1. Bo J A Haglund professor Health Promotion Introductory remarks Bo J A Haglund professor * Karolinska Institutet, Department of Public Health Sciences

2. Tasks for the presenation 1 Critical issues on Health, Health Promotion and Health Promotion Evaluation 1 Critical issues on Health, Health Promotion and Health Promotion Evaluation 2 Practice of Health Promotion 2 Practice of Health Promotion

3. Tasks for the presenation 1 Based on Jennie Naidoo and Jan Wills: Health Promotion. Foundations for Practice. 1 Based on Jennie Naidoo and Jan Wills: Health Promotion. Foundations for Practice. (2000) London: Bailliére Tindall (2000) London: Bailliére Tindall 2 Comments on First section : The Theory of Health Promotion 2 Comments on First section : The Theory of Health Promotion

4. Critical Issues What are the major health problems? What are the major health problems? What are the causes of these problems? What are the causes of these problems? What health promotion activities may reduce these problems? What health promotion activities may reduce these problems? How do we know whether we have been effective in solving these health problems? How do we know whether we have been effective in solving these health problems?

5. Definitions of health Physical health Physical health Mental health Mental health Emotional health Emotional health

6. Definitions of health Physical health Physical health Mental health Mental health Emotional health Emotional health Social health Social health Spiritual health Spiritual health Societal health Societal health

7. Health is a personal strength or ability..developed as personal tasks Health is a commodity that can be bought or given an end for providers and means for receivers Health is the physical and mental fitness to do socialized daily tasks a means towards the end of normal social functioning The theory that health is an ideal state Disease,illness and handicap and social problem absent Health is the foundation for achievment of potentials Summary of theories of health adapted after Seedhouse

8. Seedhouse argue that Health as the foundation for human achievements and Working for health is thus to create the conditions basic needs for food, drink, shelter, warmth access to information about factors influencing health skills and confidence to use that information

9. Determinants of health

11. Three waves of Public Health Industrialism evolving Goal: environment and individual measures: health policy reforms Economical growth Goal: Individual and environment Measures: programmes Postindustrial society Goal: environment and individual Measure: Supportive environments for helath Determinants of health

12. Public Health Movement (1840s-1920s) Health education (1920s-1970s) Health Promotion (1940s-1990s) New Public Health (1980s-2000) The Rise of the new public health after Bunton&Macdonald 1992 Health Promotion Discipline and Diversity

13. in Mortality/Morbidity in Wellbeing Health Determinants Risk Conditions Poverty( absolute and reative) Low social status Dangerous, stressful work(high demand/low control) Dangerous,polluted environment Natural resource depletion Greenhouse effect Ozone depletion Discriminations(e.g. sexism, racism,agism) Steep power hierarchy (incomen,weatlth,status, authority Individualism,competitiveness and meritocracy Psychosocial Risk Factors Isolation Lack of social support Poor social networks Low self-esteem High self-blame Low perceived health, self-efficacy Loss of meaning or purpose Behavioural Risk Facors Smoking Poor nutrition Physical inactivity Substance abuses (alcohol, drugs) Physiological Risk Factors Hypertension Hypercholesterolemi Release of stress hormones Elevated levels of fibrinogen Labonté 1996 Factors influencing health

14. Environment Socioeconomic strategies Tobacco Food habits After Haglund and Svanström, KI, omarbetning, Beth Hammarström Age, sex heritage Sleep habits m.m. Physical exercise Education Sex & relations Living conditions Narcots Chiled Adult contacts Farming & Food Traffic Working Conditions Alcohol Leisure & culture Social networks Heath care Social support Social- welfare Social- insurance Unem- ployment

15. The basic strategy is thus how to find methods to influence determinants of health that are possible to take action towards ! The basic strategy is thus how to find methods to influence determinants of health that are possible to take action towards ! Basic strategy

16. The health promotion concept Definitions of health promotion fall into two clusters--clusters that are not mutually exclusive. The first cluster focuses on the environment--for example, "to improve social and environmental living conditions..." the second focuses on the individual, for example to "choose new lifestyles...". Most however, recognize the need to focus on both the individual and the environment

17. 7 Principles of Health Promotion Empowering: Health promotion initiatives should enable individuals and communities to assume more power over the personal, socio- economic and environmental factors that affect their health. Empowering: Health promotion initiatives should enable individuals and communities to assume more power over the personal, socio- economic and environmental factors that affect their health. Participatory: Health promotion initiatives should involve those concerned in all stages of planning, implementing and evaluation. Participatory: Health promotion initiatives should involve those concerned in all stages of planning, implementing and evaluation. Holistic: Health promotion initiatives should foster physical, mental, social and spiritual health. Holistic: Health promotion initiatives should foster physical, mental, social and spiritual health. Intersectoral: Health promotion initiatives should involve the collaboration of agencies from relevant sectors Intersectoral: Health promotion initiatives should involve the collaboration of agencies from relevant sectors

18. 7 Principles of Health Promotion Equitable: Health promotion initiatives should be guided by a concern for equity and social justice. Equitable: Health promotion initiatives should be guided by a concern for equity and social justice. Sustainability: Health promotion initiatives should bring about changes that individuals and communities can maintain one initial funding has ended. Sustainability: Health promotion initiatives should bring about changes that individuals and communities can maintain one initial funding has ended. Multi-strategy: Health promotion initiatives should use a variety of approaches, including policy development, organisational change, community development, legislation, advocacy, education and communication, in combination with one another Multi-strategy: Health promotion initiatives should use a variety of approaches, including policy development, organisational change, community development, legislation, advocacy, education and communication, in combination with one another

19. HP definitions Various definitions of health promotion typically: Various definitions of health promotion typically: list types of actions that may be employed (educational, organisational, environmental, economic and political); list types of actions that may be employed (educational, organisational, environmental, economic and political); list adaptations or changes that occur as a result of these changes (attitudinal, behavioural, social and environmental); and list adaptations or changes that occur as a result of these changes (attitudinal, behavioural, social and environmental); and make reference to the goal of improving health. make reference to the goal of improving health.

20. Definition of Health Promotion Health Promotion based on Ottawa Charter altered by Stachtchenko and Jenicek (1990) with the adding of safety reads as follows: “the process of enabling [individuals and communities] to increase control over [the determinants of health and safety] and [thereby] improve their health.”

21. Defintion of HP Staff in the Department of Health Promotion at Curtin University in Western Australia have agreed to adopt a description of health promotion that is based on the two most widely used definitions formulated by European and North American sources (Green and Kreuter 1999; WHO 1986; WHO 1997). The following definition of health promotion was adopted for the project: “Health promotion can be regarded as a combination of educational, organisational, economic and political actions designed with consumer participation, to enable individuals, groups and whole communities to increase control over, and to improve their health through attitudinal, behavioural, social and environmental changes”

22. Practice of Health Promotion

23. Is health promotion more like pool or water polo?

24. Pool or Water polo Pool or Water polo One person, one opponent One person, one opponent Level playing surface Level playing surface Highly defined playing strategy, predictable outcomes Highly defined playing strategy, predictable outcomes No background noise No background noise Action occurs above ground under spotlights Action occurs above ground under spotlights Team game multiple opponents Team game multiple opponents Constantly changing playing environment Constantly changing playing environment Fast moving, constantly changing game plan Fast moving, constantly changing game plan Considerable background noise Considerable background noise Much action occurs below the surface Much action occurs below the surface

25. Definition of Competencies Competencies are made up of attributes such as knowledge, abilities, skills and attitudes. They can be broad and complex or specific and simple

26. 1.Följa (Monitor) hälsoläget för att identifiera samhällets hälsoproblem 2.Diagnostisera och undersöka hälsoproblem och hälsorisker i samhället (Samhällsanalyser) 3.Informera, utbilda, och maktmobilsera (empower) befolkningen om hälsofrågor 4.Mobilisera olika partner i samhället vilka kan identifiera och åtgärda hälsoproblemen. 5.Utveckla policies och planer som stöder individuella och samhälleliga ansträngningar som kan påverka hälsan 6.Förstärk lagar och regler som skyddar hälsa och förstärker säkerhet 7.Stöd människors behov av hälsoservice och försäkra att vård ges till alla behövande 8.Utveckla en kompetent arbetskraft för folkhälsoarbete och vård 9.Utvärdera effekter, tillgänglighet och kvalitet i vård och folkhälsoarbete. 10. Utveckla forskning som kan ge nya insikter och innovativa lösningar på folkhälsoproblem Nelson, J. Essien, J., Loudermilk, R. and Cohen, D. (2002). The Public Health Competency Handbook: Optimizing Individual & Organization Performance for the Public’s Health. Atlanta, GA: Center for Public Health Practice of the Rollins School of Public Health. USA report (CDC) on Public Health Core Competencies

27. Framework for Health Promotion Activities, after Ewles & Simnet 1999

28. REVIEW OF COMPETENCIES FOR AUSTRALIAN HEALTH PROMOTION 2002

29. The study identifies broad consensus around a list of 82 competencies under the eight broad headings of: Needs Assessment Needs Assessment Planning Planning Implementation Implementation Communication Communication Knowledge Knowledge Organisation and management Organisation and management Evaluation and research Evaluation and research Use of technology Use of technology

30. The health promotion concept health promotion is generally seen by those who have defined it as involving a diverse set of actions focused on the individual or environment which through increasing control, ultimately leads to improved health or well being (Rootman et al 2001). health promotion is generally seen by those who have defined it as involving a diverse set of actions focused on the individual or environment which through increasing control, ultimately leads to improved health or well being (Rootman et al 2001).

31. The health promotion concept health promotion activities involve the process of enabling or empowering individuals or communities. Therefore, the absence of empowering activities should be a signal that an intervention does not fall within the rubric of health promotion. Attempts to encourage public participation are critical to the process of empowerment

32. Settings approach Health is created and lived by people within the settings of their everyday life: where they learn, work, play and love? It is in these settings - at school, at work, in our neighborhoods - that we live our lives and it is these contexts or settings, which need to be made more conducive to health

33. Settings approach c. Healthy cities Healthy workplaces Healthy schools Healthy universities Healthy hospitals Healthy prisons Underlying principle: equity and social justice !

34. Appropriate evidence Given these complexities, there can be no single ”right” method or measure to evaluate effectiveness of programmes, and no ”absolute” form of evidence

35. Appropriate evidence Evidence of effectiveness is inextricably linked to the entry point (health issue, population or setting), method of health promotion intervention and measure of outcome used to judge ”sucess”

36. The meaning of “evidence” in health promotion Four questions: Four questions: Evidence for whom? –Defining “values” for different groups Evidence of what? –How to measure success in health promotion? Evidence from what? –What makes a good intervention? Evidence through what? –What is the best evaluation research method for health promotion interventions?

37. END