Tadulako Promotion Lecture1

7/30/2019 Tadulako Promotion Lecture1

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Introduction

John Hubley & June Copeman 2008


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Bagian Kesehatan Masyarakat - FK. UGM

Prof. dr. Siswanto Agus Wilopo, SU., M.Sc.

Sc.D.

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-basedworkers and volunteers have a role in health promotion.

Health promotion is an evolving discipline with many ongoingdebates concerning principles and practice including:

the balance between health education and legislation; the roleof individualistic and structuralistic approaches; the levels atwhich to operate; the nature of the core values/ethicalprinciples; 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 andtiming of activities.


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Sc.D.

By the end of this lecture you should be able to:

understand the history of prevention, publichealth 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, corevalues/ethical principles and assessed your own

personal approach. apply principles of health promotion to planning

a health promotion intervention for different agegroups.


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Sc.D.


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Sc.D.

Refocusing upstream

"I am standing by the shore of a swiftly flowing river and hear the cry of a drowning man. I

jump into the cold waters. I fight against the strong current and force my way to thestruggling man. I hold on hard and gradually pull him to shore. I lay him out on the bank

and revive him with artificial respiration.

Just when he begins to breathe, I hear another cry for help.

I jump into the cold waters. I fight against the strong current, and swim forcefully to the

struggling woman. I grab hold and gradually pull her to shore. I lift her out on the bankbeside the man and work to revive her with artificial respiration.

Just when she begins to breathe, I hear another cry for help.

I jump into the cold waters. Fighting again against the strong current, I force my way to the

struggling man. I am getting tired, so with great effort I eventually pull him to shore. I lay

him out on the bank and try to revive him with artificial respiration.

Just when he begins to breathe, I hear another cry for help.

Near exhaustion, it occurs to me that I'm so busy jumping in, pulling them to shore,

applying artificial respiration that I have no time to see

who is upstream pushing them all in...."

A story told by Irving Zola - but is used in an article by John B. McKinlay in "A Case for Refocusing

Upstream: The Political Economy of Illness" McKinlay, J.B. (1981)


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healthy onset of advanced disability

person symptoms symptoms death

(reversible) (not reversible )

Primary Secondary Tertiaryprevention prevention prevention

screening rehabilitation

case finding

early prevention


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Death rates from lung cancer (per 1000) by

number of cigarettes smoked, British doctors,

1951-61


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Health Field Model

Human Biology

(Genetics)

Environment

Health

Services

Lifestyle

(Human

behaviour)

B i K h M k FK UGM


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Prof. dr. Siswanto Agus Wilopo, SU., M.Sc. Sc.D.

Human behaviours important for

health promotion

Community action - actions by communities to change theirsurroundings 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 anillness/surgery to recover

B i K h t M k t FK UGM


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Saving Lives Our Healthier Nation

(1999)This White Paper from the Department of Health for England set the agenda forhealth 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 balanceddiet with plenty offruit and vegetables.

3. Keep physicallyactive.

4. Managestress 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


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182

121

125

73

63

107

0 50 100 150 200

Unskilled

Partly skilled

Manual skilled

Non-manual skilled

Managerial

Professional

Mortality from Coronary Heart Disease

men aged 20-64 by social class, England and Wales, 1991-93

England and Wales = 100

Source: Office for National Statistics (ONS), Health Inequalitiescharts. t

Standardized mortality

ratios

Social Class


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14.313.5

10.29.6 8.8

7.9

0

5

10

15

20

Pakistan BangladeshCaribbean India

Rate per 1,000 live & still births

E Africa UK

Perinatal Mortality Rate

By mothers country of birth, England and Wales,

1997-99 combined


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The Rainbow model - The main determinants of health

Independent Inquiry into Inequalities in Health report Chairman: Sir Donald Acheson 1998

Bagian Kesehatan Masyarakat FK UGM


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Amirs story"Why is Amir in the hospital? Because he has a bad infection in his leg.

But why does he have an Because he has a cut on his leg and it got infected.

infection?

But why does he have a cut Because he was playing in the junk yard next to his

on his leg? apartment building and there was some sharp,

jagged steel there that he fell on.

But why was he playing in Because his neighbourhood is kind of run down.

a junk yard? A lot of kids play there and there is no one to

supervise them.But why does he live in that Because his parents can't afford a nicer place to

neighbourhood? live.

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)

Bagian Kesehatan Masyarakat - FK UGM


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Proximal and distant causes of illness and premature mortality,

JR Seffrin Journal of health education Sep Oct 1997. Vol 28.No4.

Inequality

Social InjusticeAlienation

Lack of

empowerment

Poor education

Low prestige

Poverty

Tobacco useAnxiety

Reckless risk-

taking

Excess

illness

Low

productivity

Early death

Causes of poor health



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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



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Health Promotion

Theprocess of enabling people to

increase control over, and to improve,

their health

Ottawa Charter 1986


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Ottawa Charter for Health Promotion

Source: Canadian Public Health Association - An International Conference on Health

Promotion - November 17-21 1986

Health Promotion - the process of enabling people to increase

control over, and to improve, their health.

Enable

Mediate

Advocate

Strengthen

Community

Action

Develop

PersonalSkills

Create

Supportive

EnvironmentsReorient

Health

Services



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Bagian Kesehatan Masyarakat FK. UGM


Promoting health

Health Education

Communicat ion

directed at individ uals,

famil ies and

communi t ies to

inf luence:

Behaviour change

Determinants of behaviour change:

awareness/knowledge

decision-making

beliefs/attitudes

empowerment

community participation

Service

improvement

Imp rovements in

qual i ty and

quant i ty of

services:

accessibility

case management

counselling

patient education

outreach

social marketing

Advocacy

Agenda setting andadvocacy for

healthy public

policy:

policies for health

income generation

removal of

obstacles

discrimination

inequalities

gender barriers


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Health education. A process with intellectual,

psychological and social dimensions relating to activities that

increase the abilities of people to make informed decisionsaffecting 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)

Serv ice 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.



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Bagian Kesehatan Masyarakat FK. UGM


Advocacy

Influencing policy makers, leadersand media to raise profile of healthprogrammes

Addressing legal, financial andservice obstacles to health action

Tackling discrimination andinequalities



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ag a ese ata asya a at UG


Service Delivery

Improvement in capacity of staff trainingand support

Development of new activities

Reorienting existing activities to make themmore effective/acceptable

Strengthening communication/healtheducation within services

- Improved patient education- Outreach to schools, community, workplace

- Involvement of personnel in supportingcommunity health promotion



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g y


Health promotion needs/situation analysis

Current si tuat ion?

Health n eeds?

Inf luences on h ealth

Inf luences on h ealthact ions?

Target groups ?

Define healthpromotion strategy

Mix of health educat ion,serv ice improvement and

advocacy?

Health Education appro ach?

Methods?

Sett ings?

Persons/groups involved indel ivery?

Timing?

Targets?

Implement How to put i t a l l together?

How do we overcome

barr iers?

How to m oni tor act iv i t ies?

Evaluate, reflect,

learn Were our targets achieved?

What lesson s were learnt?

How can w e make our

programmes bet ter?

Health

Promotion

Planning Cycle



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The ten areas of competencies in public

health identified by Faculty of Public Health

1. Surveillance and assessment of the population's health and wellbeing.

2. Promoting and protecting its health and wellbeing.

3. Developing quality and risk management within an evaluative culture.

4. Collaborative working for health.5. Developing health programmes and services and reducing inequalities.

6. Policy and strategy development and implementation to improve health.

7. Working with and for communities to improve health and wellbeing.

8. Strategic leadership.

9. Research and development to improve health and wellbeing.

10. Ethically managing self, people and resources to improve

health/wellbeing.


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END

Tadulako Promotion Lecture1

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