Promo Flashcards
According to Ottawa charter, health is
health is a resource for social, economic and individual progress
1986
Prerequisites for Health
- peace, shelter
- education
- food
- income
- justice
- equity
Ottawa charter, 1986
Axis of interventions
Ottawa charter
- Build healthy public policy
- Create supportive environments
- Strengthen community action
- Develop personal skills
- Reorient health services
Ottawa charter, 1986
Bangkok Chater
Globalization – policy must be coherent across all levels, integrated policy approach (link in HiAP) development, government, community, society, private sector (intersectoral action)
2005
Obstacles to prevention
- Success Is Invisible
- Lack of Drama
- Long Delay Before Rewards Appear
- Persistent Behavior Change May Be Required
- Acceptance of Avoidable Harm as Normal
- Commercial Conflicts of Interest
- Conflicts With Personal, Religious, and Cultural Beliefs
- Complexity of intervention : how to measure success when the delays are so long, success is invisible
- Politics, policies and time
Fineberg, 2013
What is critical race theory
- Framing racism as a determinant of health that is a modifiable and NOT as a biological entity.
- Studies how racism is embedded in society and institutions using an historical perspective
AMA Center for Health equity, 2022; Krieger N
Adelaide statement
“Health is a political choice”
HiAP
2010
What is health promotion
- Interdisciplinary field of action
- Sensitive to participation, complexity and context
- 2 features: positive definition of health and orientation towards action
- 3th revolution: health is as social phenomenon as well as a biological and psychological one.
- that aspect of public health practice that is particularly concerned with the equity of social arrangements
- It imagines that social arrangements can be altered to make things better for everyone and seeks to achieve this in collaboration with citizens
- Health promotion = Health Education x Healthy Public Policy
*
McQueen, 2007; Carter, 2012
Public health revolutions
- ID
- chronic
- health as social
Objectives of promo
- ↑ health as ressource
- ↓ health and social inequities
- Empower individuals to take control
McQueen, 2007
How to balance agency and structure
in promo
- From dualism to duality
- Health is not only social, but that it is the product of a complex system between structure (social) and agency (individual)
- Easier to conceptualize the integrated, multi-level, multi-strategy approach.
- Agonism: epistemological tension between structure and agency cold be channel into productive opportunities.
- This will prevent over-socialize and over-psychologized health.
- We don’t have to choose between social and psychology, between group and individual, just recognize that they both play a role*.
Carroll
2017
Purpose of promo research
- Epistemic purpose
- Transformative purpose
Values of promo
- Empowerment
- Participation
- Social justice (good society is a just society)
- Equity
- Health as a right
- Intersectorial action
- Holism
- Contextualism
How are interventions understood in promo
Health program: defined as a set of planned and organized activities carried out over time to accomplish specific health-related goals and objectives
Critical realism
* Cannot be reduced to a hierarchical sequence of procedures; rather, they function as systems of action designed to transform social reality.
* Interventions as routines, relationships, resources, power structures, symbols, forms of talk, “powerful ideas,” and sets of values (instead of programs, technology, product
Potvin, Hawe
How is evidence understood in promo
What is the epistemology of promo
- We need to have a broad vision of evidence that embraces the inherent complexity of health promotion
- Epistemologies of the south: the world is much broader than the Western understanding of the world.
- Co-learning between academic and popular knowledge
- starting point is the recognition of mutual ignorance, and its endpoint is the shared production of knowledge
- “All knowledge is incomplete”
- Promo is open to many paradigms
- Decision making – based on client population characteristics, practitioner expertise, best evidence – all within environment and organizational context (Evidence alone is not enough)
De soussa Santos, 2016; McQueen, 2001; Satterfield JM et al.
Strategies used in promo
- Enabling
- Advocacy
- Mediation (with other sectors)
Ottawa chartter, 1986
Paradigms in promo research
- Critical realism: assessment of the relationship between context and program/intervention, and the mechanism of this relationship (i.e., agency vs structure, power relations, emplacement/time/space)
- Complexity paradigm: non-reductive, reflexive, relative conception of health and its problemization. Human health is complex
- Transformative paradigm: - Dissemination of findings in ways that encourage use of the results to enhance social justice and human rights
What are social policies?
From a promo perspective
Policies and political choices are the causes of the causes of the causes: Policies shape opportunities for a healthy life and the importance of social determinants (eg, education, race) of health.
Distal causes
Montez, 2020
How do social policies work?
Politics –> labour market + welfare state (e.g., PH coverage and expenditure)–> economic equity –> health equity
Social policies are a buffer against labour market’s health consequences
Navarro, 2006; Shahidi, 2016
What evidence do we have about the impact of social policies?
Increased social spending is favourably associated with:
* life expectancy
* infant mortality
* potential years of life lost
* obesity prevalence
* acute myocardial infarction
* mental health
* days off work.
Most beneficiaries: those with the lowest incomes
Dutton, 2018; Navarro, 2006
Theoretical bases of the relationship between income inequality and health
Economic inequality –> health
* Absolute individual income increase has a non-linear relationship with health gains
* Relative income: Perceptions of one’s income compared to others leads to stress
* Society hypothesis: The relationship is mediated by violence crime, public spending, and social capital/trust
Health –> economy inequality
* Labor market: Poor health leads to unemployment and it impacts economy
* Education: Poor health leads to poor education outcomes and thus lower social position and thus social disparities
No relationship
Leigh, 2011
The relationship between welfare, economy, and health is not only complex but also contextualized. These factors are mutually related, and a unidirectional relationship seems unlikely. The balance between them is perhaps what matter the most and that balance is in fact highly contextualized.
Target trial steps
- Protocol
- Emulate that procol + adjustment of confounders at time 0 (emulates randomization)
Hernan
C-word vs T-word
Hernan, 2021
* Be more explicit about causation
* Ask the right questions
* We infer causaltion by using the right methods (=/= from methos of association)
Jones, 2018
* The use of theory to disentangle causal mechanisms
Limitations of causal inference
- No blinding
- No randomization
- No possible with new treatments
What is implementation science?
Methods to promote uptake of research findings into routine practice including community settings
Why is evidence often not implemented?
“Lack of evidence is often not the main barrier to change/action, more oftern is lack of political will”
Equity in all policies to change political will
Brownson, 2021
What is the goal of implementation science?
Some will say to narrow the research-practice gap (including community settings).
Brownson will way that the goal is Equity!
Equity in all policies –> to change political will
What do health differences often reflect?
Health differences often reflect social injustice
“Equity begins with justice”
Brownson, 2021
What is a moderator?
Changes/alters the effect that a variable has on another (ex., gendre, age)
Answer to the questios “for where” and “for whom”
What is a mediator?
Explains the relationship
Answers the question “why”
The path between intervention and outcome
Lewis
Prepost with Non-equivalent Control Group
Interrupted time series
Stepped-wedge design
Industrial revolutions
Kickbusch I, 2019
Hill’s criteria
(Rothman KJ et al. 2008
Ladder of interventions
Nuffield Council on Bioethics
Helath belief model
Behaviour change
Limitation: Works better for actions that hapen at one point in time (e.g., vaccination)
Reasoned action approach
Behaviour change
Social cognitive theory
Behaviour change
Bandura
Transtheoretical model
Behaviour change
COM-B model
Behaviour change
Behaviour change wheel
Michie et al. 2011
