WK2. Ch. 8 Community Health Promotion PDF

# Part Two Foundations and Tools for Community Health Nursing Practice ## Chapter 8 Health Promotion **Candace Lind and Louise Baptiste** ### Introduction * Canada is credited with being a birthplace of the worldwide health promotion movement * Health promotion is a complex social and political...

# Part Two Foundations and Tools for Community Health Nursing Practice ## Chapter 8 Health Promotion **Candace Lind and Louise Baptiste** ### Introduction * Canada is credited with being a birthplace of the worldwide health promotion movement * Health promotion is a complex social and political process that has been the focus of much international discussion over the last few decades. * Numerous complex factors have affected the advancement of health promotion, which are discussed in this chapter. ### Learning Outcomes After studying this chapter, you should be able to: 1. Define and describe the concepts of health and health promotion. 2. Describe the differences between upstream and downstream approaches to addressing health issues in a population. 3. Define the concept of primary health care, and identify its values, principles, and elements. 4. Explain the significance of the Ottawa Charter, and identify key issues from other charters for health promotion. 5. Discuss variations in the social determinants of health. 6. Understand the strategies and methods used in population health promotion. 7. Define social marketing and discuss the "four Ps" of marketing. 8. Identify social justice issues in the context of "at risk" populations. 9. Discuss nursing interventions that exemplify five levels of prevention. 10. Explore the harm reduction philosophy and the role of the community health nurse when working in harm reduction. 11. Understand the importance of research, activism, and advocacy in health promotion practice. ### Definitions of Health and Health Promotion * Health is a difficult concept to define. * The traditional Euro-Canadian understanding of health and health care rests within the biomedical model, where health has been understood as the absence of disease and illness, rather than a state of wholeness. * **Health is more than a static biomedical concept.** Health is a dynamic process with multiple assumptions and understandings that evolve over time and evolve with varying professional perspectives and purpose. * **Promoting health is the foundation of nursing practice.** Nurses work alongside multiple professions (in interprofessional and multisectoral teams) to promote, support, maintain, and restore health in individuals, families, communities, and populations. * The international concept of health had been disease focused until 1946, when the World Health Organization (WHO) broadened the definition from just the absence of disease to "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (World Health Organization [WHO], 1948, para. 1). * **Health promotion is the process of enabling people to increase control over, and to improve, their health.** 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. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. ### Indigenous Health and Health Promotion * A Euro-Canadian understanding of health and health promotion has been conventionally framed from an individualistic and biomedical lens. * An Indigenous understanding of health, however, arises from a broader, more holistic, community-focused lens. *Wellness is achieved through a balance of the body, mind, emotion and spirit, and holistic health requires the family and community to work together. Each part enhances, supports, and affects the other. Individual wellness is the result of how each of these factors is addressed" (Cameron, del Pilar Carmargo Plazas, Salas, Bourque Bearskin, & Hungler, 2014, p. E10). * The land plays a critically important role in forming and maintaining cultural identities, social relationships, and health and well-being. Living in harmony with nature has traditionally been an integral component of the health of Indigenous peoples around the world. ### Upstream and Downstream Approaches to Promoting Health * Health promotion offers both upstream and downstream approaches to improving the health of populations. * **Upstream refers to the original cause of a problem.** * **Downstream refers to the solutions that happen after the problem is identified or occurring.** ### Primary Health Care * Canada is considered an international leader in the health promotion movement, population health, and primary health care (PHC). * **Primary health care (PHC) is defined as: essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.** * **PHC is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.** ### The Ottawa Charter for Health Promotion * The first international conference on health promotion was held in Ottawa in November 1986 with 212 participants from 38 counties. * The document was intended to be a worldwide charter for action, presenting strategies and approaches for health promotion that were considered vital for major progress toward individual and collective commitment to an earlier set, ambitious goal of "Health for All by the Year 2000" in a movement toward a "new public health." * A logo that represented this call for action was developed to include the following key components: * **Build healthy public policy.** Health must be on the agenda of policy makers across all sectors and levels of society-not just the health sector. * **Create supportive environments for health.** The way that society is organized (e.g., living and working conditions) must be addressed, as health cannot be separated from other goals. * **Strengthen community action.** At the heart of this action strategy is community empowerment-for communities to have a greater sense of ownership and control over their own endeavors and destinies. Community development is an important component of this strategy. * **Develop personal skills** Enhancing people's life skills. Education and institutional action are required. * **Reorient health services toward preventing diseases and promoting health.** The responsibility for health promotion in health services is one that is shared by all citizens; we must work together toward creating a health-care system that contributes to the pursuit of health. ### Social Determinants of Health * The concept of the social determinants of health has origins attributed to the discussion of the impact of physical and social environments in the Lalonde Report and expanded upon in 1996 by Tarlov to include housing, education, social acceptance, employment, and income. * The social determinants of health were developed out of attempts to understand why members of different socioeconomic groups experience different health outcomes. ### Social Marketing: An Example of a Population Health Intervention * Social marketing is a term that was introduced in 1971 to describe the use of marketing principles and techniques to advance a social cause, idea, or behaviour. The goal of social marketing is to encourage health-promoting behaviours, or to eliminate or significantly reduce behaviours that negatively impact a population's health. * Social marketing has been described as a health intervention approach. * Examples of successful long-running social marketing campaigns include ParticipACTION, with exercise promotion strategies. * Social marketing is most effective for populations that are considering change or have been unsuccessful when they try to change. ### "At Risk" Populations *"At risk" is a term often used to describe a group or population that has a higher risk of a particular illness (morbidity) or negative life outcome (such as mortality) than might be experienced by other populations. ### Levels of Prevention Used in Health Promotion * When nurses look at health promotion and the levels of prevention, they widen their lenses beyond disease prevention to include injury prevention, thereby capturing a broad area to promote the health of individuals, families, and communities. * **Primordial prevention is the most distal of prevention strategies, focusing on policies and behaviors that prevent risk factors from emerging.** This includes the broad implementation of policies across multiple sectors to reduce the risk of disease or injury from occurring (such as making smoke-free public spaces or banning the sale of tobacco products altogether). * **Primary prevention focuses on actively reducing risks factors from existing, or targeting populations that are already at risk from disease or injury.** This is where we see interventions like promoting safe and healthy lifestyles, education about different prevention strategies, and educating individuals and families to make more responsible choices. * **Secondary prevention focuses on intervening with people who have identified risk factors/are in the early stages of developing the disease/have already contracted the disease** with the intent to prevent further illness. This includes strategies like early detection, screenings, and treatment of diseases. * **Tertiary prevention is focused on reducing disability and maximizing quality of life for people who already have the disease or injury.** This is where we see things like rehabilitation, management of chronic conditions, and community programs designed to give back control to people who have been affected by these conditions. * **Quaternary prevention is a more nuanced, recently developed approach.** It is focused on identifying people who are at the highest risk for medical mishaps, such as unnecessary investigations or over-medicalization, with the ultimate goal of preventing preventable medical harm. ### Harm Reduction * Harm reduction is a philosophy and approach to health care delivery, programs, or policies, implemented with a goal to protect the health of, and reduce secondary harm for, individuals who engage in high-risk activities that are associated with poor health outcomes. * Harm reduction approach ensures access to evidence-based information for individuals to make informed decisions about their lives and health and equal access to promotive health care services. * Harm reduction requires a nonjudgmental stance that focuses on reducing potential harm from high-risk activities while treating individuals with respect and dignity. * Harm reduction programs benefit the health of the public as well as the individual by helping to control the spread of communicable diseases like human immune deficiency virus (HIV), hepatitis C, STIs, and preventable lung diseases. ### Safe Injection Sites * Vancouver's "Insite" is North America's first safe injection facility, operated by nurses. Operating from a harm reduction model, Insite opened in 2003 in Vancouver's Eastside. * The area had a high use of IVDs among the community, and people were self-injecting in alleys where they were at a high risk of experiencing theft, violence, arrest, or accidental overdose. * After the opening of Insite's 12-booth safe injection sites, the fatal overdose rate decreased by 35% in and around the area, compared to a fatal overdose rate decrease of only 9.3% in the rest of the city. * Insite offers clients a safe place to inject, in addition to access to health care, addiction treatment, mental health counselling, social support, and a way to connect with outside services. * Insite also has a needle exchange program to help protect clients from HIV/AIDS, and has demonstrated its value by saving taxpayers $1.9 million a year in HIV and accidental overdose-related health care costs. ### Research, Advocacy, and Activism in Health Promotion Practice * Nurses provide care for people from conception to death and in a variety of settings ranging from acute-care institutions to community-based settings and people's homes with the goal of helping people achieve and maintain their maximum level of health and wellness. Nurses work very closely with individuals and families and are often the first to see the impact of things like a lack of early interventions and prevention strategies. * The profession of nursing has a history of social action and activism. This includes leaders such as Florence Nightingale, who shaped the profession of nursing as a social movement intent on reform, and Lillian Wald. * **Ignoring the political realities of health, particularly health inequities, is one way of habituating them and rendering them invisible. Nurses have an important and necessary role to play in countering this process through objective debate.** * **To be advocates for clients, patients, or communities may require becoming political activists. A key question to ask is: Should I focus on helping people adapt to poverty or focus on helping people learn how to influence the environment that has contributed to their situation of poverty?** ### The Population Health Promotion Model * The population health promotion model (PHPM) is a Canadian-developed model to understand the WHO, what, how, and why of intervention or action on multiple levels across a society to create healthy change. * The model is a cube that visually represents the elements of population health promotion, and it has four components: * **Social Determinants:**These are the factors that can affect a population's health, such as Income and Social Status, Work & Working Conditions, Social Support Networks, Education, Genetic Endowment, Personal Coping Skills, Healthy Child Development, Health Services, Physical Environments, Culture, Gender, and Social Environments. * **Levels of Action:** Interventions can be implemented at different levels, such as the individual, family, community, structural or system levels, and at the society as a whole. * **Action Strategies:** This is where the different strategies used to actually implement the interventions are identified, including things like building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and re-orienting health services to promote prevention. * **Foundations:** This is the base of the cube, and it represents the "why" of the interventions. All interventions are based on a mix of research, evaluation, experiential learning, values, and assumptions. ### Population Health and Population Health Indicators * Population health is an approach used to understand and improve the health of an entire population or subpopulations, such as children, older adults, or newcomers to Canada. It is linked to health promotion that is not focused on individual people. * Population health indicators are used to measure the health of populations as well as the progress made toward creating healthier citizens.