Health Promotion

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Health Promotion!

Health Promotion & History

Health promotion is about raising the health status of individuals and communities. Health promotion is an umbrella term for the range of activities carried out in various settings, with various groups which tackle causing ill-health. The origins of health promotion lie in the 19 century when epidemic disease eventually led to pressure for saintary reform for the overcrowded towns.

This historical outline illustrates that there was a shift from public health measure in the 19th century, through health education aimed at giving advice and information, to social and envrionmental issues in the later 20th century One of the most important shifts has been from a focus on disease and treatment to health.

Disease Preventation & Health Education

Health promotion is frequentle the preventation of disease often through targeting high risks groups who have an increase likelihood of developing a specific disease. This can often be categorised primary, secondary or tertiary. Until the mid 1980's the term health education was most widely used to decribe the work of practitioners such as nurses and doctors in promoting health. An awareness that individuals make health choices which can contribute to the development of disease led to the vie that it was possible to inform people about the preventation of disease, to motivate them to change their behaviour through persuasion, and mass communication techniques, and to equiptment through education with the skills for a healthy lifestyle.

Health Promotion

The WHO has moved the definition of health promotion away from preventation of specific disease or the detection of risk groups towards the health and wellbeing of whole populations. Instead of experts diagnosing problems the people themselves define health issues of relevance to them in their local community. Teachers, primary health care workers, workplace managers andd welfare workers can be involved in promoting health. Instead of health being seen as the responsiblilty of individual alone, the social factors determining health are taken into account and health is viewed as a collective responsibility of society which needs to be prioritised by organisation and government in their decision making.

Approaches of Health Promotion

The term health promotion covers a wide variety of different activities, all of which has a part to play in promoting health. None of these approaches is easily the right way; they are simply different aspects which complement each other. The balance between them is very much choice based on person choice based on personal perspective, influence by out own life experience, personal viewpoints and values. Health promotion is commonly characterised as having five different approaches.

Medical Approach

Focuses of activity which aims to reduce morbidity and premature mortality. Activity is targeted towards high risk groups. This kind of health promotion seeks to increase medical interventions which will prevent ill health and premature death. This approach is frequently portrayed as having three levels of interventions Primary Secondary Tertiary

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Primary prevention seeks to avoid the onset of ill health by the detection of high risk groups and the provision of advice and councelling e.g. Immunisation, encouraging non-smoking Secondary prevention seeks to shorten episodes of illness and prevent the progression of ill health through early diagnosis and treatment. E.g. Advice on health eating for a diabetic or screening for breast cancer. Tertiary prevention seeks to limit disability or complications arising from an arreversible condition e.g. Include rehabilitation and education about use of a disability aid.

The Medical Approach is Popular Because:

It has high status because is uses scientific methods. In the short term, preventation and the early detection of disease is much cheaper than treatment of people who have become ill In the long-term, thism ay not be the case as people live longer and experience degenerattive conditions and draw. It is an expert led type of preventation. This kind of activity reinforces the authority of medical and health professionals who are recognised as having the expert knowledge needed to chieve the desired result. There have been spectacular success in public health as a result of using this approach. E.g. Worldwide eradication of small pox.

Medical approach is conceptualised around the absence of diseased. It does not seek to promote positive health and can be criticised for ignoring the social and envrionemental dimensions of health. In addition the medical approach encourages dependency on medical knowledge and removes health decisions from the people concerned. Health care workers are encouraged to persuade patients to cooperate and comply with treatment. The principle of preventive services such as immunisation and screening is hat they are targeted to groups at risk from a particular condition. The medical approach relies very heavily on having an infrastructure capable of delievering screening or an immunisation programme. This includes trainned personal, equipment and laboratory facilities, information systems which determine who is eligible for the procedure and record uptake rates and in the case of immunisation a vaccine is effective and safe.

Strengths of the Medical Approach

Can be very effective e.g. Immunisation programme eradicated small pox Often campaigns are based on medically sound evidence so are convincing Increased life expectancy of people if disease is detected early Can be cost effective – can see reduction in treatment costs Is an expert led approach (features doctors and other medical workers – someone people can trust/high status.

Weaknesses of Medical Approach

It is an expert led approach which relies on health professionals to diagnose and treat illnesses. Encourages dependency on medical profession and treatment This approach ignores the holistic person – social and environmental factors It relies heavily on medical profession – i.e. Identifying high risk groups, contacting those groups and recalling patients if necessary May be long waiting lists, e.g. Screening May be ingnored, e.g. People don't turn up Can be expensive – government funding may be limitied, e.g. Breast screening for 50+ have to pay privately for seperate vaccinations of MMR

Behaviourist Approach

This approach focuses on behaviour that causes illhealth and aims to persuade individuals to change their behaviour without focusing on knowledge and understanding of the issue. It is a TOP DOWN approach. This approach is popular because it views health as a property of individuals. It is then possible to assume that people can make real improvements to their health by choosing to change their lifestyle. It also assumes that if people do not take responsible action to look after themselves, then they are to blame for the consequences.

It is clear that there is a complex relationship between individual behaviour, and social environmental factors Behaviour may be a response to the conditions in which people live and the causes of these conditions (unemployment, poverty) are outside individual control. The behaviour change approach has been the main type of activitiy undertaken by the lead agencies for health promotion Campaigns persuade people to stop smoking, adopt a health diet and exercise regularly. This approach is targeted towards individuals, although mass means of communication may be used to teach them.

It is commonly an expert led appraoch, top down approach, which reinforces the divide between the expert who knows how to improve health and the general public who need education and advice. Many health care workers educae their clients about health through the provision of information and one-to-one counselling. Change may appear over a long period of time and it may be difficult to isolate any changes as attributable to a health promotion activity.

Strengths of the Behaviourist Approach

This approach views health as a property of individuals This approach is targeted towards individuals therefore patients often get one-to-one advice Focuses on changing behaviour without focusing on knowledge and understanding of issue.

Weaknesses of the Behaviourist Approach

Can be difficult to change behaviour if it is a response to social and environmental factors Difficult to evaluate its effectiveness Usually a long-term approach Relies on health professionals to provide guidance

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Educational Approach

The purpose of this approach is to provide knowledge and information, and tot develop the necessary skills so that people can make an informed choice about their health behaviour. The educational approach should be distinguished from a behaviour change approach in that it does not set out to persuade or motivate change in a partciular direction However education is intended to have an outcome. This will be the client's voluntary choice and it may not be one that the health promoter would prefer.

The educational approach is based on a set of assumptions about the relationship between knowledge and behaviour: that by increasing knowledge this will lead to change in attitude which may lead to changes in behaviour An educational approach will use leaflets, booklets, visual displays or one-to-one advice. Increase in knowledge are pretty easy to measure. Health education through mass media campaigns, leaflets etc have all shown success in increasing information about health issues, or the awareness of risk factors for a disease Information alone, is however insufficient to change behaviour.

Strengths of the Educational Approach

It enables people to make a voluntary choice – information is given, not imposed Works well if target audience is still at school or has just left as they can relate to style more easily Can reach a large audience This approach can help to develop a clients decision making skills Information usually expert/well researched – high status.

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Weaknesses to Educational Approach

An increase in knowledge and understanding does not necessarily mean that a person's behaviour will change Does not suit paraticipants who have had negative experiences at school Difficult to measure success People do not like to be told what to do Assumes target audience can read and write This approach ignores the real constraints that social and economic factors place on voluntary behaviour change.

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Social Change Approach

This approach is sometimes referred to as radical health promotion, acknowledges the imortance of the socio-economic environment in determining health. It focus is at policy level, and the aim is to bring about changes in the physical, social and economic envrionment which will have the effect of promotiong health. This may be summed up in the phrase "to make the healthy choice the easier choice". A healthy choice is available, but to make it a realistic option for most people requires changes in its cost, availablity or accessibility.

Studies have shown that a healthier diet may cost a third more than the typical diet of a low income family. The social change is targeted towards groups and populations. This approach involves key organisations taking an active and committed role. They will work in ways such as policy planning, negotiating and implementing plans. Evaluation of the social change approach included outcomes such as legislative or organisational changes which promotion health.

Strengths of Social Approach

It is an expert led approach Can reach a large group Can be successful as people do not want to be seen as being different to everyone else in society/challenges people to make changes It is usually brought about as an interventional stage, rather than a reaction Can bring about changes to health and individuals environment Acknowledges the impact of socio-economic determinants on health behaviour realises individuals don't always make informed choice Helpline/support may be available to implement social changes.

Weaknesses of the Social Approach

Needs a large scale approach – usually expensive and a lot of organisations are involved Relies on policy makers to make legislative decisions Some people may be forced into making changes rather than through personal choice/people may rebel People may feel targeted/intimidated by the state Can be difficult to evaluate its effectiveness.

Empowerment Approach

This approach helps people to identify their own concerns and gain the skills and confidence to act upon them. It is unique from the other approaches as it relies on a BOTTOM UP approach instead of top down When we talk about empowerment we need to distinguish between self-empowerment and community empowerment. For people to be empowered they need to: - Recognise and understand their powerlessness - Feel strongly enough about their sitution and want to change it

- feel capable of changing the situation by having information, support and life skills.

The emphasis on empowerment is probably fimilar to many nurses developing a care plan for patients and to teachers working to raise pupils self-esteem They may all this approach as client centred or use terms such as advocay or self-care The role of the health role is to help clients to identify their health concerns and areas for change. Evaluation of this activity is problematic because the process of empowerment and networking is long-term

This makes it difficult to be certain that any changes detected are due to intervention and not some other factor Positive results of such an approach may be vague and hard to specify, especially when compared to outcomes of other approaches.

Strengths of Empowerment Approach

It is a bottom up stragety (health promoter is a go between – get things going and then withdraw) Encourages individuals to take control of their own health This approach can be applied to invididuals and community groups This approach aims to increase physical, social, emotional health.

Weaknesses of Empowerment Approach

It relies on the motivation of individuals and community groups to make changes Can be hard to evaluate its effectiveness Relies on health agencies and other organisaitons working together Can be difficult to bring about changes in a community setting.

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Fear Arousal Approach

This approach has become an increasingly frequent approach taken by health promoters. This approach relies on 'fear' as a method to encourage better health This approach attempts to shock people in to making better health choices. This approach uses frightening images or statistics in a bid to change their behaviour. This approach carries some controversy as many believe that some of the images used can be disturbing yet still have no affect on a persons ability to change their behaviour.

Strengths of Fear Arousal Approach

Illustrates to people the consequences of poor health choices Grabs attention of target group Promotes debate and discussion about an issue Images may be memorable and have a lasting impact Promotes debate and discussion about an issue Use visual images to highlight dangers – some people can react differently to how imformation is presented.

Weaknesses of Fear Arousal Approach

Can be shocking/or cause anger or hurt to some people People becaome resistant to the message Some medica can be very expensive i.e. TV. Only just frightens people without explaining how they should be behaving – does not always give advice People find it difficult to relate to if they haven;t had first time experience (won't happen to me syndrome) Can have little/effect/can be easily forgotten Relies on mass media to display images.

Strengths of Campaigns May Include:

Help to raise awareness of health issues Generate discussion To motiate people to make changes Highlight a problem Inform people Explain consequence of undesirable behaviour Can reduce incidence of illness and disease – morbidity rate Can reduce mortality rates Meet health targets as set by the government Provide support e.g. Free phone numbers for smokers to quit.

Weaknesses of Campaigns May Include:

Can result in groups becoming immune to health messages and so they may be ineffective People do not like being told what to do People can become confused with the conflicting messages from various campaigns/organisations Can be difficult to get the information across to the target audience People can simply ignore campaigns People refuse to believe that they could be affected

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