Introduction 1 © John Hubley & June Copeman 2008

Key Issues and Learning Outcomes Bagian Kesehatan Masyarakat - FK. UGM Key Issues and Learning Outcomes 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 structuralistic 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 lecture you should be able to: Bagian Kesehatan Masyarakat - FK. UGM By the end of this lecture 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, core values/ethical principles and assessed your own personal approach. apply principles of health promotion to planning a health promotion intervention for different age groups.

Primary Secondary Tertiary prevention screening rehabilitation healthy onset of advanced disability person symptoms death (reversible) (not reversible ) Primary Secondary Tertiary prevention screening rehabilitation case finding early prevention 4

Lifestyle (Human behaviour) Health Field Model Human Biology (Genetics) Lifestyle (Human behaviour) Health Services Environment 5

Human behaviours important for health promotion Bagian Kesehatan Masyarakat - FK. UGM Human behaviours important for health promotion Community action - actions by communities to change their surroundings include community participation in health decision-making Health behaviours – actions people undertake to be healthy Utilization behaviours – utilization of health services Illness behaviours - recognition of symptoms and prompt self-referral Compliance (adherence) – following course of prescribed medicines Rehabilitation behaviours – what people need to do after an illness/surgery to recover

Saving Lives – Our Healthier Nation (1999) Bagian Kesehatan Masyarakat - FK. UGM Saving Lives – Our Healthier Nation (1999) This White Paper from the Department of Health for England set the agenda for health policy for the next decade. Lifestyle and human behaviour was given a prominent role through its “Ten Tips for Better Health” 1. Don't smoke. If you can, stop. If you can't, cut down. 2. Follow a balanced diet with plenty of fruit and vegetables. 3. Keep physically active. 4. Manage stress by, for example, talking things through and making time to relax. 5. If you drink alcohol, do so in moderation. 6. Cover up in the sun, and protect children from sunburn. 7. Practise safer sex. 8. Take up cancer screening opportunities. 9. Be safe on the roads: follow the Highway Code. 10. Learn the First Aid ABC - airways, breathing, circulation

Mortality from Coronary Heart Disease men aged 20-64 by social class, England and Wales, 1991-93 Social Class Professional England and Wales = 100 63 Managerial 73 Non-manual skilled 107 Manual skilled 125 121 Partly skilled 182 Unskilled 50 100 150 200 Standardized mortality ratios 8 Source: Office for National Statistics (ONS), Health Inequalities charts.ppt

Perinatal Mortality Rate 9 Perinatal Mortality Rate Rate per 1,000 live & still births 20 By mother’s country of birth, England and Wales, 1997-99 combined 14.3 15 13.5 10.2 9.6 10 8.8 7.9 5 Pakistan Caribbean Bangladesh India E Africa UK

The Rainbow model - The main determinants of health Independent Inquiry into Inequalities in Health report Chairman: Sir Donald Acheson 199182

Amir’s story But why ...?" "Why is Amir in the hospital? Bagian Kesehatan Masyarakat - FK. UGM Amir’s story Prof. dr. Siswanto Agus Wilopo, SU., M.Sc. Sc.13 D. "Why is Amir 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. infection? 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. Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them. Because his parents can't afford a nicer place to live. But why does he have a cut on his leg? But why was he playing in a junk yard? But why does he live in that neighbourhood? But why can't his parents afford Because his Dad is unemployed and his Mom is a nicer place to live? sick. But why is his Dad unemployed? Because he doesn't have much education and he can't find a job. But why ...?" Towards a Healthy future : second report on the health of the Canadians (1999)

Bagian Kesehatan Masyarakat - FK. UGM Causes of poor health Inequality Social Injustice Alienation Lack of empowerment Tobacco use Anxiety Reckless risk- taking Poor education Low prestige Poverty Excess illness Low productivity Early death Proximal and distant causes of illness and premature mortality, JR Seffrin Journal of health education Sep – Oct 1997. Vol 28.No4.

An effective response should Bagian Kesehatan Masyarakat - FK. UGM An effective response should Provide the information and power for the community to make decisions Make the healthy choice the easiest option Remove barriers to action

The process of enabling people to Bagian Kesehatan Masyarakat - FK. UGM Health Promotion The process of enabling people to increase control over, and to improve, their health Ottawa Charter 1986

Ottawa Charter for Health Promotion Health Promotion - the process of enabling people to increase control over, and to improve, their health. Strengthen Community Action Develop Personal Skills Create Supportive Environments Enable Mediate Advocate Reorient Health Services 17 Source: Canadian Public Health Association - An International Conference on Health Promotion - November 17-21 1986

Improvements in quality and quantity of services: Bagian Kesehatan Masyarakat - FK. UGM Promoting health Service improvement Advocacy Health Education Improvements in quality and quantity of services: Agenda setting and advocacy for healthy public policy: Communication directed at individuals, families and communities to influence: accessibility case management counselling patient education outreach social marketing policies for health income generation removal of obstacles discrimination inequalities Behaviour change Determinants of behaviour change: awareness/knowledge decision-making beliefs/attitudes empowerment community participation gender barriers Prof. dr. Siswanto Agus Wilopo, SU., M.Sc. S1c8.D.

Health education. ‘A process with intellectual, psychological and social dimensions relating to activities that increase the abilities of people to make informed decisions affecting their personal, family and community well-being. This process, based on scientific principles, facilitates learning and behavioural change in both health personnel and consumers, including children and youth.’ (Ross and Mico, 1997) Service improvement. Promoting change in services to make them more effective, accessible or acceptable to the community. Advocacy. Activities directed at changing policy of organizations or governments. 19

Bagian Kesehatan Masyarakat - FK. UGM Advocacy Influencing policy makers, leaders and media to raise profile of health programmes Addressing legal, financial and service obstacles to health action Tackling discrimination and inequalities Prof. dr. Siswanto Agus Wilopo, SU., M.Sc. S2c0.D.

Service Delivery Improvement in capacity of staff – training Bagian Kesehatan Masyarakat - FK. UGM Service Delivery Improvement in capacity of staff – training and support Development of new activities Reorienting existing activities to make them more effective/acceptable Strengthening communication/health education within services Improved patient education Outreach to schools, community, workplace Involvement of personnel in supporting community health promotion

Define health promotion strategy Bagian Kesehatan Masyarakat - FK. UGM Define health promotion strategy Health promotion needs/ situation analysis Current situation? Health needs? Influences on health Influences on health actions? Target groups? Mix of health education, service improvement and advocacy? Health Education approach? Methods? Settings? Persons/groups involved in delivery? Timing? Targets? Health Promotion Planning Cycle Implement How to put it all together? How do we overcome barriers? How to monitor activities? Evaluate, reflect, learn Were our targets achieved? What lessons were learnt? How can we make our programmes better?

health identified by Faculty of Public Health Bagian Kesehatan Masyarakat - FK. UGM The ten areas of competencies in public health identified by Faculty of 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.

END 24