HEALTH PROMOTIONGINA F. PARDILLA, M.D.M.P.H.

CONCEPTS AND DEFINITIONS

1945: HENRY E. SIGERIST, medical historian defined the 4 major tasks of medicine as

1. promotion of health2. Prevention of illness3. Restoration of the sick4. rehabilitation

DEFINITION OF HEALTH

HEALTH IS MULTIDIMENSIONAL, COMPOSED OF DIFFERENT BUT INTERRELATED DIMENSIONS.

SIX DIMENSIONS OF HEALTH

PHYSICAL- body shape, size , functionMENTAL- ability to think clearly abd coherentlyEMOTIONAL- affective healthSOCIAL- ability to make and sustain

relationships with peopleSPIRITUAL- refers to personal beliefs and

behaviorSOCIETAL- everything surrounding a person in

immediate or wider environment

The continuum of health

I’m ill ( Not at all healthy, impaired function, symptoms present, illness present)

or I’m not ill( perfect or optimal health, high level of well being)

The continuum allows for movement along the line, reflecting the dynamic nature of health which varies over time with age, stage of development and changing circumstances

WHO DEFINITION ( 1946)

HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY

“ health is promoted by a decent standard of living, good labor conditions, education, physical culture, means of rest and recreation”

1986: WHO, Health and Welfare Canada and the Canadian Public Health Association organized an International Conference on Health Promotion which was adopted by 212 participants from 38 countries

WHO AMENDED DEFINITION BASED ON OTTAWA CHARTER (1986)

HEALTH IS AN EXTENT TO WHICH AN INDIVIDUAL OR GROUP IS ABLE TO REALIZE ASPIRATIONS, TO SATISFY NEEDS, AND TO CHANGE OR COPE WITH ENVIRONMENT. HEALTH IS THEREFORE SEEN AS A RESOURCE FOR EVERYDAY LIFE, NOT THE OBJECTIVE OF LIVING. HEALTH IS A POSITIVE CONCEPT, EMPHASIZING SOCIAL AND PERSONAL RESOURCES, AS WELL AS PHYSICAL CAPACITIES.

Ottawa Charter recommended the following action areas:

1. Build healthy public policy2. Create supportive environments3. Strengthen community action4. Develop personal skills5. Reorient health services

OTTAWA CHARTER FOR HEALTH PROMOTION

Defines health as “the process of enabling people to increase control over and to improve their health”

Health is seen as a resource for everyday life, not the objective for living

Therefore, health promotion is not just responsibility of the health sector but goes beyond health lifestyles to well-being

MODELS OF HEALTH AND ILLNESS

1. THE MEDICAL MODEL- the intention is to remove the identifiable cause of the problem, returning the patient to a normal state.

2. THE SOCIAL MODEL – Improved health comes from improved environmental and living conditions

3. THE PATIENT CENTERED MODELPatient’s perception of their physical and

psychological health is important for more holistic assessment

Fundamental conditions and resources for health

1. Peace2. Shelter3. Education4. Food5. Income6. Stable eco-system7. Sustainable resources8. Social justice9. equity

WHO PRINCIPLES OF HEALTH PROMOTION

1. Involves population as a whole rather than focusing on people at risk from specific diseases

2. Directed towards action on the determinants of health

3. Combines diverse but complimentary approaches against health hazards

4. Aims particularly at effective and concrete public participation

5. Primarily a societal and political venture, not a medical service

HEALTH BELIEFS

Nurses need to have an informed understanding of the diversity of health beliefs because of their significant position as “intermediaries” between medical and lay belief systems

Have sensitivity to people’s subjective experience of illness and open-mindedness regarding limitations of medical approach

LAY BELIEFS ABOUT THE CAUSES OF ILLNESS

INDIVIDUAL LEVEL THEORIES- EMPHASIZE MALFUNCTION WITHIN THE BODY

NATURAL WORLD THEORIES- SEEKS EXPLANATION IN CLIMACTIC CONDITIONS

SOCIAL WORLD THEORIES- TEND TO BLAME OTHER PEOPLE LIKE INTERPERSONAL CONFLICT, WITCHCRAFT, SPELLS, ETC

SUPERNATURAL WORLD THEORIES- SEEKS EXPLANATION IN GODS, ANCESTORS OR SPIRITS

Becker’s health belief model

HBM explain how people behave in relation to their health. Participation in preventive health behavior which should decrease the risk of illness, is predicted on the basis of the ffg: HOW THE INDIVIDUAL PERCEIVES:

Susceptibility to a given disorderSeriousness or severity of disorderBenefits of taking actionBarriers to actionIndividual’s experiences of cues to actionHealth motivation- how highly a person values

health.

NURSES ROLE AND APPLICATION OF HBM

Nurses should offer factual, balanced health information that clearly indicated individual susceptibility or risk. Language and images used are important considerations, especially in children and people with learning disability.

Shock tactics, moral judgments or emotive language unhelpful and may alienate patients.

HEALTH EDUCATION

“Any combination of learning experience designed to facilitate voluntary adoptions of behaviors conducive to health”(Green et al 1980)

Covers the continuum of the levels of prevention

Activities: health information, communication, social marketing,etc.

LEVELS OF PREVENTION

Primary: health promotion and specific protection

Secondary: early diagnosis and prompt treatment

Tertiary: disability limitation and rehabilitation

THEORIES OF HEALTH PROMOTION

1. Pender’s Health Promotion Theory2. Bandura’s Self Efficacy Theory3. Health Belief Model

PRIMARY HEALTH CARE

WHO: essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation at a cost the community and country can afford at every stage of development

Declared during the first International Conference on PHC in Alma Ata, USSR on September 6-12, 1978

PRIMARY HEALTH CARE

GOAL: “Health for all by the year 2000”Adopted in the Philippines through LOI

949 signed by Pres. Marcos on October 19, 1979

And has an underlying theme “Health in the Hands of the people”

ELEMENTS /COMPONENTS OF PHC

1. Environmental sanitation2. Control of communicable diseases3. Immunization4. Health Education5. Maternal and Child Health and Family Planning6. Adequate Food and Proper Nutrition7. Provision of Medical Care and Emergency

Treatment8. Treatment of Locally Endemic Diseases9. Provision of Essential Drugs

FOUR CORNERSTONES/PILLARS IN PHC

ACTIVE COMMUNITY PARTICIPATION

INTRA AND INTERSECTORAL LINKAGES

USE OF APPROPRIATE TECHNOLOGY

SUPPORT MECHANISM MADE AVAILABLE

STRATEGIES IN PHC

1. Reorientation and organization of the national health care system with the establishment of functional support mechanism

2. Effective preparation and enabling process for health action at all levels

3. Mobilization of the people to know their communities and identifying their basic health needs

4. Development and utilization of appropriate technology on local indigenous resources available in and acceptable to the community

STRATEGIES OF PHC

5. Organization of communities arising from their expressed needs which they have decided to address

6. Increased opportunities for community participation in local level planning, management, monitoring, and evaluation within the context of local regional and national objectives

strategies

7. Development of intra-sectoral linkages with other government and private agencies

8. Emphasizing partnership so that health workers and community view each other as partners rather than merely as providers and receivers of health care

THE PHILIPPINE PUBLIC HEALTH SYSTEM