Here are the three principles of health promotion from the Ottawa Charter: 1. Enable - This principle aims to enable people to increase control over their own health and its determinants, and thereby improve health. 2. Mediate - This principle acknowledges that health promotion requires coordinated action by all concerned: by governments, by health and other social and economic sectors, by nongovernmental and voluntary organizations, by local authorities, by industry and by the media. 3. Advocate - This principle aims to advocate for health as a positive concept and fundamental human right. It requires the identification of obstacles to the adoption of healthy public policies in non-health sectors, and ways to remove them.

1. 3.2.1 Models of health and health
promotion including:
•Biomedical model of health
•Social model of health
•The Ottawa Charter for Health
Promotion
Key Skills:
The ability to
• analyse the different approaches to health and health
promotion;

2. The language of health:
some key words
 Diagnosis: identification of a disease or illness
through medical observation of signs and
symptoms, the patient’s history and tests
 Intervention: any action to improve health or
cure illness including the use of medication,
hospitalisation or surgery
 Prevention: any action to reduce or eliminate the
onset, causes, complications or recurrence of
disease or illness

3. Assessment
 Student must be able to:
 Explain / outline / define the models of health
 Identify the major components of each model
 Suggest ways that each model could be used to address a
particular health concern
 Evaluate each model with regards to likely success in
various situations
 Identify aspects of the models of health in case studies
 Advantages and disadvantages

4. What is a health model?
 Models of health are ‘conceptual frameworks’
or ways of thinking about health
 Three such models are:
 The Biomedical Model of Health
 The Social Model of Health
 The Ottawa Charter for Health Promotion

5. Definition –
Biomedical Model of Health
 Focuses on the physical or biological
aspects of disease and illness. It is a
medical model of care practised by
doctors and/or health professional
and is associated with the diagnosis,
cure and treatment of disease. (VCAA
HHD Study Design)

6. Biomedical Model of Health
 Has been evolving for many years leading to improvements
in medical science, technology, increase in cures and
treatments ie: increase in vaccinations /immunizations
 Emphasis on diagnosis and treating individuals
separately from their lifestyle/living conditions – this
model of health concentrates on the disease, illness, or
disability and attempts to (cure) return the physical health
of the person to a pre-illness state. The reasons for the
illness are not at the centre of the biomedical model.
 Tends to be the first thing people think of when they think
of health care
 Receives the majority of government healthcare funding
(over 90%)

7. Biomedical Model of Health
 Dominant for many years and played a large role in prolonging
life expectancy
 Bio- living or living organism
 Medical- science of diagnosing-curing disease.
 In the biomedical approach Dr’s and hospitals are the real focus
of medicine or health. The expectation being that the Dr will be
able to fix the condition and the patient will take on a passive
role.
 The 2 aspects of the biomedical approach are:
 Diagnosis: identification of the disease or illness through Dr’s
observations of symptoms or through diagnostic tests e.g. X rays,
Scans, blood tests
 Intervention: action taken to improve health e.g. via medical
treatment, hospitalisation, prescriptions, surgery etc.
****medical intervention with a fix it approach

8. Examples of the Biomedical Model
 X-rays Diagnosis – identification
 Scans of a disease or illness
through a doctor’s
 Blood Test
observation, or through the
 Ultrasound use of specific diagnostic
 Mammograms tests.
 Pap smear tests
Intervention/treatment –
 Prescription Medicine refers to any action that is
 Surgery taken to improve health
 Hospitalisation

9. Biomedical Model of Health
 The WHO defines Health as “A complete state of
physical , social and mental wellbeing, and not
merely the absence of disease of infirmity”
(WHO 1946)
 Does the Biomedical model of health address
this definition? Explain

10. Advantages
 It creates advances in technology and research
 Without this model of health there would be little
known about how to treat and diagnose illnesses
 Many common problems can be effectively treated
 Diseases that would otherwise develop and cause
considerable illness or death can be stopped.
 Extends life expectancy
 Improves quality of life
 Can be successful in returning someone back to good
health

11. Disadvantages
 Relies on professional health workers and technology and is
therefore costly
 Professionals with specialist knowledge needed are expensive to train
 Technology, equipment and technological developments expensive
 Doesn’t promote good health / narrow view of health
 Doesn’t encourage people to live healthy lives as they are treated to fix
problems as they arise. The focus is on the condition and not the
determinants that caused it.
 Not every condition can be treated
 Cancer is an example – advances have been made, but treatment not
always successful
 Affordability – not always affordable
 Not all countries can afford the medical technologies and resources
that are part of the biomedical model of health - an important factor
contributing to differences experienced in health status

12. Case Study- Stephen
Stephen, aged eight, was born with a major kidney
problem, which required surgery when he was eight
months old. His right kidney became badly scarred and
malformed as a result of several bad kidney infections
which required hospitalisation.
Throughout Stephens life his doctor has regularly
monitored the function of Stephen’s kidneys through the
use of urine tests. The consequences of Stephens kidney
failure to cope is dangerously high blood pressure.
Stephen makes regular visits to a renal specialist who uses
an ultra sound to check on his kidney growth and
occasionally Stephen requires nuclear testing with DSMA
scan which involves an injection of radioactive substance
into his blood so doctors can view his kidneys and bladder.

13. Answers
 Reliance on hospitals, medical professions
 X-rays, blood tests , kidney surgery, ultra sound,
nuclear testing DSMA scan, urine tests

14. 2 marks

15. Practise Questions
 TSSM Biomedical approach to health
 Define the Biomedical model of health
 Diagnosis, treatment & cure
 Reliance on health professions ie doctors and medial
specialists
 ‘fix it’ model that focus on the biological/physical
aspects of disease or illness

17. Social Model of Health
 This approach attempts to address the broader
influences on health (social, cultural, environmental and
economic factors) rather than disease and injury.
 It is a community approach to prevent diseases and
illnesses.
 Focus is on policies, education and health promotion.
The Social Model of Health goes beyond the focus of
lifestyles and behaviour and accepts the need for social
change to provide prerequisites for health
 It was developed in the late 1970’s 1980’s as some
members of the community were not experiencing the
same levels as health as others despite the
understanding of the impact of lifestyle and
behaviours on health.

18. Definition – Social Model of Health
A conceptual framework within which
improvements in health and wellbeing are achieved
by directing effort towards addressing the social,
economic and environmental determinants of
health. The model is based on the understanding
that in order for health gains to occur, social,
economic and environmental determinants must be
addressed. (VCAA HHD Study Design)

19. 5 Key Principles (A.R.E.A.S.)
 Addresses the broader determinants of
health
 Reduce social inequities
 Empower individuals and communities
 Access to health care
 Inter-Sectorial collaboration

20. 5 Key Principles (A.R.E.A.S.)
Addresses the broader determinants of health (all aspects of
health are addressed)
 broader determinants such as gender, ethnicity, socioeconomic
state, location and physical environment influence behavioural
determinants and have a strong relationship with health and are
becoming a focus of health promotion strategies.
Reduce social inequities (addresses equity of the social
determinants of health)
 Aims to promote equity for all people and to achieve this the
social determinants which lead to inequality such as gender,
culture, socioeconomic status, location and the physical
environment must be addressed.
Empower individuals and communities (empowers with skills,
knowledge & confidence to make positive decisions re: their
health)
 Empowering individuals and communities with health knowledge
means they have the ability to make positive decisions about their
health and participate in healthy behaviours.

21. Access to health care (accessible and appropriate health
information)
 Access to health care is a significant factor contributing to health
status. This social model of health acts to enable all people to
have access to health care. Social factors that can impact on
access to health care include cultural and language barriers,
economic and geographical factors and education level.
Inter-Sectorial collaboration (c0-ordinated approach health
and government departments)
 By involving all organisations and stakeholders (people with a
shared interest) who have an influence over the social and
environmental determinants of health can all the social
determinant be adequately addressed and affect health status
positively.

22. Advantages – Social Model
 Education for people, so don’t get the disease
 Govt support/strategies e.g. QUIT, TAC, immunization
 Less costly to prevent the disease before it happens
 Encourages individuals to take responsibility and lead
healthier lifestyles => improve quality of life
 Community approach involving all levels of
government, non-government organisations
 Increase economic development of the country as the
population is in good health and lead productive lives

23. Disadvantages – Social Model
 Lack of education for the whole population, some
people don’t get or understand the message
 Population not motivated e.g. suntans, smoking,
overweight.
 Not believing it will happen to them
 Changing lifestyles is VERY hard
 Not all diseases can be prevented
 Results of this method of health are not evident until
after a long period of time and difficult to measure its
effectiveness

24. Examples of the social model of health:
 Go For Your Life Strategy – made up of different government and
non-government stakeholders, targeted approach to education
the whole community and encourages all people to adopt
healthy dietary practises and exercise.
 Sun Smart Schools Program – aims to reduce the exposure of
children to harmful UV rays and educate them about the dangers
of sun exposure.
 Be a Man – Talk to your doctor about Prostate Cancer’ program –
aims to break down cultural beliefs about health held by men
and encourage them to visit a doctor to discuss their health.
 Rural Retention Program (RRP) – federal government provide
financial incentive for Doctors to work in rural/remote areas

25. 5 Key Principles (A.R.E.A.S.)
 Addresses the broader determinants of
health
 Reduce social inequities
 Empower individuals and communities
 Access to health care
 Inter-Sectorial collaboration

26. Using the social model of health
Principle of the Addresses the Involves Acts to reduce Acts to enable Empowers
social model broader intersectorial social access to individuals
determinants collaboration inequities health care and
Issue to be of health communities
Addressed
Mental health Ensure mental Get workplaces Focus on people Provide free Use men as the
issues health to play a part. in indigenous access to promoters of
education and Like the communities or health care programs
advice is workplace those of low assessments to targeting men
available in health checks. SES. those in low to educate men
rural and SES groups, to identify
remote areas. provide symptoms of
information at depression
football Indigenous to
matches, pubs develop and
etc. promote
programs
aimed at
indigenous.
Case study
Your Example

27. Case Study – VicHealth’s Food For All Program
(2011 exam q3)
Section B
3ci) Identify two principles of the social model of health that are relevant to
the Food for All program ( 2 marks)
3cii) Use examples from the Food for All program to demonstrate how these
two principles are reflected in the VicHealth funded program (4 marks)

30. Practise Questions
 VCAA exam 2010 Q3
 TSSM questions – social model of health
 Case study –
 Access all areas: arts program breaks down barrier

32. VCAA prac exam 2010 q4
Address broad determinants of health; aim is to decrease social
inequalities; Increase access to health care for all people
Involves intersectorial collaboration: developed by Peer Support
Program (the centre for Adolescent Health) funded by VicHealth,
Victorian Department of Human Services, Beyondblue

33.  Address all determinants of health – PATS program consisted of a Peer leader who was
responsible for the social aspects of the groups including organising activities and the
socialisation of participants.
 Reduce social inequality – PATS program was a funded program involving young people ) 12 –
18yrs) regardless of gender and SES. 5 programs were conducted across Victoria in various
locations making it available to adolescents in various locations.
 Empower individuals and the community – peer leadership training was provided to the peer
leader, adolescents in the program where provided with knowledge and skills to cope with
the challenges of a parent with mental illness. The PATS program focused on workers,
organisations and the broader community creating awareness of issues affecting young
people with a parent with a mental illness which enable community organisations to
effectively develop resources to support the young people. Seminars and professional
development sessions also provided individuals and communities with information to
address factors affecting their health.
 Accessibility to healthcare – PATS program was facilitated by a health professional in 5
different locations in Victoria providing young people in the programs with access to a
service and information that was appropriated and based on their need. Peer leaders
involved in the PATS program played a role in education and advocacy in the various
locations the program was facilitated across Victoria.
 Sectoral Collaboration – the PATS program was a result of integrated action between the
Centre of Adolescent health, funded by VicHealth, the Victoria Department of Human
Services and Beyondblue.

35. Answer:
 Addresses the broader determinants of health – services provided in
local metro, rural/ remote areas, all genders ethnicity and
socioeconomic groups has access to
 Reduce social inequities – medicare, PBS
 Empower individuals and communities – community health centres,
doctors/dietitians provide life skills education ie selection of low fat
foods
 Access to health care – bulk builing doctors, public hospitals
 Inter-Sectorial collaboration – education in schools, government
and non-government organisations to provide education on weight
loss

38. Ottawa Charter for Health Promotion
 Ottawa – Canada hosted the first international conference on health
promotion in 1986
 Charter – refers to the document that outlines the functions and
principals of health promotion
 In response to the Social model of health the WHO held its first
International Conference on health promotion in 1986 in Ottawa,
Canada.
 Outcome of this conference was a document that provided
organisations and key stakeholders guidelines to help incorporate
health promotion into their strategies, policies and campaigns with the
aim of taking action to achieve ‘health for all by the year 2000 and
beyond’ through health promotion and reduce inequalities in health.
 3 Principles of health promotion
 8 Prerequisites (conditions or resources) for gains in health
 5 Priority or action areas

39. Study Design - Definition
An approach to health development by the World Health
Organization which attempts to reduce inequalities in
health. The Ottawa Charter for Health Promotion was
developed from the social model of health and defines
health promotion as ‘the process of enabling people to
increase control over, and to improve, their health’ (WHO
1998). The Ottawa Charter identifies three basic strategies
for health promotion which are enabling, mediating, and
advocacy. (VCAA HHD Study Design)

40. Health promotion
 Health promotion is the process of enabling people
to increase control over, and to improve, their health.
 Health promotion therefore focuses on prevention
rather than cure and uses the causes of disease as the
starting point rather than diseases themselves
 Population focused

41. Three basic Principle of Health
Promotion
 Enable – Health promotion aims to enable all people to
achieve their fullest health by closing the gaps in health
inequalities by ensuring equal opportunities and resources
for everyone. Reducing differences in health status by
ensuring equal opportunities and resources to make
healthy choices
 Mediate – Professionals, social groups and health
personnel have a major responsibility to mediate
(negotiate) between differing interests in society to achieve
health. Co-ordinated action between all interested parties
ie government, NGO’s, media, health sectors,
 Advocate – supporting and making public health
recommendations for health, getting the message out

42. 8 Prerequisites for health
These 8 conditions or resources
 Peace are the basic prerequisites that
 Shelter underpin any improvements in
 Education health. – Without these
improvements in health are
 Safe and adequate food supply limited
 Adequate income
 A stable ecosystem- a balance between plants and animals
in the environment which is important for many health
resources such as food, water and air
 Sustainable resources- the need to sustain the many
resources needed for health (food, water, income - funding,
building supplies, oil) for future generations to benefit
 Social justice and equity- all people being valued and
receiving fair treatment so all people share the benefits of
society

43. 5 Priority or Action areas
That should be taken into account when devising health
promotion initiatives
1. Build healthy public policy
2. Create Supportive Environments:
3. Strengthen Community Action:
4. Develop Personal Skills:
5. Reorient Health Services:
(Bad Cats Smell Dead Rats)

44. Build healthy public policy
• Relates directly to the decisions made by the government
and organisations in relation to laws, regulations and
policies that affect/improve health.
• Examples, increasing taxes on certain alcoholic drinks which
makes participating in unhealthy behaviours more difficult
thereby reducing exposure to determinants that can cause ill
health.
• Some policies and laws are designed to make the environment
healthier for those who chose not to participate in unhealthy
behaviours ie banning smoking in public places.
• Some laws are designed to directly influence behaviour ie
wearing seat belts, safety restraints for children.
• Some law aim to deglamourise unhealthy behaviours – plain
cigarette packaging

45. Create Supportive Environments
• A supportive environment is one that promotes health
and assists people in making healthy lifestyle choices.
This priority recognises the impact that broader
determinants have on health and aim to promote a
healthy physical and social environment for the
community to allow people to live healthy lives.
• Examples – Quit line – a support service for people
wanting to quit smoking, Providing shaded areas in
schools – reduces exposure to UV rays, Sustainable energy
production – ensures future generations have access to a
healthy environment. Occupational Health and Safety
Officers
• Government childcare schemes,
• Walking and bicycle tracks to encourage physical activity

46. Strengthen Community Action:
• Focuses on building links between individuals and the
community and the centres around the community
working together to achieve a common goal. Skills
need to be developed in the community in order for action
to be taken to improve healthy.
• Giving the community a sense of ownership of a health
strategy increases the likelihood of its effectiveness.
• Example: Governments immunisation strategy involves
the media, doctors, schools, parents Neighbourhood
Watch and Safety House Programs, Driver Reviver Stations

47. Develop Personal Skills
• Education is the key aspect of this priority. It refers to
gaining knowledge and life skills to make informed
decisions that may indirectly effect their health.
• Personal skills need to be developed to assist people to live
healthy lives
• Many parts of society have a role in educating – school,
work, families, government, non-government
organisations
 Examples: Developing skills to read food labels and
select healthy foods, develop financial and budgeting
skills, practising safe sex, being sun smart, exercising
as part of one’s life, healthy eating habits

48. Reorient Health Services
• Refers to reorienting the health system so that it promotes
health as opposed to only focussing on diagnosis and
treating illness, as is the case with the biomedical model.
• To reorient health services, the health system must encompass
not only doctors and hospitals, but all members of the
community including individuals, community groups, health
professionals, health service institutions and governments.
• This priority area suggest incorporating health promotion to
play a more significant role thereby addressing all the
determinants of health, not just disease.
• Example – focusing on healthy eating rather than on surgery to
reduce the impact of CVD, doctors prescribing activity before
the development of damaging conditions such as type 2
diabetes, self-hep groups, police and emergency services (ie Fire
Brigade) working with schools to support road education
programs,

49.  The Ottawa Charter provides governments and health
promotion organisations with an effective tool to use
when planning effective strategies.
 However it is not necessary to address all five priority
areas and some effective programs may only focus on
one or two priority areas.
 Focusing on all five areas may spread resources too
thinly, meaning the strategy may not achieve its goals.
 Oxford handout

50. Arrive Alive Campaign (2008 – 2017) is the
Victorian Government’s road safety strategy.
 Through this strategy the Vic government has: built
healthy public policy by :
 introducing an additional requirement for registration
of new cares – cars manufactured after 31.12.10 must be
fitted with electronic stability control, cars
manufactured after 31.12.2011 must be fitted with head
protecting technology such as side curtain airbags.
 Graduated Licensing system (GLS) for young drivers
(1.7.08) to ensure young drivers get adequate supervision
and experience as learners.

51. Arrive Alive Campaign
 Created supportive environments: by funding a
major infrastructure program to improve roads and
roadside in Victoria aimed to reduce the most
common types of crashes as well as a heightened
enforcement effort.
 Develops personal skills through a public awareness
campaign focused on reducing driving under the
influence of drugs.
 Build healthy public policy: laws and legislation –
50km zones, 40 zones near schools, Graduated
Licensing System

52. Using the Ottawa Charter
Element of the Build public Create Strengthen Develop Reorient health
Charter health policy supportive community personal skills services
environments action
Issue to be
Addressed
childhood obesity Develop a healthy Run a breakfast Develop a whole Teach students Invite a local Dr.
in primary schools lunch policy. program and school approach about healthy or dietitian to talk
Tax on junk food make the canteen to healthy eating eating so they can about the dangers
a healthy food and include make healthy of unhealthy
zone. healthy recipes in choices in food eating.
the school technology and
newsletter health classes
the issue of Anti-bullying Provide safe Whole school Parenting School nurse /
bullying in schools policy in schools places during approach to anti- courses, self- counsellor /youth
recess and lunch bullying esteem and ‘no worker providing
breaks blame’ classes health promotion
for students education to
students

53. Case Studies and exam questions
Case Studies and exam questions
Cancer is the correct disease
Build Healthy Public Policy – Government puts in place policies re tobacco
smoking – e.g. none in covered areas e.g. hotels, restaurants that limit where
people are able to smoke, governments increase taxes on cigarettes to deter
purchase and reduce risks

56. Answer:
 Create supportive environments – provides support groups
for indigenous diabetics, where families learn to cook
together and share meals with other families dealing with
diabetes. The scheme promotes group sharing and provides
a non-threatening atmosphere where people can ask
questions and receive answers.
 Develop personal skills – the program provides education
about managing diabetes. It improves cooking skills as well
as understanding about diabetes. It also improves
communication skills and raises the confidence of
participants. Visual posters to educate understanding of
diabetes and how to monitor blood glucose levels.

57. Activities
 VCAA exam 2011
 DVD