1. dr swe swe latt health promotion
TRANSCRIPT
Dr. Swe Swe Latt
M.B.,B.S, M.Med.Sc (Public Health)
LecturerCommunity Medicine Department
KOM
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At the end of this lecture, students should be able to:
1. Define health promotion
2. List the five principles of Ottawa charter
3. Describe the importance of HP
4. Describe and explain approaches used in health promotion
6. Correlate Islamic perspective on Health Promotion
7. HP activities in Malaysia
Health Promotion ( DRSSL)
HEALTH?
Dimensions of Health?
Factors influencing on Health?
Promotion, Protection, Prevention?
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Factors Influencing on health
Human rights
Biological
Justice
Gender
Inf & com
Science &Tech
Aging of pop
Socio-cultural
Health system
Socio-economic
Environmental
Behavioral
communities
SocietiesFamilies
Individual
Health promotion Health protection Disease prevention
Developed in healthy people related to individual lifestyles (more healthy LS)Eg: 1.physical activity 2.Nutrition 3.Sexuality 4.Tobacco/ antismoking5.Alcohol and drug use6.Oral health 7.Mental health and mental disorders8.Violent and abusive behavior Actions: educational and community-based programs (encourages well-being)(health education and spe interventions)
Focus on Environmental and regulatory measures -Protection on large population groupsEg:1.unintentional injuries2.Occupational safety and health 3.Env health hazards4.Food and drug safety 5.Fluoridation of water for oral health 6.Industrial chemicals7.Exposure to lead8.Air pollutants9.Radon 10.Pesticide residues
(desire to avoid illness)
Avoidance of illness and agents of illness
Primary Secondary Tertiary
( take action to thwart the disease process)
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Health Promotion ( DRSSL)
Period of Pre-Pathogenesis Period of Pathogenesis
DeathDisease Process
LEVELS OF PREVENTION
MODES OF INTERVENTION
PRIMARY PREVENTION SECONDARY PREVENTION TERTIARY PREVENTION
Disability Limitation
RehabilitationEarly Diagnosis & Prompt Treatment
Health Promotion
Specific Protection
Before Man is Involved
Agent
Bring agent and host
Together or produce a Disease provoking stimulus
Host
Environment
In the Human Host
Interaction of host and stimulus
Host Reaction
Early Pathogenesis
Discernible early Lesion
Advance Disease Convalesence
RECOVERYStimulus or agent becomes established and increases by multiplication
Tissue & Physiologic changes
Immunity & Resistance
Disability
Defect
Chronic State
Signs & Symptoms
Illness
Clinical Horizon
The Course of disease in man
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Definition
“Health promotion is the process of enabling people
to increase control over & to improve their health.” Ottawa Charter for HP (WHO, 1986)
‘Health promotion is any combination of
educational, organizational, economic and
environmental supports for actions conducive to
health” (Green & Kreuter, 1991) 7
A Framework for Health Promotion Activities
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Health Promotion Process
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The Ottawa Charter for Health Promotion
First International Conference on Health
Promotion, meeting in Ottawa, 21 November
1986
•Uses Health Promotion to summarize new
approaches to Public health intervention
based on 5 principles
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Principles of Ottawa Charter
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1. Develop Personal Skills
• supports personal and social development through providing information, education for health, and enhancing life skills
• Enabling people to learn, throughout life• facilitated in school, home, work and community
settings• Action -through educational, professional,
commercial and voluntary bodies
institutions
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2. Strengthen Community Actions
• empowerment of communities - their ownership and control of their own endeavours and destinies
• Community development to enhance self-help and social support
• strengthening public participation in and direction of health matters
• requires full and continuous access to information, learning opportunities for health, funding support
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3. Create Supportive Environments• links between people and their environment
constitutes the basis for a socioecological approach to health
• Work and leisure should be a source of health for people.
• Creation of the society of healthy work organization
• Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable.
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4. Build Healthy Public Policy
• puts health on the agenda of policy makers in all sectors and at all levels, directing them to be aware of the health consequences of their decisions and to accept their responsibilities for health
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5. Reorient Health Services• Reorienting health services also requires stronger
attention to health research as well as changes in professional education and training.
• lead to a change of attitude and organization of health services which refocuses on the total needs of the individual as a whole person
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Health Promotion Emblem
The main graphic elements of the HP logo are:
a. one outside circle,
b. one round spot within the circle, and
c. three wings that originate from this inner spot, one of which is breaking the outside circle.
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The Health Promotion emblem and its interpretations in successive conferences
• Ottawa 1986• Adelaide 1988• Sundsvall 1991• Jakarta 1997• Mexico 2000• Bangkok 2005• Nairobi 2009
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1. UK: In equalities in health
overall health status – improved Inequalities in health still exist!
- Gap between less well – off vs. better – off social groups tend to increase
• People in the upper classes had a greater chance of avoiding illness & staying healthy than those in the lower class
• Gender differences: men vs. women
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Why do we need to do health promotion?
Health Promotion ( DRSSL)
European Public Health Association•Inequalities in health exist in all European countries. In many cases, evidence that exists shows the gap between the rich and poor is increasing.
•Many European countries do not record deaths by socio- economic categories, but years in higher education is widely taken to be a proxy for social advantage.
•In Netherlands, if the risk of dying from a heart attack is 1.00 for people with a university education, the relative risk (RR) for Dutch people without a secondary school diploma is 2.40http://www.epha.org/a/547
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Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries
Health Promotion ( DRSSL)
Economic Status and Health in Childhood: The Origins of the Gradient
• Children from lower-income households with
chronic health conditions have worse health than
do children from higher-income households.
http://www.nber.org/papers/w8344
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2. Changing disease pattern eg: CD to NCD, emerging diseases
3. Rising health care cost - continuous rise of investments in research &
development - adoption of the latest technologies to deal with the rapid emergence of new & complicated illnesses
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4. Role of population in improving health - Dengue, Typhoid
5. Limitation of medical services from health
threats – from environment (air/ water
pollution) , lifestyle
6. Shift in health care delivery
– wellness paradigm
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Treatment paradigm brings a person to the neutral point, where the symptoms of disease have been alleviated
Wellness paradigmwhich can be utilized at any point on the
continuum, helps a person to move toward higher level of wellness
Health Promotion ( DRSSL)
FIVE APPROACHES TO HEALTH PROMOTION
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Approaches to health promotion
• Medical or preventive Approach
• Behaviour change Approach
• Educational Approach
• Empowerment Approach
• Societal change Approach
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Five Approaches to Health Promotion Summary and Example (smoking)
Approach Aim Health promotion
activity
Important values
Example - smoking
Medical Freedom from medically defined disease and disability such as infectious d/ss, Ca and heart d/s.
Eg. ImmunizationScreening for HTPAP smear
Promotion of medical intervention to prevent or improve ill health
Patient compliance with preventive medical procedures
Aim- freedom from lung d/s, heart d/s and other smoking –related disordersActivity- encourage people to seek early detection and treatment of smoking- related disorder
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Five Approaches to Health Promotion Summary and Example
Approach Aim Health promotion
activity
Important values
Example - smoking
Behaviour change
Individual behaviour conductive to freedom from disease
Attitude and behaviour change to encourage adoption of ‘healthier’ lifestyle
Healthy lifestyle as defined by health promoter
Aim-behaviour change from smoking to not smokingActivity- persuasive education to prevent non-smokers from starting and to persuade smokers to stop
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Five Approaches to Health Promotion Summary and Example
Approach Aim Health promotion activity
Important values
Example - smoking
Educational Individuals with knowledge and understanding enabling well-informed decisions to be made and acted upon
Information about cause and effects of health-demoting factors.Exploration of values and attitudes. Development of skills required for healthy living
Individual right of free choice. Health promoter’s responsibility to identify educational content
Aim-Clients will have understanding of the effects of smoking on health. They will make a decision whether or not to smoke and act on the decision.Activity- giving information to clients about the effects of smoking, help them to learn how to stop smoking
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Five Approaches to Health Promotion Summary and Example
Approach Aim Health promotion
activity
Important values
Example - smoking
Client-centered/ Empowerment Approach
Working with clients on their own terms
Working with health issues, choices and actions that clients identify. Empowering the client
Client as equals. Client’s right to set agenda. Self-empowerment of client
Anti-smoking issue is considered only if clients identify it as a concern. Clients identify what, if anything, they want to know and do about it.
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Five Approaches to Health Promotion Summary and Example
Approach Aim Health promotion activity
Important values
Example - smoking
Societal change
Physical and social environment that enables choice of healthier lifestyle
Political/ social action to change physical/socialenvironment
Right and need to make environment health-enhancing
Aim-Make smoking socially unacceptable, so it is easier not to smoke than to smokeActivity- no-smoking policy in all public places. Cigarette sales less accessible to children, promotion of non-smoking as social norm, banning tobacco advertising and sports’ sponsorship32
Health Promotion Means Changing Behavior at Multiple Levels
A Individual: knowledge, attitudes, beliefs, personality
B Interpersonal: family, friends, peers C Community: social networks,
standards, norms D Institutional: rules, policies, informal
structuresE Public Policy: local policies related to
healthy practices33
Health Promotion ( DRSSL)
Health Promotion Tools• Mass media• Social marketing• Community mobilization• Health education• Client-provider interactions• Policy communication( edu tools: leaflets, videotapes, bulletin boards, overhead transpancies,
PPT material, chalk boards, other audiovisual support items, sms, TV,
Talk)
Source: Robert Hornik and Emile McAnany, “Mass Media and Fertility Change,” in Diffusion Processes and Fertility Transition: Selected Perspectives, ed. John Casterline (Washington, DC: National Academies Press, 2001): 208-39.
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A Flowchart for Planning and Evaluating Health Promotion
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Aims and Methods in Health promotion Aim Appropriate method
Health Awareness goal Raising awareness, or consciousness, of health issues
Talks/ Group work Mass media / Displays and exhibitions Campaigns
Improving knowledge Providing information
One-to-one teaching/ Displays and exhibitions Written materials/ Mass media (including internet)Campaigns/ Group teaching
Self-empoweringImproving self-awareness, self-esteem, decision-making
Group work / Practicing decision-makingValues clarification/ social skills trainingSimulation/ gaming and role playAssertiveness training/ counselling
Changing attitudes and behaviourChanging the lifestyles of individuals
Group work / skills training/ self-help groupsOne-to-one instruction/ Group or individual therapy Written material / Advice
Societal/ environmental changeChanging the physical or social environment
Positive action for under-served groups/ lobbying /Pressure groups/ community development/ community-based work / Advocacy schemes/ Environmental measures / Planning and Policy making/ organisational change/ enforcement of laws and regulations
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Important Elements in Health Promotion o Involves all sectors e.g other government
agencies, private sectors, NGOs not MOH M’sia alone
o Involves whole population, aims at public participation
o Addresses action on health determinantso Uses diverse, but complementary methods
or approaches
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Who promotes health? Agents and Agencies of HP
National GovernmentEg. Dept of Health
Health Promotion Activities
International organisations eg. WHO
National and local media eg . TV, radio, newspaper, internet
National voluntary organisaations and pressure groups
Private preventive medical services Eg. Private health checks
Professional org and trade unions
Local government eg. Teachers, environmental health officers, social workers
National health Service eg. National health development agencies, local heath workers
Police, probation, firefighters Health and Safety Executive
Local community and voluntary groups eg. Youth groups, self-help gps
Workplace employers eg. Occupational health services, human resources managers
Local branches of national organizations
Commercial and industrial orgs, manufactures and retailers
Institutions of higher leaningEg. Universities and collages
Churches and religious orgs
Complementary health practitioners The informal network eg. Family, friends, neighbors
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Factors influencing effectiveness of HP
A) Group attributes• educational level• Knowledge• Channels of communication• Confidence to act• Infrastructure• Leadership -priority
B) Perception of disease• Susceptibility• Severity• Impact on finance, family
C) Perception of action• Socially acceptable• Safety• benefit> cost
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Evaluation in health PromotionDifferent criteria to judge effectiveness of HP intervention
Effectiveness the extent to which aims and objectives
are met
Appropriateness the relevance of the intervention to
needs
Acceptability whether it is carried out in a sensitive
way
Efficiency whether time, money and resources are
well spent, given the benefits
Equity equal provision for equal need 40
Health Promotion at a glance Settings (Where?) – Schools - Work place
- Local community
Specific health issues (Which?) - Mental health - Communicable diseases - Non-communicable diseases - Violence and Accidents
Specific population groups (Whom?) – The poor - Young children - Young people - The elderly - Women
Health promotion activities (How?) - Supporting general condition - Education, training - Social mobilization
Participators/ Observers (Who?) - Politicians, financing [Cost, benefit (short term)] - Health promoting actors [Promising procedures of action,
keeping to HP principles (Ottawa,etc.)]
- Scientists [Measurement of results, evaluation of effects, process evaluation]
- Population [Orientation towards real needs, possibilities of participation] 41
Conclusion
•Health Promotion needs commitment and support from everybody
•Health workers alone is not enough to change the community behaviour
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Religion and Health (The Salutogenic Effect)Religious dimensions
Pathways Mediating factors
Salutogenic mechanisms
Religious commitment
Health –related behavior and lifestyle
Avoidance of smoking, Alcohol, drug use, poor diet, unsafe sex, etc
Lower disease risk & enhanced well-being.
Involvement & fellowship
Social support & Networks
Relationshipsfriends & family.
Stress-buffering, coping and adaptation
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Religion and Health
Figure 1: Pathways of ‘Islamic Health Theory’
Quran & Ahadith
Five Pillars of Islam
Elements of Faith
Islamic Jurisprudence
Salutogenic Mechanism
Sense of coherence
Predisposing &Enabling factors
Behavior
Healthy Lifestyle 44
HEALTH PROMOTION
ACTIVITIES
IN
MALAYSIA
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HEALTH PROMOTION ACTIVITIES IN MALAYSIA
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HEALTH PROMOTION ACTIVITIES IN MALAYSIA
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HEALTH PROMOTION ACTIVITIES IN MALAYSIA
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HEALTH PROMOTION ACTIVITIES IN MALAYSIA
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HEALTH PROMOTION ACTIVITIES IN MALAYSIA
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HEALTH PROMOTION ACTIVITIES IN MALAYSIA
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HEALTH PROMOTION ACTIVITIES IN MALAYSIA
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HP activities on Dengue Prevention
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References1) Agency, P. H. (July 6). Health promotion theories and models.
from http://www.healthpromotionagency.org.uk/Healthpromotion/Health/section5.htm
2)Ewles, L., & Simnett, I. (2003). Promoting Health. A Practical Guide: Bailliere Tindall
3) Gorin, S. S., & Arnold, J. (2006). Health Promotion in Practice: Jossey Bass
4) WHO. Health Promotion. from http://www.who.int/healthpromotion/en/
5). Islam and health promotion By Aisha Omar Maulana, MPH.
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For More Information
1. Cottrell, R. R., Girvan, J. T., & McKenzie, J.Health Promotion and Education (3
rd Edition ed.). Boston: Benjamin Cummings.
2. Tones, K., & Tilford, S. (2001). Health equity (3rd Edition ed.). Cheltenham: Nelson Thornes
3. Kiger, A.M (2004). 3. Kiger, A.M (2004). Teaching for health (3rd Edition ) Churchill Livingstone
4.Naido, J., &Wills, J. (2007). Health Promotion Foundations for Practice (2nd Edition) Royal College of Nursing
5. Elaine M. Murphy, “Promoting Healthy Behavior,” Health Bulletin 2 (Washington, DC: Population Reference Bureau, 2005). Available online at www.prb.org
http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index1.html• http://www.vichealth.vic.gov.au/Publications/VCE/Defining-health-promotion.aspx• uqu.edu.sa/.../Lecture%2053Models%20of%20Health%20Promotion.pp• https://www.google.com/search?
newwindow=1&site=&source=hp&q=caplan+and+holland+1990&oq=Caplan+and+Holland+&gs_l=hp.1.0.0l3j0i22i30l5.8022.16553.0.20230.19.14.0.5.5.0.238.1239.11j2j1.14.0....0...1c.1.32.hp..0.19.1304.7i1RYgF9Bpk
• (Health Promotion :Perspective of Malaysian Health Promotion Board • My Sihat)http://sehat.perkeso.gov.my/panelclinichtml/APS2013/lpkm.pdf
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