Week 2 - Health Promotion & Protection

BSN315 Community Health Nursing
Hand Hygiene
Health Health
Prevention Promotion
Public Health Approach Health

Protection
Health Promotion, Prevention and Protection

Week2. AY 2023 - 2024
Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z.
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 1
By the end of this session, the students will be able to: Hand Hygiene
1. Define the following terms: determinants of health, health

promotion, natural history of a disease, health prevention, and health
protection.
2. Summarize the five determinants of health.
3. Discuss the five action domains of the Ottawa Charter for Health
Promotion.
4. Apply health prevention program based on the the concept of natural
history of a disease.
5. Explain the three domains of health protection.
6. Describe the eight common features of health protection.
Outline Hand Hygiene
I. Determinants of Health
1. Biological Determinants
2. Behavioral & Socio-economic Determinants
3. Health Services
4. Aging of the Population
5. Gender
II. Health Promotion
1. Goal of Health Promotion
2. Action domains of the Ottawa Charter for Health Promotion
3. Health Promotion Events
4. Example of Health Promotion
III. Natural History of a Disease
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1. Stages of Natural History
2. Importance of Understanding Natural History
IV. Prevention of Health Problems
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
V. Health Protection
1. Domains of health protection
a. Control of communicable diseases
b. Emergency preparedness resilience and response
c. Environmental Public Health
2. Common features of health protection
Introduction Hand Hygiene
 From previous session, we learned that community-based nursing care

focuses on promoting health and preventing illness.
 Health promotion & wellness are important concepts throughout
nursing practice & education.
 Nurses promote health & wellness of themselves, their loved ones &
their patients.
 Wellness is the state of being.
 Health promotion is how to get there.
 In order to achieve promoting health and preventing illness we should
understand the determinants of health.
Determinants of Health Hand Hygiene
• Health is shaped by a complex interaction of elements that extend beyond

medical care.
• Determinants of health include the range of personal, social, economic,
environmental factor which determine the health status of the population.
• Health is multifactorial.
• The factors which influence health lie both within the individual and
externally in the society in which he or she lives.
• Understanding these determinants is crucial for promoting better health
outcomes.
Determinants of Health Hand Hygiene
Hand Hygiene
1. Biological Determinants
• The physical and mental traits of every human being are to some
extent determined by the nature of his genes at the moment of
conception.
• Several diseases are now known to be of genetic origin, e.g.
chromosomal anomalies, errors of metabolism, mental retardation,
some types of diabetes etc.
2. Behavioral & Socio-economic Determinants Hand Hygiene
• It is composed of cultural and behavioral

patterns and lifelong personal habits (e.g.,
smoking, alcoholism) that have developed
through processes of socialization.
• For the majority of the world's people,

health status is determined primarily by
their level of socio-economic
development, e.g. per capita GNP,
education, nutrition, employment,
housing, the political system of the country
etc.
3. Environmental Determinants Hand Hygiene
• It is an established fact that environment has a direct impact on the

those living in it.
4. Health Services Hand Hygiene
• The purpose of health services is to improve the

health status of population.
• For example, immunization of children can
influence the incidence/prevalence of particular
diseases .
• Provision of safe water can prevent mortality
and morbidity from water-borne diseases.
• The care of pregnant women and children would
contribute to the reduction of maternal and
child morbidity and mortality.
5. Aging of the Population Hand Hygiene
A major concern of rapid population aging is the increased

prevalence of chronic diseases and disabilities, both being
conditions that tend to accompany the aging process and
deserve special attention.
6. Gender Hand Hygiene
• Gender has implications for health across the course of every person's
life. Gender can influence a person's experiences and exposure to
diseases and their access to healthcare, education, water, hygiene and
sanitation.
• For example, in 1993, the Global Commission on Women's Health was

established. The commission drew up an agenda for action on
women's health covering nutrition, reproductive health, the health
consequences of violence, aging.
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Health Promotion
• Health Promotion Definition:
“Process of enabling individuals and communities to increase control over and
improve their health by addressing the social, economic, environmental, and
cultural determinants that influence health behaviors and outcomes”. (WHO 2021)
It encompasses the integration of educational, organizational, and environmental

activities to:
1. Improve health knowledge
2. Foster positive behaviors
3. Establish an environment that support overall well-being.
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Health Promotion
• Health Promotion is recognized as one of the most important
components of community health practice.
• It includes all efforts that seek to move people closer to optimal well-
being or higher levels of wellness.
• Nursing, in particular, has a social mandate for engaging in health
promotion programs and activities, for example:
oTeaching the dangers of drug use, demonstrating healthful practices
such as regular exercise, and providing more health-promoting
options such as heart-healthy menu selections.
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Goal of Health Promotion

• The goal of health promotion is to raise levels of wellness for
individuals, families, populations, and communities.
• Community health efforts accomplish this goal through efforts to:
1. Increase the span of healthy life for all citizens.
2. Reduce health disparities among population groups.
3. Achieve access to preventive services for everyone.
Ottawa Charter for Health Promotion Hand Hygiene
• The first International Conference on Health Promotion took place in October

1986 in Ottawa, Canada, resulting in the creation of what is now universally
recognized as the Ottawa Charter for Health Promotion.
• The Ottawa Charter for Health Promotion outlines five key action domains. These
domains constitute a comprehensive structure for health promotion framework
and are vital for achieving improved health outcomes and well-being.
1. Build healthy public policy
2. Create supportive environments for health
3. Strengthen community action for health
4. Develop personal skills, and
5. Re-orient health services
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1. Build Healthy Public Policy

• Building healthy public policy involves developing and implementing policies that
prioritize health and well-being at all levels of government.
• This includes regulations, laws, and guidelines that promote healthy behaviors
and discourage harmful ones.
• Examples include policies that restrict tobacco advertising and tobacco control
policies, implement sugar taxes to reduce sugary beverage consumption, and
ensure safe and nutritious school meals.
2. Create Supportive Environments for Health Hand Hygiene
• Creating supportive environments means shaping physical, social, and economic

surroundings to make healthy choices easier for individuals and communities.
• This can involve urban planning that promotes physical activity through walkable
neighborhoods, establishing smoke-free zones, ensuring workplaces are
conducive to mental well-being.
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3. Strengthen Community Action for Health

• This action area emphasizes the importance of involving communities in health
promotion efforts.
• Empowering communities to identify their own health needs and participate in
decision-making processes can lead to locally relevant and effective
interventions.
• Examples: Community-led initiatives, support groups, and grassroots campaigns.
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4. Develop Personal Skills

• Enhancing personal skills involves providing individuals with the knowledge, skills,
and resources they need to make informed decisions about their health.
• Health education programs, workshops, and campaigns aim to improve health

literacy, communication skills, and other abilities that contribute to healthy
behaviors and decision-making.
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5. Re-orient Health Services

• Re-orienting health services means shifting the focus of healthcare systems from
primarily treating illnesses to also promoting health and preventing diseases.
• Healthcare providers play a role in health promotion by integrating preventive

services, promoting patient education, and adopting a holistic approach to health
that considers physical, mental, and social well-being.
Health Promotion Events Hand Hygiene
• Physical activity and fitness.

• Nutrition.
• Tobacco use.
• Teaching the dangers of alcohol and drug use.
• Family planning.
• Mental health and mental disorders.
• Violent and abusive behavior.
• Educational and community-based programs.
Example of Health Promotion: Smoking Cessation
Program Hand Hygiene
• This program is designed to support individuals in quitting smoking, thus

improving their overall health and well-being.
Components of the Program:
1. Education and Awareness: The initiative teaches participants with
insights into the hazards linked to smoking, such as pulmonary diseases,
cardiac problems, and different types of cancer. Educational materials
highlights the advantages of cessation, such as enhanced lung capacity,
reduced in the risk of diseases, and improved in the quality of life.
2. Behavioral Interventions: Participants get counseling sessions that
focus on behavioral changing techniques. These sessions help them to
identify triggers for smoking, develop coping strategies, and set
achievable goals for quitting.
3. Nicotine Replacement Therapy: The program may offer nicotine
replacement stuff like patches or gums, to ease withdrawal symptoms
and gradually reduce nicotine dependence.
24
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org
4. Supportive Environment: Establishing a supportive environment is essential for
achieving positive outcomes. Participants might be encouraged to Hand
interact
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with
support groups, peers, and family, who can offer encouragement and
motivation.
5. Policy Support: The program can be fostered by creating community

regulations and policies to establish smoke-free zones in public areas,
workplaces, and other public settings. This reinforces the idea that giving up
smoking isn't solely advantageous for individuals, but also contributes to a
healthier community.
5. Measurement and Evaluation: The effectiveness of the program is evaluated

through monitoring participants' progress in quitting smoking, tracking
improvements in health indicators (e.g., lung capacity), and conducting follow-
up surveys to measure long-term success.
Benefits of the Program: Hand Hygiene
1. Improved health outcomes: Reduction in the risk of smoking-related diseases.

2. Enhanced well-being: Quitting smoking result in an increased energy levels,
improved lung function, and a better sense of smell and taste in addition to
other related morbidity and mortality.
3. Health care cost savings: Cost of baying smoking products as well as health
related consequences.
4. Positive social impact: Through cessation, individuals play a role in diminishing
secondhand smoke exposure for others, thereby promoting a healthier
environment for non-smokers.
Natural History of Disease Hand Hygiene
Introduction
• The natural history of a disease provides a comprehensive view through which health
professionals can understand the entire path of an illness, from its initial stages to its
final outcomes.
• This knowledge is essential for effective disease management, prevention, and the
development of directed interventions.
Concept of Natural History:

• It forms the series of events from the time of exposure to an etiological agent or risk
factor to the final resolution of the disease.
• It includes: 1) the preclinical phase (asymptomatic period), 2) clinical phase (symptoms
and diagnosis), and 3) potential outcomes such as recovery, disability, or death.
• Understanding this progression enables healthcare practitioners to anticipate disease
patterns, establish appropriate interventions, and allocate resources efficiently.
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Figure 1. : The natural history of a disease, from the medical view

Stages of Natural History: Hand Hygiene
1. Prepathogenesis Stage:
• This phase focus on factors that foster an environment conducive to the emergence of a
disease.
• These factors, referred to as health determinants, encompass a spectrum of influences,
including social, economic, environmental, and genetic factors.
• Example: the effect of smoking, an environmental determinant, that increases the
susceptibility to lung cancer.
2. Pathogenesis Stage:
• In this phase, disease pledges due to exposure to an infectious agent, harmful
substance, or genetic predisposition.
• It starts with the exposure event and develops through incubation, onset, and
establishment.
• Example: HIV infection progresses through stages from initial exposure to clinical AIDS.
3. Clinical Disease Stage:
• During this period, symptoms become apparent, resulting in the identification of
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the disease through diagnosis.

• The clinical manifestations vary based on the specific disease, encompassing a
spectrum from mild to severe manifestations.
• For example diabetes, where clinical symptoms are polydipsia and polyurea
indicate of the disease's presence.
4. Outcome Stage:
• The range of potential outcomes includes diverse scenarios like recovery, chronic
disease, disability, or death.
• The ultimate depends on the management and treatment of the disease and
individual factors.
• For example, effective antiretroviral therapy for HIV can yield an extended and
healthy life, whereas inadequate treatment might give rise to complications
linked to AIDS.
30
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org
Importance of Understanding Natural History: Hand Hygiene
1.Preventive Strategies
2.Early Detection and Treatment
3.Resource Allocation
Examples:
1.Influenza: In the preclinical phase, individuals encounter the virus. The stage of
pathogenesis encompasses viral replication and the incubation period. The clinical
phase is marked by noticeable symptoms such as fever, cough, and body aches.
Potential outcomes span from recuperation to the emergence of serious respiratory
complications or even mortality.
2.Type 2 Diabetes: Diabetes is influenced by genetic predisposition and lifestyle choices.

The pathogenesis phase entails processes like insulin resistance and disrupted glucose
regulation. During the clinical stage, symptoms like polydipsia, polyurea and polyphagia
become evident. In cases of inadequate management, potential consequences
encompass diabetic complications such as neuropathy and cardiovascular disorders.
Prevention of Health Problems Hand Hygiene
• Prevention is better than cure (‫)درهم وقاية خير من قنطار عالج‬

• The prevention of health problem forms a significant component within
community health practice.
• Preventive measures can be applied at any stage along the natural history of a
disease, with the goal of preventing further progression of the condition
• Prevention involves the anticipation and mitigation of problems, either by early
averting them or identifying them at an early stage to reduce the potential for
disability and impairment.
• Prevention strategies are organized into three distinct levels: 1) primary
prevention, 2) secondary prevention, and 3) tertiary prevention.
• Each level targets specific stages of disease development, from initial risk factors
to advanced illness, and employs different approaches to mitigate their impact.
Hand Hygiene
Figure 2: Clinical course of a disease: four prevention stages

1. Primary Prevention Hand Hygiene
• It aims to prevent the onset of disease by addressing risk factors before they lead
to health problems.
• It focuses on the general population, including individuals without any signs or
symptoms of the disease. This level of prevention is proactive, emphasizing
health promotion and education.
• The objective is to prevent the onset of particular diseases through the reduction
of risks, achieved by modifying:
a. Behaviors that may contribute to disease onset,
b. Exposures that may contribute to disease onset,
c. By improving resistance against to the disease agent.
Examples:
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• Immunization Programs: Childhood vaccinations against diseases like measles,
mumps, and rubella.
• Tobacco Control Initiatives: Campaigns against smoking and policies to restrict
tobacco advertising.
• Nutrition and Physical Activity Campaigns: Promoting healthy eating habits and
regular exercise helps prevent obesity and related chronic diseases.
2. Secondary Prevention Hand Hygiene
• It involves detecting and treating diseases at an early-stage pre-clinical

pathological changes and thereby control disease progression, often before
symptoms become apparent.
• This level focuses on individuals who are at a higher risk due to their exposure to
risk factors or early signs of disease.
Examples:
• Screening Programs: Breast self exam, Mammograms for breast cancer and
colonoscopies for colorectal cancer help detect these diseases at early,
better treatable stages.
• Blood Pressure Screening: Regular checks for hypertension, enabling timely
interventions to prevent complications such as heart disease.
3. Tertiary Prevention Hand Hygiene
• It focuses on managing, minimizing and the effect of established diseases to

prevent further deterioration and complications as well as to soften the
effect caused by the disease on the patient’s function, long life
complications, and quality of life.
• Tertiary prevention emphases on rehabilitation, support the patient to
accommodate to his disability.
Examples:
• Cardiac Rehabilitation: Following Acute MI, cardiac rehabilitation programs
assists patients to recover and reduce the risk of subsequent complications.
• Diabetes Management: Involves monitoring blood sugar levels and managing
complications to prevent further damage to organs.
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Health Protection
Introduction
• Just as Emergency Department (ED) serve as the frontline of healthcare,
addressing immediate and acute health problems, health protection serves as
the frontline of public health, managing sudden public health crises related to
both communicable and non-communicable diseases.
• Unlike ED, however, health protection also addresses chronic public health
situations such as contamination/pollution of land, air, or water, which can result
in both acute and chronic health effects.
• Moreover, health protection involves the collection of evidence and the
provision of information and assistance to ready for emergencies, while also
anticipating future problems, incidents, emergencies, and other health threats.
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Definition of Health Protection

“The protection of individuals, groups and populations through expert advice and
effective collaboration to prevent and mitigate the impact of infectious disease,
environmental, chemical and radiological threats.” (Ghebrehewet et al. 2016)
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Domains of health protection

• Encompass a range of strategies and measures designed to safeguard individuals
and communities from health hazards, threats, and potential harms.
• These domains collectively contribute to ensuring public health and well-being by
preventing harm and mitigating the impact of health risks.
• The domains of health protection can include:
1. Control of communicable diseases
2. Emergency preparedness resilience and response
3. Environmental Public Health
Hand Hygiene
1. Control of communicable diseases

• It encompasses the prevention, investigation, control, and management of
infections via dedicated local, regional, and national specialist health protection
teams.
• Its scope can vary, from individual patient infected with E. Coli infection to
broader scenarios such as a significant measles outbreak within a community.
This outbreak could involve multiple smaller outbreaks in schools, affecting local
hospital patients, staff, nearby communities, and potentially extending beyond.
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2. Emergency Preparedness Resilience and Response

• It encompasses readiness, prevention, investigation, control, and management of
occurrences that pose a significant risk to human well-being. Which include both
communicable diseases and environmental public health consequences.
• The scope of coverage can differ, ranging from incident where three inhabitants
in a residence above a restaurant are exposed to carbon monoxide, to a huge
chemical incident with a smoke plume carrying harmful substances drifting over a
substantial residential community that includes nursing homes, healthcare
facilities, and schools. Additionally, their area of operation and array of services
extend beyond devising plans and readiness measures for local and nationwide
situations (such as incidents, outbreaks, and epidemics) to also encompass
preparations and responses to pandemics.
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3. Environmental Public Health

• The recognition, description, and provision of safe and and sustainable
responses, encompassing immediate and future approaches, against any form of
health threat arising from factors within the natural or non-natural environment.
• Its scope ranges from investigating claims of potential health effects of

powerlines on a small group of residents to addressing complex and persistent
concerns related to contaminated land. In the latter case, pollutants are seeping
into the air and water, potentially causing health effects that could be
psychological or perceived. These situations demand inspection, reassurance,
long follow – up.
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Common features of the three domains

• The provision of health protection services, in whichever domain and whether large or
small in scope, are supported and underpinned by:
• Providing health protection services, regardless of their domain or scale, are supported
by:
1. Good surveillance
2. Strong multi-agency partnership
3. Clear and robust epidemiology
4. Supportive science (Microbiology, toxicology, environmental sciences, clinical
sciences, and radiation sciences).
5. Timely audit
6. Focused research
7. Clear communication strategy
8. Learning and development

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BSN315 Community Health Nursing

Public Health Approach Health

Health Promotion, Prevention and Protection

1. Define the following terms: determinants of health, health

 From previous session, we learned that community-based nursing care

• Health is shaped by a complex interaction of elements that extend beyond

• It is composed of cultural and behavioral

• For the majority of the world's people,

• It is an established fact that environment has a direct impact on the

• The purpose of health services is to improve the

A major concern of rapid population aging is the increased

• For example, in 1993, the Global Commission on Women's Health was

It encompasses the integration of educational, organizational, and environmental

Goal of Health Promotion

• The first International Conference on Health Promotion took place in October

1. Build Healthy Public Policy

• Creating supportive environments means shaping physical, social, and economic

3. Strengthen Community Action for Health

4. Develop Personal Skills

• Health education programs, workshops, and campaigns aim to improve health

5. Re-orient Health Services

• Healthcare providers play a role in health promotion by integrating preventive

• Physical activity and fitness.

• This program is designed to support individuals in quitting smoking, thus

5. Policy Support: The program can be fostered by creating community

5. Measurement and Evaluation: The effectiveness of the program is evaluated

1. Improved health outcomes: Reduction in the risk of smoking-related diseases.

Concept of Natural History:

Figure 1. : The natural history of a disease, from the medical view

the disease through diagnosis.

2.Type 2 Diabetes: Diabetes is influenced by genetic predisposition and lifestyle choices.

• Prevention is better than cure (‫)درهم وقاية خير من قنطار عالج‬

Figure 2: Clinical course of a disease: four prevention stages

• It involves detecting and treating diseases at an early-stage pre-clinical

• It focuses on managing, minimizing and the effect of established diseases to

Definition of Health Protection

Domains of health protection

1. Control of communicable diseases

2. Emergency Preparedness Resilience and Response

3. Environmental Public Health

• Its scope ranges from investigating claims of potential health effects of

Common features of the three domains

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