 Concentra partners w/ employers to offer ambulatory medical care to their employees such as pre-

employment testing, primary care, and urgent care for ill or injured workers
 Good example of health protection:
~Midterm Coverage~ o Regular testing of soil where farmers grow or raise items for consumption

CHAPTER 1  By ensuring food supply will not be contaminated, FDA - prevent people from eating
tainted food and becoming sick
Health Promotion and Disease Prevention
Ottawa Charter for Health Promotion
Health Promotion
 First International Conference on Health Promotion, meeting in Ottawa, Canada this 17th to 21st day
 Addresses large scale public health concerns beginning w/ well-being of each individual of November 1986
 Health promotion activities = modify behavior of individual by improving the choices that affect  Presents this charter for action to achieve health for all by the year 2000 and beyond.
society at large  This conference was primarily a response to growing expectations for a new public health movement
 Goal:  Discussion focused on the needs in industrialized countries and considered similar concerns in other
o Decrease risk of illness or disease and improve overall health regions
 Initiatives that fall under Health Promotion are educational in nature  Built on the progress made through the Declaration on Primary Health Care at Alma-Ata, the World
o address individual’s knowledge of specific risk topic such as: nutrition, physical fitness, Health Organizations’ Targets for Health for All document, and the recent debate at the World
sexual practices, drugs and alcohol, tobacco, mental health, family planning, and forms of Health Assembly on intersectoral action of health.
abuse.  Health Promotion
o US = health promotion initiatives - part of a larger public policy o Process of enabling people to increase control over, and to improve, their health
 Popular example of successful HP: o Reach a state of complete physical, mental, and social well-being, an individual or group must
o Warning label on cigarettes be able to:
 Cigarettes - socially acceptable and sold w/o the warning of the risks however, health experts noted  Identify and realize aspiration
the increase incidence of disease and began to educate public on the risk of smoking and tobacco  Satisfy needs
use.  Change or cope w/ environment
 HP activity led to a change in public policy and requires manufacturers to add warning  Health, seen as resource for everyday life, not the objective of living
labels directly to the package  Health, positive concept emphasizing social and personal resources as well as physical capacities
 Health promotion experts hope that educating people about danger, they will gradually curb their  Health promotion is not just the responsibility of health sector but goes beyond healthy life-styles to
behavior and make healthier choices well-being

Health Protection Prerequisites for Health

 Concerned w/ preventing spread of communicable diseases = establishing minimums standards in the  Fundamental conditions and resources for health are:
form of regulations 1. Peace
 managed by public sector 2. Shelter
 In US, responsibility of establishing and maintaining health protection standards is entrusted to the 3. Education
government agencies such as Food and Drug Administration, Environmental Protection Agency, and 4. Food
Department of Health and Human Services 5. Income
 Example: 6. Stable eco-system
o Includes standardized response and reporting procedures, occupational safety standards, 7. Sustainable resources
and certain guideline for optimizing worker rehabilitation following injury. 8. Social justice and equity
 Occupational Safety and Health Administration regulates many of these workplaces in the US  Improvement in health requires a secure foundation in these basic prerequisites
 As a leading provider of occupational medicine, Concentra works closely w/ these agencies to assist
The 3 Basic Strategies for Health Promotion
employer efforts to follow proper employee health and safety regulations
1. Advocacy for Health d. Coordinated action that leads to health, income, and social policies that foster greater
a. Good health is a major resource for social, economic and personal development and an important equity
dimension of quality of life e. Joint action contributes to ensuring safer and healthier goods and services, healthier public
b. Political, economic, social, cultural, environmental, behavioral and biological factors can all favor services and cleaner and enjoyable environment
health or be harmful to it f. Health promotion policy require identification of obstacles to the adoption of health public
c. Health promotion action aims at making these conditions favorable through advocacy for health policies in non-health sectors and ways of removing them
2. Enabling all people to attain their full health potential g. Aim: make the healthier choice the easier choice for policy makers
a. Health promotion focuses on achieving equity in health 2. Create Supportive Environments
b. Health promotion action aims at reducing differences in current health status and ensuring equal a. Inextricable links between people and their environment constitutes the basis for a
opportunities and resources to enable all people to achieve fullest health potential socioecological approach to health
c. Includes: b. Overall guiding principle for the world, nations, regions, and communities is the need to
i. Secure foundation in a supportive environment encourage reciprocal maintenance to take care of each other, our communities and our
ii. Access to information, life skills, and opportunities for making healthy choices natural environment
d. People cannot achieve fullest health potential unless they are able to take control of things w/c c. Conservation of natural resources throughout the world should be emphasized as a global
determine their health responsibility
e. Must apply equally to men and women d. Changing patterns of life, work, and leisure = significant impact on health
3. Mediate e. Work and leisure = source of health for people
a. Mediating among the different sectors of the society in efforts to achieve health f. Way society organizes work should help create a healthy society
b. Prerequisites and prospects for health cannot be ensured by the health sector alone g. Health promotion generates living and working conditions that are safe, stimulating,
c. Health promotion demands coordinated action by all concerned by: satisfying, and enjoyable
i. Governments h. Systematic assessment of health impact of a rapidly changing environment—particularly in
ii. Health and other social and economic sectors areas of technology, work, energy production and urbanization—essential and must be
iii. Non-governmental and voluntary organization followed by action to ensure positive benefit to the health of the public
iv. Local authorities i. Protection of the natural and built environments and conservation of natural resources
v. Industry must be addressed in any health promotion strategy
vi. The Media 3. Strengthen Community Actions
d. People in all walks of life are involved as individuals, families, and communities a. Health promotion works through concrete and effective community action in setting
e. Professional and social groups and health personnel have major responsibility to mediate between priorities, making decisions, planning strategies and implementing them to achieve better
differing interests in society for the pursuit of health health
f. Health promotion strategies and programmes should be adapted to the local needs and possibilities b. Heart of this process is the empowerment of communities—ownership and control of their
of individual countries and regions to consider different social, cultural, and economic system. own endeavors and destinies
c. Community development draws on existing human and material resources in the community
5 Priority Action Areas provide Support to these 3 Strategies to enhance self-help and social support, to develop flexible systems for strengthening
Health Promotion Action Means public participation in and direction of health matters
d. Requires full and continuous access to information, learning opportunities for health, as
1. Build Healthy Public Policy well as funding support
a. Health promotion goes beyond health care 4. Develop Personal Skills
b. Puts health on agenda of policy makers in all sectors and at all levels, directing them to be a. Health promotion supports personal and social development through providing information,
aware of health consequences of their decisions and to accept their responsibilities for education for health, and enhancing life skills
health b. increases options available to people to exercise more control over their own health and
c. Health promotion policy over their environments and make choices conducive to health
i. Combines diverse but complementary approaches including legislation, fiscal c. Enabling people to learn, throughout life, prepare themselves for all of its stages and cope w/
measures, taxation, and organizational change chronic illness and injuries is essential
d. Has to be facilitated in school, home, work, and community settings
 e. Action is required through educational, professional, commercial, and voluntary bodies and 1. Lifestyles
w/n institutions themselves 2. Psychological health
5. Reorient Health Services 3. Social and cultural environment
a. Responsibility for health promotion in health services is shared among individuals, iv. not eating fresh vegetables because one grew up not consuming produce is a way
community groups, health professionals, health service institutions and governments of understanding why someone may suffer from a severe condition like obesity.
b. Must work together towards a health care system w/c contribute to the pursuit of health 2. Health Belief Model (HBM)
c. Role of health sector must move increasingly in a health promotion direction, beyond its a. What follows this initial outcome might be an informed recommendation of the risk factors
responsibility for providing clinical and curative services that can worsen illness
d. Health services need to embrace an expanded mandate w/c is sensitive and respect cultural 3. Transtheoretical Model (TTM)
needs a. When a healthcare professional informs a patient about a potential medical condition and
 This mandate should support needs of individuals and communities for a healthier educates them about preventive measure, the person may believe them but avoid
life, open channels between health sector and broader social, political, economic, immediate action
and physical environmental components b. This choice is based on idea that when someone receives information about their health,
e. Reorienting health services requires stronger attention to health research as well as they might think about it before acting
changes in professional education and training c. Because of this behavior, transtheoretical theory outline six stages that someone might go
f. Must lead to a change of attitude and organization of health services w/c refocuses on through:
total needs of individual as a whole person i. Pre-contemplation: patient does not intent to act yet despite knowing about
medical condition
Moving into the Future ii. Contemplation: patient is planning to act w/ intention
iii. Preparation: patient establishes course of action and sets a timed objective
 Health is created and lived by people w/n settings of their everyday life (where they learn, work, play,
iv. Action: patient takes the course of action
and love)
v. Maintenance: patient focuses on not relapsing and maintaining a plan w/n their
 Health is created by caring for oneself and others, being able to take decisions and have control over
daily routines
one’s life circumstances, by ensuring that the society one lives in creates conditions that allow
vi. Termination: patient is actively healthy and no longer interested in returning to
attainment of health by all its members
old behaviors
 Caring, holism, and ecology are essential issues in developing strategies for health promotions
4. Theory of Reasoned Action (TRA)
 Those involved should take as a guiding principle that each phase of planning, implementation, and
a. Although it is not a model, theory is highly credited under HBM and considered separate
evaluation of health promotion activities, men and women should be equal partners
b. a person will act a certain way on a health issue depending on their willingness due to
Theories of Health Promotion subjective norms
 Norms = result of social and environmental surroundings and the person’s
 Health promotion = process of encouraging people to make healthy choices and motivating them to perceived control over that behavior
be consistent w/ their intentions based on theories related to human behavior c. Example:
i. Healthcare professional might ask a young man if his close circle of friends thinks
he should incorporate exercise into their daily routine
d. Medical study by Iran University of Medical Sciences, researchers used TRA to evaluate
effectiveness of an educational intervention dealing w/ breakfast consumption amongst
The 5 Approaches to Health Promotion children
5. Diffusion of Innovation Theory (DOI)
1. Health Promotion Model (HPM)
a. Another theory that falls under community and organization participation models
a. Pender’s Health Promotional Model
b. The theory investigates how a new idea or health behavior is disseminated in social
i. people’s experiences affect their health outcomes
structure or community and identifies what influences how quickly the idea or behavior is
ii. Health promotion models are focused on exploring people’s attitudes about adopted
health and individual experiences related to it
c. Adoption of new ideas depends on type of innovation, communication channels, time, and
iii. To understand most of their health-related decisions, one would look at:
social justice
 d. According to Health Communication Capacity Collaborative, the DOI model highlight  Psychological (fear of pain, embarrassment or inconvenience)
uncertainties associated w/ new behaviors and help public health program implementers  Cues to Action
consider ways to resolve these uncertainties o Events, people, or things that trigger people to change behavior
o Advice from others, illness of a family member or social media can provide cues
o Restaurant provide nutrition information on their menus offering a cue to consider calorie
Six Health Belief Model Concepts content
 Perceived Susceptibility o Posters offering handwashing cues
o Refer to person’s belief about their chances of getting a certain condition o Highway signs to buckle up cues
o For a person to take action, must believe they are at risk for disease, illness, or negative o Calendar reminders and device alarms
health outcomes o Cues can be internal: chest pain, discomfort, or fatigue fear of pain, embarrassment or
 When ppl believe = risk, they do something to prevent it from happening inconvenience
 When people believe = not at risk or low risk, have behaviors that are less healthy  Self –efficacy
o Perceived susceptibility = not enough to cause behavior change o Person’s confidence and belief in ability to take action or perform a given behavior
 Older adults = most at risk for food-borne illness; knows they are at risk but o People generally do not try to adopt new behaviors unless they believe they can do them
continues to use unsafe food-handling practices o Person who thinks altering behavior is worthwhile but is unsure of their ability to make a
 Perceived Severity change is unlikely to attempt lifestyle changes
o a person’s belief about seriousness or severity of a disease o Even if a person believes adopting healthier behaviors will have significant benefits, they
o Severity can be based on medical consequences like death or disability or personal beliefs are unlikely to change current behavior if they doubt the barriers to change can be
about how condition or disease would affect their life overcame
Example: o Self-efficacy can be increased with encouragement, training, and other support
 Despite public health recommendations, some people do not get the flu vaccine.
Preventive Approach to Health
They know they can get the flu but believes it will not be serious
o Perceived severity might be heightened among those self-employed because missing a Health Promotion and Levels of Prevention
week of work means reduced income
o When perceived susceptibility and severity are heightened, people are more likely to take  Health Promotion
action o Activities enhance resources directed at improving well-being
 Perceived Benefits  Disease Prevention
o person’s opinion of the value or usefulness of a new behavior in lowering risk of disease o Activities protect people from disease and effects of disease
o To make a change, people must believe that the change will have a positive result  Leavel and Clark (1958) identified 3 levels of prevention:
o Example: o Primary prevention
 People w/ diabetes take medication believing it will work to control blood sugar o Secondary prevention
 People quit smoking because they believe it will improve their health o Tertiary prevention
o Belief that the action will lead to beneficial results makes a person more likely to take action
Primary Prevention
o Sometimes, benefits of changing behavior are not strong enough to cause a change
o Perceive benefits may be outweighed by perceived barriers  preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible
 Perceived Barriers individuals
o Most significant factor in determining behavior change  Consist of 2 elements:
o person’s view of obstacles that stand in the way of behavior change o General health promotion
o If barriers are stronger than benefits, change will not occur o Specific protection
o Barriers = tangible or intangible  Health promotion efforts enhance resiliency and protective factors and target essentially well
 Tangible populations
 Lack of financial resources, lack of transportation, childcare needs  Examples:
 Intangible o Promotion of good nutrition
 o Provision of adequate shelter Relationship of Risk to Health and Health Promotion Activities
o Encouraging regular exercise
o Earthquake and fire drills  Health is directly related to: (Risk Factors)
 Specific protection efforts reduce or eliminate risk facts (risk reduction) including: o lifestyle
o Immunization o food that we eat
o Seat belt use o substances we are exposed daily
o Water purification o genetic makeup
o gender
Secondary Prevention o age
o environment
 early detection and prompt intervention during period of early disease pathogenesis
 Implemented after a problem has begun but before s/sx appear and targets populations that have 2 Types of Risks
risk factors
1. Modifiable Risks (patient has some control)
 Examples:
a. Example:
o Mammography
i. smoking
o BP screening
ii. sedentary or active lifestyle
o Newborn screening
iii. type and amount of food eaten
o Pap smear
iv. type of activity he/she engages
 Directed toward prompt intervention to prevent worsening conditions of affected populations
2. Non-Modifiable Risks (px has little or no control)
 Examples:
a. Example:
o Teaching mother how to give ORESOL to her kid w/ diarrhea to prevent dehydration
i. Genetic makeup
o Adm. Vitamin A to children w/ measles
ii. Gender
o Provision of first-aid and emergency care
iii. Age
Tertiary Prevention iv. Environment

 Target population that have experienced disease or injury; focuses on limitation of disability and Risk Reduction
rehabilitation
 Proactive process which individuals participate in behaviors that enable them to react to actual or
 Aims:
potential threats to their health
o Keep health problems from getting worse
o Reduce effects of disease and injury Risk Communication
o Restore individuals to their optimal level of functioning
 Examples:  Process through w/c public receives information regarding possible or actual threats to health
o teaching how to perform insulin injections and disease management to a diabetic patient  Affected by way individuals and communities perceive, process, and act on their understanding of
o referral of a patient with spinal cord injury for occupational and physical therapy the risk
o leading a support group for cancer patients who have undergone cancer treatment
o palliative treatment for those with chronic illness
 applying Levels of Prevention concerning malnutrition among young children in community
o nurse might perform following intervention:
 Primary Prevention: Educate pregnant women on benefits of breastfeeding first 6
months of life
 Secondary Prevention: conduct periodic operation timbang
 Tertiary Prevention: provide nutrition education to mothers of children w/ chronic
and severe malnutrition