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Introduction to Health Studies Health Promotion II: Controversies and Issues

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Individual/Lifestyle (Heart Health in Ontario) ... Structural (North York Heart Health Coalition) Recommended means to. Reduce poverty ... – PowerPoint PPT presentation

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Title: Introduction to Health Studies Health Promotion II: Controversies and Issues


1
Introduction to Health Studies Health
Promotion IIControversies and Issues
  • Dennis Raphael
  • School of Health Policy and Management
  • York University, Toronto, Canada

2
Current Controversies
  • Health Promotion and Values
  • Values and Health Promotion The Medical and
    Social Cases
  • Individual, Community or Societal Focus
  • Top-Down (Expert) or Bottom-Up (Community)
    Direction
  • Evidence (Scientific, Lay, Critical)
  • Current Practice Some Examples
  • A Final Word Health Promotion Principles from
    the WHO
  • Exercise Putting Health Promotion Principles
    into Action

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5
Medical Approach (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.

6
Values and Health Promotion The Medical
(Traditional) and Social (Structural) Cases
  • Medical Health Promotion
  • Scientific Objectivity, Evidence Based, Expert
    Driven
  • Prudence, Utilitarianism
  • Preserve the Status Quo, Conservatism
  • Values identified by David Seedhouse in Health
    Promotion Philosophy, Principles, and Practice,
    New York John Wiley Sons, 1997.

7
Socio-Environmental Approach (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.

8
Values and Health Promotion The Medical
(Traditional) and Social (Structural) Cases
  • Social Health Promotion
  • Fairness, Empowerment, Solidarity
  • Egalitarianism, Social Democracy, Socialism,
    Marxism
  • Values identified by David Seedhouse in Health
    Promotion Philosophy, Principles, and Practice,
    New York John Wiley Sons, 1997.

9
Health Promotion Focus Individual, Community or
Societal
  • Individual focus sees the target of intervention
    as the individual. Can be applied within the
    medical, lifestyle, or structural models.
  • Screening, lifestyle change, emancipatory
    education.

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11
Health Promotion Focus Individual, Community or
Societal
  • Community focus sees the target of intervention
    as the community.
  • Can emphasize community organizing in the service
    of medical screening, behaviour change, or
    effecting structural change.

12
Community Quality of Life Study
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14
Health Promotion Focus Individual, Community or
Societal
  • Structural focus sees societal institutions as
    influencing health.
  • Usually recognizes the presence of resource and
    power inequalities and the need to address these
    inequalities in society. May involve a class,
    gender, or ethnicity approach.

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16
Top-Down (Expert) or Bottom-Up (Community)
Decision-Making
  • Who decides what the health issues are?
  • Who decides how to address these issues?
  • Who benefits from these actions?
  • Much of public health and health policy decisions
    are made by "experts" whose life experience may
    share little with those of the clients whose
    interests they are serving.
  • Public health and health policy decisions may be
    based traditional models of health that may be
    too narrow in their outlook and not what citizens
    want.

17
Evidence in Health Promotion I
  • Decision-making in health promotion should be
    influenced by at least three kinds of knowledge.
  • Instrumental knowledge is also known as
    traditional, scientific, positivist,
    quantitative, or experimental and is the dominant
    paradigm in health research.

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20
Evidence in Health Promotion II
  • Lay or Interactive knowledge is derived from
    lived experience. Also known as constructivist,
    naturalistic, or ethnographic, knowledge, its
    focus is on meanings and interpretations
    individuals provide to events.

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23
Evidence in Health Promotion III
  • Critical knowledge is reflective knowledge and is
    concerned with the role that societal structures
    and power relations play in promoting
    inequalities and disenabling people.

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27
Current Practice in Ontario Some Examples
  • Individual/Lifestyle (Heart Health in Ontario)
  • The Ontario Ministry of Health has allocated
    17,000,000 over five years to programs that
    address the cardiovascular health risk factors of
    tobacco use, poor diet, and physical inactivity.
  • Examples include smoke-cessation workshops
    contests, heart-health recipe contests, nutrition
    workshops, direct mail print materials, walking
    trails, screening for CVD risk factors, mailed
    material about healthy weight, videotapes about
    lifestyle issues, food label information, etc.

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29
Individual/Lifestyle (Heart Health in Ontario)
  • The program is based on medically oriented models
    that view the cause of disease as traditional
    biomedical risk factors of high cholesterol,
    tobacco use and physical inactivity. It is
    believed that through community-based activities,
    these risk factors can be modified.

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31
Community (Healthy Communities in Ontario)
  • Healthy Communities Ontario evolved from the
    Healthy Cities approach of the City of Toronto.
    Emphasizes local social, economic, and
    environmental issues.
  • Community animators work with community members
    to promote discussion and action on the linkages
    between problems and their root causes.

32
Community (Healthy Communities in Ontario)
  • Emphasizes participation, multi-sectoral
    involvement, local government commitment, and
    healthy public policy.
  • Examples include Food security in Peterborough.

33
The OHCC works with the diverse communities of
Ontario to strengthen their social,
environmental, and economic well-being
34
Structural (North York Heart Health Coalition)
  • Produced a report questions the value of reliance
    on medical and lifestyle approaches to CVD
    prevention.
  • Stresses differences among Canadians in CVD
    status.
  • Identified income and social exclusion as causes
    of CVD.

35
Structural (North York Heart Health Coalition)
  • Recommended means to
  • Reduce poverty
  • Reduce social exclusion
  • Restore social infrastructure to support health

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37
Health Promotion Principles from the WHO
  • Health promotion initiatives should be planned
    and implemented in accordance with the following
    principles
  • Empowering Health promotion initiatives should
    enable individuals and communities to assume more
    power over the personal,
    socioeconomic and environmental factors that
    affect their health.

38
Health Promotion Principles from the WHO
  • Participatory Health promotion initiatives
    should involve those concerned in all stages of
    planning, implementation and evaluation.
  • Holistic Health promotion initiatives should
    foster physical, mental, social and spiritual
    health.
  • Intersectoral Health promotion initiatives
    should involve the collaboration of agencies from
    relevant sectors.

39
Health Promotion Principles from the WHO
  • Equitable Health promotion initiatives should be
    guided by a concern for equity and social
    justice.
  • Sustainable Health promotion initiatives should
    bring about changes that individuals and
    communities can maintain once initial funding has
    ended.

40
Health Promotion Principles from the WHO
  • Multi-strategy Health promotion initiatives
    should use a variety of approaches, including
    policy development, organizational change,
    community development, legislation,
    advocacy, education and communication, in
    combination with one another.

41
A Final Exercise
  • Imagine that you were charged with reducing the
    use of tobacco among teenagers within a
    community.
  • What might be some activities be that you would
    carry out?
  • How would you decide which activities to carry
    out?

42
A Final Exercise
  • What might be some barriers to carrying out your
    program to promote tobacco use reduction?
  • What principles and values are influencing your
    program's approach?
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