1. Health education and health promotion
Bojana Matejić
Associate Professor of Social Medicine
2013

2. What is health?
It is difficult to define health in objective-measurable criteria
For centuries, health was defined in terms of absence of disease
Health has
both
objective
and
subjective
aspects

3. Determinants of health
Our health is influenced by many factors
These factors could be categorized into three groups:
Internal determinants
External determinants
Prevalent system of health care

4. Prerequisites for Health
The fundamental conditions and resources for
health are:
• peace,
• shelter,
• education,
• food,
• income,
• a stable eco-system,
• sustainable resources,
• social justice, and equity.
Improvement in health requires a secure foundation in these basic prerequisites.
Health is both a fundamental human right and a sound social investment. Governments need to invest resources in healthy public policy and health
promotion in order to raise the health status of all their citizens. A basic principle of social justice is to ensure that people have access to the essentials
for a healthy and satisfying life. At the same time, this raises overall societal productivity in both social and economic terms

5. Health and behavior Health is associated with our own actions!
Think of an important health problem in your community.
What behavior cause and spread the problem?
What behavior prevents it?
Health and illness are not just biological events. Some actions can keep us healthy or make us ill
In Greek and Roman mythology, Hygieia (Ὑγιεία), or Hygeia (Ὑγεία), was a daughter of the god of medicine, Asclepius. She was the goddess of health, cleanliness and sanitation and afterwards, the moon. She also played an important part in her father's cult. While her father was more directly associated with healing, she was associated with the prevention of sickness and the continuation of good health. Her name is the source of the word "hygiene".

6. The Context of Health and Behavior
The most frequent causes of death in the developed countries and globally are chronic diseases, including heart disease, cancer, lung diseases, and diabetes.
Behavioral factors, particularly tobacco use, diet and activity patterns, alcohol consumption, sexual behavior, and avoidable injuries are among the most prominent contributors to mortality
(Schroeder, 2007; Mokdad, Marks, Stroup, and Gerberding, 2005).

7. The Changing Context of Health and Behavior
Projections of the global burden of disease for the next two decades include increases in noncommunicable diseases, high rates of tobacco-related deaths, and a dramatic rise in deaths from HIV/AIDS
Malaria, diarrheal diseases, and other infectious diseases, in addition to AIDS, are major health threats to the poorest people around the world
The trajectory of infectious diseases and also chronic diseases, may be influenced by the application of effective health behavior intervention

8. Why do people behave as they do?
Predisposing factors -knowledge, attitudes, beliefs, personal preferences, existing skills, and self-efficacy towards the desired behavior change.
motivate an individual or group to act
Reinforcing factors include factors that reward or reinforce the desired behavior change, including social support, economic rewards, and changing social norms.
strengthen or inhibit the motivation to act
Enabling factors are skills or physical factors such as availability and accessibility of resources or services that facilitate achievement of motivation to change behavior - facilitate the motivation to act
Tell me, what are the reinforcing factors in smoking cessation. The social norms are changed and the smoking is not desirable behavior any more, and the legislation is changed so it is even forbidden in public in many situations. Only few years ago, smoking was allowed among teachers in schools and among doctors in hospitals.
Support groups, counseling services

9. Health education
The recognition that individual behavior plays an important role in the development of many health problems influenced the development of health education as professional and scientific field
Having in mind all the previously mentioned, we come to the concept of health education. Namely, the recognition…

10. Health education
Health education is a social science that draws from the biological, environmental, psychological, physical and medical sciences to promote health and prevent disease, disability and premature death through education-driven voluntary behavior change activities
Health education is the development of individual, group, institutional, community and systemic strategies to improve health knowledge, attitudes, skills and behavior.
The purpose of health education is to positively influence the health behavior of individuals and communities as well as the living and working conditions that influence their health.

11. Health education-definition
"any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions."
(The Joint Committee on Health Education and Promotion Terminology, 2001)
Health Education comprise of consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health (WHO, 1989) ] 11

12. Health literacy
Health literacy represents the cognitive and social skills necessary to understand and use information, and to take action in ways that promote and maintain good health, including changing lifestyles and living conditions
Health literacy is an individual's ability to read, understand and use healthcare information to make decisions and follow instructions for treatment
Studies reveal that up to half of patients cannot understand basic healthcare information. Low health literacy reduces the success of treatment and increases the risk of medical error. Various interventions, such as simplified information and illustrations, avoiding jargon, "teach back" methods and encouraging patients questions, have improved health behaviors in persons with low health literacy. Health literacy is of continued and increasing concern for health professionals, as it is a primary factor behind health disparities.
Studies reveal that up to half of patients cannot understand basic healthcare information!

13. Why is health education important?
• Health education improves the health status of individuals, families, communities, states, and the nation • Health education enhances the quality of life for all people • Health education reduces premature deaths • By focusing on prevention, health education reduces the costs (both financial and human) that individuals, employers, families, insurance companies, medical facilities, communities, the state and the nation would spend on medical treatment
It is of little surprise that the number of topics on which health professionals and health
education specialists focus has grown and evolved as health problems have changed around the
world. Some professionals may counsel people at risk for AIDS about safe sex; help children
avoid tobacco, alcohol, and drugs; assist adults to stop smoking; help patients to manage and cope
Health Behavior and Health Education, Fourth Edition – final draft, for desk review only.
Not for circulation or use without permission of the publisher
with their illnesses, and organize communities or advocate policy changes aimed at fostering
health improvement. Other health professionals may focus on environmental concerns. We
expect that, over the next decade, more behavior change interventions will be directed at
changing individual and community behaviors related to water consumption and to behaviors that
may affect global climate change.

14. Who provides health education?
Medical professionals specialized in health education (trained and/or certified health education specialists).
Others perform selected health education functions as part of what they consider their primary responsibility (medical treatment, nursing, social work, physical therapy, oral hygiene, etc.).
Other professionals are responsible to do specific, limited educational tasks to encourage healthy behavior.
Health education professionals work all over the world in a variety of settings, including schools, worksites, nongovernmental organizations (including voluntary health organizations), medical settings, and communities
Many kinds of professionals contribute to and conduct health education and health behavior programs and research. Health education practice is strengthened by the close collaboration among professionals of different disciplines, each concerned with the behavioral and social intervention process and each contributing a unique perspective. Although health behavior professionals have usually worked this way, there is increasing emphasis on an interdisciplinary or even a transdisciplinary focus.
Psychology brings to health education a rich legacy of over one hundred years of research and practice on individual differences, motivation, learning, persuasion, and attitude and behavior change (Matarazzo and others, 1984), as well as the perspectives of organizational and community psychology.
Physicians are important collaborators and are in key roles to effect change in health behavior. Likewise, nurses and social workers bring to health education their particular expertise in working with individual patients and patients’ families to facilitate learning, adjustment, and behavior change, and to improve quality of life. Other health, education, and human service professionals contribute their special expertise as well. Increasingly, there are partnerships with genetic counselors and other specialists in this rapidly developing field

15. Communication
Communication is essential not only in informing people about health concerns, but also in maintaining health issues on the agenda
Health communication interventions aim to:
to informe
to persuade
to educate

16. Information flow Two-way-flow One-way-flow of information
Mass media..…..lectures…...demonstrations…..…small groups…..…dialog
The communication is very dinamic so the information has its flow

17. Health education: traditional approach
Making individuals aware of negative consequences of behaviour for health by providing knowledge and information
Characterised by:
medical practice
target group is empty vessel
human as logical information processor
victim blaming
health educator
information
target group

18. Remember… Knowledge is important but insufficient
Motivation, skills, social
and physical environment
Members of target groups are experts too
strongly influence
individual behavior

19. Health education nowadays: definition
Consciously constructed opportunities for learning, designed to improve health literacy, including improving knowledge, and developing life skills, which are conducive to individual and community health (WHO, 1998)
Preferably designed together with (representatives of) the target population (Koelen & van den Ban, 2004)
health educator
information
target group

20. An additional move in improving public health
Based on the notion that health is not only influenced by biology and individual behaviour (lifestyle)
but also by the social and physical environment, and the system of health care
The process of enabling individuals and communities to increase control over the determinants of health, and thereby to improve their health (WHO, 1998)
Health promotion
Making healthy choices easy choices

21. Health promotion action areas
Build healthy public policy
Create supportive environments
Strengthen community actions
Develop personal skills
Reorient health services
This logo was created for the First International Conference on Health Promotion. held in Ottawa, Canada, in 1986.
The logo represents a circle with 3 wings. It incorporates five key action areas in Health Promotion (and three basic HP
strategies (to enable, mediate, and advocate).
The main graphic elements of the HP logo are:
• one outside circle,
• one round spot within the circle, and
• three wings that originate from this inner spot, one of
which is breaking the outside circle
This wing is breaking the circle to symbolise that society and communities as well as individuals are constantly changing and, therefore, the policy sphere has to
constantly react and develop to reflect these changes: a “Healthy Public Policy” is needed;
Charter of Ottawa, WHO, 1986

22. Healthy Public Policy
Healthy public policy covers a combination of diverse but complementary measures and approaches such as legislation, taxation, fiscal incentives and disincentives, policy analysis and review, and organizational change
Joint action by all sectors will contribute to achieving safer and healthier goods and services, healthier public services, and cleaner and more healthy environment.
The aim is to make the healthier choice the easier choice for all people.
Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors
and at all levels, directing them to be aware of the health consequences of their decisions and to accept
their responsibilities for health. Decision-makers must be firmly committed to social
responsibility. Both the public and private sectors
should promote health by pursuing policies and
practices that:
• avoid harming the health of individuals
• protect the environment and ensure sustainable
use of resources
• restrict production of and trade in
inherently harmful goods and substances
such as tobacco and armaments, as well as
discourage unhealthy marketing practices
• safeguard both the citizen in the marketplace
and the individual in the workplace
• include equity-focused health impact
assessments as an integral part of policy
development

23. Health in All Policies: strengthening the link between health and other policies
Health in All Policies is an encompassing approach which goes beyond the boundaries of the health sector.
All relevant government sectors like agriculture, trade, education, industry and finance need to give important consideration to health as an essential factor during their policy formulation
EU regulatory framework is (in principle) in place to extend the impact assessment of regulations and policies to health protection, but so far this has not been particularly evident.

24. Supportive Environment
Supportive environments cover the physical, social, economic, and political environment.
Supportive environments encompass where people live, work and play
Everyone has a role in creating supportive
environments for health.
Our societies are complex and interrelated.
Health cannot be separated from other goals.
The inextricable links between people and
their environment constitutes the basis for a
socioecological approach to health

25. Strengthen Community Action
Health promotion is carried out by and with people, not on or to people. It improves both the ability of individuals to take action, and the capacity of groups, organizations or communities to influence the determinants of health.
Improving the capacity of communities for health promotion requires practical education, leadership training, and access to resources.
Empowering individuals demands more consistent, reliable access to the decision-making process and the skills and knowledge essential to effect change.
There are many ways of defining community. Factors used are geography, culture and social stratification.

26. Strengthen Community Action: community Participation
Community participation is a social process whereby groups with shared needs living in a defined geographic area actively pursue identification of their needs, take decisions and establish mechanisms to meet these needs
Full community participation occurs when communities participate in equal partnership with health professionals as stakeholders in setting the health agenda.
(Rifkin et al. 1988)

27. Develop Personal Skills
Strategies for empowering the community include leadership training, learning opportunities for health, and access to resources including material and funding
Empowerment helps people to identify their own needs and concerns, and gain the power, skills and confidence to act upon them. It is a bottom-up strategy which requires the health promoter to act as a facilitator and catalyst for change.

28. Develop Personal Skills
Skills which can promote an individual’s health include those pertaining to identifying, selecting and applying healthy options in daily life.
Health education is life-long, so that people can develop the relevant skills to meet the health challenges of all stages of life, and to be able to cope with chronic illness and disabilities.
Health education should be conducted in all settings.

29. Reorientation of Health Services
Shift of emphasis from provision of curative services.
Health care system must be equitable and client-centered.
May necessitate reengineering and organizational
change, especially in the areas of professional
education and training, management, recruitment
and deployment of health personnel, and planning,
development and delivery of services

30. Three basic health promotion strategies
Enable
Mediate
Advocate

31. Enable
Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential
This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices
People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women and men.
Health promotion focuses on achieving equity in health

32. Mediate
Health promotion demands coordinated action by all concerned: by governments, by health and other social and
economic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and by the media.
Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health.
Health promotion strategies and programmes should be adapted to the local needs and possibilities of individual countries and regions to take into account differing social, cultural and economic system
The prerequisites and prospects for health
cannot be ensured by the health sector alone.
More importantly, health promotion demands
coordinated action by all concerned

33. Advocate
Good health is a major resource for social, economic and personal development and an important dimension of quality of life.
Political, economic, social, cultural, environmental,
behavioural and biological factors can all favour health or be harmful to it.
Health promotion action aims at making these conditions
favourable through advocacy for health
Health is created and lived by people within the
settings of their everyday life; where they learn,
work, play and love. Health is created by caring for
oneself and others, by being able to take decisions
and have control over one’s life circumstances, and
by ensuring that the society one lives in creates
conditions that allow the attainment of health by all
its members.
Caring, holism and ecology are essential issues in
developing strategies for health promotion. Therefore,
those involved should take as a guiding principle
that, in each phase of planning, implementation and
evaluation of health promotion activities, women and
men should become equal partners.

34. Moving into the Future
Health is created by caring for oneself and others, by being able to take decisions and have control over one’s life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members.
Caring, holism and ecology are essential issues in
developing strategies for health promotion.
Therefore, those involved should take as a guiding principle that, in each phase of planning, implementation and evaluation of health promotion activities, women and
men should become equal partners
Health is created and lived by people within the
settings of their everyday life; where they learn,
work, play and love.

35. Thank you!