Evolution of Health Promotion

1. Health Protection Era:

• Period: Antiquity to 1830s •

Dominant Paradigm:
 regulation of human behaviour in order to protect the health of individual
and community.
 Health protection mediated through societies social structure.
 Regulations were enforced by ruling elites through religious, political,
cultural and quarantine practices.
• Action Frameworks: enforcement of spiritual practices, community taboos,
customs and quarantine. • Examples – hand washing, sanctioned lepers,
black death plaque
 Evolution of Health Promotion
2. Miasma Era: Period: 1840s to 1870s
 Result of the impacts of the industrial revolution
 Filthy environmental conditions: rapid growth of cities with poor water
supply, sewage disposal and sanitation.

• Dominant Paradigm:
 Addressing unsanitary environmental condition may prevent disease.

• Action Framework: Centralized action to improve environmental sanitation,

public health legislation relating to minimum standards for drainage, sewage
and refuse disposal. • Eg: clean water and sanitation programs, aspects of
healthy cities program.
 Evolution of Health Promotion

3. Contagion Era: • Period: 1880s to 1930s

• Dominant Paradigm: Germ Theory - positivist approach to demonstration of
infectious origins/ pathogenesis of disease: “The organism must be shown to
be constantly present in characteristic form and arrangement in the diseased
tissue, the organism which, from its behaviour appears to be responsible for
the disease must be responsible for the disease, must be isolated and grown
in pure culture must be shown to induce the disease experimentally.”

• Action Framework: Resulted in better water filtration, vaccination,

bacteriology provided contemporary measures to control outbreak of
infectious disease. • Eg: ethical vaccination practices, evidence based practice
 Evolution of Health Promotion
4. Preventive Medicine Era: • Period: 1940s to 1960s

Extended the contagion control

• Dominant Paradigm: Public health activities became centered on
“high risk” population groups such as school children, pregnant
women, elderly,
• Action Framework:
 Accounted for the concepts of disease vectors - mosquitoes
 Recognized that not all microbes were dangerous.
 Highlighted the role of nutrient deficiencies in impairing optimal
health
 Evolution of Health Promotion
5. Primary Health Care Era: • Period: 1970s to 1980s
Formalized by 1978 Alma Ata Declaration

• Dominant Paradigm: Health for all: health care geared toward community by
the community.
• Action Framework:
 Global cooperation and peace  Recognition that PHC should be adapted to
the particular circumstances of the country and communities within it.
 Intersectoral approaches in promotion of health
 Achievement of equity in health care
 Recognition that health care reflects broader social and economic
development.
 Primary Health Care
- has been a central concept in global health since its inception at Alma-Ata (country bet.
Russia and China) in 1978.
Defn. is essential health care based on
- practical
- scientifically sound
- socially acceptable methods and technology
- made universally accessible to individuals and families in the community thru their full
participation
- at a cost that the community and country can afford to maintain at every stage of their
development in the spirit of self-reliance and self-determination (WHO/UNICEF, 1978)
 Health Promotion (HP)
Process of;

• Enabling people to increase control over and improve their health

• reach a state of complete, physical, mental and social well-being

Strategies and programs to be adaptable to the local needs taking into

account the social/cultural/economic systems
HP Initiatives - The Global Scene

2nd Global Adelaide Conference on HP

Priority action areas were;

-Supporting the health of women

-Food and nutrition

-Tobacco and alcohol

-Creating supportive environments

- Developing New Health Alliances

3rd Global Sundsvall (Sweden) Conference

Supportive Environments for Health

- millions of people are living in extreme poverty and deprivation

- increasingly degraded environment
- threatens their health
-goal of Health For All by the Year 2000 extremely hard to achieve.

Way forward
– physical/social/economic/political environ to be supportive rather than damaging
health.

- recognize everyone has a role.

4th Jakarta Global Conference

Priority areas for health promotion in the 21st Century were identified as;

1. Promoting social responsibility for health

2. Increase investments for health development

3. Consolidate and expand partnerships for health

4. Increase community capacity and empower the individual

5. Secure an infrastructure for HP

All countries should develop the appropriate political, legal, educational, social
and economic environments required to support HP.
5th Mexico Global Conference: Bridging the Equity Gap

reported technical themes on;

• Evidence base for HP

• Investment for Health

• Social responsibility for Health

• Building community capacity and empowerment of the individual

• Securing an infrastructure for HP

• Reorienting health services

6th Bangkok Global Conference: Charter for Health Promotion in a Globalized World

4 key commitments: a core responsibility for all of government

1. Must tackle poor health because health is a major determinant of socioeconomic

and political development

2. Need to have the rights, resources and opportunities. Support for capacity
building in less developed communities.

3. Well organized and empowered communities are highly effective in determining

their own health

4. a good corporate practice - a direct impact on the health of people and on the
determinants of health
Liverpool Declaration: Promoting Oral Health in the 21st Century

Call for Action by the year 2020: Countries should;

1. ensure that the population has access to clean water, proper sanitation facilities, a
healthy diet and good nutrition.

2. ensure appropriate and affordable fluoride programmes for the prevention of tooth
decay.

3. provide evidence-based programmes for the promotion of healthy lifestyles and the
reduction of modifiable risk factors common to oral and general chronic diseases.

4. Use the school as a platform for promotion of health, quality of life and disease
prevention in children and young people, involving families and communities.
5. ensure access to primary oral health care with emphasis on prevention and health promotion.

6. strengthen promotion of oral health for the growing numbers of older people, aiming at improving their
quality of life.

7. formulate policies for oral health as an integral part of national health programmes.

8. support public health research and specifically consider the recommendations of WHO which recommends
10% of a total health promotion programme budget be devoted to programme evaluation.

9. establish health information systems that evaluate oral health and programme implementation, support the
development of the evidence base in health promotion and disease prevention through research and support
the international dissemination of research findings.

support the efforts of the WHO Oral Health Programme in inter-country sharing of experiences in health
promotion and oral disease prevention.
 Pacific Scene

1995 A ministerial conference on health for Pacific Islands convened in Fiji, adopted the
Yanuca Declaration.

3 priority issues identified

• human resources development
• health promotion and health protection
• and the supply and management of pharmaceuticals and other medical supplies

1997 Ministers of the Pacific Island countries - Rarotonga, Cook Islands adopted the
Rarotonga Agreement: Towards Healthy Islands.

1999 Republic of Palau, reviewed progress made in implementation of the Healthy Islands
concept and unanimously adopted the "Palau Action Statement“
2001 in PNG,ways to strengthen collaboration using the Healthy Islands approach in the following
areas:

• communicable diseases with special reference to control of tuberculosis and filariasis,

• and surveillance; noncommunicable diseases, in particular diabetes;
• human resource development in such areas as distance learning and primary health management.

2003 in Tonga, focused on the theme of "Healthy Lifestyles and Supportive Environments".
• diabetes and other noncommunicable diseases
• diet, physical activity and health
• the Tobacco Free Initiative
• mental health
• environmental health
• and HIV/AIDS in the Pacific

The meeting adopted the "Tonga Commitment to Promote Healthy Lifestyles and Supportive
Environments"
Wellness Centre

The Wellness Unit was established in February 2012 by the merging of Non Communicable
Diseases (NCD) control unit and the National Centre for Health Promotion (NCHP).

Wellness unit is now rebranded “Wellness Fiji – harvest the wellness within you“.

All Fijians from conception to senior citizens have the potential to harvest wellness, as they
sail throughout lifespan in settings.

Source MOH website 2018 - 2021 www.health.gov.fj

The strategic objective for Wellness and NCD is to reduce premature deaths (deaths aged less than 60
years) due to non-communicable diseases.

Recent Achievements for Wellness

Completion of the review of Public Health Act.
Establishment of the Wellness Framework and initiation of National Wellness Policy.
Review of National NCD Strategic Plan 2010-2014.
Development of National Strategic Plan 2015-2019 and Community Health Worker Policy.
Declaration of Fiji National University as No Tobacco University.
Launch of first Wellness bus for Fiji Public Health Community Outreach.
Development of the Wellness Competency Manual for Community Health Worker Training and the
Wellness Manual for all Public Health Community workers by FHSSP.
Establishment of WHO PEN model for multidisciplinary approach to blood sugar, blood pressure and
cholesterol to SOPD/HUBs in Fiji.
Diabetes Foot Care project commenced in collaboration with WDF.

Source MOH website 2018 - 2021 www.health.gov.fj