HEALTH EDUCATION and HEALTH PROMOTION

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HEALTH EDUCATION and HEALTH PROMOTION

• OEDOJO SOEDIRHAM
• DEPARTMENT OF HEALTH PROMOTION AND BEHAVIORAL
  SCIENCES
• FKM-UNAIR, SURABAYA

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HEALTH EDUCATION and HEALTH PROMOTION

• HEALTH EDUCATION AND HEALTH PROMOTION
• introduction
• Definitions and Concepts
• Foundation for Practice
• Others

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INTRODUCTION

• OVERVIEW
• Everyone engaged in the tasks of promoting health
  starts with a view of what health is.
• However, there is a wide variety of these views,
  or concepts, of health. It is, important of the
  outset to be clear about the concepts of health
  which you personally adhere to, and to recognize
  where these differ from those of your colleagues
  and clients. Otherwise, you may find yourself
  drawn into conflicts about appropriate strategies
  and advice that are actually due to different
  ideas concerning the end goal of health.

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• This lecture does not discuss about health only,
  but also to present the process of attempting to
  promote health that may include a whole range of
  interventions including
• Those which foster healthy lifestyle
• Those which encourage access to services and
  involvement in health decisions
• Those which seek to promote an environment in
  which the healthy choice becomes the easier
  choice
• Those which educate about the body and keeping
  healthy

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• Until the 1980s most of these interventions were
  referred to as health education and the
  practice was almost exclusively located within
  preventive medicine or, to a lesser extent,
  education. In recent years, the term health
  promotion has become widely used. This course
  considers whether this change in name signifies a
  difference in ideology, policy, and practice.
  Using typology first suggested by Bunton and
  Macdonald (1992), it describes the development of
  health education and health promotion, and shows
  their interdependent.

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• The 19th century public health movement informed
  the health education of the earlier part of the
  20th century which, in turn, informed the
  development of health promotion. It shows how
  the debate about the meaning of health education
  and health promotion has stemmed from a growing
  awareness that achieving Health For All
  requires not just changes in individual behavior,
  but also, social and environmental change.

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• The development of health education
• The origins of health education lie in the 19th
  century when epidemic disease eventually led to
  pressure for sanitary reform for the overcrowded
  industrial towns. Alongside the public health
  movement emerged the idea of educating the public
  for the good of its health. The Medical Officers
  of Health appointed to each town under the Public
  Health legislation of 1848 frequently
  disseminated everyday health advice on safeguards
  against contagion. (Voluntary associations were
  also formed including the London Statistical
  Society,1839 the Health of Towns
  Association,1842 and the Sanitary Institute,
  1876).

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• The Temperance Movement held Band of Hope mass
  meetings, through schools and churches lectured
  to young people on the virtue of abstinence. By
  the 1920s health education had become associated
  with diarrhoea, dirt, spitting and venereal
  disease. The evidence that between 10 and 20
  of soldiers in the First World War had contracted
  venereal disease led to propaganda, one-off
  lectures and the first use of shock-horror
  techniques in which soldiers were shown lurid
  pictures of diseased genitals to dissuade them
  from having sex.

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• Changing patterns of morbidity and mortality
  shifted attention away from disease to personal
  behavior. The Central Council for Health
  Education was established in 1972, paid for by
  local authority public health departments and
  public health doctors formed the majority of its
  membership. An extract from some of the tasks
  listed as important reflects an emphasis on
  information, and education to bring about change
  in personal habits and behavior

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• The provision of better and cheaper posters and
  leaflets
• The provision of exhibits for exhibition
• The production of readable monthly bulletin
• The provision of a panel of lectures who really
  could lecture and hold an audience

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• The Central Council was principally concerned
  with propaganda and instruction. During the
  Second World War it delivered 3799 lectures on
  sex education and venereal disease which were
  attended by 340,000 people.
• But, according to Sutherland (1979) the two
  principal functions or aims of the Central
  Council for Health education were

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• First to promote and encourage education in the
  science and art of healthy living and, second,
  to coordinate the work of all statutory bodies in
  carrying out their powers and duties under the
  Public Health Acts relating to the promotion
  of Public Health.

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• Unfortunately, health education confined itself
  in the main to the first, largely lifestyle,
  function and neglected the second, largely
  structuralist, issue. Health promotion in the
  last 20 years or so has attempted to fill that
  gap. It is worth noting, however, that health in
  turn did not develop in a vacuum but emerged as a
  consequence of the public health measures of the
  late 19th and early 20th centuries.

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• This lecture does not to conclude which one come
  first, whether health education or health
  promotion. Rather, to give information about
  what is inside of those two. Is there any real
  different, both in concept and in practice?
• What do you think about these two tables below,
  which one is more useful for you as public health
  worker?

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TABLE 1
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TABLE 2
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Definitions and Concepts

• What is
• HEALTH ?

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Health in the River of Life
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• The river as a metaphor of health development has
  often been used. According to Antonovsky, it is
  not enough to promote health by avoiding stress
  or by building bridges keeping people from
  falling into the river. Instead people have to
  learn to swim (Antonovsky 1987).

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• The river of life is a simple way to demonstrate
  the characteristics of medicine (care and
  treatment) and public health (prevention and
  promotion) shifting the perspective and the focus
  from medicine to public health and health
  promotion towards population health.

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• Cure or treatment of diseases
• The curative perspective on health means that we
  save people from drowning using expensive high
  technology and well-educated professionals. Up
  stream thinking would offer people support and
  interventions at an earlier stage.

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• Health protection/disease prevention
• This stage can be divided in two phases, i.e. the
  protective and the preventive. The protective
  perspective means that the interventions are
  limiting the risks of disease. The efforts and
  interventions are population-based and passive.

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• In the metaphor of the river, the interventions
  are aimed at preventing people from falling into
  the river by building fences. The preventive
  perspective aims at preventing diseases by active
  interventions characterized by an empowering
  attitude where people are actively involved.

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• People are here supplied with a life vest. The
  rationale is to reduce the negative effects and
  risks thus maintaining the health of the public.
  The interventions are both population-directed
  (protective) and individual-based (preventive).

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• Health education/health promotion
• This stage consists both of health education and
  health promotion. Health education has a long
  tradition in public health practice. Originally,
  it was a question of the professionals informing
  people of health risks and giving advice how
  people should live their lives.

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• Today it is based on a dialogue, involving people
  in their own lives, making their own decisions
  supported by the professionals. People are, in
  general, more actively involved than in the
  previous stages. The interventions are directed
  towards both individuals and groups. Improved
  health literacy is the key outcome of health
  education (Nutbeam, 2000).

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• Returning to the river, the efforts here aim at
  teaching people how to swim. In health
  promotion, health is seen as a human right. The
  focus is on the co-ordination of activities
  between professions and professionals in
  societies. This is a positive concept emphasizing
  social and personal resources as well as physical
  capacities.

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• The responsibility of health promotion action
  extends far beyond the health sector and health
  behavior to wellbeing and QoL. It is a humanistic
  approach having the human being, human rights at
  focus again. The individual becomes an active
  and participating subject.

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• The task for the professionals is to support and
  provide options, enabling people to make sound
  choices, point out the key determinants of
  health, to make people aware of them and able to
  use them (Lindström and Eriksson, 2006). Health
  education is here replaced by learning about
  health referring to the reciprocity of a health
  dialogue. The salutogenic perspective can be
  applied in all these stages.

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• Improving health perception/wellbeing/quality of
  life
• Going up-streams towards the source the last
  stage deals with health perception and QoL. The
  ultimate objective of health promotion activities
  is to create prerequisites for a good life.
  Perceived good health is a determinant for QoL.
  The salutogenic framework can create a fusion of
  the complexity of health and QoL development
  (Eriksson and Lindström, 2006, 2007).

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• It is necessary to learn how to reflect on the
  options of ones life situation, such as what
  generates health, what improves QoL and what
  develops SOC. Traditionally, the difference
  between the biomedical model and public health
  has been described through a metaphor of a river
  moving from the down river approach where people
  already are struck by disease up streams through
  the stages described above.

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• However, to explain the shift of paradigm of the
  salutogenic framework, the metaphor of the river
  is different. This is Health in the River of
  Life. Here the river flows vertically across your
  view. Along the front side of the river, there is
  a waterfall continuously following the whole
  stretch of the river. This means the main flow
  and direction of the river is not down the
  waterfall.

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• At birth, we are dropped into the river and float
  with the stream. The main direction is life not
  death and disease in the waterfall. Some are born
  close to the opposite side of the river where one
  can float at ease and the opportunities for life
  are good and there are many resources at
  disposal, like in a welfare state. Some are born
  close to the waterfall, at dis-ease, where the
  struggle for survival is harder and the risk of
  going over the rim is much greater.

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• The river is full of risks and resources.
  However, the outcome is largely based on our
  ability to identify and use the resources to
  improve our options for health and life.

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Definitions and Concepts

• BIOMEDICAL
• PSYCHOLOGICAL
• SOCIOLOGICAL (SOCIOCULTURAL)

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Definitions and Concepts

• BIOMEDICAL
• Focuses solely on the individuals physiological
  state
• Health is defined simply as the absence of
  disease or physiological malfunction
• It is NOT positive state but the absence of a
  negative state

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Definitions and Concepts

• PSYCHOLOGICAL
• Asserts that individual constantly make
  subjective evaluations of their own health
• Originally, this assessment was assumed to focus
  solely on a general feeling of overall well-being
• Psychological wellness includes
• Pleasurable involvement
• Long-term satisfaction
• The absence of negative affect

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Definitions and Concepts

• SOCIOLOGICAL (SOCIOCULTURAL)
• Emphasizes on the social and cultural aspects of
  health and illness
• Focuses on the individuals capacity to perform
  roles and tasks and acknowledges that there are
  social differences in defining health

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Definitions and Concepts

• Health promotion is the process of enabling
  people to increase control over, and to improve,
  their health.
• To reach a state of complete physical, mental,
  and social well-being, an individual or group
  must be able to identify and to realize
  aspirations, to satisfy needs, and to change or
  cope with the environment.
• Health is, therefore, seen as a resource for
  everyday life, not the objective of living.

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Definitions and Concepts

• Health is a positive concept emphasizing social
  and personal resources, as well as physical
  capacities.
• Therefore, health promotion is not just the
  responsibility of the health sector, but goes
  beyond healthy life styles to well-being

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Definitions and Concepts

• PREREQUISITIES FOR HEALTH
• Peace
• Shelter
• Education
• Food
• Income
• A stable eco-system
• Sustainable resources
• Social justice
• Equity

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Definitions and Concepts

• HEALTH PROMOTION ACTION MEANS
• BUILD HEALTHY PUBLIC POLICY
• CREATE SUPPORTIVE ENVIRONMENTS
• STRENGTHEN COMMUNITY ACTION
• DEVELOP PERSONAL SKILLS
• REORIENT HEALTH SERVICES

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Definitions and Concepts
These actions are interdependent, but healthy
public policy establishes the environment that
makes the other four
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Definitions and Concepts
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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• 1. Healthy Public Policy
• Healthy public policy is a pre-requisite for
  successful health promotion.
• A Healthy Public Policy is characterized by a
  concern for health and equity and an
  accountability for health impact.
• Health should be made a priority item on the
  agenda of policy-makers in all sectors.
• Policy-makers should be made aware of the health
  consequences of their decisions. They should
  create pro-health policies, whether in the area
  of development, legislation, taxation etc.

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• Healthy public policy covers a combination of
  diverse but complementary measures and approaches
  such as legislation, taxation, fiscal incentives
  and disincentives, policy analysis and review,
  and organizational change
• Joint action by all sectors will contribute to
  achieving safer and healthier goods and services,
  healthier public services, and cleaner and more
  healthy environment.
• The aim is to make the healthier choice the
  easier choice for all people.
• HPP should lead to the creation of a supportive
  environment to enable people to lead healthy live

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• According to the Adelaide Conference (1988), The
  main aim of HPP is to create a supportive
  environment to enable the people to lead healthy
  lives. Healthy choices are thereby made possible
  and easier for citizens.
• All relevant government sectors like agriculture,
  trade, education, industry and finance need to
  give important consideration to health as an
  essential factor during their policy formulation.

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• 2. Create Supportive Environment
• A supportive environment is essential for health.
• Supportive environments cover the physical,
  social, economic, and political environment.
• Supportive environments encompass where people
  live, work and play. This is what is envisaged by
  the settings approach.
• Everyone has a role in creating supportive
  environments for health.

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• 3. Strengthen Community Action Community
  Participation
• According to the Ottawa Charter, health
  promotion works through concrete and effective
  community action in setting priorities, making
  decisions, planning strategies and implementing
  them to achieve better health.
• There are many ways of defining community.
  Factors used are geography, culture and social
  stratification.

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• Community action is any activity undertaken by a
  community in order to effect change (including
  voluntary and self-help services).
• Community participation covers a spectrum of
  activities
• At the low end, it may be token participation in
  the form of consultation or endorsing plans drawn
  up by the health authorities. At the high end, it
  may be in the form of people power where they
  have full say in identifying needs, setting
  priorities, planning strategies and activities
  and implementing the program.

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• Full community participation occurs when
  communities participate in equal partnership with
  health professionals as stakeholders in setting
  the health agenda.
• A Definition (Rifkin et al. 1988)
• Community participation is a social process
  whereby groups with shared needs living in a
  defined geographic area actively pursue
  identification of their needs, take decisions and
  establish mechanisms to meet these needs

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• According to the Jakarta Declaration (1997),
  health promotion improves both the ability of
  individuals to take action, and the capacity of
  groups, organizations or communities to influence
  the determinants of health.
• Empowerment is an important strategy, based on
  the notion that health is significantly affected
  by the extent to which one has control or power
  over ones life.

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• 4. Develop Personal Skills
• Strategies for empowering the community include
  leadership training, learning opportunities for
  health, and access to resources including
  material and funding
• Empowerment helps people to identify their own
  needs and concerns, and gain the power, skills
  and confidence to act upon them. It is a
  bottom-up strategy which requires the health
  promoter to act as a facilitator and catalyst for
  change.

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• Skills which can promote an individuals health
  include those pertaining to identifying,
  selecting and applying healthy options in daily
  life.
• Health education is life-long, so that people can
  develop the relevant skills to meet the health
  challenges of all stages of life, and to be able
  to cope with chronic illness and disabilities.
• Health education should be conducted in all
  settings.

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THE FIVE MAJOR AREAS/STRATEGIES IN HEALTH
PROMOTION(OTTAWA CHARTER)

• 5. Reorient Health Services
• Shift of emphasis from provision of curative
  services.
• Health care system must be equitable and
  client-centered.
• May necessitate reengineering and organizational
  change, especially in the areas of professional
  education and training, management, recruitment
  and deployment of health personnel, and planning,
  development and delivery of services,

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Health Promotion Theory

• Why study health promotion theory?
• Although it is clear why public health
  practitioners and students of public health
  should learn about how to devise and implement
  health promotion interventions, it may be less
  obvious why it is necessary to spend time
  learning about the theory of health promotion. As
  this book makes clear, health promotion is far
  from straightforward.

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Health Promotion Theory

• Why study health promotion theory?
• Unless public health practitioners explore and
  understand the theory underpinning health
  promotion, there is a real risk, at best, of
  establishing ineffective interventions and, at
  worst, of antagonizing and even harming the very
  people you are seeking to help.

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SECTION 1Philosophy and theory of health
promotion

• Health promotion is probably the most ethical,
  effective, efficient and sustainable approach to
  achieving good health. It was defined initially
  by the World Health Organization in 1986, but the
  definition has since been refined to take account
  of new health challenges and a better
  understanding of the economic, environmental and
  social determinants of health and disease.

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• Health is the most sought after subject on the
  World Wide Web. The problem of definition is
  confusing because terms such as health (and
  education and promotion) are widely used in
  everyday language and, as such, are used to mean
  very different things in different contexts.
  These are essentially contested concepts, as they
  are used and abused, in the familial sense, in
  everyday language.

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thank you