Definition of Health Promotion
Health promotion began to gain acceptance worldwide after launching the Ottawa Charter for Health Promotion at the first international health promotion conference held in Ottawa, Canada 1986. It introduced a focus on health and its determinants into a debate that so far was dominated by a biomedical approach to health.
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Health promotion was defined in the Charter as a ‘process of enabling people to increase control over, and to improve their health’. It also built on new types of health programmes in the developed world that moved beyond a focus on individual risk behaviour towards "making the healthy choice the easier choice" through a wide range of environmental and social interventions.
Health promotion refers to enabling people to increase control over their health and its determinants and improve their health. Health promotion is a behavioural, social science that draws from the biological, environmental, psychological, physical and medical sciences to promote health and prevent disease, disability and premature death through education-driven voluntary behaviour change activities.
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According to K Park, "Health promotion is a process that informs motives and helps people adopt healthy practices and lifestyles, advocates environmental changes as needed to facilitate this goal, and conducts professional training and research.
So, Health promotion is the process of enabling people to increase control over and improve their health.
Features of Health Promotion
Helps people to increase control over their own health.
Improve a person’s or population’s health by providing information.
Providing clients with information to enhance health and prevent disease.
To reach a state of complete physical, mental and social well-being
To change or cope with the environment.
Focuses on achieving equity in health.
Reducing differences in current health status and ensuring equal opportunities.
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Five Principles of Health Promotion
“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.” This statement in the preamble of the WHO Constitution - with the inclusion of gender - sets out the point of departure for the fundamental values driving health promotion.
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Five fundamental principles have guided health promotion strategies.
1. Health promotion is context-driven: Focuses on health and its underlying social and economic determinants for analysing socioeconomic, gender, and ethnic gaps in health and disease patterns in populations.
2. Health promotion integrates the three dimensions of the WHO health definition: Promoting health means addressing the multi-dimensional nature of health: its physical, social, and mental dimensions (and often, spiritual health).
3. Health promotion underpins the overall responsibility of the state in promoting health: All levels of government have a responsibility and accountability for protecting, maintaining, and improving the health of its citizens and need to include health as a significant component.
4. Health promotion champions good health as a public good: Good health is beneficial to society and its social and economic development.
5. Participation is a core principle in promoting health: The participation of people and their communities in improving and controlling the conditions for health is a core principle in promoting health.
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Other values and principles are mentioned by Dr Md. Abul Hossen
Choice / Interest (make it dynamic to consciousness, subconscious, and unconscious to critical consciousness)
Participation
Known to unknown
Learning by doing
Respect
Leader involvement
Empowerment
Social justice/Equity
Priority to common good
Positive health.
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Three Strategies of Health Promotional
According to Dr Md. Abul Hossen Sir, (Health Communication, Self Help Group, Organizational Change, Policy Development)
According to WHO, Geneva, 1995; Three basic health promotion strategies are given below:
Advocacy
Advocacy for Health is a combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or programme. Advocacy is one of the three major strategies for health promotion. It can take many forms, including the use of the mass media and multi-media, direct political lobbying, and community mobilisation through, for example, coalitions of interest around defined issues. Health professionals have a significant responsibility to act as advocates for health at all levels of society.
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Mediation
Health promotion is a process through which the different interests (personal, social, economic) of individuals and communities and other sectors (public and private) are reconciled to promote and protect health. Changing people’s lifestyles and living conditions inevitably produces conflicts between the different industries and interests of a population. Such conflicts may arise, for example, from concerns about access to, use and distribution of resources or constraints on individual or organisational practices. Reconciling such disputes in ways that promote health may require considerable input from health promotion practitioners, including applying skills in advocacy for health.
Enabling
In health promotion, enabling means acting in partnership with individuals or groups to empower them to promote and protect their health through the mobilisation of human and material resources.
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Five Approaches to Health Promotion
Health promotion approaches introduce the various methods used to promote health. There are approaches to health promotion:
Medical Approach
Behaviour changes Approach
Educational Approach
Empowerment Approach
Social Change Approach
1. Medical Approach: It aims
• To reduce morbidity and premature mortality.
• To ensure freedom from disease and disability.
Uses medical intervention to prevent ill-health or premature death, i.e. Immunization, screening, fluoridation.
2. Behaviour Change Approach: It aims
• To encourage individuals to adopt healthy behaviours.
• Views health as the responsibility of individuals.
Methods
Communication, Education, Persuasion, motivation
Expert-led, top-down. ‘Victim-blaming’
Behaviour is very complex & Multi-factorial
3. Educational Approach: It aims
• To provide knowledge and information.
• To develop the necessary skills for informed choice.
• The outcome is the client’s voluntary choice.
Methods
Information-giving through interpersonal channels, small groups and mass media so that the clients can make an informed choice.
Group discussion for sharing and exploring health attitudes
Roleplay for decision-making and negotiating skills
4. Empowerment or Client-centered Approach: It aims at helping people to identify their own needs and concerns and gain the necessary skills and confidence to act upon them.
Role of health promoter: facilitator and catalyst.
Two types of empowerment:
Self-empowerment - based on counselling and aimed at increasing people’s control over their own lives.
Community empowerment - related to community development to create active, participating communities which can change the world about them through a programme of action
Methods
• Client-centred, including counselling, community development and advocacy.
• Health advocacy refers to the action of health professionals to influence and shape the decisions and actions of judgment- and policy-makers who have some control over the resources which affect or influence health
• Promoting public involvement and participation in decision-making on health-related issues.
5. Societal/Social Change Approach: it aims
• To bring about changes in the physical, social, and economic environment, enabling people to enjoy better health.
• Radical health promotion - makes the environment supportive of health.
• To make the healthy choice the easier choice.
• The focus is on changing society, not on changing the behaviour of individuals.
Methods
• Focus on shaping the health environment
• lobbying/advocacy
• development of healthy public policies and legislation
• fiscal measures
• creating supportive social and physical environments
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Three Models of Health Promotional
The kinds of health promotion programs that students and schools implement reflect the health education models they are based on. There are three (3) main categories in which health education models can be broadly placed:
Behavioral Change Model
The behavioural change model is a preventive approach and focuses on lifestyle behaviours that impact health. It seeks to persuade individuals to adopt healthy lifestyle behaviours, use preventive health services, and take responsibility for their own health. It promotes a 'medicalised' view of health that may be characterised by a tendency to 'blame the victim'. The behavioural change model is based on the belief that providing people with information will change their beliefs, attitudes, and behaviours. This model is ineffective in many cases because it ignores the factors in the social environment that affect health, including social, economic, cultural, and political factors.
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Characteristics of Behavioural change model
Focuses on health professionals' perceptions of health needs – suggests that 'experts' know best.
Transmits knowledge – increases people's knowledge of the factors that improve and enhance health.
Educates 'about' health.
Uses health campaigns.
Uses the transmission approach to teaching – the learners are primarily passive.
Often reflects 'healthism'*.
It may have a 'moralistic' tone.
Emphasises disease and other medical problems, so tend to be negative and deficit-focused.
Focuses on risks rather than on protective or preventive factors and takes a 'band-aid' approach.
Tends not to reflect the socio-ecological perspective.
Do not consider determinants of health or think about who is responsible for health.
It may imply 'victim-blaming.'
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Self-empowerment Model
This approach seeks to develop the individual's ability to control their own health status as far as possible within their environment. The model focuses on enhancing an individual's sense of personal identity and self-worth and on the development of 'life skills, including decision-making and problem-solving skills, so that the individual will be willing and able to take control of their own life. People are encouraged to engage in critical thinking and action at an individual level. This model, which is often successful for individuals, is not targeted at population groups and is unlikely to affect social norms.
Characteristics of the Self-empowerment model
Develops a sense of identity.
Promotes reflection about others and society.
Encourages people to reflect and change their views.
Clarifies values.
Helps people to know where, when, why, and how to seek help.
Encourages independence.
Uses critical thinking and critical action about oneself.
Uses the action competence process for the individual, recognising determinants that may be beyond their control.
Fosters resilience and empowerment at a personal level.
Enhances self-awareness.
Focuses mainly on the individual.
Gives opportunities to celebrate individuality.
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Collective Action Model
This socio-ecological approach encompasses ideas of community empowerment, which requires people individually and collectively to acquire the knowledge, understanding, skills, and commitment to improving the societal structures that have such a powerful influence on people's health status. It engages people in critical thinking to enhance their understanding of the factors affecting individual and community well-being. It also engages them in necessary action to contribute to positive change at a collective level. Given the importance of determinate health, using a collaborative action model is more likely to achieve healthy outcomes, both for individuals and groups within society.
Characteristics of the Collective action model
Encourages democratic processes and participation 'by all for all.
Takes a student-centred/constructivist approach to teaching and learning.
Takes determinants of health into consideration.
Emphasises empowerment for all participants.
Educates 'for' health.
Uses a social action or action competence process to work with others.
Uses a whole community/school development approach.
Views teachers and students as social agents.
Uses critical thinking and critical action about the individual, others, and society.
Takes a holistic approach – inclusive of Hauora.
It is based on authentic needs.
Fosters resilience at broader community and societal levels – not just at an individual level.