An Introduction to Health Promotion Policy, Programming and Approaches Sue Thompson Lecturer in Adult Nursing University of Nottingham

Public Health Health Promotion Enabling people to increase control over their health Health Education Providing information Raising awareness Health Surveillance Monitoring people’s health Health Protection Fighting epidemics, infectious diseases

What is health promotion? “The process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health” (WHO 1985)

Who makes policy? Dept of Health (in England and the devolved nations) strongly influenced by government in power – Minister for Health NHS bodies – regional strategic health authorities/health trusts Local authorities to be given power to commission public health Advisory bodies – eg NICE Professional bodies – eg RCN, BMA Single issue groups eg ASH Independent commissions eg Health care Commission, Acheson Enquiry

The Proposed New System of Public Health Provision in England New body Public Health England to get ring fenced money from Dept of Health to spend on population (country) wide interventions Local Authorities to commission public health services to address local needs (ring fenced) Disadvantaged areas to get more money (a health premium) if they prove successful, especially in reducing health inequalities

Needs Normative. Defined by professionals Felt. Defined by clients, what they want/say they want Expressed. Defined by action, a demand for and take up of services Comparative. Defined by equality issues, what is provided to comparable populations Needs may be defined already – national epidemiological data. Local community profiles and local agencies reports

Who’s agenda is it? Practitioners very often do not start with a blank sheet and often have to work on issues that have been determined nationally.

Community Problem Definition (Nutbeam 2001) Epidemiological and Demographic information Behavioural and social research on the determinants of health Community needs and perceived priorities

Solution Generation (Nutbeam 2001) Theory and intervention models Evidence from past programmes Experience from practitioners

Programme Evaluation (Nutbeam 2001) Assess Health Promotion outcomes. Intervention impact measures eg health literacy, social action and influence, healthy public policy and organisational practice Intermediate health outcomes. Modifiable determinants of health eg healthy lifestyles, effective health services, healthy environments Health and social outcomes eg reduced morbidity/avoidable mortality and increased quality of life, functional independence

Health Promotion Approaches Medical Approach  Aims to prevent ill health, to reduce morbidity and premature mortality through clinical interventions,  eg medication to control of blood pressure and cholesterol. Also surgical interventions eg Angioplasty

Behavioural Approach Aims to ensure that individual lifestyles are healthy and therefore risk of disease is less Egs weight management programmes, stop smoking clinics

Educational Approach Aims to provide information on health issues which will increase knowledge and understanding of public health issues. Hopes to lead to people making informed decisions and taking positive action to improve their health.

Empowerment Approach  Aims to provide support to enable people and communities to take control of their health, to set their own priorities and format their own agenda.  Working in partnership with patients to facilitate their control over their own condition, treatment, management etc.

Social Change Approach  Aims to bring about changes in physical, social and economic environment in order to make healthy choices easier.  Policy development at local and national level

Health Practitioners Role in Health Promotion Population wide-Lobby and advise through strategic work or through professional body 1-1 work with patients/relatives Provide information Facilitate empowerment and self efficacy Be aware of others services for referral and signposting Provide on going support and practical help Be non judgemental

References and reading Davies M and Macdowall W (2006) Using theory to guide changing individual behaviour in Health Promotion Theory p Maidenhead: OU Press Department of Health (2006) Health Profile of England. DoH Pubs Gross R (2001). Models and beliefs in Psychology:the science of mind and behaviour. p Naidoo J and Wills J. (1994)Helping People to Change in Health Promotion, Foundations for Practice p London: Bailliere Tindall Tones K and Green J.(2004) Education for Health-the conditions of learning in Health Promotion, Planning and Strategies p London: Sage