Health promotion

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					   Health Promotion


Dr. Aidah Abu Elsoud Alkaissi
  Najah National University
      Faculty of Nursing




                                1
          Promoting Health


   Health promotion strategies are not limited to a specific health
    problem, nor to a specific set of behaviours. WHO as a whole applies
    the principles of, and strategies for, health promotion to a variety of
    population groups, risk factors, diseases, and in various settings.

   Health promotion, and the associated efforts put into education,
    community development, policy, legislation and regulation, are
    equally valid for prevention of communicable diseases, injury and
    violence, and mental problems, as they are for prevention of
    noncommunicable diseases.

                                                                        2
          Department of Chronic Diseases and Health Promotion
          (CHP)


   The rapid rise of chronic, noncommunicable diseases represents one
    of the major health challenges to global development.

   The principle chronic diseases are: stroke, cancer, diabetes and
    chronic respiratory diseases. Chronic diseases currently account for
    some 60% of global deaths and almost one third of the global burden
    of disease. The Department of Chronic Diseases and Health
    Promotion (CHP) leads the global efforts to prevent and control
    chronic diseases and promote health.



                                                                     3
          Diet and physical activity: a public health priority


   few largely preventable risk factors account for most of the world's
    disease burden. This reflects a significant change in diet habits and
    physical activity levels worldwide as a result of industrialization,
    urbanization, economic development and increasing food market
    globalization.
   Recognising this, WHO has adopted a broad-ranging approach and
    has developed, under a May 2002 mandate from Member States, a
    Global Strategy on Diet, Physical Activity and Health, which was
    endorsed by the May 2004 World Health Assembly



                                                                        4
           Objectives
           Foundation for Health Promotion



Health Defined: Objectives for Promotion and Prevention
 Define the term health
 Examine the healthy people 2010 comitiment to a single, overarching (extending
  over) purpose: to promote health and prevent illness, disabilities, and premature
  death
 Explain the differences between health, illness, disease, disability and premature
  death
 Compare the three levels of prevention (primary, secondary and tertiary) with the
  levels of service provision available across the lifespan
 Describe the importance of research and the nurse´s role in the research process to
  the promotion of health for individuals and populations



                                                                                  5
          Health promotion


   Promoting health
   Protecting health
   Preventing disease and injury
   Public concern- Lifestyle
   Physical fitness
   Good nutrition
   Avoidance of health hazards such as smoking



                                                  6
          Health promotion



   To improve the health status of individuals and groups
   Encouraging positive health changes
      Effort of individuals

      The goverment

      Health professionals

      Society

   Reduce costs of health services
   Improve the overall quality of life for all people
   The health of each individual is influinced by health
    environment of all individuals worldwide

                                                             7
Ten categories are identified as important determinants of health
status. Change and improve behaviour in these areas can lead to a
decrease in morbidity and mortality




   Smoking                             Exercise
   Nutrition                           Sexuality and contraceptive use
   Alcohol use                         Family relationships
   Habituating drug use                Risk management
   driving                             Coping and adaptation




                                                                    8
          Health protection, disease and injury prevention- Nurses need
          to understand


   Directed at population groups of all ages
   Involves adherence to standards
   Infectious disease control
   Government regulation and enforcement
   Reducing exposure to various sources of hazards including air,
    water, foods, drugs, motor vehicles




                                                                     9
         Health care providers


   Present the individual with disease and injury prevention
    services which include:
   Immunization
   Screening include blood pressure, glaucoma, and diabetes
    screening
   Health education
   Couselling




                                                                10
            To implement prevention strategies effectively



   Develop cross-cutting activities targeted to and tailored for all
    age groups in various setting, including:
   Schools
   Industies
   The home
   The health care delivery system
   Community



                                                                        11
           The surgeon General´s report on health promotion and
          disease prevention was published 1979 and followed by
                           healthy people 2000




   Increase the span of healthy life for people
   Reduce health disparities (Health disparities refer to gaps in the
    quality of health and health care across racial and ethnic groups)
    among people
   Acheive access to prevent services for all people




                                                                         12
                   Healthy people 2000

Four broad categories:
 Health promotion

 Health protection

 Preventive services

 Surveillance (Close observation of a person or group, The

  act of observing or the condition of being observed) and
  data systems




                                                        13
                             Improvements include


   Reduction in infant mortality
   Teenage pregnancies
   Injuries
   Tobacco
   Alcohol
   Illicit (contrary to or forbidden by law) drug use
   Death rate from coronary heart disease & cerebrovascular accidents
   Childhood vaccination rates are at the highest record



                                                                   14
        Many more improvements are needed in the health of many
                              people




   Tobacco use by adolescents continue to increase
   Adults do not participate in leisure-time physical activity
   Obesity
   Violence and other abusive behaviors continue to destroy
    individuals, families and communities
   Chronic health problems as Mental disorders, diabetes mellitus
    continue to be undiagnosed and untreated
   The occurance of HIV and AIDS


                                                                     15
          The vision of Healthy People 2010


   Healthy people in healthy communities
   Health affected by the environments in which each individual
    lives, works, travels and plays
   Dimensions of the environment are not only physical, but
    psychological and spiritual, including the behaviors, attitudes,
    and beliefs of each individual




                                                                       16
                                Health Promotion


   What is Health Promotion
   Is a broad field encompassing educational, social, economic and
    political efforts to improve the health of a population
   Health promotion is practiced in a variety of settings
   Health promotion workers put health on the agenda of policy
    makers to be a ware of the health consequences of their decision




                                                                       17
        Health promotion

   A planned combination of educational, political, regulatory
    and organizational supports for actions and conditions of
    living conducive (tending to bring about) to the health of
    individuals, groups, or communities (Green & Kreuter 1999)




                                                                  18
                                    Health promotion

   The process of enabling people to increase control over and to
    improve their health. A commitment (act) to dealing with the
    challenges of reducing inequilities (injustice, unfairness),
    extending the scope (The range of one's perceptions, thoughts, or
    actions) of prevention and helping people to cope with their
    circumstances… creating environments conducive (tending to
    bring about) to health, in which people are better able to take
    care of themselves (World Health Organization 1986)




                                                                        19
          Exploring Concept of Health

   Nursing literature paradigms (A set of assumptions, concepts, values,
    and practices that constitutes a way of viewing reality for the
    community that shares them)
   First paradigm‫ :نموذج‬Wellness-illness continuum
    High- level wellness- a sence of well being, life satisfaction and
    quality of life
   Second paradigm characterizes health as an indirectional development
    phenomenon of unitary patterning of person-environment




                                                                    20
        Health



   Health is used to describe a number of entities (The fact of
    existence; being) such as a philosophy of care (health promotion
    and health maintenance), a system (health care delivery system),
    practices (good health practices), behaviors ( healthy behaviors),
    costs (health care costs), and insurance




                                                                    21
          Health



   Before 1940 Infectious diseases claimed the lives of many children
    and young adults, therefore health: the absence of disease
   After World War II in 1940 the idea of role performance became a
    focus
   Health became linked to a person´s ability to fulfil their roles in
    society
   From 1960 to the present: control spending and health care costs have
    escalated




                                                                    22
          Health




   Primary care providers: nurse practitioners
   Attempt to involve individuals and their families in the delivery
    care as individual responsibilities and lifestyle choices have
    become an important part of care
   Health has become linked to the changing environment to which
    individuals could react and change rather than becoming a fixed
    state




                                                                        23
          Health



   Adaptation fit well with the self-help movement and progressive
    growth in knowledge from research about disease prevention and
    health promotion
   Emphasis on the quality of a person´s life as a component of health
   There are multiple factors contributing to a person´s perception of
    his/her health. In addition to function cognitively and physically,
    fulfill social roles, and obtain health services
   Health is related to environment, socioeceonomic level, race, and
    geografic location


                                                                     24
          Models of health


   Clinical model: the absence of signs and stmptoms of disease as
    indicative of health
   People who use this model of health to guide their use of health
    care services may not seek preventive health services or
   Wait until they are very ill to seek care
   The clinical model is the conventional model of the discipline of
    medicine




                                                                        25
          Role Performance Model


   The ability to perform social roles as indicative of health
   Role performance includes work, family, and social roles, with
    performance based on societal (relating to the structure, organization,
    or functioning of society) expectations
   Illness would be the failure to perform a person´s roles at the level of
    others in society
   This model is the basis for work and school physical examinations
    and physician –exused- absences
   The idea of the sick role, in which people can be excused from
    performing their social roles while they are ill


                                                                       26
          Adaptive Model


   Is reflective of Rene Duvos´ (1980) work on adaptation
   Hans Selye´s research on stress (1950)
   Jean Piaget´s (1975) discussion of cognitive development
   Has the ability to adapt positively to social, mental, physiological
    changes as indicative of health
   Illness occurs when the person fails to adapt to changes




                                                                       27
          Eudaimonistic Model


   Term indicates a model that embodies (symbolize) the interaction and
    interrelationships between the physical, social, psychological and
    spititual aspects of life and the environment
   Illness is reflected by a denervation (resection or removal of the
    nerves to an organ or part) or languishing (feeble, weak), a wasting
    away, or lack of involvement with life
   This model more congruent with integrative (to join) modes of
    therapy, which is used increasingly by the majority of people



                                                                   28
          Health-Illness Continuum



   Is a traditional depiction (describe) relationship between the
    concepts of health and illness
   In this paradigm, health is a positive state in which incremental
    increases in health can be made beyond the mid point on a line
    there the first end is health and the other end is illness.
   These increases involve improved physical and mental health states
   The opposite end of the continuum is illness, with the possibility of
    incremental decreases in health beyond the midpoint



                                                                      29
        High-Level Wellness


   A health-illness contiuum that would assess a patient based on his or
    her relative health compared with others and the environment
   Favourable environment allows high-level wellness to occur
   Unfavorble environment allows low-level wellness to exit
   The person can have a terminal disease and be emotionally prepared
    for death, while acting as a support for other people and acheiving
    high level wellness




                                                                   30
                                    Functioning


   Defining X´s of life is the ability to function
   Can X´s as being present or absent, high level or low level
   There are physical , mental and social levels of function reflected in
    terms of performance (carrying out of something) and social
    expectations
   Loss of function may be a sign or symptom of a disease




                                                                       31
                                       Health


   Is a state of physical, mental, ans social functioning that realizes a
    person´s potential (powerfull, efficacious)
   Health is an individual´s responsibility, but it requires collective
    action to ensure a society and an environment in which people can act
    responsibly
   The culture and beliefs of the people can also influence health. This is
    consistent with WHO definition of health as the state of complete
    physical, mental and social well being and not merely the absence of
    disease and infirmity


                                                                       32
                     Illness, disease, and health



   Health and disease are not simply antonyms (opposite meaning) and
    disease and illness are not synonyms
   Disease means ”without ease”
   Disease defines the failure of a person´s adaptive mechanism to
    counteract (act in the opposite direction) stimuli and stresses
    adequately, resulting in functional or structural disturbances




                                                                 33
          Illness, disease, and health



   Illness is a social construct in which people are in an
    imbalanced, unsustainable relationship with their environment
    and are failing in their ability to survive and create a higher
    quility of life
   Illness is a mismatch between a person´s needs and the resources
    available to meet those needs
   Illness signals individuals and population that the present
    balance is not working



                                                                       34
       Illness, disease, and health




   Disease is a biomedical term indicating the presence of a
    recognizable health deviation, whereas illness is a state of being
   Illness has social, psychological, and biomedical components
   A person can have a disease without feeling ill (asymptomatic
    hypertension)




                                                                   35
                            Planning for health
       general´s report on health promotion and disease prevention
                                   issued



   Reducing infant death 35% (through low birth wt and birth defect)
   Reducing death in children 20%( growth and development screening
    and injury prevention)
   Reducing death in adolescents and young adults 20% (preventing
    motor vehicle injuries and decreasing the use of drugs and alcohol)
   Reducing adult death 25% (screening and prevention of heart
    attacks, stroke and cancer)
   Reducing sick days in older adult 20% (maintaining functional
    independence and prevent influenza and pneumonia)


                                                                     36
                           Planning for health
      general´s report on health promotion and disease prevention
                                  issued



   Three causes of the major health issues
      Careless habits

      Pollution of the environment

      Permiting harmful social conditions to persist (hunger, poverty,

       and ignorance) that destroy health especialy for infant and
       children




                                                                    37
         Healthy people 2000 goals




  Increase quality and years of healthy life (longevity (Long life)
   and quality of life )
 Eliminate health disparities (inequality, negative) differences in

   treatment based on race, gender, ability to pay, and related issues
   such as urban versus rural health, insurance coverage, medicare
   and satisfaction with service delivery
 e.g. Racial disparity in health care, black people and white people




                                                                         38
          Some terms


   Ethnocentrism: culture influences every aspect of human life,
    including beliefs, values, and customs regarding health care can lead
    to a devaluing of the beliefs, values and customs of others known as
    racism
   Empathy: the ability to view another person´s situations from their
    perspective




                                                                     39
       Objective
       Important feature of Healthy people 2010



 Increase the proportion of adults who engage regularly, preferably
  daily, in moderate physical activity for at least 30 min per day
 Health indicators: physical activities and wt (obesity)

 Other indicators as tobacco and substance abuse and mental health
  are indirectly related to this objectives
 Physical activity can contribute to positive mental health through
  stress reduction and physical fittness
 Responsibility for intervention- not to do a ”repair shop”

 Health care provider need to be responsible for offering preventive
  health services and monitoring behavior
They do tasks rather than counsell and help individuals choose between
  various behaviors
                                                                40
          Provider incentive (A reward for a specific behavior,
          designed to encourage that behavior.
          Saving Plan



   Cigaretts
   How much do they cost
   How much the person will save in money wise
   How to use the money, half for restaurant and half for vaccation




                                                                       41
          Providers need to look for partnership in the community
          through which they can better serve the needs of
          individual

   Work sites and communities need to become partners in
    providing opportunities for people to lead healthy lives through
    flexible work schedules, work site wellness programs, safe park,
    availability of exercise facilities
   E.g. Insurance company eliminate tobacco use from its building
    and campus: limiting smoking, offering in-house smoking
    cessation courses
   The company experienced a cost savings in lower premiums for
    health and fire insurance
   Less frequent use of ventilation system
   Less smoke and fire damage to furniture and equipment

                                                                       42
Imagine a hospital where the staff

   Can set their schedules to accommodate family needs,
    exercise at an in-hospital exercise facility
   Eat in an esthetically (a tasteful way) pleasing environment
    with relaxing music and healthy food
   Participate in stress reduction activities




                                                            43
        Problem identification
        analysis of Frank´s situation


   How many problems does Frank´s situation present
   The answer depends on who is asked the question and his/her
    position related to the Frank:
   His physician
   His nurse
   His children
   His wife
   His employer
   Insurance company


                                                                  44
             Planning intervention

   Asset planning: planning approach that, given the realities of the present , helps
    focus the family and their providers on the building blocks for their future
   The lifestyle changes become tools for Frank´s recovery and for change within his
    family
   His cardiac event becomes a risk factor for heart disease for the lives of his children
   A plan was developed to help Frank begin to take control of his life through
    behavior changes:
      Relaxation techniques

      Diet modification

      Smoking cessation

      Mild chair exercises

      Spokes person talking about stress management and smoking cessation based on
        his personal experiences

                                                                                    45
          What was the actual cause of Frank´s problem


   Not possible to separate. The source of illness were found in the many
    interrelationships in his life
   Imbalance betwen his personal resources and the demands of his
    family and the economic world
   Cigaretts use by persons who have hypertension or high serum
    cholesterol levels multiplies their risk of coronary heart disease




                                                                     46
             Evaluation of situation


   The health status of an individual depends on a sustainable balance of the
    complex response between internal physiological and psychological and
    external social and environmental factors interpreted with the context of
    the immediate environment
   The infarction and resulting disability permanently reshaped Frank´s
    environment
   After few month working a full time , he realized that he needed to find a
    less stressful job
   Health is not acheivement or a prize but a high quality interaction between
    a person´s inner and outer world that provides the capacity to respond to
    the demands of the biological, psychological, and environmental system of
    these worlds



                                                                                  47
          Assignment


   Based on the information about frank and his experience, determine
    what his children should be taught based on the Healthy People 2010
    objectives in this focus area




                                                                   48
             Levels of promotion
             primary prevention


   Precede disease or dysfunction
   It includes as health as beneficial to well being
   It uses therapeutic RX an a process or behaviour towards
    enhancing health




                                                               49
          Secondary prevention


   Ranging from providing screening, activities and treating early
    stage of disease to limiting disability by averting (the act of
    preventing something from occurring) or delaying the
    consequences of advanced disease




                                                                      50
          Tertiary prevention

   Occurs when a defect or disability is permanent and irreversible

   The process involves minimizing the effects of the disease and
    disability by surveillance and maintenance activities aimed at
    preventing complications




                                                                       51
          Nurses Roles


   Shifting from acute, hospital-based care to preventive
    community-based care, which is closely related to the changing
    demographic of people

   The home and community become the existing site of care ,
    nurses must assume new roles




                                                                     52
          Nursing roles in health promotion and protection

   Advocate: Strives to ensure that all persons receive quality,
    appropriate and cost-effective care

   Care manager: to prevent duplication of services and reduce
    costs
      ”E-care” manager is to know how to search for and find

       specific and high-quality information on the internet
      Facilitating communication among parties is one of the care

       manager´s most important function


                                                                     53
          Nursing roles in health promotion and protection

   Consultatnt: consultative exchanges can occur with
    schoolteachers, legislators, or others who maintain a working
    relationship with the person
      Gerontological nurse: planning for a new senior citizens´

        housing development

   Educator: health practices- a good nutrition, industrial and high
    way safety, immunization, specific drug therapy. Teaching is of
    the primary prevention techniques available to avoid the major
    causes of disability and health today

                                                                        54
             Nursing roles in health promotion and protection

   Healer: healing resides in the ability to glimpse (trace) or intuit the ”interior”
    of an individual´s care, to sense and identify what everyone else has missed
    or underappreciated
، ‫المعالج : الشفاء يكمن في القدرة على نظرة (تتبع) أو يستشعر في "الداخلية" للرعاية الفرد ، ومعنى‬
     ‫وتحديد ما قد غاب عن الجميع أو ال تقدر حق قدرها‬
   Researcher: evidence-based practice is defined as the conscientious (extreme
    care and great effort), explicit (Fully and clearly expressed), and judicious
    (careful and sensible; marked by sound judgment) use of current best
    evidence in making decision about the care of individual patients

   The practice of evidence-based medicine means integrating individual clinical
    expertise with the best available external clinical evidence from systematic
    research

                                                                                                  55
         Future research for the next five years, National Institute of
         Nursing Research (NINR)



   From management of individuals during illness and recovery to
    the reduction of risks for disease and disability
   Promoting health life style
   Promoting quality of life for persons with chronic illness
   Identifying effective approaches to acheiving and sustaining
    good health




                                                                          56
          Future research for the next five years, National Institute of
          Nursing Research (NINR)

   Health promotion research should focus on health problems and
    disease-prevention techniques such as obesity reduction, smoking
    cessation, prevention on cancer, heart disease

   Traditionally teaching prenatal classes, stressing prevention of
    infectious diseases through education and immunizations, teaching
    hygiene and safety principles in school and industry, and
    disseminating information on how to reduce risk factors leading to
    chronic disease


                                                                       57
        Research Design- RandomizedClinical Trials (RCTs)


   Experiment in which individuals are randomly assigned into groups called
    study and control groups
   The study group receives the intervention and the control group does not
    receive the intervention
   Randomization can be acheived by using computer-generated lists, a table of
    radom numbers
   Blinding ensures that subjects are unaware of the treatment or intervention to
    which they are exposed
   Double-blinded studies are ones in which neither the researcher nor the
    subject knows what treatment or intervention they are receiving
   In drug studies. The investigator and subjects are not told what medication
    they are receiving, so as not to influence the outcome


                                                                                     58
          Research Design- Cohort Studies

   The investigators do not determine which individuals receive the intervention
    at the outset (the time at which something is supposed to begin)
   People who have already been exposed to the risk factor, or intervention, and
    control subjects who have not been exposed are selected by the investigators
    to be followed longitudinally over time in an effort to observe differences in
    outcome
   Disadvantages: require a large sample size, many years of observation to
    provide adequate statictical power to measure differences in outcome,
    expensive, time consuming
   Drop out of the study before it is completed
   Attrition (The loss of subjects during the course of a study) or mortality
    refers to the loss of subjects from both experimental and control groups for
    various reason


                                                                                     59
          Research Design- Case-Controlled Studies


   Both the study group and the control group are selected on the basis of
    whether they have the disease and not whether they have been
    exposed to a risk factor or a clinical intervention
   Therefore the design is retrospective
   Disadvantages: difficulty identifying important confounding variables
    and adjusting them for the outcome, difficulty getting the past history
    of participants and the improper selection of control groups which
    may invalidate conclusions about the presence or absence of statistical
    associations


                                                                     60
           Improving Prospects for Health

   Population effects:
      Cultural and socioeconomics changes within the population

       unequivocally (Admitting of no doubt or misunderstanding)
       influence lay concepts of health promotion

       The projectd age distribution- considerable growth is expected in
        the proportion of the population




                                                                      61
                  Improving Prospects for Health

   Shifting problems:environmental pollution is a complex and increasingly
    hazardous problem
   Disease related to industry and technology, including accidents and trauma,
    important threat to health
   The physical and psychological stresses of a rapidly changing and fast-paced
    society present daily problems as economic pressures, poor health habits
   Obesity from the lack of exercise is product of modern technology
   The ingestion of potentially toxic, nonnutritios, high fat foods is contributing
    factor to poor health, the abuse of tobacco, drugs and alcohol negatively
    affects health
   Orientation towards illness clearly focuses on the effects rather than the
    causes of disease


                                                                                       62
            Improving Prospects for Health
            Shifting Problems


   A substantial (Possessing wealth or property) change in wellness
    patterns has occured:

       Infectious and acute diseases were the major causes of death in the early
        twentieth century whereas chronic condition, heart disease,
        cerebrovascular accident (stroke)and cancer are the major causes today




                                                                                    63
           Improving Prospects for Health
           Moving Toward Solution


   Individual involvement: action related to life style beggining early in life
    with the young child and the goverment involvement- the learning and the
    inherent changes that are involved require an attitudinal change, which is
    the most difficult requirement

   Motivational factors play a role:
      Program for health promotion

      Financial incentive for prevention may be another motivating factor

       and health advocacy by professionals in the health field is critical




                                                                                   64
          Improving Prospects for Health
          Moving Toward Solution

   Private and public action at all levels is needed to reduce
    possible environmental hazards
   Toxic agents in the environment can present health hazards that
    may not be detected for years
   Therefore it is necessary for the individuals to monitor industrial
    and agricultural production processes to reduce exposure to
    potentially toxic agent
   Government activity in the form of Legislation and financing-
    Bicycle safety, seat belts, taxes on cigarettes
   Putting more emphasis on primary prevention


                                                                          65
         To shift directions in today´s health care

   Provide leadership in finding the vision and the path
   To inform, educate and reeducate themselves and their colleagues,
    the media and the general public
   Nurses calls for seeing the health problem in new ways and helping
    others to do the same
   Responsibility means developing new roles and looking at the
    problem through others´eyes including the eyes of individuals, the
    public, other proffessionals and other nations




                                                                  66

				
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