KIN 464 Health Promotion & Physical Activity Communities of Practice Reflective Practice Social Determinants of Health Evolution of Health Promotion in Canada – Era 1 Thanks to those who have already submitted their completed community of practice/group worksheet – due this Friday. January 12, 2016

Week 1 - Summary Health promotion - beyond promoting individual healthy lifestyle choices Comprehensive definitions of health and health promotion Values and key concepts of health promotion Ottawa Charter & Intro to Social Determinants of Health Socio-economic gradient in health status Post your suggested quiz questions on the blog. Quiz 1 is on Thursday February 4 th. If you are not yet on the course blog register by the end of this week for continued access. For assistance review the FAQ section or contact

Group work is mandatory Community Health Mapping – Preliminary Evidence-Based Report 5% group mark for the introduction and conclusion 20% individual mark for each task (see below) 9:30am Feb 25 Submit a group pdf by to the instructor and provide one hard copy in class Community Health Mapping – Final Briefing Report 20% group mark 9:30am March 24 Submit a group pdf by to the instructor and provide one hard copy in class Community Health Mapping – Peer Participation 10%April 7, must be in class

Communities of Practice (CoPs) “groups of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise by interacting on an ongoing basis.” Wenger, E., McDermott, R., & Snyder, W.C. (2002). Cultivating Communities of Practice: A Guide to Managing Knowledge. Boston, MA: Harvard Business School.

Key features of CoPs Integrates experiential, instrumental, relational & academic knowledge. Respects and gains from different forms of knowledge and competence. Supports reflective practice including dialogue to explore alternative ways to solve problems. Buysse, V., Sparkman, K.L. & Wesley, P.W. (2003). Communities of practice: Connecting what we know with what we do. Exceptional Children, 69(3):

Benefits of CoPs Reduced isolation, social support, new connections Pooling knowledge, resources, and responsibility for outcomes Cross disciplinary & cross professional communication Increased knowledge translation & knowledge transfer Increased opportunities to have an impact

kin464/groups/ Communities of Practice Worksheet Please your completed form to Lori by Friday – January 14 Creating groups (4 students/group)

MoU – ToR – Group Contract Memorandum of Understanding: - describes the agreement between parties Terms of Reference: - describes the purpose and structure of how a collection of people will work together to achieve a shared outcome – defines who, what, how and when. KIN 464 Group contract: - outline tasks and timelines, steps to be taken if conflicts arise, and criteria for peer evaluations (10%). Template and samples on the Blog.

KIN 464 Group Contract

A matrix of the goals and core activities in the Ottawa Charter Healthy Public Policy Personal skills Healthy environments Community mobilization Reorient health services Enable (enable all people to achieve their fullest health potential) Saan, H., & Wise, M. (2011). Enable, mediate, advocate. Health promotion international, 26(suppl 2), ii187-ii193.

A matrix of the goals and core activities in the Ottawa Charter Healthy Public Policy Community mobilization Healthy environments Personal skills Reorient health services Mediate (coordinated action by all concerned) Saan, H., & Wise, M. (2011). Enable, mediate, advocate. Health promotion international, 26(suppl 2), ii187-ii193.

A matrix of the goals and core activities in the Ottawa Charter Healthy Public Policy Community mobilization Healthy environments Personal skills Reorient health services Advocate (Advocacy for health) Saan, H., & Wise, M. (2011). Enable, mediate, advocate. Health promotion international, 26(suppl 2), ii187-ii193.

Advocacy Educating and influencing policy makers, leaders and media to raise profile of health promotion, social determinants of health and existing health inequities Tackling discrimination, marginalization and inequities Facilitating community and individual empowerment, capacity building and action; support individual and community advocates Addressing political, legal, financial and service obstacles to effective community health promotion action

Reflective Practice? Collaborative - collective consideration of issues, actions, questions and practices including those that impact group interactions Individual - deliberate examination of situations, behaviour, practices and effectiveness (Boutilier & Mason, 2012)

Reflection & Action a process of continuous learning How does what you’ve learned inform/impact/change what you do to promote health and physical activity? In your experience what has worked well and why? What didn’t and why? How will you apply what you’ve learned? Processing your experiences in variety of ways… consistently making time to explore your understanding of your actions and experience, and the impact of these on you and others.

Personal Worldview How do you view and make sense of the world… ? Respecting differences Life experiences, education View of life’s purpose or meaning and one’s place in the word Examining our own: -Beliefs, values, knowledge, assumptions, biases

STATEMENT: Socio-economic status impacts health more than personal lifestyle choices. Agree or Disagree Why? People who don’t exercise at least three times a week are not taking personal responsibility for their health and are a potential burden on our health care system. The media has an important and influential role in promoting health.

Examining our own: Beliefs, values, knowledge, assumptions, biases

awareness of power relations and one’s own social location and positionality (how do class and gender relations affect how we do our work as individuals and as a group) – being aware of one’s own power and privilege. the importance of reflexive practice – being aware of our own personal, social and political identities helps us to avoid unknowingly perpetuating, sustaining and reinforcing harmful stereotypes. Reflexive Practice? (Boutilier & Mason, 2012)

“The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience”

Social Determinants of Health 1. Income 2. Education 3. Unemployment & Job Security 4. Employment & Working Conditions 5. Early Childhood Development 6. Food Insecurity 7. Housing 8. Social Exclusion 9. Social Safety Network 10. Health Services 11. Aboriginal Status 12. Gender 13. Race 14. Disability Source: The Canadian Facts (Mikkonen & Raphael, 2010)

1. Income 2. Education 3. Unemployment & Job Security 4. Employment & Working Conditions 5. Early Childhood Development 6. Food Insecurity 7. Housing 8. Social Exclusion 9. Social Safety Network 10. Health Services 11. Aboriginal Status 12. Gender13. Race14. Disability Hypothetically – what happened?

1. Income 2. Education 3. Unemployment & Job Security 4. Employment & Working Conditions 5. Early Childhood Development 6. Food Insecurity 7. Housing 8. Social Exclusion 9. Social Safety Network 10. Health Services 11. Aboriginal Status 12. Gender13. Race14. Disability Hypothetically – what would help?

Evolution of Health Promotion in Canada O’Neill et al., 2012 EraPredominant ApproachYears 1Health Education Prior to Health Promotion Development Population Health Population Health Promotion Present

Era 1: Health Education (Before 1974) O’Neill et al., 2012 Sanitation and Infectious Disease In the late 1800’s and early 1900’s, the Canadian government and most industrialized countries were focused on sanitation (e.g. sewage, clean drinking water) to reduce infectious diseases Health education/messaging via radio broadcasts and print materials. 1940s and early 1950s - a more systematic and scientific approach to educating the public on health matters led to the International Union for Health Education created in Paris.

Era 1: Health Education con’t (Before 1974) O’Neill et al., 2012 Diseases of Civilization Early 1950s until the mid 1970s health education information targeted the professional-patient relationship epidemiological patterns of so- called “diseases of civilization” (e.g., cardiovascular disease, cancers, accidents) were rapidly displacing the pattern of infectious diseases in industrialized countries.

new sources of mortality were largely behavioural ‘at-risk’ factors (e.g., smoking, sedentary lifestyles, eating habits, etc.) became the prime targets of health education Era 1: Health Education con’t (Before 1974) O’Neill et al., 2012

Health Education “Any intentional activity which is designed to achieve health or illness related learning”. Effective health education may produce changes in knowledge and understanding or ways of thinking, it may influence values, beliefs, attitudes, skill acquisition, and changes in behaviour or lifestyle. (Tones & Tilford, 1994, cited in Green, 2008).

Era 1: Health Education con’t (Before 1974) O’Neill et al., 2012 In the s social psychologists, sociologists, and communication specialists were involved in the development of: – models to help understand and predict health related behavior – effective health education campaigns.

Era 1: Health Education con’t (Before 1974) O’Neill et al., 2012 In the 1950s the famous Health Belief Model, the first of a long series of theoretical models of individual health behavior, was conceived at Johns Hopkins School of Hygiene and Public Health in Baltimore.

Era 1: Health Education con’t (Before 1974) O’Neill et al., 2012 Canada's fitness movement: Committing armchair suicide (CBC, 1968) Health education was eventually marginalized as Western industrialized governments focused establishing acute medical care systems.

ParticipACTION (Started in 1971) Edwards (2004)

Blaming the Victim… A consistent criticism of health education and behaviour strategies targeting individuals. Most national responses to the increase in body weight focus on behaviour change strategies targeted at individuals – is this blaming the victim? What alternative approaches would be effective to reduce obesity? Emphasis is on self-blame, personal responsibility and individual action (Laverack, 2012). Individualism is an ideology that holds people responsible for their own actions and the consequences that these may have (Laverack, 2012). Individual behaviour change approaches dominate because ‘medical ideology’ stresses individual responsibility and lifestyle responses (Baum & Saunders, 2011). POVERTY, ILLNESS, OBESITY

Criticisms of Era 1 health education focused on changing individual behaviour and did not take the wider determinants of health into account. I.e. implemented programs such as ‘Look After Yourself’ rather than confronting the tobacco and other industries or considering poverty, thereby blaming the victim for their own poor health. too closely aligned to the medical profession - emphasis on disease rather than promoting health NOTE - education component can still have a major role to promoting equity, empowerment, and freedom of choice (voluntarism) (Green, 2008) – as a component of a comprehensive strategy that targets broad health determinants.

Evolution of Health Promotion in Canada O’Neill et al., 2012 EraPredominant ApproachYears 1Health Education Prior to Health Promotion Development Population Health Population Health Promotion Present

Social Justice & Health Equity “When we all do better, we all do better” – Paul Wellstone