it is very useful for the health promotion team

1. Approaches to Health
Promotion
Puja Myles
Puja.myles@nottingham.ac.uk

2. Learning Outcomes
• To recognise the ethical and philosophical
principles underpinning health promotion
practice
• To categorise and describe various
approaches to health promotion
• To choose an appropriate health
promotion approach in different contexts

3. Session Outline
• The context of health promotion:
individuals vs. population
• Intervention ladder and ethical
underpinnings
• Approaches to health promotion
• Social Marketing and Media Advocacy
• Group exercise

4. The context of health
promotion: individual vs.
population

5. Sick individual and sick
populations (Rose)
• Populations as a whole may be susceptible to a
particular disease
• Not all individuals belonging to a susceptible
population get that disease
• Determinants of illness (or health) are different
depending on the level: individual or population
Should health promotion practice focus on
individual determinants of health or population
determinants?

6. Ethical and philosophical
principles underpinning health
promotion practice

7. Why should you concern yourselves with
ethics and philosophy?
Does the choice of health promotion
model and approach by an individual,
organisation or government reflect
particular individual and societal values?

8. Why is state intervention
required?
• Tension between autonomy and state
paternalism
• Does the state have a duty to protect its citizens
and if yes, under what conditions?
– The concept of ‘public goods’
– Beneficence
– Non-maleficence
– Respect for autonomy
– Justice
– Equity, equality

9. Approaches to Health
Promotion

10. 3 main approaches
• Behavioural approaches
• Self-empowerment approaches
• Collective action or community
development approaches
These are not mutually exclusive!!

11. Other ways of approaching
Health Promotion
• Targeted versus universal approaches
• Settings approach
• Ecological or whole-systems approach

12. Targeted vs. Universal
approaches
• Targeted (high-risk) approach: Identify
individual person or group of people at
high risk, offer advice & treatment
• Universal (population) approach: Lower
the average level of risk in the population

13. Prevention Paradox
A large number of
people exposed to a
small risk may
generate many more
cases than a small
number exposed to
high risk.
A preventive measure
that brings large
benefits to the
community offers
little to each
participating
individual.

14. Settings
From Ottawa Charter:
• “Health is created & lived by people within
the settings of their everyday life: where
they learn, work, play and love”.
– Schools
– Workplaces
– Homes
– Communities
– Cities

15. Settings
WHO 1998 definition:
• “…identified as having physical
boundaries, a range of people with defined
roles and an organisational structure …”

16. Settings
Settings approach
– Enables access to groups or individuals
– Focus: whole ethos of the setting is health
promoting (holistic approach)
– Integration of health promotion into the daily
activities of the setting
– Example: ‘health promoting schools’ rather
than ‘health promotion in schools’
– Creation of conditions for reaching out into the
community

17. Settings
• Who is left out?
– Constrained to those within setting?
• Possible solutions:
– Go for novel settings
– Demands organisational change &
commitment
– Balance between top-down and bottom-up
approaches

18. 2 useful additions to your
Health Promotion toolkit

19. Social Marketing
• Included in behaviour change approaches
• The adaptation of commercial marketing
techniques to achieve specific behavioural goals
for a social good.
• “A social change campaign is an organized
effort conducted by one group (the change
agent) which attempts to persuade others (the
target adopters) to accept, modify, or abandon
certain ideas, attitudes, practices or behaviour.”
--Kotler, Roberto, & Lee, 2002
– Consumer-oriented approach, but…
– Contrast with commercial marketing: profit goal

20. Media Advocacy-1
• Not a health promotion approach per se but a
means of getting an issue on the policy agenda
• Kingdon’s policy model:
Windows of opportunity when coupling of
three streams occurs: problems, policy
(technically feasible and sustainable solutions)
and politics (commitment)

21. Media Advocacy-2
Media advocacy by ‘policy entrepreneurs
(like you!!) could result in the recognition
of an issue as a problem, create
awareness of possible solutions and
generate wide scale political commitment

22. Further reading-1
1. Nuffield Council on Bioethics (2007). Public Health:
Ethical Issues
http://www.nuffieldbioethics.org
2. Oxford Handbook of Public Health Practice 2nd ed.
(2006):
Chapter 1.7 (Pp. 64-70): Understanding ethics in Public
Health (Angus Dawson)
Chapter 4.7 (Pp. 348-353): Influencing governments via
media advocacy (Simaon Chapman)
Chapter 3.7 (Pp. 266-275): The public health response to
‘hard to reach’ populations

23. Further reading-2
3. Social Marketing- Big pocket guide (2007)
http://www.nsms.org.uk
4. Rose, G. (2001). Reiteration: Sick Individuals and sick
populations. International Journal of Epidemiology; 30:
427-432

24. Scenario 1:HIV/AIDS
• Targeted (high-risk) or Universal
(population) approach?
• Behavioural/Self-
empowerment/Community Development
approach?
• What are the values and assumptions
underlying your choices?

25. Scenario 2: Obesity
• Does the state or its agents (NHS/Public
Health?!) have a duty to intervene?
• Look at the intervention ladder- which
rungs would you choose?
• What approaches would you use:
behavioural/self-empowerment/community
development?
• What values and assumptions underpin
your choices?