Introduction to Health

Promotion

BY; Hiwot T. (MPH in HPBS and MPH in

Human Nutrition)

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 Learning objectives
At the end of this chapter you are expected to:
 Define health
 HE in Ethiopia
 Identify the r/ships b/n H.I, BCC, IEC, H.E and H.P
 Discuss the rational of health education
 Explain the ultimate goals and educational objectives of HE
 Describe the role of Health Promotion/E in PHC
 Explain the basic principles of health education
 Explain the level of health education
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 Definition and concepts of health

 Health:- Differs among social classes, cultures, religion and ethnic

groups.

1. Negative model

 Absence of diseases or disability or infirmity

 Biological integrity of the individual

 Physical and physiological capabilities to perform routine tasks.

 According to this definition individual is healthy if all the body parts;

cells, tissues, organs, organ systems are functioning well.

Disease “A” + Medical treatment=health

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 II) The positive model

 It is broader and more holistic concept.

 “A state of complete physical, mental, and
social well-being not merely the absence of
disease or infirmity.” WHO(1948)

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 1. Physical health

 Anatomical integrity and physiological functioning

of the body.

2. Mental health
 it is subjective sense of well being.

A) Cognitive component
 It is the ability of an individual to learn, perceive and,
think clearly. E.g. Mentally retarded if he/she cannot
learn something new at a pace in which an ordinary
person learns.
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 Cont…

B) Emotional component
 Is the ability of expressing emotions (e.g. fear,
happiness, and to be angry) in an “appropriate”
way.
3. Social health
 Is the ability to make and maintain “acceptable”
and “proper” interaction and communication with
other people. 6
 Historical Development of HP/E

 As a practice as old as human being

 As a profession in the world ~>100 years –
USA
 Health belief model 1966: the oldest model
 As a course: Gondar Health science ~ 1954
 As a profession in Ethiopia: JU > 10 yrs
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 The health policy of Ethiopia and H.P
 In 1974 the first health policy was established
 The 1993 Health Policy boldly indicated
priority health issues and the significance of
 IEC, as well as health education and
 Community mobilization

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Health Policy Con’t….

 The promotion, preventive & disease control

strategies further more consolidated by
adoption of PHC.
 To realize these better emphasis was given to
HP by health policy, HSDP

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 Brainstorming

 What is Health education ?

 What is Health information?
 What is Health promotion?
 What are the d/ce b/n HE,HI & HP?

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 Health Education
 Health education is the process of behavior change
towards healthy life
 A person’s behavior may be the main cause of a health
problem, but it can also be the main solution
 HE is “Any combination of learning experiences
designed to facilitate voluntary action conducive to
health”

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 What HE really means?
 Elaboration of the definition:

 Combination: the importance of matching multiple

determinants of behaviors with multiple learning experiences
or educational intervention

 Designed: health education is not incidental learning

experiences. It is a systematically planned and organized
activity

 Facilitate: creating favorable condition such as predispose,

enable, reinforce
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 What HE really means?...

 Voluntary: with full understanding and

acceptance of the purpose of the action
 Action: behavioral steps/measures taken by
individuals, groups or community to
achieve the desired health effect.

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 HEALTH INFORMATION [HI]
 It is health message disseminated to the target
audience focusing on the basic facts related to the
health issue under consideration.
 What is the difference between HE and HI?

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 Comparison of health education and health information
No Health education
1 Baseline information or current level of
Multiple determinants of behavior are
necessarily required
2 The assumption is people are not rational all
the times, but rationalize all the times.
3 Appropriate for old problems (problems
Known to the people for long period of time)
4 Required at all stages in behaviors change
continuum (it is continues, even to prevent
defaulter after adoption)
5 Encourage people to make their own choices
for healthy life
6 Focus on the reason behind behaviors
7 People are not blamed for unhealthy
behaviors
8 Use a variety of methods or educational
strategy as appropriate.
Health information
Baseline information or data are not necessarily
required
The assumption is people are rational and make
predictable use of information available to them
(unhealthy behaviors is due to knowledge gap and
knowledge alone leads to action)
Appropriate for newly emerging health problems
and during epidemics
One time telling facts provided that the
information reaches at all the intended Audiences
and understanding takes place
Merely telling people to follow healthy behaviors
Blind to the reason behind behaviors
People blamed for un healthy behaviors
May not use a variety of methods.
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 HEALTH INFORMATION…

 Generally, HI is the scientific facts (e.g. the causes,

mode of transmission, prevention methods of particular
diseases) content of health education which primarily
aimed at increasing of knowledge on that particular
health problems.
 But HE address the other factors that affect health
behaviors other than knowledge such as beliefs,
attitude ,reinforcing factors etc.

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 HEALTH PROMOTION
 “A combination of educational and environmental
supports for actions and condition of living conducive to
health.” (GREEN AND KRUETR ,1991)

Elaboration of the definition: Educational: refers to the

communication part of health promotion.

Environmental: refers to the social, political, and

economic, organizational, policy and regulatory
circumstances influence behavior or more directly health
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 Cont…

Elements/component of health promotion

 Health education
 Political environment
 Social environment
 Economic environment
 Organizational environment
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 Health promotion

Organization

Regulatory Social

Environment
Environmenta Health Education al
l

Economical

Policy
Political

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Health Promotion
 Examples of health promotion intervention
Health Educational intervention Environmental/ecological/politic
problem al action
Educating the public focusing on
health problems related with Establishment of stop smoking
smoking such as lung cancer clinics.
Tobacco through different media. Control of tobacco advertising
Educating the public not to start Increase taxes on price of cigarettes
smoking and to persuade smokers Bans on smoking in public areas.
to stop
Making counseling service available
Educating general public and
Social marketing of condoms
specific groups such as drivers
Increasing VCT services
HIV/AIDS ,sex workers, youth, on safe
Setting up peer education program
sexual behaviors
Enforcing of legal protection of sex
workers and injecting users

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 Rationale for HP/E

“We must recognize that most of the world’s major

health problems and premature death are
preventable through changes in human behaviors
and at low cost” (Dr. Hiroshi Nakajiima, Director –
General, WHO, 1998).

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 Rationale for HP/E…

 The continued existence and spread of communicable diseases

such as malaria, TB, HIV/AIDS that need the involvement of
the community members and environmental interventions.
 About 75% of childhood illnesses are preventable e.g. measles
by immunization
 For some diseases health education is the only practical
choice in order to prevent the spread of the disease or to lead a
normal life. E.g. HIV/AIDS.

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 Rationale for HP/E…
 There is a shift in the major causes of death from
infectious and treatable diseases to degenerative
diseases.
 Therefore, prevention of those currently
emerging health problems are possible only
through life style modification and b/ral changes
 Increased awareness of people on chronic health
problems and the need to know preventive actions.
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 Rationale for HP/E…
 Many people are ignorant of the causes of their
illnesses and may be afraid of seeking treatment and
hide their illness not to be considered and many
others do not seek treatment until it is too late.
 Increasing threats to the young from new and harmful
behaviors. E.g. tobacco use, teen-age pregnancy,
substance use, etc.

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 The ultimate goals and educational
objectives of health education

A) The ultimate goals of health education

 To help each individual and family exercise the
right to achieve a harmonious development of the
physical, mental and social potential.
 To promote health, prevent illness, self-adjust to
live with disabilities and decrease morbidity and
mortality. 25
 Cont…

B) Educational objectives of health education

 To provide appropriate knowledge: provision of
correct knowledge, facts and information.
 To help develop positive attitude: has a lot to do
with changing opinions, feelings and beliefs of
people.

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 Cont…
 To help exercise health practice/behavior: concerned
with helping people in decision-making and actually
performing.
For example:- helping people choosing alternatives
(weather to abstain, be faithful, or use condom)
 Decision-making:- means choosing between and/or
among alternatives in the future about health. Health
education has paramount importance to help people
develop the skill of decision-making.
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 Health Promotion in PHC

PHC:- Is essential health care based on practical,

scientifically sound and socially acceptable methods
and technology made accessible to individuals and
families in the community through their full
participation and at a cost that the community and
country can afford to maintain in the spirit of self-
reliance and self-determination” (WHO, 1978)

 
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 Components/Elements of PHC
1. Health Education
2. Promotion of food supply and proper nutrition
3. Adequate supply of safe water and basic sanitation
4. MCH care, including FP
5. Immunization
6. CDC
7. Prevention and control of locally endemic diseases;
8. Appropriate treatment of common diseases and
injuries and
9. Provision of essential drugs
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Components/Elements of PHC…

Elements added after Alma Ata declaration

10. Oral health

11. Mental health promotion

12. Use of traditional medicine

13. Occupational health

14. Prevention of HIV/AIDS

15. ARI
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 Main Principles of PHC
1. Equity: Services should be physically, socially, and
financially accessible to everyone

2. Community Participation:
 Creating and preserving a healthy environment
 Maintaining preventive and promotive health
activities
 Sharing information about their needs and wants with
higher authorities, implementing health care priorities
and managing clinics and hospitals
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 Main Principles of PHC…

3. Inter-Sectoral Approach

4. Appropriate Methods and Technology

5. Health Promotion and Prevention- PHC requires

a comprehensive approach that is based on the
following interventions:
 Promotive- addresses basic causes of ill-health at
the level of society

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 Cont…
 Preventive- reduces the incidence of disease by
addressing the immediate and underlying causes at
the individual level
 Curative- reduces the prevalence of disease by
stopping the progression of disease among the sick
 Rehabilitative- reduces the long-term effects or
complications of a health problem.

 
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 What are the scope of HE&HP?
 Health education is an eclectic/diverse in nature
 Health education is life long process. It is not one
time affair
 Health education is concerned with people at all
points of health and illness continuum.
 Health education is not an end by itself.
 Health education is not limited to patients in clinical
setups. 34
 Principles of health education
 Educational diagnosis
 Participation
 Multiple methods
 Planning and organizing
 Facts
 Segmentation
 Need based
 Culture
 Motivation
 Reinforcement
 Feedback
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 1. Principle of educational diagnosis
 The first task in changing behaviors is to determine its
causes.
 Must diagnose an illness before it can be properly
treated, so, too, must a behavior be diagnosed before it
can be properly changed.
 If the causes of the behaviors understood health
educator can intervene with the most appropriate and
efficient combination of education, reinforcement and
motivation 36
 2. Principle of Participation

 The prospect for success in any attempt to change

behaviors will be greater if the individuals,
families, community groups, etc have been
participated in identifying their own needs for
change and have selected the methods that will
enable them to take action.

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 3. Principle of multiple methods

 This principle follows from the principle of

educational diagnosis. In so far as multiple causes
will invariably be found for any given behaviors.
 For each of the multiple predisposing, enabling, and
reinforcing factor identified a different methods or
components of comprehensive behavioral change
must be provided
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 4. Principle of planning and organizing
 Planning and organizing are fundamentals for health education
which distinguishes it from other incidental learning
experiences.
 It involves deciding in advance the when, who, what, how, and
why of health education.
 It also requires the planning for resources, methods and
materials to be used, identification of target groups etc.
 It is very difficult and often unsuccessful when carrying out
health education program that are not planned and organized
appropriately. 39
 5. Facts
 Health education is given based on scientific findings/facts
and current knowledge.
 It is unthinkable to provide health education without
scientific and knowledge related to the topic or issues to be
addressed. eg. Health educator must know the current
scientific knowledge how HIV/AIDS transmitted and
prevention methods.
 This is because scientific knowledge is changing with time.
For example, it is incorrect to say I think FGM is harmful.
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 6. Segmentation
 Health education should be designed for a specific
group of people/ specific target groups
7. Need based
 Health education is primarily educational and its
purpose is to ensure a desired health related behavior
after real need identification.
 The common man is only interested in knowing what
the problem is and its solutions.
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 8. Culture
 Health education should not consider as artificial
situation or formal teaching –learning process.
 One has to get into the culture of the community and
introduce novel ideas with a natural ease and caution.
 Therefore Health education starts from where people
are and slowly build up the talking point to avoid any
clash of ideas to allow for people understanding,
appreciation and internalization of fresh ideas.
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 9. Principle of motivation

 Motivation is mental direction/desire for doing

or rejecting something.
 In strictly speaking, in health education, we can
appeals to people's motives through motive
arousing appeals but not through external stimuli

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 10. Principle of reinforcement
 States that those individuals, group who started to
undertake health behaviors should verbally
encouraged or received positive feed back (positive
reinforcement ) until the started health behaviors will
develop its full potential.
 Unhealthy behaviors should be discouraged until it
disappear(negative reinforcement )

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 11. Principle of feedback
 It is a mechanism of assessing what has been
happened in the target Population after receiving the
message.
 Therefore, the two way communication particularly of
important in health education to help people in getting
proper feedback (where the communicate/receiver
become a communicator/sender and vice versa) to get
the doubts cleared.
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The levels of health education in disease
prevention & control

What is prevention?
 Prevention is defined as the planning for and the
measures taken to prevent the onset of a disease or
other health problem before the occurrence of
undesirable health events.
 There are three distinct levels of prevention

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 Cont…
1. Primary health education
 Is comprised of those preventive measures that forestall the
onset of illness or injury during the pre-pathogenesis period
(before the disease process begins), and health education
program that aimed specifically at forestalling the onset of
illness or injury among health individuals is called primary
health education

Examples
 Wearing safety belt, Immunization, Physical exercises and
Breast feeding 47
 The levels of health education…

2. Secondary health education

 Any health education/promotion programs that aimed at promoting early

diagnosis and prompt treatment of a disease to cure or to limit

disability and prevent more serious pathogenesis is called secondary

health education

Example
 Breast-cancer screening
 Blood pressure examination
 Cholesterol level examination
 Treating malaria patients 48
 The levels of health education…
3. Tertiary health education
 Health education programs that specifically aimed at patients with
irreversible, incurable, and chronic condition for social and
psychological adjustment is called tertiary health education
 The health educator work to retain, reeducate, and rehabilitate the
individual who has already incurred disability, impairment, or
dependency.

Example:- Educating after lung cancer surgery

 Working with the diabetes individual to ensure the daily
Injections are taking 49
 Levels of health education in disease
prevention…

Healthy person early signs disease disability/death

Primary Secondary Tertiary

prevention prevention prevention

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References
 FMOH, HSDP IV and HSTP
 FMOH, Health and Health related indicator, 2015
 FDRE, Prevention and Control of Chronic Non-Communicable Diseases Strategic
Framework, 2014
 FMOH, The National Health Promotion and Communication Strategy (NHPCS,
2016-2020)
 John Hubley 1993. Communicating health. An action guide to health education and
health promotion.
 Lawrence W. Green et al. 1980. Health education planning a diagnostic approach
 Getnet Mitike 2003 health education for health science students. Lecture note series.
Addis Ababa University, Ethiopia.
 Randall R. Cottrell, James T. Girvan, James F. McKenzie 2006. Principles&
foundations of health promotion and education. Third ed.
51 USA.
THANK YOU FOR YOUR
ATTENTION !!