Introduction to Health Studies Health Promotion I

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Introduction to Health Studies Health
Promotion I

• Dennis Raphael
• School of Health Policy and Management
• York University, Toronto, Canada

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Overview of Todays Presentation

• Differing Concepts of Health Promotion
  
• Canadian Contributions
• The Ottawa Charter for Health Promotion
• Current Approaches to Health Promotion
• Reflection The Role of Values
• Class Exercise How Should We Reduce the
  Incidence of Heart Disease?

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Defining Health The Medical Definition

• The normal physical state, i.e., the state of
  being whole and free from physical and mental
  disease or pain, so that the parts of the body
  can carry on their proper function.

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Defining Health The World Health Organization

• Health is a state of complete physical, mental,
  and social well-being and not merely the absence
  of disease and infirmity.
• Health is a positive concept emphasizing personal
  resources, as well as physical capacities.

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Three Broad Concepts of Health

• Medical (Traditional)
• Behavioural (Lifestyle)
• Socio-Environmental (Structural)
• These approaches lead to different definitions of
  problems, different strategies, different target
  groups, and different people responsible for the
  activities of promoting health.

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Concepts of Health Promotion Medical Approach I
(Traditional, Biomedical)

• Health Concept is biomedical, absence of disease
  and/or disability
• Leading Health Problems defined in terms of
  disease categories and physiological risk factors
  such as physiological deviation from the norm
  CVD, AIDS, diabetes, obesity, arthritis, mental
  disease, hypertension, etc.

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Concepts of Health Promotion Medical Approach II

• Principal Strategies surgical interventions,
  drug and other therapies, health care, medically
  managed health behaviour change (diet, exercise,
  patient education, patient compliance), screening
  for physiological and genetic risk factors
  
• Target high risk individuals
• General Approach Individualized
• Actors physicians, nurses, allied health workers

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Concepts of Health Promotion Behavioural
Approach I (Lifestyle, Public Health)

• Health Concept is individualized, health as
  energy, functional ability, disease-preventing
  lifestyles
• Leading Health Problems defined in terms of
  behavioural risk factors smoking, poor eating
  habits, lack of fitness, drug abuse, alcohol
  abuse, poor stress coping, lack of lifeskills,
  etc.

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Concepts of Health Promotion Behavioural
Approach II

• Principal Strategies health education, social
  marketing, advocacy for public policies
  supporting lifestyle choices (e.g. smoking bans,
  low fat meat production,
  bicycle paths, ad bans)
• Target high risk groups, children and youth
• General Approach individualized, elements of
  societal focus as related to public policy
• Actors public health workers, illness-related
  advocacy groups (e.g., Cancer Society),
  governments
•  

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Concepts of Health Promotion Socio-Environmental
Approach I (Structural)

• Health Concept is a positive state defined in
  connectedness to one's family/friends/community,
  being in control, ability to do things that
  are important or have meaning,
  community and societal structures supporting
  human development
• Leading Health Problems defined in terms of
  psychosocial risk factors and socio-environmental
  risk conditions poverty, income gap, isolation,
  powerlessness, pollution, stressful environments,
  hazardous living and working conditions, etc.

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Concepts of Health Promotion Socio-Environmental
Approach II (Structural)

• Principal Strategies small group development,
  community development, coalition building,
  political action and advocacy, societal change
• Target high risk societal conditions
• General Approach structural, focussed on
  organization of communities and society,
  development of just political/economic policies
• Actors citizens, social development and welfare
  organizations, political movements and parties

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Canadian Contributions I

• Lalonde Report - 1974
• A New Perspective on the Health of Canadians
• Health Field Concept
• Human Biology
• Lifestyle
• Environment
• Health Care

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Canadian Contributions II

• Epp Report - 1986
• Achieving Health for All
• Challenges Reducing inequities, increasing
  prevention, enhancing coping
• Mechanisms self care, mutual aid, and healthy
• environments.
• Strategies public participation, strengthening
  services, coordinating healthy public policy

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Canadian Contributions III

• Healthy Cities Movement was developed in Toronto,
  and is now very strong in Europe
• The Healthy Cities approach incorporates a broad
  definition of health, one that emphasizes
  prevention of community problems and the
  development of people.
• Health encompasses all aspects of people's lives
  including housing, education, religion,
  employment , nutrition, leisure and recreation,
  health and medical care, good transportation, a
  clean and green environment, friendly people, and
  safe streets and parks that promote a Healthy
  City.

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The Ottawa Charter for Health Promotion World
Health Organization, 1986

• Health is a positive concept emphasizing social
  and personal resources as well as physical
  capacities
• Health Promotion is the process of enabling
  people to increase control over, and to improve
  their health
• Prerequisites for Health are peace, shelter,
  education, food, income, stable ecosystem,
  sustainable resources, social justice and equity
• Health Promotion Actions are building healthy
  public policy, creating supportive environments,
  strengthening community action, developing
  personal skills, reorienting health services