health promotion notes .docx

Health Promotion notes https://quizlet.com/ca/914527734/cultural-diversity-in-healthcare-flash-cards/?i=5flfwx&x=1jqt https://quizlet.com/914527734/test?answerTermSides=4&promptTermSides=2&questionCount=40&questionTypes=12&showImages=true https://quizlet.com/914527734/learn What...

Health Promotion notes https://quizlet.com/ca/914527734/cultural-diversity-in-healthcare-flash-cards/?i=5flfwx&x=1jqt https://quizlet.com/914527734/test?answerTermSides=4&promptTermSides=2&questionCount=40&questionTypes=12&showImages=true https://quizlet.com/914527734/learn What is health? It is subjective → Each culture and generation defines health differently Health is more than the absence of disease Health is holistic → body, mind, spirit Health is a basic human right Historical Views of Health 500AD was when Greeks first recognized that health could not be separated from the physical and social environments and human behavior Plato considered health to be a state of being in complete harmon Hippocrated defined health balance between environmwnts forrces and individual habits Illness was considered a disruption in equilibrium World health organization: 1946 → WHO proposed “health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity” “Health is not an end in itself but, rather a resource for living, and the concept can be applied to individuals, groups of individuals, communities, or whole populations” (WHO, 1986; Ottawa Charter 1986). Health is: The extent to which an individual or group can realize aspirations, satisfy needs, and change or cope with the environment Health is a positive concept emphasizing social and personal resources as well as physical capacities “Health is an ongoing process throughout the life span, influenced by several factors, including lifestyle choices” Health is a perception Factors that influence health: Cultural lens Religion, culture, beliefs, and ethnic customs can influence how clients understand health concepts, how they care for their health, and how they make decisions related to their health Sociological lens Focus on how the different processes (life events, social conditions, social roles/structures & cultural systems) affect our social life and state of mind Ecological lens Recognizes the interconnection between people and their physical & social environments and the factors that enhance or limit health and healthy behaviors Promotion of Health Health Promotion - Is a strategy to improve health - The Ottawa Charter (1986) defined it as “enabling people to increase control over and to improve their health.” - This was the beginning of the conceptualization of empowerment as a component of health promotion Development of health: Early to mid-1900s Health was defined as the absence of disease Health was measured using indicators of disease such as morbidity and mortality statistics They would track the population of how many have morbidity vs mortality Morbidity → whole bunch of diseases at the same time Mortality → death 1947 The World Health Organization (WHO) amended its defintion of health “A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” 1986 The Ottawa Charter defined health as a positive concept, a holistic resource for everyday living that includes physical, social, and personal capabilities “Health is not an end in itself but, rather a resource for living, and the concept can be applied to individuals, groups of individuals, communities, or whole populations” “To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment.” Illness: an individual's personal experience, perception, and reaction to a disease, whereby he or she is unable to function at the desired “usual” level A subjective experience of loss of health What the patient says → “I have a stomach ache” Illness trajectory: Expected short long term course over time with a degree of uncertainty about the disease Disease: The presence of abnormal alterations in the structure of functioning of the human body that fits within the medical model Disease is an objective state of ill health The pathology of disease detected by medical science The doctor says → “A case of acute gastroenteritis” Disease course: An identifiable progression of a disease in an individual Disease prevention: The activities taken by the health sector are to prevent the occurrence of disease, to detect and stop disease development, and to reduce the negative effects once a disease is established. Injury prevention: Using strategies to help patients prevent and reduce the risk of injury. Risk avoidance: A disease prevention strategy is used to avoid health problems and to remain at a low-risk level. Risk reduction: A disease prevention strategy that is used to reduce or alter health concerns so that the disease is detected and treated early, to prevent moving to a high-risk level. Health enhancement: A health promotion strategy that is used to increase health and resiliency, to promote optimal health and well-being. Harm reduction: Includes strategies to decrease the adverse health consequences of substance abuse with the eventual goal of abstinence, as opposed to having abstinence be a prerequisite for program participation. Resiliency: The capacity of patients as individuals, families, groups, and communities to manage effectively when faced with considerable adversity or risk Resiliency develops and changes over time, depending on changes in risk and protective factors. Risk factors: Variables that create stress and challenge patients' health status. Protective factors: Variables such as individual characteristics, family support systems, and environmental supports help patients manage the stressors associated with being at risk. Brief History of the Evolution of Nursing in Canada Global Historical Roots of Public Health Since ancient times, people have been trying to prevent, understand, and control disease. The ultimate goal of healing is to increase longevity and prevent death Ex, ancient Babylonians, Egyptians, ancient Greeks Early public health efforts in canada In the early years of North American settlement, the sick were cared for informally in the home, by the women of the household In the seventeenth and eighteenth centuries, these women, religious orders, and wealthy philanthropists took care of the sick who could not afford their care Early Nursing Leaders in Canada All the women who made a difference have a high social status due to their husbands Marie Rollet Hebert (1588-1649) Arrived in new France with husband Advice from the Indigenous community Focused on children Jeanne Mance (1606 – 1673) Established a hospital in 1642 Marguerite d’Youville (1701-1771) Changed the way nursing was in Canada Founded the les soeurs grises (the grey nuns) → a group of visiting nurses in Canada Was named a saint Lady Aberdeen (1898) – founded the Victoria Order of Nursing VON Found the victoria order of nursing VON Florence Nightingale: 1850s: Sent by the British government to Asia Minor to care for soldiers wounded in the Crimean War. Using simple epidemiological measures, documented a mortality rate that decreased from 415 per 1,000 at the beginning of the war to 11.5 per 1,000 at the end of it. Returned to England and revamped nursing education, replacing untrained lay nurses with “Nightingale nurses” Eunice Dyke: Early 1900s: this Ontario nurse became interested in public health 1911: she became the director of public health nursing in Toronto Public health nursing evolved in Canada in the late nineteenth and early twentieth centuries largely because of her pioneering work Nursing education in Canada: 1874: The first “training schools” (hospital diploma schools) for nurses opened. Based on the Nightingale model 2-year diploma program Montreal, Hamilton, and St. Catherine's 1920: Kathleen Russell helped establish the first integrated basic degree nursing program at the University of Toronto. By 1930: there were nearly 330 schools of nursing in Canada Summary: The Late 1800s - Early 1900s: Epidemics killed tens of thousands of people, especially Aboriginal peoples Canadian authorities began to take action to protect public health, introducing vaccination programs and establishing boards of health Immigrants arrived from Europe carrying highly contagious diseases (e.g., smallpox, typhus, cholera, and influenza) Between WW1 and WW2: 1918 to 1939: Public health nursing began to focus on screening programs. The federal government initiated social assistance for health care. Provinces concentrated on public health programs such as immunization, improved sewage systems, and clean water. Early 1920s: A public health nursing practice was formally recognized. 1920s to 1940s: Nurses specializing in TB care were replaced by PHNs. Canadian universities began to offer degree programs. The Weir Report of 1932 concluded that public health nursing should become a specialty area in advanced education Post WW1: WWII Sept 1, 1939 – Sept 2, 1945 1945 to 1970: Public health expanded beyond public hygiene to include prevention of diseases and health education. 1950s and 1960s: PHNs became generalists, visiting clients in homes, schools, and clinics Medical Care Act, 1966: Pre-1966 – there was no federal health care plan. Each province was responsible for the health of its citizens The federal election of 1963 resulted in a Liberal minority government Lester Pearson (PM) held a meeting with all the provincial leaders Resulted in the Medical Care Act – implemented on July 12, 1966 First time in Canadian history that health care was covered by the federal government In order for provinces to receive funding – they were required to implement an insurance plan that met 4 basic principles: Universal Publicly administered Comprehensive Portable Evolution of Health Promotion 1974: Lalonde Report Conceptualized the health field concept “A New Perspective on the Health of Canadians” Shift from medical to a behavioral approach to health Shifts responsibility for their own health Heavily criticizes “blaming the victim” for their poor health 1978: Alma-Ata Declaration International Conference focus on Primary Health Care “Health for All by the Year 2000” by the World Health Organization in Russia: Declared health as a fundamental human right, Worldwide social goal 1984: WHO working group Federal level: liberal party led by Pierre Trudeau To replace the Medical Care Act of 1966 and the Hospital and Diagnostic Services Act of 1957 by harmonizing both To address the problem of “extra billing” where some hospitals and doctors introduced “user fees” 1986: Ottawa Charter of Health Identified health as a ‘resource for everyday living Canada hosted the first international conference on health promotion in Ottawa Identified the fundamental conditions or prerequisites for health: Peace, shelter, education, food, income, social justice, equity, sustainable resources and a stable ecosystem. Charter stressed that individuals, governments, & non-governments sectors must work in partnership for health Outlined 3 health promotion strategies for practice Advocating = “...good health is a major resource for social, economic, and personal development and important dimension of quality of life....advocacy for health” Enabling = “...focuses on achieving equity in health aims at reducing differences in current health status… apply equally to women and men” Mediating = “..health promotion demands coordinated action by all concerned: by governments, by health & other social & economic sectors...peoples from all walks of life...adapted to local needs...” Outlined 5 health promotion actions: Build healthy public policy Create supportive environments Strengthen community action Develop personal skills Reorient health services 1986: Epp Report Identified 3 health promotion challenges: Reducing inequalities Increasing prevention Enhancing coping Identified 3 health promotion mechanisms Self-care in the interest of own health Mutual aid Healthy environments Suggested 3 key strategies Fostering public participation Strengthening community health services Coordinating Healthy Public Policy International conferences on health promotion 1994: Federal, Provincial, and Territorial Advisory Committee on Population Health 1996: Population Health Promotion Model ⭐Prerequisites for health: What you need to have health and protective factor Peace Shelter Education Food Income Stable eco-system use Sustainable resources Social justice (not equal) Equity Empowerment of women Social security Respect for human rights Social relations Population Health Determinates Determinates of health outlined Influence of environment on personal behaviors and that ‘health-inhibiting’ behaviors could be coping strategies of managing stress created by living & working conditions. Population Health Promotion Model (1996) Key determinates added; gender, culture, & social environment Jakarta Declaration (1997) Jakarta Declaration on Health Promotion Into the 21st Century (WHO, 1997) 1st international conference held in a developing country Reaffirmed the Ottawa Charter prerequisites for health & declared poverty to be the greatest threat to health. Identified the following priorities for action: promoting social responsibility for health in public and private sectors; increasing investments for health in all sectors, consolidating & expanding partnerships for health community capacity & empowering individuals 2000 to the Present 2001: Researchers demonstrated that home care for the elderly costs less than institutional care. 2002: The Romanow Report identified home care as the most rapidly growing area of community health care. Lack of health care workers is evident across Canada Advocates for more health care professionals 2003 The CHNC Standards of Practice were published. 2008 The core competencies for CHNs were released. Evolution of Health Promotion Summary: 1970s: The first dimension of health promotion focused on managing preventable diseases and risk behaviours. The most popular health promotion strategies were providing health information and “simple” education. 1980s: Emphasis shifted to complementary intervention approaches as outlined in the Ottawa Charter, for example, building healthy public policy and strengthening community action. 1990s: Focus was on providing health promotion to individuals and groups in their communities. 2000s: A fourth dimension of health promotion became evident: the social Determinants of Health Principals of Primary Health Care Primary Health Care In the early 1970s, the most common model used in health care was the medical model, which focused on treatment and cure in institutions. In 1974, the Lalonde Report initiated a shift toward population health promotion. In 1978, at the Alma-Ata conference, primary health care became the preferred international strategy. In 2002, the Romanow Report provides “the essential building blocks that must be basis of all potential primary care model” Primary health care: A model for essential health care Based on practical, scientifically sound, and acceptable methods and technology Universally accessible to individuals and families in the community at a cost that the community and country can afford to maintain Comprehensive care that includes: Disease prevention Community development A wide spectrum of services and programs Working in interdisciplinary teams Intersectoral collaboration Differs from primary care, which is the first contact between individuals and the health care system for the purpose of treating a disease. Primary care usually relates to the curative treatment of disease Five principles of primary health care were adopted at Alma-Alta in 1978: Accessibility Regardless of geographical location, culture, and income Does not mean equal Equitable distribution of essential health services to all populations Health Promotion Increased emphasis on services that are preventive and promotive rather than curative only. (increase health promotion and disease prevention) Such as health education and immunization Focus on promotion health and preventing disease to maintain health Eg) teaching low-income people to eat healthily n restricted budgets Public Participation Maximum individual and community involvement in the planning and operation of health care services. (public participation) Often referred to as public participation in decision making Communities need to be encouraged in managing their health care Eg) school breakfast program, heart health, and safe walking Intersectoral Collaboration The integration of health development with social and economic development. (inter-sectoral and interdisciplinary collaboration) Involves interdisciplinary teams working together Work with agriculture, food, industry, housing Eg) decrease smoking in all public places The use of appropriate technology. Finding the most cost-effective way to provide appropriate health care to everyone in the community Eg) telehealth technology Primary care vs. Primary Health Care Primary health care: A comprehensive concept Includes disease prevention and community development Within a Primary Health Care framework health promotion encompasses all activities that enable and facilitate health. Community development Provides a wide spectrum of services and programs Facilitates working in interdisciplinary teams Involves intersectoral collaboration for healthy public policy Practice Considerations Community health nursing practice: one area of focus = disease prevention. Disease prevention is divided into three levels: Primary prevention (seeks to prevent disease from the beginning). Risk avoidance eg) immunization Secondary prevention (seeks to detect disease early in its progression in order to make early diagnosis and begin treatment). Risk reduction eg) BSE/TSE Tertiary prevention (begins once a disease has become obvious; aims to interrupt the course of the disease). Rehab eg) teaching foot care to diabetic clients Rachel (2004) Three Key action areas for social equality and health Need to “think upstream” = social policies develop policies to reduce the incidence of low income develop policies to reduce social exclusion develop policies to restore and enhance Canada’s social infrastructure (CNA Backgrounder 2005:6) Upstream vs Downstream thinking Downstream thinking: Considers individual health concerns and treatments without considering the sociopolitical, economic, and environmental variables Upstream thinking: A “big picture” approach Considers determinants of health and other economic, political, and environmental factors Health Promotion and Empowerment Health promotion: A process of empowering people to increase control over and improve their health. Empowerment: Means actively engaging the client to gain greater control. Involves political efficacy, improved quality of community life, and social justice. Not something that can be done “to” or “for” people; it involves people discovering and using their own strengths Health Promotion Models, Theories, and Frameworks Health Promotion Models Nursing models (theories) are important for guiding nursing education, research, and practice, and for strengthening the links between nurses who perform these roles Health promotion is... “the process of enabling people to increase control over their health and its determinants and thereby improving their health” WHO As nursing has moved from doing for clients to: Working with clients, Helping people to care for themselves, and Involving them in their care and decisions about their health, The modes of nursing are increasingly those of: Educating, Guiding, and/or Motivating the client, family &/or community Development of HP Models Conceptually, promotion of health is health- centered; prevention of disease is disease-centered. Individual-Focused Perspectives: - Social Cognitive Models Social cognitive models consider cognitive (mental) and effective (emotional) factors as the primary determinants of behavior Social cognitive models attempt to account for factors that determine behavior and behavioral change Include the Health belief model, the theory of planned behavior, social cognitive & self-efficacy theory, and the health promotion model. The Health Belief Model - Earlier model – 1960s (Rosenstock, 1960) Health behaviour can best be explained by understanding an individual’s beliefs about health Four components: Individual’s perceptions (susceptible to threat) Modifying factors Cues to action Likelihood of action (acceptable cost) Health Belief Model (HBM) Nursing interventions and perspectives consistent with HBM: Nursing intervention is to make the threat clear Nurse is “expert” Nursing action = health education Provide risks and benefits of “compliance” with treatment Results of research on HBM: Inconsistent, variable success in changing behaviour However, encouraging change in health beliefs can lead to beneficial behavioural health changes Mass media can increase knowledge and beliefs Theory of Planned Behaviour - Social Cognitive Theory Based on social learning theory (Bandura, 1985) Behaviour change is a result of the interplay of individuals and their environment Key elements: Reciprocal determinism Observational learning Expectations Self-efficacy Self-Efficacy theory - Self-efficacy is a person’s belief about their capability of performing a certain action Behavior is contingent on efficacy expectations and outcome expectations Self efficacy is the stronger predictor Efficacy from 4 sources Performance Vicarious experience Verbal persuasion Physiological state Efficacy characteristics Magnitude Strength Generality Different for each behaviour May change over time (especially with interventions) What does it do? It influences the choices we make The effort we put forth How long we persist when we confront obstacles (and in the face of failure) How we feel Based on perception not true capability Perceptions of ability affect behaviour, level of motivation, thought patterns and emotional responses Self - Efficacy theory Uses: Used to predict behaviour change Limitations: Research suggests self-efficacy is important in making lifestyle changes but may not maintain change over time Theories of Reasoned Action and of Planned Change These theories assume a relationship among attitudes, beliefs, intention, and behaviour. The most influencing factor is the intent to act: Beliefs, attitudes, and perceived behavioural control influence action and behaviour. The CHN needs to assess these three influences in all patient situations in order to develop interventions and programs that will meet patient needs. Transtheoretical Model - Stages of Change Model (1995) - The process of changing health behaviours usually proceeds through five stages: Pre-contemplation - Not considering change in next 6 months Contemplation - Thinking about change in next 6 months Preparation - Identifies start date within the next month Action - Implementing change builds self-efficacy – reinforce behaviour Maintenance - Continues new behaviour – no temptation, increased self efficacy * A sixth stage, termination, is associated with changing addictive behavior. Community Focused Perspectives - Health as more that an individual responsibility: Diffusion of innovation theory Community mobilization framework Building healthy public policy models Other models Diffusion of Innovation Theory - Individuals adopt innovations at different rates and are classified into one of these five categories: Innovators (quick adopters) Early adopters (keeners) Early majority - 30-35% of general population Late majority - - 30-35% of general population Laggards (resistant to adopting the innovation) Patients are more likely to adopt health-related practices if the following conditions exist: Compatibility, flexibility, reversibility, simplicity, advantageousness, and cost-efficiency Nurses who are developing and implementing new health promotion ideas and practices need to consider the types of responders to innovation and the six conditions influencing adoption. Community Mobilization Framework - Identifies three health promotion community mobilization approaches to bring about community change: Social planning Locality development Social action Building Healthy Public Policy Models At present, three frameworks help in understanding healthy public policy: Milo’s framework for the development of healthy public policy Weiss’s framework on the relationships between evidence and policy Impact assessment and health impact assessment (HIA) on policy development and implementation Other Models Ecological models: Have a system-level focus Explore relationships between individuals and communities and between sociocultural and environmental factors Example: PRECEDE-PROCEED Model Existential and humanistic theoretical perspectives: Emphasize caring for humankind Emphasize the therapeutic interpersonal relationship between the nurse and the patient. Critical Social Theory Describes and explains oppressive social conditions Goal is to liberate people from health damaging conditions Exposes inequities and assists in changes Partnership approach to raise consciousness and mobilize community action Grass roots organizations – social advocacy Lobby politicians IV. Health Promotion Approaches Three approaches to viewing health (formerly called models): Biomedical Behavioural Socioenvironmental Health Promotion Approaches Biomedical Approach: Pre 1974 – the traditional model viewed health as the absence of disease Focuses on treatment and prevention of disease, especially on the biological and physiological risk factors associated with disease and ill health. The prevention of disease includes the three levels of prevention (primary, secondary, tertiary). Behavioural Approach: 1974 – First introduced in the Lalonde Report– individual health promotionand has been further developed since then Influences in biology, environment & lifestyle/behavior Focuses on using lifestyle changes, especially behavioural risk factors, to promote health (e.g., obesity is a risk factor for hypertension) Socioenvironmental Approach: Started with the Alma-Ata Conference on Primary Health Care in 1978 Focuses on health as a resource and considers the psychosocial and environmental risk factors related to the Determinants of Health in relation to health and health promotion The Senate Subcommittee on Population Health (2009) recommends a focus on the Determinants of Health and the population health framework as an investment in Canada’s future. The determinants of health The Government of Canada has identified 12 determinants of health, which were developed from: The Lalonde Report (1974) The Epp Report (1986) Ottawa Charter of Health Promotion (WHO, 2006) Social Determinants of Health Definition: The economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole “The primary factors that shape the health of Canadians are not medical treatments or lifestyle choices but rather the living conditions they experience”. (Social Determinants of Health: The Canadian Facts Mikkonen and Raphael, 2010:7) Recent literature points to the importance of social determinants of health for client health. See “What Makes us Healthy” in the curriculum 12 Social Determinants of Health Income and social status Social support networks Education and literacy Employment and working conditions Social environments Physical environments Personal health practices and coping skills Healthy child development Biology and genetic endowment Health services Gender Culture The Determinants of Health The most influential determinant of health is socioeconomic status. Factors of socioeconomic status include: Gender Income Social position Education Employment Working conditions Social, environmental, political, and economic determinants of health can be considered related to: Living and working ➡ Social support ➡ Can lead to Individual behavior ➡ stress & illness Genetic make-up ➡ Social economic status = SES How does SES influence health? Consistent and persistent relationship whether measured with mortality/morbidity or perceived health Indicates that a person's sense of well-being is related to their social status Direct correlation: greater wealth = greater health ********* Effects of SES on morbidity and mortality = many Decreased life expectancy Chronic health problems Prematurity Dental decay Mental health issues How do these processes work? Materialist approach Dennis Raphael, 2002 & 2004 Links health to basic material goods & services Income central to health Includes physical assaults Once person is ill – poverty prolongs healing Poor people are likely to suffer from a host of diseases Neo-materialist approach Acknowledges material adequacy but centers attention of the distribution of goods & services Societies with greater wealth distribution have greater overall health as a society Longer life expectancy Longer disability-free life expectancy Lowest infant mortality Social-psychological approach Explains the neo-materialist theory at the level of the individual Focuses attention on the impacts of inequality, inclusion/exclusion and social life Social capital = social inclusion Enhanced community involvement Exclusion = negative personal health effects Life-course approach Overlaps with the previous 3 but focuses on how negative effects are exacerbated in children Throughout life course Latency effect = low birth weight Pathway effect = early development problems Cumulative effect = (dis)/advantages through life For example, a low-class teenage girl is more likely to become pregnant than finish school Economic inequality: The gap between the richest Canadians and the poorest Canadians has widened from 1980 to 2016. More polarization in income gap In 1996 Stats Canada estimated that 23% of years of life lost from all causes prior to 75 yrs could be attributed to income differences 2 most common diseases: CVD, Diabetes CNA Backgrounder 2005:5 The determinants of health: People with low socioeconomic status face a range of conditions that put them at risk for poor health, for example: Drug and alcohol addiction Homelessness Food insecurity Low income/social exclusion Stress Low income → more likely to be exposed to socioecological stresses Also, may experience more psychological distress May have fewer resources to cope with stress Coping strategies used may be harmful to health May have ↓ social support Chronic stress compromises the immune system Many lead to cardiac complications Why is the issue important to nurses? Health care utilization Low-income Canadians are more likely to contact health care providers Also, more likely to be hospitalized & use ER May have ↓ access to preventive health care Health behaviours Limited income → may be more likely to engage in health-limiting behaviours Unable to comply with medication regime without finances to pay for treatment Implications for nurses? Front line workers of the health care system Work to change health-limiting conditions rather than focus only on behaviours (social advocates) During assessment ask the right questions to find links between illness and social factors “Our system is really about sick care, not health care” Structural (violence) problems Health promotion and empowerment Empowerment: Means actively engaging the client to gain greater control. Involves political efficacy, improved quality of community life, and social justice. Not something that can be done “to” or “for” people, but involves people discovering and using their own strengths. 1) Strengthening community action Community development: A process whereby community members identify health problems or issues impacting their community that require the development of capacity-building skills to bring about change. Capacity building: Recognizing and utilizing strengths (rather than deficits) such as available services, resources, and programs in order to assist communities, individuals, or organizations in resolving their health issues. Asset mapping serves as the starting point for determining the resources and assets available in the community. Community mobilization: Individuals in a community working together as a group to influence healthy public policy and to bring about change regarding a health issue. Community-based strategies vs. community development strategies: Community-based strategies: Connect programs and services to community groups Decision-making power usually rests with the sponsoring organization or professional, and not with community participants. Community development strategies: Involve a health concern or issue defined by community residents, rather than by a sponsoring organization or professional Decision-making power rests primarily with community residents. Empowerment: A key concept in health promotion Refers to an active process whereby individuals, groups, and communities are able to state their health requirements and be involved in and take charge of the strategies required to achieve improved health. 2) Building healthy public policy Healthy public policy: Policy that has a positive effect on or promotes health Building healthy public policy: Creating environments that support health and reduce inequities in health and social policies. 3) Creating supportive environments Requires attention to the Determinants of Health The Determinants of Health: Have a direct impact on the health of individuals and populations Are the best predictors of individual and population health Structure lifestyle choices Interact with each other to produce health 4) Developing Personal Skills Literacy refers to nine skills essential to achieving success and safety in work, learning, and life: Reading Writing Oral communication Numeracy Thinking Document use Working with others Computer use Continuous learning Health literacy: The ability to access, understand, evaluate, and communicate information as a way to promote, maintain, and improve health in a variety of settings across the lifespan Illiteracy can prove to be a barrier to accessing health services Literacy can be related to the following, and is therefore linked to the Determinants of Health: Overall health status Co-morbidity burden Life expectancy Lifestyle practices Culture Income and socioeconomic status Living and working conditions Educational attainment Gender Early life Health education is a strategy for the development of personal health skills, for example: Stress management Healthy eating Physical activity Improved literacy Various teaching methods are used, for example, lectures, demonstrations, small groups, and health fairs. 5) Reorienting health services Outlined in the Ottawa Charter Refers to reforming health services/sectors to include a health promotion focus Work withstrategiesnity partners Common strategy include health communication and social marketing How the Other Half Heals - Robert Sapolsky This article by Robert Sapolsky is an example of the social determinants of health He provides suggestions the “should aid everyone in making lifestyle decisions. If you wish to live a long and healthy life....” While reading the article think about the questions on the next slide How does the stress of poverty affect health? Stress arises from lack of control Face seasonal lay-offs Live paycheck to paycheck Worry about food, rent, basic necessities of life Hold 2 jobs, no time for relaxing, no vacations Lack of money for medicines, dentists SES = socioeconomic status gradient (lower economic status = greater risk of disease) What are the most common diseases affecting the poor? (direct correlation SES) Smokers Alcoholism Hypertension Diabetes, obesity Inverse SES (diseases of affluence/wealthy) What are the most common diseases affecting the rich? Multiple Sclerosis Melanoma Endometriosis Anorexia Breast cancer What is the relationship between health and wealth? The poor are more likely to have more illnesses Increased heart disease, respiratory disease Ulcers Cancers Psychiatric disorders Rheumatoid disorders How does the stress of poverty affect health? Stress makes you sick Live paycheck to paycheck Lack of money for medicines, dentists What are the most common diseases affecting the poor? (direct correlation SES) Poor dental health What are the most common diseases affecting the rich? (Inverse SES) Gout, melanoma Notice that disease classifications change through time. Disease categories are socially constructed. What is hospitalism? How was hospitalism a socially constructed disease? What is hospitalism? How was hospitalism a socially constructed disease? What do we know ‘hospitalism’ as today? Social construction of disease, how disease is thought of and talked about What is hospitalism- How is it a socally constrictive disease What is hospitalism today Review → concepts of health Prerequisites for health Population health determinants Social determinants of health for canadians Ottawa Charter (WHO, 1986) Jakarta Declaration (WHO 1997) Public Health Agency of Canada (2002) Toronto Charter on Social Determinants of health (Raphael et al., 2004) Do not need a job just income Peace Shelter Education Food Income stable ecosystem sustainable resource use social justice Equality empowerment of women social security respect for human rights social relations income & social status social support networks healthy child development Education employment & working conditions physical environment health services biology & genetic endowment personal health practices & coping skills Gender Culture social environments Aboriginal status Disability income & its equitable distribution early childhood development Education employment & working conditions food security health care services housing shortage Gender Race social safety nets social exclusion unemployment & Employment security Culture and Diversity Culture: a set of beliefs, values, and assumptions about life that held amongst a group of people and across generations. Culture characteristics: Learned Adaptive Dynamic Invisible Shared Selective Multiculturalism: a belief that promotes recognition of diversity of citizens with respect to ancestry and supports acceptance and belonging. Multiculturalism is seen as a protective wellness factor within diverse populations Diversity: uniqueness of the client within the cultural context Two types: Visible diversity Invisible diversity Visible minority: People of colour, people who are neither aboriginal or caucasian Racially visible: Indicate visible minority status Includes aboriginal people Race: A social classification that relies on physical markers like skin colour to identify Ethnicity: Cultural membership Based on individuals sharing similar cultural patterns (ex, beliefs, values, customs, behaviours, traditions) Ethnocentrism: The assumption that ones own groups lifestyle, values, and patterns of adaption are superior to all others Cultural relativism: The principle that all cultural systems are inherently equal in value, and each culture item must be understood on its own terms Indigenous peoples: 2.1 million indigenous people in canada Fastest growing population First nations are the largest group Metis are the second-largest group Inuit are the smallest QUIZ!!!!! Being aware of culture is a necessary skill for nurses to have. How does knowing about a patient’s culture help the nurse? It helps the nurse provide the right environment for the patient. It helps the nurse to work in a non-judgmental and tolerant manner. It helps the nurse to provide the right religious/clerical support for the patient. It helps the nurse decide what type of nursing care the patient will need. My guess is here but gotta guess first (its in white writing) → im guessing C Types of diversity: Ethnic diversity Linguistic diversity Religious diversity Sexuality and gender diversity diability/diverse abilities Approaches to diversity: The mnemonic ASKED represents key questions that can encourage ongoing reflexive practice: Awareness Skills Knowledge Encounters Desire Cultural competence: An ongoing process, rather than an outcome Process whereby health care professionals respect, accept, and apply knowledge and skill appropriate to client interactions without allowing personal beliefs to influence the clients views Ex, paying attention to dietary practices, attitudes toward pain, beliefs about death and dying, modesty, eye contact, closeness, physical contact Key attributes to cultural competence: Cultural awareness Cultural knowledge Cultural understanding Cultural sensitivity Cultural interaction Cultural skill Cultural competence: Important because Reduces disparities in health services and increases detection of culture-specific diseases Addresses inequitable access to primary health care Impacts health status of culturally diverse commuinities Responds to changing demographics - increasingly diverse population Inhibitors to culturally responsive care: Ethnocentrism Cultural blindness Bias Culture shock Stereotyping Prejudice Racism Racism: Response to skin colour, ethnic orgin, religion, cultural celebrations, traditional food and outfits Two types: Overt racism Systemic (institutional) racism QUIZ!!!! To what does culturally competent care refer? Rules and caring for patients from different countries Guidelines about how to care for patients who are immigrants Culturally based care and health knowledge expressed in sensitive, creative, and meaningful ways Understanding religious and ethnic habits of patients My guess is here but gotta guess first (its in white writing) → im guessing C Cultural safety: Defined by the patient Involves gaining an understanding of others health beliefs and practies to demonstrate working toward equity and avoidance of discrimination Cultural awareness: an initial understanding that variations exist Cultural sensitivity: showing respect and valuing cultural diversity Cultural humility: commitment to actively taking responsibility for seeking to understand the culture and experience of others Being comfortable with not being the expert NRSG 1016 Health Promotion 2023 Study Guide Test #1 Please answer the following: What is the difference between health promotion and disease prevention? Health promotion is a strategy to improve health, while disease prevention prevent the occurrence of disease, to detect and stop disease development, and to reduce the negative effects once a disease is established How does the World Health Organization (WHO, 1986) define health? “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity” How does WHO define health promotion? “Health promotion, as outlined in the Ottawa Charter, is a strategy to enable people to increase control over the determinants of health and thereby improve their health. Enabling, within the framework of health promotion, refers to taking action with patients to empower them to gain control over their health and environment, with the goal of improving their health.” Why is health promotion important to Canadians and the world in general? 2. Complete the following chart Theoretical Model Describe Model Uses for Model Self-Efficacy Model (Bandura) Della Faulkner article Sources: Performance Vicarious experience Verbal persuasion Physiological state Characteristics: Magnitude Strength Generality Used to predict behaviour change Limitations: Research suggests self-efficacy is important in making lifestyle changes but may not maintain change over time Transtheoretical Model (stages of change) 5 stages of change: Pre-contemplation - Not considering change in next 6 months Contemplation - Thinking about change in next 6 months Preparation - Identifies start date within the next month Action - Implementing change builds self-efficacy – reinforce behaviour Maintenance - Continues new behaviour – no temptation, increased self efficacy * A sixth stage, termination, is associated with changing addictive behavior. Diffusion of Innovation Theory 5 Categories: Innovators (quick adopters) Early adopters (keeners) Early majority - 30-35% of general population Late majority - - 30-35% of general population Laggards (resistant to adopting the innovation) Six Conditions: Compatibility Flexibility Reversibility Simplicity Advantageousness Cost-efficiency Nurses who are developing and implementing new health promotion ideas and practices need to consider the types of responders to innovation and the six conditions influencing adoption. 3. What are the prerequisites for health, according to the Ottawa Charter? What are the determinants of health, according to Health Canada? What does the Ottawa Charter (1986) say about? i. Building healthy public policy Look at notes Ii. Creating supportive environments Look at notes Iii. Strengthening community action Look at notes Iv. Develop personal skills Look at notes V. Reorienting health services Look at notes 4. How does socioeconomic status influence health? 5. What are some of the health challenges of those with low income? 6. Explain the principles of primary health care. a) b) c) d) e) 7. What is “downstream thinking?” 8. What is “upstream thinking?”