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Health Promotion

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Title: Health Promotion


1
Health Promotion
  • Dr. Aidah Abu Elsoud Alkaissi
  • Najah National University
  • Faculty of Nursing

2
Promoting Health
  • Health promotion strategies are not limited to a
    specific health problem, nor to a specific set of
    behaviours. WHO as a whole applies the principles
    of, and strategies for, health promotion to a
    variety of population groups, risk factors,
    diseases, and in various settings.
  • Health promotion, and the associated efforts put
    into education, community development, policy,
    legislation and regulation, are equally valid for
    prevention of communicable diseases, injury and
    violence, and mental problems, as they are for
    prevention of noncommunicable diseases.

3
Department of Chronic Diseases and Health
Promotion (CHP)
  • The rapid rise of chronic, noncommunicable
    diseases represents one of the major health
    challenges to global development.
  • The principle chronic diseases are stroke,
    cancer, diabetes and chronic respiratory
    diseases. Chronic diseases currently account for
    some 60 of global deaths and almost one third of
    the global burden of disease. The Department of
    Chronic Diseases and Health Promotion (CHP) leads
    the global efforts to prevent and control chronic
    diseases and promote health.

4
Diet and physical activity a public health
priority
  • few largely preventable risk factors account for
    most of the world's disease burden. This reflects
    a significant change in diet habits and physical
    activity levels worldwide as a result of
    industrialization, urbanization, economic
    development and increasing food market
    globalization.
  • Recognising this, WHO has adopted a broad-ranging
    approach and has developed, under a May 2002
    mandate from Member States, a Global Strategy on
    Diet, Physical Activity and Health, which was
    endorsed by the May 2004 World Health Assembly

5
Objectives Foundation for Health Promotion
  • Health Defined Objectives for Promotion and
    Prevention
  • Define the term health
  • Examine the healthy people 2010 comitiment to a
    single, overarching (extending over) purpose to
    promote health and prevent illness, disabilities,
    and premature death
  • Explain the differences between health, illness,
    disease, disability and premature death
  • Compare the three levels of prevention (primary,
    secondary and tertiary) with the levels of
    service provision available across the lifespan
  • Describe the importance of research and the
    nurses role in the research process to the
    promotion of health for individuals and
    populations

6
Health promotion
  • Promoting health
  • Protecting health
  • Preventing disease and injury
  • Public concern- Lifestyle
  • Physical fitness
  • Good nutrition
  • Avoidance of health hazards such as smoking

7
Health promotion
  • To improve the health status of individuals and
    groups
  • Encouraging positive health changes
  • Effort of individuals
  • The goverment
  • Health professionals
  • Society
  • Reduce costs of health services
  • Improve the overall quality of life for all
    people
  • The health of each individual is influinced by
    health environment of all individuals worldwide

8
Ten categories are identified as important
determinants of health status. Change and improve
behaviour in these areas can lead to a decrease
in morbidity and mortality
  • Exercise
  • Sexuality and contraceptive use
  • Family relationships
  • Risk management
  • Coping and adaptation
  • Smoking
  • Nutrition
  • Alcohol use
  • Habituating drug use
  • driving

9
Health protection, disease and injury prevention-
Nurses need to understand
  • Directed at population groups of all ages
  • Involves adherence to standards
  • Infectious disease control
  • Government regulation and enforcement
  • Reducing exposure to various sources of hazards
    including air, water, foods, drugs, motor
    vehicles

10
Health care providers
  • Present the individual with disease and injury
    prevention services which include
  • Immunization
  • Screening include blood pressure, glaucoma, and
    diabetes screening
  • Health education
  • Couselling

11
To implement prevention strategies effectively
  • Develop cross-cutting activities targeted to and
    tailored for all age groups in various setting,
    including
  • Schools
  • Industies
  • The home
  • The health care delivery system
  • Community

12
The surgeon Generals report on health promotion
and disease prevention was published 1979 and
followed by healthy people 2000
  • Increase the span of healthy life for people
  • Reduce health disparities (Health disparities
    refer to gaps in the quality of health and health
    care across racial and ethnic groups) among
    people
  • Acheive access to prevent services for all people

13
Healthy people 2000
  • Four broad categories
  • Health promotion
  • Health protection
  • Preventive services
  • Surveillance (Close observation of a person or
    group, The act of observing or the condition of
    being observed) and data systems

14
Improvements include
  • Reduction in infant mortality
  • Teenage pregnancies
  • Injuries
  • Tobacco
  • Alcohol
  • Illicit (contrary to or forbidden by law) drug
    use
  • Death rate from coronary heart disease
    cerebrovascular accidents
  • Childhood vaccination rates are at the highest
    record

15
Many more improvements are needed in the health
of many people
  • Tobacco use by adolescents continue to increase
  • Adults do not participate in leisure-time
    physical activity
  • Obesity
  • Violence and other abusive behaviors continue to
    destroy individuals, families and communities
  • Chronic health problems as Mental disorders,
    diabetes mellitus continue to be undiagnosed and
    untreated
  • The occurance of HIV and AIDS

16
The vision of Healthy People 2010
  • Healthy people in healthy communities
  • Health affected by the environments in which each
    individual lives, works, travels and plays
  • Dimensions of the environment are not only
    physical, but psychological and spiritual,
    including the behaviors, attitudes, and beliefs
    of each individual

17
Health Promotion
  • What is Health Promotion
  • Is a broad field encompassing educational,
    social, economic and political efforts to improve
    the health of a population
  • Health promotion is practiced in a variety of
    settings
  • Health promotion workers put health on the agenda
    of policy makers to be a ware of the health
    consequences of their decision

18
Health promotion
  • A planned combination of educational, political,
    regulatory and organizational supports for
    actions and conditions of living conducive
    (tending to bring about) to the health of
    individuals, groups, or communities (Green
    Kreuter 1999)

19
Health promotion
  • The process of enabling people to increase
    control over and to improve their health. A
    commitment (act) to dealing with the challenges
    of reducing inequilities (injustice, unfairness),
    extending the scope (The range of one's
    perceptions, thoughts, or actions) of prevention
    and helping people to cope with their
    circumstances creating environments conducive
    (tending to bring about) to health, in which
    people are better able to take care of themselves
    (World Health Organization 1986)

20
Exploring Concept of Health
  • Nursing literature paradigms (A set of
    assumptions, concepts, values, and practices that
    constitutes a way of viewing reality for the
    community that shares them)
  • First paradigm????? Wellness-illness continuum
  • High- level wellness- a sence of well being,
    life satisfaction and quality of life
  • Second paradigm characterizes health as an
    indirectional development phenomenon of unitary
    patterning of person-environment

21
Health
  • Health is used to describe a number of entities
    (The fact of existence being) such as a
    philosophy of care (health promotion and health
    maintenance), a system (health care delivery
    system), practices (good health practices),
    behaviors ( healthy behaviors), costs (health
    care costs), and insurance

22
Health
  • Before 1940 Infectious diseases claimed the lives
    of many children and young adults, therefore
    health the absence of disease
  • After World War II in 1940 the idea of role
    performance became a focus
  • Health became linked to a persons ability to
    fulfil their roles in society
  • From 1960 to the present control spending and
    health care costs have escalated

23
Health
  • Primary care providers nurse practitioners
  • Attempt to involve individuals and their families
    in the delivery care as individual
    responsibilities and lifestyle choices have
    become an important part of care
  • Health has become linked to the changing
    environment to which individuals could react and
    change rather than becoming a fixed state

24
Health
  • Adaptation fit well with the self-help movement
    and progressive growth in knowledge from research
    about disease prevention and health promotion
  • Emphasis on the quality of a persons life as a
    component of health
  • There are multiple factors contributing to a
    persons perception of his/her health. In
    addition to function cognitively and physically,
    fulfill social roles, and obtain health services
  • Health is related to environment, socioeceonomic
    level, race, and geografic location

25
Models of health
  • Clinical model the absence of signs and stmptoms
    of disease as indicative of health
  • People who use this model of health to guide
    their use of health care services may not seek
    preventive health services or
  • Wait until they are very ill to seek care
  • The clinical model is the conventional model of
    the discipline of medicine

26
Role Performance Model
  • The ability to perform social roles as indicative
    of health
  • Role performance includes work, family, and
    social roles, with performance based on societal
    (relating to the structure, organization, or
    functioning of society) expectations
  • Illness would be the failure to perform a
    persons roles at the level of others in society
  • This model is the basis for work and school
    physical examinations and physician exused-
    absences
  • The idea of the sick role, in which people can be
    excused from performing their social roles while
    they are ill

27
Adaptive Model
  • Is reflective of Rene Duvos (1980) work on
    adaptation
  • Hans Selyes research on stress (1950)
  • Jean Piagets (1975) discussion of cognitive
    development
  • Has the ability to adapt positively to social,
    mental, physiological changes as indicative of
    health
  • Illness occurs when the person fails to adapt to
    changes

28
Eudaimonistic Model
  • Term indicates a model that embodies (symbolize)
    the interaction and interrelationships between
    the physical, social, psychological and spititual
    aspects of life and the environment
  • Illness is reflected by a denervation (resection
    or removal of the nerves to an organ or part) or
    languishing (feeble, weak), a wasting away, or
    lack of involvement with life
  • This model more congruent with integrative (to
    join) modes of therapy, which is used
    increasingly by the majority of people

29
Health-Illness Continuum
  • Is a traditional depiction (describe)
    relationship between the concepts of health and
    illness
  • In this paradigm, health is a positive state in
    which incremental increases in health can be
    made beyond the mid point on a line there the
    first end is health and the other end is
    illness.
  • These increases involve improved physical and
    mental health states
  • The opposite end of the continuum is illness,
    with the possibility of incremental decreases in
    health beyond the midpoint

30
High-Level Wellness
  • A health-illness contiuum that would assess a
    patient based on his or her relative health
    compared with others and the environment
  • Favourable environment allows high-level wellness
    to occur
  • Unfavorble environment allows low-level wellness
    to exit
  • The person can have a terminal disease and be
    emotionally prepared for death, while acting as a
    support for other people and acheiving high level
    wellness

31
Functioning
  • Defining Xs of life is the ability to function
  • Can Xs as being present or absent, high level or
    low level
  • There are physical , mental and social levels of
    function reflected in terms of performance
    (carrying out of something) and social
    expectations
  • Loss of function may be a sign or symptom of a
    disease

32
Health
  • Is a state of physical, mental, ans social
    functioning that realizes a persons potential
    (powerfull, efficacious)
  • Health is an individuals responsibility, but it
    requires collective action to ensure a society
    and an environment in which people can act
    responsibly
  • The culture and beliefs of the people can also
    influence health. This is consistent with WHO
    definition of health as the state of complete
    physical, mental and social well being and not
    merely the absence of disease and infirmity

33
Illness, disease, and health
  • Health and disease are not simply antonyms
    (opposite meaning) and disease and illness are
    not synonyms
  • Disease means without ease
  • Disease defines the failure of a persons
    adaptive mechanism to counteract (act in the
    opposite direction) stimuli and stresses
    adequately, resulting in functional or structural
    disturbances

34
Illness, disease, and health
  • Illness is a social construct in which people are
    in an imbalanced, unsustainable relationship with
    their environment and are failing in their
    ability to survive and create a higher quility of
    life
  • Illness is a mismatch between a persons needs
    and the resources available to meet those needs
  • Illness signals individuals and population that
    the present balance is not working

35
Illness, disease, and health
  • Disease is a biomedical term indicating the
    presence of a recognizable health deviation,
    whereas illness is a state of being
  • Illness has social, psychological, and biomedical
    components
  • A person can have a disease without feeling ill
    (asymptomatic hypertension)

36
Planning for healthgenerals report on health
promotion and disease prevention issued
  • Reducing infant death 35 (through low birth wt
    and birth defect)
  • Reducing death in children 20( growth and
    development screening and injury prevention)
  • Reducing death in adolescents and young adults
    20 (preventing motor vehicle injuries and
    decreasing the use of drugs and alcohol)
  • Reducing adult death 25 (screening and
    prevention of heart attacks, stroke and cancer)
  • Reducing sick days in older adult 20
    (maintaining functional independence and prevent
    influenza and pneumonia)

37
Planning for healthgenerals report on health
promotion and disease prevention issued
  • Three causes of the major health issues
  • Careless habits
  • Pollution of the environment
  • Permiting harmful social conditions to persist
    (hunger, poverty, and ignorance) that destroy
    health especialy for infant and children

38
Healthy people 2000 goals
  • Increase quality and years of healthy life
    (longevity (Long life) and quality of life )
  • Eliminate health disparities (inequality,
    negative) differences in treatment based on race,
    gender, ability to pay, and related issues such
    as urban versus rural health, insurance coverage,
    medicare and satisfaction with service delivery
  • e.g. Racial disparity in health care, black
    people and white people

39
Some terms
  • Ethnocentrism culture influences every aspect of
    human life, including beliefs, values, and
    customs regarding health care can lead to a
    devaluing of the beliefs, values and customs of
    others known as racism
  • Empathy the ability to view another persons
    situations from their perspective

40
ObjectiveImportant feature of Healthy people
2010
  • Increase the proportion of adults who engage
    regularly, preferably daily, in moderate physical
    activity for at least 30 min per day
  • Health indicators physical activities and wt
    (obesity)
  • Other indicators as tobacco and substance abuse
    and mental health are indirectly related to this
    objectives
  • Physical activity can contribute to positive
    mental health through stress reduction and
    physical fittness
  • Responsibility for intervention- not to do a
    repair shop
  • Health care provider need to be responsible for
    offering preventive health services and
    monitoring behavior
  • They do tasks rather than counsell and help
    individuals choose between various behaviors

41
Provider incentive (A reward for a specific
behavior, designed to encourage that
behavior.Saving Plan
  • Cigaretts
  • How much do they cost
  • How much the person will save in money wise
  • How to use the money, half for restaurant and
    half for vaccation

42
Providers need to look for partnership in the
community through which they can better serve the
needs of individual
  • Work sites and communities need to become
    partners in providing opportunities for people to
    lead healthy lives through flexible work
    schedules, work site wellness programs, safe
    park, availability of exercise facilities
  • E.g. Insurance company eliminate tobacco use from
    its building and campus limiting smoking,
    offering in-house smoking cessation courses
  • The company experienced a cost savings in lower
    premiums for health and fire insurance
  • Less frequent use of ventilation system
  • Less smoke and fire damage to furniture and
    equipment

43
Imagine a hospital where the staff
  • Can set their schedules to accommodate family
    needs, exercise at an in-hospital exercise
    facility
  • Eat in an esthetically (a tasteful way) pleasing
    environment with relaxing music and healthy food
  • Participate in stress reduction activities

44
Problem identificationanalysis of Franks
situation
  • How many problems does Franks situation present
  • The answer depends on who is asked the question
    and his/her position related to the Frank
  • His physician
  • His nurse
  • His children
  • His wife
  • His employer
  • Insurance company

45
Planning intervention
  • Asset planning planning approach that, given the
    realities of the present , helps focus the family
    and their providers on the building blocks for
    their future
  • The lifestyle changes become tools for Franks
    recovery and for change within his family
  • His cardiac event becomes a risk factor for heart
    disease for the lives of his children
  • A plan was developed to help Frank begin to take
    control of his life through behavior changes
  • Relaxation techniques
  • Diet modification
  • Smoking cessation
  • Mild chair exercises
  • Spokes person talking about stress management and
    smoking cessation based on his personal
    experiences

46
What was the actual cause of Franks problem
  • Not possible to separate. The source of illness
    were found in the many interrelationships in his
    life
  • Imbalance betwen his personal resources and the
    demands of his family and the economic world
  • Cigaretts use by persons who have hypertension or
    high serum cholesterol levels multiplies their
    risk of coronary heart disease

47
Evaluation of situation
  • The health status of an individual depends on a
    sustainable balance of the complex response
    between internal physiological and psychological
    and external social and environmental factors
    interpreted with the context of the immediate
    environment
  • The infarction and resulting disability
    permanently reshaped Franks environment
  • After few month working a full time , he realized
    that he needed to find a less stressful job
  • Health is not acheivement or a prize but a high
    quality interaction between a persons inner and
    outer world that provides the capacity to respond
    to the demands of the biological, psychological,
    and environmental system of these worlds

48
Assignment
  • Based on the information about frank and his
    experience, determine what his children should be
    taught based on the Healthy People 2010
    objectives in this focus area

49
Levels of promotionprimary prevention
  • Precede disease or dysfunction
  • It includes as health as beneficial to well being
  • It uses therapeutic RX an a process or behaviour
    towards enhancing health

50
Secondary prevention
  • Ranging from providing screening, activities and
    treating early stage of disease to limiting
    disability by averting (the act of preventing
    something from occurring) or delaying the
    consequences of advanced disease

51
Tertiary prevention
  • Occurs when a defect or disability is permanent
    and irreversible
  • The process involves minimizing the effects of
    the disease and disability by surveillance and
    maintenance activities aimed at preventing
    complications

52
Nurses Roles
  • Shifting from acute, hospital-based care to
    preventive community-based care, which is closely
    related to the changing demographic of people
  • The home and community become the existing site
    of care , nurses must assume new roles

53
Nursing roles in health promotion and protection
  • Advocate Strives to ensure that all persons
    receive quality, appropriate and cost-effective
    care
  • Care manager to prevent duplication of services
    and reduce costs
  • E-care manager is to know how to search for and
    find specific and high-quality information on the
    internet
  • Facilitating communication among parties is one
    of the care managers most important function

54
Nursing roles in health promotion and protection
  • Consultatnt consultative exchanges can occur
    with schoolteachers, legislators, or others who
    maintain a working relationship with the person
  • Gerontological nurse planning for a new senior
    citizens housing development
  • Educator health practices- a good nutrition,
    industrial and high way safety, immunization,
    specific drug therapy. Teaching is of the primary
    prevention techniques available to avoid the
    major causes of disability and health today

55
Nursing roles in health promotion and protection
  • Healer healing resides in the ability to glimpse
    (trace) or intuit the interior of an
    individuals care, to sense and identify what
    everyone else has missed or underappreciated
  • ??????? ?????? ???? ?? ?????? ??? ???? (????)
    ?? ?????? ?? "????????" ??????? ????? ? ????? ?
    ?????? ?? ?? ??? ?? ?????? ?? ?? ???? ?? ?????
  • Researcher evidence-based practice is defined as
    the conscientious (extreme care and great
    effort), explicit (Fully and clearly expressed),
    and judicious (careful and sensible marked by
    sound judgment) use of current best evidence in
    making decision about the care of individual
    patients
  • The practice of evidence-based medicine means
    integrating individual clinical expertise with
    the best available external clinical evidence
    from systematic research

56
Future research for the next five years, National
Institute of Nursing Research (NINR)
  • From management of individuals during illness and
    recovery to the reduction of risks for disease
    and disability
  • Promoting health life style
  • Promoting quality of life for persons with
    chronic illness
  • Identifying effective approaches to acheiving and
    sustaining good health

57
Future research for the next five years, National
Institute of Nursing Research (NINR)
  • Health promotion research should focus on health
    problems and disease-prevention techniques such
    as obesity reduction, smoking cessation,
    prevention on cancer, heart disease
  • Traditionally teaching prenatal classes,
    stressing prevention of infectious diseases
    through education and immunizations, teaching
    hygiene and safety principles in school and
    industry, and disseminating information on how to
    reduce risk factors leading to chronic disease

58
Research Design- RandomizedClinical Trials (RCTs)
  • Experiment in which individuals are randomly
    assigned into groups called study and control
    groups
  • The study group receives the intervention and the
    control group does not receive the intervention
  • Randomization can be acheived by using
    computer-generated lists, a table of radom
    numbers
  • Blinding ensures that subjects are unaware of the
    treatment or intervention to which they are
    exposed
  • Double-blinded studies are ones in which neither
    the researcher nor the subject knows what
    treatment or intervention they are receiving
  • In drug studies. The investigator and subjects
    are not told what medication they are receiving,
    so as not to influence the outcome

59
Research Design- Cohort Studies
  • The investigators do not determine which
    individuals receive the intervention at the
    outset (the time at which something is supposed
    to begin)
  • People who have already been exposed to the risk
    factor, or intervention, and control subjects who
    have not been exposed are selected by the
    investigators to be followed longitudinally over
    time in an effort to observe differences in
    outcome
  • Disadvantages require a large sample size, many
    years of observation to provide adequate
    statictical power to measure differences in
    outcome, expensive, time consuming
  • Drop out of the study before it is completed
  • Attrition (The loss of subjects during the course
    of a study) or mortality refers to the loss of
    subjects from both experimental and control
    groups for various reason

60
Research Design- Case-Controlled Studies
  • Both the study group and the control group are
    selected on the basis of whether they have the
    disease and not whether they have been exposed to
    a risk factor or a clinical intervention
  • Therefore the design is retrospective
  • Disadvantages difficulty identifying important
    confounding variables and adjusting them for the
    outcome, difficulty getting the past history of
    participants and the improper selection of
    control groups which may invalidate conclusions
    about the presence or absence of statistical
    associations

61
Improving Prospects for Health
  • Population effects
  • Cultural and socioeconomics changes within the
    population unequivocally (Admitting of no doubt
    or misunderstanding) influence lay concepts of
    health promotion
  • The projectd age distribution- considerable
    growth is expected in the proportion of the
    population

62
Improving Prospects for Health
  • Shifting problemsenvironmental pollution is a
    complex and increasingly hazardous problem
  • Disease related to industry and technology,
    including accidents and trauma, important threat
    to health
  • The physical and psychological stresses of a
    rapidly changing and fast-paced society present
    daily problems as economic pressures, poor health
    habits
  • Obesity from the lack of exercise is product of
    modern technology
  • The ingestion of potentially toxic, nonnutritios,
    high fat foods is contributing factor to poor
    health, the abuse of tobacco, drugs and alcohol
    negatively affects health
  • Orientation towards illness clearly focuses on
    the effects rather than the causes of disease

63
Improving Prospects for HealthShifting Problems
  • A substantial (Possessing wealth or property)
    change in wellness patterns has occured
  • Infectious and acute diseases were the major
    causes of death in the early twentieth century
    whereas chronic condition, heart disease,
    cerebrovascular accident (stroke)and cancer are
    the major causes today

64
Improving Prospects for HealthMoving Toward
Solution
  • Individual involvement action related to life
    style beggining early in life with the young
    child and the goverment involvement- the learning
    and the inherent changes that are involved
    require an attitudinal change, which is the most
    difficult requirement
  • Motivational factors play a role
  • Program for health promotion
  • Financial incentive for prevention may be another
    motivating factor and health advocacy by
    professionals in the health field is critical

65
Improving Prospects for HealthMoving Toward
Solution
  • Private and public action at all levels is needed
    to reduce possible environmental hazards
  • Toxic agents in the environment can present
    health hazards that may not be detected for years
  • Therefore it is necessary for the individuals to
    monitor industrial and agricultural production
    processes to reduce exposure to potentially toxic
    agent
  • Government activity in the form of Legislation
    and financing- Bicycle safety, seat belts, taxes
    on cigarettes
  • Putting more emphasis on primary prevention

66
To shift directions in todays health care
  • Provide leadership in finding the vision and the
    path
  • To inform, educate and reeducate themselves and
    their colleagues, the media and the general
    public
  • Nurses calls for seeing the health problem in new
    ways and helping others to do the same
  • Responsibility means developing new roles and
    looking at the problem through otherseyes
    including the eyes of individuals, the public,
    other proffessionals and other nations
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