HEALTH PROMOTION

Paul Okyere
Lecturer
School of Public Health
KNUST –Kumasi
Email: pokyere.chs@knust.edu.gh
 OUTLINE
• Overview of key concepts
Health
Health promotion and education
Determinants of health
Levels of prevention
• Community diagnosis (Community analysis)
• Communicating health
• Behaviour change models/theories
• School health promotion/education
• Counselling
• Sociology of health and illness
 Learning Outcomes
• After this section you should be able to:
1. Define health, health promotion and health education
2. Identify the limitations of the traditional definition of health
3. Differentiate between health promotion and health education
4. List methods used in health education
5. Identify the five domains of health determinants
6. Explain community diagnosis
7. List the steps one must follow in conducting community
diagnosis
8. State how health/social needs are classified
Defining Health
CONT.
• “A state of complete physical, mental and
social well-being and not merely the absence
of disease or infirmity “(WHO, 1946)
 Limitations of the WHO definition of health
Table 1.1

Health is dynamic, not a state

The dimensions are inadequate
Measurement is difficult
The definition is idealistic rather than realistic
Health is not an end but a means to an end
McKenzie et al. (2008)
• “Health is a dynamic state or condition of the organism
that is multidimensional in nature, a resource for living
and results from a person’s interaction with and
adaptation to his or her environment. Therefore it can
exist in varying degrees and is specific to each
individual and his/her situation”.
Holistic (whole) health

Environment
Societal

Emotional
Mental Spiritual 8
Social Physical Sexual
 Models of Health
• Bio-medical model of health
Disease is generated by specific aetiological agents which leads to
changes in the body’s structure and function
The human body is viewed as a machine (if a part malfunctions it can
be repaired or replaced)
The mind and body function independently (duality of mind & body)
Based on scientific rationality (emphasis on objective, numerical
measurement and an emphasis on physical and chemical data
With this model, health is seen in terms of the absence of disease
The bio-medical model focuses on treating disease and risk-taking
among individuals
The social model of health
• Ill-health is caused by a combination of biological (eg.genetic
predisposition), social (poverty) and psychological factors (eg anxiety,
depression)
• Illness and sickness (subjective feelings and perceptions of dis-ease)
are not necessary detected by biochemical indicators
• The social model locates people in their social context and
understand ill health as a process of interaction between people and
their environments
• The social model focuses on societal factors that are risk imposing or
illness inducing (for example, toxic pollution, stressful work,
discrimination, and peer pressure etc)
Figure 1.1 Factors influencing the development of
coronary heart disease (CHD)

Housing Diet
Socioeconomic
Environment Smoking Blood C
group Physical activity
Gender
Access to health cholesterol H
services Psychosocial Blood pressure D
Age factors (eg
Access to leisure Obesity
Ethnicity
facilities stress)

Key social Environmental Lifestyle Physiological

stratification factors factors factors
factors
 Defining Health Promotion

• Health promotion is the process of enabling

people to increase control over the
determinants of health and thereby improve
their health (WHO, 1998)
Defining Heath Education ………
• Health education may be defined as planned
opportunities for people to learn about health
and make changes in their behaviour (Naidoo
and Wills, 2009)
 What is distinctive about health promotion?

• What is distinctive about health promotion is the attention

that it gives to the facilitation of healthy lives: the idea
that it is no good just telling people that they should
change their lifestyles without also altering their social,
economic and ecological environments (Bunton et al.,
2005)
 Tannahill’s model of health promotion

Health Education –
communication to
enhance well-being by
improving knowledge
and attitudes

Health Prevention –
reducing or avoiding the
risk of diseases and ill- Health Protection –
health safeguarding population
health through
legislative, financial or
social measures

Health promotion comprises of 3 overlapping spheres of activity

 Selection of Methods in Health Education
• The key question that guides the selection of methods
for heath education are:
1. What learning is required?
2. Who is the target (group)?
3. How large is the group?
4. What are the contextual factors?
 Health Learning
• Learning has been defined as a relatively permanent change in
capability or disposition. This might involve change in:
• Knowledge and understanding
• Ways of thinking
• Beliefs
• Values
• Attitudes
• Acquisition or development of skills (psychomotor, social
interaction and problem solving or decision making)
 Classification/Domains of
learning
• Cognitive – concerned with knowledge and
beliefs
• Affective – concerned with values and feelings
• Conative – concerned with purposeful action
and change
 HEALTH EDUCATION METHODS
Size of target group

Large
 Mass media

 Local media
Level of participation

 Displays, posters

High Low
 Class discussion
 Lecture/Talk
 Group discussion

 Structured group work

 Simulation and games

 Professional advice

 Counselling  Tutorial
Small
 Reflections
• Would the definitions of health, health education and
health promotion have any influence on your medical
practice? Please explain your answer.
 Determinants of Health
• The range of personal, social, economic, and
environmental factors that influence health status.
• Health status is determined by the interaction of five domains:
1. Gestational endowment/genetic make-up
2. Social circumstances (eg. Education,employment, income,
poverty, housing, crime, and social cohesion)
3. Environmental conditions where people live and work (i.e. toxic
agents, microbial agents, and structural hazards)
4. Behavioural choices (eg. Diet, physical activity, substance use
and abuse)
5. Availability of quality medical care
Reflection
• Do socio-cultural factors like educational status,
employment status, marital status, access to
healthcare, cultural beliefs/customs impact the
health status of individuals?. Please explain your
answer.
 Levels of Prevention
• Activities aimed eradicating , eliminating, or minimizing the impact of
disease and disability. The concept of prevention is best defined in the
context of levels: primary, secondary and tertiary levels

• Primary prevention is concerned with preventing the development

of disease by reducing exposure to risk factors – environmental and
behavioural eg. Immunizations, environmental modifications as well as
health education in settings (school, hospital, community, prisons etc)

• Secondary prevention: Actions which halts the progress of disease

at its early stage and prevents complications. Specific intervention
include early diagnosis (screening test) and adequate treatment
CONT.
• Tertiary prevention: Includes measures to reduce
the consequences of illness and is often seen as
integral to a rehabilitation programme.
Interventions that are carried out include disability
limitation and rehabilitation
COMMUNITY DIAGNOSIS
 Community………………………..
• A group of people who have common characteristics;
communities can be defined by location, race, ethnicity, age,
occupation, interest in particular problems or outcomes, or
common bonds
• Communities are characterized by the following;
• Membership
• Common symbol systems
• Shared values and norms
• Mutual influence
• Shared needs and interests
 Community Diagnosis (Community analysis)

• Community diagnosis aims to understand many facets of

the community including culture, values and norms,
leadership and power structure, means of
communication, helping patterns, important
community institutions and history.
• It also suggests what it is like to live in a community, what
the important health problems are, what interventions are
likely to be most efficacious, and how the programme
would be best evaluated (Quinn, 1999; cited in Tones and
Green, 2010)
 Benefits of community diagnosis
1. Provide opportunities for communities to participate in
directing the course of health services delivery
2. It provides an overall picture of the local community and
the residents’ concerns
3. Community diagnosis suggests priority areas for
intervention and the feasible solutions to address them.
4. It creates opportunity for inter-sectoral collaboration and
media involvement
Conducting community diagnosis
• The process of community diagnosis involves five(5) stages;

1.Initiation
2. Data Collection and analysis
3. Diagnosis
Health status of the community
Determinants of health in the community
4. Prioritisation of needs
5. Dissemination
 Community diagnosis tools
• Community meeting (town hall/public forum)
• Surveys
• Interview
• Focus group
• Community mapping
• Asset inventory
Components
• Geography
• Demography (age, sex, birth/death rate
• Economic life (sources of income and employment etct)
• Social indicators
 Education
 Housing, communication and transportation
 Sources of health care and health information
 Recreation
 Leadership pattern
 Health status of the community (morbidity and mortality
 Environmental indices (water supply, sanitation etc)
 Food/nutrition
 Types of Health/Social Needs
(Bradshaw, 1972)
• Normative Needs: Defined by experts or professional groups (such
as the need for medical treatment)

• Felt Needs: Individual’s perception of variations from normal health

• Expressed Needs: Vocalization of need or how people use service

• Comparative Needs: Identified when people, groups or areas fall

short of an established standard
 Alternative interpretations of need at the scene of
accident

It took too long to get

We need first
him to the hospital –
aid training we need an
emergency helicopter

We need to
have a speed
limit We need road
safety education

We need
somewhere
to play safely
 Prioritization of health needs
• Regardless of the approach taken to study a community health
status, a number of different health needs will emerge in view of the
wide range of factors which impact on health status. Therefore some
prioritization will be necessary:

• Impact – in terms of the severity or magnitude of the problem

• Changeability – feasibility of change
• Acceptability of change and availability of resources are also
important consideration
THANK YOU