HEALTH PROMOTION

MM 2020
Introduction To Health Promotion
• The field of Health Promotion emerged during the second half of the
20th century as medicine and science became successful, treating
infectious diseases with antibiotics, advancing maternal and child
health and improving sanitations practices.
• These gains improved the quality and quantity of life for all. Yet, now
we face the medical crisis of non communicable and chronic diseases.
Introduction To Health Promotion
• Medicine and science have continued to manage disease conditions
through procedures, surgeries and pharmaceuticals.
• All these approaches are costly to the individual through reduced
quality of life and poses an economic cost to the government
responsible for providing health care.
• Health care costs accounts for a huge percentage of the gross
domestic product.
• Controlling these health care costs is a priority for nations.
Introduction To Health Promotion
•Over 70% of all health care costs are related to non
communicable and chronic diseases and that many risk factors
for these can be modified such as tobacco use, beer drinking,
physical inactivity, food choices and managing stress.
•These modifiable risk factors are the core behaviours the field
of Health Promotion focuses on to improve the quality of
people’s lives and to manage rising health care costs ( it is said
prevention is cheaper than cure).
Introduction To Health Promotion
• These modifiable risk factors are the core behaviours the field of
Health Promotion focuses on to improve the quality of people’s lives
and to manage rising health care costs ( it is said prevention is
cheaper than cure).
• Health promotion is the process of enabling people to increase
control over, and to improve, their health. It moves beyond a focus on
individual behaviour towards a wide range of social and
environmental interventions.
Introduction To Health Promotion
• The 1st International Conference on Health Promotion was held in
Ottawa in 1986. This conference resulted in the "Ottawa Charter for
Health Promotion”.
Introduction To Health Promotion
The following are the common areas which are addressed by health
promotion specialists;
1. Smoking
2. Alcohol
3. Diet
4. Obesity
5. Exercises
6. Sexual health - including STIs, family planning
7. Mental health - including suicide prevention
1.1 Definition Of Terms
Health Promotion
• “Health Promotion is the process of enabling people to increase
control over, and to improve, their health” (WHO, Ottawa Charter,
1986)
• “Health promotion refers to planned actions, which aim to empower
people to control their own health by gaining control over it’s
determinants.”
• This is the science and art of helping people change their lifestyle to
move toward a state of optimal health.
Key values and principles of health
promotion
“The enjoyment of the highest attainable standard of health is one of
the fundamental rights of every human being without distinction of
race, religion, political belief, economic or social condition (Preamble of
the WHO Constitution).
Key Principles of Health Promotion
1. Involvement of the whole population in the context of
everyday life
2. Tackling the determinants of health
3. Use different methods and approaches –legislation and fiscal
measures, organizational change, and community
development
4. Effective public participation
5. The role of health professionals in education and advocacy for
Health
Key Principles of Health Promotion
Therefore, Health Promotion aims at;
•Strengthening health
•Redistributing power and control over individual and collective
health issues
•Reducing the negative impact of a broad range of health
determinants associated with social, political and economic
environments
•Shifting the allocation of resources, towards preventing
problems before they occur.
Key Principles of Health Promotion
• Giving attention to the domain of health beyond the
physical, including the mental, social and possibly spiritual
dimensions
• Taking an ecological approach
• Recognizing community development and involvement as
legitimate and effective strategies
1.2 Nature And Scope Of Health Promotion
Health promotion are measures that are intended to improve the general
health and well being of the individual, family and community e.g.
Health education
Environmental sanitation
Clean water supply
Proper refuse disposal
Good nutrition
Marriage counselling
Sex education
Screening
1.2 Nature And Scope Of Health Promotion
Origin and Milestone of Health Promotion
The Lalonde Report
• Many scholars, policy makers, and practitioners pick 1974 as
the point in history that marks the beginning of health
promotion.
• In that year, Canada published a policy statement, A new
perspective on the health of Canadians, which was called the
Lalonde report (after the Minister of National Health and
Welfare.
1.2 Nature And Scope Of Health Promotion
• The paper identified two main health-related objectives: the
health care system; and prevention of health problems and
promotion of good health.
• It proposes integrating these two aspects of health in health
care policy development, and detailed out strategies and 74
proposals to meet this object
1.2 Nature And Scope Of Health Promotion
Developments in the US
• In 1974, the United states congress passed a public law 94-317, the
health information and health promotion act, which created the office
of Health Information and Health Promotion, later renamed the office
of Disease Prevention and Health Promotion.
• These developments set in motion the healthy people 2000 objective
• A new perspective on the health of Canadians (Mac Lalonde, 1974):
Lalonde Report.
• The Alma-Ata Declaration on Primary Health Care (1978).
1.2 Nature And Scope Of Health Promotion
WHO influence
• In 1984, the World Health Organization set up a new
programme on health promotion
• It recognized the need for change in the ways and
conditions of living, in order to promote health
• In 1986, the Ottawa charter was developed at the first
international conference on health promotion (WHO, 1986)
and has been a constant source of reference ever since
1.2 Nature And Scope Of Health Promotion
The Ottawa charter – The first international conference
• This was an extended application for the Alma-Ata Declaration on
Primary Health Care (1978).
• The Ottawa Charter, 1986 identified that, Better health needs to be
found on these basic conditions;
Peace
Shelter
Education
Food
Income
1.2 Nature And Scope Of Health Promotion
Stable eco-system
Sustainable resources
Social justice and
Equity
1.2 Nature And Scope Of Health Promotion
Key strategies
1. Advocacy
2. Mediation
3. Enabling
Important action areas for consideration
4. Building a Healthy Public Policy (HPP)
5. Creating supportive environments
6. Strengthening community actions
7. Developing personal skills
8. Reorienting health services
1.2 Nature And Scope Of Health Promotion
Second international conference on Health Promotion - Adelaide
(Australia) (1988): Concept of “Healthy Public Policy.
• It highlighted the importance of Healthy Public Policy as a human
right. The participants resolved that;
HPP is an explicit concern for health and equity in all areas of policy
and an accountability for health impact
HPP aims to create a supportive environment
In pursuit of HPP, government sectors concerned with agriculture,
trade, education, industry, and communication need to take into
account health as an essential factor when forming policy.
1.2 Nature And Scope Of Health Promotion
• These sectors should be accountable for the health consequences of
their policy decisions
• The conference identified four key areas as priorities for Healthy
Public Policy;
1. Supporting the health of women (gender dimension was
given a specific attention)
2. Food and nutrition
3. Tobacco and alcohol
4. Creating supportive environments
1.2 Nature And Scope Of Health Promotion
1991: Third International Conference (Sundsvall, Sweden): Concept of
“Supportive environment for health”
• It focused on supportive environments for health – called for active
engagement in making environments more supportive for health (conducive
to health) and links to sustainable development.
• The conference talked about extreme poverty and degraded environments
that threatens millions of people
• The conference emphasized in making the environments –physical, socio-
economic and the political environment-supportive to health than damaging
it.
1.2 Nature And Scope Of Health Promotion
1997: Fourth International Conference (in Jakarta, Indonesia):
Concept of New partners for a new era-leading to health promotion
into the 21st Century (globalization)
It focused on new responses that were needed in the 21st century,
which included;
• Promoting social responsibilities for health
• Increase investments for health development
• Consolidate and expand partnership for health
• Increase community capacity and empower the individual
1.2 Nature And Scope Of Health Promotion
•Secure an infrastructure for health promotion
•It focused bridging the equity gap
•Ministerial statement for promoting health.
Actions
•Position the promotion of health as fundamental priority
•Take a leading role to ensure the active participation of all sectors
•Support the preparation of country wide plans of action for
promoting health (Globalization)
1.2 Nature And Scope Of Health Promotion
2005: Sixth International Conference (Bangkok, Thailand):
Globalization, health challenges and the Bangkok Charter.
The Bangkok charter looked at;
Increasing inequalities within and between countries
New patterns of consumption and communication
Commercialization
Global environmental change, and
Urbanization.
1.2 Nature And Scope Of Health Promotion
• The Bangkok charter affirms that policies and partnerships to
empower communities, and to improve health and health quality,
should be at the centre of global and national development.
1.2 Nature And Scope Of Health Promotion

The Bangkok Charter for HP in a Globalized World (2005)

The four key commitments to make the promotion of
health:
1. Central to the global development agenda
2. A core responsibility for all of government
3. A key focus of communities and civil society
4. A requirement for good corporate practice.
1.2 Nature And Scope Of Health Promotion
• 2009: Seventh International Conference (Nairobi, Kenya); A
Call to Action.
• STUDENTS ASSIGNED TO READ ON THIS CHARTER AND PRESENT IN
CLASS WHAT WERE THE MAJOR COMPONENTS.
1.2 Nature And Scope Of Health Promotion
Health promotion practice in Zambia
Main Actors
• Ministry of Health
• Ministry of local Government and Housing
• Ministry of Education
• Ministry of Agriculture
• Ministry of Information and broadcasting
• Ministry of Community development
• WHO Zambia
• International Development Agencies
1.2 Nature And Scope Of Health Promotion
• The MoH of takes the lead in health promotion through its health
promotion unit (HPU) under the directorate of the Public Health and
Research
• HPU is responsible for strategic planning, coordination, health education,
material development, national and regional networking
Health promotion policy
Focus is on;
• Promotion of healthy environments
• Educations and Information for prevention of diseases and illness
• Behaviour Change Communications
1.3 Methods of Health Promotion
• Health education provides conditions necessary to generate varieties
of health or illness –related learning, understanding and motivation
• The communication process is a prerequisite to all kinds of learning
• Understanding behaviours and environments that influence people’s
health is important to implement successful health education
programs
1.3 Methods of Health Promotion
Levels of Health Education
1. Individual – One to one/ person-to-person
2. Group or family – A directed discussion of new ideas provides
reinforcements of certain actions
3. Mass – Radio/TV/Newspapers/Films
• The person-to-person method appears to be the most effective.
• Unless people in a group all have the same problem, difficulties, way
of life, it is not possible as a group to take the same steps to solve
their problems
1.3 Methods of Health Promotion

1. Health Education
- This is a communication process enhancing well being of an
individual
• It is to make people think about health and related problems
with a view that they see the need to modify their behaviour
and life styles to contain (and reduce) existing health
problems and prevent new ones (behaviour change is one of
the important outcomes of health education)
1.3 Methods of Health Promotion
Types of health education
1. Health education as persuasion – Associated with ‘coercing’ people
into adopting health, illness and sick role behaviours in order to prevent
disease at primary, secondary and tertiary levels (associated with
disease prevention model)
2. Health education as empowerment – concerned to strengthen
individual capacity and achieve social and political change – associated
with empowerment model ( a preferred model for promoting health)
1.3 Methods of Health Promotion
Health education is one of the most important components of health promotion and
involves activities directed at individuals, families and communities for:
1. Motivation to adopt health-promoting behaviours;
2. Helping people to make decisions about their health and acquire the necessary
confidence and skills to put their decisions into practice.
3. One of the main ways of influencing the health of a community is health
education, which is a planned process aimed at helping individuals and
communities achieve and maintain a level of health which is appropriate for them.
4. The term heath education may be considered as an umbrella which encompasses a
number of communication activities concerned with promoting the health of both
the well and the sick.
1.3 Methods of Health Promotion
Types of health education activities
 Community health education programmes directed by health
education officers
 Health promotion through the public media
 Education of patients or clients, conducted by health professionals
 School health education programmes, carried out by teachers and
health workers
 Self-help activities enabled by voluntary groups, community workers
or health care professionals.
1.3 Methods of Health Promotion
Goals for health education
 To contribute to self-fulfillment of individuals and promote
their well-being as individuals;
 To enhance the ability of people to cope effectively with
health promotion, health maintenance and illness control;
 To reduce undesired risks of disease and illness;
1.3 Methods of Health Promotion
 To help people maintain personal and civil integrity while
receiving health care
 To create more active individual and community
participation in the health system by increasing, (a) personal
competence in self-care, and (b) social skills in working
within the formal health systems.
1.3 Methods of Health Promotion
 To reduce or limit the drain on the public purse created by ill health
which could be prevented by changes in the behaviour of individuals.
 To raise health awareness
 To change attitudes and behaviours
 To improve knowledge
 To empower individuals
 To bring about societal and environmental change.
1.3 Methods of Health Promotion
Channels or settings can you work through to reach your
audience:
1. Child health services
2. Schools
3. Work place
4. Markets
5. Farms/gardens
1.3 Methods of Health Promotion
6. Public places
7. Bars
8. Night clubs
9. Home
10. Community
1.3 Methods of Health Promotion
Suggestions to succeed in health education;
 Know the people you need to advise
 Know their thinking
 Know their beliefs
 Know their customs and daily habits
 Know the way they live
1.3 Methods of Health Promotion
 Know what they can and what they cannot do
 Start with something people know –work towards new ideas
 Work from things we can see and hear to less obvious things
 Start with the particular and move to the general
 Start with simple ideas and move to those more complex
 Start with easy skills and move to those more difficult
1.3 Methods of Health Promotion
2. Social mobilization
Definition
•Social Mobilization is a broad scale movement to engage people's
participation in achieving a specific development goal through
self-reliant efforts.
•It involves all relevant segments of society: decision and policy
makers, opinion leaders, bureaucrats and technocrats,
professional groups, religious associations, commerce and
industry, communities and individuals (UNICEF).
1.3 Methods of Health Promotion
•This is when members of institutions, community
networks, civic and religious groups begin to work in
a coordinated way to reach specific groups of people
for dialogue with planned messages
•Social mobilization seeks to facilitate change
through a range of players engaged in interrelated
and complementary efforts
1.3 Methods of Health Promotion
Approaches to social mobilization
1. The process of social mobilization usually takes the form of large
public gatherings:
• Mass meetings e.g. elections and other voting events, marches,
parades, processions and demonstrations.
• Protest actions
2. Social Media and the internet - These have made mass mobilization
easier to organize and disseminate ideas.
• Internet very critical in political sphere
• Internet plays significant role in many mass mobilization efforts
1.3 Methods of Health Promotion
Social mobilization for health
• Social mobilization is critical to successful and effective
health promotion.
 Through deliberate and calculated process of engaging
various stakeholders, health promotion becomes everyone's
business
1.3 Methods of Health Promotion
Steps in Social Mobilization
Basically, there are 7 Steps
1. Prepare to mobilize
2. Organize community for action
3. Explore health issues & set priorities
4. Plan together
5. Act together
6. Evaluate together
7. Prepare to scale up
1.3 Methods of Health Promotion

Step 1: Preparing to mobilize

• Organizing and training community mobilization teams
• Understanding selected communities
• Making contact with your communities
• Gathering more information on communities
• Assets and Barriers
• District Community mobilization plans
1.3 Methods of Health Promotion

Step 2: Organize the community for action

Orienting the community
• Building relationships and trust
• Encouraging Community Participation
• Building a Leadership Team
• Building a Health Committee (Facility-based)
1.3 Methods of Health Promotion
Step 3: Exploring & setting priorities
• Exploring critical issues with Health Committees
• Analyzing the information
• Setting priorities for action
1.3 Methods of Health Promotion

Step 4: Planning together

• Have clearly set out objectives in your planning process
• Involvement of all participants, with roles and
responsibilities
• Designing the planning session(s)
• Conducting/facilitating the planning session(s) to
create a community action plan
1.3 Methods of Health Promotion

Step 5: Act together

•Encourage community participation
•Involve local leadership
•Take technical assistance & advocacy
roles
1.3 Methods of Health Promotion

Step 6: Evaluate together

• Whole essence of monitoring and evaluation
• Evaluate what works
• Evaluate what does not seem to work
• Evaluate pitfalls to success
• Take corrective measures
Repeat cycle in event of failure
1.3 Methods of Health Promotion

Step 7: Scale up
•Build on success stories
•Reach out to larger population
•Attract resources based on your
success
1.3 Methods of Health Promotion
3.Social marketing
This is a process that attempts to create voluntary exchange between the
marketing organization and the members of a target market based on
mutual fulfilment of mutual interest. A marketing organization uses its
resources to;
 Understand the perceived interests of target market members
 Enhance and deliver the package of benefits associated with a product
service or idea
 Reduce barriers that interfere with the adoption or maintenance of that
product, service or idea
1.3 Methods of Health Promotion

4. Mass media
Type of mass media includes;
• Television
• Radio
• Newspapers
• Leaflets
• Billboards
1.3 Methods of Health Promotion

TV and Radio
• Reaches large numbers of people
• TV has visual dimension and sound
• Radio has only sound
• Mass media can be trusted-for many it is
their main source of information
1.3 Methods of Health Promotion

News papers and magazines

• Reach smaller audience than radio/TV but includes
decision-makers and influential leaders
• Daily readership can be large.
Bill boards
• Widely used in commercial advertising
• Impact heavily depends on location.
1.3 Methods of Health Promotion

How does mass media influence health?

• Advertising of health damaging products
• News coverage on media and the way
prevention and cure are addressed
• Modeling on fictional characters or real-life
• Health promotion media campaigns
1.3 Methods of Health Promotion

What mass media can accomplish

• Tell people about new ideas
• Agenda-setting
• Advocacy
• Create a favorite climate of opinion
• Behaviour change - when the behaviour change is a
simple one.
1.3 Methods of Health Promotion
5. Communication
Definition
A dynamic, continuous and reciprocal sending, receiving and
comprehending messages, feelings and ideas’
Relation between communication and health
1. For history taking
2. For counselling
3. For health education
4. Patient satisfaction
5. Adherence to treatment
1.3 Methods of Health Promotion
6. Lobbying (persuasion or interest representation)
• This is the process of influencing public and government
actions, decisions or policies at all levels.
• It involves the advocacy of an interest that is affected by the
decisions of government leaders.
1.3 Methods of Health Promotion
7. Advocacy
•This is continuous and adaptive process of gathering, organizing and
formulating information and data into a logical argument
•This is then communicated to policy-makers through various
interpersonal and mass media communication channels
•Advocacy is one of many possible strategies, or ways to approach a
problem.
•Advocacy can be used as part of a community initiative, nested in with
other components.
1.3 Methods of Health Promotion
• To encourage or support an activity that helps a consumer,
company, or organization to secure health care coverage
designed to best meet their unique needs. 
• Advocacy is the deliberate process of influencing those who
make policy decisions
• Taking an active role in the education and care of an
individual or the act or process of supporting a cause or
person
1.3 Methods of Health Promotion

• In summary, Advocacy is speaking up for, or

acting on behalf of, yourself or another
person.
• Advocates plead in favor of a cause.
• They work often in the face of opposition for
the things that matter to local communities.
1.3 Methods of Health Promotion
Purpose of Advocacy
• Seeks to influence policy-makers, political and social
leaders to:
- Create an enabling policy and legislative environment
- Allocate resources equitably in order to create and
sustain social transformation.
• Advocacy efforts occur at global, national and sub-
national levels
1.3 Methods of Health Promotion
Core principles of successful advocacy
Successful advocacy entails that: 
 Clearly define the issue  
 Determining specific goals and objectives
 Understanding which kinds of evidence are available to
develop clear evidence-based messages
(quantitative/qualitative/mixed methods)
 Evaluate messaging through participatory approaches
1.3 Methods of Health Promotion
Qualities of effective advocates
Be Organized:
•Keep track of whom you have talked to, (agency the person works for, when
and where the conversation occurred, what was said and any decisions
made)
•Helpful to have a notebook/electronic gadget to keep notes centrally located
Be Articulate:
•Seek to be able to share what is going on, what is wrong and what you would
like done
1.3 Methods of Health Promotion
Know the system’s pressure points/systems
Identify & maintain contact with key relevant players instrumental in
policy changes
Know the appropriate process (institutional lines of command)
• Ask all of your contacts (caseworkers, counsellors, advocates, fellow
family members, others) on how the system is supposed to work
• Follow the process and document what you are doing;
• If procedures not being followed correctly, “make noise” about these
failings in a polite but firm and strong-willed manner.
1.3 Methods of Health Promotion
Document and form paper trail:
Save all written correspondences (letters, emails, etc.) and all notes on
conversations
Be sure to include dates on all documents
Foster a spirit of collaboration and accountability:
• Work to form a team with family members, or person you are
advocating for and system staff.
• Appreciate and validate people when they are helpful or make strides
to improve the situation.
1.3 Methods of Health Promotion
8. Mediation for health promotion
• This takes place between differing interests in society with
the aim of getting coordinated action to improve health by
the government, public sector, industry and the media.
• This is achieved by Public health nurses identifying local
health issues, influencing local and national policy by
lobbying, presenting evidence, participating in policy
formulation on working parties and using influence of trade
unions and professional organizations.
1.4 Health promotion strategies – Ottawa
Charter
Broad strategies
1.Advocacy – for creation of conditions favourable to health
2.Enabling – creating supportive environments, providing information and skills
needed to make healthy choices
3.Mediation - between different groups to ensure pursuit of health
Main action areas
• Build healthy public policy
• Create supportive environments
• Strengthen community actions
• Develop personal skills
• Reorient health services
1.4 Health promotion strategies – Ottawa
Charter
Five key principles guiding health promotion strategies
1. Health promotion is context driven: Focuses on health and its
underlying social and economic determinants for analyzing socio-
economic, gender and ethic gaps in health and disease patterns in
population.
2. Health promotion integrates the three dimensions of the WHO
health definition: Promoting health means addressing the multi-
dimensional nature of health: its physical, social, and mental
dimensions (and often, spiritual health).
1.4 Health promotion strategies – Ottawa
Charter
3. Health promotion underpins the overall responsibility of the state
in promoting health: All levels of government have a responsibility and
accountability for protecting, maintaining and improving the health of
its citizens, and need to include health as a major component.
4. Health promotion champions good health as a public good: Good
health is beneficial to the society as a whole, its social and its economic
development.
5. Participation is a core principle in promoting health: The
participation of people and their communities in improving and
controlling the conditions for health is a core principle in promoting
health.
1.4 Health promotion strategies – Ottawa
Charter
Approaches/Models to Health promotion
1. The disease prevention approach
2. The educational approach
3. The ecological approach
4. The empowerment model
1.4 Health promotion strategies – Ottawa
Charter
1. The disease prevention approach (the medical model)
Its key features include
• A mechanistic view of the body
• The mind-body dualism
• Disease as the product of disordered functioning of the body or part of it
• Focuses on pathogenesis-that is the cause of disease
• Pursues the cause consequences of disease and an emphasis on micro-
causality
• Specific diseases have specific causes
1.4 Health promotion strategies – Ottawa
Charter
1. It has a reductionist view of the causes of ill-health.
2. The medical model is linked to medical practice or more generally, biomedicine
3. Application of the medical model to health promotion leads to an emphasis on
prevention, particularly primary prevention
4. The dominant concept is risk, often conceptualized narrowly, ignoring the
wider social and environmental determinants of health.
5. Emphases individual responsibility to reduce their exposure to risk by avoiding
risk behaviour and contact with risks in the environments
6. Attempts to influence behaviour takes the form of health education
interventions
1.4 Health promotion strategies – Ottawa
Charter
The role of health education in relation to different levels of
prevention
Primordial
• Persuade people not to abandon healthy lifestyles and ways of living
Primary
• Persuade to adopt healthy life styles and reduce exposure to risk,
persuade individuals to use prevention services, such as immunisation
1.4 Health promotion strategies – Ottawa
Charter
Secondary
• Persuade people to seek screening, raise awareness of early signs and
symptoms of disease, persuade people to seek early treatment,
persuade people to comply with treatment
Tertiary
• Persuade people to comply with treatment, persuade people to
comply with rehabilitation advise, encourage resumption of an
appropriate life styles
1.4 Health promotion strategies – Ottawa
Charter
• The preventive model results in ‘victim-blaming’ approach in its
disregard for the social, environmental and political factors that shape,
and indeed constrain behavioural choices.
• It is also inconsistent with equity and empowerment-two central
tenets of health promotion because of its emphasis on individualism
and luck of attention to the social and environmental factors that
impinge on health.
• However, health promotion practice needs the biomedical knowledge
because of the evidence it provides about the micro-causes of disease
1.4 Health promotion strategies – Ottawa
Charter
2. The education approach
• The commitment to an educational approach is partly for practical
necessity, partly political expediency, and partly philosophical to
provide for informed consent and voluntary change before attempting
to change social structures and ecologies
• Health promotion not only encompasses health education and
emerged from it
• When Dr. Ilona Kickbusch was director of the Division of Health
Promotion, Education, and Communication of WHO, she gave the
following reasons;
1.4 Health promotion strategies – Ottawa
Charter
Why health promotion emerged out health education
• First: health educators became more aware of the need of positive
approaches to health education- enhancing health and creating
health potential rather than focusing on disease prevention.
• Second: it became self evident that health education could only
develop its full potential if it was supported by structural measures
(legal, fiscal policy, environmental, regulatory, etc.)
1.4 Health promotion strategies – Ottawa
Charter
Milio (1983) put it this way;
• “the task of health promotion beyond health education was to make
healthier choices the easier choices”
• “That the policy, organizational, economic, regulatory, and other
environmental interventions are necessary to accomplish the original
intent of health education does not justify abandoning health
education as the primary modality for democratic social and
behavioural change”
1.4 Health promotion strategies – Ottawa
Charter
• Health education provides the consciousness-raising, concern
arousing, action-stimulating impetus for public involvement and
commitment to social reform essential in a democracy.
• Without health education, health promotion would be a
manipulative social engineering enterprise
• Health education of the public keeps the social change component of
health promotion accountable to the public it serves.
1.4 Health promotion strategies – Ottawa
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• Without the policy supports for social change, on the other hand,
health education is often powerless to help people reach their health
goals even with individual efforts
• Health promotion encompasses health education and is aimed at the
complementary social and political actions that will facilitate the
necessary organizational, economic, and other environmental
supports for the conversion of individual actions into health
enhancements and quality of life gains
1.4 Health promotion strategies – Ottawa
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3.Ecological approach
The ecological approach view health as a product of the
interdependence of the individual (behaviour) and subsystems
of the ecosystem (such as family, community, culture, and
physical and social environment)
• To promote health, the eco-system must offer economic and
social conditions conducive to health and healthy lifestyles.
1.4 Health promotion strategies – Ottawa
Charter
• These environments must also provide information and life skills for
individuals can make decisions to engage in behaviour that maintains
the health.
• Finally, healthful options among goods and services offered must be
available
• Reciprocal Determinism- The ecological view of behaviour holds that
the organism’s functioning is mediated by behaviour-environmental
interaction. This implies;
1.4 Health promotion strategies – Ottawa
Charter
Environment largely controls or sets limits on the behaviour that
occurs in it.
Changing environmental variables results in the modification of
behaviour.
• Therefore, health promotion can achieve the best results by exercising
whatever control or influence it can over the environment.
• On the other hand, behaviour of individuals, groups, and
organizations also influences the environment.
1.4 Health promotion strategies – Ottawa
Charter
• This leads to the credo of health promotion that seeks to
‘empower’ people by giving them control over the
determinants of health (behavioural or environmental)
• By taking greater control themselves, rather than depending
on health professions to exercise control for them, they
should be in a better position to adjust their behaviour to
changing environmental conditions, or to adjust their
environments to the changing behavioural conditions.
1.4 Health promotion strategies – Ottawa
Charter
4. The empowerment model of health promotion
•Key WHO publications since the inception of health for all by the
year 2000 have placed emphasis on individuals gaining control over
their lives and their health and the importance of active participating
community
•Empowerment has to do with people acquiring a degree of power
and control
•This means building environments that facilitate healthy choices and
remove barriers that militate against these
1.4 Health promotion strategies – Ottawa
Charter
•Self-empowerment describes the extent to which individuals have the
power and control over their interactions with their physical and social
environment.
•Empowered communities should also possess power and control.
•Empowerment is impossible unless the physical, socio-economic and
cultural circumstances are favourable.
•Health promotion aims at engaging into the thorny question of
environmental change to make physical, socio-economic and cultural
circumstances favourable for healthy behaviours
1.4 Health promotion strategies – Ottawa
Charter
Keep in mind
 Most people are not interested in health except when sick
 People have knowledge but do not act on it. Why?
 Change of behaviour means change of something, which one
has lived with for a very long time.
 Provide information and motivation at crucial times
1.4 Health promotion strategies – Ottawa
Charter
Approaches for health promotion
1. Healthy population
2. Healthy life style
3. Healthy environment
1. Healthy population
Looks at targeting all life stages and groups.
Since the health needs of people vary according to their stage in the life
cycle or their gender, the health population approach encourages
initiatives that focus on the health needs and contributions of people
at every life stage.
1.4 Health promotion strategies – Ottawa
Charter
2. Healthy life style
• This approach focuses more on the behaviour of individuals
and their decisions and actions can lead to healthier
outcomes.
• This can be done through health education, social
mobilization and advocacy programs.
• No smoking, better nutrition and exercise are examples of
healthier life styles approach.
1.4 Health promotion strategies – Ottawa
Charter
1.5 Framework For Planning And Implementation
For Health Promotion Activities
• MOH –Spearheading
• Zambia information Services – Support activities at community levels
by producing relevant health education materials
• Other ministries – Collaborates on activities such as school health,
road safety etc.
• Private sectors and civil society - partners in implementing of
activities such as work based or community based health promotion
e.g. A recent campaign on Cholera free Lusaka/Zambia
1.5 Framework For Planning And
Implementation For Health Promotion Activities
• Media house – delivery and communication of health
messages e.g. ZNBC every after 19:00hrs news have a
program called Health Matters
Legal Framework
• The Public Health Act – regulations concerning Food safety,
Tobacco control, environmental protection
• Statutes under Ministry of Local Government banning
smoking in Public places
1.5 Framework For Planning And
Implementation For Health Promotion Activities
The Future
• Development of Guidelines for Districts
• Building a monitoring and evaluation system
• School health promotion
• Intersectoral and multidisciplinary approach
1.5 Framework For Planning And
Implementation For Health Promotion Activities
• Training- Integration of health promotion training in all health
related and relevant non health sectors in curriculums.
• Started PHN program/training with a course Health Promotion
in 2017
• More international collaborations to train Zambians in Heath
promotion
• Integrated health promotion in other setting such as prisons,
work etc.
Health Promotion Planning And Evaluation
Cycle
Planning phase Major task
Problem identification and prioritizing Clarify major health issues for a population,
and prioritize in terms of potential for
effective intervention
Planning a solution Develop a program, which specifies program
objectives, strategies and the sequence of
activity
Mobilization of resources and implementation Generate public and political support, build
the capacity of partner organizations and
secure resources
Implementation Execute the program as planned utilizing
multiple strategies (as appropriate to the
program objective)
Evaluation Asses the impact and outcome of the
program according to the pre-defined
objectives
1.6 Ethics In Health Promotion

Ethics refers to moral principles and values that guide human

behaviors.
Ethics is about doing the right thing.
1.6 Ethics In Health Promotion
1.Doing No Harm” (Nonmaleficence)
•One important obligation is that when one aims to better people’s health
one needs to avoid doing them harm (Nonmaleficence).
•The obligation to “do no harm” causes ethical concerns when an
intervention of any kind, might directly or indirectly harm individuals or
communities, whether on a physiological, psychological, social, or cultural
level.
•One example of potential harm elicited in health promotion
communication interventions concerns initiatives that focus on body
weight and obesity prevention.
1.6 Ethics In Health Promotion
• Health promotion interventions aimed at body weight are associated
with ethical concerns because people’s identities are influenced by
their body image, and thus messages about their bodies essentially
concern their self-image and personal worth.
• People might also be affected by such interventions by viewing
themselves more negatively, by having others see them in a more
negative way, such as by being blamed for their presumed lack of
willpower or character, regardless of economic, social, genetic, or
psychological factors that affect their body weight and food
consumption.
1.6 Ethics In Health Promotion

•This can serve as an example of situations in which

people find it difficult to change their health
conditions because of not having appropriate
opportunities, support systems, or supportive
environments, and might not succeed in their
attempts to change, which could create or reinforce
a cycle of self-blame and helplessness.
1.6 Ethics In Health Promotion
2. “Doing Good” (Beneficence)
•The obligation to “do good” (beneficence), which is
considered a basic tenet of the helping professions.
•This obligation is supposed to be carried out by actively
pursuing means to help individuals and communities to
reach a positive state of health or by preventing them
from being endangered by risks and potential harm.
1.6 Ethics In Health Promotion
•The obligation could involve the protection and promotion of
people’s health on the individual level, as well as the family,
community, and societal levels.
•Numerous dilemmas emerge when interventions aim to “do
good,” but other factors might be involved that raise concerns
regarding the means applied in the intervention.
•For example, to reach male youth who are typically uninterested
in health information, health promoters might seek to employ
computer video games.
1.6 Ethics In Health Promotion
3.Respecting people’s privacy and their autonomy to make free
choices and not to be manipulated
• Respecting people’s right to autonomy and the obligation to protect
their privacy.
• These are based on the premise that individuals have an intrinsic right
to make their own decisions on matters that affect them, so long as
such decisions do not bring harm to others.
• This places high importance on individual choice regarding both
political life and personal development.
1.6 Ethics In Health Promotion
•It underlies democratic forms of government and self-determination of
individuals, communities, and nations, and it has been the foundation
for the development of important medical care codes such as patients’
rights, informed consent, and confidentiality.
•Ethical issues associated with respect for autonomy and privacy
typically concern the use of persuasive arguments that might be
considered manipulative, or the use of graphic material such as
mutilated bodies or human suffering that might offend people or
expose them to issues or sights to which they do not want to be
exposed.
1.6 Ethics In Health Promotion
4. Ethical Issues in Choosing Issues and Obtaining Consent
• In the medical care context, it has become an ethical and often a legal
requirement to obtain people’s consent to perform a medical
intervention on them or on their dependents and to inform them
about the procedures and possible risks or adverse consequences
• Because health promotion activities are often viewed as relatively
unobtrusive or educational, and because they are mainly implemented
in the context of populations or through the media, the question of
whether informed consent is required is often not even considered.
1.6 Ethics In Health Promotion
• Further, because health promotion interventions are a result of the
initiatives of government agencies or not-for-profit organizations that aim
to promote the health of the public, it is taken for granted that the public
approves of them.
• Yet, health promotion interventions, by definition, intervene in people’s
lives, and their topics are often chosen by the government or influential
public and commercial organizations.
• This raises the question of what should and could be the standards or
procedures to ensure that informed consent is obtained on behalf of
diverse populations.
1.6 Ethics In Health Promotion
5. Obligation to promote health effectively and efficiently
• Another ethical obligation concerns designing and implementing
health promotion interventions so that they will benefit most people
and will be conducted in the most efficient and effective way of using
public resources.
• This approach is associated with utilitarianism that assesses the worth
of actions on what was or will be the most beneficial to most people
or society as a whole
1.6 Ethics In Health Promotion
• One of the underlying premises for this type of justification is
also that society has limited resources, which should be
utilized to maximize their effectiveness.
• This obligation can influence decisions about how to choose
the intended population for a health promotion intervention
by drawing on a utilitarian basis rather than needs.
1.6 Ethics In Health Promotion
6. Justice and Equity
• An important guiding principle in democratic ethical frameworks
refers to equity and justice.
• These are broad and contested issues that encompass obligations
associated with distribution of resources, opportunities, benefits, and
risks.
• Health promotion activities are typically committed to the moral
obligation to promote equity in terms of health promotion
opportunities across social groups.
1.6 Ethics In Health Promotion
• Overall, disparities in health have been linked to social and
economic determinants and many health promotion
interventions aim to address these disparities.
• However, health promotion activities that have achieved
significant improvements in the adoption of healthier
practices among large populations may serve to reinforce,
rather than reduce, existing social disparities.
1.6 Ethics In Health Promotion
Digital Gaps
• Digital media offer opportunities to widely disseminate health
promotion information in various formats and have become the main
source of health information for many people.
• However, their use also raises ethical concerns regarding equity and
the so-called digital divide.
• People with limited digital literacy or who lack physical access to
computing facilities, as well as relevant skills and competencies, are
less able to access or use health information distributed online.
1.6 Ethics In Health Promotion
Equity and Strategic Segmentation and “Targeting”
• Designing health promotion programs to focus on particular
segments of the population is accepted as both a practical
and ethical strategic approach in health promotion.
• It is considered a more ethical and effective approach
because it requires the provision of equivalent but culturally
appropriate messages to populations with different
sociocultural backgrounds and levels of literacy.
1.6 Ethics In Health Promotion
• It is also considered efficient because interventions that are
developed according to the social norms and values of the
particular population, and which draw on symbols that they
are familiar with, would likely be more effective in reaching
its health promotion goals.
• Ethical issues that concern justice and equity are also related
to these strategic decisions regarding which populations
should be the “target” of the intervention and which will not.
1.6 Ethics In Health Promotion
• However, the decision to “segment” a population according to certain
parameters and to allocate limited resources to adapt particular
health promotion activities to certain populations raises ethical issues
regarding equity as well as utility.
Equity and Trust
• Health promotion scholars raise an interesting ethical point regarding
equity and the issues of trust.
• Some people do not obtain health information that could be
beneficial to them because they do not trust the sources.
1.6 Ethics In Health Promotion
• There is an ethical obligation regarding earning trust from
populations believing they have been discriminated against,
stigmatized, or marginalized in the past.
• Otherwise, their lack of trust in the health promoters will
serve as an unfair barrier, and thus, they will not benefit
from the health promotion initiative.
1.7 Integrating Health Promotion In Priority
Health Programmes
• Integration refers to combining components of Health
Promotion services that are separate, with the goal of
maximizing coverage and health outcomes for the client and
optimizing the wise use of scarce resources.
• Integration of health promotion
1.7 Integrating Health Promotion In Priority
Health Programmes
Forms of integrating services
• Health Promotion services can be integrated into health programs
• Health Promotion services can be added to maternal-child, or
primary health care services.
• Health Promotion services can be made available in the same
location during the same visit and perhaps by the same provider.
• Services can also be linked by referring a client from one service
to another.
1.7 Integrating Health Promotion In Priority
Health Programmes
The rationale for integration
Integration of Health Promotion services is vital because;
• The integration of these services share the key intended health
outcomes of prevention
• Comprehensive services will be provided in one setting.
• Increase access to health promotion options.
• Increase use of health promotion activities on the population which will
decrease non communicable diseases, thereby improve people’s health
• Decrease the number of non communicable diseases though healthy
life styles
1.7 Integrating Health Promotion In Priority
Health Programmes
Opportunities For Integration
• Health Promotion and well child clinic.
• Health Promotion and Maternal Child Health
• Health Promotion and HIV counseling and testing
• Health Promotion and family planning services
• Health Promotion and curative services
1.7 Integrating Health Promotion In Priority
Health Programmes
Steps for integrating health promotion in priority health
programmes
• Generate demand for integrated services.
• Organize services.
• Train providers.
• Challenge provider bias.
• Reinforce referral system.
• Strengthen skills for supportive supervision.
• Monitor and evaluate performance.
1.8 Collective And Individual Responsibility
And Interaction For Health
 Good health gives better quality of life so it necessitates
advocacy (fighting for it)
The following factors can favor health or can harm it;
 Political conditions
 Economic conditions
 Social conditions
1.8 Collective And Individual Responsibility
And Interaction For Health
 Cultural conditions
 Environmental factors or concerns
 Biological factors or conditions (Physical)
 Behavioral factors
Health promotion aims at making these conditions favorable
for health.
1.8 Collective And Individual Responsibility
And Interaction For Health
Who promotes health?
1. Individual role
• Health consciousness
• Life style
• Genetic
• Beliefs
• Occupation
1.8 Collective And Individual Responsibility
And Interaction For Health
2. Government role
• Legislation
• Environment health
• Health services
• Other ministries
• Policy and budget
1.8 Collective And Individual Responsibility
And Interaction For Health
Who promotes health?
• International organization
• Health authorities
• Non-Government Organizations
• Primary health care team
• Private physician
• Other health professions
• Religious organizations
1.8 Collective and individual responsibility
and interaction for health
Guiding principles of Health Promotion
1. Empowering individuals and communities
2. Participatory – involving all
3. Holistic – all four dimensions of health
4. Inter-sectoral – collaboration of all agencies
5. Equitable – equity and social justice
6. Sustainable – changes are maintained
7. Multi-strategy – variety of approaches
1.9 Community Partnerships For Health
• GROUP ASSIGNMENT TO BE GIVEN ON MONDAY 26/10/2020
• DUE DATE 2/11/2020
• GROUPS TO BE MADE!!!!