HEALTH PROMOTION, EDUCATION and PREVENTION

1. HEALTH PROMOTION, EDUCATION and PREVENTION CONCEPTUAL FRAMEWORK

2. Epidemiology and HPP • 1909, Ludwig Teleky, Vienna: declared the need to investigate the relation between health status and living conditions of the population. • 1943, John A. Riley, Oxford: Social Medicine -- development of non-infectious disease epidemiology. (Public Health in U.S.A.)

3. Cont… • 1945- Henry E. Sigerist defined it as one of the four major task of medicine. “ Health is promoted by providing a decent standard of living, good labor conditions, education, physical culture, means of rest and recreation”. • 1974, Canada. Lalonde’s report, was the first comprehensive theoretical report that proposed Health Promotion as a strategy directed at changing lifestyles.

4. THREE REVOLUTIONS IN PUBLIC HEALTH(Milton Terris 1983) • Fight against communicable/infectious diseases, malnutrition and environmental factors over which people had little control ( water, basic sanitation, food security) • Fight against non-communicable diseases over which people had some personal control, when social conditions and context were favorable (obesity/healthy diet, sedentary lifestyles/exercise, addictions/ATOD abuse, mental health, risky behaviors)

5. HEALTH PROMOTIONThe Third Public Health Revolution(M. Terris 1983, L. Breslow 2004) • Strategic activities to promote health as a “resource for every day life” not merely “absence of disease”, with focus on wellbeing and quality of life, for which it is necessary to empower communities for action; create healthy, supportive and enabling environments; develop skills and build capacity (healthy public policy, healthy settings, life skills)

6. The concept of HP • 1986 the Ottawa Charter for Health Promotion declared : “The fundamental conditions and resources for health are peace, shelter,education, food, income, a stable eco-system, sustainable resources, social justice and equity.Improvement in health requires a secure foundation in these basic prerequisites.”

7. THE HEALTH PROMOTION FRAMEWORK CONTAINED IN THE OTTAWA CHARTER BUILDING HEALTHY PUBLIC POLICY CREATE SUPPORTIVE ENVIRONMENTS HEALTH PROMOTION ACTION DEVELOP PERSONAL SKILLS STRENGHTEN COMMUNITY ACTION REORIENTING HEALTH SERVICES

8. THE OTTAWA CHARTER(86) ANDCCHP(93):PRINCIPLES OF HEALTH PROMOTION • Building/Formulating healthy public policy • Develop personal skills/Developing-Increasing personal health skills. • Create/Creating supportive environments. • Strengthen community action/Empowering communities to achieve well-being. • Reorienting health services. (same) • Building alliances with special emphasis on the media.

9. HP Process HEALTH PROMOTION PROMOTES A POSITIVE VISION OF HEALTH, HEALTH IS SEEN AS A RESOURCE FOR LIFE

10. Conceptual Pillars of Health Promotion • Communication: interpersonal,group,mass. • Empowerment: ownership, giving voice and decision to the individual and community. • Healthy Spaces Health fostering environment • Determinants of Health

11. PUTTING HEALTH PROMOTION IN CONTEXT • It is not synonymous with prevention and health education. • Prevention: delaying the onset of diseases- addressing risk factors, immunization, use of condoms, cholesterol reduction > cardiac disease. • Educate on sanitary issues to inform individuals and groups in regard to issues affecting their health and the risk of getting sick and dying. • Promote healthy lifestyle patterns, that will avoid the probability of exposure to risk factors and modify behaviors: healthy nutritional habits, fidelity, abstinence, etc…

12. Cont… • A process whereby people take control of their health and can improve it • Combines personal selection with social responsibility for health • Uses various basic strategies such as healthy municipalities and communities (HMC), intersectoral collaboration, social participation, and healthy public policies

13. Health Promotion • Goal: CREATE OR FACILITATE HEALTHY POLITICAL, ECONOMICAL,SOCIAL AND ENVIRONMENTAL CONDITIONS AND TO REORIENT THE POPULATION TOWARDS HEALTHY LIFESTYLES • Is a cross cutting strategy for health and development. • It facilitates strategic allegiances. • It deals with the social dimension of health. • It promotes advocacy and empowerment for the individual and the community.

14. 1.Life conditions: Is the reality in which we live. The result of the biological, socio-economical and physical environment of the individual and the community. 2.Lifestyles: Is the way we live based on behavioral patterns determined by the interaction of individual characteristics, social integration, socio-economical and environmental conditions. Determinants of Health

15. Key Issues • Extension of social protection in health. • Reorienting health systems and services with health promotion criteria for increasing the effectiveness of health interventions, promoting quality of care and improving public health practice.

16. HP and the prevention/management of TB/HIV • False assumption that “Knowledge” mean compliance • Lack of perceived risk by health providers and clients Someone else will deal with it. • Control of HIV/TB is more a political and communication challenge than a medical technical issue  Evidence based practices. • Process requires leadership to support field interventions and propel action on behalf of individual and communities at all levels Comfort niche

17. HP, Health Education and social communication • Brochures, posters, videos are not enough to achieve the association of healthy behavior and associated knowledge • How can health workers engage the response of the patients with out behavioral communication and mobilization? • Communication and promotion campaigns that are people centered must be planned, targeted, implemented, monitored and evaluated to determine the impact it has on the program outputs and outcomes.

18. Cont… • Train to mobilize public health personnel at all levels and community towards promoting healthy behaviors and practices. • One of the difficulties is to convince individuals in the community and family environment to adopt and maintain healthy behaviors (auto responsibility for health)

19. Challenges • How far is the institutional responsibility reach? • How can strategic interventions help to develop alliances and promote supportive environment conducive to successful management of the NTBP and prevention control measures for TB, MDR and TB/HIV? • How to ensure that the person will swallow their treatment as daily indicated? • Personal benefit versus collective wellbeing

20. BCC • Methodology that combines communication through mass media and through interpersonal networks to produce an interactive influence on behavior. • Promotes behavioral objectives selected by policy makers and citizens representatives. • Cost effective • Reaches larger segments of the populations • Involves voluntary participation from diverse population groups

21. COMBI (Communication for behavioral change) • Integrates lessons learned through CAUSE and PEOPLE to enhance social mobilization with strategic interventions that will influence policy makers, mobilize support and prompt individuals to adopts and maintain a particular behavior. • Behavioral impact is achievable when strategically planned mobilization and communication programmes are properly executed.

22. Response • Create a C.A.U.S.E. to advocate for political commitment and mobilize resources. (Celebrity—Activity– Unexpected Story ---Symbol – Event) • P.E.O.P.L.E centered to influence personal and community healthy behavior and response: Promote Healthy Behavior– Enable Support – Offer Value – Performance Monitored – Listen to people – Expectations must be met.

23. Process • Research: Model based on reality with community/target group participation • Planed: Define objectives and goals of behavioral modeling • Program: Select modalities of BCC campaigns or other and validate with target groups • Implement campaign • Monitor and evaluate: Define indicators and milestones to assess progress and eventually evaluate impact.

24. Thank you.