Lecture Notes - Health Promotion F24.docx

**Lecture 1** **Health Education -- Then and Now** **Evolution of Knowledge and Communication Strategies** - **Past**: Limited understanding of health, reliance on traditional methods. - **Present**: Advanced medical knowledge, evidence-based practices. **Impact of Science and Technolog...

**Lecture 1** **Health Education -- Then and Now** **Evolution of Knowledge and Communication Strategies** - **Past**: Limited understanding of health, reliance on traditional methods. - **Present**: Advanced medical knowledge, evidence-based practices. **Impact of Science and Technology** - **Past**: Basic tools and techniques, slow dissemination of information. - **Present**: Cutting-edge technology, rapid information sharing through digital platforms. **Changes in Communication Preferences** - **Past**: Face-to-face interactions, printed materials. - **Present**: Online resources, social media, telehealth services. **Summary: What Has Changed?** - **Knowledge**: From traditional to evidence-based. - **Technology**: From basic tools to advanced digital platforms. - **Communication**: From face-to-face to digital and online methods. **What do you think is the biggest difference in how health information was communicated between now and the early 1900s?  ** - Social media - Literacy rate changed (more people are able to discern whatever is being said) - In the past there was less knowledge on health conditions (risk factors, mode of transmission, control measures) - Differences in how we reach people based on tech available **Example of poster that shows the presentation of cholera:** - Early 1900s - Cholera guidance has evolved - Posters less common now - We tend to see more visuals now **We\'re more likely to see information shared like this:**  \- This is the type of info we be seeing nowadays \- Anyone can use this for info **Sharing Health Information** **Types of Media** - **Books and Printed Resources**: Traditional, reliable, and in-depth. - **Media (TV, Newspaper, Online)**: Broad reach, timely updates. - **Social Media**: Interactive, real-time engagement. **Choosing an Effective Medium** - **Know Your Audience**: Tailor the medium to the audience's preferences and needs. **Pros and Cons of Media Use for Health Information** **Pros:** - **Wide Reach**: Can disseminate information to a large audience quickly. **Cons:** - **Non-Experts Sharing Information**: Not all sources are from health experts. - **Potential for Misinformation**: Difficult to verify the credibility of sources. **The Growth of Health Education in Canada:** **The Beginnings -- 17th/early 18th Century** - **Colonization and Fur Trade**: British and French colonization introduced several communicable diseases such as smallpox, measles, and tuberculosis (TB). - **Impact**: Led to the creation of sanitary reforms, boards of health, and public health legislation (e.g., quarantine measures). **Advances in Science and Public Health** - **Link Between Unsanitary Conditions and Disease**: Recognition of this link led to significant scientific advancements. - **First Vaccine**: Developed for smallpox in 1796. - **Mandatory Vaccinations**: Smallpox vaccinations became mandatory in Canada. **The Sanitary Movement -- Late 18th/Early 19th Century** **Evolution of Public Health Post-Confederation (1867)** - **Municipal Infrastructures**: Development of water and sewage systems to control the spread of diseases. - **Scientific Discoveries**: Advances in understanding the transmission and prevention of infectious diseases, leading to the bacterial revolution. **Changes in Public Perception** - **Health Awareness**: Shift in public thinking about health, emphasizing the importance of personal and public hygiene (sanitation). **Public Health Statistics** - **Tracking Disease**: Recognition of the need for public health statistics to monitor morbidity and mortality rates. - **Legislation and Infrastructure**: Introduction of the Census and Statistics Act, Public Health Acts, and establishment of public health laboratories. **Public Education** - **Fundamental Role**: Growing awareness that public education is essential in combating infectious diseases. - **Early Days of Public Health Statistics**: Increasing awareness and efforts to track and manage public health data. **Social Transformation and World War I** **Public Health Concerns** - **Houseflies, Public Drinking Cups, and STDs**: Major health concerns during this period. **Spanish Influenza (1918)** - **Impact**: Led to the creation of a Federal Department of Health. - **Programs Initiated**: Immunization, child and maternal health, and pasteurization programs. **Public Health in the 1920s** - **Increased Confidence**: Dedicated initiatives improved public confidence in health measures. - **Canada Public Health Association**: Established to promote public health. - **School of Hygiene**: Provided training for public health professionals. **Indigenous Health** - **Threat of TB**: Growing recognition of tuberculosis as a significant threat to Indigenous Peoples. - **Federal Inaction**: Lack of federal response due to the populations affected. **Legacy of the Spanish Influenza** - **Creation of Federal Department of Health**: The pandemic highlighted the need for a federal health department. - **Public Health Education**: Before this time, there was limited focus on public health education and study. **Knowledge is Power!** **Emphasis on Information and Education** - **Goal**: To bring about change in personal habits and behavior through education. **Methods Used** - **Posters**: Improved quality and affordability. - **Exhibits**: Engaging and informative displays. - **Monthly Bulletins**: Regular updates and information. - **Lectures**: Educational talks and presentations. A close-up of a book Description automatically generated - Ways info was being shared in early 1900's - Different styles for spreading the info as u can see  - Another form of public education (spreading info) **The debate about sex ed continues** A group of people holding signs Description automatically generated - These issues still being communicated - There is debate if this is the right avenue  - The way info is presented visually has changed - This is an example of how covid 19 was presented **Health Education** **New Public Health Movement** - **Identification**: Recognized as part of a "new" public health movement in the 1980s. - **Formalized Approaches**: Led to structured methods for health education. **Addressing Health Issues** - **Need for Change**: Identified the necessity for changes in how health issues were addressed. - **Onus on Individuals**: Placed responsibility on individuals, sometimes leading to "blaming the victim." **Promoting Healthier Lifestyles** - **Participation**: Key organization promoting healthier lifestyles across Canada. - **National Agenda**: Ensured physical activity became a priority. - **Inspiration**: Encouraged Canadians to move more and inspired societal changes to make it easier. **Ottawa Charter for Health Promotion** **Overview** - **Creation**: Established in 1986, organized by WHO and CPHA. - **Purpose**: Presents strategies for global progress in health promotion. - **Goal**: Achieve 'health for all by 2000'. **Definition of Health** - **Changed**: Health is now viewed as a product of daily life. **Core Values of Health Promotion** - **Enablement** - **Mediation** - **Advocacy** **Five Action Areas:** 1. **Building Healthy Public Policy**: Example - smoking legislation. 2. **Creating Supportive Environments**: Example - creating bike lanes, parks. 3. **Strengthening Community Action**: Example - support/working groups. 4. **Developing Personal Skills**: Example - health literacy skills. 5. **Re-orienting Health Services**: Example - focusing on prevention instead of treatment. **Definition: Health Education** **What is Health Education?** - **Process**: Assisting individuals, acting separately or collectively, to make informed decisions about matters affecting their personal health and that of others. **Goals of Health Education** - **Closing the Gap**: Bridging the gap between what is known about optimum health practices and what is actually practiced. - **Opportunities for Learning**: Consciously constructed opportunities involving communication designed to improve health literacy, including enhancing knowledge and developing life skills conducive to individual and community health. **Key Questions Health Education Attempts to Answer** 1. **Behavior**: Why do people behave as they do? 2. **Impact**: How does what they do affect their health? 3. **Change**: What causes them to change their health-related behavior? 4. **Targeting Messages**: How can messages be targeted to particular groups? 5. **Organizational Focus**: How can organizations change their focus and ways of working? **Factors affecting the delivery of Health Education messages**  - All diff factors that come when designing health education message **Health Education Theories** - Attempt to understand: - Why some parents refuse health interventions\ (e.g. vaccinations for their children) - Why some people think they are at risk of disease and others do not - How people prioritize health issues Health Education attempts to... A diagram of a graph Description automatically generated with medium confidence - **Note:** Someone gotta have the skills to apply this message. Doesn't mean u have to tackle all this steps as health educator too **Health Education vs. Health Promotion** **Definition of Health Promotion (Ottawa Charter for Health Promotion)** - **Enabling**: The process of enabling people to increase control over, and improve, their health. - **Commitment**: A commitment to dealing with the challenges of reducing inequities, extending the scope of prevention, helping people cope with their circumstances, and creating environments conducive to health, in which people are better able to take care of themselves. **Key Differences** - **Health Promotion**: Considers the broader social context and emphasizes the Social Determinants of Health (SDOH). - **Health Education**: A facet or strategy used within Health Promotion.  - In addition to changes in health education and promotion, the causes of illness have also significantly changed over time\...  **Increased Public Education** - **Healthy Behaviors and Practices**: Greater awareness and education on maintaining health. **Environmental and Sanitation Changes** - **Improvements**: Enhanced sanitation and immunization efforts. **Shift to Lifestyle-Related Diseases** - **Preventable Diseases**: Increase in diseases related to lifestyle choices (e.g., diet, physical activity). - **Complex Factors**: Influence of industry, food environment, and other societal factors. **Observed Trends here** - **Decrease in Infectious Diseases**: Due to increased awareness, better sanitation, and immunization. - **Increase in Chronic Diseases**: Resulting from lifestyle changes and modern living conditions. **Why This Shift?** - **Public Education**: Improved knowledge about infectious diseases led to better prevention and control. - **Lifestyle Changes**: Modern lifestyles, including poor diet and lack of physical activity, contributed to the rise in chronic diseases. - **Environmental Factors**: Industrialization and changes in the food environment played a role in the shift. **Major Epidemics of the Modern Era (**Not expected to memorize the timeline on this link) - Review year 2000 to 2022 at this link: - 2002 to 2003: Severe Acute Respiratory Syndrome (SARS) - 2005: WHO releases new rules to boost defenses against global health challenges - 2009 to 2010: New influenza pandemic (H1N1) - 2012: Middle East Respiratory Syndrome (MERS) - 2014: Rise in Polio cases - 2014 to 2016: Ebola - 2015: Dengue - 2015 to 2016: Zika virus - 2018 to 2020: Ebola returns - 2019 to present: COVID-19 - 2022 to present: Monkeypox **Global Burden of Disease ** A graph of disease burden by cause Description automatically generated - Most common diseases in the wolrd **Life Expectancy by Province (CANADA)**  **Life Expectancy continued** A screenshot of a screen shot of a table Description automatically generated - 10-year difference of life expectancy between Quebec and Nunavut -- not expected to know the table, just know the paterrn and differences  - Third world countries bad (e.g. Africa...) - Due to colonization past, a lot of intersections - Canada on global scale doing very well (NO SHIT) **What Does This Data and History Tell Us?** **Changes Over Time** - **Causes of Illness and Life Expectancy**: These have drastically changed over time. **Public Information** - **Continuous Updates**: The public has continuously been given information about the latest health concerns. **Public Interest** - **General Lack of Interest**: Despite the information provided, there has always been a general lack of interest. **Leading causes of death in 2020** A list of medical information Description automatically generated **The World Health Organization (WHO) defines health as:** \"a state of complete physical, mental and social well-being rather than a mere absence of disease or infirmity."  **Public Conceptions of Health** **World Health Organization (WHO) Definition of Health** "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." **Medical Definition of Health** "The normal physical state, ie., the state of being whole and free from physical and mental disease or pain, so that the parts of the body carry on their proper function." **Academic Definition of Health** Health "involves the interplay of biology, psychological and social aspects of the person's life" **Indigenous Definitions of Health** "Living in total harmony with nature and having the ability to survive under exceedingly difficult circumstances." **Health Education Settings** **School** - **Population Reach**: The majority of the population attends school at some point in their lives. - **Informal Learning**: Children learn new skills informally, including how to deal with stress, change, and peer pressure. - **Formal Curriculum**: Health education topics are formally covered at each grade level. **Workplaces** - **Adult Interaction**: Adults spend approximately 60% of their waking hours at work, creating an opportunity to interact with the "healthy" adult population. **Communities** - **Community Connection**: People feel a connection to their community. - **Health Promotion**: Neighborhoods can create and promote health. **Healthcare Sites** - **Credible Sources**: Health practitioners are seen as credible sources of health information by the public. - **Personal Communication**: Offer one-on-one communication about health. **Home** - **Convenient Access**: Home visits, Internet, telephone, and mail provide convenient ways to reach larger groups. **Consumer Marketplace** - **Health Information**: Consumer health information is disseminated via social marketing. **Communication Environment** - **Digital Platforms**: Internet, social media, SMS, apps, and virtual worlds are used for health communication. **Measuring Health** - Why? - To establish priorities - To assist in planning - To justify resources - To promote the health promotion field **How can we measure health?** - The definition of health you use will determine how it is measured **Discussion** - If you wanted to develop a program to improve the health of workers at your workplace, would **number of workplace accidents** be a **good** or **bad** health **indicator**? Why or why not? - **Good Indicator**: - **Safety Focus**: Indicates the level of safety and risk management in the workplace. - **Preventive Measures**: Highlights areas where preventive measures can be implemented to reduce accidents. - **Bad Indicator**: - **Limited Scope**: Only reflects physical safety, not overall health and well-being. - **Reactive**: Focuses on incidents that have already occurred rather than proactive health measures. - Can you think of other indicators? - Are they positive or negative health indicators? - **Absenteeism Rates**: - **Positive Indicator**: Low absenteeism suggests good overall health and job satisfaction. - **Negative Indicator**: High absenteeism may indicate poor health or workplace conditions. - **Employee Wellness Program Participation**: - **Positive Indicator**: High participation rates suggest employees are engaged in maintaining their health. - **Negative Indicator**: Low participation may indicate a lack of interest or awareness. **Measuring Health** **Negative Measurements -- Measuring the Opposite of Health** **Examples:** - **Mortality**: The number of deaths in a population. - **Morbidity**: The incidence of disease or illness in a population. **Are These Good Indicators of Health?** - **Yes**: - **Mortality**: Provides information on the leading causes of death and life expectancy. - **Morbidity**: Helps identify the prevalence and impact of diseases and health conditions. - **No**: - **Limited Scope**: Focuses on negative outcomes rather than overall well-being. - **Reactive**: Measures health issues that have already occurred rather than preventive health. **Where Do We Find Them?** - **Mortality Data**: - **Sources**: Vital statistics, death certificates, national health databases. - **Morbidity Data**: - **Sources**: Hospital records, health surveys, disease registries, public health reports. **Positive Measurements -- Measuring Health in Its Own Right** **Measures Can Include:** - **Physical Well-Being**: Assessments of physical health and fitness. - **Psychological Well-Being**: Measures of mental health and emotional stability. - **Social Well-Being**: Evaluations of social relationships and community involvement. - **Quality of Life**: Overall satisfaction with life and personal fulfillment. - **Other Measures**: Any other indicators that reflect a person's overall health and well-being. **Health Indicator Examples** - Morbidity - Mortality - Neighbourhood initiatives - WSIB claims - Suicide rates - Healthy workplace initiatives - Vaccine rates - Wealth - Housing density - Dental health - Availability of services - Hospital wait times - Absence from work - Smoking rates **Lecture 2 -- Social Determinants of Health (SDH)** **How Healthy Are Canadians?** **Overall Health Status** - **Quite healthy, relatively speaking** - **OECD Ranking**: Canada ranks among the top and middle third performers for most health indicators. **Key Health Indicators** 1. **Life Expectancy** - **Increased**: Canadians are living longer. - **Decreased Morbidity and Mortality Rates**: Improved health outcomes. 2. **OECD Ranking** - **Current Position**: Canada is rated 6th out of 30 countries. **Areas of Concern** 1. **Aging Population** - **Cardiovascular and Chronic Respiratory Disease** - **Cancer** - **Diabetes** - **Prevalence**: More than 1 in 5 Canadian adults live with one of these chronic diseases. **The 'Healthy Immigrant Effect'** - **Initial Health**: Most recent immigrants are in good health (better than Canadian-born). - **Decline Over Time**: Health declines as their years in Canada increase. **Reasons for Health Decline in Immigrants** 1. **Social Isolation** 2. **Lifestyle Changes** 3. **Immigration Difficulties** **Healthy Immigrant Effect** **Immigration Selection** - **Healthier Adults**: The process of selecting immigrants tends to favor healthier adults. **Cultural Factors** - **Beneficial Habits**: Diet, lifestyle, and behaviors from the country of origin are often associated with better health. **Resilience** - **Motivation and Determination**: Newcomers often have the drive to seek out resources for good health. - **Selection Bias**: Immigration tends to select individuals who are already healthy. **Habits from Country of Origin** - **Potentially Better Habits**: Habits brought from the country of origin may be better for health (though this is not universally true and depends on the country). **How Healthy Are Canadians?** A graph with a line going up Description automatically generated **Infant Mortality Rate** - **Current Rate**: 3.9 infant deaths per 1,000 live births. This rate can be an important indicator of overall health. **Decline in Infant Mortality Rate** - **Visible Decline**: The decline in the infant mortality rate is a positive sign. - **Contributing Factors**: - **Better Education** - **Economic Development** - **Improved Healthcare** **Life Expectancy by Province **  - Another indicator to make assessment how well ppl living **Life Expectancies among G7 Countries** A graph of the country\'s growth Description automatically generated with medium confidence - G7 countries - Canada doing good **Chronic Disease Prevalence in Canada**  - Another indicator that shows how healthy pop is in Canada - Obesity may lead to the other health conditions **What Shapes Health?** - **Determinants of Health Status** - **Multiple Inter-related Factors**: Health status is influenced by various interconnected factors. - **Independent and Interacting Effects**: Some factors may independently affect health, while others interact with different variables. - **Example: Coronary Heart Disease (CHD)** 1. **Physiological Factors** - **Age** - **Sex** - **Family History** 2. **Lifestyle Factors** - **Smoking** - **Physical Activity** 3. **Environmental Factors** - **Access to Healthy Food** - **Neighborhood Built Environment** 4. **Social Factors** - **Social Support for Coping with Stress** **Social Determinants of Health** **Definition** - **Social Determinants of Health**: The non-medical factors that influence health outcomes. **Key Aspects** - **Conditions of Life**: They are conditions in which people are born, grow, work, live, and age. - **Forces and Systems**: Are the wider set of forces and systems shaping daily life conditions. **Influencing Factors** 1. **Economic Policies and Systems** 2. **Development Agendas** 3. **Social Norms** 4. **Social Policies** 5. **Political Systems** **Health Equity** **Definition** - **Equity**: The absence of unfair, avoidable, or remediable differences among groups of people, whether defined socially, economically, demographically, geographically, or by other dimensions of inequality (e.g., sex, gender, ethnicity, disability, or sexual orientation). **Fundamental Right** - **Health as a Human Right**: Health is a fundamental human right. **Achieving Health Equity** - **Full Potential**: Health equity is achieved when everyone can attain their full potential for health and well-being. - **Equal Opportunities**: Not all groups have the same opportunities to achieve good health. - **Reducing Barriers**: Health equity is achieved when barriers that may impede an individual from reaching their full health potential are reduced or eliminated. **Population Patterns** - **Morbidity and Mortality**: Population patterns exist for morbidity and/or mortality. **Interacting Variables** - **Multiple Factors**: Health is influenced by many variables interacting together, not just one. **SDOH FRAMEWORKS** A diagram of social and community health issues Description automatically generated with medium confidence **Key Determinant 1: Income and Social Status** **Importance** - **Most Important Determinant**: Some argue that income and social status are the most important determinants of health. **Premise** - **Living Conditions**: Income determines living conditions such as safe housing and the ability to buy sufficient good food. - **Healthiest Populations**: The healthiest populations are found in societies that are prosperous and have an equitable distribution of wealth. **Canada has relatively high poverty levels**  - Not commonly talked about here in CAD - Poverty rate in Canada surprisingly high - Overall it has declined but still high **Canada\'s Poverty Levels: By Province ** A graph of poverty rate Description automatically generated 8.1% = Canadian average - Vancover is highest poverty approx. 12% - Toronto 11.5% approx  \- Purple female, blue male. \- Q1 lowest income, q5 highest - As income increases life expectancy increases - Richer neighboryhood, men have higher expency just like women **Income and Social Status: Supporting Facts** **Health Disparities** - **Mortality and Illness**: Low-income Canadians are more likely to die earlier and suffer more illnesses than Canadians with higher incomes, regardless of age, sex, race, and residence. **Life Expectancy** - **Wealthiest vs. Poorest Neighborhoods**: - **Men**: Men in the wealthiest neighborhoods in Canada live on average more than 5 years longer than men in the poorest neighborhoods. - **Women**: Women in the wealthiest neighborhoods live on average 3 years longer than women in the poorest neighborhoods. **Income Distribution** - **Importance of Distribution**: The distribution of income in a given society may be a more important determinant of health than the total amount of income earned by society members. **How would we factor in \'income and social status\' to health education/promotion?** - Identifying vulnerable pop - Understanding unique access issues for vulnerable populations - Advocating to government agencies - Health literacy **Key Determinant 2: Social Support Network** **Importance of Social Support** - **Problem Solving**: Helps people solve problems. - **Dealing with Adversity**: Assists in dealing with adversity. - **Sense of Control**: Maintains a sense of control over life circumstances. **Benefits of Social Relationships** - **Caring and Respect**: The caring and respect in social relationships lead to satisfaction and well-being. - **Buffer Against Health Problems**: Acts as a buffer against health problems. A poster with people and text Description automatically generated **Supporting Facts** 1. **Social Contacts** - **Premature Death Rates**: For both men and women, the more social contacts people have, the lower their premature death rates. 2. **Emotional Support and Social Participation** - **All-Cause Mortality**: Low availability of emotional support and low social participation are associated with all-cause mortality. 3. **Coping with Stress** - **Boosts Immune and Nervous Systems**: Coping with stress and having control boost the immune and nervous systems' responses, keeping us healthy. **How would we factor in \'social support networks\' to health education and promotion? ** - Identifying health education settings that align with existing social support networks - Helps to understand how people access information, and who they are talking to - Creating groups that support the dissemination of health information- - Using interactive tools that create networks **Key Determinant 3: Education and Literacy** **Importance** - **Socioeconomic Status**: Closely tied to socioeconomic status. - **Knowledge and Skills**: Equips people with knowledge and skills for problem-solving. - **Sense of Control**: Helps provide a sense of control and mastery over life circumstances. **Supporting Facts** 1. **Access to Healthy Environments** - People with higher levels of education have better access to healthy physical environments. 2. **Child Preparation** - Better able to prepare their children for school. 3. **Healthier Behaviors** - Tend to smoke less. - Tend to be more physically active. - Tend to have access to healthier foods. **Highest Level of Completed Education in Canada: 2006 vs 2016**  Shows general level of educationa across Canada, \- Visible that a lot either do not have diploma, degree 4. **Self-Reported Health** - Lower among those with education less than high school compared to university graduates. 5. **Lost Workdays** - Higher number of lost workdays among those with lower levels of education. 6. **Life Expectancy** - **Men in** neighborhoods with the highest educational levels have a life expectancy 3.7 years higher than those in neighborhoods with the lowest educational levels. - **For women**, the difference is 2.3 years. 7. **Prevalence of Smoking** - Nearly 4 times higher among adults with less education than high school compared to university graduates. 8. **Heavy Drinking** - Prevalence is lowest among university graduates and similar across other education groups. 9. **Economic Status and Education** - People with higher economic status are more likely to have post-secondary education and opportunities. 10. **Benefits of Being Well-Educated** - Greater understanding of the implications of unhealthy behavior. - Increased ability to navigate the healthcare system, contributing to better health outcomes. **How would we factor in \'education and literacy\' to health education and promotion? ** - Messaging (use of infographic, less text) - Mode of delivery - Promote health literacy - Consider educational backgrounds in program design etc **Key Determinant 4: Employment and Work Conditions** **Premise** - **Control Over Work Circumstances**: People who have more control over their work circumstances and fewer stressful demands are healthier and often live longer. - **Influence on Health**: Work influences many aspects of life that affect health, including: - **Income/Social Status** - **Workplace Hazards** - **Healthcare Access** - **Housing** - **Economic Security** **Occupation Type and Life Expectancy ** A graph of the sector Description automatically generated with medium confidence - Life expectancy based on sector - Safer jobs higher expectancy **Metropolitan Employment Rates **  **Supporting Facts** 1. **Precarious Work** - **Definition**: Uncertain or unstable types of work, typically with no regular schedule and no work benefits. - **Health Impact**: Linked to a decrease in mental and physical health. 2. **Injuries** - **Risk**: Physically demanding jobs pose mental and physical health risks. 3. **Unemployment** - **Life Expectancy**: Associated with a reduced life expectancy and health problems compared to employed status. 4. **Unpaid Work** - **Time Spent**: Many Canadians (especially women) spend almost as many hours engaged in unpaid work, such as housework and caring for children or older relatives. **How would we factor in \'employment and work conditions\' to health education and promotion? ** - Work places as potential health education settings: - To implement healthy practices and policies - TO disseminate info - Identifying specific risk factors to target messaging **Key Determinant 5: Social Environments** **Premise** - **Supportive Society**: Social stability, recognition of diversity, safety, good working relationships, and cohesive communities provide a supportive society that reduces many potential health risks. - **Coping Strategies**: Social or community responses can improve coping strategies and foster health. **Components of Social Environment** - **Interactions**: Family, friends, coworkers, and others in the community. - **Social Institutions/Settings**: Workplace, schools, community centers. **Sense of Belonging** - **Statistics**: In 2021 and 2022, almost half of people (47%) in Canada reported having a strong sense of belonging to their community. - **Variations**: - **Lower**: Among young people aged 15 to 34, and among LGBTQ2S+. - **Lower**: Among people experiencing social and economic challenges. - **Higher**: Among rural compared to urban residents. - **Higher**: Among some racialized groups (i.e., South Asian, Filipino, Arab, Black). **Supporting Facts** 1. **Psychosocial Factors** - **Impact on Physical Health**: Psychosocial factors affect physical health. - **Stress**: Social environments can either create or mitigate stress. - **Stress Responses**: Turning on stress responses diverts energy from bodily processes important for long-term health. Prolonged stress can make individuals more vulnerable to various health conditions. 2. **Stress from Social Situations** - **Family Violence**: Stress from social situations, including family violence, has a devastating effect on health in both the short and long term. - **Discrimination, Stigmatization, and Marginalization**: Experienced in social contexts, leading to negative impacts on mental health. - **Access to Resources**: Can impact access to resources and information for taking care of physical health (i.e., culturally-appropriate services). **Key Determinant 6: Physical Environments** **Premise** - **Contaminants and Health Effects**: At certain levels of exposure, contaminants in our air, water, food, and soil can cause a variety of adverse health effects, such as: - Cancer - Birth defects - Respiratory illness - Gastrointestinal ailments **Supporting Facts** 1. **Air Pollution** - **Health Association**: Air pollution, including exposure to second-hand tobacco smoke, has a significant association with health. - **Respiratory Illness**: Link between hospital admissions for respiratory illness in the summer months and air quality. 2. **Water Quality** - **Importance**: Access to good water quality is imperative to health. - **Arsenic Contamination**: 150 million people have been exposed to arsenic-contaminated water globally, posing serious health risks such as carcinogenic effects, cardiac failure, and hypertension. 3. **Processed Food** - **Health Risks**: The recent increase in processed food production and consumption has been associated with obesity and other non-communicable diseases. 4. **Soil Quality** - **Direct Effects**: Soil quality can affect human health directly through skin contact, ingestion, and inhalation. - **Indirect Effects**: Indirectly through the consumption of plants and microbial activity of the soil affecting ecosystems. **Urban Planning and Health: What Makes a Healthy City?** **Key Features of a Healthy City** 1. Pedestrian Walkways 2. Bike Lanes 3. Separation of Neighborhoods from Industrial Operations 4. Greenspaces 5. Public Transit **Environmental Inequalities** **Distribution of Pollution** - **Pollution**: Air, land, and water pollution tend to be highest in the least desirable residential areas. **Vulnerable Populations** - Children - Outdoor Workers - Low-Income and Racialized Communities **Impacts on Health Outcomes** - **Examples**: - Childhood asthma - Safety concerns - Cancer rates **Supporting Facts** 1. **Core Housing Need** - **Income Disparity**: The prevalence of core housing need among Canadians in the lowest income group is nearly 7.5 times as high as among Canadians in the highest income group. - **Immigrant Disparity**: Recent immigrants report a prevalence of core housing need twice that of non-immigrants. A map of the united states with percentages and numbers Description automatically generated **How would we factor in \'social and physical environments\' to health education and promotion? ** - Recognizing the importance of community organizations, volunteering etc - Improving built environment to enable better health for communities at large. (i.e. advocating for green spaces) **Key Determinant 7: Personal Health Practices and Coping Skills** **Premise** - **Influences**: Influenced by social, economic, and environmental factors. - **Impact on Lifestyle Choices**: Affects lifestyle choices through at least five areas: 1. Personal Life Skills 2. Stress 3. Culture 4. Social Relationships and Belonging 5. Sense of Control  **- Most Canadians, even tho aware, don't engage in physical activiyt** A graph of a number of people with red and blue bars Description automatically generated - **Only tobacco smoking** - **Higher among males at all age groups**  - **Higher among males at all age groups** - **Declining trend w age** **Supporting Facts** 1. **Risk-Taking Behaviors** - **Young People**: Multiple risk-taking behaviors (i.e., alcohol/drug use, driving, etc.) are higher among young people, especially young men. 2. **Diet** - **Health Impact**: Poor diet is linked to some of the major causes of death, including cancer and coronary heart disease. 3. **Coping Skills** - **Effectiveness**: Effective coping skills enable people to be self-reliant, solve problems, and make informed choices that enhance health. 4. **Socioeconomic Gradient** - **Healthy Behaviors**: A strong socioeconomic gradient is evident for healthy behaviors (e.g., smoking, diet, physical activity, alcohol consumption). **Key Determinant 8: Healthy Child Development** **Premise** - **Early Experiences**: Evidence on the effects of early experiences on brain development and school readiness. - **Consensus**: Early child development is a powerful determinant of health. **Paternal Income Correlates with Newborn Birth Weight ** A graph with numbers and lines Description automatically generated - Lowest birthweight among low income **Supporting Facts** 1. **Brain Development** - **Critical Period**: Experiences from conception to age 6 have the most important influence on brain development. - **Positive Stimulation and Attachment**: Early positive stimulation and attachment improve learning, behavior, and health into adulthood. 2. **Pregnancy and Birth Outcomes** - **Tobacco and Alcohol Use**: Use during pregnancy can lead to poor birth outcomes. 3. **Neglect and Abuse** - **Risks**: Infants and children who are neglected or abused are at higher risk for injuries and a number of behavioral, social, and cognitive problems later in life. 4. **Income and Birth Weight** - **Income Level**: There is a strong relationship between the income level of the mother and the baby's birth weight. - **Income Gradient**: Mothers at each step up the income scale have babies with higher birth weights, on average, than those on the step below. 5. **Developmental Vulnerability** - **Deprived Neighborhoods**: The proportion of children with developmental vulnerability is twice as high for those living in materially and socially deprived neighborhoods. **Key Determinant 9: Biology and Genetics** **Premise** - **Two-Fold Influence**: 1. **Predisposition to Diseases**: Genetic endowment appears to predispose certain individuals to particular diseases or health problems. 2. **Individual Responses**: Genetic endowment provides an inherited predisposition to a wide range of individual responses that affect health status. **Supporting Facts** 1. **Role in Development** - **Personality Development**: Genetic endowment may play a role in personality development. - **Intelligence Levels**: Genetic factors can influence intelligence levels. - **Mental Health**: Genetics can impact a person's mental health. 2. **Aging and Health** - **Aging**: Aging is not synonymous with poor health. - **Compensation**: Education and lifelong learning can help compensate for cognitive losses that occur with age. - **Physical Activity**: Importance of physical activity in maintaining health. **Key Determinant 10: Health Services** **Premise** - **Purpose**: Health services are designed to maintain and promote health, prevent disease, and restore health for populations. - **Scope**: Includes treatment, management, and prevention. **Supporting Facts** 1. **Health Promotion** - **Benefits**: Health promotion, surveillance, and immunization activities have proven to be beneficial. 2. **Hospital Stays** - **Decreased Stay**: The average hospital stay has decreased, leading to increased financial, physical, and emotional burdens on families, especially women. 3. **Access to Services** - **Limited Access**: Many low and moderate-income Canadians have limited or no access to eye care, dentistry, mental health counseling, and prescription drugs. - **Jurisdictional Variations**: Access to care varies by jurisdiction. - **Indigenous Peoples**: Indigenous Peoples living in remote and isolated communities may lack access to basic health services. **Key Determinant 11: Gender and Sex** **Premise** - **Gender Identity**: Refers to our gender identity, socially-constructed roles, personality traits, attitudes, behaviors, values, relative power, and influence of both sexes. - **Sex**: Refers to a set of biological attributes in humans and animals, such as chromosomes, gene expression, hormone levels, and reproductive organs. **Life expectancy at birth in Canada from 2011 to 2021, by sex**  **Gender Differences in Health Outcomes** - **Life Expectancy**: Women live longer than men. - **Health Issues**: Women are more likely to suffer from depression, stress overload (often due to efforts to balance work and family life), chronic conditions such as arthritis and allergies, and injuries and death resulting from domestic violence. **Supporting Facts** 1. **Lifestyle and Healthy Behaviors** - **Differences**: Differences in lifestyle and healthy behaviors, such as smoking, drinking, and types of sedentary activities. 2. **Health-Seeking Behavior** - **Differences**: Differences in health-seeking behavior, such as the likelihood to visit a doctor, engage in medical intervention, and seek support from peers (i.e., coping strategies). 3. **Health Research** - **Focus on Male Subjects**: Most health research (until recently) has focused on male subjects. - **Extrapolation Concerns**: Health findings cannot always be extrapolated across genders (i.e., cardiac health). **Key Determinant 12: Culture** **Premise** - **Health Risks**: Some people may face additional health risks due to dominant cultural values that contribute to: - Perpetuating marginalization or stigmatization - Loss or devaluation of language and culture - Lack of access to culturally appropriate health care and services - **Intersection with Other SDOH**: Culture typically intersects with other social determinants of health (SDOH). - **Protective Factor**: Culture can also be a protective factor, linked to social support and positive health practices. **Supporting Facts** 1. **Impacts of Colonization** - **Historical Trauma**: Legacy of discrimination and historical trauma have had consequences for intergenerational transmission of health risks. - **Infant Mortality Rates**: Much higher among Indigenous populations compared to other Canadian populations. - **Chronic Diseases**: Higher prevalence of major chronic diseases, including diabetes, heart problems, cancer, hypertension, and arthritis/rheumatism. 2. **Challenges for Indigenous Peoples** - **Northern and Remote Regions**: Indigenous Peoples living in northern and remote regions face additional challenges, such as lack of clean water or affordable food. 3. **Health Inequalities** - **Internalized Stress**: Can lead to internalized stress. - **Access to Information and Care**: Differential access to information and care can result from not having culturally appropriate resources (e.g., language, beliefs, value systems, acknowledging varying attitudes to health). 4. **Culture as a Protective Factor** - **Healthy Practices**: Many cultures have healthy practices (e.g., diet, social cohesion) that have immense benefits for health. - **Mitigation of Other SDOH**: Can mitigate some of the other social determinants of health, such as low income. **Some First Nations reserves don\'t have clean drinking water** **Source: **  **Main points from video:** - **Spiritual and cultural importance of water**: Water is essential for First Nations communities, reflecting their spiritual and cultural identity. - **Lack of clean drinking water**: Many First Nations reserves in Canada still lack access to safe drinking water. - **Government promises and progress**: Prime Minister Justin Trudeau promised to eliminate long-term boil water advisories by 2021, but 56 advisories remain. - **Challenges and causes**: Issues vary by location, including water sources, infrastructure, and remoteness. - **Risk scores**: Government assessments show many water systems on reserves are still at high risk. - **Infrastructure issues**: Building or repairing infrastructure doesn't always solve the problem due to lack of funding for operation and maintenance. - **Historical context**: The Indian Act and colonial policies have contributed to the current situation. **How would we factor in \'gender\' and \'culture\' to health education and promotion? ** - Language - Diverse representation in messaging and images - Targeted interventions and info for vulnerable groups **Discussion Question:** - **For which determinant of health do you think health education has the largest role? ** - Prolly Health education likely has the largest impact on **health literacy**, a key part of the **education** determinant of health. By improving people's ability to access and understand health information, it helps them make informed decisions, manage chronic conditions, and adopt healthier behaviors. This, in turn, can influence other determinants like income, social support, and access to healthcare. Health education empowers individuals and communities to take control of their health, especially in marginalized populations. **Talking about SDOH** - How do we translate the topic to the public? - How do we make it easy to understand and meaningful? A puzzle with different colored pieces Description automatically generated **Messaging guides** 1. Scientific phrasing is not well understood 2. Connect it with messages they already believe  3. Use one strong and compelling fact 4. Identify the problem, but offer solutions 5. Incorporate the role of personal responsibility 6. Mix traditional conservative values with progressive ones 7. Focus broadly on how SDOH affects everyone **Lecture 3**  - Health promotion covers wide range of topics **Health Promotion** **Definition** - **Health promotion** is the process of enabling people to increase control over, and to improve their health. *(Ottawa Charter for Health, 1986)* **Goals for Well-being** To reach a state of complete physical, mental, and social well-being, an individual or group must be able to: - Identify and realize aspirations - Satisfy needs - Change or cope with the environment **Responsibility** - Health sector - Individuals - Groups **What does this definition tell us about how we think about 'health'?** - **Resource for everyday life**: Not the objective of living. - **Positive concept**: Emphasizes social and personal resources, as well as physical capacities. **Health Promotion Aims** - Promote changes in lifestyle and environmental conditions to facilitate the development of a culture of health. *(Pan-American Health Organization, 2002)* - Focus on planned change of lifestyles and life conditions impacting health using various strategies: - Health education - Social marketing - Mass communication - Political action - Community organization - Organizational development *(Rootman & O'Neill, 2017)* **How is health promotion political?** - **Involves values and beliefs** about: - Extent of personal responsibility - Role of government - Role of the economy and economic regulation - Legitimate ways to encourage choices/decisions - Nature of society and our connection to each other - Extent to which inequalities should be reduced **Health promotion is political** - **Policies**: Development and rationale (e.g., government social assistance programs). - **Methods**: Providing advice/information, redistributing resources, community-led solutions. - **Content**: Issues addressed, definitions, and inclusions. **Health promotion is evidence-based** - **Decisions**: Based on the best available scientific evidence with high-quality data collection and research methods. - **Community Engagement**: Involves engaging with the community in decision-making. **Key Benefits** - Access to high-quality information on best practices. - Higher likelihood of successful health promotion programs and policies. - Greater workforce productivity. - More efficient use of public and private resources. **Health Promotion vs. Disease Prevention** - **Health Promotion**: Focuses on both removing negatives (e.g., disease) and gaining positives (e.g., increased access, better control over health decisions). - The strategies for disease prevention and health promotion are common, however there are several features and values that distinguish it from traditional disease prevention efforts 1. Focus on assets/strengths 2. Commitment to participatory approaches (i.e., capacity building) 3. Greater focus on social, economic, and environmental causes of health and illness - In contrast, disease prevention focuses mainly on modifying health behaviours of individuals and medical interventions A table of health and prevention Description automatically generated **Proximate, Intermediate and Distal Risk Factors**  **Importance of Understanding Determinants of Health** - Essential for health promotion and disease prevention. - Health promotion refocuses upstream (distal factors). **Approaches to Disease Prevention** **High-Risk Approach** - **Target**: Proximal risk factors (high-risk group but small segment of the population). - **Example**: Targeting individuals with hypertension due to its association with stroke. **Population-Wide Approach** - **Target**: Intermediate or distal factors (more prevalent in the population). - **Example**: Reducing salt intake to minimize the risk of hypertension. A diagram of a health care system Description automatically generated - Example on cardiac disease - Left side factors that increase risk - Right side factors that decrease risk - Many of these factors overlap - Left side, proximal cause for cancer could be not filling up prescription due to cost, taking prescription meds. Distal cause could racis, colonization. Intermediate would be difficulty accessing routine health care  **Risk Factors in Health Fields** **Proximal Risk Factors** - Directly affect health. - Also referred to as 'downstream' factors or interventions when targeted. **Distal Risk Factors** - Do not have an immediate effect on health. - Referred to as **'upstream' factors** or interventions when targeted (e.g., income). **Key Milestones in the Evolution of Health Promotion** **1920s** - Earliest published reference to public health: "the science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort" *(CEA Winslow, Yale Professor)*. **1946** - Concept of health promotion further refined. - Holistic concept re-emerged 30 years later in the Ottawa Charter. - Calls for coordinated efforts across sectors: "health is promoted by providing a decent standard of living, good labour conditions, education, physical culture, and means of rest and recreation" *(Sigerist, British Medical Historian, 1946)*. **1947** - WHO Definition of Health: "a state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity." **Evolution of Health Promotion - Health Education Era (1946 - 1974)** - Shift in public health practice. - Decrease in communicable diseases due to mandatory health measures (e.g., immunization, water purification). - Development of the 'social safety net' due to efforts by labour unions and political movements. - Emphasis on risk factors of chronic disease and promotion of healthy lifestyles. **1969** - Medical Care Act (later replaced by Canada Health Act): Universal access to health care for all Canadians. - Increased costs led to an emphasis on health promotion and disease prevention. **1971** - ParticipACTION launched: Canada's first Canada-wide media campaign promoting healthy lifestyles. **1972** - ParticipACTION: First Canada-wide media campaign promoting healthy lifestyles. - Highlighted the importance of moving more for health. **Influence of ParticipACTION** **Why was ParticipACTION so influential?** - Facilitated a public health natural experiment with evidence collected using population-level surveys. - Increased **knowledge, awareness, and understanding of physical activity benefits** (individual level). - Improved levels of physical activity among Canadians (individual level). - Enhanced capacity, readiness, and advocacy for physical activity promotion among physical activity organizations (interviews with organizations). **ParticipACTION's Role in Promoting Physical Activity (PA)** - Non-profit organization running community campaigns for over 30 years. - Inspired and supported people to incorporate physical activity into their lives. **Evolution of Health Promotion - Health Education Era** **1974** - A New Perspective on the Health of Canadians (the Lalonde Report): Milestone document. - Introduced the health field model. - Emphasis on lifestyle and personal responsibility. http://www.med.uottawa.ca/sim/data/Models/Lalonde.jpg **The Lalonde Report** **Key Points** - **First to recognize**: Medical care and health services are not enough. - **First to suggest**: Health promotion as a key strategy. - **Health Field Model**: Proposed that health is determined by the interplay of human biology, health care organization, environment, and lifestyle. **Evolution of Health Promotion - Health Education Era** **1977: World Health Assembly at Alma Ata** - All member countries committed to Health for All by 2000. - Emphasized the need for international action. **1978: Creation of a Health Promotion Directorate** - Canadian government response to the Lalonde Report. - First bureaucratic structure dedicated to Health Promotion in the world. **1979: MHSc Health Promotion** - First Canadian post-secondary degree in Health Promotion, University of Toronto. **1979 - 1984: Research Advances** - **The Black Report**: Highlighted health inequalities among low-income groups. - **Alameda County Study (California)**: Noted the importance of social support and social networks as determinants of health. - Health Promotion programs criticized for 'blaming the victim'. **1984: Healthy Cities Movement (Toronto)** - Workshop proposing a model of healthy communities. - Participatory approach to Health Promotion by engaging the community. - Widely adopted; now includes over 7500 cities/towns globally. **Healthy Cities Research Initiative (HCRI)** - Aims to identify solutions to support physical activity, healthy eating, social connectivity, economic opportunity, injury prevention, access to health services, clean air, nutritious food, and green space. - 81% of Canada's population live in cities, highlighting the research need for urban health promotion. **1986: Ottawa Charter for Health Promotion** - Produced at the first international conference on Health Promotion. - Predominant framework for Health Promotion practice. - Guide to health promotion around the world. **Achieving Health for All: A Framework for Health Promotion** - Instrumental in developing Health Promotion knowledge worldwide. - Canada is an international leader in health promotion: 1974 Lalonde Report, 1978 Health Promotion Directorate, 1986 Ottawa Charter. **Challenges in Health Promotion (1991 - 1996)** - Severe economic recession. - Erosion of the social safety net. - Demands on Health Promotion to prove the effectiveness of its programs. **1997: The Jakarta Declaration on Leading Health Promotion into the 21st Century** - Reaffirmed commitment to social justice, equity, and sustainability. - Identified poverty as the greatest threat to health. - Born from the fourth international conference on Health Promotion. **Five Priority Areas of the Jakarta Declaration** 1. Promote social responsibility for health (public and private). 2. Increase investments for health development. 3. Consolidate and expand partnerships to improve health. 4. Increase community capacity and empower individuals. 5. Secure infrastructure for health promotion. **Population Health Era (1994-2007)** **1994: Development of Population Health** - **Purpose**: Address health inequities. - **Approach**: Improve the health of the entire population and reduce health inequities among population groups (PHAC, 2012). - **Strategies**: Policy emphasis; community development, mutual aid not included. - **Change**: Health Promotion Directorate becomes Population Health Directorate in 1995. - **Debate**: Compatibility of Health Promotion and Population Health concepts. **Critiques of Health Promotion** - Did not lead to short-term cost savings. - Evaluations may lack measurable outcomes. **Critiques of Population Health** - Too focused on outcomes with statistical methods and measurable indicators. - Does not account for context. **Health Promotion in an Era of Complexity (2007-2017)** **2008: Closing the Gap in a Generation** - **Report**: Health Equity through Action on the Social Determinants of Health (International). - **WHO Call**: Address inequalities rooted in the social determinants of health. - **Inclusion**: Health promotion as part of strategies. **Anniversaries of the Ottawa Charter** - 25th and 30th anniversaries involved international meetings and new declarations. - Universities continue to teach health promotion from undergraduate to graduate programs. **2016: Formation of Health Promotion Canada** - **Event**: 6th Global Forum on Health Promotion in Charlottetown, Prince Edward Island. - **PEI Health Promotion Declaration, 2016**: Addressed climate change, ecological determinants of health, social determinants of health, rapid development of technologies, global security issues, impact of austerity budgets, global infectious disease epidemics, increasing non-communicable diseases, global migrations, and deepening inequities. - Also now recognize the [breadth of evidence] that can be incorporated, including the **teachings of Indigenous cultures and traditional knowledge**. This variety of world views values the balance of mental, psychosocial, physical, spiritual, and emotional health and to understand that a **relationship with the earth and our social environment** is essential to achieving health at all levels."  **Evolution of Health Promotion - Health Education Era (2000 -- Present)** **Ongoing Developments** - Many global Health Promotion conferences have established and developed global principles and action areas for health promotion. - New tools and approaches. - New challenges. **Key Issues and Challenges affecting health promotion in the present and future?** - **New Tools and Approaches**: Internet, social media. - **New Challenges**: Shift in priorities -- novel communicable diseases (SARS, COVID), climate change, global health. **Five Distinct Features of Health Promotion** **1. Holistic View of Health** - **Definition**: 'A state of complete physical, mental, and social well-being rather than mere absence of disease or infirmity' (WHO). **2. Focus on Participatory Approaches** - **Empowerment**: Process through which people gain greater control over the decisions and actions affecting their health. - **Social Justice and Equity**: Ensuring equitable access to food, income, employment, shelter, education, and other factors needed to maintain good health. - **Inclusion**: Ensuring access to resources needed to maintain good health and a voice in decisions affecting health. - **Respect**: Respecting diverse viewpoints, cultures, and perspectives on health and wellness.  **3. Focus on the 12 Determinants of Health** 1. Income and social status 2. Social support networks 3. Education and literacy 4. Employment and working conditions 5. Physical environments 6. Social environments 7. Personal health practices and coping skills 8. Biology and genetic endowment 9. Healthy child development 10. Health services 11. Gender 12. Culture **Who might be some of the priority populations at increased risk of socially produced health inequities?** - People living on low incomes - First Nations, Inuit, or Metis communities - Those with limited education - Unemployed or underemployed people - Those living in rural, remote, and/or isolated communities - People living with disabilities and/or mental illness - People who are homeless or precariously housed - Those who may be discriminated against due to culture, race, language, sexual orientation, etc. - Different marginalized communities (i.e., BIPOC, LGBTQIA2+) **Ontario Public Health Definition** - **Priority Population**: "Groups that would benefit most from public health programs and services... that are at risk and for which public health interventions may be reasonably considered to have a substantial impact at the population level." **Priority Populations ** A graph with arrows pointing to the top Description automatically generated with medium confidence ** ** - **As advantage increases, health outcome increases** - **To improve health of disadvantage, u can see the actions taken proportionate to need on the graph** **4. Building on Strengths and Assets** - **Focus**: Positive factors to promote the health of individuals and communities. - **Examples**: Existing programs and services, community leaders, social institutions and events, strong social networks. **5. Using Multiple, Complementary Strategies to Promote Health** **Ottawa Charter for Health Promotion** - **Five Action Areas**: 1. Building healthy public policy 2. Creating supportive environments 3. Strengthening community action 4. Developing personal skills 5. Re-orienting health services **Examples of Healthy Public Policy** - Mandated mask or vaccination policies - Legislation to ban smoking in public places, workplaces, pubs, and clubs - Drinking and driving laws - Increased taxation on tobacco - Compulsory wearing of bicycle helmets - Anti-bullying policies in schools - Nutrition content on food labels - Occupational Health and Safety legislation - National breast and cervical cancer screening programs and policies **Creating Supportive Environments** - Cycling in Vancouver - Universal Access to Water - Ontario education minister announces new measures to fight bullying in schools **Examples of Supportive Environments** - Programs for new parents - Cooking classes for students living in on-campus residences at universities - Bike paths and bike lanes on roads - Lighting at local parks - Provision and sale of healthy food and drink in school cafeterias - Safe children's playgrounds - Vending machines with healthy food and drink choices - Public workout areas, sporting and playing fields, and other exercise facilities - Free phone helplines (e.g., Quit Smoking helpline) **Examples of Strengthening Community Action** - Neighbourhood Watch programs - Developing a whole-school approach to drug education - Self-help groups - Alcohol-free events for young people - Local community programs, such as walking groups **Developing Personal Skills** - This helps individual build awareness o take care of their health - An example of a place where community members can learn how to cook **Examples of Developing Personal Skills** - Health education programs in schools - Teaching children sun-safe behaviours - Working with young people to develop responsible drinking behaviours - Information brochures in medical centres - Prenatal classes - Free information resources marketed to and accessible by the community - Online learning programs - Distribution of accurate information via mass media **Reorienting Health services** - Incudes placing safe spaces - Clinics for homelessness - Community health centers **Examples of Re-orienting Health Services** - **Educating acute care nurses** in health promotion practices. - **General practitioners** incorporating advice on nutrition and physical activity when treating overweight or obese patients. - **Health promotion officers** developing and coordinating preventative health programs. - **Police** working in schools to support road safety education. **Key Health Promotion Strategies** **Health Communication** - **Definition**: The use of communication techniques and technologies to positively influence individuals, populations, and organizations for the purposes of promoting conditions conducive to human and environmental health. **Health Education** - **Definition**: Consciously constructed opportunities for learning involving some form of communication designed to improve health literacy, including improving knowledge and developing life skills conducive to individual and community health. **Self-Help/Mutual Aid** - **Definition**: A process by which people who share common experiences, situations, or problems can offer each other support. **Organizational Change** - **Definition**: Working within settings for health, such as schools, worksites, businesses, universities, hospitals, and recreational facilities, to create supportive environments that better enable people to make healthy choices. **Community Development and Mobilization/Community Empowerment** - **Definition**: Collective efforts by communities directed towards increasing community control over the determinants of health, thereby improving health. **Advocacy** - **Definition**: A combination of individual and social actions designed to gain political commitment or support for a particular health goal or program. **Healthy Public Policy** - **Definition**: The process of developing legislative and regulatory measures that protect the health of communities and make it easier for individuals to make healthy choices. **Roles of Health Promoters** **Work Environments** - Public health offices - Community health centers - Not-for-profit organizations - Provincial resource centers - Hospitals - Private sector for health in the workplace **Responsibilities** - Project planning - Workshop facilitation - Community development - Policy development **Examples of Activities** - Individual or community education - Social marketing - Development of healthy public policy - Assessments of community needs - Evaluation of programs - Advocacy **Health Promotion as a Multi-Disciplinary Field** **Involvement in Various Occupations** - Epidemiologists - Public health inspectors - Public health nurses etc **Specific Disciplines or Programs** - Chronic disease and injury prevention - STDs division **Levels of Health Promotion Branches and Jobs** - Local - Provincial - National - International **Lecture 4** **Andragogy** **Six Assumptions** 1. **Self-concept**: Adults move from dependency to self-directedness. 2. **Experience**: Adults draw upon their life experiences for learning. 3. **Readiness to learn**: Adults are ready to learn when they assume new roles. 4. **Orientation to learning**: Adults want to solve problems and apply knowledge. 5. **Learners need to know**: Adults need to know the reason for learning something. 6. **Motivation to learn**: Adults are driven by intrinsic/personal motivations to learn. **Key Points** - **Support for Adults**: Andragogy asks how adults can be supported through new learning, problem-solving, and strengthening independent thinking. - **Self-driven**: Compared to teacher-led methods. - **Different Methods**: Methods of educating adults are typically different than those used for children. **Pedagogy** **Definition** - Refers to the thought and behavioral habits and patterns instilled in children by their adult teachers. - Translates to "leading children". **Teacher's Role** - Provide opportunities for students to gain experiential learning. - Centers learning on the essential stages that a child must accomplish before moving on to the next stage. **Andragogy vs. Pedagogy** **Andragogy** - **Learner-focused approach**: For people of all ages, i.e., self-directed. **Pedagogy** - **Teacher-centered approach**: Directive learning approach. **Research Findings** - Adults and children actually learn in similar ways. - Age is no longer an adequate means of distinguishing learning styles. **Adult Education Principles** 1. **Autonomous and self-directed**: Adults are autonomous and self-directed. 2. **Foundation of life experiences**: Adults have accumulated a foundation of life experiences and knowledge. 3. **Goal-oriented**: Adults are goal-oriented. 4. **Relevancy-oriented**: Adults are relevancy-oriented. 5. **Practical**: Adults are practical. 6. **Respect**: Adults need to be shown respect. **How Do People Learn? Saying/Doing vs Seeing/Hearing** - **Asselin and Mooney (1996)**: People remember 90% of what they say and do, as opposed to 30% of what they see and hear. **Visual, Audio, Kinesthetic (VAK) Model** **Learning Styles** - **Visual**: Seeing. - **Auditory**: Hearing. - **Kinesthetic**: Doing. **Concept** - Students learn best when course content is delivered in a way to 'match' their self-reported learning style. **Visual Learner Activities** - Guided imagery - Demonstrations - Copying notes - Highlighting key ideas in notes/textbooks - Flash cards - Color coding - Diagrams, photographs, charts, graphs, maps - Filmstrips, movies, TV **Auditory Learner Activities** - Auditory tapes - Reading aloud - Oral instructions - Lectures - Repeating ideas orally - Using rhythmic sounds - Poems, rhymes, word association - Group discussions - Music, lyrics **Kinesthetic/Tactile Activities** - Experiments/labs - Plays, acting scenes out, role playing - Games - Problem-solving - Field trips - Writing notes - Making lists - Props, physical examples **Academic Consensus** - There is no scientific evidence that backs the VAK hypothesis of learning styles (Kirschner 2017, Pashler 2008, Simmonds 2014). **Kolb's Experiential Learning Theory** **Publication** - Published "Experiential Learning: Experience As The Source Of Learning And Development" in 1984. **Key Concepts** - **Cycle of Learning**: Central principle of experiential learning theory. - **Four-Stage Cycle**: Immediate or concrete experiences provide a basis for observations and reflections. **Learning Style Preference** - Product of two pairs of variables or two separate choices. - Represented as lines of axis, each with conflicting modes at either end. - Stages of feeling, thinking, watching, and doing. **Influencing Factors** 1. **Acquisition**: Birth to adolescence -- development of basic abilities and cognitive structures. 2. **Specialization and Integration**: Schooling, early work, and personal experiences of adulthood; mid-career through to later life; leads to expression of non-dominant learning style in work and personal life. **Critiques of Kolb's Theory** **Problems with Measurement** - Critiques of poor reliability and validity. - Several studies testing the learning style showed poor construct validity. - The proposed cycle may not be the best fit for reflective observations/opportunities. - Some learning encounters are experienced simultaneously, rather than in the stages outlined. **Right vs. Left Brain Thinking** **Dominant Hemisphere** - Results mean that you tend to lead with your dominant hemisphere. - Our neurological profile essentially guides the way we learn and teach our classes. **Description of the Left Hemisphere** - Constantly monitors our sequential, ongoing behavior. - Responsible for awareness of time, sequence, details, and order. - Responsible for auditory receptive and verbal expressive strengths. - Specializes in words, logic, analytical thinking, reading, and writing. - Responsible for boundaries and knowing right from wrong. - Knows and respects rules and deadlines. **Description of the Right Hemisphere** - Alerts us to novelty; tells us when someone is lying or making a joke. - Specializes in understanding the whole picture. - Specializes in music, art. - Visual-spatial and/or visual-motor activities. - Helps us form mental images when we read and/or converse. - Responsible for intuitive and emotional responses. - Helps us to form and maintain relationships. **Learning Preferences** **The Left-Brain Student** - Prefer to work independently. - Favor a quiet classroom without a lot of distraction. - Great difficulty understanding lessons with a visual-spatial orientation. - Often a perfectionist. **The Right-Brain Student** - Prefer to work in groups. - Favor a busy and active classroom. - Prefer to design, create, or construct rather than write another term paper. - Difficulty processing verbal information. **The Left-Brain Teacher** - Prefer to teach using lecture and discussion. - Give problems to the students to solve independently. - Assign more research and writing. - Prefer an ordered, structured, clean classroom. **The Right-Brain Teacher** - Prefer hands-on activities. - Incorporate more art, visuals, and music into their lessons. - Assign more group projects and activities. - Prefer a busy, active, noisy classroom environment. **Middle Brain Development** - Tend to be more flexible. - Often vacillate between the two hemispheres when making decisions. - Sometimes get confused when decisions need to be made. - Can do most tasks through either a left-brain or a right-brain method. **The Myth of the Left-Brain -- Right-Brain Theory** - A lot of evidence to discount this theory. - Brain is not as dichotomous (divided into two parts) as originally thought. - The two sides of the brain collaborate. - Theory is a point of historical interest only. **The Myth of Learning Styles** **Important Factors to Improve Learning** - Helpful to reflect on how learners are different from one another. - Challenges with matching teaching to learning styles. **Problems with Learning Styles** - Pigeonholing: Putting yourself in one category can be limiting. - Neuroscientists are in disagreement about these theories. - Reliability, validity, and predictive powers: Many of these theories fail in these domains. - No evidence that accommodating learning styles improves learning. - Commercial interests: Promoting products for different learning or teaching styles. **Recommendations for Adult Learning** - **Studying vs. Learning Processes**: Students benefit from different kinds of instruction. - **Thinking About Learning**: Students benefit from thinking about how they learn. - **Effective Instructional Methods**: Can vary across disciplines and course content. - Students will develop their own preferences for reviewing content, but these practices differ from deeper cognitive processes. **Adult Health Literacy in Canada** **Definition of Literacy** - "The ability to identify, understand, interpret, create, communicate and compute, using printed and written materials associated with varying contexts. Literacy involves a continuum of learning to enable an individual to achieve their goals, to develop their knowledge and potential, and to participate fully in the wider society." **Literacy vs. Health Literacy** - How does literacy impact health? - How do we measure health literacy? **The Adult Literacy and Life Skills (ALLS) Survey** - Assesses health content such as: - Health promotion and behaviors related to healthy habits. - Health protection and accident prevention. - Disease prevention. - Health care activities. - Learning about illness and disease. - Navigating the health care system. - 350 assessment items, with 191 of them measuring health-related activities. **Importance** - Approximately 4 in 5 Canadian adults have at least one modifiable risk factor for chronic disease. - Increasing rates of chronic disease (at least 1 in 5 Canadians with a chronic disease). - Aging population. - Disease management requires understanding and applying complex medical information, knowing where/how to access healthcare services, etc. **At-Risk Populations for Low Health Literacy** - Seniors (social support, how they access info). - Recent immigrants (language). - People with lower levels of education and low French or English proficiency. - People with lower incomes. **Barriers to Health Literacy** **Individual Barriers** - Declines associated with aging. - Low levels of formal education. - Lack of health knowledge and skills. - Language barriers. **System Barriers** - Inadequate training for healthcare workers. - Confusing or conflicting health information. - Complex health systems. **Actions for Health Educators** - Understand the levels of health literacy in our population. - Understand the at-risk populations. - Address social factors related to poverty, employment, food security, and housing. - Offer cultural sensitivity training. - Use plain, simple language for health-related information. - Develop multi-faceted, clear language strategies for relaying health-related information beyond print materials (videos, visuals). - Offer workshops and discussion groups on health topics to adults with literacy challenges. **Types of Interventions** - **Improving Usability of Health Services**: Health forms and instructions, accessibility of the physical environment. - **Building Knowledge to Improve Health Decision-Making**: Community-led initiatives. - **Improving Access to Accurate and Appropriate Health Information**: Use of various media platforms. **Canadian Health Literacy Survey (2017)** **Findings** - Overall health literacy of Canadians comparable to Europeans for health knowledge and disease prevention but struggle more with navigating the health system. - Strong association between high health literacy and good health. - 73% of Canadians fell into the 'excellent' or 'sufficient' categories. - Canadians find it challenging to judge the reliability of health information outside of their physician/pharmacist (more likely to trust physicians/pharmacists). **All readings summary** **Lecture 2:** - The document covers references to various publications and reports related to health disparities, health equity, social determinants of health, and specific health issues among different Indigenous groups in Canada. - It emphasizes the importance of understanding health disparities, health equity, and social determinants of health for addressing healthcare access and outcomes. - Specific attention is given to income-related health inequalities and the unique health challenges faced by Indigenous groups like the Inuit and the Metis in Canada. - Recognizing historical, cultural, and structural factors influencing Aboriginal health is essential for promoting better health outcomes. - The role of the health sector in reducing disparities, promoting equity, and advocating for justice in healthcare is highlighted. - The document provides insights into health status profiles, healthcare utilization patterns, and economic development strategies related to Indigenous land rights in Canada. - It discusses the concepts of equity and health, emphasizing the need for precise definitions of health disparities and health equity. - Initiatives like the Pan-Canadian Health Inequalities Reporting Initiative and collaborations with various organizations aim to measure, monitor, and report health inequalities to inform policy and program decisions. - The theoretical framework is based on the World Health Organization\'s conceptual framework on social determinants of health. - Over 70 indicators on health outcomes, risk factors, and social determinants of health are systematically disaggregated across various variables. - Significant health inequalities are observed among Indigenous peoples, sexual and racial minorities, immigrants, and those with functional limitations. - Daily living conditions, structural drivers, and historical, political, social, and economic conditions are highlighted as key health determinants. - Recommendations include adopting a human rights approach, intervening across the life course with evidence-informed policies, addressing material contexts and sociocultural processes, implementing a \"Health in All Policies\" approach, and carrying out ongoing monitoring and evaluation. - The overall message stresses the need for collective effort, innovation, and ongoing monitoring to address social determinants of health effectively in Canada. - The Lalonde Report in 1974 established key factors determining health: lifestyle, environment, human biology, and health services. - Factors influencing population health include income, social status, social support networks, education, employment/working conditions, social environments, physical environments, personal health practices and coping skills, healthy child development, biology and genetic endowment, health services, gender, and culture. - Higher income and social status are associated with better health outcomes. - Social support networks contribute to better health by aiding in problem-solving and maintaining a sense of control. - Education is linked to better health outcomes and socioeconomic status. - Employment and working conditions impact physical, mental, and social health. - Social environments, including civic vitality and social stability, influence health. - The physical environment, including air quality and housing, affects health. - Personal health practices and coping skills play a role in preventing diseases and promoting self-care. - Healthy child development is crucial for long-term health outcomes. - Genetics and biology influence health predispositions. - Health services, prevention, and access to care contribute to population health. - Gender and culture play roles in health disparities and access to healthcare. - Various studies and reports provide evidence supporting these determinants of health. **Lecture 3 Reading:** - **Determinants of Health:** - Factors decisively affecting health outcomes. - Include human biology, environment, lifestyle, health care organization, income, social status, social support networks, education, employment, physical environments, biology, personal health practices, healthy child development, health services, gender, and culture. - Social determinants of health emphasize social conditions\' impact on health. - Include circumstances of birth, growth, living, working, aging, and systems for dealing with illness. - Attention to the physical environment\'s role in health promotion, especially sustainable development. - **Empowerment:** - Mechanism for individuals, organizations, and communities to gain control over their lives. - Involves psychological and community empowerment, leading to health improvements. - Social action process to enhance equity and quality of life. - Rooted in the work of Paulo Freire, emphasizing self-empowerment and liberation. - Contributes to reducing health inequities, a core goal of health promotion. - **Health Literacy:** - Involves accessing, understanding, appraising, and communicating health information for good health. - Crucial in health promotion. - Key outcome of health education activities. - Evolving definitions emphasize contextual nature and variation over the life-course. - Canadian contributions to health literacy development include research, practice, and intersectoral approaches. - **Quality of Life:** - Ultimate outcome of health promotion efforts. - Degree to which a person enjoys the important possibilities of life. - Model includes Being (physical, psychological, spiritual), Belonging (physical, social, community), and Becoming (practical, leisure, growth) elements. - Positive and inclusive concept, fitting well in health promotion. - Included in the Bangkok Charter for Health Promotion as a fundamental aspect. - **Life-course Perspective:** - Examines how social factors like class, gender, and ethnicity impact health disparities at different life stages. - Linked to determinants of health, health disparities, and intersectional theory. - Effective use in health promotion for underserved populations. - **Health Promotion:** - Enabling people to increase control over and improve their health. - Involves planned interventions to change lifestyles and environmental conditions. - Specialized field within public health focusing on individual and collective strategies. - Evolved from traditional health education to a holistic and ecological approach. - Includes strategies like health education, social marketing, and political action. - **Evolution of Health Promotion in Canada:** - Shifted from individually oriented health education to encompass environmental and policy concerns. - Lalonde Report in 1974 introduced the term health promotion. - Ottawa Charter for Health Promotion formalized principles and values. - Population health emerged in the mid-1990s, focusing on social determinants of health. - Advocates stress intersectoral action to promote health and reduce disparities. - Academic sector took a leadership role in health promotion after 2007. - Despite challenges, health promotion remains resilient in Canada. **Lecture 4 reading:** - Health literacy is crucial for making informed health decisions, navigating the healthcare system, and maintaining good health. - Daily reading habits have a significant positive impact on health literacy proficiency. - Health literacy levels vary by province and population sub-groups, with vulnerable groups including seniors, immigrants, and the unemployed. - Factors influencing health literacy include education, daily reading practices, parental education, income, age, gender, community size, and language. - Low health literacy is linked to negative health outcomes, blocked access to services, chronic illness, preventable diseases, and accidents. - Strategies to address low health literacy include promoting daily reading, simplifying health information, and involving patients in their healthcare decisions, requiring a collective effort from all sectors of society.