Health promotion

Question 1

Model of health promotion (5)

Answer 1

• The Medical Model of Health (pre 1970s): absence of disease, risk
behaviours, healthy lifestyles; focuses purely on education, individual
responsibility, considers people in isolation of their environments
• A Social Model of Health (1970s onwards): influenced by political,
economic, social, psychological, environmental – social determinants of health,
focus is on social inequity, empowerment and is about enabling access
• Ecological model of health (1980s onwards): acknowledges reciprocal
relationship between HRB and environments, environment influenced by
multiple factors (different levels of action), comprehensive and multi-faceted
• Place-based models (2000 onwards): targets struggling communities,
draws on ecological and social models, partnerships, planning, measures
change
• Primary prevention (mid-2000 onwards): used interchangeably with
health promotion, refers to activities and interventions to prevent a condition,
focused at individual AND population level

Question 2

What is health promotion? (4)

Answer 2

• Diverse and dynamic field of practice
• Evolving
• Emerged in 1980s; poor rising rates of
health
• Lofty vision

Question 3

Ottawa Charter’s 3 basic strategies for health promotion (3)

Answer 3

Advocate
Enable
Mediate

Question 4

Ottowa Charter’s 5 Priority Action Areas (5)

Answer 4

• Build healthy public policy
• Create supportive environments
• Strengthen community actions
• Develop personal skills
• Reorient health services

Question 5

Determinants of Health (5)

Answer 5

‘Policy Rainbow’ has provided a framework for range of hypotheses
and research about relative contributions and interrelations of
determinants.
• Different mortality rates across grades of civil servants (Marmot et al
1978)
• Children & adolescents living in poor quality housing more likely to
have had low birth weight (Bartley et al 1994)
• Material deprivation (housing tenure, unemployment etc) predicts
mortality and limiting long term illness (Townsend et al 1988)
• In utero experience linked to risk of adult disease (Barker 1998)
• Cumulative effect of social disadvantage over
the life course

Question 6

WHO: nine social determinants of health

Answer 6

Stress
Early life
Social exclusion
Work
Unemployment
Social support
Addiction
Food 
Transport

Question 7

Systems thinking (8)

Answer 7

• Complex and requires modelling to suit system
• More likely to be effective and sustainable
• Learning emerges from experiences and interactions
• Success comes form learning and emergent thinking
• Power relations affect processes and outcomes
• Actions affected by differing values and goals of stakeholders
• Contributions of stakeholders dependent on whether goals and
actions favourable
• Systems thinking is about PARTNERSHIP working

Question 8

Place-based and settings approaches (4)

Answer 8

Place-based
• Targets entire community – not always successful
Settings
• Range of settings
• Not a discrete and bounded area
• Can be subject to same critique as place-based

Question 9

Partnership working in health promotion

Answer 9

• Integral to health promotion
• Agreed ethical principles
• Mutual understanding of each other’s roles and
responsibilities
• Commitment to agreed outcomes
• Respect for capacity and contribution of each of the
partners

Question 10

Characteristics of partnership working (6)

Answer 10

• Networking
• Co-operation
• Co-ordination
• Collaboration
• Integrated partnerships
• Collective Impact

Question 11

Collective impact (5)

Answer 11

• Common Agenda
• Shared measurement
• Mutually reinforcing activities
• Continuous communication
• Backbone organisation