Summary Health promotion programs

P A R T O N E C H A P T E R O N E ■ Define health and health promotion, and describe the role of health promotion in fostering good health and quality of life ■ Summarize the key historical developments in health promotion over the last century ■ Describe the national public - private initiative for health promotion ■ Compare and contrast health education and health promotion ■ Describe the nature and advantages of each health promotion program setting ■ Identify health promotion program stakeholders, including the role each can play in fostering the development or continuation of health promotion programming W H AT A R E H E A LT H P R O M O T I O N P R O G R A M S ? CARL I. F ERTMAN D IANE D. A LLENSWORTH M. ELAINE AULD C H A P T E R O N E LEARNING OBJECTIVES 4 WHAT ARE HEALTH PROMOTION PROGRAMS? HEALTH PROMOTION PROGRAMS can improve physical, psy- chological, educational, and work outcomes for individuals and help control or reduce overall health care costs by emphasizing prevention of health problems, promoting healthy lifestyles, improving patient compliance, and facilitating access to health services and care. Health promotion programs play a role in creating healthier individuals, families, communities, workplaces, and organizations. They contribute to an environment that promotes and sup- ports the health of individuals and the overall public. Health promotion programs take advantage of the pivotal position of their setting (for example, schools, work- places, health care organizations, or communities) to reach children, teenagers, adults, and families with the knowledge and skills they need to make informed decisions about their health. This chapter sets the stage for discussing how to plan, implement, and evaluate health promotion programs. HEALTH, HEALTH PROMOTION, AND HEALTH PROMOTION PROGRAMS The World Health Organization (1947) defined health as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” While most of us can identify when we are sick or have some infirmity, identifying the characteristics of complete physical, mental, and social well-being is often a bit more difficult. What does complete physical, mental, and social well-being look like? How will we know when or if we arrive at that state? If it is achieved, does it mean that we will not succumb to any disease, from the common cold to cancer? In 1986, the first International Conference of Health Promotion, held in Ottawa, Canada, issued the Ottawa Charter for Health Promotion, which defined health in a broader perspective: “health has been considered less as an abstract state and more as a means to an end which can be expressed in functional terms as a resource which permits people to lead an individually, socially, and economi- cally productive life” (World Health Organization, 1986). Accordingly, health in this view is a resource for everyday life, not the object of living. It is a positive con- cept emphasizing social and personal resources as well as physical capabilities. Arnold and Breen (2006) identified the characteristics of health not only as well-being but also as a balanced state, growth, functionality, wholeness, tran- scendence, and empowerment and as a resource. Perhaps the view of health as a balanced state between the individual (host), agents (such as bacteria, viruses, and toxins), and the environment is one of the most familiar. Most individuals can readily understand that occasionally the host-agent interaction becomes unbal- anced and the host (the individual) no longer is able to ward off the agent (for example, when bacteria overcome a person’s natural defenses, making the indi- vidual sick). When needed, the interventions of a health specialist may restore balance (for example, by providing drugs to help the individual’s natural defenses fight against the foreign agents or bacteria). But as will be explained before the end of this chapter, it is now the host-environment interactions that, we are learn- ing through emerging research, are making us ill in ways that we previously were not aware of. Environmental factors are ascending as a focus of interest, and interventions to address host-environment interactions are increasingly being employed to address the prevention of chronic and infectious diseases as well as injuries and developmental disorders in order to ensure balance and prevent disease in specific populations. Clearly, good health doesn’t just happen; it’s more than just luck. Although being born with good genes and having access to health care are important, they do not provide a guaranteed ticket to wellness. The food we eat, levels of physical activity, exposure to tobacco smoke, social interactions, the environment in which we live, and many other factors ultimately influence our health or lack thereof. The health of individuals as well as the health of our communities reflects the unique combination of biological, psychological, social, intellectual, and spiritual components as well as the cultural, economic, and political environment in which we live. Exploration of the interaction that occurs between individuals and their environment in regard to health has been a hallmark in the progress of nations in promoting and improving the health of individuals and the community at large. This ecological perspective on health emphasizes the interaction between and interdependence of factors within and across levels of a health problem. The ecological perspective highlights people’s interaction with their physical and sociocultural environments. McLeroy, Bibeau, Steckler, and Glanz (1988) iden- tified three levels of influence for health-related behaviors and conditions: (1) the intrapersonal or individual level, (2) the interpersonal level, and (3) the population level. The population level encompasses three types of factors: insti- tutional or organizational factors, social capital factors, and public policy factors (see Table 1.1 ). The ecological health perspective helps to locate intervention points for pro- moting health by identifying multiple levels of influence on individuals’ behavior and recognizing that individual behavior both shapes and is shaped by the envi- ronment. Using the ecological perspective as a point of reference, health promo- tion is viewed as planned change of health-related lifestyles and life conditions through a variety of individual, interpersonal, and population-level changes. HEALTH , H EALTH PROMOTION , AND H EALTH PROMOTION PROGRAMS 5 6 WHAT ARE HEALTH PROMOTION PROGRAMS? Health promotion programs provide planned, organized, and structured activities and events over time that focus on helping individuals make informed decisions about their health. In addition, health promotion programs promote policy, environmental, regulatory, organizational, and legislative changes at vari- ous levels of government and organizations. These two complementary types of interventions are designed to achieve specific objectives that will improve the health of individuals as well as, potentially, all individuals at a site. Health promo- tion programs are now designed to take advantage of the pivotal position of their setting within schools, workplaces, health care organizations, or communities to reach children, adults, and families by combining interventions in an integrated, systemic manner. This focus on planned change in health promotion can be applied among individuals in varied settings and at any stage in the natural history of an illness or health problem. Using a framework proposed by Leavell and Clark (1965), health promotion programs can help prevent new cases or incidents of a health problem (for example, preventing falls among the elderly, smoking and drug abuse among middle school and high school students, or risky drinking among college students). TABLE 1.1 Ecological Health Perspective: Levels of Influence Concept Definition Intrapersonal level Individual characteristics that influence behavior, such as knowledge, attitudes, beliefs, and personality traits Interpersonal level Interpersonal processes and primary groups, including family, friends, and peers, that provide social identity, support, and role definition Population level Institutional factors Rules, regulations, policies, and informal structures that may constrain or promote recommended behaviors Social capital factors Social networks and norms or standards that may be formal or informal among individuals, groups, or organizations Public policy factors Local, state, and federal policies and laws that regulate or support healthy actions and practices for prevention, early detec- tion, control, and management of disease Source : Adapted from McLeroy, Bibeau, Steckler, and Glanz, 1988. These are programs that take action prior to the onset of a health problem to intercept its causation or to modify its course before people are involved. This level of health promotion is called primary prevention. Health promotion programs can interrupt problematic behaviors among those who are engaged in unhealthy decision making and perhaps showing early signs of disease or disability. This type of health promotion is called secondary prevention. Examples of this type of health promotion program include smoking cessation programs for tobacco users and physical activity and nutrition programs for overweight and sedentary individu- als. Health promotion programs can improve the life of individuals with chronic illness (tertiary prevention). Examples are programs that work to improve the quality of life for cancer survivors or individuals with HIV/AIDS. Health promotion programs are a bridge between medicine and health and are part of an ongoing dialogue about how to improve the health and well-being of individuals across settings. Here are some examples of strategies for primary, secondary, and tertiary prevention applied in health promotion and disease prevention. Primary health promotion and disease prevention strategies include Identifying and strengthening protective ecological conditions that are conducive to health Identifying and reducing various health risks Secondary health promotion and disease prevention strategies address low- risk factors and high protective factors through Identifying, adopting, and reinforcing specific protective behaviors Early detection and reduction of existing health problems Tertiary health promotion and disease prevention strategies include Improving the quality of life of individuals affected by health problems Avoiding deterioration, reducing complications from specific disorders, and preventing relapse into risky behaviors Health promotion programs are designed to work with a priority popula- tion (in the past called a target population)—a defined group of individuals who share some common characteristics related to the health concern being addressed. Programs are planned, implemented, and evaluated for their priority population. The foundation of any successful program lies in gathering information about a priority population’s health concerns, needs, and desires. Also, engaging the schools, workplaces, health care organizations, and communities where people live and work as partners in the process of promoting health is most effective. Finally, health promotion programs are also concerned with prevention of the root causes of poor health and lack of well-being resulting from discrimina- tion, racism, or environmental assaults—in other words, the social determinants • • • • • • • • • HEALTH , H EALTH PROMOTION , AND H EALTH PROMOTION PROGRAMS 7 8 WHAT ARE HEALTH PROMOTION PROGRAMS? of health. Addressing root causes of health problems is often linked to the con- cept of social justice. Social justice is the belief that every individual and group is entitled to fair and equal rights and equal participation in social, educational, and economic opportunities. Health promotion programs have a role in increasing understanding of oppression and inequality and taking action to overcome them and to improve the quality of life for everyone. HISTORICAL CONTEXT FOR HEALTH PROMOTION