1. Introduction 1
© John Hubley & June Copeman 2008

2. 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.

3. 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.

4. 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

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

6. 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

7. 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

8. Mortality from Coronary Heart Disease
men aged by social class, England and Wales,
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

9. Perinatal Mortality Rate9
Perinatal Mortality Rate
Rate per 1,000 live & still births 20
By mother’s country of birth, England and Wales,
combined
14.3 15
13.5
10.2
9.6 10
8.8
7.9 5
Pakistan
Caribbean
Bangladesh
India
E Africa UK

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

13. Amir’s story But why ...?" "Why is Amir in the hospital?
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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)

14. 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 Vol 28.No4.

15. 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

16. 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

17. 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

18. 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.

19. 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

20. 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.

21. Service Delivery Improvement in capacity of staff – training
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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

22. 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?

23. 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.

24. END 24