CONNECTING THE PUZZLE

PIECES: PUBLIC HEALTH

STRATEGIES, HEALTH
PROMOTION AND
CLINICAL ROLE

Dr Gargi Sinha
. THIS DOCUMENT IS UPLOADED JUST FOR LEARNING PURPOSES. IT IS MY

ORIGINAL WORK SUBMITTED FOR PUBLIC HEALTH STRATEGIES: EDITH

COWAN UNIVERSITY, WESTERN AUSTRALIA.

I WOULD LIKE TO ACKNOWLEDGE THE CONTRIBUTION OF MY LECTURER FOR

PROVIDING VALUABLE FEEDBACK FOR THIS REFLECTIVE PIECE.

D r Ga rg i Si n h a
Connecting the puzzle pieces: public health strategies, health promotion and clinical role

Introduction
On 21st of November 1986, the Ottawa Charter challenged the focus of individualist
approach of health (Baum, 2016) and integrated health promotion with social, cultural and
economic dimensions (World Health Organisation, 1986).The Ottawa Charter identifies the
following - three essential strategies for health promotion: advocacy, enabling and mediating
(Detels, Gulliford, Abdool Karim, & Tan, 2015). These strategies are the backbone of current
practices of health promotion (Detels et al., 2015).The World Health Organisation underpinned
democratic principle of justice, equity and access to outline five essential action areas of health
promotion (Fleming, 2015). These areas are central to the development of a socioecological model
of health and influences public policies (Scambler, 2003). Despite, a robust framework, the
concept of health promotion is struggling to address the core principles of Ottawa charter
(Pettersson, 2011). This article systematically explains the key concept of health promotion
strategies and navigate health promotion strategies with my clinical role in medical field.
Understanding concept of social determinants in health promotion
The Ottawa charter model advocates the integration of health education with structural
changes in the environments in which people live (Detels et al., 2015). Linking health and
environment was a crucial component of the Charter because it assisted policymakers to focus on
addressing the social determinant of health (Germov, 2014). To explain further, the term social
determinants of health explore the health of an individual through the lens of the social factors
such as the social conditions and the position in the social hierarchy ladder (Baum, 2016, p. 308).
Marmot and Wilkinson (2006) explained that health outcomes are linked to the social status. For
example, the fundamental concept of enabling or empowerment in health promotion (Detels et al.,
2015) is facing setbacks due to health inequity (Baum, 2016, p. 40). Detels et al. (2015) argued
that a segment of influential people in the population have access and advantage of the health
promotion intervention, however, the disadvantaged individuals are often left out.
Drawing from my observation while working in a rural community in India, the
health outcome of excessive alcohol use was different for rich and poor. For instance, affluent
people can visit tertiary centres in urban areas to seek help for alcohol addiction from specialists.
However, due to lack of accessibility of services in the village, poor people were more prone to
health hazards of alcohol. It further aggravates problems for their children (Thomas, 2012) and
wives(Saxena, Sharma, & Maulik, 2009). The finding of various researchers on impact of alcohol
on families (Ramanan & Singh, 2016; Saxena et al., 2009) were similar to my observations of the
tragic conditions of wives of chronic alcoholics. As a health provider, I tackled sensitive issues
which amalgamated with alcohol such as strained relationships and domestic violence towards
women. At that time, I also noticed that children of chronic alcoholics were compelled to leave
school early to earn their livelihood. However, I was unable to provide any scientific explanation
for my observation. Hence, for me, most significant learning aspect happened when I understand
the importance of social factors which linked to alcohol addiction. With this knowledge, I can
explain why the policy makers should consider social dimensions while addressing excessive use
of alcohol in the community.
Application of action areas of health promotion
While unpacking health promotion strategies one need to understand that initially the
Ottawa Charter proposed five action areas (Detels et al., 2015). However, later in 1997, the Jakarta
Declaration five more action areas added to strengthen health promotion (Keleher, MacDougall, &
Murphy, 2007). Talking about each action areas is beyond the scope of the paper hence, I would
elaborate on few and explain how it shaped my current clinical domain.
One of an important action component of Ottawa charter is create supportive environments
(Detels et al., 2015).While reading about health promotion in Australia, I understand the
importance of designing tailored strategies for a given community. For example, Men's Shed
Movement in Australia supports a range of targeted health promotion objectives (Wilson, Cordier,
Doma, Misan, & Vaz, 2015). These sheds contain items that feature positive health messages and
also include tool boxes with items usually used by men, such as carpenter tool boxes (Cavanagh,
McNeil, & Bartram, 2013; Wilson et al., 2015). Before reading Wilson et al. (2015) and Cavanagh
et al. (2013) on men’s health promotion, I had no idea about such initiative. I could easily connect
the key point of ‘community participation’ in the men’s shed (Cavanagh et al., 2013) with my
work in rural and remote areas of India. For me, the most useful idea was how to engage men in
the community for health promotion activities. Previously, I had no knowledge how to run a
successful health promotion programme for men. As I work with alcohol addicts who are usually
men, such innovative ideas would provide an opportunity to develop a sustainable plan to create a
supportive environment.
Detels et al. (2015) illustrated that the core of health promotion is strengthening
community action. My lay knowledge (Keleher et al., 2007) agree that advocacy, enabling and
mediating all intersecting at this action area (Detels et al., 2015). For example, will it be possible
without community strengthening and public participation (Keleher et al., 2007) to fight wicked
problem (Pennay, 2012) such as alcohol ? Hence, I would read more about this aspect in future and
develop projects which entail strengthening community action.
Fleming (2015) elaborated that reorienting health services require strategies to integrate
heath sector with individual and community. As a clinician, I had experienced how alcohol
intervention failed for young people without reorienting health services. For instance,
unemployment among youth can act as a catalyst for stress, and individuals can adopt drinking
alcohol as their coping strategy (Correia, Murphy, & Barnett, 2012). Hence, treatment of young
alcoholics should reorient from hospital arrangements to incorporate a community model ;where a
person may receive the sessions of harm minimisation strategy (Cousins, Connor, & Kypri, 2014)
and also gain a job and coping skills under the same roof.
How is knowledge of health promotion strategies crucial for future?
There is a degree of ambiguity palpable in conceptualizing health promotion across the
various terrain of the health professionals (Scambler, 2003). Further, Germov (2014) explained
how the influence of medical model in the health sector has, gradually marginalised the role of
other sciences such as public health. Keleher et al. (2007) raised a valid concern: how the medical
model can address the complex health promotion strategies at population level which is limited to
one to one health education? Thus, for me, most crucial reading was learning angle of health
promotion from the various domains of health sector.
Similarly, Scambler (2003) explained that biomedical model of health campaign
exclusively addresses on diseases and still unable to focus on the multidimensional concept of
health promotion. For example, a doctor in a clinical role would suggest eating green leafy
vegetable and iron tablets for an anaemic woman, however, the cause of anaemia is not only
related to low level of haemoglobin but also linked to deprivation. From my clinical role, I further
can trace the poverty of a woman to chronic alcohol use by a husband. Which not only hampers
the physical health of a woman but also leads her into depression and anxiety (Ravindran &
Joseph, 2017). I agree with the viewpoint of Scambler (2003) that the health of a person is not a
personal choice, it is under influence of social factors which encompass cultural, biological, social
and environmental domains. Therefore, I changed my approach and currently developing a project
NashaMitra which incorporate material of health promotion action areas with the clinical domain.
Conclusion
The term health promotion often seen as a marginalised concept of public health from
doctors and nurses (Germov, 2014). Nevertheless, the capacity of public health strategies for the
health of the community is enormous if used judiciously. I try to fill the gaps of medical and public
health model of health through the concept of health promotion. This knowledge is essential for
me to lead other health professionals to participate in health promotion. As a next step, I need to
gain experience in research of health promotion so that I can develop sustainable projects at
community level.

Baum, F. (2016). The new public health (4th edition. ed.). South Melbourne, Vic. :: Oxford
University Press.
Cavanagh, J., McNeil, N., & Bartram, T. (2013). The Australian Men's Sheds movement:
human resource management in a voluntary organisation. Asia Pacific Journal of
Human Resources, 51(3), 292-306.
Correia, C. J., Murphy, J. G., & Barnett, N. P. (2012). College student alcohol abuse : a
guide to assessment, intervention, and prevention
Cousins, K., Connor, J. L., & Kypri, K. (2014). Effects of the Campus Watch intervention on
alcohol consumption and related harm in a university population. Drug and Alcohol
Dependence, 143, 120-126
Detels, R., Gulliford, M., Abdool Karim, Q., & Tan, C. C. (2015). Oxford textbook of global
public health Oxford medical publications;

Fleming, M. L. (2015). Introduction to public health (3e. ed.). Chatswood, NSW :: Elsevier.
Germov, J. (2014). Second opinion : an introduction to health sociology (Fifth edition. ed.).
Australia :: Oxford University Press.
Keleher, H., MacDougall, C., & Murphy, B. (2007). Understanding Health Promotion.
Sydney: oxford university press.
Marmot, M., & Wilkinson, R. G. (2006). Social determinants of health (Second edition. ed.).
Oxford :: Oxford University Press.
Pennay, A. E. (2012). ‘Wicked problems’: The social conundrum presented by public
drinking laws. Drugs: education, prevention and policy, 19(3), 185-191
Pettersson, B. (2011). Some bitter-sweet reflections on the Ottawa Charter commemoration
cake: a personal discourse from an Ottawa rocker. Health promotion international,
26(Suppl 2), ii173-179.
Ramanan, V. V., & Singh, S. K. (2016). A study on alcohol use and its related health and
social problems in rural Puducherry, India. Journal of family medicine and primary
care, 5(4), 804-808.
Ravindran, O., & Joseph, S. (2017). Loss of coping resources and psychological distress in
spouses of alcohol dependents following partner violence. Indian Journal of Social
Psychiatry, 33(3), n/a.
Saxena, S., Sharma, R. A. J., & Maulik, P. K. (2009). Impact of alcohol use on poor families:
a study from North India. Journal of Substance Use, 8(2), 78-84.
Scambler, G. (2003). Sociology as applied to medicine (5th ed. ed.). Edinburgh ;: Saunders.
Thomas, D. S. (2012). Children Of Alcoholic Fathers : An Explorative Survey. GSTF
International Journal on Bioformatics & Biotechnology (JBio), 2(1), 64-68.
Wilson, N. J., Cordier, R., Doma, K., Misan, G., & Vaz, S. (2015). Men's Sheds function and
philosophy: towards a framework for future research and men's health promotion.
Health Promotion Journal of Australia, 26(2), 133-141.
World Health Organisation. (1986). The Ottawa Charter for Health Promotion. Retrieved
from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/