บทบาทของคณะแพทยศาสตร์ในการจัดการศึกษาด้าน การสร้างเสริมสุขภาพ อานุภาพ เลขะกุล คณะแพทยศาสตร์ มหาวิทยาลัยสงขลานครินทร์

Scope of Presentation Concept of health promotion Medical school and HP Health Promotion in Medical Curriculum, PSU

Medical Education Health Care System Medical Service Medical Education Health Promotion in Medical Curriculum, PSU

Concept of Health Promotion Health Promotion in Medical Curriculum, PSU

นโยบายสร้างเสริมสุขภาพ สร้างนำซ่อม ใคร……สร้าง ใคร……ซ่อม สร้าง……อย่างไร Health Promotion in Medical Curriculum, PSU

การส่งเสริมสุขภาพ การสร้างเสริมสุขภาพ นโยบายสร้างเสริมสุขภาพ การส่งเสริมสุขภาพ vs การสร้างเสริมสุขภาพ Health Promotion in Medical Curriculum, PSU

Health Health Care Organization Human Biology Lifestyle Environment Lalonde, 1974 Health Promotion in Medical Curriculum, PSU

How Poverty Affects Health Food poverty, Fuel poverty Poor housing, Poor transport Social isolation, Relative powerlessness Poor access to recreation/social facilities Psychological Health Effects Stress Anxiety Depression Low self-esteem Behavioral changes Smoking Drug abuse Low exercise levels Poor diets Physical Health Effects Low birth weights Infant deaths Poor growth in children Respiratory diseases Heart disease Accidents (Blackburn,1992) Health Promotion in Medical Curriculum, PSU

Maslow’s Needs Self Actualization Esteem Needs Needs for Love & Care Safety Needs Physiological Needs

Health Promotion (WHO) A process of enabling people to increase control over and improve their health To reach a state of complete physical, mental, social and spiritual well-being, 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 Promotion in Medical Curriculum, PSU

From disease prevention to health promotion Health Promotion in Medical Curriculum, PSU

Levels of Disease Prevention Behavioral risk factors Tobacco Alcohol Physical inactivity Diet Physiological risk factors BMI (Obesity) Blood pressure Blood glucose Cholesterol Disease outcomes Heart disease Stroke Diabetes Cancer Accidents COPD Chronic diseases Health Promotion in Medical Curriculum, PSU

Health Promotion (WHO) A comprehensive social and political process It not only embraces actions directed at strengthening the skills and capabilities of individuals, but also action directed towards changing social, environment and economic conditions so as to alleviate their impact on public and individual health Health Promotion in Medical Curriculum, PSU

Health Promotion Health is, therefore, seen as a resource of everyday life, not objective of living “…the health of populations will not be improved without the participation of all groups with an interest in and an influence on health care..” Health Promotion in Medical Curriculum, PSU

Three Basic Strategies for Health Promotion Advocacy Political, economic, social, cultural, environment, behavioural and biological factors can all favour health or be harmful to it. Enabling To support people in communities to achieve their full health potential and to reduce health inequalities Mediating To coordinate and collaborate all groups concerned

Five Priority Actions for Health Promotion (The Ottawa Charter, 1986) Building a healthy public policy Creating supportive environments Developing personal skills Strengthening community action Reorienting health service (from tertiary to primary) Health Promotion in Medical Curriculum, PSU

(Jakarta Declaration, 1997) Five Priority Actions for 21st Century Health Promotion (Jakarta Declaration, 1997) Promote social responsibility for health Increase investments for health development Expand partnerships for health promotion Increase community capacity and empower the individual Secure an infrastructure for health promotion Health Promotion in Medical Curriculum, PSU

Key Issues in Health Promotion Equity Being fair and just, not equality Effectiveness and evidence-based practice Collaborative working Health Promotion in Medical Curriculum, PSU

Evidence-based Practice Effectiveness and Evidence-based Practice Medical model RCT, challenged extensively in the literature Educational model Ensure clients and patients have access to information Behavioural model Promote behavioral changes linked to health lifestyles Social model Modify people’s environment Empowerment model Empowerment of individuals and communities Health Promotion in Medical Curriculum, PSU

Collaborative Working Identify the need for shared objectives Innovative work Commitment of time Resources and energy Regular review procedures Importance of key players Impact of different professional and organization culture Impact of funding issues Health Promotion in Medical Curriculum, PSU

Beattie’s Model of Health Promotion Mode of Intervention Authoritative Focus of Intervention Individual Collective Negotiated Health Promotion in Medical Curriculum, PSU

Focuses/Levels of Health Promotion An individual Organization level Healthy cities, villages, islands Healthy promoting schools, hospitals, market places Healthy workplaces Community level

Medical School and HP Health Promotion in Medical Curriculum, PSU

Medical Schools and HP Health Promoting Hospital Health Promotion in Higher Education Health Promotion in Medical Curriculum Medical Schools and Communities

Medical Schools and HP Health Promoting Hospital Health Promotion in Higher Education Health Promotion in Medical Curriculum Medical Schools and Communities

Health Promotion in Hospitals Management Policy Patient Assessment Patient Information and Intervention Promoting a Healthy Workplace Continuity and Cooperation

Medical Schools and HP Health Promoting Hospital Health Promotion in Higher Education Health Promotion in Medical Curriculum Medical Schools and Communities

Health Promotion in Higher Education (ACHA) Integration with the learning mission of higher education Collaborative practice Cultural competence Theory-based practice Evidence-based practice Continuing professional development and service

Medical Schools and HP Health Promoting Hospital Health Promotion in Higher Education Health Promotion in Medical Curriculum Medical Schools and Communities

Planning a Curriculum Identifying the need Establishing the learning outcomes Analysing possible constraints (SWOT analysis) Agreeing the content Organising the content including the sequence Deciding the educational strategy Health Promotion in Medical Curriculum, PSU

Planning a Curriculum Deciding the teaching methods Preparing the assessment Communication about the curriculum Promoting an appropriate educational environment Managing the curriculum Health Promotion in Medical Curriculum, PSU

What to Teach Cognitive (Knowledge) Skills Affective Health Promotion in Medical Curriculum, PSU

Application of HP Components in Teaching Building a healthy public policy Creating supportive environments Building environment in favor of staff and patient’s health Developing personal skills Learning and skills development in communicating with patients and relatives Health Promotion in Medical Curriculum, PSU

Application of HP Components in Teaching Strengthening community action Empower community of decide, of their own, the right choices of their health Reorienting health service (from tertiary to primary) Holistic approach for promotive, preventive and curative Health Promotion in Medical Curriculum, PSU

Examples of Core Content Health behavior model Determinants of health Concept of healthy lifestyle and health promotion Social aspect of health and diseases Health promotion model and level : Individual, group/organization, community Self-development and technique Communication skills : counseling, group dynamics, social marketing Health Promotion in Medical Curriculum, PSU

Examples of Core Content Health promotion : Individual level – life cycle approach Healthy eating Oral health Substance use – drug abuse, alcohol, tobacco Physical activity and exercise Stress reduction Healthy sex Healthy elderly Health Promotion in Medical Curriculum, PSU

Examples of Core Content Health promotion : Organization level Healthy workplace Healthy city Health promoting hospital Health promotion : Community level Health reform People empowerment Social movement Civil society Alternative medicine Health promotion : Community level Health reform People empowerment Social movement Civil society Alternative medicine Health Promotion in Medical Curriculum, PSU

HP in Preclinical teaching Topics related to health Anatomy Musculoskeleton – Working posture Osteoarthritis Accidents - fracture Cardiovascular – Coronary heart disease Respiratory – Occupation lung disease Smoking, COPD Health Promotion in Medical Curriculum, PSU

HP in Preclinical teaching Topics related to health Physiology Blood pressure – Hypertension Exercise Menopause, Aging process Biochemistry Carbohydrate metabolism – DM Lipid metabolism – Dyslipidemia Calcium metabolism – Osteoporosis Nutrition - Obesity Health Promotion in Medical Curriculum, PSU

HP in Preclinical teaching Topics related to health Genetics Prenatal diagnosis Genetic counseling GMO Microbiology AIDS Hygienic control Infection control Biological terrorism Parasitic infection SARS, Avian flu Health Promotion in Medical Curriculum, PSU

HP in Preclinical teaching Topics related to health Pharmacology Rational use of drugs Herbal medicines Pathology Pathogenesis of diseases Miscellaneous Hazardous risk management in Lab Healthy learning Health Promotion in Medical Curriculum, PSU

Skills in Health Promotion Social skills Communication skills Negotiation & empowerment skills Research skills Epidemiology skills Professional (clinical) skills Counseling skills Education skills ………………… Health Promotion in Medical Curriculum, PSU

How to Teach Separate or integrated teaching Issues of number of hour available, number of subjects taught Educational strategies Create learning environment Extra(supporting)-curricular activities How to integrate with existing curricula Start with students’ own lifestyle Health Promotion in Medical Curriculum, PSU

Content-based Education Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Yr 6 Content 1 Content 2 Content 3 Content 4 . Content n Health Promotion in Medical Curriculum, PSU

Outcome-based Education Yr 1 Yr 2 Yr 3 Yr 4 Yr 5 Yr 6 Competency 1 Competency 2 Competency 3 Competency 4 . Competency n Health Promotion in Medical Curriculum, PSU

Putting Health Promotion into the Curriculum Unfamiliar to medical students, as well as teachers A hybrid/integrated discipline Social sciences (Sociology, Social policy, psychology) Medical sciences (Including Epidemiology, Biostatistic) Not only function of Community Medicine Inadequate body of knowledge/experiences Health Promotion in Medical Curriculum, PSU

Putting Health Promotion into the Curriculum Specialist (expert) can teach HP Incorporate health-promotion principles in learning approaches Use practical vignettes enables students to identify key characteristics of health promotion Practical and concrete illustrations of the potential of health promotion Health Promotion in Medical Curriculum, PSU

Putting Health Promotion into the Curriculum Promote students’ health Starts with their own needs Encourages collaborative working Develops their personal skills Provide safe and secure environment in which to practise new skills and approaches Health Promotion in Medical Curriculum, PSU

Improving HP Teaching Role of institution Creating HP environment Staff development/Role model Multidisciplinary and multiprofessional approach Concrete real-life experiences Integrating HP into various clinical specialties Research for body of knowledge Health Promotion in Medical Curriculum, PSU

Health Promotion in Medical Curriculum, PSU