Health Promotion and Epidemiological Triangle

Session 1: Introduction to Health Promotion and Social Determinants of Health

• The Epidemiological Triangle conceptual framework is used in public health to understand the interplay between three key factors in disease transmission: the host, the agent, and the environment.
• These three elements interact and influence each other, ultimately leading to the occurrence and spread of diseases in populations.

The Biopsychosocial Model

• Recognizes the complex interplay between biological, psychological, and social factors in determining an individual's overall health and well-being.
• Highlights the importance of considering biological, psychological, and social factors when assessing health and well-being.

The Socioecological Model

• Recognizes the multiple levels of influence on health outcomes, ranging from individual characteristics to broader social, community, and environmental factors.
• Emphasizes the interconnectedness and interdependence between these levels, highlighting the need for comprehensive interventions that address health determinants at multiple levels to promote health and well-being.

The CSDH Framework

• Health equity is described by the absence of unfair and avoidable or remediable differences in health among social groups.
• The framing of social justice and health equity points towards the adoption of related human rights frameworks as vehicles for enabling the realization of health equity.

Health System Building Blocks

• Provides a comprehensive view of the essential components needed for a functional healthcare system.
• The building blocks include health service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance.

Social Determinants of Health

• Social, economic, and political mechanisms give rise to a set of socioeconomic positions, which in turn shape specific determinants of health status.
• Context, structural mechanisms, and the resultant socioeconomic position of individuals are "structural determinants" and are referred to as the "social determinants of health inequities".
• Intermediary determinants of health include material circumstances, psychosocial circumstances, and behavioral and biological factors.

Health System

• The role of the health system is particularly relevant through the issue of access, which incorporates differences in exposure and vulnerability, and through intersectoral action led from within the health sector.
• The health system plays an important role in mediating the differential consequences of illness in people's lives.

Social Cohesion/Social Capital

• The concepts of social cohesion and social capital occupy an unusual and contested place in understandings of SDH.
• Influential researchers have proclaimed social capital a key factor in shaping population health.
• Adoption of social capital as a key for understanding and promoting population health is part of a broader, radically depoliticizing trend.

Policy Action

• Three broad approaches to reducing health inequities can be identified: targeted programs for disadvantaged populations, closing health gaps between worse-off and better-off groups, and addressing the social health gradient across the whole population.
• Policy development frameworks can help analysts and policymakers to identify levels of intervention and entry points for action on SDH.

DOH's Health Promotion Framework Strategy 2020-2030

• Not provided in the text.

Session 2: Measuring Progress in Health Promotion

• The scope and practice of health promotion have evolved over time, from traditional understanding of communicating health information to a more encompassing approach.
• prevailing models, approaches, and strategies to health promotion include socio-ecological models, which recognize multiple levels of influence on health behaviors.

Socio-ecological Models

• Recognize the interaction between, and interdependence of, factors within and across all levels of a health problem.
• Highlight people's interactions with their physical and sociocultural environments.
• Recognize multiple levels of influence on health behaviors, including intrapersonal/individual factors, interpersonal factors, institutional factors, community factors, and public policy factors.### Ecological Models of Health Promotion and Disease Prevention
• The ecological model focuses on specific efforts to reduce disease risk factors and promote healthy behaviors.
• It addresses the wider social determinants of health, including interpersonal, institutional, community, and policy factors.

The Health Belief Model

• The Health Belief Model is a theoretical model that explains and predicts individual health behaviors.
• It focuses on individual beliefs about health conditions, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy.
• Key elements of the model include:
  • Perceived susceptibility to sickness or disease
  • Belief of consequence (perceived severity)
  • Potential positive benefits of action (perceived benefits)
  • Perceived barriers to action
  • Exposure to factors that prompt action (cues to action)
  • Confidence in ability to succeed (self-efficacy)

Examples of Health Belief Model

• The Michigan Model for Health is a curriculum designed for implementation in schools, targeting social and emotional health challenges.
• Boston University School of Public Health provides an overview of the Health Belief Model in health promotion setting and includes examples for each stage and the limitations of using this model in public health.

Stages of Change Model (Transtheoretical Model)

• The Stages of Change Model explains an individual's readiness to change their behavior.
• It describes the process of behavior change as occurring in stages:
  • Gathering information
  • Conveying the consequences of health issues
  • Providing assistance in identifying and reducing barriers to action
  • Demonstrating actions and providing support
• The model is cyclical, and individuals may progress to the next stage or regress to a previous stage.

Social Cognitive Theory

• Social Cognitive Theory (SCT) describes the influence of individual experiences, the actions of others, and environmental factors on individual health behaviors.
• Key components of SCT related to individual behavior change include:
  • Self-efficacy: The belief that an individual has control over and is able to execute a behavior.
  • Behavioral capability: Understanding and having the skill to perform a behavior.
  • Expectations: Determining the outcomes of behavior change.
  • Expectancies: Assigning a value to the outcomes of behavior change.
  • Self-control: Regulating and monitoring individual behavior.
  • Observational learning: Watching and observing outcomes of others performing or modeling the desired behavior.
  • Reinforcements: Promoting incentives and rewards that encourage behavior change.

Examples of Social Cognitive Theory

• Healthy Relationships, a program implemented by Chattanooga CARES, is a small-group intervention for people living with HIV/AIDS.
• HoMBReS is a community-based intervention designed to reduce the risk of HIV and other sexually transmitted diseases among Latino men living in rural areas of the United States.

Health Communication

• Health communication is the study and use of communication strategies to inform and influence individual and community decisions that enhance health.
• It integrates components of the health promotion models to promote positive changes in attitudes and behaviors.
• Effective health communication and social marketing strategies include:
  • Use of research-based strategies to shape materials and products and to select the channels that deliver them to the intended audience.
  • Understanding of conventional wisdom, concepts, language, and priorities for different cultures and settings.
  • Consideration of health literacy, internet access, media exposure, and cultural competency of target populations.

Policy, Systems, and Environmental (PSE) Change

• For health promotion and disease prevention strategies to be successful, policies, systems, and environments (PSE) must be supportive of health.
• PSE change strategies are designed to promote healthy behaviors by making healthy choices readily available and easily accessible in the community.
• Examples of PSE change strategies include:
  • Establishing policies for smoke-free zones and public events.
  • Establishing healthy food options in vending machines in public places.
  • Adding a tax to unhealthy food options.
  • Requiring the use of safety equipment in a work setting to avoid injury.### Systems Change
• Refers to a fundamental shift in the way problems are solved within an organization, affecting purpose, function, and connections.
• Affects organizational culture, beliefs, relationships, policies, and goals.

Environmental Change

• Involves changing economic, social, or physical surroundings to affect health outcomes.
• Examples: increasing parks and green spaces, installing signs promoting walking and biking paths, increasing availability of fresh and healthy food.

Examples of PSE Change Interventions

• Kentucky Homeplace: addresses health through PSE changes, emphasizing care coordination and health coaching for diabetes, hypertension, and tobacco cessation.
• Healthy Adams County: implements PSE changes through community task forces, such as the Breast Cancer Coalition, Food Policy Council, and Tobacco Prevention.

Integrating Health Promotion Models

• The Ottawa Charter outlines three basic strategies: advocate, mediate, and enable.
• Advocate: combines individual and social actions to gain political commitment, policy support, and social acceptance.
• Mediate: reconciles different interests to promote and protect health.
• Enable: empowers individuals and groups through partnership, skills development, and access to resources.

The Ottawa Charter

• Launched in 1986, the Ottawa Charter outlines a global definition and approach to health promotion.
• Logo represents the three basic strategies for health promotion, with wings representing five key action areas: strengthening community action, developing personal skills, creating supportive environments, reorienting health services, and building healthy public policy.

5 Key Actions

• Build healthy public policy that combines diverse approaches, including legislation, fiscal measures, and organizational change.
• Create supportive environments that promote health through reciprocal maintenance of people, communities, and the natural environment.
• Strengthen community actions through empowerment and community development.
• Develop personal skills through education and access to information, enhancing life skills and control over one's own health.
• Reorient health services to focus on the total needs of the individual, moving beyond curative services to health promotion and disease prevention.

Approaches to Health Promotion

• Community-based approach: engages and empowers local communities to address specific needs and priorities.
• Whole-systems approach: combines individual behavior change, systemic changes, and supportive environments to address multiple determinants of health.
• Settings approach: creates healthy environments in specific settings, such as schools or universities.