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Oxford Textbook of Public Health, Marcia Hills and Simon Carroll

By: Izzeldin F. Adam, BPEH, MPH
Department of International Health, TMDU
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Concept and definitions
Health education
Beliefs and approaches in health promotion
Health promotion strategies and priority
actions
Public health, social movement, health
inequity and millennium goals
Canadian experience in health promotion
Conclusion




-

health promotion is centered on the values and
principles of equity, participation, and
empowerment.
health promotion must be much more active in
supporting the global efforts to address equity in
health and development represented on
the UN's MDGs
WHO's Commission on the Social Determinants of
Health


„the process of enabling people to increase control
over, and to improve their health‟ (WHO,1986)‟.



„Health promotion represents a comprehensive
social and political process, it not only embraces
actions directed at strengthening the skills and
capabilities of individuals, but also action directed
towards changing social, environmental and
economic conditions so as to alleviate their impact
on public and individual health. Health promotion is
the process of enabling people to increase control
over the determinants of health and thereby
improve their health (WHO 1998)‟.




Any intentional activity which is designed to
achieve health or illness-related learning, that
is, some permanent change in an individual's
capability or disposition‟ (Tones 2004: 7).
Freire proposes that the main strategy of
empowerment education, critical dialogue, requires
us to engage in a process of problem posing rather
than a process of problem solving.


All people have strengths and are capable of determining their own needs, finding
their own answers, and solving their own problems.



Every person and family lives within a social-historical context that helps shape their
identity and social relationships.



Diversity is positively valued.



People without power have as much capacity as the powerful to assess their own
needs (people are their own experts).



Relationships between people and groups need to be organized to provide an equal
balance of power (professional/client ).



The power of defining health problems and needs belongs to those experiencing the
problem.



The people disadvantaged by the way that society is currently structured must play
the primary role in developing the strategies by which they gain increased control over
valued resources.



Empowerment is not something that occurs purely from within (only I can empower
myself), nor is it something that can be done to others (we need to empower the
group).



Shared power relations do not deny health professionals their specialized expertise
and skills.
Approach

medical

Behavioral

Socio-ecological

Health
concept

Biomedical;
absence of disease
or disability

Individualized;
physical-functional
ability; physical
well-being

Positive state; connectedness;
ability to do important things;
psychological well-being

Health
determinants

Disease categories, Behavioral risk
physiological risk
factors (unsafe sex)
factors (hyper.)

Psychological risk factors
(isolation); socioenvironmental risk condition
(poverty)

Principle
strategy

Surgery; drug
therapy; illness
care; medically
managed
behavioral change

Advocacy for
healthy life style
choices

Personal empowerment; small
groups development;
community organization ;
coalition advocacy, political
action

Program
development

Professionally
managed

Negotiated with
individuals
communities and
professional

Managed by community in
critical dialogue with
supporting professionals and
agencies
1.

Advocacy for health to create the essential
conditions for health;

2.

enabling all people to achieve their full health
potential; and

3.

mediating between the different interests in
society in the pursuit of health
Strengthen
community
action
Create
supportive
environments

3
2

Build healthy
public policy

1

Develop
personal
skills

4
Health
promotion

5

Re-orient
health
services






policy action must come from policy
sectors other than health but the
health sector would play a role in
public policy action. how?
Healthy public policy requires the
coordinated use of all policy levers
available, including „legislation,
fiscal measures, taxation, and
organizational change.
Healthy public policy requires the
identification and removal of
obstacles to the adoption of healthy
public policies in non-health sectors








National health policy for food and
drugs
National health policy for protection
of water and environment
National health policy for health care
and health insurance.
National health policy for social
insurance, equity and social justice.
National policy for socio-economic
development.
National policy for health promotion
National policy for ……etc.


Both the natural and built environments
are inextricably linked with people's
health.



It involves creating conditions that allow
people to have „living and working
conditions that are safe, stimulating,
satisfying, and enjoyable.



both past endeavors and future
prospects, one must take into account
the lofty ambition of this programme of
action (HIA, EIA)
strengthening the capacity of
people as active citizens through
their community groups,
organizations and networks to
address and prioritize their
problems, shape and determine
change in their communities.
 The foundational principles for
community development are:
• Empowerment
• Community competence
• Participation
• Issue selection
• Creating „critical consciousness‟

Supporting personal and
social development through
providing information,
education for health, and
enhancing life skills.
 while we must be vigilant
against the temptation and
limitations of an individually
focused, skills development
approach, we must also reengage with the most
advanced and progressive
elements in this area of work.

Breast Self-Examination

Testicular Self-Examination

Digital measuring for blood pressure












universal access to health services (universality)
and the removal of barriers to access such as,
geographic, social, economic, or cultural
(accessibility);
It demands community participation in planning,
operation, and evaluation of health services
(participation);
It requires integration across health and other
sectors such as housing, education, and
employment;
It recognizes the power of multi-disciplinary
teams working as equal partners for the health of
the community;
It focuses on a range of services, determined by
the community, that include health promotion,
primary prevention, rehabilitative, and curative
(essentiality); and,
It demands a commitment to equity concerning
issues of power and resources (equity and access




The more recent emphasis on health in the context
of globalization makes the necessity for health
promotion to engage with larger social movements,
particularly on the global development agenda, even
more apparent.
Health promotion suspended between its
constitutive desire to become one with the
„community‟ and its real position as a mediating
professional fraction, often acting on behalf of
formal public institutions.






Health Promotion Glossary describes what equity in
health entails: „That all people have an equal
opportunity to develop and maintain their
health, through fair and just access to resources for
health‟.
Health promotion must fully engage with recent work
in political philosophy, particularly in the arguments
surrounding the concept of social justice
As health promoters, charged with the responsibility
to advocate, enable, and mediate for equity in
health, we should be armed with the very best
arguments supporting our position.


(MDGs) adopted by all UN Member States in 2000,
have become a universal framework for
development and a vehicle by which low- and
middle-income countries and their development
partners can work together „in pursuit of a shared
future for all.



In year 2005, the preventative health inequities
reported are overwhelming and their impact is
devastating. Even more discouraging is a call within
the report for high-income countries to scale up
their response if we are to have any hope of
meeting these goals.
focus on health promotion, disease prevention and
population health status
 place greater emphasis on community-based rather
than institutional care
 decentralize and regionalize the health care system
 emphasize primary care and move away from fee-forservice structures
 place greater emphasis on self-care and personal
responsibility for health maintenance.








In year 1978,the federal Directorate of Health
Promotion was created.
In the late 1980s and early 1990s, health
promotion gained considerable acceptance within
the academic community.
In the early 1990s, a new construct—entitled
population health—began to replace health
promotion in many government and health policy
circles.
The “Healthy Community” and “Strengthening
Community Health” Initiatives The “Healthy
Cities/Communities” movement originated in
Canada and was implemented in 1986.
5th international
conference on
health promotion
(Mexico,2000)

6th international
conference on
health promotion

1st international
conference on
health promotion
(Ottawa,1986)

4th international
conference on
health promotion

7th international
conference on
health promotion
(Nairobi,2009)

2nd international
conference on
health promotion

3rd international
conference on
health promotion

(Adelaide,1988)

(Sundsvall,1991)

Lalonde report
1974

(Jakarta,1997)

(Bangkok,2005)

8th
Where, when, why?







Health promotion is a complex, often ambiguous
concept and set of practices. It has an intimate
connection with health education and has its roots
in the deep history of public health.
The foundational principles of health promotion are
equity, participation, and empowerment.
Health promotion must take its duty to enable
people to control the determinants of their health
seriously.
To achieve its goals health promotion must engage
directly with political philosophy and it must be
aware of the dynamics of the global political
economy and its effect on health.
Health promotion (2)

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Health promotion (2)

  • 1. Oxford Textbook of Public Health, Marcia Hills and Simon Carroll By: Izzeldin F. Adam, BPEH, MPH Department of International Health, TMDU
  • 2.        Concept and definitions Health education Beliefs and approaches in health promotion Health promotion strategies and priority actions Public health, social movement, health inequity and millennium goals Canadian experience in health promotion Conclusion
  • 3.   - health promotion is centered on the values and principles of equity, participation, and empowerment. health promotion must be much more active in supporting the global efforts to address equity in health and development represented on the UN's MDGs WHO's Commission on the Social Determinants of Health
  • 4.  „the process of enabling people to increase control over, and to improve their health‟ (WHO,1986)‟.  „Health promotion represents a comprehensive social and political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health. Health promotion is the process of enabling people to increase control over the determinants of health and thereby improve their health (WHO 1998)‟.
  • 5.   Any intentional activity which is designed to achieve health or illness-related learning, that is, some permanent change in an individual's capability or disposition‟ (Tones 2004: 7). Freire proposes that the main strategy of empowerment education, critical dialogue, requires us to engage in a process of problem posing rather than a process of problem solving.
  • 6.  All people have strengths and are capable of determining their own needs, finding their own answers, and solving their own problems.  Every person and family lives within a social-historical context that helps shape their identity and social relationships.  Diversity is positively valued.  People without power have as much capacity as the powerful to assess their own needs (people are their own experts).  Relationships between people and groups need to be organized to provide an equal balance of power (professional/client ).  The power of defining health problems and needs belongs to those experiencing the problem.  The people disadvantaged by the way that society is currently structured must play the primary role in developing the strategies by which they gain increased control over valued resources.  Empowerment is not something that occurs purely from within (only I can empower myself), nor is it something that can be done to others (we need to empower the group).  Shared power relations do not deny health professionals their specialized expertise and skills.
  • 7. Approach medical Behavioral Socio-ecological Health concept Biomedical; absence of disease or disability Individualized; physical-functional ability; physical well-being Positive state; connectedness; ability to do important things; psychological well-being Health determinants Disease categories, Behavioral risk physiological risk factors (unsafe sex) factors (hyper.) Psychological risk factors (isolation); socioenvironmental risk condition (poverty) Principle strategy Surgery; drug therapy; illness care; medically managed behavioral change Advocacy for healthy life style choices Personal empowerment; small groups development; community organization ; coalition advocacy, political action Program development Professionally managed Negotiated with individuals communities and professional Managed by community in critical dialogue with supporting professionals and agencies
  • 8. 1. Advocacy for health to create the essential conditions for health; 2. enabling all people to achieve their full health potential; and 3. mediating between the different interests in society in the pursuit of health
  • 10.    policy action must come from policy sectors other than health but the health sector would play a role in public policy action. how? Healthy public policy requires the coordinated use of all policy levers available, including „legislation, fiscal measures, taxation, and organizational change. Healthy public policy requires the identification and removal of obstacles to the adoption of healthy public policies in non-health sectors
  • 11.        National health policy for food and drugs National health policy for protection of water and environment National health policy for health care and health insurance. National health policy for social insurance, equity and social justice. National policy for socio-economic development. National policy for health promotion National policy for ……etc.
  • 12.  Both the natural and built environments are inextricably linked with people's health.  It involves creating conditions that allow people to have „living and working conditions that are safe, stimulating, satisfying, and enjoyable.  both past endeavors and future prospects, one must take into account the lofty ambition of this programme of action (HIA, EIA)
  • 13.
  • 14. strengthening the capacity of people as active citizens through their community groups, organizations and networks to address and prioritize their problems, shape and determine change in their communities.  The foundational principles for community development are: • Empowerment • Community competence • Participation • Issue selection • Creating „critical consciousness‟ 
  • 15.
  • 16. Supporting personal and social development through providing information, education for health, and enhancing life skills.  while we must be vigilant against the temptation and limitations of an individually focused, skills development approach, we must also reengage with the most advanced and progressive elements in this area of work. 
  • 18.       universal access to health services (universality) and the removal of barriers to access such as, geographic, social, economic, or cultural (accessibility); It demands community participation in planning, operation, and evaluation of health services (participation); It requires integration across health and other sectors such as housing, education, and employment; It recognizes the power of multi-disciplinary teams working as equal partners for the health of the community; It focuses on a range of services, determined by the community, that include health promotion, primary prevention, rehabilitative, and curative (essentiality); and, It demands a commitment to equity concerning issues of power and resources (equity and access
  • 19.
  • 20.   The more recent emphasis on health in the context of globalization makes the necessity for health promotion to engage with larger social movements, particularly on the global development agenda, even more apparent. Health promotion suspended between its constitutive desire to become one with the „community‟ and its real position as a mediating professional fraction, often acting on behalf of formal public institutions.
  • 21.    Health Promotion Glossary describes what equity in health entails: „That all people have an equal opportunity to develop and maintain their health, through fair and just access to resources for health‟. Health promotion must fully engage with recent work in political philosophy, particularly in the arguments surrounding the concept of social justice As health promoters, charged with the responsibility to advocate, enable, and mediate for equity in health, we should be armed with the very best arguments supporting our position.
  • 22.  (MDGs) adopted by all UN Member States in 2000, have become a universal framework for development and a vehicle by which low- and middle-income countries and their development partners can work together „in pursuit of a shared future for all.  In year 2005, the preventative health inequities reported are overwhelming and their impact is devastating. Even more discouraging is a call within the report for high-income countries to scale up their response if we are to have any hope of meeting these goals.
  • 23. focus on health promotion, disease prevention and population health status  place greater emphasis on community-based rather than institutional care  decentralize and regionalize the health care system  emphasize primary care and move away from fee-forservice structures  place greater emphasis on self-care and personal responsibility for health maintenance. 
  • 24.     In year 1978,the federal Directorate of Health Promotion was created. In the late 1980s and early 1990s, health promotion gained considerable acceptance within the academic community. In the early 1990s, a new construct—entitled population health—began to replace health promotion in many government and health policy circles. The “Healthy Community” and “Strengthening Community Health” Initiatives The “Healthy Cities/Communities” movement originated in Canada and was implemented in 1986.
  • 25. 5th international conference on health promotion (Mexico,2000) 6th international conference on health promotion 1st international conference on health promotion (Ottawa,1986) 4th international conference on health promotion 7th international conference on health promotion (Nairobi,2009) 2nd international conference on health promotion 3rd international conference on health promotion (Adelaide,1988) (Sundsvall,1991) Lalonde report 1974 (Jakarta,1997) (Bangkok,2005) 8th Where, when, why?
  • 26.     Health promotion is a complex, often ambiguous concept and set of practices. It has an intimate connection with health education and has its roots in the deep history of public health. The foundational principles of health promotion are equity, participation, and empowerment. Health promotion must take its duty to enable people to control the determinants of their health seriously. To achieve its goals health promotion must engage directly with political philosophy and it must be aware of the dynamics of the global political economy and its effect on health.

Editor's Notes

  1. Health promotion represents a comprehensive social and political process, it not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environmental and economic conditions so as to alleviate their impact on public and individual health.
  2. Health education plays a profound role in the history of health promotion. This refers to whatknowledge, attitudes, or skills can be acquired by individuals through a variety of health educationprocesses.
  3. These strategies are supported by five priority action areas as outlined in the Ottawa Charter (action strategies)
  4. Active Living/Go for Green” programpractices that are both healthy and environmentally-friendly.
  5. This action area is at the very heart of health promotion; in fact, it can be argued that it is in this oneaction area where the basic principles of health promotion lie
  6. computerized health risk assessment programs
  7. Creating a health system that is based on the principles of health promotion(Alma Ata Declaration and the Ottawa Charter ) and advocates for equity and social justice
  8. Health Care Reform By the mid-1980s, it was apparent that Canada’s health care system had reached a crossroads. The system was financially strained and in need of reform. Generally, provincial/territorial governments arrived at the conclusions that there was a need to:
  9. 4th international conference on health promotion(Jakarta,1997) to re-examine health determinants and devolve new strategies for health (healthy ageing, healthy school, healthy cities, health work environment) 5th international conference on health promotionHealth Promotion: Bridging the Equity Gap, Mexico 6th international conference on health promotion(Bangkok,2005identifies major challenges, actions and commitments needed to address the determinants of health 7th international conference on health promotion(Nairobi,2009 ) Call To Action identified key strategies and commitments urgently required to close the implementation gap in health and development through health promotion8thHelisinki in Finlad 2013 about critical issues in health promotion such as education, environment, empowerment, hosing and other related issues