Introduction to Health Promotion and Population Health

1. Introduction to Health Promotion and Population Health Presentation by Irving Rootman to SFU Class on Principles and Practices of Health Promotion September 13, 2010

2. Purpose • To provide an introduction to health promotion and population health

3. Outline 1. Milestones in the development of health promotion and population health 2. Concepts and elements of health promotion and population health 3. Differences and commonalities between health promotion and population health

4. 1. Milestones in health promotion and population health

5. Milestones • 1974:

6. Health Field Concept (Lalonde, 1974) • Human biology • Environment • Lifestyle • Health care organization

7. Strategies (Lalonde, 1974) • Health promotion • Regulatory • Research • Health care efficiency • Goal setting

8. Milestones (Cont.) • 1978: Health Promotion Directorate established • 1984: Beyond Health Care Conference (Toronto) Concept and Principles Document (WHO-EURO)

9. Definition of Health Promotion • “the process of enabling people to increase control over, and to improve, their health” (WHO-EURO, 1984)

10. Principles of Health Promotion (WHO-EURO, 1984) • Involves population as a whole • Acts on the determinants of health • Combines diverse approaches • Aims at public participation • Health professionals have enabling role

11. Milestones (Cont.) • 1986: First International Conference Ottawa Charter for Health Promotion (WHO)

12. Ottawa Charter: Pre-requisites for Health (WHO, 1986) Peace...shelter....education... Food...income Stable eco-system Sustainable resources Social justice Equity

13. Health Promotion Action Areas (WHO,1986) • Building healthy public policy • Creating supportive environments • Strengthening community action • Developing personal skills • Reorienting health services

14. Health Promotion Approaches(WHO, 1986) • Communication • Education • Legislation • Fiscal Measures • Organizational Change • Community Development • Spontaneous Local Activities

15. Epp, 1986

16. Milestones (Cont.) • 1987: CIAR Population Health Program • 1990: Determinants of Health Model (Evans and Stoddart)

17. (Evans and Stoddart, 1990)

18. Milestones (Cont.) • 1994:

19. Milestones (Cont.) • 1994: Health Promotion in Canada (Pederson, O’Neill and Rootman) Strategies for Population Health (FPT AC on Population Health)

20. Determinants of Health (FPT ACPH, 1994) • Income & social status • Social support networks • Education • Employment & working conditions • Physical environments • Biology & genetic endowment • Personal health practices & coping skills • Healthy child development • Health services

21. Strategic Directions (FPT ACPH, 1994) • strengthening public understanding of the determinants of health • building understanding of the determinants of health among sectors outside of health • developing comprehensive intersectoral population health initiatives

22. Milestones (Cont.) • 1995: Health Promotion Directorate replaced by Population Health Directorate • 1996: Population Health Promotion Workshop and Paper (Hamilton and Bhatti) Action Statement for Health Promotion in Canada (CPHA)

23. Population Health Milestones • 1998: Population Health-Putting Concepts into Action (Zollner and Lessof, 1998)

24. Strategies for putting population health into practice (Zollner and Lessof, 1998) • Leadership (securing a champion) • Building partnerships across public sector • Engaging private sector • Putting public health to work • Looking for evidence and monitoring success • Making population health attractive • Raising the stakes towards accountability

25. Population Health Milestones • 1998: Population Health, Sustainable Development and Policy Futures (Hayes and Glouberman)

26. Conclusions regarding link between population health and sustainable development (Hays and Glouberman, 1998) • Major overlap between population health and sustainable development is connection between social sustainability and socio-economic influences on health • Must consider not only short-term, but also medium, and to some extent long-term goals and outcomes in creating health policy • Development of policy envelope that considers short, medium and long-term policy initiatives separately may be helpful

27. Milestones (Cont.) • 1996: Establishment of Canadian Consortium for Health Promotion Research • 1999: Publication of IUHPE Review on Effectiveness of Health Promotion (IUHPE, 1999) • 2001: Publication of Evaluation in Health Promotion (Rootman et al., 2001)

28. Milestones (Cont.) • 2005: 6th WHO Global Conference on Health Promotion Bangkok Charter for Health Promotion in a Globalized World

29. Required Actions by Bangkok Charter • advocate for health based on human rights and solidarity • invest in sustainable policies, actions and infrastructure to address the determinants of health • build capacity for policy development, leadership, health promotion practice, knowledge transfer and research, and health literacy • regulate and legislate to ensure a high level of protection from harm and enable equal opportunity for health and well-being for all people • partner and build alliances with public, private, nongovernmental and international organizations and civil society to create sustainable actions

30. Key Commitments of Bangkok Charter To make the promotion of health: 1. Central to the global development agenda 2. A core responsibility for all of government 3. A key focus of communities and civil society 4. A requirement for good corporate practice

31. Milestones (Cont.) • 2005: Federal Health Promotion Centre established in PHAC • 2007: 19th IUHPE Global Conference on Health Promotion and Health Education

32. Milestones (Cont.) • 2008: Report of the WHO Commission on the Social Determinants of Health (CSDH, 2008).

33. CSDH Principles of Action 1. Improve the conditions of daily life—the circumstances in which people are born, grow, live work , and age 2. Tackle the inequitable distribution of power, money, and resources---the structural drivers of those conditions of daily life—globally, nationally and locally 3. Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health (CSDH, 2008, p.2)

34. Milestones (Cont.) • 2009: 7th Global Conference on Health Promotion (WHO) Nairobi Call to Action • 2010:

35. Questions? Comments?

36. 2. Concepts and other elements of health promotion and population health

37. Key Concepts of Health Promotion • Health • Health Promotion • Empowerment • Healthy Communities • Determinants of Health • Health Literacy • Quality of Life

38. Definitions of “health” • “...a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO,1946) • The normal physical state, i.e. 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" (Critchley, 1978, p. 784)

39. Definitions of Health (Cont.) • “the bodily, mental and social quality of life of people as determined in particular by psychological, societal, cultural and policy dimensions.” (Rootman and Raeburn, 1994)

40. Definitions of “health” (cont.) • “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.” (WHO, 1986)

41. Well Being-Being Well Wheel, Circle of Change, 1998

42. Concept of health for health promotion in the 21st Century • “In the health promotion domain, health is equivalent to healthiness and is related to concepts of resilience and capacity. It refers primarily to mental and physical dimensions of healthiness, has strong experiential and social aspects, and is determined by many internal and external factors, including those of a personal, collective, environmental, political and global nature” (Rayburn and Rootman, 2007)

43. Definitions of health promotion • a strategy “aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health” (Lalonde, 1974) • “the implementation of efforts to foster improved health and well-being in all four domains of health” (physical, social, psychological and personal) (Perry and Jessor, 1985)

44. Definitions of health promotion (cont.) • “the maintenance and enhancement of existing levels of health through the implementation of effective programs, services, and policies” (Goodstadt, et al.,1987) • “the advancement of wellbeing and the avoidance of health risks by achieving optimal levels of the behavioral, societal, environmental and biomedicial determinants of health” (Kar, 1987)

45. Definitions of health promotion (cont.) • “the process of enabling people to increase control over, and to improve, their health: (WHO, 1984, 1986; Epp, 1986) • “the process of enabling [individuals and communities] to increase control over [the determinants of health] and [thereby] improve their health” (Nutbeam, 1985)

46. Definitions of Empowerment • “the mechanism by which people, organizations and communities gain mastery over their lives” (Rappaport, 1984) • “a process of helping people to assert control over the factors which affect their lives” (Gibson, 1991) • “where people are unambiguously in control and self-determining”(Raeburn & Rootman, 1998)

47. Psychological and Community Empowerment • Psychological empowerment is “a feeling of greater control over their own lives which individuals experience following active membership in in groups or organizations” (Rissel, 1994) • “Community empowerment includes a raised level of psychological empowerment among its members, a political action component in which members have actively participated, and the achievement of some redistribution of resources or decision-making favorable to the group or community in question” (Rissel,1994)

48. Community Empowerment Model (Rissel, 1994)

49. Healthy Communities • “A healthy city is not a finished product created at one point in time; it is a dynamic place where citizens and government have established relationships and processes that allow them to collaborate in tackling any problems that arise. The healthy city approach calls for collective action, in which all the sectors—local government as well as community, religious and other groups and individual citizens—work together for a common purpose.” (Duhl & Hancock, 1997). • A healthy community works to improve its environments and share its resources so that people can support each other in achieving their highest potential (World Health Organization, 1997) • A Healthy Communities approach integrates four key building blocks: community involvement, intersectoral partnerships, political commitment and healthy public policy (BC Healthy Communities, 2006)

50. Determinants of health: definitions • “factors that enhance the health and well being of the overall population” (PFT ACPH, 1994)