Health Education and Promotion Umm Al-Qura University Faculty of Public Health and Health Informatics Environmental Health Department Health Education and Promotion BY: Dr. Ahmed Abdullah

Contents of the course Topic Lecture 1 Introduction to health promotion Principles of health education 2 Health promotion, and education programs Ottawa charter for health promotion The factors that influence community health education Planning program adoption, implementation & sustainability Monitoring and evaluation of program Health promotion model-1 Health promotion model-2 Health promotion model-3 Field visit Revision

Introduction to Health Promotion Lecture 1 Introduction to Health Promotion

Definitions of health “...a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO,1946) The normal physical state, i.e. the state of being whole and free from physical and mental disease or pain, so that the parts of the body carry on their proper function.

Definition of Health Promotion This definition was derived from the  from the Government of Canada,  which contained a health promotion strategy "aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health"

Definition of Health Promotion Another predecessor of the definition was the 1979 Healthy People report of the Surgeon General of the United States,  which noted that health promotion "seeks the development of community and individual measures which can help... [people] to develop lifestyles that can maintain and enhance the state of well-being".

Definition of Health Promotion “the process of enabling people to increase control over, and to improve, their health” (WHO-EURO, 1984) It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.

Definition of Health Promotion In 1984 (WHO) Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health".  In addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organizational change, community development and spontaneous local activities against health hazards" as health promotion methods.

Definition of Health Promotion The "first and best known" definition of health promotion, promulgated by the American Journal of Health Promotion since at least year 1986, is "the science and art of helping people change their lifestyle to move toward a state of optimal health"

Definition of Health Promotion In 1986, Jake Epp, released Achieving health for all: a framework for health promotion which also came to be known as the "Epp report". This report defined the three "mechanisms" of health promotion as "self-care"; "mutual aid, or the actions people take to help each other cope"; and "healthy environments".

Definition of Health Promotion In Ottawa, 1986: "is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being“ Aims at making... [political, economic, social, cultural, environmental, behavioural and biological factors]. favourable through advocacy for health. focuses on achieving equity in health. demands coordinated action by all concerned: by governments, by health and other social organizations.

Definition of Health Promotion Health promotion has been defined by the World Health Organization's (WHO) 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"

What is Health Promotion1? Concept was first introduced in USA 1979 Has evolved to include the educational, organizational, procedural, environmental, social, and financial supports that help individuals and groups reduce negative health behaviors and promote positive change among various population groups in a variety of settings

What Is Health Promotion? Health promotion programs are designed to help people who are healthy, but engaging in risky behaviors (i.e., smoking, drinking, risky sexual behaviors) or actions that increase their susceptibility to negative health consequences (i.e., physical inactivity, unhealthy diets) to change their behaviors.

Definition of Behavior Merriam- Websters define behavior as: (Any thing that an organism does involving action and response to stimulus). The key word is ( ACTION) A behavior is any overt action conscious or un conscious, with measurable frequency, intensity and duration. Level of behavior ( 5 levels).

Health Promotion Values Empowerment Participation Social Justice/Equity Respect Priority to common good Choice Positive health

Effective Health Promotion Does saying, “Just do it!” work? No … Health promotion is not simply an information campaign or just providing opportunities. Information campaign is the easiest and most common form of program, yet least effective “Just do it!” sounds ‘good’, but doesn’t work.

Effective Health Promotion Can be achieved By :help people to: modify behaviors, increase skills, change attitudes, increase knowledge, influence values, and improve health decision making. maintain healthy lifestyles. Provide educational, organizational, environmental, financial, and social support

Key Concepts of Health Promotion Empowerment Healthy Communities Determinants of Health Health Literacy Quality of Life

Need for Health Promotion Physical Inactivity is a Global Problem In developed countries: Industrialization, modern technologies, automation, and a global food market have taken away the need and opportunity for physical exertion In developing countries: Over crowding, poverty, crime, traffic, low air quality, plus lack of parks, sports and recreation facilities, and sidewalks make physical activity a difficult choice Result: 60% ~ 85% global population fails to achieve 30 minute moderate intense physical activity daily

Need for Health Promotion Physical movement and activity are essential for the human organism to grow, develop, and maintain health. Consequences of physical inactivity increased levels of obesity, diabetes, cardiovascular disease (the leading cause of death in most countries)

Need for Health Promotion Physical inactivity: second greatest threat to U.S. public health a major public health problem affecting huge numbers of people in all regions of the world Effective health promotion programs are urgently needed to promote physical activity and improve public health around the world.

Need for Health Promotion Chronic diseases associated with unhealthy behaviors, such as unhealthy diets, caloric excess, inactivity, and obesity are the greatest public health problems in most countries of the world The increasing incidence of chronic diseases causing ~60% of the 56.5 million reported deaths globally. contributing ~46% to the spread of disease worldwide. These estimates are expected to rise to 73% and 60%, respectively, by 2020

Physical activity A sedentary lifestyle increases the risk of: overall mortality (2 to 3-fold) cardiovascular disease (3 to 5-fold). The effect of low physical fitness is comparable to that of hypertension, high cholesterol, diabetes, and even smoking. A sedentary lifestyle, in turn, is a well established risk factor for cardiovascular disease, stroke, and all-cause mortality,[i],[ii],[iii][iv][v] while physical activity prolongs life.[vi],[vii] Men in the lowest quintile of physical fitness have a two- to threefold increased risk of dying overall, and a three- to five-fold increased risk of dying of cardiovascular disease, compared to men who are more fit.[viii] Among women, walking ten blocks per day or more is associated with a 33 per cent decrease in the risk of cardiovascular disease.[ix] The risk of low physical fitness is comparable to, and in some studies greater than, the risk of hypertension, high cholesterol, diabetes, and even smoking.[x],[xi] [i]. U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention, 1996. [ii]. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. NIH Consensus Conference: physical activity and cardiovascular health. JAMA 1996;276:241-246. [iii]. Wannamethee SG, et al. Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in middle-aged British men. Arch Internal Med 1998;158(22):2433-40. [iv]. Wannamethee SG et al. Physical activity and the prevention of stroke. J Cardiovasc Risk 1999;6(4):213-6. [v]. Pate RR, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402-407. [vi]. Lee IM, Paffenbarger RS Jr. Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol 2000;151:293-9. [vii]. Wannamethee SG, et al. Changes in physical activity, mortality and incidence of coronary heart disease in older men. Lancet 1998;351:1603-08. [viii]. Wei M, et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 1999;282:1547-1553. [ix]. Sesso HD, et al. Physical activity and cardiovascular disease risk in middle-aged and older women. Am J Epidemiol 1999;150(4):408-16. [x]. Wei M, et al. Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men. JAMA 1999;282:1547-1553. [xi]. Blair SN, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996;276:205-210.

Approaches in Health Promotion: the example of healthy eating Aims Methods Worker/client relationship Medical To identify those at risk from disease. Primary health care consultation. e.g. measurement of body mass. Expert-led. Passive, conforming client.

Ten Leading Risk Factors for Preventable Disease Maternal and child underweight Unsafe sex High blood pressure Tobacco Alcohol Unsafe water, poor sanitation, & hygiene The behavior-health link becomes clear when examining the 10 leading risk factors identified by the World Health Organization for preventable death and disease worldwide: maternal and child underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe water, poor sanitation, and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency; and high body mass index, or overweight. According to WHO, forty percent of deaths worldwide are due to these 10 risk factors alone.

Ten Leading Risk Factors for Preventable Disease High cholesterol Indoor smoke from solid fuels Iron deficiency High body mass index or overweight The behavior-health link becomes clear when examining the 10 leading risk factors identified by the World Health Organization for preventable death and disease worldwide: maternal and child underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe water, poor sanitation, and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency; and high body mass index, or overweight. According to WHO, forty percent of deaths worldwide are due to these 10 risk factors alone.

Health Promotion Tools Mass media Social marketing Community mobilization Health education Client-provider interactions Policy communication Most health planners use a combination of theory-based approaches and tools to promote positive behavior change. No single approach is likely to produce significant or sustainable change. For example, in the case of developing countries’ fertility transition to smaller families, mass media played a contributory role but only as part of a complex social process rather than as an independent effect. Multiple channels over time provide reinforcing messages that produce interpersonal discussion among more and more people and eventually result in a change in social values and behavior. Health promotion tools include: mass media, social marketing, nationwide and intensive community mobilization, health education, client-provider interactions in health facilities, and policy communication.

Health Promotion Approaches (Ottawa Charter, 1986) Communication Education Legislation Fiscal Measures Organizational Change Community Development Spontaneous Local Activities

Ottawa Charter: Pre-requisites for Health (WHO, 1986) Peace Shelter Education Food income Stable eco-system Sustainable resources Social justice Equity

Questions? Comments?