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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
The third edition of this popular introductory textbook has been revised to provide a totally up-to-date and hands-on guide to the practical aspects of health promotion. Focusing on the range of skills needed to become an effective practitioner, it takes readers step-by-step through the different settings in which health promotion takes place and the various tools they might employ, including chapters on health promotion through the lifespan, one-to-one communication, working with groups, advocacy, social media, workplace settings and planning and management. As well as incorporating the most recent government policies and initiatives in public health, there is new and expanded material on issues such as community initiatives and alliances, social media, health literacy, understanding health behaviours, stress in the workplace and much more. Throughout the text there are activities to develop students' understanding and encourage reflective practice. Each chapter opens with a list of the central issues and learning objectives which are reinforced with real-life case studies. The key terms highlighted are clearly explained and checklists dispersed throughout the book, enabling practical application. The new edition of Practical Health Promotion will continue to be the ideal and indispensable guide for students at all levels. It will inspire anyone involved with health care to find practical ways of promoting change.
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CONTENTS
Cover
Title Page
Copyright
Illustration Credits
Introduction
How to use this book
Organization of the book
Health-Promotion Needs Assessment
Defining Health-Promotion Strategy – Methods and Settings
Implementation, Evaluation and Reflection
Part I Health-Promotion Needs Assessment
1 Health Promotion and Public Health
What is health promotion?
Putting health promotion into practice – regrouping the five dimensions of the Ottawa Charter
Health promotion as a multi-disciplinary activity
The rationale for health promotion
Historical overview of health promotion
Criticisms of health education and the emergence of health promotion
Inequalities in health
The New Public Health
Debates in health promotion
Health-promotion planning process
Defining the health-promotion strategy
Some concluding remarks on health promotion
Further reading
2 Epidemiological Tools for Health Promotion
What is epidemiology?
Assessing health-promotion needs
Assessing priorities
Indicators for health and disease
Where do we get data on health and disease?
Analysing health data – ‘people’
Analysing health data – ‘place’
Prevention
Establishing causes
Systematic reviews
Epidemiology and health-promotion debates
Further reading
3 Understanding Health and Illness Behaviours
Introduction
What are behaviours?
Illness behaviour – the medical anthropology perspective
Models of behaviour
Tailored health promotion and the use of health-promotion theories
The role of research in understanding behaviour
Models, theories and debates in health promotion
Further reading
4 Health Promotion through the Lifespan
Critical issues affecting a lifespan approach
Pre-conception to birth
Preschool child, 0–4 years
Pre-pubescent school-aged child, 5–9 years
Pubescent and adolescent school child, 10–17 years
Young person, 18–24 years
Middle adulthood, 25–49 years
Older adulthood, 50–69 years
Elderly person, 70+ years
A lifespan approach to health promotion
Further reading
Part II Defining Health-Promotion Strategy: Health-Promotion Methods
5 One-to-One Communication
Verbal and non-verbal communication
Language and communication
Health worker–patient communication
Participatory one-to-one communication
Self-management
Burnout
Telephone and online advice lines
One-to-one communication and health promotion
Further reading
6 Health Promotion with Groups
Why are groups important in health promotion?
Group dynamics
Group decision-making
Small-group teaching
Consciousness-raising, health-empowerment and assertiveness groups
Participatory learning methods
Further reading
7 Mass Media
Types of mass media
The influence of mass media on health
Local and community media
Media formats
Using theory for planning mass media: the six-stage model of communication
Appeals and mass media
Entertainment education – drama and popular music
How effective are the mass media for health promotion?
The planning process for mass-media health promotion
Further reading
8 Print Media
Literacy and numeracy
Health literacy
Readability
Leaflets
Visual communication and visual literacy
Posters
Displaying printed materials
Using materials with different cultures and languages
A framework for producing a leaflet
Print media and debates in health promotion
Further reading
9 Electronic Media and the Internet
Web-based health promotion
Should the internet be considered a new setting for health promotion?
Electronic communication and the future
Further reading
10 Advocacy
Policy and health
Influences on health policy in the UK
Globalization and health
Health movements
Health agenda-setting
Planning advocacy programmes
Forming coalitions, alliances and partnerships
Lobbying
Working with the press
Direct action
Advocacy and debates in health promotion
Further reading
Part III Defining Health-Promotion Strategy: Settings in Health Promotion
11 Community Settings
What is a community?
Outreach
The theoretical basis for community work
Coalitions, partnerships and intersectoral collaboration
Assessing the level of community participation
Working with communities
‘Seldom-heard’ groups in society
Healthy cities programme
Area-based regeneration
Working with volunteers and peer education
Community arts and health
The community setting and debates in health promotion
Further reading
12 Health-Facility Settings
The settings approach and health facilities
Primary-care settings
Patient education
Health-promotion debates and health settings
The well-person clinic
The pharmacist
The hospital as a setting
Critical issues for health promotion in health-care settings
Realizing the potential for health promotion within health services
Further reading
13 The Workplace Setting
What is a workplace?
The influence of the workplace on health
Health-promotion debates and the workplace
Workplace health policies
What kinds of health promotion can be carried out in the workplace?
Teamwork in workplace health promotion
Health services as a workplace
Challenges for health promotion in workplace settings
Further reading
14 Settings Used by Children and Young People
The contribution of schools to public health
Preschool education
Schools and health promotion
School health services
The school environment
Health-education component
The health-promoting school
Violence in schools
Mental-health interventions in school
Reaching young people in out-of-school settings
Settings in higher education
Further reading
15 Institutional Settings
The health-promoting institution
Transition – transfer between settings
Institutions for older people
Institutions for children
Institutions for persons with learning disabilities
Prisons and young offender institutions
Further reading
Part IV Implementation, Evaluation and Reflection
16 Planning and Management of Health Promotion
What is a manager?
Leadership
Key management skills
Setting aims and objectives
Strategic decision-making
Defining roles and responsibilities
Delegation and supervision
Giving and receiving criticism
Coordination and effective communication
Training
Managing time
Monitoring and evaluation
Assessing resource needs and resource mobilization
Introducing change
Concluding remarks
Further reading
17 Evaluation and Reflection
The reflective practitioner
Evaluation
Managing your personal development
Learning about health promotion
Professional networking through discussion groups
Professional associations
Closing remarks
Further reading
References
Index
End User License Agreement
Guide
Cover
Table of Contents
Title Page
Copyright
Illustration Credits
Introduction
Begin Reading
References
Index
End User License Agreement
List of Illustrations
Introduction
Figure i.1
The iterative health-promotion cycle
Figure i.2
The structure of the book
Chapter 1
Figure 1.1
The HESIAD framework for health promotion
Figure 1.2
The health field model (Lalonde, 1973)
Figure 1.3
Increasing inequalities in smoking in Great Britain (men and women aged sixteen …
Figure 1.4
The rainbow model to explain inequalities in Health (Dahlgren and Whitehead, 199…
Figure 1.5
Structuralistic and individualistic approaches in health promotion (Midha and Su…
Figure 1.6
Levels for health promotion
Figure 1.7
The coercion/persuasion/health-empowerment continuum in health promotion
Figure 1.8
The iterative health-promotion planning cycle
Chapter 2
Figure 2.1
The role of epidemiology
Figure 2.2
Health-service- and community-determined needs
Figure 2.3
Levels of prevention
Figure 2.4
Cohort and intervention studies
Figure 2.5
Correlation between smoking and cancer found in the cohort study of UK doctors c…
Chapter 3
Figure 3.1
Explanatory models and change models
Figure 3.2
Illness behaviour
Figure 3.3
The health-belief model
Figure 3.4
Using the stages-of-change model to develop tailored advice on smoking
Figure 3.5
Theory of reasoned action
Figure 3.6
An ecological model for health promotion (based on McLeroy et al., 1988)
Figure 3.7
The health-action model
Chapter 4
Figure 4.1
Examples of lifelines (with thanks to Dai Williams, Eos 2001)
Figure 4.2
Inequalities in health – cycles of deprivation (the boxed portions refer to heal…
Chapter 5
Figure 5.1
Sources of health information cited by respondents in Oedekoven et al.’s study (…
Chapter 7
Figure 7.1
Influences of mass media on health
Figure 7.2
The six-stage model of communication
Figure 7.3
A systematic approach to planning mass media health promotion
Chapter 8
Figure 8.1
Key decisions in preparing a leaflet
Chapter 10
Figure 10.1
Some influences on UK health policy
Figure 10.2
Setting the health agenda
Figure 10.3
Planning process for advocacy
Chapter 11
Figure 11.1
Concepts and disciplines that provide the theoretical basis for community work
Figure 11.2
Benefits of intersectoral collaboration
Figure 11.3
Building blocks for community development
Figure 11.4
The community development process
Chapter 14
Figure 14.1
Ways in which preschool provisions can improve child health and development
Figure 14.2
How schools promote health
Figure 14.3
The role of the school nurse in public health (Department for Education and Skil…
Chapter 15
Figure 15.1
Transition lifeline – an individual journey illustrating some potential transiti…
Chapter 16
Figure 16.1
Turning an indicator into an objective/target
Figure 16.2
A competency-based approach to planning training
Chapter 17
Figure 17.1
Three common evaluation designs
List of Boxes
Chapter 1
Box 1.1
Extracts from the Ottawa Charter for Health Promotion
Box 1.2
Examples of application of HESIAD
Box 1.3
Who does health promotion?
Box 1.4
Prevention is better than cure
Box 1.5
Refocusing upstream
Box 1.6
A timeline of important events affecting the development of health promotion in …
Box 1.7
What makes Jason unhealthy?
Box 1.8
The ten areas of competencies in public health
Box 1.9
Areas of debate in health-promotion practice
Box 1.10
Examples of health-promotion activities at different levels for smoking/tobacco …
Box 1.11
Core and defined competency areas of public-health practice
Box 1.12
Methods in health promotion
Chapter 2
Box 2.1
Some common indicators used for measuring disease in a population
Box 2.2
Subjective wellbeing and older people
Box 2.3
Common sources of health data
Box 2.4
Potential data links
Box 2.5
Social class
Box 2.6
Examples of some current screening programmes and implications for health promot…
Box 2.7
Criteria for causality
Chapter 3
Box 3.1
Models for health and illness behaviour
Box 3.2
How social networks influence health
Box 3.3
How to investigate social networks
Box 3.4
How to determine the role of culture on health
Box 3.5
How to tailor a communication to influence a health action
Box 3.6
Case study: Tailored communications – healthy birthdays
Box 3.7
Qualitative and quantitative research in health promotion
Chapter 4
Box 4.1
A basic framework for considering the lifespan
Box 4.2
A selection of life events used in the social readjustment rating scale (Holmes …
Box 4.3
Reported road casualties in Great Britain in 2018
Box 4.4
Social exclusion, theories of poverty and the lifespan
Box 4.5
Human genetics and health
Box 4.6
What should antenatal health education cover?
Box 4.7
The Healthy Child Programme
Box 4.8
Adolescent risk-taking behaviour
Box 4.9
Benefits of promoting healthy active ageing among older adults
Box 4.10
How to apply a lifespan approach
Chapter 5
Box 5.1
How to listen actively
Box 5.2
Common barriers in interpersonal communication
Box 5.3
How to assess provider–patient interaction
Box 5.4
How to work with interpreters
Box 5.5
How to carry out participatory-one-to-one communication
Box 5.6
Case study: arthritis and self-management
Box 5.7
How to break bad news
Box 5.8
Case study: NHS 111 urgent care telephone triage service
Box 5.9
How to assess the quality of one-to-one communication
Chapter 6
Box 6.1
Self-help groups
Box 6.2
Obstacles to group decision-making
Box 6.3
A good visual aid
Box 6.4
Examples of types of learning for HIV/AIDS
Box 6.5
How to do assertiveness training
Box 6.6
How to use participatory learning methods
Box 6.7
How to facilitate group discussions
Box 6.8
How to plan a group learning session
Chapter 7
Box 7.1
Mechanisms explaining celebrity influence
Box 7.2
Body image, women and the media
Box 7.3
Case study: Together TV and local action
Box 7.4
Formats on radio and television
Box 7.5
Formats in newspapers
Box 7.6
The debate about using fear and shock tactics
Chapter 8
Box 8.1
How to write simple English
Box 8.2
How to do readability tests
Box 8.3
Case study: Patient information leaflets in GP surgeries
Box 8.4
Case study: Posters and the promotion of exercise
Box 8.5
Cancer-risk message concept development
Box 8.6
How to design the text
Box 8.7
How to pre-test printed materials
Chapter 9
Box 9.1
How to identify a good health-promotion website
Box 9.2
Some social-media tools and their potential use for health promotion
Box 9.3
Case study: Social-media-promoted weight loss among an occupational population: …
Box 9.4
Case study: Social media – why blog? Reasons for blogging
Chapter 10
Box 10.1
Case study: National Childbirth Trust or NCT
Box 10.2
How to identify key decision-makers, gatekeepers and stakeholders
Box 10.3
How to form partnerships and alliances
Box 10.4
How to use local and community media
Box 10.5
How to plan a media event
Box 10.6
How to speak in public
Box 10.7
How to use the internet for advocacy
Box 10.8
Case study: The BUGA UP direct action campaign
Chapter 11
Box 11.1
Community work
Box 11.2
How to classify community groups
Box 11.3
How to estimate how much participation is going on in a community programme
Box 11.4
How to decide what information you need for a community profile
Box 11.5
Causes of homelessness
Box 11.6
What is a healthy city?
Box 11.7
Some examples of community-based initiatives
Box 11.8
How to implement health promotion in community settings
Chapter 12
Box 12.1
A health-promoting setting
Box 12.2
How to recognize a health-promoting waiting area
Box 12.3
Some points of contact between the public and the NHS health workers
Box 12.4
How to help people to use medicines properly
Box 12.5
Approaches to patient education
Box 12.6
Vision for a successful Expert Patient Programme
Box 12.7
How to run a well-person clinic
Box 12.8
Pharmacies’ Role in Breastfeeding Support
Box 12.9
Standard 3: Communication with patients on hospital wards
Box 12.10
Case study: Patient attitudes to behaviour change before surgery to reduce peri-…
Box 12.11
How to help your patient get better
Box 12.12
Case study: Barriers and enablers to South Asian women’s attendance for asymptom…
Chapter 13
Box 13.1
The European Network for Workplace Health Promotion
Box 13.2
How to tell if your workplace is health promoting
Box 13.3
Health promotion in the workplace setting. Work in tune with life: an example of…
Box 13.4
NHS Health and Wellbeing Framework
Box 13.5
Benefits of workplace health promotion
Chapter 14
Box 14.1
Key settings to reach young people
Box 14.2
How to involve fathers in preschool activities
Box 14.3
How to improve the school health services and environment
Box 14.4
Subjects in the National Curriculum
Box 14.5
Personal, social, health and economic education (PSHE) in the National Curriculu…
Box 14.6
Physical health and mental wellbeing statutory guidance (2019) – selected extrac…
Box 14.7
Approaches in school health education
Box 14.8
Types of services required to address inequalities in the access of young people…
Box 14.9
Case study: Football Beyond Borders
Box 14.10
Case study: Addressing university students’ self-identified health needs
Box 14.11
Factors affecting prevalence rates and demand for mental-health services among s…
Box 14.12
Potential initiatives and activities to improve student mental health and wellbe…
Box 14.13
Targeted provision for specific student groups
Box 14.14
Case study: Student living: collaborating to support mental health in university…
Chapter 15
Box 15.1
How can I tell if an institution is health promoting?
Box 15.2
Journey through transitions – health education and service improvements
Box 15.3
How to communicate with older persons
Box 15.4
Specialist provisions for older persons
Box 15.5
How to support the carers
Box 15.6
How to communicate with a person with learning disabilities
Box 15.7
Why health promotion in prison
Box 15.8
How to assess whether a prison is health promoting
Chapter 16
Box 16.1
How to be a good manager
Box 16.2
Examples of effective performance using Level 2 and 3 selected NHSKSF core dimen…
Box 16.3
How to write a measurable objective/target
Box 16.4
How to prepare a workplan
Box 16.5
How to delegate
Box 16.6
How to create a motivating environment
Box 16.7
How to manage meetings
Box 16.8
Leadership and effective group functioning
Box 16.9
How to plan a training programme
Box 16.10
How to control your use of time
Box 16.11
Example of a Gantt (timeline) chart for a peer-education programme
Box 16.12
How to prepare a budget
Box 16.13
How to facilitate change
Box 16.14
How to prepare an action plan
Chapter 17
Box 17.1
How to be a reflective practitioner
Box 17.2
Indicators for evaluation – strengths and weaknesses
Box 17.3
How to assess a health-promotion activity
Box 17.4
How to map out my own future development in health promotion
Box 17.5
How to find out about health-promotion activities/evidence
Box 17.6
Some peer-reviewed journals for health promotion
Box 17.7
How to tell if the information on an internet website can be trusted
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PRACTICAL HEALTH PROMOTION
Third Edition
John Hubley, June Copeman and James Woodall
polity
Copyright © John Hubley, June Copeman and James Woodall 2021
The right of John Hubley, June Copeman and James Woodall to be identified as Author of this Work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.
First edition published in 2008 by Polity PressSecond edition first published in 2013 by Polity PressThis third edition first published in 2021 by Polity Press
Polity Press65 Bridge StreetCambridge CB2 1UR, UK
Polity Press101 Station LandingSuite 300Medford, MA 02155, USA
All rights reserved. Except for the quotation of short passages for the purpose of criticism and review, no part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.
ISBN-13: 978-1-5095-4175-1
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging-in-Publication DataNames: Hubley, John, 1948- author. | Copeman, June, author. | Woodall, James, author.Title: Practical health promotion / John Hubley, June Copeman and James Woodall.Description: 3rd edition. | Cambridge, UK ; Medford, MA : Polity, 2021. | Includes bibliographical references and index. | Summary: "Foundational guide to health promotion across the full range of settings and users"--Provided by publisher.Identifiers: LCCN 2020020546 (print) | LCCN 2020020547 (ebook) | ISBN 9781509541737 (hardback) | ISBN 9781509541744 (paperback) | ISBN 9781509541751 (epub)Subjects: MESH: Health PromotionClassification: LCC RA427.8 (print) | LCC RA427.8 (ebook) | NLM WA 590 | DDC 362.1--dc23LC record available at https://lccn.loc.gov/2020020546LC ebook record available at https://lccn.loc.gov/2020020547
The publisher has used its best endeavours to ensure that the URLs for external websites referred to in this book are correct and active at the time of going to press. However, the publisher has no responsibility for the websites and can make no guarantee that a site will remain live or that the content is or will remain appropriate.
Every effort has been made to trace all copyright holders, but if any have been overlooked the publisher will be pleased to include any necessary credits in any subsequent reprint or edition.
For further information on Polity, visit our website: www.politybooks.com
Illustration Credits
Chapter 1 © Leeds Beckett University; chameleonseye/iStock; FatCamera/iStock; Leeds Beckett University; Leeds Beckett University
Chapter 2 © Fabio Neo Amato/Unsplash; John Hubley; luis seco/iStock
Chapter 3 © FatCamera/iStock; Alberto Pomares/iStock; Goodboy Picture Company/iStock; John Hubley
Chapter 4 © Jovanmandic/iStock; ViktoriiaNovokhatska/iStock; alvarez/iStock; Sharon Dominick/iStock
Chapter 5 © Bojan89/iStock; poco_bw/iStock
Chapter 6 © sturti/iStock; iStock
Chapter 7 © Ken Browne; gary milner/iStock; NuStock/iStock
Chapter 8 © John Hubley; Leeds Beckett University
Chapter 9 © piola666/iStock; NHS.uk; sunanman/iStock
Chapter 10 ©WHO.int; Sinn Féin/Flickr; Rawpixel/iStock; Sydney Harbour Federation Trust
Chapter 11 © Leeds Beckett University; Leeds Beckett University; iStock
Chapter 12 © Dennis Sabo/iStock; Mustafa Arican/iStock
Chapter 13 © Kenneth C. Zirkel/iStock
Chapter 14 © JasonRWarren/iStock; Football Beyond Borders; Edge Hill University
Chapter 15 © Andrew Gentry/iStock; xyno/iStock; Arthur Preston/iStock
Chapter 16 © Leeds Beckett University; John Hubley
Chapter 17 © Frances Twitty/iStock; PeopleImages/iStock
Introduction
How to use this book
Health promotion The process of enabling people to increase control over, and to improve their health. (WHO, 1998)
Health promotion is a core component of public health and combines health education directed at individuals and communities, service improvements to make them more appropriate and acceptable, and advocacy directed at influencing policies that affect health. Health promotion is an essential part of the work of most health and community workers, including nurses, doctors, allied health workers, rehabilitation therapists, community workers, and environmental and public-health practitioners. With illustrations, case studies, guidelines, and checklists with step-by-step ‘how-tos’, this book provides:
a practical introduction to the discipline of health promotion, the debates and ethical issues involved in promoting health and encouraging healthy lifestyles, reorienting services, developing community action on health and tackling social and economic determinants of health and influencing policy
links to some key competencies/skills in public health, communication for health and health promotion identified in the Skills for Health Programme and National Occupational Standards
a guide to the promotion of health in the community, workplace, education, primary care, hospital and other institutional settings
structured activities, for the reader to apply content to their own situation. These activities can be undertaken independently or in small groups, with subsequent discussion to share ideas. Sometimes it might be feasible to extend the activity with linked fieldwork, provided a risk assessment is completed.
a starting point for further studies in health promotion. At the end of each chapter we include suggestions for further reading and in the final chapter provide an overview of sources of literature in health promotion.
Organization of the book
This book is organized around the iterative health-promotion planning cycle shown in figure i.1 and introduced in chapter 1. The process that we put forward is a cycle because, no matter how much time and effort you put into planning your health promotion, what is really important is how much impact you have achieved and what lessons you can learn for the future. Health-promotion planning is a continuous – ‘iterative’ – process of analysis, intervention and evaluation/reflection, followed by further action.
Figure i.1 The iterative health-promotion cycle
The structure of the book is shown in figure i.2.
Figure i.2 The structure of the book
Health-Promotion Needs Assessment
Part I of the book introduces health promotion, the use of epidemiology in analysis of needs/influences on health, and the role of behavioural models in understanding human motivation, and explores how an understanding of lifespan processes can be used in interventions tailored to the needs of people at different stages of the life course.
Defining Health-Promotion Strategy – Methods and Settings
Part II (chapters 5–10) and Part III (chapters 11–15) introduce core health-promotion methods and settings. Each chapter presents an overview of the method or setting in health promotion with case studies and ‘how to’ checklists giving practical guidelines on action.
Implementation, Evaluation and Reflection
Chapter 16 in Part IV presents a basic guide to management skills for health promotion, including setting objectives, managing people, developing training programmes and promoting organizational change and improvements in services.
Chapter 17 reviews the evaluation of health promotion and the skills that enable a practitioner to reflect on their practices and learn from experience. Basic concepts in evaluation and evidence-based practice are introduced alongside guidelines on evaluating evidence for impact of health promotion.
Each chapter ends with suggested further reading. The final chapter also explores ways of learning more about health promotion through health-promotion research literature and other routes.
PART IHealth-Promotion Needs Assessment
CHAPTER 1Health Promotion and Public Health
Contents
What is health promotion?
Putting health promotion into practice – regrouping the five dimensions of the Ottawa Charter
Health promotion as a multi-disciplinary activity
The rationale for health promotion
Historical overview of health promotion
Criticisms of health education and the emergence of health promotion
Inequalities in health
The New Public Health
Debates in health promotion
The relevance of medical and social models of health and disease
Individual and structural approaches
Levels of health-promotion practice
Core values of health promotion
Coercion, persuasion or health-empowerment approaches
Ethics of health promotion
Principles of health-promotion practice
Health-promotion planning process
Needs/situation analysis
Defining the health-promotion strategy
Implementation/evaluation, reflection and learning
Some concluding remarks on health promotion
Further reading
Key issues within this chapter:
Health promotion is a key element of public-health practice.
Health promotion involves a combination of health education, service improvement and advocacy.
Many health workers, professional groups, community-based workers and volunteers have a role in health promotion.
Health promotion is an evolving discipline with many ongoing debates concerning principles and practice, including the balance between health education and legislation, the role of individualistic and structuralist approaches, the levels at which to operate, the nature of the core values/ethical principles, and the balance between coercive, persuasive and health-empowerment approaches.
A systematic approach to planning health promotion needs to take into account assessment of needs and influences on health, and involves decisions on target groups, methods, settings and timing of activities.
By the end of this chapter you should be able to:
understand the history of prevention, public health and the evolution of health promotion
define health promotion and its component parts – health education, service improvement and advocacy
have considered the debates in health promotion, including approaches and core values/ethical principles, and assessed your own personal approach
apply principles of health promotion to planning a health-promotion intervention.
What is health promotion?
The starting point for any discussion of health promotion is the Ottawa Charter, which in 1986 set out the concept of health promotion (WHO, 1986). Alongside the five key areas of action, summarized in box 1.1, the Ottawa Charter also reaffirmed the importance of community participation and introduced the goal of empowerment – a concept of which we will say more later in this book.
Box 1.1 Extracts from the Ottawa Charter for Health Promotion
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 wellbeing, 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 lifestyles to wellbeing.
HEALTH-PROMOTION ACTION MEANS:
Building Healthy Public Policy – Health promotion goes beyond health care. It puts health on the agenda of policy-makers in all sectors and at all levels. It directs policy-makers to be aware of the health consequences of their decisions and accept their responsibilities for health. Health-promotion policy combines diverse but complementary approaches including legislation, fiscal measures, taxation and organizational change. It is coordinated action that leads to health, income and social policies that foster greater equity. Joint action contributes to ensuring safer and healthier goods and services, healthier public services, and cleaner, more enjoyable environments. Health-promotion policy requires the identification of obstacles to the adoption of healthy public policies in non-health sectors, and ways of removing them. The aim must be to make the healthier choice the easier choice.
Creating Supportive Environments – Health promotion generates living and working conditions that are safe, stimulating, satisfying and enjoyable. Systematic assessment of the health impact of a rapidly changing environment – particularly in areas of technology, work, energy production and urbanization – is essential and must be followed by action to ensure positive benefit to the health of the public. The protection of the natural and built environments and the conservation of natural resources must be addressed in any health-promotion strategy.
Strengthening Community Action – At the heart of this process is the empowerment of communities, their ownership and control of their own endeavours and destinies. Community development draws on existing human and material resources in the community to enhance self-help and social support, and to develop flexible systems for strengthening public participation and direction of health matters.
Developing Personal Skills – Health promotion supports personal and social development through providing information, education for health and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their health and environment, and to make choices conducive to health. Enabling people to learn throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential. This has to be facilitated in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies, and within the institutions themselves.
Reorienting Health Services – The responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health-service institutions and governments. They must work together towards a health-care system that contributes to the pursuit of health. Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization of health services, which refocuses on the total needs of the individual as a whole person.
Putting health promotion into practice – regrouping the five dimensions of the Ottawa Charter
Two of the action areas in the Ottawa Charter’s concept of health promotion (box 1.1) – Developing personal skills and Strengthening community action – can be seen as different dimensions of health education. The action area Reorienting health services can be broadened to encompass other sectors such as schools, environmental services, community development and social services. Building healthy public policy and Creating supportive environments both involve advocacy. A practical approach to health promotion is to regroup the five components in the Ottawa Charter into the three areas of action: health education, service improvement and advocacy for policy changes (HESIAD) (see figure 1.1). In box 1.2 we show how the HESIAD framework can be applied to different health topics.
Figure 1.1 The HESIAD framework for health promotion
Advocacy Activities directed at changing policy of organizations or governments.
Health education Health education is any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes.
Service improvement Promoting change in services to make them more effective, accessible or acceptable to the community.
Box 1.2 Examples of application of HESIAD
Activity 1.1
For one of the following, or a health topic of your own choice, apply the HESIAD approach and suggest contributions of health education, service improvement and advocacy: reduction of injuries among children from road traffic; promotion of measles immunization; prevention of falls in elderly people; reduction of sexually transmitted infections among young people; promotion of breast-cancer screening among Asian women.
Health promotion as a multi-disciplinary activity
Health promotion is a core part of the work of many different groups inside and outside health services – see box 1.3.
Box 1.3 Who does health promotion?
Health services
NursesSchool health nursesHealth visitorsCommunity public-health nursesMidwivesGeneral practitionersDoctorsPhysiotherapistsOccupational therapistsDietitiansSpeech and language therapistsExercise counsellorsPharmacistsOpticians/optometristsAmbulance servicesSupport workers/Health-care assistants
Local authorities and non-statutory agencies
Youth workersTeachersPlay workersCommunity workersSocial workersEnvironmental-health officersPrison workers
Private sector and voluntary agencies
Occupational health doctors and nursesTrade union safety representativesPressure groups, e.g. Action on Smoking and Health (ASH), the Royal Society for the Prevention of Accidents (RoSPA)Personal fitness instructors
Media
Health correspondents
A wide variety of professionals and volunteers are involved in health promotion, each with an important role to play. Interprofessional working is often a key aspect of planning and implementing health-promotion activities.
In the United Kingdom, public-health services are located in local government, with their remit also to promote and protect health, but a great deal of health-promotion activity in the United Kingdom is undertaken by voluntary and community-sector groups and organizations. In other parts of the world, for example Ghana, there are dedicated government departments which focus on health-promotion matters. Many universities offer postgraduate diplomas or master’s degrees in public health or health promotion, which are recognized qualifications for specialist public-health/health-promotion personnel. The role of these specialist support services is in a state of change; in some areas the name ‘health promotion’ is still used, in others the more generic term ‘public health’ or ‘health improvement’ is used, with a strong focus on health promotion in their expected roles. In Canada, for example, ‘population health’ was introduced as an alternative to health promotion and in Australia the term ‘health promotion’ has been substituted by ‘preventative health’ (Van den Broucke, 2017).
National bodies provide strategic support for health promotion. Public Health England and Public Health Wales are good examples of overarching bodies that oversee and advise strategy and planning at a population level.
The rationale for health promotion
The scope for prevention of ill health and promotion of health
The rationale for health promotion comes from the scope for prevention of ill health and promotion of health. Health promotion works with and alongside individuals and communities to support and facilitate action over the wider influences affecting their health. In contemporary society, threats to health are extremely complex and challenging, requiring action across a number of sectors. The World Health Organization (2019) has identified ten contemporary threats to individual and community health. These are:
Air pollution and climate change
Noncommunicable diseases
Global influenza pandemic
Fragile and vulnerable settings
Antimicrobial resistance
Ebola and other high-threat pathogens
Weak primary health care
Vaccine hesitancy
Dengue
HIV
Warwick-Booth and Cross (2018) have also suggested, in addition to the WHO, current health challenges concerning population growth and, linked to this, the implication of ageing populations in many countries. They also highlight the health threats caused by war and terrorism, as well as the social and economic damage caused. There is little doubt that health promotion, with its distinctive values and approach, plays an important contributory role in tackling these contemporary threats; this will be discussed throughout this book. The application of epidemiology to the study of causes of ill health shows that much of the current burden of disease can be prevented or alleviated by appropriate action. As well as improving people’s life expectancy and quality of life, there is also an argument that ‘prevention is cheaper than cure’ and well-designed health-promoting interventions may save health-care costs. The promotion of a healthy lifestyle has become a key element of health policy, as indicated in government strategy (see box 1.4).
Box 1.4 Prevention is better than cure
Government strategy has placed a focus on preventing ill health and seeks to improve healthy life expectancy so that, by 2035, individuals are living at least five extra years of healthy, independent life, while closing the gap between the richest and poorest. Adopting a life-course approach, the strategy sets out how individuals can take more responsibility for their health, but also how systems and structures can be supportive of that. Focusing on the fact that health is ‘everyone’s business’ the strategy suggests that individuals, families, communities, employers, charities, the NHS, social care, and local and national government have a significant part to play.
(Department of Health and Social Care, 2018)
Historical overview of health promotion
The setting up in the United Kingdom of the National Health Service in 1947 was a time of great hope. The general assumption was that, with universal and accessible health care, the health of the population would improve, thereby reducing the need for health services.
By the 1970s it had become evident that this approach with its faith in medical science and technology was naive, that many health problems persisted, and that there was a need to ‘refocus upstream’ (see box 1.5).
Box 1.5 Refocusing upstream
I am standing by the shore of a swiftly flowing river and hear the cry of a drowning man. I jump into the cold waters. I fight against the strong current and force my way to the struggling man. I hold on hard and gradually pull him to shore. I lay him out on the bank and revive him with artificial respiration. Just when he begins to breathe, I hear another cry for help.
I jump into the cold waters. I fight against the strong current, and swim forcefully to the struggling woman. I grab hold and gradually pull her to shore. I lift her out on the bank beside the man and work to revive her with artificial respiration. Just when she begins to breathe, I hear another cry for help. I jump into the cold waters. Fighting again against the strong current, I force my way to the struggling man. I am getting tired, so with great effort I eventually pull him to shore. I lay him out on the bank and try to revive him with artificial respiration. Just when he begins to breathe, I hear another cry for help.
Near exhaustion, it occurs to me that I’m so busy jumping in, pulling them to shore, applying artificial respiration that I have no time to see who is upstream pushing them all in …
(A story told by Irving Zola, but used in McKinlay, 1981)
The emergence of health promotion as a distinct, organized field in health policy and practice can be traced to a Canadian strategy document. The publication in 1974 of the report A New Perspective on the Health of the Canadians by the then Minister of National Health and Welfare of Canada Marc Lalonde is recognized as one of the fundamental documents in the development of health promotion. Central to this report was the Health Field Model. This argued that – far from being determined by health services – health was determined by human biology or genetic endowment, environment and human behaviour (see figure 1.2). The report was effective in providing a justification for developing health-promotion initiatives for improving public health, as it proposed that health-care organizations would be unable to meet this need. The term lifestyle entered the discourse as a key determinant of health. The Lalonde report inspired health-promotion initiatives in the United States and Australia. It also stimulated a series of conferences under the leadership of the WHO, beginning with the Alma Ata declaration in 1978. However, and as already discussed, it was not until 1986 that the first dedicated international conference on health promotion was hosted in Ottawa, Canada.
Lifestyle The sum total of behaviours that make up the way people live, including leisure and work.
Figure 1.2 The health field model (Lalonde, 1973)
Activity 1.2
Apply the health field model and suggest possible human biology, health services, environment and lifestyle influences for one of the following: coronary heart disease, diabetes, breast cancer, road traffic injuries. Which of the four components do you feel have the most influence on the health topic you have chosen?
In the UK in 1976 a discussion paper, Prevention and Health, Everybody’s Business, and a White Paper, Prevention and Health, were published and resulted in an expansion of health-education services throughout the United Kingdom. On the international stage in 1977 the World Health Organization convened its meeting of the World Health Assembly in Alma Ata (then in the USSR, now in Kazakhstan), which issued its landmark declaration on primary health care. This declaration affirmed the importance of prevention but at the same time introduced other key concepts: social justice, tackling poverty, appropriate technology, community participation, and the need for economic and social action to address the determinants of health.
Criticisms of health education and the emergence of health promotion
By the early 1980s there was increasing disquiet among the health community. While accepting the importance of lifestyle, many felt that not enough attention was being given to the social and economic factors that influenced it. In England, Sir Douglas Black produced a damning report that highlighted the persistence of inequalities in health. Many health educators became critical of what they saw as an over-reliance on a medical model of health and a ‘victim-blaming’ approach, which put most effort into persuading individuals to change, while ignoring powerful influences in the family, the community and society. They saw a need for political action to influence local and national governments to introduce policies that promoted health. The early 1980s had also seen an unprecedented global mobilization to introduce international guidelines to limit the marketing of infant formulas in poor countries, which included actions such as consumer boycotts of Nestlé. Particularly aggressive programmes in Australia were pushing conventional health education to the limits, with hard-hitting anti-smoking television advertising that challenged commercial interests. Pressure groups such as ASH in the UK and street-action movements such as BUGA UP in Australia were challenging the tobacco industry through pressure-group techniques and direct action.
These concerns about the limitations of health education led to the conference in 1986 in Ottawa which set out the concept of health promotion discussed earlier in this chapter.
Box 1.6 A timeline of important events affecting the development of health promotion in the United Kingdom
1948
WHO constitution, with its definition of health as a complete state of physical, mental and social wellbeing
1965
Publication of McKeown,
Medicine in Modern Society
1972
Publication of Cochrane,
Effectiveness and Efficiency
1974
Lalonde Report,
A New Perspective on the Health of Canadians
1976
Publication of Illich,
Medical Nemesis: The Expropriation of Health
1976
Publication by DHSS of discussion paper
Prevention and Health, Everybody’s Business
and White Paper
Prevention and Health
1977
World Health Assembly issues Alma Ata Declaration on Primary Health Care
1979
Launch of journal
Radical Community Medicine
(later to become
Critical Public Health
)
1980
Black,
Inequalities in Health: Report of a Research Working Group
(DHSS)
1981
Publication of McKinley, ‘A case for refocussing upstream’
1981
Scotland, the Real Divide
– review of poverty in Scotland
1984
Radical Community Medicine
publishes special issue on public health
1985
European region of World Health Organization sets targets for Health for All by the year 2000
1986
Ottawa Charter for Health Promotion
produced at the WHO’s first International Congress for Health Promotion
1988
The New Public Health, published by the Open University
1992
Rio Earth Summit on sustainable development
1998
Publication of the Acheson Report
Independent Inquiry into Inequalities in Health
1998
Society of Public-Health Medicine opens membership to non-medical practitioners and changes name to Society of Public Health
1998
Better Health: Better Wales
(Welsh Office)
1999
Saving Lives: Our Healthier Nation
, White Paper (Department of Health, England)
1999
Towards a Healthier Scotland: a White Paper on Health
(Scottish Office)
2003
Improving Health in
Scotland
(Scottish Executive)
2004
Choosing Health
(Department of Health, England)
2005
Shaping the Future of Public Health: Promoting Health in the NHS
(Department of Health and the Welsh Assembly Government)
2010
Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post 2010
(Marmot)
2010
Healthy Lives, Healthy People: Our Strategy for Public Health in England
(HM Government, England)
2019
All Our Health: Personalized Care and Population Health
(Public Health England)
2020
Health Equity in England: The Marmot Review 10 Years On (
Marmot, Institute of Health Equity)
Inequalities in health
One of the most important criticisms was that health-education approaches, based mainly on behaviour change of individuals, were failing to address inequalities in health. Figure 1.3 shows that anti-smoking programmes in the 1960s had successfully reduced levels of smoking in Great Britain. But the decline had been greater in the professional groups, leading to a widening of the gap between rich and poor. Health education, as it was then being practised, was reaching mainly better-off groups in society. It was conclusions such as this for smoking and other health problems that led to a rethinking of health education and the emergence of the broader notion of health promotion.
Victim blaming An approach to health education that emphasizes individual action and does not address external forces that influence the individual person.
The issue of inequalities in health and social exclusion became a central feature of the health policy of the New Labour government that came into power in 1997. A series of reports exposed the inequalities in health between geographic regions, social classes guidelines to limit the marketing of infant formulas in poor countries, which included actions such as consumer boycotts of Nestlé. Particularly aggressive programmes in and ethnic groups. The most significant of these was the Acheson Report in 1998, which drew on the ‘rainbow model’ of Dahlgren and Whitehead (1993) (figure 1.4) to show that inequalities were a result of an interaction of many factors in society and called for the following actions to tackle inequalities:
breaking the cycle of inequalities
tackling the major killer diseases
strengthening disadvantaged communities
targeted interventions for specific groups.
Social exclusion A term to describe the structures and dynamic processes of inequality among groups in society. Social exclusion refers to the inability of certain groups or individuals to participate fully in life due to structural inequalities in access to social, economic, political and cultural resources. These inequalities arise out of oppression related to race, class, gender, disability, sexual orientation, immigrant status and religion. (Definition adapted from Galabuzi, 2002)
Professor Sir Michael Marmot in his report Fair Society, Healthy Lives (2010) reiterated the link between health and social groups, demonstrating that the lower a person’s social position, the worse his or her health. Marmot argues that a reduction in health inequalities requires the following action:
Give every child the best start in life;
Enable all children, young people and adults to maximize their capabilities and have control over their lives;
Create fair employment and good work for all;
Ensure a healthy standard of living for all;
Create and develop healthy and sustainable places and communities;
Strengthen the role and impact of ill-health prevention.
Figure 1.3 Increasing inequalities in smoking in Great Britain (men and women aged sixteen and over) (Office for National Statistics, 2003)
Figure 1.4 The rainbow model to explain inequalities in Health (Dahlgren and Whitehead, 1993)
Health Equity in England: The Marmot Review 10 Years On report clearly demonstrates the consequence of not focusing on the social determinant of health in a period of austerity. This has impacted adversely on the more deprived sections of society, with health and life expectancy deteriorating among some groups of the population, particularly poorer communities, women and those living in the North, as the protective role of the state has been reduced and the importance of the social determinants of health downplayed. Health follows a social gradient and therefore support and interventions need to be proportionately focused on those with greatest need, in order to create solidarity and cohesion in the population. The report shows that if health equity and wellbeing are put at the heart of local, regional and national economic planning and strategy there is potential to achieve a healthy standard of living for all within a generation (Marmot et al., 2020).
The chain of events by which structural factors in society influence health is shown in Jason’s story, reproduced in box 1.7.
Box 1.7 What makes Jason unhealthy?
The extract below appeared in the opening pages of the report Toward a Healthy Future: Second Report on the Health of Canadians (1999), prepared by the Federal, Provincial and Territorial Advisory Committee on Population Health. It challenged the readers to consider how determinants of health issues are rooted in the structure of society.
Why is Jason in the hospital?
Because he has a bad infection in his leg.
But why does he have an infection?
Because he has a cut on his leg and it got infected.
But why does he have a cut on his leg?
Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on.
But why was he playing in a junk yard?
Because his neighbourhood is kind of run down.A lot of kids play there and there is no one to supervise them.
But why does he live in that neighbourhood?
Because his parents can’t afford a nicer place to live.
But why can’t his parents afford a nicer place to live?
Because his Dad is unemployed and his Mom is sick.
But why is his Dad unemployed?
Because he doesn’t have much education and he can’t find a job.
But why …?
(Federal, Provincial and Territorial Advisory Committee on Population Health, 1999)
The determinants of health are rooted in the structure of society. For example, healthy foods such as fresh fruit and vegetables are often priced out of the reach of the poorest families.
Activity 1.3
Choose a health problem in a person and use the But why? approach to prepare a similar story to that of Jason which brings out the social determinants of health.
The New Public Health
While it is a major component of public health, health promotion has often struggled in outlining what makes it distinctive from broader public-health practice. One crude distinction that is sometimes made is that public health is about disease prevention, where health promotion concerns more than this (Wilson and Mabhala, 2009). Others, however, assert that it is the ideology and principles of health promotion that set it apart from public-health medicine. However, there is not currently an agreed ‘set’ of values that can be referred to, with different professional organizations, bodies and institutions in health promotion subscribing to different and nuanced positions. Health promotion and public health, for example, clearly have overlapping values and intentions, but health promotion has a stronger value-set around involvement, participation and autonomy contributing to empowerment (Tilford et al., 2003). Public health in contrast emphasizes more firmly values relating to paternalism; positivist research; and protection (Green, 2004). These values play out and manifest both in practice and in the approach to tackling health issues, but also in professional training competencies, education and training (see further discussion later in the chapter). For example, the ten core competencies required for acceptance of practitioners onto the voluntary register are listed in box 1.8.
Public health The science and art of preventing disease, prolonging life and promoting health through the organized efforts of society.
Box 1.8 The ten areas of competencies in public health
Surveillance and assessment of the population’s health and wellbeing
Promoting and protecting its health and wellbeing
Developing quality and risk management within an evaluative culture
Collaborative working for health
Developing health programmes and services and reducing inequalities
Policy and strategy development and implementation to improve health
Working with – and for – communities to improve health and wellbeing
Strategic leadership
Research and development to improve health and wellbeing
Ethically managing self, people and resources to improve health/wellbeing
Globally, the Galway Consensus sets out the competencies required for the health-promotion workforce. These competencies are in place to ensure effective health-promotion practice. The competencies in the Galway Consensus have similarities with the competencies in box 1.8, but also include partnership working and working collaboratively across disciplines and sectors to enhance the effectiveness of health-promotion programmes and policies (Barry et al., 2009). These competency frameworks are increasingly being used to identify the contribution to public health of nurses, environmental-health officers and the many other health-related professional groups listed in box 1.3 who carry out health promotion.
Activity 1.4
Examine the list of ten areas of competencies in box 1.8. How important are each of these to your own area of work? Rate each on a scale of 1 to 5 and compare your rating with those of your colleagues. What skills do you need to carry out each of these ten?
Debates in health promotion
Health promotion is an evolving discipline and there is continuing debate on key practice issues (see box 1.9).
Box 1.9 Areas of debate in health-promotion practice
The relevance of medical or social models of health and disease
Individual and structural approaches
Levels of health-promotion practice
Core values of health promotion
Coercion, persuasion and health-empowerment approaches
Ethics of health promotion
Principles of health-promotion practice
The relevance of medical and social models of health and disease
The medical model of health emphasizes disease rather than health, and sees people as machines that break down and require medical technology to repair them. While the medical model recognizes that individual behaviour can be a risk factor, it sees behaviour change as something that is in the power of the individual. In contrast, the social model takes a more holistic view of health, which it sees as influenced by culture, social class, economic position and environment. Engel’s biopsychosocial model combines biological, social and psychological factors in understanding health and illness, arguing that the individual’s mental state and social capacity need to be considered. People with negative thinking and ‘an unwillingness to try’ appear to have a lengthened recovery time and poorer health-promotion outcomes.
Holistic approach An approach that addresses all of the dimensions of health (physical, mental, emotional, spiritual, vocational, social).
Individual and structural approaches
Sociologists within health promotion have paid relatively little attention to the structuralistic and individualistic debate (Scambler, 2003). The core issue surrounds the extent to which individuals are ‘free agents’, who choose their health behaviour, or the extent to which their behaviours are influenced by broader structural forces, such as class, gender, ethnicity, politics and culture.
Tension between individualistic and structuralistic approaches remains a source of lively debate and discussion within current health-promotion practice. A simple either/or polarization of individualistic and structuralistic approaches is useful (figure 1.5) but simplifies what are in fact a range of options for approaches to working with people, assumptions about causes of ill health, points of intervention and values.
Figure 1.5 Structuralistic and individualistic approaches in health promotion (Midha and Sullivan, 1998)
In many situations both approaches need to be combined. It is possible to deal with the individual but locate the problem within a wider context. Ecological approaches to health promotion offer an alternative perspective that incorporates both individualistic and structural approaches and may provide a more effective strategy in tackling health inequalities. Ecological approaches can be used as an overarching framework with which to understand the interrelations among diverse personal and environmental factors in human health and illness. For example, faced with a man who has borderline hypertension, and drawing on evidence from systematic reviews that he can reduce his blood pressure by losing some weight and taking exercise, it would seem appropriate to advise him to change his behaviour. But even so, the advice would have to take into account the influences of food availability, affordability and income.
Levels of health-promotion practice
An alternative to an individual/structural approach is one that sees health promotion as operating from the individual, the family and the community through to the international level (see figure 1.6).
Figure 1.6 Levels for health promotion
