Health Promotion

1. Health Promotion

2. Health The ultimate goal of health-care providers is to promote health and prevent disease.

3. What Is Health? • The definition continues to evolve, but many view health as the absence of disease. • This view does not account for the multidimensional characteristics integral to a human being. • Humans are social, emotional, and spiritual beings. • The Merriam-Webster online dictionary defines health more globally as “the condition of being sound in body, mind, or spirit and a flourishing condition.”

4. What Is Health? (cont’d) • In 1948, the World Health Organization (WHO) defined health as a “state of complete physical, mental, and social well-being.” • This definition does not account for the spiritual dimension of a person. • Health is therefore a state in which the physical, psychological, social, and spiritual attributes of a person are in balance, creating harmony within the body.

5. What Is Health? (cont’d) • A balance of each of these dimensions is an important parameter when considering health. • A patient may be physically healthy but the spiritual, social, and psychological dimensions may not be balanced, and therefore the patient is not truly healthy. • We cannot determine someone’s health status without evaluating all of these attributes.

6. What Is Health? (cont’d) • Historically, the evaluation of a patient was based only on physical signs and symptoms of a disease. • Lack of symptoms meant healthy • We now know that this type of assessment is incomplete.

7. Assessing a Patient • Social, psychological, and spiritual well-being is as important as the physical state. • The provider should ask questions about the person’s • Social and dietary habits • Current living and working environments • Feelings, beliefs, life satisfaction • Philosophical and spiritual beliefs

8. Health Promotion • Health promotion as defined by O’Donnell in 1989 is “the science and art of helping people change their lifestyle to move toward a state of optimal health.”

9. Health Promotion (cont’d) • Requires a commitment on the part of the individual patient, the health-care provider, and the community • Partnership to achieve goals that will enhance health and well-being

10. Health Promotion Efforts • Should begin with the clinician • Pivotal role in educating the patient and the community about health-promoting behaviors • Provides insight to each patient about how his or her environment can contribute to health or disease

11. Health Promotion Efforts (cont’d) • Consultation with influential members of the community can help in the development of legislation that can support healthy living conditions in a community. • If patients are trying to promote their own health, living conditions in the community must also be healthy to sustain and support their efforts.

12. Health Promotion Efforts (cont’d) • Basic community resources such as water, sanitation, and hygiene must be monitored for potential threats to health and well-being and are the responsibility of community and local government agencies. • Health-care providers and patients need to work in collaboration with these agencies to ensure that elements essential to health are maintained or improved.

13. Health Promotion • Has been viewed as an effort to prevent disease and illness • Most sources cite three levels of prevention

14. Three Levels of Prevention • Primary prevention: the prevention of disease • Secondary prevention: early screening and detection of disease • Tertiary prevention: the restoration of health after illness or disease has occurred

15. First Half of the 20th Century Health Care • The focus in health care during the first half of the 20th century was on care for the patient who was already ill. • The belief at the time was that patients should seek health care when they were ill.

16. First Half of the 20th Century Health Care (cont’d) During this time, most health-care practitioners cared for patients at the tertiary level by • Preventing further insult or injury after the disease or illness had occurred, by stabilizing the patient’s condition to prevent deterioration • Helping patients to recover from the current illness or disease through treatment • Helping restore patients to their previous state of health

17. Second Half of the 20th Century Health Care • Advancements in technology during the second half of the 20th century contributed to better diagnostic testing, helping to shift the focus of health care to secondary prevention.

18. Second Half of the 20th Century Health Care (cont’d) • Providers became savvier about the importance of screening “at risk” patients during appropriate intervals for known diseases and illnesses. • A focus on secondary levels of prevention led health-care providers to encourage early detection and treatment.

19. Second Half of the 20th Century Health Care (cont’d) • With the focus on screening and early detection, treatment could be instituted before overt signs and symptoms appeared. • For example, blood pressure would be checked in a patient with no symptoms of hypertension, and if elevated, a plan of treatment would be instituted. • The goal was and is maintaining the patient’s blood pressure within normal limits and minimizing the development of catastrophic complications such as stroke or myocardial infarction.

20. Screening • In determining whether or not screening is appropriate, health-care providers should keep in mind that early signs of chronic disease surface in midlife or between 40 and 65 years. • The earlier disease is identified, the easier it is to treat and have a successful outcome.

21. Screening (cont’d) • Individuals in midlife tend to focus more on behaviors to extend life and prevent disability than do younger people. • Adults 20 to 40 years old focus more on relationships, family, self-image, and career development. • Those older than 65 spend much time responding to and coping with established illness. • As life expectancy increases and older adults anticipate living longer, more attention is focused on health enhancement.

22. Uses of the Levels of Prevention Health-care providers can use the levels of prevention in several ways • On an individual level • With small groups (families) • On larger groups such as a community

23. Individual Level Individual encounters with patients provide an opportunity to educate patients about their individual risk factors and changes they can make to prevent, or at the very least, delay the onset of disease and the potential sequelae of disease (implementing primary and secondary prevention strategies).

24. Small Groups • Incorporating family members into the educational process of health promotion can provide support and reinforcement for patients during the early phase of risk reduction. • This incorporation of family may also serve the individual family members by educating them regarding their own risk for disease. • Family members can also serve as advocates for patients by helping to synthesize the information given and providing the patient with a support system to make healthy lifestyle changes.

25. Larger Groups • Health-care providers can be instrumental in developing health promotion strategies in a community • This can be accomplished by developing interventions that include identifying community groups at risk for certain diseases and developing community-wide educational programs that will educate this group about their potential risks. • Community-based educational programs reach a broad audience with the potential to have a significant impact on the health status of a community.

26. Early Assessment and Management • Expanding knowledge has increased our awareness that many diseases today can be minimized or potentially avoided with early assessment and management. • The effects of diseases such as hypertension, cardiovascular disease, and diabetes on patients’ lives can be minimized or avoided with early interventions.

27. Early Assessment and Management (cont’d) • For example, most patients diagnosed with diabetes have had the disease for at least five years. • Diabetes has serious consequences in many organ systems if it is not diagnosed early and treated aggressively. • The development of a community-wide diabetes education/screening program can help identify patients who are at high risk for the disease.

28. Early Assessment and Management (cont’d) • With early diagnosis and treatment, long-term complications associated with diabetes such as peripheral neuropathy, cardiovascular complications, and retinopathies can be minimized.

29. Early Assessment and Management (cont’d) • Clinicians can take a leadership position within a community by developing targeted programs for early identification and treatment. • This type of wide-scale intervention can reduce morbidity and mortality. • If patients are identified early, educated about the importance of healthy nutrition and lifestyle, and treated aggressively, the outcome may be a long and healthy life.

30. Risk Factors in Health Promotion • The identification of risk factors is an essential component of health promotion. • Some patients have no known risk factors while others have many. • The key component of effective health promotion is to screen patients for potential known risk factors and intervene. • Not all diseases can be prevented, and not every person with unhealthy lifestyle choices will get a particular disease, but the elimination or alteration of certain risk factors can have animpact on disease outcomes.

31. Risk Factors in Health Promotion (cont’d) • Some risk factors are modifiable, while others are nonmodifiable. • Nonmodifiable risk factors include sex, age, and genetic/family history. • Nonmodifiable means the risk factors cannot be changed in any way. • Because these factors are nonmodifiable, early and aggressive identification of all risk factors should be done so that these patients can make any possible changes in the modifiable risk factorsin order to have a more favorable outcome.

32. Risk Factors in Health Promotion (cont’d) • Modifiable risk factors include weight, diet, social habits, lifestyle choices, and stress reduction.

33. Risk Factors in Health Promotion (cont’d) • For example, 38-year-old Mr. Hart has a past medical history negative for any diseases, surgeries, or illnesses. • His social history includes the use of alcohol and cigarettes; he works an average of 60 hours per week as a emergency medical technician and does not exercise. • His family history reveals that his father, paternal uncle, and grandfather had all had a myocardial infarction before the age of 50. • Mr. Hart’s physical exam reveals the following: height, 69 inches; weight, 230 lbs.; and body mass index, 34. • Mr. Hart’s laboratory results include cholesterol,250; high-densitylipoprotein (HDL), 30; and low-density lipoprotein (LDL), 160.

34. Risk Factors in Health Promotion (cont’d) • Although Mr. Hart cannot change his age, sex, or family history, there are several factors that he can change. • With improvements in his diet, regular exercise, stress reduction, moderation of alcohol intake, and smoking cessation, Mr. Hart can reduce his risk for heart disease. • This case illustrates the importance of early identification of risk factors for intervention.

35. Risk Factors in Health Promotion (cont’d) • Ongoing research has shown the relationship between certain risks such as smoking, alcohol, and diet and the presence of disease. • For example, some patients will have no identified risk factors for a particular disease, yet will still develop the disease. • Conversely, some patients may have several identified risk factors and yet never go on to develop the disease.

36. Influences on Health Promotion • Many factors influence health promotion activities today. • Government initiatives, community health programs, and media attention focus on the importance of health promotion and disease prevention. • Two major government initiatives that have had great impact on effecting change in the United States are Healthy People 2000, 2010, and now 2020, and the United States Preventive Services Task Force (USPSTF).

37. Healthy People 2000, 2010, 2020 • Disease prevention has always been a major goal of the Public Health Service (PHS), but this department recommitted its efforts to health promotion and disease prevention during the late 1970s as a result of the Public Health Service Act. • The Secretary of Health and Human Services was commissioned by the legislature to develop an agenda for promoting the health of the nation.

38. Healthy People 2000, 2010, 2020 (cont’d) • The result of the initiative was a landmark report: The Surgeon General’s Report on Health Promotion and Disease Prevention, published in 1979. • This document highlighted the fact that many of the diseases and injuries affecting the population at that time could be prevented or minimized with early intervention. • The report also stressed the importance of healthy lifestyle choices to enhance health and well-being. • As a result of this report, five major goals for the nation were established and 226 objectives were developed to meet these goals. • The result of this initiative was the government publication of Healthy People 2000.

39. Healthy People 2000, 2010, 2020 (cont’d) • The target year to achieve these goals was 1990. • By 1987, a review of the progress on this initiative found that all of the goals had already been achieved except for goal 2, which was to reduce deaths in children by 20% by injury prevention and screening for growth and development delays.

40. Healthy People 2000, 2010, 2020 (cont’d) • In 1990, the focus on health promotion and disease prevention continued and was expanded into what became Healthy People 2000. (www.healthypeople.gov) • The five overall goals from the previous initiative were reviewed and evaluated and three new goals were established. • The overall goals for Healthy People 2000 focused more on the general health of the population.

41. Healthy People 2000, 2010, 2020 (cont’d) • These new goals established a more general view of health promotion and disease prevention without reference to specific parameters for achieving these goals. • In other words, the focus was on the general improvement in health without the constraints of achieving a specific target number.

42. Healthy People 2000, 2010, 2020 (cont’d) • However, to meet these goals, 22 priority areas were developedand divided into four areas of focus: health promotion, health protection, preventative services, and surveillance and data systems. • Individual objectives to meet the overall goals were also developed and categorized under one of these 22 priority areas,including specific targets for meeting the goals. • These objectives identified specific parameters that could be measured to evaluate the success of the program.

43. Healthy People 2000, 2010, 2020 (cont’d) • According to the Healthy People initiative, health promotion is defined as strategies that help individuals make personal choices in a social context about lifestyle that will have a positive influence on the individual’s health prospects. • Health protection is defined as those interventions that are related to the environment made by regulatory bodies to protect a large population group. • Preventative services include screening for disease, counseling, medication to prevent disease, or immunization interventions for individuals in the clinical setting.

44. Healthy People 2000, 2010, 2020 (cont’d) • The last priority area of surveillance and data systems was essential to tracking all of the changes that would occur with programs focusing on meeting the goals of Healthy People 2000. • Systems were set up to monitor and organize the data for this initiative. • Progress toward meeting the goals was evaluated and reviewed every five years.

45. Healthy People 2000, 2010, 2020 (cont’d) • The results of this review and evaluation were presented in a report titled “Midcourse Reviews for Healthy People 2000.” • The National Center for Health Statistics (2001) stated that by the year 2000 • 68 objectives (21%) met the goals of Healthy People 2000 • 129 objectives (41%) made progress toward meeting the target goal for 2000 • 11 percent of the goals had mixed results • 15 percent of the goals were moving away from the target • Although all of the major goals were not reached by 2000, the goal of of eliminating health disparities (major goal 2) was achieved at 50 percent.

46. Healthy People 2000, 2010, 2020 (cont’d) • As the new millennium approached, the goals and objectives for Healthy People 2000 were reevaluated and Healthy People 2010 was established. • The major goals for Healthy People 2010 were streamlined into two overriding objectives • To increase quality and years of a healthy life • To eliminate health disparities

47. Healthy People 2000, 2010, 2020 (cont’d) • While the major goals for this initiative decreased from three to two, the focus areas were expanded from 22 to 28. • In addition, the objectives expanded to 467 in Healthy People 2010 • Healthy People 2010 was “designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21st century.” • Healthy People 2020 is under development at the time this edition is being written.

48. Healthy People 2000, 2010, 2020 (cont’d) • The Healthy People 2000 and 2010 initiatives have had significant impact on primary health care in the United States. • The incorporation of health-promoting and disease-prevention strategies has become the foundation for primary care. • It is believed that all of the goals of Healthy People 2010 are achievable with support from individual health-care providers, local and national government agencies, and, most importantly, the active participation of individual patients.

49. Healthy People 2000, 2010, 2020 (cont’d) • In Healthy People 2020, many of the original objectives are being retained, new ones developed, and others modified. • Healthy People stresses the importance of each individual taking personal responsibility for his or her own health, in partnership with his or her health-care professional.

50. United States Preventive Services Task Force • The United States Preventive Services Task Force (USPTF) is composed of private-sector experts who make recommendations to the health-care community regarding clinical prevention strategies. • It was first convened by the U.S. Public Health Service in 1984 and since 1998 has come under the umbrella of the Agency for Healthcare Research and Quality (AHRQ).