Defining and conceptualising Using models Case studies Health Promotion Defining and conceptualising Using models Case studies

Session outcomes The explain the roots of health promotion To apply three different frameworks(models or typologies) that explain the scope of health promotion to different contemporary topics. To explain selected principles of health promotion practice to a case study

The roots of health promotion Health Promotion emerged from health education movement. Health education noticeable in early 1900s with emphasis on cleanliness, personal behaviour and therefore responsibility for ones own ill-health and health. The Central Council for Health Education was founded in 1927. This explains why health education is often viewed as the main

What is Health Promotion? Today Health Promotion is more than personal and population education. Defined in a number of ways “The process of enabling people to increase control over and improve their health” (World Health Organisation 1986) Health Promotion = health education x healthy public policy. (Tones and Tilford, 1994)

The scope of health promotion activity Frameworks and Models are tools that help explain phenomena. Many tools developed to explain the scope of health promotion. Tannahill, (1985) model of health promotion Naidoo and Wills (2000) typology of health promotion Beattie’s (1991) model of health promotion Tones and Tilford’s (1994) empowerment model of health promotion Caplan and Holland’s (1990) Four perspectives on health promotion

Beattie’s model of Health Promotion Authoritative Legislative Action Focus Act Resources Policy Health persuasion Needs to focus on why behaviour is happening Individual Collective Community Development Empowerment community level Skills Personal Counselling Greater control Negotiated

Beattie’s model applied Key features Examines 2 axis i) type of approach used top down (authoritarian) or bottom up (negotiated or owned by clients) ii) size of approach Categorises 4 types of activities Personal Counselling eg working with dietician on food and physical individual personal plans and goals Health persuasion eg Campaign of eating 5 fruit and vegetables a day on TV Legislative action eg laws that subsidise the price of healthy food stuff Community development eg communities producing and distributing food themselves

Tones and Tilford’s (1994) model of health promotion Key features States interaction between two main sets of processes for health improvement i)development and implementation of healthy public policy ii) health education in which people are empowered to take control of their life. Example is attempts of Jamie’s School Diners campaign where school meals was brought into public consciousness and lead to standards for meals and an increase in the budgets for school meals. Only when these two approaches work in parallel can the conditions for living and individuals behavioural aspects of health be addressed

Caplan and Holland’s model of health promotion (1990)

Caplan and Holland’s model of health promotion (1990) Key features More complex and theoretically driven Attempts to unpick what determines health and ill-health and therefore what activities can be used to address health issues. One axis refers to a theory of knowledge and how knowledge is generated in relation to health The other axis refers to how society is constructed and how this impacts on health.

Application to domestic violence Nature of knowledge Traditional Treatment of injuries Educational campaigns about the issue to raise awareness and change attitudes to domestic violence in populations. Radical Humanist Provide supportive networks and self help groups and use of safe houses to remove women from violence. Women to gain more power by developing economic and social power via work and stronger networks. Radical structuralist Working to reduce power inequality between men and women through legislation for gender equality. Issue to be taken seriously by criminal justice system . Social unacceptability of issue generated through advocacy and lobbying. Humanist Working with women (and men) directly so they can understand the nature of their experiences and what they can do themselves. Using cognitive-behavioural therapy (CBT) approaches to understand the issues and change behaviour. Nature of society

Key principles in health promotion Principles are important as they relate to how we should work in practice. The World Health Organisation provides a global perspectives Gregg and O’Hara (2007) provide a good synthesis of many of these

Focus on upstream approaches “You know”, he said, “...sometimes it feels like this. There I am standing by the shore of a swiftly flowing river and I hear the cry of a drowning man. So I jump into the river, put my arms around him, pull him to shore and apply artificial respiration. Just when he begins to breathe, there is another cry for help. So I jump into the river, reach him, pull him to shore, apply artificial respiration, and then just as he begins to breathe, another cry for help. So back in the river again, reaching, pulling, applying, breathing and then another yell. Again and again, without end, goes the sequence. You know, I am so busy jumping in, pulling them to shore, applying artificial respiration, that I have no time to see who the hell is upstream pushing them all in” (McKinlay, 1979 p 249).

Non- victim blaming approaches Victim blaming is an approach to health education which only focuses on individual action rather than the external forces that influence an individual person resulting in blaming people for their health behaviour and related consequences (Hubley and Copeman, 2008). Practitioners should resist victim-blaming as it does not show understanding of the influences of health behaviour. Instead practitioners should consider the social and economic experiences of people’s lives and which may explain how & why people behave in the manner that they do.

Evidence based practice Evidence based practice is concerned with trying to understand which approaches and methods of working are likely to produce the strongest health improvement. The principle of generating evidence by providing stronger evaluation of programmes and initiatives as they are developed & implemented and encouraging the utilisation of the existing evidence base by practitioners, are both key principles of practice.

Participation and empowerment Participation implies ‘being present and taking part’ in health promotion activities and secondly recognising that when people participate what they say should be listened to and acted upon (Lowcock and Cross, 2011). Empowerment is an approach that facilitates people working together to increase the control that they have over events that influence their lives and health (Woodall et al. 2010) Given that a definition of health promotion is about taking control then these two interlinked concepts are fundamental to how we act as practitioners

Equity Equity in health is concerned with fairness and the idea that everyone should have equal right to the fullest health possible. The term inequity enshrines an unfair distribution of health status. Eg poorer health is experienced in lower social classes Health should be more equally distributed and that health promotion approaches should, as a high priority, address health inequities. Policies and projects are now being evaluated to assess their impact on health equity, to reduce the disproportional impact on those that already experience poorer health, using a technique known as health equity audits (Health Development Agency, 2003)

Ethical principles There are four major ethical principles outlined in Naidoo and Wills, 2009 Autonomy – “Respect for the rights of individuals and their rights to govern their own lives” (Naidoo and Wills, 2000 p91) Beneficence - Doing and promoting good but we would need to consider whose good, the individual or wider group Non-maleficence - Doing no harm Justice - People should be treated equally and fairly.

Summary The scope of health promotion is varied and diverse and not limited to health education. In order to address health issues a wider range of health promotion approaches should be used that directly address the wider upstream determinants. Approaches should be evaluated on the basis of key health promotion principles.