Introduction to Health Promotion

Introduction to Health Promotion

• Health Promotion is about improving health at individual, community, and global levels.
• WHO definition: Enables people to gain control over their own health by addressing root causes of ill health.
• Ottawa Charter provides a framework for health promotion strategies.
  • Principles:
    • Build healthy public policy
    • Create supportive environments
    • Strengthen community action
    • Develop personal skills
    • Reorient health services towards prevention and health promotion

Health Promotion Frameworks

• Primary Health Care: Whole-of-society approach to equitable access to essential health services.
  • Features:
    • Evidence-based
    • Intersectoral
    • Culturally acceptable
    • Accessible technology
    • Participatory approach
    • Affordable services
    • First contact with health services
• Health for All: Aims to provide comprehensive health care, including prevention, treatment, rehabilitation, and palliative care, as close to the patient's environment as possible.
  • Primary care: Subset of primary health care, including GP appointments and community nursing.
• Health in All Policies (HiAP): Involves policy makers across all government departments making health a central aspect of their policies.
  • WHO: Emphasizes integrating health considerations into decision-making.
  • Example: South Australia's "Health in All Policies" initiative, known as the Helsinki Statement.
• Planetary Health: Recognizes the interdependence of human and planetary health.
  • Key themes:
    • Intergenerational equity
    • Eco-social perspective of health
    • Transdisciplinary approach
  • Focus: Addressing environmental and social determinants of health.

Barriers to Effective Health Promotion

• Lack of time and incentives: Clinicians often prioritize acute care over preventive measures.
• Inadequate infrastructure: Limited resources, such as clinical nurse practitioners, may hinder effective interventions.
• Lack of integration at the policy level: Insufficient coordination between different government departments can limit impact.
• Patient factors: Patient's beliefs, attitudes, and access to resources can influence adherence to health advice.
• Lack of GP understanding about principles of health promotion: Clinicians may not be well-equipped to implement effective strategies.

Health Promotion for the Clinician

• Clinical Encounters: Clinicians need to balance managing acute problems, prevention, managing chronic conditions, and modifying health-seeking behavior.
• Prevention: Three types:
  • Primary: Reducing the chance of a disease occurring.
  • Secondary: Early detection of disease before symptoms manifest.
  • Tertiary: Minimizing complications or progression of an already existing disease.
• Labonte's Strategies for Health Promotion at different levels:
  • Medical Level: Illness care, screening, immunization, medically managed behavior change.
  • Behavioral Level: Mass media campaigns, social marketing, advocacy for policy change.
  • Socioenvironmental Level: Encouraging community organization, action, and empowerment.
• SNAP Guidelines: Framework for addressing key health risks in Australia:
  • Smoking: Reducing tobacco use.
  • Poor Nutrition: Promoting healthy dietary choices.
  • Alcohol: Reducing excessive alcohol consumption.
  • Limited Physical Activity: Encouraging regular exercise.
• The 5 A's: Approach to addressing risk factors:
  • Ask: Identify patients at risk.
  • Assess: Determine the level of risk, readiness for change, and health literacy.
  • Advise/Agree: Provide information and negotiate goals.
  • Assist: Develop a management plan and support self-monitoring.
  • Arrange: Referrals to services and follow-up appointments.

Mental Health Promotion

• Medical Level:
  • GP capacity building for mental health conditions.
  • Understanding of mental health services and referrals.
  • Physical health screening and management.
• Behavioral Level:
  • Media programs about mental health and suicide prevention.
  • Advocacy for policy change.
• Socioenvironmental Level:
  • Empowering women.
  • Domestic violence programs.
  • School/community programs.

Health Advocacy

• UBC Framework:
  • Agency: Clinicians acting on behalf of the patient to navigate resources and systems.
  • Activism: Clinicians working to bring about broader societal change.
• Shared Advocacy: Collaborative effort between clinicians and communities.
• Direct Advocacy: Clinicians advocating for specific patient needs.

Conclusion

• Health promotion is a multi-dimensional approach integrating individual, community, and global levels of intervention.
• Clinicians play a crucial role in promoting health through prevention, community outreach, and advocacy.
• Understanding health promotion frameworks and strategies is essential for improving health outcomes.

General Barriers to Health Promotion

• GPs cite insufficient time and patient resistance to change as major barriers to health promotion.
• The Transtheoretical Model (Prochaska & DiClemente) highlights the stages of change, including precontemplation and contemplation.

LGBTQIA Communities

• Australia has a strong response to HIV, with government, healthcare, and community collaboration.
• Implementation strategies include condom vending machines, needle and syringe exchange programs, and media campaigns.
• "Safe Schools" is a program aiming to create safe, supportive, and inclusive environments for LGBTQIA+ students.

Barriers to Health Promotion for LGBTQIA Communities:

• Individual:
  • Acceptance by healthcare workers.
  • Understanding LGBTQIA+ health needs.
  • Accessing healthcare services.
• Community:
  • Social stigma, discrimination, and past experiences.
  • The role of media.
• System:
  • Lack of LGBTQIA+ engagement in policymaking.
  • Insufficient healthcare services for the community.
  • Government sector disengagement.
  • Non-inclusive public health campaigns.

Indigenous Communities

• Key focus areas include non-communicable diseases (heart issues, CVD) and communicable diseases (trachoma, Group A Strep).
• The Aboriginal lens of health promotion framework emphasizes indigenous self-determination, a holistic view of health, community ownership, and recognition of cultural context.
• The theory of empowerment is a crucial component.

Barriers to Health Promotion for Indigenous Communities:

• A strengths-based approach is essential.
• Cultural safety is based on respectful engagement, addresses power imbalances, and aims to create a safe and inclusive space.
• Cultural humility involves self-reflection to identify biases and fosters respectful processes based on mutual trust.
• SNAP guidelines may not adequately consider cultural differences.

Refugee and Asylum Seeker Communities

• Health promotion for refugees should focus on conditions they are susceptible to and appropriate screening options.
• NCDs, CDs, and mental health issues are considered a "triple burden."

Barriers to Health Promotion for Refugee and Asylum Seeker Communities:

• Individual:
  • Trust in the healthcare system.
  • Accessibility of services.
  • Language barriers, health literacy, and lack of healthcare worker knowledge.
• Community:
  • Discrimination.
• System:
  • Healthcare costs.
  • Language barriers.
  • Mandatory detention.
  • Non-inclusive public health campaigns.