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TN4400 Promoting HealthWorkbook

Promoting Health Version1 (2014) A Primary Health Care Approach

TN4400 Promoting Health

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Promoting Health Version1 (2014) A Primary Health Care Approach 2

Table of Contents

TN4400 Overview 3TN4400 Pre-Session Survey 5TN4401-1 Policy Framework: Alma Ata 6TN4401-1 Learning Activity 9TN4401-2 Ottawa Charter 10TN4401-2 Learning Activity 15TN4402-1 The Social Determinants of Health 16TN4402-1 Learning Activity 21TN4402-2 Engaging Communities 22TN4402-2 Learning Activity 26TN4400 Theory to Practice 27TN4400 Quiz 28TN4401-1 Learning Activity Feedback 31TN4401-2 Learning Activity Feedback 32TN4402-1 Learning Activity Feedback 33TN4402-2 Learning Activity Feedback 34TN4400 Theory to Practice Feedback 35TN4400 Quiz Feedback 37TN4400 Post-Session Survey 40TN4400 References 41

Promoting Health Version1 (2014) A Primary Health Care Approach3

TN4400 Overview

Introduction

Health promotion creates opportunities for individuals, communities and populations to understand the determinants (influences) of their health and wellbeing and what they can do to improve them. Effective health promotion incorporates empowerment, social justice and equity, inclusion and respect.

Health promotion is based on a holistic view of health that uses participatory approaches. It focuses on address-ing the determinants of health including the social, behavioural, economic and environmental conditions that are the root causes of health and illness. It also builds on existing strengths and assets and uses multiple, com-plementary strategies to promote health at the individual (downstream), community and population (upstream) level.

Learning Objectives

On completion of this session participants will be able to: • Define Health Promotion• Discuss the link between comprehensive primary health care, the Alma Ata, the Ottawa Charter for

Health, social determinants of health and community engagement• Define the principles of the Alma Ata• Explain the intent of the Ottawa Charter• Identify the 5 action areas of the Ottawa Charter• Identify and discuss the social determinants of health• Define community engagement• Identify the levels of community engagement• Discuss the principles of good practice in community engagement.

Topics

This session presents four important components of health promotion. Topic one discusses the policy framework supporting comprehensive primary health care and topic two the practice framework for comprehensive primary health care.

Modules

Topic One introduces the Alma Ata which consists of the ten fundamental principles for effective comprehensive primary health care, and The Ottawa Charter which provides the blueprint for action for primary health care.

Topic Two discusses the social determinants of health and reviews community engagement, which is essential in the provision of comprehensive primary health care.


Pre and Post Session Surveys

Before you commence, we ask you to complete a quick survey to identify current knowledge base. This will provide a baseline you can refer to once you have completed this topic.

When you have completed this session, we ask you to complete another quick survey to determine if we have met your learning needs.

Learning activities / Quiz

An ungraded, interactive learning activity is included in each module and an ungraded theory to practice activity for the course is included and must be completed before moving onto the graded quiz.

Certificate

Once the quiz is completed you are eligible to receive a personalised certificate which provides evidence of your training. Included on this is the average time the session takes which can be used for professional development points.

If this course is completed using the workbook it will need to be forwarded to the PaRROT team who will issue the certificate.


TN4400 Pre-Session Survey

Before you commence this session we ask you to take a few moments to complete the pre-session survey for this topic. This will give us some indication what your learning needs might be.

At the end of this session we will also ask you to complete another survey to see how well we have met your needs.

Please indicate the degree to which you agree to the following, by ticking the box most relevant.

I am able to define health promotion

I understand the links between comprehensive primary health care, the Alma Ata, the Ottawa Charter, social determinants of health and community engagement

I understand the principles of the Alma Ata

I can explain the intent of the Ottawa Charter

I am able to discuss the determinants of health

I understand what is required for effective community engagement

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TN4401-1 Policy Framework: Alma Ata

Learning Objectives

On completion of this module learners will be able to:

• Define Health Promotion• Discuss the principles of the Alma Ata• Discuss the link between comprehensive primary health care and the Alma Ata

Comprehensive Primary Health Care

Comprehensive primary health recognises the expertise of the individual and the importance of community or individual empowerment.

Comprehensive primary health care is:

• Complete physical, mental and social wellbeing • Addresses issues of equity and social justice• Considers the impact of education, housing, food and income• Acknowledges the value of community development• Recognises the expertise of individuals over their own health• A comprehensive approach to chronic disease prevention, early intervention and management is

preferable to a selective primary health care approach which is clinician controlled and usually initiated when a person presenting with a health problem.

Talbot and Verinder 2005

Declaration of the Alma Ata

In 1978 the World Health Organisation and the United Nations International Children’s Emergency Fund held a conference on primary health care. The main outcome of the conference was the Declaration of Alma Ata which has ten fundamental principles of primary health care.

They are:

• Equity• Community participation• Use of socially accepted technology• Health promotion and disease prevention• Involvement of ALL government departments• Political action• Cooperation between countries• Redirection of funding to health• World peace.

This challenged the world’s nations to embrace the principles as way of overcoming health inequality and encouraged primary health care to become a main philosophy, and strategy for embracing health care.


Alma Ata

The declaration of the Alma Ata defined a set of minimum requirements for Primary Health Care to be imple-mented. It included:

• Education on health problems, prevention and management• Promotion of food supply and good nutrition• Provision of a safe and adequate water supply• Provision of maternal and child health care• Immunisation against major infectious diseases• Prevention and control of endemic diseases• Appropriate treatment of common diseases and injury• Provision of essential drugs.

Basic Principles

The Alma Ata provides a framework for the basic principles of primary health care which are

• Community participation which involves the community in making decisions about health e.g. consumer reps on committees and customer service feedback

• Intersectoral collaboration when government departments work together to provide a healthy environment as above; e.g. project steering groups

• Health service integration when health services work in partnerships e.g. ensuring seamless care when patients are “handed over” from one part of the health care service to another.

• Equity which includes the equitable distribution of resources; » 4.1 The principles of social justice are aligned to the concept of equity in that resources are

distributed according to greatest need• Self Reliance which ensures communities are in control of health services.

» 5.1 This is a particularly important concept for Aboriginal and Torres Strait Islander communities and is the opposite of passive welfare;

» 5.2 It means the community is “calling the shots” e.g. Community Boards deciding what services to support that meet the needs of the local community.

Community Participation

Community participation provides the basis for true primary health care, without which it will not succeed.

It supports individuals and families to assume responsibility for their own health and those of the community and develop the capacity to build community.

Effective community participation addresses the self-identified health needs of the people and ensures social responsibility in the community;

It supports the sustainability of services as they are more acceptable to the community.It supports sharing the cost of health by a number of organisations and agencies and the people of the communityIt enhances and supports shared knowledge and encourages Inter-sectoral collaboration


Inter-sectoral Collaboration

Intersectoral collaboration is collaboration between health and other agencies and integration of health services.

This approach to health ensures the cost is shared and organisations work towards the same aim.

It also supports efficiency, sustainability and standardisation of care, reducing duplication and spending blowouts.

Health Service Integration

Health service integration ensures coordination of health care which has many benefits including:

• Comprehensive provision of services which improves health outcomes by reducing fragmentation of care

• Consumers remain central to services • Standardised care ensuring consistent evidence-based approaches to addressing health conditions/

issues• Efficient use of resources which supports increasing the focus on addressing major burdens of disease

through prevention, treatment and management • Ensuring greater sustainability of the health system by reducing duplication and increasing the range of

services provided.

Equity

Equity in the provision of health services means resources available to the community should be evenly distributed, accessible and affordable to all.

In Australia this is supported in the provision of Medicare, which ensures everyone has access to health services and the Medicare funded initiatives including:

• The Rural and Remote Medical Benefits Scheme (RRMBS)• The Pharmaceutical Benefits Scheme (PBS)• The COAG for rural areas scheme

Self-Reliance

Self reliance places the control of health services, health technology and research into the hands of the community.

This ensures: Affordability, sustainability and acceptability of health services by the community.


TN4401-1 Learning Activity

1. List the minimum requirements for primary health defined by the Alma Ata

Answer


TN4401-2 Ottawa Charter

Learning Objectives

On completion of this module learners will be able to:

• Discuss the connection between Comprehensive Primary Health Care and the Ottawa Charter• Discuss the intent of the Ottawa Charter• Discuss the 5 action areas of the Ottawa Charter

The Ottawa Charter

http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index4.html

This logo defines the Ottawa charter and was created for the First International Conference on Health Promo-tion held in Ottawa, Canada, in 1986.

At that conference, the Ottawa Charter for Health Promotion was launched.

The World Health Organisation uses this symbol for Health Promotion , as outlined in the Ottawa Charter.

The logo contains a circle with 3 wings and incorporates the five key action areas in Health Promotion which represent building healthy public policy, creating supportive environments for health, strengthening community

http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index4.html


action for health, developing personal skills, and re-orienting health services.

It also includes the three basic Health Promotion strategies which are to enable, mediate, and advocate.

a) The red outside circle represents the goal of “Building Healthy Public Policies”, symbolising the need for policies to “hold things together”.

This circle encompasses the three wings, symbolising the need to address all five key action areas of health promotion identified in the Ottawa Charter in an integrated and complementary manner.

b) The central circle stands for the three basic strategies for health promotion, “enabling, mediating, and ad-vocacy “, which are needed and applied to all health promotion action areas

c) The three wings represent and contain the words of the five key action areas for health promotion that were identified in the Ottawa Charter for Health Promotion in 1986

These were reconfirmed in the Jakarta Declaration on Leading Health Promotion into the 21st Century in 1997.

The Ottawa Charter was the defining document of the new public health movement.

The Ottawa Charter was developed following the declaration of the Alma Ata and is known as the formal beginning of the new public health.

The idea behind the charter was to increase the relevance of Primary Health Care in that it was a clear statement of action that incorporates selective and comprehensive Primary Health Care.

The Ottawa Charter highlights the responsibility of organisations, systems, governments, communities and individual behaviour in ensuring effective and quality health services are developed and provided.

Building Healthy Public Policy

Health promotion puts health on the agenda of policy makers in all sectors and at all levels, ensuring they aware of the consequences of their decisions.

Health promotion policy combines diverse but complementary approaches including legislation, fiscal measures, taxation and organisational change.

It is coordinated action that leads to health, income and social policies that foster greater equity.

Joint action contributes to ensuring safer and healthier goods and services, healthier public services, and cleaner, more enjoyable environments.

Health promotion policy requires the identification of obstacles to the adoption of healthy public policies in non-health sectors, and strategies for overcoming them.

The aim must be to make the healthier choice the easier choice for policy makers as well.


Current Status

The current status of an infant’s or child’s health includes medical history and immunisations.

The medical history contains information on the family and the child’s history.

It identifies risks and potential issues that may impact on the child’s long term health including:

• Current problems or concerns• Examination findings • Current medications

The immunisation status of a child includes information on the current immunisation status and what immunisations are due.

Body Measurements

Body measurements provide a benchmark for future comparison and provide early indications of potential health risks.

Body Measurements include:

• Weight at all ages• Height or length checked 3 monthly until 2 years then annually• Head circumference up to and including 2 years• Fontanelles up to an including 2 years - Posterior up to 2 months and Anterior up to 2 years• Body mass index from 2 years• Blood pressure if a child’s BMI is above the 85th percentile and if• There is a family history of diabetes, hypertension or other criteria such as Acute Post Streptococcal

Glomerulo Nephritis.

Creating Supportive Environments

Modern society is complex and health cannot be separated from other factors such as education, the environ-ment and employment.

The links between people and their environment provides the basis for a socio-ecological approach to health. The overall guiding principle is to ensure people care for each other, the community and the natural environ-ment, which is a global responsibility.

The ongoing changing patterns of life, work and leisure have a significant impact on health. Work and leisure should not impact on the health of people.

The promotion of health includes ensuring that living and working conditions are safe, stimulating, satisfying and enjoyable.

Monitoring and managing the impact of a rapidly changing environment on health is essential, particularly in areas of technology, work, energy production and urbanisation.


The protection of the natural and built environments and the conservation of natural resources must be addressed in any health promotion strategy.

Strengthen Community Action

Health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them.

Central to this is empowerment of communities to control their environment.

Community development draws on human and material resources in the community to enhance self- management and social support, and to develop flexible systems for strengthening public participation in decisions about health.

This requires full and continuous access to information, learning opportunities for health, as well as funding support.

Develop Personal Skills

Health promotion supports personal and social development by providing information, health education, and enhancing life skills.

This increases individual options and supports greater control over health, environments and choice.

Enabling people to learn, throughout life, to prepare themselves for all of its stages and to cope with chronic illness and injuries is essential.

This has to be facilitated in school, home, work and community settings.

Action is required through educational, professional, commercial, health and voluntary organisations.


Reorientate Health Services

The responsibility for health promotion is shared between individuals, community groups, health professionals, health service institutions and governments.

They must work together to establish a health care system which contributes to the pursuit of health rather than the management of illness.

The role of the health sector needs to actively promote health rather than focus on the provision of clinical and curative services.

Health services need to embrace an expanded mandate that supports the needs of individuals and communities and is sensitive to and respects cultural needs.

This mandate should support partnerships between the health sector and broader social, political, economic and physical environmental components.

Reorienting health services also requires greater attention to health research as well as changes in professional education and training.

This must lead to a change of attitude and organisation of health services which refocuses on holistic needs of the individual.



1. What are the five action areas for primary health care, identified by the Ottawa Charter?

Answers


TN4402-1 The Social Determinants of Health

Learning Objectives

On completion of this module participants will be able to:

• Identify the social determinants of health• Describe their impacts on health• Discuss how they relate to primary health care

Social Determinants of Health

The WHO definition of comprehensive primary health care clearly identifies that the social determinants impact greatly on health.

If we are to respond to ill health, we need to respond to the social determinants as well as the presenting problem. Few of these factors can be controlled by individuals.

Rather than blaming people who are suffering because of these circumstances, the underlying causes of ill health need to be changed.

All Australians, are affected by social determinants. People with low incomes, no work or insecure jobs, or who feel excluded from mainstream society are likely to have poorer health.

At least 90% of the health budget is spent on the provision of health services, including salaries, medication, laboratory testing, hospital care and health infrastructure.

Because the social determinants are not only the responsibility of health, there is a good case for why health services need to work with other government departments, such as education and housing, and other organisations to ensure a collaborative approach to managing the social determinants of health.

The social determinants of health include:

• Income and social status• Stress – control over our life• Early childhood development• Social exclusion• Stress at work

Smith, JD (2007)

Social determinants of health also include:


• Employment and job security• Social support• Addiction• Diet and lifestyle choices• Exercise and transport

Income and Social Status

A person’s social and economic circumstances strongly affect their health throughout life.

People with lower-socio economic backgrounds have twice the risk of serious illness and premature death. As socioeconomic status decreases health standards show a continuous social gradient that reflects disadvantage and the risk of poor outcomes increases.

Disadvantage may mean:

• Having few family assets;• A poor education;• Being in a dead-end or insecure job;• Living in poor housing;• Trying to bring up a family in difficult circumstances; • Being relatively poor in a rich society.• The longer people live in stressful economic and social circumstances, the greater the ‘wear and tear’

and the less likely they are to live to a healthy old age.

Stress

Anxiety, insecurity, low self-esteem, lack of control over work or home life, all have powerful effects on health. These are ‘psycho-social’ risks.

They trigger the ‘stress response’ in our hormonal and nervous system, but when this is turned on too often, It increases the risks of depression, susceptibility to infection, diabetes, high cholesterol, high blood pressure, heart attack and stroke.

The closer people are to the lower end of the social scale, the more common these health problems become.


Early Childhood Development

Important foundations of adult health are laid before birth and in early childhood.

Poor social and economic circumstances, or poor nutrition of mother or child, can lead to slow growth of the child.

This in turn is associated with heart, respiratory and kidney disease and other chronic health problems in adult life.

Poor nutrition and physical development affect mental development, and combined with poverty, can mean reduced readiness for school and poor educational attainment.

This creates a higher risk of unemployment or work in low-status, low-control jobs in adult life.

Social Exclusion

Social exclusion is harmful. It creates misery and costs lives.

People who are socially excluded include groups such as Aboriginal and Torres Strait Islander people, migrants, ethnic minority groups and refugees.

The disabled (mentally and physically), people with illnesses such as AIDS, trans, bi and homosexual persons and the homeless are also marginalised.

Social exclusion and marginalisation, experiences of racism, discrimination and hostility can all harm health.

Social exclusion is associated with unemployment and poverty, and increases the risk of poor socio-economic outcomes.

Stress at Work

Stress at work increases the risk of disease. This kind of stress is not that of the busy executive, but the stress of lower level jobs.

When people have little control over their work, or few opportunities to use their skills, the risks of illness increase.

Jobs with high demand and few rewards carry special risks.


Unemployment and Job Insecurity

Unemployment puts health at risk, especially in regions where unemployment is widespread.

Job insecurity is a chronic stress which increases the longer the situation continues.

The longer job insecurity persists the poorer the health outcome for the individual

Social Support

Good support networks, friendships and relationships improve health.

Communities with high levels of social cohesion have, for example, lower rates of coronary heart disease. Conversely, these diseases increase when social cohesion declines.

Addiction

Misuse of alcohol, drugs and tobacco is harmful to health, but is often a response to social breakdown.

Alcohol dependence, drug use and smoking cigarettes are all closely associated with social and economic disadvantage and social disruption.

Poor economic and social conditions cause more dependence on alcohol.

In turn alcohol dependence intensifies the factors that led to its use in the first place.

Poor housing, low income, single parenthood, unemployment and homelessness are all associated with high rates of smoking. Smoking is a drain on income and a major cause of ill health.

Blaming the victims of these situations does not solve the problem, the social and economic circumstances that generate drug use need to be changed.


Diet and Lifestyle

Availability of affordable, healthy food is critical to good health and is an important public health issue. Health experts say that access to good, affordable food makes more difference to what people eat than health education.

It is not just a matter of educating people to eat good food, the food must be available and affordable in the first place.

Food poverty can exist side by side with food plenty.

When people cannot access good food, they suffer from obesity, cardiovascular disease, diabetes, cancer, eye disease and tooth decay. Exercise and Transport

A lack of reliable transport increases the risk of poor health.

In urban areas, healthy transport means better public transport, less traffic, more walking and cycling, which all promote better health.

For people in regional, rural and remote areas however, transport is vitally important to health in other ways. Access to transport means being able to travel to centres for shopping, school and health care.



1. List the social determinants of health

Answers

2. How might they impact on health?

Answers


TN4402-2 Engaging Communities

Learning Objectives

On completion of this module participants will be able to:

• Define community engagement• Discuss the importance of community engagement• Identify the levels of community engagement• Discuss the principles of good practice in community engagement• Describe some community engagement activities

Definition

Community engagement is the process by which aspirations, concerns, needs and values of citizens and communities are incorporated in decision making.

It aims to make better decisions that are supported by the community.

Why is it Important?

Community engagement is important as it

• Aligns with consumer rights because in includes consumers in decision-making processes that affect their health care

• Legitimises consumers’ views and helps the health system to accept and value the views, concerns and priorities of the consumer.

• Increases the chances of the activity being adopted by the community, as they have been involved in its development and have some ownership over it.

• Increases the chances of a positive outcome from the activity as consumers are more likely to undertake the activity as they have a vested interest in it.

• Empowers the community which gives them a sense of control


What can it achieve?

Connecting Community Engagement with decision making at a local level provides an opportunity to foster, facilitate and promote innovative approaches to primary health care services.

It is important to ensure community engagement strategies align with what the community is being consulted on, what decision processes they will be using and the level of influence to be provided by the community.

Effective community engagement can: • Enhance participant awareness and capability• Enhance the quality and productivity of collaboration• Build confidence and enjoyment of change• Share decision making, risk, reward and leadership • Increase the ethical quality of outcomes • Links values with outputs to deliver outcomes

Public Participation

Inform Consult Involve Collaborate EmpowerPublic Participation Goal

Provide balanced and objective information

Obtain public feedback on decisions

Work directly with the public throughout the process

Partner with the public in each aspect of the process

Place final decision making into hands of community

Promise to public

Keep the public informed

Keep public informed, listen and acknowledge input and provide feedback

Ensure concerns and aspirations are reflected and addressed

Seek advice and information in formulating solutions and incorporate into decisions

Implement what the community decides

Example Techniques

Fact sheetsWeb SitesOpen houses

Public commentFocus groupsSurveysPublic meetings

WorkshopsDeliberative polling

Community advisory committeesConsensus buildingParticipatory decision making

Community juriesBallotsDelegated decisions

This table is based on the IAP2 spectrum which is a flexible framework that ensures full community engagement.

It provides information on potential levels of engagement from informing the public, which is the lowest level, to empowering the community at the highest level.

The ideal is to empower the community, but in health, policy and funding arrangements will often dictate the level to which we can engage. It is recommended that engagement happens at the highest possible level.


Levels of Engagement

The potential levels of engagement with examples of activities at that level are listed here.

Inform which means giving information to help determine priorities based on research e.g. health status data using fact sheets.

Consult which includes reviewing current health services using focus groups and community meetings to give feedback.

Involve community members by running workshops to identify community concerns.

Collaborate with community advisory groups working with health staff to develop health services and programs based on priorities.

Empower Health Action Teams to identify and determine health priorities based on information provided.

Australian General Practice Network – IAP2 spectrum of Public Participation

Principles of Good Practice

It is important that the principles of good practice are adopted in a community engagement process. They include:

• Trust; Mutual agreement and productive working relationships• Respect; Show consideration and value each others input• Openness; Honesty and a willingness to consider input from all stakeholders• Equal opportunity; Equality in participation and ability to be heard• Advocacy and support; Required by all levels e.g. health service and community management• Responsiveness; Ability to respond quickly and openly• Shared ownership and accountability of decisions, outcomes and issues• Dissemination; Wide distribution of information, decisions and ability for consumers to provide feedback• Evaluation; Findings disseminated widely

Good practice also includes:

• Legitimacy by ensuring the process is legitimate and applicable to the community• Ensuring the process is well managed and resourced before beginning• Clear purpose with the reason for the process being clearly articulated• Awareness impacts by ensuring the impacts the process may have need to be identified• Variety of participatory methods including allowing participants to provide input using a number of

different processes• Keeping participants informed about progress and decisions• Giving honest feedback as part of an evaluation


Summary

To ensure effective health service provision, it is important for health providers to engage the community in the process.

This goes beyond the provision on information to include processes that consult, involve, collaborate and empower the community.

The process also needs to be transparent, with the community remaining informed and involved throughout the process.



1. Complete the following table providing information on the levels of engagement for listed activities

Under the following headings, list examples to match the level of community engagement. An example for policy development has been provided.

Inform Consult Involve Collaborate EmpowerProvide balanced and objective information





New PolicyDocument

Plan for a new multi-purpose health centre

Plan to develop a new service for at risk youth


TN4400 Theory to Practice Take a few minutes to think about a primary health care practice setting you are familiar with then answer the following questions

1. List 5 examples of services that meet the minimum requirements for primary health care.

Answers

2. What agencies or organisations contribute to these services?

Answers

3. What programs would you like to be involved in and in what form might this involvement take?

Answers


TN4400 Quiz

1. The Alma Ata defined a set of minimum requirements for primary health care to be implemented

Tick Choices

True

False

2. Match the component of the Alma Ata with an example in practice

A. Community health action groups B: Organisations planning services together C. Health services working in partnership to provide care D. Resource distribution based on need E. Health services are controlled by the community

Component Example in Practice

Community participation

Intersectoral collaboration

Integration of health care programs

Equity

Self-reliance


3. Match the component of the Ottawa Charter with an example in practice

A. Governments working together to plant more trees B: Ensuring working and living conditions are safe C. Communities planning health services D. Provision of health information to consumers E. Focus on preventative rather than curative services


Building healthy public policy

Creating supportive environments

Strengthening community action

Developing personal skills

Reorientating health services

4. Which of the following are true of the Social Determinants of health

Tick Choices

Impact greatly on health

Can be controlled by individuals

Need to be considered when responding to acute presentations

Are the sole responsibility of health services

Only affects some people


5. Arrange the following components from the least (1) to the greatest (5) level of community engagement 1. Empower 2. Inform 3. Involve 4. Consult 5. Collaborate

Level Component

Inform

Consult

Involve

Collaborate

Empower


TN4401-1 Learning Activity Feedback

1. List the minimum requirements for primary health defined by the Alma Ata

Answer

Education on health problems, prevention and management

Promotion of food supply and good nutrition

Provision of a safe and adequate water supply

Provision of maternal and child health care

Immunisation against major infectious diseases

Prevention and control of endemic diseases

Appropriate treatment of common diseases and injury

Provision of essential drugs



1. What are the five action areas for primary health care, identified by the Ottawa Charter?

Answers

Building healthy public policyCreating environments which support healthy livingStrengthening community actionDeveloping personal skillsReorientating health care



1. List the social determinants of health

Answers

Income and social statusStress and control over lifeEarly childhood developmentSocial exclusionStress at workEmployment and job securitySocial supportAddictionDiet and lifestyle choicesExercise and transport

2. How might they impact on health?

Answers

People living in poor socio-economic situations have greater risks of

Developing stressPoor childhood developmentPoor education outcomesLimited employment opportunitiesGreater chance of being in a low paying jobPoor nutritionGreater chance of developing addictionsGreater chance of developing chronic disease resulting in higher morbidity and decreased life expectancy



1. Complete the following table providing information on the levels of engagement for listed activities

Under the following headings, list examples to match the level of community engagement. An example for policy development has been provided.

Inform Consult Involve Collaborate EmpowerProvide balanced and objective information





New PolicyDocument

New policy document circulated for information purposes

New policy document circulated with requests for comments

Respond to concerns about a new policy document raised by consumers

Engage consumers in the development of a new policy document

Allow consumers to develop a new policy document

Plan for a new multi-purpose health centre

Community advised of a decision to build a new health centre

Community invited to a community focus group to discuss proposal

Run workshops for community allowing them to provide input and raise issues or concerns

Community members invited join a community advisory group to provide input and feedback throughout pro-cess

Community action teams lead the process, utilising health experts to pro-vide input

Plan to develop a new service for at risk youth

Community ad-vised of plan

Community invited to a community focus group to discuss proposal including any concerns they may have

Run workshops for community allowing them to provide input and raise issues or concerns

Community members invited join a community advisory group to provide input and feedback throughout process

Community action teams lead the process, utilising health experts to provide input


TN4400 Theory to Practice Feedback Take a few minutes to think about a primary health care practice setting you are familiar with then answer the following questions

1. List 5 examples of services that meet the minimum requirements for primary health care.

Answers

Answers could include• Health education programs e.g. personal, hygiene, smoking cessation, alcohol management• Programs that focus on the prevention and management of risk factors and chronic disease e.g.

screening programs for specific population groups, or for specific diseases• Healthy nutrition programs e.g. breakfast programs in schools, healthy cooking classes• Provision of maternal and child health care services e.g. early child hood screening, immunisation,

parents’ groups, early intervention services• Disease control programs e.g. Dengue Fever eradication, healthy skin programs

There are many more potential responses to this question – it is important you think about what is available in your community or one you are familiar with.

2. What agencies or organisations contribute to these services?

Answers

Ideally organisations including the local council, education, housing, employment, environmental services and community organisations will be involved. The involvement may include creating healthy environments, maintaining housing, promoting community clean up, providing programs in schools working with health to promote healthy messages etc.


3. What programs would you like to be involved in and in what form might this involvement take?

Answers

This is based on personal choice but some examples could include

• Working with schools to run healthy eating programs• Attending council meetings and making suggestions about improving the health of the community

including bike paths, footpaths, walking tracks, park lands etc.• Working with community groups to establish and implement health promotion, education, screening,

early intervention and chronic disease management programs


TN4400 Quiz Feedback

1. The Alma Ata defined a set of minimum requirements for primary health care to be implemented

Tick Choices

True

False

2. Match the component of the Alma Ata with an example in practice

A. Community health action groups B: Organisations planning services together C. Health services working in partnership to provide care D. Resource distribution based on need E. Health services are controlled by the community


Community participation Community health action groups

Intersectoral collaboration Organisations planning services together

Integration of health care programs Health services working in partnership to provide care

Equity Resource distribution based on need

Self-reliance Health services are controlled by the community


3. Match the component of the Ottawa Charter with an example in practice

A. Governments working together to plant more trees B: Ensuring working and living conditions are safe C. Communities planning health services D. Provision of health information to consumers E. Focus on preventative rather than curative services


Building healthy public policy Governments working together to plant more trees

Creating supportive environments Ensuring working and living conditions are safe

Strengthening community action Communities planning health services

Developing personal skills Provision of health information to consumers

Reorientating health services Focus on preventative rather than curative services

4. Which of the following are true of the Social Determinants of health

Tick Choices

Impact greatly on health

Can be controlled by individuals

Need to be considered when responding to acute presentations

Are the sole responsibility of health services

Only affects some people


5. Arrange the following components from the least (1) to the greatest (5) level of community engagement 1. Empower 2. Inform 3. Involve 4. Consult 5. Collaborate

Level Component

1 Inform

2 Consult

3 Involve

4 Collaborate

5 Empower


TN4400 - Post-Session Survey

Now that you have completed this session we ask you to take a few moments to complete the post-session survey for this topic. This will give us some indication about how well we have met your learning needs. Once submitted you will be eligible to receive your certificate.

Please indicate the degree to which you agree to the following, by ticking the box most relevant.

I am able to define health promotion

I understand the links between comprehensive primary health care, the Alma Ata, the Ottawa Charter, social determinants of health and community engagement

I understand the principles of the Alma Ata

I can explain the intent of the Ottawa Charter

I am able to discuss the determinants of health

I understand what is required for effective community engagement

What, if anything could have been added to this session?

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TN4400 References

1. Carson B. Dunbar T. Chenhall D and Bailie R eds. (2007). Social Determinants of Indigenous Health. Crows Nest: Allen and Unwin.

2. Couzos S and Murray R. (2008). Aboriginal Primary Health Care (3rd ed.). Melbourne: Oxford University Press.

3. McMurray A. (2003). Community Health and Wellness, a sociological approach (2nd ed.). Marickville: Elsevier.

4. Queensland Health and the Royal Flying Doctor Service (Queensland Section). (2010). Chronic Disease Guidelines (3rd ed.). Cairns.

5. Smith J. (2007). Australia’s Rural and Remote Health: a social justice perspective (2nd ed.). Croydon: Tertiary Press.

6. Talbot L, & Verrinder G. (2005). Promoting Health The Primary Health Care Approach (3rd ed.). Marrickville: Elsevier.

Transition to Practice - Queensland Health · • Define Health Promotion Discuss the link between...

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