1. The document defines key terms related to health promotion and outlines the five principles of the Ottawa Charter for health promotion. 2. It describes different approaches to health promotion, including medical, behavioral change, educational, empowerment, and societal change approaches. Examples are given for each. 3. The importance of health promotion is discussed in terms of changing disease patterns, rising healthcare costs, the role of populations in improving health, and limitations of medical services. Health promotion aims to empower individuals and communities.

1. Dr. Swe Swe Latt
M.B.,B.S, M.Med.Sc (Public Health)
Lecturer
Community Medicine Department
KOM

2. 2
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)

3. HEALTH?
Dimensions of Health?
Factors influencing on Health?
Promotion, Protection, Prevention?
3Health Promotion ( DRSSL)

4. Factors Influencing on health
Human rights
Biological
Justice
Gender
Inf & com
Science
&Tech
Aging of pop
Socio-cultural
Health system
Socio-
economic
Environmental
Behavioral
communiti
es
Societies
Families
Individual

5. 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/ antismoking
5.Alcohol and drug use
6.Oral health
7.Mental health and mental
disorders
8.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 groups
Eg:
1.unintentional injuries
2.Occupational safety and
health
3.Env health hazards
4.Food and drug safety
5.Fluoridation of water for
oral health
6.Industrial chemicals
7.Exposure to lead
8.Air pollutants
9.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)
5
Health Promotion ( DRSSL)

6. 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
6
Health Promotion ( DRSSL)

7. 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

8. A Framework for Health Promotion Activities
8

9. Health Promotion Process
9
Health Promotion ( DRSSL)

10. 10Health Promotion ( DRSSL)

11. 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
11Health Promotion ( DRSSL)

12. Principles of Ottawa Charter
12Health Promotion ( DRSSL)

13. 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
13Health Promotion ( DRSSL)

14. 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
14Health Promotion ( DRSSL)

15. 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.
15

16. 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
16Health Promotion ( DRSSL)

17. 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
17

18. 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.
18
Health Promotion ( DRSSL)

19. The Health Promotion emblem and its
interpretations in successive conferences
• Ottawa 1986
• Adelaide 1988
• Sundsvall 1991
• Jakarta 1997
• Mexico 2000
• Bangkok 2005
• Nairobi 2009
19

20. 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
20
Why do we need to do health promotion?
Health Promotion ( DRSSL)

21. 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 2.40
http://www.epha.org/a/547
21
Health inequalities according to educational
level in different welfare regimes: a comparison
of 23 European countries
Health Promotion ( DRSSL)

22. 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
22Health Promotion ( DRSSL)

23. 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
23Health Promotion ( DRSSL)

24. 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
24Health Promotion ( DRSSL)

25. 25
Treatment paradigm
 brings a person to the neutral point, where the
 symptoms of disease have been alleviated
Wellness paradigm
which can be utilized at any point on the
continuum, helps a person to move toward
higher level of wellness
Health Promotion ( DRSSL)

26. FIVE APPROACHES
TO HEALTH PROMOTION
26Health Promotion ( DRSSL)

27. Approaches to health promotion
• Medical or preventive Approach
• Behaviour change Approach
• Educational Approach
• Empowerment Approach
• Societal change Approach
27Health Promotion ( DRSSL)

28. 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. Immunization
Screening for HT
PAP 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
disorders
Activity-
encourage people
to seek early
detection and
treatment of
smoking- related
disorder
28

29. 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 smoking
Activity-
persuasive
education to
prevent non-
smokers from
starting and to
persuade smokers
to stop
29

30. 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
30

31. Five Approaches to Health Promotion
Summary and Example
Approach Aim Health
promotion
activity
Important
values
Example -
smoking
Client-
centered/
Empower
ment
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.
31

32. 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/social
environment
Right and need
to make
environment
health-
enhancing
Aim-
Make smoking
socially
unacceptable, so it
is easier not to
smoke than to
smoke
Activity-
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’ sponsorship
32

33. 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
structures
E Public Policy: local policies related to
healthy practices
33
Health Promotion ( DRSSL)

34. 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.
34

35. A Flowchart for Planning and Evaluating
Health Promotion
35

36. 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-empowering
Improving self-awareness, self-
esteem, decision-making
Group work / Practicing decision-making
Values clarification/ social skills training
Simulation/ gaming and role play
Assertiveness training/ counselling
Changing attitudes and behaviour
Changing the lifestyles of
individuals
Group work / skills training/ self-help groups
One-to-one instruction/ Group or individual therapy
Written material / Advice
Societal/ environmental change
Changing 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 36

37. 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 determinants
o Uses diverse, but complementary methods
or approaches
37Health Promotion ( DRSSL)

38. Who promotes health? Agents and Agencies of HP
National Government
Eg. 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 leaning
Eg. Universities and collages
Churches and religious orgs
Complementary health practitioners The informal network eg. Family,
friends, neighbors
38

39. 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
39Health Promotion ( DRSSL)

40. Evaluation in health Promotion
Different 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

41. 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

42. Conclusion
•Health Promotion needs commitment and
support from everybody
•Health workers alone is not enough to
change the community behaviour
42Health Promotion ( DRSSL)

43. 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
Relationships
friends &
family.
Stress-
buffering,
coping and
adaptation
43

44. 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

45. HEALTH PROMOTION
ACTIVITIES
IN
MALAYSIA
45Health Promotion ( DRSSL)

46. HEALTH PROMOTION ACTIVITIES IN MALAYSIA
46Health Promotion ( DRSSL)

47. HEALTH PROMOTION ACTIVITIES IN MALAYSIA
47Health Promotion ( DRSSL)

48. HEALTH PROMOTION ACTIVITIES IN MALAYSIA
48Health Promotion ( DRSSL)

49. HEALTH PROMOTION ACTIVITIES IN MALAYSIA
49Health Promotion ( DRSSL)

50. HEALTH PROMOTION ACTIVITIES IN MALAYSIA
50Health Promotion ( DRSSL)

51. HEALTH PROMOTION ACTIVITIES IN MALAYSIA
51Health Promotion ( DRSSL)

52. HEALTH PROMOTION ACTIVITIES IN MALAYSIA
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53. 53Health Promotion ( DRSSL)

54. 54Health Promotion ( DRSSL)

55. HP activities on Dengue Prevention
55Health Promotion ( DRSSL)

56. 56Health Promotion ( DRSSL)

57. References
1) Agency, P. H. (July 6). Health promotion theories and models.
from
http://www.healthpromotionagency.org.uk/Healthpromotion/Healt
h/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.
57Health Promotion ( DRSSL)

58. 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 58

59. 59

60. 60Health Promotion ( DRSSL)