APPROACHES TO HEALTH PROMOTION
interventions will be seen as appropriate.
CHAPTER 6
KEY CONCEPTS AND DEFINITIONS
Model
→ A simplified description or graphic representation of reality (processes,
organizations, beings).
→ often used to hypothesize the outcomes of specific inputs or processes.
Theory
→ An idea or proposition, often using general principles, used to explain
something specific.
Medical Model
→ This model uses medical concepts of health and sickness rooted in
physical or psychological changes that can be measured and quantified.
Social Model
→ This model uses sociological concepts to theorize about health and
illness. Health is normal social functioning, whereas illness is any
impairment (physical or psychological) of social functioning.
Empowerment
→ The act of acquiring power and the ability to make decisions and take
control over one’s life.
IMPORTANCE
o The diversity in concepts of health influences on health, and ways of
measuring health lead, not surprisingly, to a number of different
approaches to health promotion. If health is seen as the absence of
disease, clinical interventions will be seen as appropriate. If health is
viewed as the product of interaction and interdependence between the
individual and the environment, then legislative or regulatory
Medical or Preventive
→ to prevent disease
Behavior Change
→ to encourage people to adopt healthy behaviors
Educational
→ to ensure that people are well informed and able to make health
choices
Empowerment
→ to help people to acquire the skills and confidence to take control over
their health
Social Change
→ to change policies and environments in order to facilitate healthy
choices
The Medical Approach
o This approach focuses on activity which aims to reduce morbidity and
premature mortality. Activity is targeted towards whole populations or
high-risk groups. This kind of health promotion seeks to increase
medical interventions which will prevent ill health and premature
death. The approach is frequently portrayed as having three levels of
intervention.
o The medical approach to health promotion is popular for several
reasons.
o It has high status because it uses scientific methods, such as
epidemiology (the study of the pattern of diseases in society).
 o In the short term, prevention and the early detection of disease are
much cheaper than treatment of people who have become ill. Of
course, in the long term this may not be the case, as people live longer,
experience degenerative conditions and draw pensions for a longer
period.
o It is an expert-led, or top-down, type of intervention. This kind of
activity reinforces the authority of medical and health professionals,
who are recognized as having the expert knowledge needed to achieve
the desired results.
o There have been spectacular successes in public health as a result of
using this approach, for example the worldwide eradication of smallpox
as a result of the vaccination programme.
Methods
→ Immunization and Screening
Evaluation
→ reduction in disease rates and associated mortality
BEHAVIOR CHANGE
The approach is popular because it views health as a property of individuals. It is
then possible to assume that people can make real improvements to their
health by choosing to change their lifestyle. It also assumes that if people do not
take responsible action to look after themselves, then they are to blame for the
consequences.
METHODS:
o Campaigns
o Mass Media
o Social Marketing Techniques
o One-to-one Counseling
EVALUATION
“Has the health behaviour changed after the intervention?”
Behaviour,
→ is a response to the social context in which people live, and therefore
attempts to simply change those health behaviours may be victim
blaming. Population- based behaviour change approaches, such as
mass-media campaigns, assume a homogeneity which may not exist
amongst the receivers of the health promotion messages.
EDUCATIONAL APPROACH
AIMS
The purpose of this approach is to provide knowledge and information, and to
develop the necessary skills so that people can make an informed choice about
their health behaviour. The educational approach should be distinguished from
a behaviour change approach in that it does not set out to persuade or motivate
change in a particular direction.
The educational approach is based on a set of assumptions about the
relationship between knowledge and behaviour: that by increasing knowledge,
there will be a change in attitudes which may lead to changed behaviour.
METHODS
Learning involves:
o Cognitive
o Affective
o Behavioral
o Leaflets, booklets, visual displays or one-to-one advice
o Educational programs, led by a teacher or a facilitator
EVALUATION
o Increases in knowledge are relatively easy to measure. Health
education programmes using mass-media campaigns, one-to-one
education and classroom-based work have all shown success in
increasing information about health issues, or the awareness of risk
factors for a disease. Information alone is, however, insufficient to
 change behaviour and even the desire and ability to change behaviour
are no guarantee that the individual will do so.
EVALUATION

o Evaluation of empowering activity is problematic, partly because the

EMPOWERMENT
AIMS
o This approach helps people to identify their own concerns and gain the
skills and confidence to act upon them.
o It is unique in being based on a ‘bottom- up’ strategy, and calls for
different skills from the health promoter.
o The health promoter needs to become a facilitator whose role is to act
SOCIAL CHANGE
as a catalyst, getting things going and freeing up resources, and then to
AIMS
withdraw from the situation.
o Self-empowerment is used in some cases to describe those approaches
to promoting health which are based on counselling and use non-
directive, client-centered methods aimed at increasing people’s control
over their own lives.
Empowered people:
o recognize and understand their powerlessness feel strongly enough
METHODS
about their situation to want to change it feel capable of changing the
situation by having information, support and life skills.
METHODS
o Community development is a similar way of working to empower
groups of people by identifying their concerns, and working with them
to plan a programme of action to address these concerns. Some health
EVALUATION
promoters have a specific remit to undertake community development
work; most do not.
Community development work disadvantages:
o time-consuming, and most health promoters have clearly defined
priorities which take up all their time Funding for this kind of work is
invariably insecure and short term; and the communication, planning
and organizational skills necessary for the approach may not be
included in professional training.
process of empowerment and networking is typically long term.
o Positive results of such an approach may appear to be vague and hard
to specify, especially when compared to outcomes used by other
approaches, such as targets or changes in behaviour which are capable
of being quantified.
o Evaluation therefore needs to include qualitative methods that reveal
people’s perceptions and beliefs as well as quantitative methods that
demonstrate outcomes such as behaviour change.
o This approach, which is sometimes referred to as radical health
promotion, acknowledges the importance of the socio-economic
environment in determining health.
o Its focus is at the policy or environmental level, and the aim is to bring
about changes in the physical, social and economic environment which
will have the effect of promoting health.
o The social change or radical approach is targeted towards groups and
populations, and involves a top-down method of working.
o Change may be in organizations (e.g. nutritional standards for school
meals), communities (e.g. age-friendly cities) or policies and laws (e.g.
smoke- free legislation).
o Evaluation of the social change approach includes outcomes such as
legislative, organizational or regulatory changes which promote health,
e.g. regulations governing food labelling, a ban on tobacco sponsorship
and advertising and a ban on smoking in public places.
o The extent of partnership working and the profile of health issues on
common agendas may also be used to demonstrate a greater degree of
commitment to social change for health. These outcomes are typically
long-term, complex processes, making it difficult to prove a link to
particular health promotion interventions.