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Health Promoting Settings

Milka Donchin MD, MPH



Braun School of Public Health
& community Medicine
Jerusalem
Main activities in Health Promotion
Settings
programs
training
The setting-based approach
A setting is a social system in which people live,
work, learn, love and play
Characterized by a particular organizational culture,
structure, functions, norms and values.
The setting-based approach

A setting is the context
within which and through which
health occur
The setting-based approach
A holistic and socio-ecological model of health
Focus on populations, policy and environments
Protect human rights, equity and social justice
sustainability
Community participation
Enablement and empowerment
Cooperation
The setting-based approach
Key elements:
A healthy working and living environments
Integrating health promotion into the daily
activities of the setting
Reaching out into the community

The setting-based approach
Underpinned by:
Health for all
Ottawa Charter
Agenda 21
Sustainable Development
'development which meets the needs
of the present without compromising
the ability of future generations to
meet their own needs'

Principles for Sustainable Development in Israel
(partly) Agenda 21
Integrated Resource
Management
Inter-generational and
Intra-generational
Equity
Environmental and
Social Justice
Accountability and
Transparency



Eco-Efficiency
Polluter Pays
User Pays
Sustainable
Consumption



Source: European Sustainable Development and Health Series:1
The first
health promoting setting
Healthy cities
One in which residents, business, non-
governmental organizations and the
municipal government work together to
ensure a viable and livable city.
A Healthy City
Healthy cities networks
Israel network of healthy cities
Established in 1990 with 4 cities
In 2012 50 cities & local authorities,
& 4 regional authorities
Covers >50% of the population in Israel

Israel Network of Healthy Cities
In operation since 1990

A unit of the Union of Local Authorities
Ministries
Health
Education
Environment
Welfare
Sports
Cities
Local councils
Regional councils
Institutions
School of Public Health, Jerusalem
Israel cancer Association
Nature protection society
Community centers association
4 HMOs
Beterm
Enosh
Milenium
Association of cardiologists
IMA
Individuals
A member of the European Network
of National Healthy Cities Networks , lead by WHO
Members of the Network
Membership Criteria for cities
A formal decision of the city council to adopt HFA principles
Nominate a multi-sectoral steering committee
Nominate a city health coordinator
A commitment to prepare a city health profile
A commitment to prepare a strategic health development
plan based on the profile
A commitment to cooperate with the networks activities.
The Healthy City mode of action
Steering
committee
City profile
Strategic planning for health
& sustainable development
Health
promotion
projects
Action plans in city settings
Sustainable
development
projects
Identify needs of the population
Determine inequalities in health
Identify desires and aspiration of the citizens

City health profile

All Healthy Cities are committed to preparing a City
Health Profile as a basis for their strategic planning
for Health for All and Sustainable Development
The profile includes:
data on the state of health of the population
socio-economic and environmental determinants
Identification of social and health inequalities
Mapping of the services in the city and their usage
City Health Profiles
A toolkit for preparing city profile
Enable standardization
Has operational
definitions
Forms for extracting
information
A questionnaire



A CITY PROFILE

A basis for strategic planning for
health and sustainable
developments
GUIDELINES

Updated version 2010



The profile a joint effort
Expert
network team
collect data
from national
sources
facilitators and
consultants to the
city coordinators
and their teams
City
coordinator &
local team
collect data
from municipal
sources
Define determinants
for inequalities and
vulnerable groups
CBS
provide population
random samples and
weights for population
estimates
Selected results
Selected characteristics
Ash P-T N - Z
5 6 7 Socio-economic cluster
30 33 31 Median age
16.2 8.8 5.6 % of families with 4+
children
55.9 61.3 70.2 % entitled to
matriculation certificate
of 12
th
graders
49.6 25.7 15.7 % elderly receiving
supplement income
Participated in the surveys aged 22+
Ash P-T N - Z
city
539 414 489 N
86.2 66.2 77.9 Response rate
2006-7 2007-8 2008 Year of conducting
the survey
Selected characteristics of the
population in geographical areas
P-T Ash
Social capital
Trust people Mutual support
lifestyles
Ash P-T N - Z
27.5 20.0 20.8
Rate of smokers
12.7 33.4 40.3 Rate of physically
3+/w
46.2 68.6 62.1 50+ women
performed
mammography
Women aged 50+ performed
screening mammography (%)
Self assessment of health by areas in cities and age
Predictors of assessing health as good-very good
Logistic regression in P-T -
P
C.I OR
<0.001
1.8-16.2 5.3 Age 22-44
0.3-1.4 0.6 45-64
1 + 65
<0.001 immigration
2.3-11.8 5.2
Israeli born
0.8-4.2 1.8
Immigrated before 1990
1
Immigrated 1990+
<0.001 Employment
3.8-18.8 8.4
Yes
1
No
0.002 Satisfaction from life
1.6-8.0 3.6 Yes
1 no
Predictors of assessing health as good-very good
Logistic regression in N-Z-
P
C.I OR
<0.001
Age
3.4-41.1 11.9 22-44
1.3-7.5 3.1 45-64
1 + 65
0.015
1.0-1.3 1.1
Education
0.041
Employment
1.0-6.2 2.5 Yes
1 no
0.003
Satisfaction from life
1.6-10.1 4.0 yes
1 No
Environmental and social nuisances
P-T
N-Z
conclusions
Variation in population composition exists within and
between cities
Inequalities between geographical areas in each city
are determined by the population mix as well as by
their physical and social environments
Predictors of self assessment of health are not
identical in different cities.
A city health profile should be performed in each city
as a basis for identifying and prioritizing needs and as
a basis for evaluating the implementation of a health
equity policy.

Strategic health development plan
Based on needs assessment
Integrates public desires and aspirations
Has a participatory planning process
Is integrated in the city action plans
Haifa

Schools &
kindergartens
Community
centers
Work
places
Health
services
Deprived
neighborhoods
municipality
Narrowing gaps, answer needs,
improving quality of services
Reduce
injuries
Improve the
environment
Awareness
Reduce
smoking
Physical
activity



Haifa - a healthy city
Towards an active city
The Haifa forum for healthy & active living
Steering committee
Sharing knowledge and experience
Mapping needs & assets
Political commitment
Participatory planning process

Determinants of physical activity
multi-component interventions that are adapted to the
local context were found to be the most successful.
What works?
Effective interventions invariably involved participants
in the planning and implementation stages, such as
involving the workers themselves in workplace
interventions, and community leaders in community
and..
WHO, 2009
Evaluation framework
WHO global strategy on diet, physical activity and health: a framework to
monitor and evaluate implementation, 2008

Health promoting hospitals - HPH
Health promoting hospitals
The health promoting hospitals (HPH) project and
network facilitates change to promote total quality
management of the hospital.
It produces evidence to help hospitals achieve their
health mission and to support cooperation and
exchanges of experience between participating
hospitals.

http://www.euro.who.int/healthpromohosp


objectives:

To change the culture of hospital care towards
interdisciplinary working, transparent decision-
making and with active involvement of patients
and partners.
To evaluate health promotion activities in the
health care setting and build an evidence-base in
this area.
To incorporate standards and indicators for health
promotion in existing quality management
systems at hospital and at national levels.

Health promoting hospital - hospitals
promote human dignity, equity and solidarity,
and professional ethics, acknowledging
differences in the needs, values and cultures
of different population groups;
be oriented towards quality improvement, the
well-being of patients, relatives and staff,
protection of the environment and realization
of the potential to become learning
organizations;
The Vienna Recommendations, adopted at the 3rd Workshop of National/Regional Health
Promoting Hospitals Network Coordinators, Vienna, 16 April 1997
Standards of a HPH
1. A hospital has a written policy for health
promotion. This policy must be implemented as
part of the overall organization quality system
and is aiming to improve health
outcomes. It is stated that the policy is aimed at
patients, relatives and staff.
2. describes the organizations' obligation to ensure
the assessment of the patients' needs for health
promotion, disease prevention and rehabilitation.

3. the organization must provide the patient with
information on significant factors concerning
their disease or health condition and health
promotion interventions should be
established in all patients' pathways.
4. gives the management the responsibility to
establish conditions for the development of
the hospital as a healthy workplace.
5. deals with continuity and cooperation,
demanding a planned approach to collaboration
with other health service sectors and
institutions.


Universities
Teaching health promotion in all schools of
public health
Health promotion university

J. Orme and M. Dooris, HEALTH EDUCATION RESEARCH, 2010, 25: 425 437
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