Health Promotion and Education

• Health

  • “a state of complete physical, social and mental well-being, and not merely the absence of disease or infirmity” (WHO, 1948)
  • “Process of enabling people to increase control over the determinant of health and thereby improve their health.” (WHO, 1998)
  • “realize aspirations and satisfy needs and to change or cope with the environment. Health is ... 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” (Ottawa Charter Change for Health Promotion, 1986)
• Risk behaviour or risk factors are specific forms of behaviour that have been shown, usually through epidemiological research, to be associated with increased susceptibility to a specific disease or ill-health. Risk conditions are aspects external to the individual (social, economic, environmental) that are associated with increased susceptibility to disease or ill-health.
• • Health enhancement targets the entire community. Although the activities may help prevent disease or reduce risk, their main focus is to develop or enhance health rather than to reduce or prevent illness.
• • Risk avoidance targets those who are at low risk and who have not yet developed the health problems associated with the risk. The aim is to maintain good health by supporting people at low risk levels.
• • Risk reduction targets people who are at moderate levels of risk for health problems. It helps people in these higher risk categories (because of environmental conditions or risk behaviour) who have not yet developed the health problems associated with the risk, to reduce their risk.
• • Early intervention targets persons who are experiencing health problems soon after the problem occurs. The intervention is usually brief and attempts to restore the person to a state of good health or lower risk.
• • Treatment/rehabilitation targets persons experiencing overt illness. Treatment components are intended to prevent further deterioration and to stabilize the individual; rehabilitation components are intended to restore health and independent functioning to the extent possible. A well known three level continuum of prevention used in public health is as follows (Figure A2). 
• Primary prevention

  • The target population is large, and it is not possible to say with certainty who will develop the problem of concern.
  • Programmes focus on improving everyone's interest in and capacity to maximize their own health and on environmental factors that enhance or impede health. Primary prevention decreases the number of new cases of a disorder, illness and premature death (reduces incidence).
  • How do we keep ourselves well? 
• Secondary prevention

  • The target population is more narrowly defined as some identifiable subgroup known to be likely to develop a problem. 
  • Programmes focus on characterizing these at-risk subgroups and developing early detection and intervention methods. Again, programmes attend to both individual and environmental issues. Secondary prevention reduces incidence as well as the rate of established cases in the community (reduces prevalence).
  • If we are getting ill, how can we detech these conditions early?
• Tertiary prevention

  • Members of the target group are demonstrating clear pathology and require immediate intervention.
  • Programmes focus on specific therapeutic interventions, factors that affect treatment uptake and outcome and risks to the general population posed by the pathology or offending agents).
  • If we are ill, how can we get the best medical care?
• 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.
• Alma Ata Declaration

  • Health is a fundamental human right and that the attainment of the highest possible level of health is a most important worldwide social goal.
  • The existing goal inequality in the health status of the people particularly between developed and developing countries is politically, socially and economically unacceptable.
• Cognitive Approaches - Enable learners to think critically and teach decision-making for appropriate choices.
• Changing Behavior - Major components of this methodology are motivation, behavior modification, goal setting, positive reinforcement, behavior contracting, self-monitoring and management skills and modeling behavior.
• Freeing/Functioning - Focus is the holistic and humanistic approach, grounded in the principles of humanistic psychology
• Social Change - This approach proposes that it is ineffective to focus on an individual’s responsibility for health, which distracts from the environmental and economic factors that have larger effects on a nation’s health.
• Build Healthy Public Policy

  • Relates to the decision that are made by the governments and organizations in relation to healthcare policy, rules and regulations.
  • Includes changes in policy that will make healthier choices easier and contribute to healthier, safer, cleaner and more services and environment.
  • Examples:
  • Ban smoking in public areas
  • Reducing speed limits in roads/streets near schools
• Create Supportive Environments

  • building links between individuals and their environments (economic, physical and social) and promoting environments that encourage safe, stimulating and enjoyable living and working conditions so individuals can reach their full potential.
  • Key feature: encourages individuals to support and help each other to make healthy choices now and in the future
  • Examples:
  • Bike lanes on the road
  • Provision and sale of healthy food and drinks at canteen
• Strengthen Community Actions

  • Require communities working together to set priorities, make decisions and plan and implement strategies that will help them achieve better health for their over-all community
  • Examples:
  • Alcohol free events for young people
  • Sunday funday to promote sports/outdoor games
• Develop Personal Skills

  • Involves an individual gaining life skills and information through health promotion and education
  • Examples:
  • Information sessions on how to check breast cancer
  • Information sessions on how to protect yourself from cyber bullying
• Reorient Health Services

  • involves individuals, community groups, health professionals and the government working together to achieve a healthcare system that promotes health
  • Examples:
  • A doctor discussing the benefits of stopping smoking to a patient with type 2 diabetes
  • Police visibility in school premises to support road safety education
• Clarke (65) views a health literate person as being one who:

  • can think things through and make health choices in solving his/her own problems as well as family member problems?
  • is responsible and makes health choices that benefit him/herself and family members?
  • is in charge of his/her own health learning and teaches family members to do the same?
  • can use communication skills to express needs, questions and concerns to health care providers and staff?
• Nutbeam’s Levels of Literacy

  • Basic/Functional Literacy
  • Communicative/Interactive Literacy
  • Critical Literacy