HEALTH PROMOTION IN HEALTH PROMOTION IN ACTION: PRACTICAL ACTION: PRACTICAL

IDEAS ON PROGRAMME IDEAS ON PROGRAMME IMPLEMENTATIONIMPLEMENTATION

HEALTH PROMOTION: HEALTH PROMOTION: WHERE DO WE START?WHERE DO WE START?

• From disease/conditions.From disease/conditions.

• From issues eg. Safety, environment, From issues eg. Safety, environment, tobacco control.tobacco control.

• From lifestyles.From lifestyles.

• From settings eg. From settings eg. workplaceworkplace

homehome

schoolsschools

clinicsclinics

WHY SETTINGS?WHY SETTINGS?

• Human health behaviour is determined by the Human health behaviour is determined by the physical and social forces which are present physical and social forces which are present and interacting in any setting.and interacting in any setting.

• Involves the target population as a whole in Involves the target population as a whole in the context of their everyday life and in their the context of their everyday life and in their unique environment.unique environment.

• Holistic and comprehensive approach.Holistic and comprehensive approach.

SETTINGS FOR HEALTHSETTINGS FOR HEALTH

• This approach to health promotion This approach to health promotion arose from the arose from the Ottawa Charter:Ottawa Charter:

““Health is created and lived by Health is created and lived by people within the settings of their people within the settings of their everyday life; where they learn, everyday life; where they learn, work, play and love”.work, play and love”.

SETTINGS FOR HEALTHSETTINGS FOR HEALTH• The Settings For Health approach in The Settings For Health approach in

concerned with creating health in our concerned with creating health in our different settings.different settings.

• Examples of Healthy Setting are:Examples of Healthy Setting are:– Healthy CitiesHealthy Cities– Healthy VillagesHealthy Villages– Healthy IslandsHealthy Islands– Health Promoting HospitalsHealth Promoting Hospitals– Health Promoting SchoolsHealth Promoting Schools

WHAT IS A HEALTHY CITY?WHAT IS A HEALTHY CITY?

““A Healthy City is one that improves its A Healthy City is one that improves its environment and expands its environment and expands its resources so that people can support resources so that people can support each other in achieving their highest each other in achieving their highest potential… A Healthy City is conscious potential… A Healthy City is conscious of health as an urban issue and is of health as an urban issue and is striving to improve it. Any city can be a striving to improve it. Any city can be a healthy if it is committed to health”.healthy if it is committed to health”.

Healthy CitiesHealthy Cities• The Healthy Cities project was the first settings The Healthy Cities project was the first settings

project to arise from the Ottawa Charter.project to arise from the Ottawa Charter.

• Over a thousand cities worldwide are working on this Over a thousand cities worldwide are working on this project.project.

• The Healthy Cities project was first initiated in The Healthy Cities project was first initiated in Malaysia in 1994. Two cities, Johor Bahru and Malaysia in 1994. Two cities, Johor Bahru and Kuching, were initially selected.Kuching, were initially selected.

• Currently, many Healthy Cities projects are being Currently, many Healthy Cities projects are being undertaken throughout Malaysia, involving undertaken throughout Malaysia, involving cities/towns like Kota Bahru, Kuala Terengganu, cities/towns like Kota Bahru, Kuala Terengganu, Georgetown, Kuantan, Malacca, Petaling Jaya, Miri, Georgetown, Kuantan, Malacca, Petaling Jaya, Miri, Seremban, Ipoh, and Kuala Lumpur.Seremban, Ipoh, and Kuala Lumpur.

The Aims of Healthy Cities The Aims of Healthy Cities ProjectProject

• To minimise health hazards in urban To minimise health hazards in urban areas through integration of health areas through integration of health and environmental protection and environmental protection measures in urban planning and measures in urban planning and management processes.management processes.

• To enhance the quality of the To enhance the quality of the physical and social environment.physical and social environment.

• To increase public awareness towards To increase public awareness towards healthier behaviours, lifestyles and habits.healthier behaviours, lifestyles and habits.

• To improve the provision of health services by To improve the provision of health services by developing appropriate urban health care developing appropriate urban health care systems.systems.

• To upgrade the country’s capabilities to To upgrade the country’s capabilities to improve urban health through better improve urban health through better intersectoral coordination and participation.intersectoral coordination and participation.

The Ten Signs of a Healthy The Ten Signs of a Healthy CityCity1. A clean, safe physical environment of high 1. A clean, safe physical environment of high

quality (including housing quality).quality (including housing quality).

2. An ecosystem that is stable now and 2. An ecosystem that is stable now and sustainable in the long term.sustainable in the long term.

3. A strong, mutually supportive and non-3. A strong, mutually supportive and non-exploitive community.exploitive community.

4. A high degree of participation and control by 4. A high degree of participation and control by the public over the decisions affecting their the public over the decisions affecting their lives, health and wellbeing.lives, health and wellbeing.

5. The meeting of basic needs (for food, 5. The meeting of basic needs (for food, water, shelter, income, safety and work) water, shelter, income, safety and work) for all the city’s people.for all the city’s people.

6. Access to a wide variety of contact, 6. Access to a wide variety of contact, interaction and communication.interaction and communication.

7. A diverse, vital and innovative economy.7. A diverse, vital and innovative economy.

8. The encouragement of connectedness 8. The encouragement of connectedness with the past, with the cultural and with the past, with the cultural and biological heritage of city dwellers and biological heritage of city dwellers and with other groups and individuals.with other groups and individuals.

9. An optimum level of appropriate public 9. An optimum level of appropriate public health and sick care services accessible to health and sick care services accessible to all.all.

10. High health status (high levels of 10. High health status (high levels of positive health and low levels of disease).positive health and low levels of disease).

Health Promoting SchoolsHealth Promoting Schools

• A WHO programme first launched in Europe in A WHO programme first launched in Europe in 1991.1991.

• HPS are schools that make efforts to influence & HPS are schools that make efforts to influence & promote health.promote health.

• Schools as a healthy setting for living, learning Schools as a healthy setting for living, learning and working.and working.

• Engages health and education officials, teachers, Engages health and education officials, teachers, students, parents & community leaders.students, parents & community leaders.

HEALTH PROMOTING HEALTH PROMOTING SCHOOLS (HPS)SCHOOLS (HPS)• Covers a wide spectrum of the population.Covers a wide spectrum of the population.

– pupils, staff, families, communitypupils, staff, families, community

• Covers 2 essential human rights.Covers 2 essential human rights.– HealthHealth– EducationEducation

• Wide reach, due to compulsory enrolment.Wide reach, due to compulsory enrolment.

• A powerful way to influence health from an A powerful way to influence health from an early age.early age.

Program Bersepadu Program Bersepadu Sekolah Sihat (PBSS)Sekolah Sihat (PBSS)• In 1996, the MOH together with Ministry of In 1996, the MOH together with Ministry of

Education carried out a HPS pilot project in 6 Education carried out a HPS pilot project in 6 states.states.

• A revival of the School Health Programme A revival of the School Health Programme (1967).(1967).

• PBSS became a national programme in 1997.PBSS became a national programme in 1997.

• Integrates & coordinates all the health Integrates & coordinates all the health activities in schools.activities in schools.

6 Major Elements6 Major Elements

1. School health policy.1. School health policy.

2. Physical environment.2. Physical environment.

3. Social environment.3. Social environment.

4. Community 4. Community relationships.relationships.

5. Personal health skills.5. Personal health skills.

6. Health services.6. Health services.

Six Core Elements in PBSSSix Core Elements in PBSS

1. School Health Policy1. School Health Policy–Food safety in canteens.Food safety in canteens.–Smoke-free & drug-free.Smoke-free & drug-free.–Disease control (eg. Dengue-free school).Disease control (eg. Dengue-free school).–Health education.Health education.

2. Physical environment2. Physical environment–Safe, healthy and clean.Safe, healthy and clean.–Free from threat of disease.Free from threat of disease.

3. Social environment3. Social environment–Fosters development of healthy attitudes and Fosters development of healthy attitudes and practices.practices.

–Conducive for healthy mental development Conducive for healthy mental development and stress reduction.and stress reduction.

–Balanced development in the physical, Balanced development in the physical, emotional, spiritual and intellectual aspects.emotional, spiritual and intellectual aspects.

–Deals with social problems eg. through Deals with social problems eg. through religious/moral education & counselling.religious/moral education & counselling.

4. Community involvement4. Community involvement–Obtaining the support and involvement of Obtaining the support and involvement of parents and outside community.parents and outside community.

–Support can be material, financial or expertise.Support can be material, financial or expertise.

5. Personal health skills5. Personal health skills–Related to lifestyle practices.Related to lifestyle practices.–Through formal and non-formal activities.Through formal and non-formal activities.–Areas of skills developmentAreas of skills development

•personal and oral hygienepersonal and oral hygiene

•exercise and fitnessexercise and fitness

•first aid and emergenciesfirst aid and emergencies

•healthy eatinghealthy eating

•social skills and stress managementsocial skills and stress management

6. School Health service6. School Health service–Covers health promotion, health Covers health promotion, health and nutritional assessment, and nutritional assessment, treatment and referrals.treatment and referrals.

–Special programmes eg. Special programmes eg. Supplementary feeding and Supplementary feeding and School Milk Programmes.School Milk Programmes.

PRIMARY HEALTH CARE PRIMARY HEALTH CARE SETTING [PHC]SETTING [PHC]

PHC is the first level of contact of PHC is the first level of contact of individuals, the family and community individuals, the family and community with the national health system with the national health system bringing health care as close as bringing health care as close as possible to where people live, work possible to where people live, work and constitutes the first element of a and constitutes the first element of a continuing health care process”.continuing health care process”.

(Mac Donald, 1993)(Mac Donald, 1993)

Primary Health Care Primary Health Care Setting [PHC]Setting [PHC] PHC is an important setting for PHC is an important setting for

Health Promotion.Health Promotion.

• Most people have contact with PHC Most people have contact with PHC practitioners.practitioners.

• PHC practitioners are credible and PHC practitioners are credible and qualified.qualified.

• PHC and health promotion is cheaper PHC and health promotion is cheaper and better than hospital care.and better than hospital care.

Focal areas for Health Promotion.Focal areas for Health Promotion.

• Anti-smoking/Smoking Cessation.Anti-smoking/Smoking Cessation.

• CHD/stroke preventionCHD/stroke prevention– opportunistic health checksopportunistic health checks– lifestyle advice and health interventionslifestyle advice and health interventions

Healthy LifestylesHealthy Lifestyles– exercise and fitnessexercise and fitness– healthy eatinghealthy eating– stress management stress management – Safety promotionSafety promotion

Well Adult Clinics (WAC)Well Adult Clinics (WAC)

– Established under RM7 at all Health Clinics.Established under RM7 at all Health Clinics.– Expanded scope of Family Health Services Expanded scope of Family Health Services

Programme.Programme.– To cater to adults and adolescents with no To cater to adults and adolescents with no

known pathological conditions but may known pathological conditions but may possess pre-disposing risk factors.possess pre-disposing risk factors.

– Besides clinic-based, activities will also be Besides clinic-based, activities will also be extended to the community 3 times a year.extended to the community 3 times a year.

Well Adult ClinicsWell Adult Clinics

Specific objectivesSpecific objectives

1. To promote the adoption of 1. To promote the adoption of healthy lifestyle practices.healthy lifestyle practices.

2. To provide early detection of 2. To provide early detection of specific, underlying health problems specific, underlying health problems and provide appropriate and provide appropriate management plan.management plan.

• Health promotionHealth promotion– exerciseexercise– nutritionnutrition– smoking smoking

cessationcessation

• Prevention

• screening• counselling• referrals

Activities

CONCLUSIONCONCLUSION

• Health Promotion can be approached in Health Promotion can be approached in several ways.several ways.– disease , issues, lifestyle, settingsdisease , issues, lifestyle, settings

• Settings is a good approachSettings is a good approach– Considers the physical and social forces.Considers the physical and social forces.– Involves the whole population in the Involves the whole population in the

context of their everyday life situation.context of their everyday life situation.– Holistic.Holistic.

• School is a good setting.School is a good setting.– Advocated by WHO (Health Promoting Advocated by WHO (Health Promoting

Schools)Schools)

– Six major elements.Six major elements.

– The Program Bersepadu Sekolah Sihat is a The Program Bersepadu Sekolah Sihat is a national programme that integrates and national programme that integrates and coordinates all the health activities in schools.coordinates all the health activities in schools.

• PHC is accessible to most people & gives PHC is accessible to most people & gives opportunities for health staff to promote opportunities for health staff to promote health.health.– Health staff need to be role models and Health staff need to be role models and

advocates of good health.advocates of good health.

• Well Adult Clinics (WAC) caters for adults and Well Adult Clinics (WAC) caters for adults and adolescents.adolescents.– WAC promotes healthy lifestyles and early WAC promotes healthy lifestyles and early

detection and management of health detection and management of health problems.problems.

THANK YOUTHANK YOU