Models of health promotion
Criticised for victim-blaming, not addressing social issues.
Developed from educational model:
- knowledge and concepts
- clarification of attitudes and values
- development of decision-making skills
- informed choices in health-related behaviour
- development of life-skills for personal and social development (assertiveness, communication skills)
- enhancement of self esteem
Knowledge, attitudes, practice
Model started after W.W.II in USA. Not too successful, and from it arose the Health Belief Model, in which attitudes (cognitive, affective and conative [action]) were thought to be the key components determining behaviour, as opposed to knowledge.
The model developed in the 1950s to include individuals’ perceptions of susceptibility and severity; and cues for action.
Downie, Fyfe & Tannahill’s model
“Health promotion comprises efforts to enhance positive health and prevent ill-health, through the overlapping spheres of health education, prevention, and health protection.” (Downie RS, Fyfe C & Tannahill A. Oxford: Oxford University Press, 1990.) See Health promotion - Downie, Fyfe & Tannahill's model for more details.
Determinants of health
- 1. General socio-economic, cultural and environmental conditions.
- 2. Living and working conditions.
- 3. Social and community influences.
- 4. Individual lifestyle factors.
- 5. Age, sex, and hereditary factors.
Five principles, based on a WHO report. See Ottawa Charter for Health Promotion, 1986 for details.
Building healthy public policy
Ensuring that policy decisions have a positive impact on peoples’ lives.
Creating a supportive environment
Ensuring that peoples’ living and working conditions are safe, satisfiying, stimulating and enjoyable.
Strengthening community action
Recognising that real changes can be achieved if people in communities are involved in setting priorities, planning strategies and implementing them in the pursuit of health.
Developing personal skills
Ensuring that people have enough information and education about health and develop life skills to ensure increased self-esteem and increased control over factors that affect their own health.
Reorienting health services
Promoting a health care system committed to the pursuit of health beyond its responsibility for providing clinical and curative services.
See screening articles.
Health promotion Planning structure
- Diagnostic stage - establish (health) needs, knowing what’ been done elsewhere and what works, local sensitivities… (National and local prevalence etc. statistics; literature review; surveys, etc.).
- Reaching the target group - approaches, settings, interventions.
- Identifying and collaborating with appropriate agencies/¬services
- Set agreed aims and objectives - decide priorities, establish milestones/¬targets
- Personnel involved. (Who’s in direct contact with target group; who trains educators…)
- Action taken and outcomes
- Resource implications
- Barriers and enabling factors
Pros and cons of target-setting for health promotion
Pros and Cons of settings and methods for health promotion
|Health services (primary care, hospitals)||
Accident prevention matrix - example
Example of a road accidents prevention matrix
|Pre-event||Eyesight||Alcohol level Road-worthiness (tyres, brakes…)||Road surface and markings.|
|Event||Seat belt wearing||Crash resistance of car||Crash barriers|
|Post-event||Excellence of trauma services||Rigidity of passenger compartment, ability to open doors||Response and access to ambulance and casualty services.|
"Health for all 2000" - Alma Ata declaration 1978
Alma Ata declaration in 1978 preceded by 30th World Health Assembly in 1977, at which it was stated that:
The full document is available here.
Principles of Alma Ata declaration
- 1978, in Alma Ata (USSR)
- Health is a human right
- Inequalities in health are unacceptable
- Health promotion and protection are an essential part of economic development
- It is the individual’s right and duty to participate
- Governments are responsible for health and should aim for health for all by the year 2000
- The basis for the achievement of HFA 2000 is primary health care
- Primary health care reflects and evolves from the social conditions of the community
- Plans, policies and strategies need to be produced by governments an implemented by them in a co-ordinated way
- International co-operation is needed.
- Resources are needed: a possible source of these is the current spending on armaments
Subsequent Alma Ata declaration predicated on the principles that:
- health is not an end in itself, but a means to an end;
- lifestyles conducive to good health should be encouraged through the empowerment of individuals and their communities;
- social, political and physical environments which are conducive to good health should be encouraged through community participation, and multisectoral and international collaboration;
- the resources directed at improving health should be distributed equitably so that the unacceptable inequalities in health should be reduced.
CHIMPE (revision aid)
Community participation Health promotion International co-operation Multisectoral co-operation Primary health care Equity
UK health promotion bodies
Once upon a time there was the Health Education Authority (HEA). This was founded in 1987 as a special health authority, and was largely funded by the UK government's Department of Health. This kept banging on about inequalities and deprivation as a cause of ill-health, which annoyed the UK's Conservative government; so it was abolished in 1993. Some of its functions went to the Health Development Agency (HDA). The Health Development Agency was a special health authority established in 2000 or was it 1993? to develop the evidence base to improve health and reduce health inequalities. It "worked in partnership with professionals and practitioners across a range of sectors to translate that evidence into practice". As a result of the Department of Health's 2004 review of its "arms length bodies", the functions of the HDA were transferred to NICE on 1 April 2005.
With the implementation of the Health and social care act 2012 much of the role of health promotion in England moved into public health departments in local government authorities.