HEALTH PROMOTION

Amany R.Abo-El-Seoud
Prof. Of Community Medicine
Zagazig University,EGYPT
 Health promotion
It is the science aiming at reaching optimal
(perfect) health
All activities aiming at increasing well-being,
prevention of disease and health hazards,
or control of disease are included under
health promotion. (it is the highest aim of CM)
Health promotion is to add ‘life into the
years’ and not just add ‘years onto life’
 Definition of health promotion
Is a process of activating communities,
policy makers, professionals and the
public in favor of health supportive
policies, systems and ways of living.
It is carried out through acts of advocacy,
empowerment of people and building
social support systems that enable people
to make healthy choices and live healthy
lives.
 The basic principles for health
promotion:
• Social justice & equity

A stable
ecosystem
Sustainable
resources Health
Income
Peace
Food
Shelter
Education

Promotion of health requires a secure foundation in

these basic prerequisites.
 Advocate for health:
- Good health gives better quality of life so it
necessitates advocacy (fighting for it).
- The following factors can favor health or can harm it:

Political conditions
Economic conditions
Social conditions Health
Cultural conditions
Environmental factors or conditions
Behavioral factors or conditions
Biological factors or conditions

- Health promotion aims at making these conditions

favorable for health.
 Approaches for health promotion

How can we promote health?

 Healthy population (infrastructure)
 Healthy lifestyle
 Healthy environment
Healthy populations- 1

By targeting all life stages and groups.

Since the health needs of people vary
according to their stage in the life cycle or
their gender, the healthy population
approach encourages initiatives that focus
on the health needs and contributions of
people at every life stage.
Healthy lifestyles -2
This approach focuses more on the
behavior of individuals and how their
decisions and actions can lead to healthier
outcomes. This can be done through
health education, social mobilization and
advocacy programs.
No smoking, better nutrition and exercise
are examples of healthy lifestyles
approach.
Healthy settings-3
Creating social, economic and
environmental conditions that are
favorable to good health. Health
conditions in developing countries must be
viewed in a wider socio economic context
because millions of people are trapped in
the vicious cycle of poverty, despair,
disparity, illiteracy and disease
Other approach for health
promotion

Prevention
.Immuniz
Protection
Environment
Laws&policy
H.Services

Health education
Appreciate health
Keen to keep healthy
 Who promote health?

Individual role Governmental role

Legislation
H.Conciousness
Environmental health
Life style
Health services
Genetic
Other ministries
Beliefs
Policy & budget
Occupation
 WHO PROMOTES
?HEALTH
 International organization
 Health authorities
 Non-Governmental Organizations
 Primary health care team
 Private physician.
 Other health professions: nurses,
professions allied to medicine.
 Religious organizations
 Guiding Principles of Health
Promotion
 Empowering individuals and communities.
 Participatory (involving all).
 Holistic (all four dimensions of health).
 Intersectoral (collaboration of all agencies)
 Equitable (equity and social justice)
 Sustainable (changes are maintained)
 Multistrategy (variety of approaches)
Health promotion "23 years of
"continuous development
- Ottawa (Canada) 1986:
→ first international health promotion
conference as an extended application for the
Alma Ata declaration 1978 on primary health
care.
- Australia 1988:
→ Concept of healthy public policy being a
human right. gender dimension was given
specific attention.
- Sweden 1991:
→ Concept of supportive environments
conductive to health and the links with
sustainable development.
-Jakarta, Indonesia 1997:
Issues related to globalization (the potentials
and controversies around public-private
partnership) infra-structures and funding.
- Mexico city, Mexico 2000:
→ High level political commitment to health
promotion.
Positioning health promotion higher on the
political agenda and recognizing it as a priority
in local, regional, national, and international
programs.
- Bangkok (Thailand) 2005:
Identified major challenges, actions &
commitments needed to address the
determinants of health in the world by reaching
out to people, groups & organizations that are
critical to the achievement of health.
 Ottawa Charter put five
:action areas for promotion
1- Develop healthy public policy.
2- Create supportive environment
for
health
3- Strengthen community action.
4- Develop personal skills i.e.
modifying their life style towards
healthy behaviors.
5- Reorient health services.
 Develop healthy public policy-1
health should be on the policy agenda in all
sectors, and at all levels of government.
Governments are ultimately accountable to their
people for the health consequences of their
policies, or the lack of policies. A commitment to
healthy public policies means that governments
must measure and report on their investments
for health, and the subsequent health outcomes
of these investments and policies in a language
that all groups in society readily understand.
Create supportive -2
:environment

(1)Protection and conservation of the

natural environment - as a natural
resource - must be addressed in
any health promotion strategy.
(2)We must create a healthy working
& living conditions and making
them safe, stimulating for health,
satisfying & enjoyable.
(3) Systematic assessment of the
health impact of any rapidly
changing environment as in Work
places, energy production areas
and rapidly urbanized areas.
(4)Encourage research studies for
detection of environmental hazards
on health and methods of
controlling them.
 Strengthen community -3
action

 Health promotion depends on concrete &

effective community action.
The community has to share in:
• Setting priorities
• Making decisions
• Planning strategies
• Implementing these strategies
This can be enhanced by:
 • Empowering the community
 • Create ownership
 • Control of their actions & efforts
This requires:
 • Continuous access to information.
 • Learning opportunities for health.
 • Funding support.
Health promotion strategies -4
directed towards individuals
1. Increase individual awareness of disease and
disability prevention actions.
2. Changing lifestyles to healthy ones
3. Encourage individuals to have check-ups and
to use health screening opportunities.
4. Early seeking for medical advice
5. Compliance to physician
instruction and treatment schedule
 Reorient health services-5
Health promotion requires reorientation of health
systems from tertiary (curative strategies) to
primary and secondary prevention models. This
reorientation is often be resisted by doctors, and
pharmaceutical companies and hospitals, those
who adopt ‘find it and fix it’ approach.
Encourage health service providers to build
opportunities for health education settings in
primary and secondary prevention of disease
and disability when delivering services.
Evaluation of Health promotion
activities in a community:
By assessing:
1. Quality of life indicators.
2. Health knowledge, attitude, motivation
and skills among population sectors.
3. Social action and influence (community
participation & public opinion).
4. Legislation, regulation for public health
5- Resource allocation for health in relation to
national budget.
6- improved health indicators as morbidity &
mortality
7- improved productivity, reduced absenteeism.
8- decrease in medical care utilization
9- decrease in health care cost.

H. Promotion = h.education x healthy public policy

Problems facing health promotion
in developing countries
 Poverty and consequently the poor living
conditions (e.g. poor nutrition, poor housing,
environmental degradation) associated with it
are major obstacle for improving health of
people in developing countries. Unless
fundamental changes are made to this wider
context it will be difficult to make major advances
in health promotion. The challenge of reducing
poverty cannot be underestimated.
Decision makers must find answers for
these questions:
1-How to draw more resources from the
community and individuals to meet the
health challenges they face?
2-How to direct health expenditures? Either
for prevention or for control?
 Economic priorities
Most developing countries have limited resources and
many competing demands for these resources. They are
seeking to achieve rapid economic gains and
development by industrialization and food production
that gives priority to foreign markets for earning foreign
exchange.
Insufficient attention is given to the needs of local citizens
leading to low wages and poverty, poor nutrition and
worse environmental condition, all of which have serious
health consequences. International donors tend to
encourage activities that promote economic
development and have quick and visible outcomes.
The challenge for health promotion is to convince policy-
makers that good health is an economic asset rather
than a cost and it is an essential component of social
and economic empowerment
 Education
Low levels of literacy specially health literacy
provide another challenge for the health
promotion approach. This can be an obvious
problem when trying to promote better health
behavior among people. Poor levels of
knowledge is an important factor that contribute
to almost all diseases. Efforts done to improve
illiteracy actually share in health promotion
:Political stability

Where there is political instability,

internal conflict and war, it is extremely
difficult to develop health-promoting
environments. Not only are the economic
resources and priorities of governments
directed elsewhere, but also the regulatory
environment to create health supportive
settings is lacking.
:Inter sectoral co-operation

Decision-makers in all sectors (even in

areas that are indirectly related to health
as agriculture, commerce, education,
industry etc) must focus on the health
implications of their policies, in fact, their
competing priorities may lead them to
disregard the health implications of their
decisions.
Commercial interests

Marketing does not necessarily consider

health of citizens of developing countries
uppermost in their priorities. This is often
result in poor health outcomes. For example
marketing tobacco, and western food products.
Commercial propaganda of unhealthy products and
lifestyles make it difficult for healthy choices to be the
easiest or the attractive choices.
Regulation of the activities of these commercial interests is
required through political rules to introduce sufficient
levels of regulation as the taxes gained from unhealthy
products and used as an important source of
governmental funds. Poor governments can find it
difficult to resist this source of revenue.
The double burden of disease

One of the particular challenges that face

developing countries is that the epidemic
of non communicable disease is
developing before the burden of
communicable (infectious disease) has
been dealt with. The difficulty faced by
developing nations is to deal with these
dual sources of disease without adequate
economic resources.
The speed of change

Populations in the developing

world are increasing at a much
faster rate than countries in
the developed world. It is
much easier for countries to
adjust to gradual population transitions than to
these rapid changes. Population increase at
such a rate that all policy systems have not kept
pace. The speed of the transition and the
economic cost make it nearly impossible for d.
countries to provide all needs of citizens.
 QUALITY OF LIFE QOL
 WHO defined QOL as the individual ’s
perception of position in life in relation to
his goals, expectations, standards and
concerns.
 It is to live normal life, to feel happy,
achieve your goals and to be satisfied with
your self and your surroundings.
 It is the sense of wellbeing.
 ?Why measuring QOL
 To evaluate the effects of health (and other)
services on citizen’s life. The higher the score of
QOL the better is the promotion services.
 To classify health hazards according to their
effect on QOL (in putting priorities)
 To evaluate the effects of different lines of
treatment on patients.
 To evaluate the rehabilitation methods used by
handicapped.
How to assess QOL?
By using questionnaires :
1- physical aspects
2- psychological aspects
3- spiritual aspects
4- social aspects
5- environmental aspects
 Global burden of disease

Using certain indicators as:

 QALY= quality adjusted life years
 DALY=disability adjusted life years
 YLL= years of life lost
 YLD=years lost due to disability
Thank you
 Health education
Definition:
Is planned opportunities for people to learn
about health and make changes in their
behavior
Steps: to know (knowledge)
to feel importance to health(attitude)
to change (practice)
 Era of health education
 Improvement of quality of life
 Restore state of good health
 Make the best of remaining health

i.e. in health promotion, prevention of

hazards, control of disease and
complications and in rehabilitation.
i.e. in physical, mental, social health
it is life long process.
 Health education
 Source or educator (doctor, nurse, T.V.,
book, film)
 Message (knowledge, information body)
 Channel (method): face-face or broad cast
 Receiver : the target of the process
 Noise (barriers): factors decreasing
response
 Health education
Health education program:
 What is the message?
 Who will give it? Who is our target?
 How it will be given?
 Where?
 When? How frequent?

Evaluation of program.
 Community participation
 People sharing the same culture, experience,
problems, place they live, language, religion.
 C. participation is important in:

1- success of health education program

2- improving health services
3- giving power to people to solve health problems
and criticize un-needed health services or
health policy.
4- gaining a health responsibility
 Community participation
How?
 Involve representatives in planning and
execution team. (in health education)
 Population needs must be assessed in
health planning. They can evaluate also
 Help people to get knowledge, skills,
information, fund.
 Enable all population sectors to represent
themselves.
Behavioral science

How people think in health & disease

 For health promotion & education

 To improve doctor-patient relationship

 To solve health problems easily.

People differ in behavior because of

demographic factors & psychological
factors
Health belief model

Healthy individuals perceive risk, its

severity, that he’s susceptible, realize
the benefits of protection from risk,
certain barriers prevent him from
taking action. He has motive for
change. He either decides to act at
once (with or without trigger) or cancel
the whole subject.
Health belief model

Perception of disease
severity

personal
motivation
external action relapse

cancel Healthy
behavior
Behavior in illness

Disease

Do Not
nothing adherent

Self Go to treatment compliance

treatment doctor

cured
Factors affecting illness behavior
 Severe, prolonged or frequent symptom.
 Unusual symptom
 Personal tolerance to symptom
 Culture and knowledge about symptom
 Stigma of disease
 Doctor-patient relationship
 Availability of reliable health services
 Cost of service & ttt. Time waste
 Communication
• Definition :it is a dynamic, continuous
and reciprocal sending, receiving and
comprehending messages, feelings &
ideas.
• Relation between communication&health
1. For history taking, counseling
2. For health education
3. Patient satisfaction & adherence to ttt
 Steps of communication
• Initiation of simple introduction
• Listening carefully to your client
• Probing to assure your care, observation
of non-verbal expressions
• Giving information: clear, concise,
summarize, in simple language etc..
 Methods of communication
• Verbal : spoken or written words
• Non-verbal: any other method except
words e.g.:
1. Body movement, posture, sitting, walking
2. Facial expressions
3. Touch ,shake hands
4. Personal appearance: cloths,hair
5. Voice interference.
 Barriers to communication
• Environmental
• Pathological
• Language
• Personal : SE, values, belief, experience
• Psychological :stress, anger, tiredness