15-11-21 - Introduction to Health Promotion

Question 1

Learning outcomes

Answer 1

• Define health promotion
• Distinguish between the risk behaviour and risk context approaches to health promotion
• Distinguish between top-down and bottom-up approaches to health promotion
• Describe the 5 approaches to health promotion
• Describe the role of empowerment in bottom-up health promotion

Question 2

What is the Ottawa charter?

Answer 2

• Health promotion is the process of enabling people to increase control over, and to improve, their health.
• To reach a state of complete physical, mental and social well- being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment.
• Health is, therefore, seen as a resource for everyday life, not the objective of living.
• Health is a positive concept emphasizing social and personal resources, as well as physical capacities.
• Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being.

Question 3

2)	What is involved in the medical approach of health promotion including:
•	Aim
•	Assumptions
•	Examples
•	Criticisms

Answer 3

• Aim
• reducing morbidity or mortality, by targeting risk groups or risk behaviours with medical interventions
• Assumptions
• Application of medical knowledge / evidence base
• Expertise of professional important.
• Compliance of patient required.
• Examples
• immunisation, screening, surgery, medication
• Criticisms
• focus is absence of disease; doesn’t promote positive health; ignores social determinants of health; encourages dependence on medical knowledge; removes health decisions from lay people

Question 4

What is involved in the behaviour change approach of health promotion including:
•	Aim
•	Assumptions
•	Examples
•	Criticisms

Answer 4

• Aim
• To encourage people to adopt healthy behaviours by increasing knowledge about causes of health & illness.
• Provision of info on health risks & hazards.
• Persuade individuals to make change
• Assumptions
• Humans are rational decision makers.
• Health a property of individuals, individual responsibility.
• Examples
• Campaigns to persuade people to make healthier choices.
• Criticisms
• doesn’t take into account social determinants, expert led, top-down (policy maker priorities); blameworthy

Question 5

What is involved in the Education approach of health promotion including:
•	Aim
•	Assumptions
•	Examples
•	Criticisms

Answer 5

• Aim
• To provide knowledge & information and develop necessary skills so people can make an informed choice about their health behaviour.
• Assumptions
• that by increasing knowledge, there will be a change in attitude, which may lead to changed behaviour.
• Examples
• Provision of leaflets / booklets.
• Criticisms
• used widely, informally & opportunistically in many settings.
• Increasing knowledge & changing beliefs / attitudes does not necessarily lead to changes in behaviour.
• 12 Empowerment approach

Question 6

What is involved in the Empowerment approach of health promotion including:
•	Aim
•	Assumptions
•	Examples
•	Criticisms

Answer 6

• Aim
• To increase control over one’s physical, social, & internal environments. Helps people identify own concerns – gain skills & confidence to act upon them.
• Assumptions
• Equal actors.
• Power is a universal resource which can be mobilised by every individual.
• Examples
• participatory learning; group work; client centred counselling; assertiveness training; social skills training; educational drama
• Criticisms
• assumed that rational choices are healthy choices; what citizens choose at odds with health policy priorities?; time consuming / is it cost effective / measuring outcomes?; true participation or tokenism?

Question 7

What is top-down?

What is bottom up?

Answer 7

• Top down (authoritative)
• Priorities set by those with power/resources to make decisions and impose ideas of what should be done
• Bottom-up (negotiated)
• Priorities set by the people themselves, identifying issues they seem as relevant

Question 8

What is involved in the social change approach of health promotion including:
•	Aim
•	Assumptions
•	Examples
•	Criticisms

Answer 8

• Aim
• To modify social, economic & physical structures which generate ill health.
• Change society, not the individual.
• Make healthier choice, the easier choice.
• Assumptions
• Individuals organise and act collectively in order to change their physical & social environments.
• Examples
• Changes to policy & legislation; healthy working lives; healthy cities.
• Criticisms
• most healthcare professionals have limited role in developing policy; wider political structural change required; vulnerable to lack of funding & official oppositions (e.g. industry).

Question 9

Approaches to Health Promotion and levels of intervention

What is;

medical/preventive approach?

Behaviour change approach?

Educational approach?

Empowerment approach?

Social change approach?

Answer 9

• Medical / preventive approach - now we should be thinking about the reorientation of health services and realistic medicine
• Behaviour Change approach – understanding and development of personal skills, can also be an educational approach
• Educational approach – can include community actions
• Empowerment approach – can include aspects of supportive environments and community actions and the reorientation of health services
• Social change approach – includes healthy public policy and aspects of community action and supportive environments