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Health Promotion

Dr. Aidah Abu Elsoud AlkaissiNajah National University

Faculty of Nursing

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Promoting Health

Health promotion strategies are not limited to a specific health problem, nor to a specific set of behaviours. WHO as a whole applies the principles of, and strategies for, health promotion to a variety of population groups, risk factors, diseases, and in various settings.

Health promotion, and the associated efforts put into education, community development, policy, legislation and regulation, are equally valid for prevention of communicable diseases, injury and violence, and mental problems, as they are for prevention of noncommunicable diseases.

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Department of Chronic Diseases and Health Promotion (CHP)

The rapid rise of chronic, noncommunicable diseases represents one of the major health challenges to global development.

The principle chronic diseases are: stroke, cancer, diabetes and chronic respiratory diseases. Chronic diseases currently account for some 60% of global deaths and almost one third of the global burden of disease. The Department of Chronic Diseases and Health Promotion (CHP) leads the global efforts to prevent and control chronic diseases and promote health.

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Diet and physical activity: a public health priority

few largely preventable risk factors account for most of the world's disease burden. This reflects a significant change in diet habits and physical activity levels worldwide as a result of industrialization, urbanization, economic development and increasing food market globalization.

Recognising this, WHO has adopted a broad-ranging approach and has developed, under a May 2002 mandate from Member States, a Global Strategy on Diet, Physical Activity and Health, which was endorsed by the May 2004 World Health Assembly

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Objectives Foundation for Health Promotion

Health Defined: Objectives for Promotion and Prevention Define the term health Examine the healthy people 2010 comitiment to a single, overarching (extending

over) purpose: to promote health and prevent illness, disabilities, and premature death

Explain the differences between health, illness, disease, disability and premature death

Compare the three levels of prevention (primary, secondary and tertiary) with the levels of service provision available across the lifespan

Describe the importance of research and the nurse´s role in the research process to the promotion of health for individuals and populations

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Health promotion

Promoting health Protecting health Preventing disease and injury Public concern- Lifestyle Physical fitness Good nutrition Avoidance of health hazards such as smoking

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Health promotion

To improve the health status of individuals and groups Encouraging positive health changes

Effort of individuals The goverment Health professionals Society

Reduce costs of health services Improve the overall quality of life for all people The health of each individual is influinced by health

environment of all individuals worldwide

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Ten categories are identified as important determinants of health status. Change and improve behaviour in these areas can lead to a decrease in morbidity and mortality

Smoking Nutrition Alcohol use Habituating drug use driving

Exercise Sexuality and contraceptive use Family relationships Risk management Coping and adaptation

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Health protection, disease and injury prevention- Nurses need to understand

Directed at population groups of all ages Involves adherence to standards Infectious disease control Government regulation and enforcement Reducing exposure to various sources of hazards including air,

water, foods, drugs, motor vehicles

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Health care providers

Present the individual with disease and injury prevention services which include:

Immunization Screening include blood pressure, glaucoma, and diabetes

screening Health education Couselling

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To implement prevention strategies effectively

Develop cross-cutting activities targeted to and tailored for all age groups in various setting, including:

Schools Industies The home The health care delivery system Community

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The surgeon General´s report on health promotion and disease prevention was published 1979 and followed by

healthy people 2000

Increase the span of healthy life for people Reduce health disparities (Health disparities refer to gaps in the

quality of health and health care across racial and ethnic groups) among people

Acheive access to prevent services for all people

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Healthy people 2000

Four broad categories: Health promotion Health protection Preventive services Surveillance (Close observation of a person or group, The

act of observing or the condition of being observed) and data systems

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Improvements include

Reduction in infant mortality Teenage pregnancies Injuries Tobacco Alcohol Illicit (contrary to or forbidden by law) drug use Death rate from coronary heart disease & cerebrovascular accidents Childhood vaccination rates are at the highest record

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Many more improvements are needed in the health of many people

Tobacco use by adolescents continue to increase Adults do not participate in leisure-time physical activity Obesity Violence and other abusive behaviors continue to destroy

individuals, families and communities Chronic health problems as Mental disorders, diabetes mellitus

continue to be undiagnosed and untreated The occurance of HIV and AIDS

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The vision of Healthy People 2010

Healthy people in healthy communities Health affected by the environments in which each individual

lives, works, travels and plays Dimensions of the environment are not only physical, but

psychological and spiritual, including the behaviors, attitudes, and beliefs of each individual

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Health Promotion

What is Health Promotion Is a broad field encompassing educational, social, economic and

political efforts to improve the health of a population Health promotion is practiced in a variety of settings Health promotion workers put health on the agenda of policy

makers to be a ware of the health consequences of their decision

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Health promotion

A planned combination of educational, political, regulatory and organizational supports for actions and conditions of living conducive (tending to bring about) to the health of individuals, groups, or communities (Green & Kreuter 1999)

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Health promotion

The process of enabling people to increase control over and to improve their health. A commitment (act) to dealing with the challenges of reducing inequilities (injustice, unfairness), extending the scope (The range of one's perceptions, thoughts, or actions) of prevention and helping people to cope with their circumstances… creating environments conducive (tending to bring about) to health, in which people are better able to take care of themselves (World Health Organization 1986)

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Exploring Concept of Health

Nursing literature paradigms (A set of assumptions, concepts, values, and practices that constitutes a way of viewing reality for the community that shares them)

First paradigmنموذج: Wellness-illness continuum

High- level wellness- a sence of well being, life satisfaction and quality of life

Second paradigm characterizes health as an indirectional development phenomenon of unitary patterning of person-environment

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Health

Health is used to describe a number of entities (The fact of existence; being) such as a philosophy of care (health promotion and health maintenance), a system (health care delivery system), practices (good health practices), behaviors ( healthy behaviors), costs (health care costs), and insurance

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Health

Before 1940 Infectious diseases claimed the lives of many children and young adults, therefore health: the absence of disease

After World War II in 1940 the idea of role performance became a focus

Health became linked to a person´s ability to fulfil their roles in society

From 1960 to the present: control spending and health care costs have escalated

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Health

Primary care providers: nurse practitioners Attempt to involve individuals and their families in the delivery

care as individual responsibilities and lifestyle choices have become an important part of care

Health has become linked to the changing environment to which individuals could react and change rather than becoming a fixed state

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Health

Adaptation fit well with the self-help movement and progressive growth in knowledge from research about disease prevention and health promotion

Emphasis on the quality of a person´s life as a component of health There are multiple factors contributing to a person´s perception of

his/her health. In addition to function cognitively and physically, fulfill social roles, and obtain health services

Health is related to environment, socioeceonomic level, race, and geografic location

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Models of health

Clinical model: the absence of signs and stmptoms of disease as indicative of health

People who use this model of health to guide their use of health care services may not seek preventive health services or

Wait until they are very ill to seek care The clinical model is the conventional model of the discipline of

medicine

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Role Performance Model

The ability to perform social roles as indicative of health Role performance includes work, family, and social roles, with

performance based on societal (relating to the structure, organization, or functioning of society) expectations

Illness would be the failure to perform a person´s roles at the level of others in society

This model is the basis for work and school physical examinations and physician –exused- absences

The idea of the sick role, in which people can be excused from performing their social roles while they are ill

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Adaptive Model

Is reflective of Rene Duvos´ (1980) work on adaptation Hans Selye´s research on stress (1950) Jean Piaget´s (1975) discussion of cognitive development Has the ability to adapt positively to social, mental, physiological

changes as indicative of health Illness occurs when the person fails to adapt to changes

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Eudaimonistic Model

Term indicates a model that embodies (symbolize) the interaction and interrelationships between the physical, social, psychological and spititual aspects of life and the environment

Illness is reflected by a denervation (resection or removal of the nerves to an organ or part) or languishing (feeble, weak), a wasting away, or lack of involvement with life

This model more congruent with integrative (to join) modes of therapy, which is used increasingly by the majority of people

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Health-Illness Continuum

Is a traditional depiction (describe) relationship between the concepts of health and illness

In this paradigm, health is a positive state in which incremental increases in health can be made beyond the mid point on a line there the first end is health and the other end is illness.

These increases involve improved physical and mental health states The opposite end of the continuum is illness, with the possibility of

incremental decreases in health beyond the midpoint

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High-Level Wellness

A health-illness contiuum that would assess a patient based on his or her relative health compared with others and the environment

Favourable environment allows high-level wellness to occur Unfavorble environment allows low-level wellness to exit The person can have a terminal disease and be emotionally prepared

for death, while acting as a support for other people and acheiving high level wellness

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Functioning

Defining X´s of life is the ability to function Can X´s as being present or absent, high level or low level There are physical , mental and social levels of function reflected in

terms of performance (carrying out of something) and social expectations

Loss of function may be a sign or symptom of a disease

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Health

Is a state of physical, mental, ans social functioning that realizes a person´s potential (powerfull, efficacious)

Health is an individual´s responsibility, but it requires collective action to ensure a society and an environment in which people can act responsibly

The culture and beliefs of the people can also influence health. This is consistent with WHO definition of health as the state of complete physical, mental and social well being and not merely the absence of disease and infirmity

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Illness, disease, and health

Health and disease are not simply antonyms (opposite meaning) and disease and illness are not synonyms

Disease means ”without ease” Disease defines the failure of a person´s adaptive mechanism to

counteract (act in the opposite direction) stimuli and stresses adequately, resulting in functional or structural disturbances

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Illness, disease, and health

Illness is a social construct in which people are in an imbalanced, unsustainable relationship with their environment and are failing in their ability to survive and create a higher quility of life

Illness is a mismatch between a person´s needs and the resources available to meet those needs

Illness signals individuals and population that the present balance is not working

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Illness, disease, and health

Disease is a biomedical term indicating the presence of a recognizable health deviation, whereas illness is a state of being

Illness has social, psychological, and biomedical components A person can have a disease without feeling ill (asymptomatic

hypertension)

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Planning for healthgeneral´s report on health promotion and disease prevention

issued

Reducing infant death 35% (through low birth wt and birth defect) Reducing death in children 20%( growth and development

screening and injury prevention) Reducing death in adolescents and young adults 20% (preventing

motor vehicle injuries and decreasing the use of drugs and alcohol) Reducing adult death 25% (screening and prevention of heart

attacks, stroke and cancer) Reducing sick days in older adult 20% (maintaining functional

independence and prevent influenza and pneumonia)

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Planning for healthgeneral´s report on health promotion and disease prevention

issued

Three causes of the major health issues Careless habits Pollution of the environment Permiting harmful social conditions to persist (hunger, poverty,

and ignorance) that destroy health especialy for infant and children

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Healthy people 2000 goals

Increase quality and years of healthy life (longevity (Long life) and quality of life )

Eliminate health disparities (inequality, negative) differences in treatment based on race, gender, ability to pay, and related issues such as urban versus rural health, insurance coverage, medicare and satisfaction with service delivery

e.g. Racial disparity in health care, black people and white people

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Some terms

Ethnocentrism: culture influences every aspect of human life, including beliefs, values, and customs regarding health care can lead to a devaluing of the beliefs, values and customs of others known as racism

Empathy: the ability to view another person´s situations from their perspective

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ObjectiveImportant feature of Healthy people 2010

Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 min per day

Health indicators: physical activities and wt (obesity) Other indicators as tobacco and substance abuse and mental health are

indirectly related to this objectives Physical activity can contribute to positive mental health through stress

reduction and physical fittness Responsibility for intervention- not to do a ”repair shop” Health care provider need to be responsible for offering preventive health

services and monitoring behaviorThey do tasks rather than counsell and help individuals choose between

various behaviors

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Provider incentive (A reward for a specific behavior, designed to encourage that behavior.Saving Plan

Cigaretts How much do they cost How much the person will save in money wise How to use the money, half for restaurant and half for vaccation

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Providers need to look for partnership in the community through which they can better serve the needs of individual

Work sites and communities need to become partners in providing opportunities for people to lead healthy lives through flexible work schedules, work site wellness programs, safe park, availability of exercise facilities

E.g. Insurance company eliminate tobacco use from its building and campus: limiting smoking, offering in-house smoking cessation courses

The company experienced a cost savings in lower premiums for health and fire insurance

Less frequent use of ventilation system Less smoke and fire damage to furniture and equipment

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Imagine a hospital where the staff

Can set their schedules to accommodate family needs, exercise at an in-hospital exercise facility

Eat in an esthetically (a tasteful way) pleasing environment with relaxing music and healthy food

Participate in stress reduction activities

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Problem identificationanalysis of Frank´s situation

How many problems does Frank´s situation present The answer depends on who is asked the question and his/her

position related to the Frank: His physician His nurse His children His wife His employer Insurance company

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Planning intervention

Asset planning: planning approach that, given the realities of the present , helps focus the family and their providers on the building blocks for their future

The lifestyle changes become tools for Frank´s recovery and for change within his family His cardiac event becomes a risk factor for heart disease for the lives of his children A plan was developed to help Frank begin to take control of his life through behavior

changes: Relaxation techniques Diet modification Smoking cessation Mild chair exercises Spokes person talking about stress management and smoking cessation based on his

personal experiences

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What was the actual cause of Frank´s problem

Not possible to separate. The source of illness were found in the many interrelationships in his life

Imbalance betwen his personal resources and the demands of his family and the economic world

Cigaretts use by persons who have hypertension or high serum cholesterol levels multiplies their risk of coronary heart disease

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Evaluation of situation

The health status of an individual depends on a sustainable balance of the complex response between internal physiological and psychological and external social and environmental factors interpreted with the context of the immediate environment

The infarction and resulting disability permanently reshaped Frank´s environment

After few month working a full time , he realized that he needed to find a less stressful job

Health is not acheivement or a prize but a high quality interaction between a person´s inner and outer world that provides the capacity to respond to the demands of the biological, psychological, and environmental system of these worlds

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Assignment

Based on the information about frank and his experience, determine what his children should be taught based on the Healthy People 2010 objectives in this focus area

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Levels of promotionprimary prevention

Precede disease or dysfunction It includes as health as beneficial to well being It uses therapeutic RX an a process or behaviour towards

enhancing health

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Secondary prevention

Ranging from providing screening, activities and treating early stage of disease to limiting disability by averting (the act of preventing something from occurring) or delaying the consequences of advanced disease

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Tertiary prevention

Occurs when a defect or disability is permanent and irreversible

The process involves minimizing the effects of the disease and disability by surveillance and maintenance activities aimed at preventing complications

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Nurses Roles

Shifting from acute, hospital-based care to preventive community-based care, which is closely related to the changing demographic of people

The home and community become the existing site of care , nurses must assume new roles

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Nursing roles in health promotion and protection

Advocate: Strives to ensure that all persons receive quality, appropriate and cost-effective care

Care manager: to prevent duplication of services and reduce costs ”E-care” manager is to know how to search for and find

specific and high-quality information on the internet Facilitating communication among parties is one of the care

manager´s most important function

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Nursing roles in health promotion and protection

Consultatnt: consultative exchanges can occur with schoolteachers, legislators, or others who maintain a working relationship with the person Gerontological nurse: planning for a new senior citizens´

housing development

Educator: health practices- a good nutrition, industrial and high way safety, immunization, specific drug therapy. Teaching is of the primary prevention techniques available to avoid the major causes of disability and health today

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Nursing roles in health promotion and protection

Healer: healing resides in the ability to glimpse (trace) or intuit the ”interior” of an individual´s care, to sense and identify what everyone else has missed or underappreciated

" " ) الداخلية : ) في يستشعر أو تتبع نظرة على القدرة في يكمن الشفاء المعالجقدرها حق تقدر ال أو الجميع عن غاب قد ما وتحديد ، ومعنى ، الفرد للرعاية

Researcher: evidence-based practice is defined as the conscientious (extreme care and great effort), explicit (Fully and clearly expressed), and judicious (careful and sensible; marked by sound judgment) use of current best evidence in making decision about the care of individual patients

The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research

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Future research for the next five years, National Institute of Nursing Research (NINR)

From management of individuals during illness and recovery to the reduction of risks for disease and disability

Promoting health life style Promoting quality of life for persons with chronic illness Identifying effective approaches to acheiving and sustaining

good health

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Future research for the next five years, National Institute of Nursing Research (NINR)

Health promotion research should focus on health problems and disease-prevention techniques such as obesity reduction, smoking cessation, prevention on cancer, heart disease

Traditionally teaching prenatal classes, stressing prevention of infectious diseases through education and immunizations, teaching hygiene and safety principles in school and industry, and disseminating information on how to reduce risk factors leading to chronic disease

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Research Design- RandomizedClinical Trials (RCTs)

Experiment in which individuals are randomly assigned into groups called study and control groups

The study group receives the intervention and the control group does not receive the intervention

Randomization can be acheived by using computer-generated lists, a table of radom numbers

Blinding ensures that subjects are unaware of the treatment or intervention to which they are exposed

Double-blinded studies are ones in which neither the researcher nor the subject knows what treatment or intervention they are receiving

In drug studies. The investigator and subjects are not told what medication they are receiving, so as not to influence the outcome

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Research Design- Cohort Studies

The investigators do not determine which individuals receive the intervention at the outset (the time at which something is supposed to begin)

People who have already been exposed to the risk factor, or intervention, and control subjects who have not been exposed are selected by the investigators to be followed longitudinally over time in an effort to observe differences in outcome

Disadvantages: require a large sample size, many years of observation to provide adequate statictical power to measure differences in outcome, expensive, time consuming

Drop out of the study before it is completed Attrition (The loss of subjects during the course of a study) or mortality

refers to the loss of subjects from both experimental and control groups for various reason

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Research Design- Case-Controlled Studies

Both the study group and the control group are selected on the basis of whether they have the disease and not whether they have been exposed to a risk factor or a clinical intervention

Therefore the design is retrospective Disadvantages: difficulty identifying important confounding variables

and adjusting them for the outcome, difficulty getting the past history of participants and the improper selection of control groups which may invalidate conclusions about the presence or absence of statistical associations

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Improving Prospects for Health

Population effects: Cultural and socioeconomics changes within the population

unequivocally (Admitting of no doubt or misunderstanding) influence lay concepts of health promotion

The projectd age distribution- considerable growth is expected in the proportion of the population

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Improving Prospects for Health

Shifting problems:environmental pollution is a complex and increasingly hazardous problem

Disease related to industry and technology, including accidents and trauma, important threat to health

The physical and psychological stresses of a rapidly changing and fast-paced society present daily problems as economic pressures, poor health habits

Obesity from the lack of exercise is product of modern technology The ingestion of potentially toxic, nonnutritios, high fat foods is contributing

factor to poor health, the abuse of tobacco, drugs and alcohol negatively affects health

Orientation towards illness clearly focuses on the effects rather than the causes of disease

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Improving Prospects for HealthShifting Problems

A substantial (Possessing wealth or property) change in wellness patterns has occured:

Infectious and acute diseases were the major causes of death in the early twentieth century whereas chronic condition, heart disease, cerebrovascular accident (stroke)and cancer are the major causes today

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Improving Prospects for HealthMoving Toward Solution

Individual involvement: action related to life style beggining early in life with the young child and the goverment involvement- the learning and the inherent changes that are involved require an attitudinal change, which is the most difficult requirement

Motivational factors play a role: Program for health promotion Financial incentive for prevention may be another motivating factor

and health advocacy by professionals in the health field is critical

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Improving Prospects for HealthMoving Toward Solution

Private and public action at all levels is needed to reduce possible environmental hazards

Toxic agents in the environment can present health hazards that may not be detected for years

Therefore it is necessary for the individuals to monitor industrial and agricultural production processes to reduce exposure to potentially toxic agent

Government activity in the form of Legislation and financing- Bicycle safety, seat belts, taxes on cigarettes

Putting more emphasis on primary prevention

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To shift directions in today´s health care

Provide leadership in finding the vision and the path To inform, educate and reeducate themselves and their colleagues,

the media and the general public Nurses calls for seeing the health problem in new ways and helping

others to do the same Responsibility means developing new roles and looking at the

problem through others´eyes including the eyes of individuals, the public, other proffessionals and other nations