems defined in terms of disease categories and physiological risk factors such as physiological deviation from the norm: CVD, AIDS, diabetes, obesity, arthritis, mental disease, hypertension, etc.

Concepts of Health Promotion: Medical Approach II Principal Strategies: surgical interventions, drug and other therapies, health care, medically managed health behaviour change (diet, exercise, patient education, patient compliance), screening for physiological and genetic risk factors Target: high risk individuals General Approach: Individualized Actors: physicians, nurses, allied health workers

Concepts of Health Promotion: Behavioural Approach I (Lifestyle, Public Health) Health Concept is individualized, health as energy, functional ability, disease‑preventing lifestyles Leading Health Problems defined in terms of behavioural risk factors: smoking, poor eating habits, lack of fitness, drug abuse, alcohol abuse, poor stress coping, lack of lifeskills, etc.

Concepts of Health Promotion: Behavioural Approach II Principal Strategies: health education, social marketing, advocacy for public policies supporting lifestyle choices (e.g. smoking bans, low fat meat production, bicycle paths, ad bans) Target: high risk groups, children and youth General Approach: individualized, elements of societal focus as related to public policy Actors: public health workers, illness‑related advocacy groups (e.g., Cancer Society), governments  

Concepts of Health Promotion: Socio-Environmental Approach I (Structural) Health Concept is a positive state defined in connectedness to one's family/friends/community, being in control, ability to do things that are important or have meaning, community and societal structures supporting human development Leading Health Problems defined in terms of psychosocial risk factors and socio‑environmental risk conditions: poverty, income gap, isolation, powerlessness, pollution, stressful environments, hazardous living and working conditions, etc.

Concepts of Health Promotion: Socio-Environmental Approach II (Structural) Principal Strategies: small group development, community development, coalition building, political action and advocacy, societal change Target: high risk societal conditions General Approach: structural, focussed on organization of communities and society, development of just political/economic policies Actors: citizens, social development and welfare organizations, political movements and parties

Canadian Contributions I Lalonde Report - 1974 A New Perspective on the Health of Canadians Health Field Concept: Human Biology Lifestyle Environment Health Care

Canadian Contributions II Epp Report - 1986 Achieving Health for All Challenges: Reducing inequities, increasing prevention, enhancing coping Mechanisms: self care, mutual aid, and healthy environments. Strategies: public participation, strengthening services, coordinating healthy public policy

Canadian Contributions III Healthy Cities Movement was developed in Toronto, and is now very strong in Europe The Healthy Cities approach incorporates a broad definition of health, one that emphasizes prevention of community problems and the development of people. Health encompasses all aspects of people's lives including housing, education, religion, employment , nutrition, leisure and recreation, health and medical care, good transportation, a clean and green environment, friendly people, and safe streets and parks that promote a Healthy City.

The Ottawa Charter for Health Promotion – World Health Organization, 1986 Health is a positive concept emphasizing social and personal resources as well as physical capacities Health Promotion is the process of enabling people to increase control over, and to improve their health Prerequisites for Health are peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice and equity Health Promotion Actions are: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, reorienting health services