Health education and health promotion

Bojana MatejićAssociate Professor of Social Medicine

2013

What is health?

Determinants of health

• Our health is influenced by many factors

• These factors could be categorized into three groups:

– Internal determinantsInternal determinants

– External determinantsExternal determinants

– Prevalent system of health care Prevalent system of health care

The fundamental conditions and resources forhealth are:

• peace,• shelter,• education,• food,• income,• a stable eco-system,• sustainable resources,• social justice, and equity.

Improvement in health requires a secure foundation in these basic prerequisites.

Prerequisites for Health

Health and behavior

Health is associated with our own actions!

Think of an important health problem in your community.

What behavior cause and spread the problem?

What behavior prevents it?

Think of an important health problem in your community.

What behavior cause and spread the problem?

What behavior prevents it?

The Context of Health and Behavior

• The most frequent causes of death in the developed countries and globally are chronic diseases, including heart disease, cancer, lung diseases, and diabetes.

• Behavioral factors, particularly tobacco use, diet and activity patterns, alcohol consumption, sexual behavior, and avoidable injuries are among the most prominent contributors to mortality

(Schroeder, 2007; Mokdad, Marks, Stroup, and Gerberding, 2005).

• Projections of the global burden of disease for the next two decades include increases in noncommunicable diseases, high rates of tobacco-related deaths, and a dramatic rise in deaths from HIV/AIDS

• Malaria, diarrheal diseases, and other infectious diseases, in addition to AIDS, are major health threats to the poorest people around the world

The Changing Context of Health and Behavior

The trajectory of infectious diseases and also chronic diseases, may be influenced by the application of effective health behavior intervention

The trajectory of infectious diseases and also chronic diseases, may be influenced by the application of effective health behavior intervention

Why do people behave as they do?• Predisposing factors -knowledge, attitudes, beliefs, personal preferences, existing

skills, and self-efficacy towards the desired behavior change.

– motivate an individual or group to act

• Reinforcing factors include factors that reward or reinforce the desired behavior

change, including social support, economic rewards, and changing social norms.

– strengthen or inhibit the motivation to act

• Enabling factors are skills or physical factors such as availability and accessibility

of resources or services that facilitate achievement of motivation to change behavior -

facilitate the motivation to act

Health education

• The recognition that individual behavior plays an important role in the development of many health problems influenced the development of health education as professional and scientific field

Health education

• Health education is a 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 behavior change activities

• Health education is the development of individual, group, institutional, community and systemic strategies to improve health knowledge, attitudes, skills and behavior.

The purpose of health education is to positively influence the health behavior of individuals and communities as well as the living and working conditions that influence their health.

The purpose of health education is to positively influence the health behavior of individuals and communities as well as the living and working conditions that influence their health.

Health education-definition

• "any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire information and the skills needed to make quality health decisions." (The Joint Committee on Health Education and Promotion Terminology, 2001)

• Health Education comprise of consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge, and developing life skills which are conducive to individual and community health (WHO, 1989)

Health literacy

• Health literacy represents the cognitive and social skills necessary to understand and use information, and to take action in ways that promote and maintain good health, including changing lifestyles and living conditions

• Health literacy is an individual's ability to read, understand and use healthcare information to make decisions and follow instructions for treatment

Studies reveal that up to half of patients cannot understand basic healthcare information! Studies reveal that up to half of patients cannot understand basic healthcare information!

Why is health education important?

• Health education improves the health status of individuals,families, communities, states, and the nation

• Health education enhances the quality of life for all people

• Health education reduces premature deaths

• By focusing on prevention, health education reduces thecosts (both financial and human) that individuals, employers,families, insurance companies, medical facilities, communities,the state and the nation would spend on medical treatment

Who provides health education?

• Medical professionals specialized in health education (trained and/or certified health education specialists).

• Others perform selected health education functions as part of what they consider their primary responsibility (medical treatment, nursing, social work, physical therapy, oral hygiene, etc.).

• Other professionals are responsible to do specific, limited educational tasks to encourage healthy behavior.

Communication

Information flowOne-way-flowof information

Two-way-flowof information

Mass media..…..lectures…...demonstrations…..…small groups…..…dialog

Health education: traditional approach

• Making individuals aware of negative consequences of

behaviour for health by providing knowledge and

information

• Characterised by:

– medical practice

– target group is empty vessel

– human as logical information processor

– victim blaming

health educatorhealth educator information information target grouptarget group

Remember…

• Knowledge is important but insufficient

• Motivation, skills, social

and physical environment

• Members of target groups are experts too

strongly influenceindividual behaviorstrongly influence

individual behavior

Health education nowadays: definition

Consciously constructed opportunities for learning,

designed to improve health literacy, including improving

knowledge, and developing life skills, which are

conducive to individual and community health (WHO, 1998)

Preferably designed together with (representatives of) the

target population (Koelen & van den Ban, 2004)

health educatorhealth educator information information target grouptarget group

An additional move in improving public health

• Based on the notion that health is not only influenced by biology and individual behaviour (lifestyle)

• but also by the social and physical environment, and the system of health care

• The process of enabling individuals and communities to

increase control over the determinants of health, and

thereby to improve their health (WHO, 1998)

Health promotion

Making healthy choices easy choicesMaking healthy choices easy choices

Health promotion action areas

• Build healthy public policy

• Create supportive environments

• Strengthen community actions

• Develop personal skills

• Reorient health services

Charter of Ottawa, WHO, 1986

Healthy Public Policy

• 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.

Health in All Policies: strengthening the link between health and other policies

• Health in All Policies is an encompassing approach which goes beyond the boundaries of the health sector.

• 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

• EU regulatory framework is (in principle) in place to extend the impact assessment of regulations and policies to health protection, but so far this has not been particularly evident.

Supportive Environment

• Supportive environments cover the physical, social, economic, and political environment.

• Supportive environments encompass where people live, work and play

• Everyone has a role in creating supportive

environments for health.

Strengthen Community Action

• Health promotion is carried out by and with people, not on or to people. It improves both the ability of individuals to take action, and the capacity of groups, organizations or communities to influence the determinants of health.

• Improving the capacity of communities for health promotion requires practical education, leadership training, and access to resources.

• Empowering individuals demands more consistent, reliable access to the decision-making process and the skills and knowledge essential to effect change.

Strengthen Community Action: community Participation

• 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

• Full community participation occurs when communities participate in equal partnership with health professionals as stakeholders in setting the health agenda.(Rifkin et al. 1988)

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.

Develop Personal Skills

• Skills which can promote an individual’s 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.

Reorientation of 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

Three basic health promotion strategies

• Enable

• Mediate

• Advocate

Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential

This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women and men.

Enable

Health promotion demands coordinated action by all concerned: by governments, by health and other social andeconomic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and by the media.

Professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health.

Health promotion strategies and programmes should be adapted to the local needs and possibilities of individual countries and regions to take into account differing social, cultural and economic system

Mediate

Advocate

Good health is a major resource for social, economic and personal development and an important dimension of quality of life.

Political, economic, social, cultural, environmental,behavioural and biological factors can all favour health or be harmful to it.

Health promotion action aims at making these conditionsfavourable through advocacy for health

Moving into the Future Health is created by caring for oneself and others, by being able to take decisions and have control over one’s life circumstances, and by ensuring that the society one lives in creates conditions that allow the attainment of health by all its members.

Caring, holism and ecology are essential issues indeveloping strategies for health promotion.

Therefore, those involved should take as a guiding principle that, in each phase of planning, implementation and evaluation of health promotion activities, women andmen should become equal partners

Thank you!