HS 2500 - Midterm 1

1. Population Health (other approaches to HP)

- "The health of the population, measured by health status indicators."(Dictionary of Public Health, John Last) ○ Population health is influenced by physical, biological, behavioral, social, cultural, economic and other factors ○ The term may also refer to the health status of a subset of the population, or to the level to which the population aspires ○ Approach - Societal-level policies → Examples; increase tobacco taxes, regulation of sodium levels, bicycle helmet laws - Mass population interventions → Aim to lower the average level of risk in a population by removing risk factors → Examples; mass immunization campaign, sun-safety campaign, health education focusing on condom use - High-risk approach → Focus on individuals and groups that are most susceptible to a particular health problem or behavior → Examples; breast screening, HIV testing, school bullying interventions - The effectiveness of these approaches is monitored through large-scale population health status surveys

Health Education Specialist

- "[a]n individual who has met, at a minimum, baccalaureate-level required health education academic preparation qualifications, who serves in a variety of settings, and is able to use appropriate educational strategies and methods to facilitate the development of policies, procedures, interventions, and systems conducive to the health of individual groups and communities" (Joint Committee, 21) □ Evolved over time and was based on the need to provide people with educational interventions to enhance their health □ Mid 1800s - school hygiene education, PA □ By mid 1900s - spread to public health arena, writers, journalists, social workers, and visiting nurses and primary caregivers were the educators - Burden of work and lack of training on educating health required the need for HE specialists □ Jan,1979 - Role Delineation Project began through a comprehensive process this project yielded --> Entry-level health educator - responsibilities for HE specialists □ A framework for the Development of Competency-Based Curricula for Entry level Health Educators (NCHEC, 1985) - provided a structure for professional preparation programs in HE, that can be used to design competency-based curricula ○ The Documents were comprised and are known as the Framework - seven major areas of responsibility which defined the scope of practice and several different competencies that delineated the responsibilities ○ The CUP model that merged contributed to the development of a three-tiered (i.e Entry, Advanced Level -1, and Advanced Level-3) hierarchal model reflecting the role of the health educator

Methods

- 13,500 students from u of t random selected on basis of the approximately 20-25% response rate typically seen in administration of the National College Health Assessment - NCHA-II survey contains items assessing student health behaviours and health status, access to health information, barriers to academic performance and perceived norms across a range of health areas such as tobacco, alcohol and other drugs, as wells as sexual health

Beginnings - 2920 to 1972

- 1920: Earliest reference ○ The earliest published reference to health promotion was made in 1920 by American public health expert, C.E.A. Winslow ("the art and science of preventing disease, prolonging life and promoting health...) - 1946: Concept refined ○ Concept of HP was refined by a British Medical Historian named Harry Sigerist ○ "Health is promoted by providing a descent standard of living, good labour conditions, education, physical culture, and means of rest and recreation." ○ Prerequisites for health: § A decent standard of living § Good labour conditions § Education § Physical culture § Rest and recreation - 1948: WHO provides a comprehensive, positive definition of health ○ "A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity". ○ This definition provided the basis for the features and values that have come to characterize health promotion practice ○ Health status of western industrialized countries improves due to: 1. Mandatory public health measures 2. Development of the "social safety net" ○ In the 30 years following the end of the Second World War, there was a marked improvement in the health status of Canada + other western, industrialized countries. This improvement occurred for two main reasons 1. Mandatory public health measures, including mass immunization, sewage disposal, water purification and the mandatory pasteurization of milk, substantially decreased the incidence of communicable diseases 2. Years of advocacy efforts by labour unions, community, activists and progressive political movements led to the development of the "social safety net" and other economic reforms. These reforms enabled substantial progress towards the elimination of poverty, poor housing and unhealthy living conditions - Chronic di

History of HP

- 20th C. ○ Many infectious diseases were controlled -- chronic diseases became a greater concern ○ Average life span increased 29.7 years ○ Ex. Invention of penicillin ○ US ranked 89th (out of 22 countries) in crude death rate and 50th (out off 233 countries) in life expectancy ○ Health promotion era of public health began in 1974 ○ Canada published its landmark policy statement --> A New Perspective on the Health of Canadians ○ Lalonde Report in Canada ○ Health Information and HP Act in United States ○ Tommy Douglas, Canada Health Act ○ Four modifiable health - damaging health behaviours identified ○ Inspires public health campaign ○ Number 1 economic burden --> mental health - 21st C. ○ Behaviour patterns continue to "represent the single most prominent domain of influence over health prospects in the US" (McGinnis, Williams-Russo, & Knickman, 2002, p. 82) ○ There is a need for health information to be understood by the average person (avg. person does no know about their health) ○ There is a need for health professionals to provide the public with the information and skills to make quality health decisions - Historical roots of HP ○ We became more aware

Areas of Responsibility

- 4 of the 7 are directly related to program planning, implementation, and evaluation, other 3 can be associated with these processes depending on the program being planned

Conventional Model of Health & Disease

- A medical model that tends to be disease focused - In our culture, and in Western medicine, we rely on a common model of health and disease: ○ Key element is interaction of individuals susceptibility (or resilience) on one hand, and risks (or protective factors) on the other ○ Susceptibility (or resilience) is grounded in individual characteristics such as sex, age, and genetics ○ Risks (or protective factors) range from pathogens and poisons to environmental conditions

Discussion

- A subsequent aim was to assess common personal characteristics as correlates of meeting the guidelines - This study demonstrated that there are differences in sex and weight status among individuals who meet PA, dietary, and smoking guidelines - This study was the first to examine strength training guidelines specifically in the university student population - A need to consider promoting both MVPA and strength training guidelines - This study highlights the need for health professionals to address the low prevalence of healthy behaviours such as PA participation, rather than the traditional focus on risk behaviours such as binge drinking, among university students

Common Issues & Behaviours

- Although many factors come together to determine our health, there are some common issues and behaviours that we deal with in this field. ○ Heart health ○ Obesity ○ Physical activity, nutrition ○ Stress ○ Smoking ○ Mental Health

HP Emergies

- Early 20th century HP emerges as a distinct concept from traditional public health practice or disease prevention, though many of the strategies used to promote health and prevent disease have been around far longer - Ex. The ancient Egyptians developed systems for sewage disposal, distributed surplus grain to feed the poor, and printed warnings against the harmful effects of consuming to much alcohol. (24) their writings, from 4000 B.C, provide some of the earliest records of public health practice and illustrate two HP strategies that have remained in use today 1. Education encouraging individuals to adopt healthy behaviours 2. Healthy public policies at the community level

Values of HP

- Empowerment ○ Defined in the WHO HP Glossary as a "process through which people gain greater control over the decisions and actions affecting their health" ○ Nina Wallerstein, in her paper called Empowerment and Health: Theory and Practice of Community Change, identifies three conditions that contribute to empowerment: 1. Social networks 2. Community participation 3. Community competence ○ Positive Health Impacts § Increased levels of social support § Enhanced comping capacities § Increased life satisfaction § Decreased susceptibility to illness - Social justice and equity ○ We emphasize the role of equitable access to food, income, employment, shelter, education, and other actors are needed to maintain good health ○ There is a large body of research showing that poverty and income inequality are the greatest determinants of health status ○ Lower-income Canadians are more likely to die younger and suffer more illness than Canadians with higher income regardless of age, sex, race or place of residence - Inclusion ○ People who excluded do not have the opportunity to reap the health, social, and economic benefits of full participation in society ○ People can be excluded due to: § Poverty, ill health, gender, race, disability or lac education ○ To ensure that everyone has a voice in the decisions affecting health, we work with members of marginalized groups who face systemic barriers to good health - Respect ○ Respecting a diverse range of viewpoints, cultures and perspectives is an important prerequisite for building sustainable relationships, the basis for action to achieve shared goals

We need both HE and HP

- HE provides concern-arousing, action-stimulating impetus for public involvement and social reform - Without HE, HP would be "a manipulative social engineering enterprise" - HE essential for democracy in decision-making and accountability - HE of the public keeps the social change components of HP accountable to the public it serves - Without policy supports for social change, HE is often powerless to help people reach their health goals.. Even with successful individual efforts= - HE aims a voluntary actions people can take (individually or collectively) for their own health or common good of community - HE is inherent within HP (symbiotic relationship) - Aimed at complementary social & political actions to facilitate organizational, economic &other environmental supports to convert - About enhancing awareness, changing behaviours and creating environment that support good health practices - HP produces results through recruiting and targeting social and political actions and molding them into a form/forms of programs that will target specific gains (planning) - For example, heart disease or cancer = big social problem, and political issue ($)... therefore, HP targets these sectors (organizations that focus on these sectors) and produces programs like "walk of cancer" or heart healthy cookbook." - HP is a broader term than HE - HP = " the combination of education and ecological supports od actions conducive to health" (Green & Kreuter, 1999) - Education refers to HE, and environmental refers to social, political, organizational, policy economic, and regulatory circumstances bearing on health - To reach a state of physical, mental, and social well-being, an individual or group must be able to identify and realize aspirations, satisfy needs, and change or cope with the environment - HP = process of enabling peopl

HP

- Health = + and multidimensional concept - Participatory model of health - Aimed at population in its total environment - Diverse & complimentary strategies - Facilitating and enabling approaches - Incentive measures offered to the population - Changes in persons' status and their environment sought by the program - Non-professional organizations, civic groups, local, municipal, regional & national governments necessary for achieving the goal of HP

Disease prevention

- Health = absence of disease - Medical Model - Aimed mainly at high-risk groups in the population - Concerns a specific pathology - One-shot strategy - Directive and persuasive strategies - Directive measures enforced in target groups - Preventative programs considered the affairs if professional groups from health disciplines

Settings of HP

- Help to understand the behaviour and when, where, and how to build supportive environments that encourage health - Home and family, school, workplace, health care setting, and community 1. Home and Family § A dynamic influence, shaping our: attitudes, practices, behaviours, coping mechanisms, and health behaviour § Generally primary influence shaping who we are as individuals, plays a large role in determining health behaviour § Influenced by internal factors such as values and traditions § Influenced by external factors such as employment status and neighbourhood safety § This setting is in a constant state of flux § Source of information, protector or enabler, considerable impact on health, and primary target for health promotion interventions 2. School § Children and youth spend their most formative, impressionable years in this setting § Peer relationships that affects attitudes and behaviours re formed here § Potential for both profound positive or negative effects § Formal and informal learning about; nutrition, PA, sexual health and behaviour, substance use § Programs in this setting have the potential for enormous impact 3. Workplace § Technological innovations, globalizations, mechanization of manual labour and increased controls on environmental workplace hazards, have changed the nature of workplace HP § While Physical factors such as air quality, hazardous exposures and injures are still a concern, the focus is increasingly moving to social aspects of health and mental health □ Identifying the root causes affecting physical and mental health □ The development of equitable, safe and supportive working environments □ Support good organizational management through policy development ( strong focus) 4. Health Care § Health care settings play a multi-dimensional role in HP

Host and Agent

- If I am elderly, eat poorly, and have little social support, I am very susceptible to the risk posed by exposure to influenza virus - Characteristics which increase/decrease my vulnerability constitute host susceptibility The characteristics of risk such as the virulence of a strain of influenza constitute agent potential to damage health

1969 - Medical Care Act passed by Trudeau government

- Medical Care Act passed by Trudeau government ○ Ensures universal access to health care for all Canadian citizens ○ Emphasis on HP and disease prevention ○ Later re-introduced at the Canada Health Act

Analysis of Risks

- Medicine and epidemiology are concerned with risk analysis: → How do various risk factors and variables affecting susceptibility interact? → What is the probability of a health outcome associated with those variables? ○ *Risk factor analysis requires - population of people with and without a disease of interest and population who have not been exposed to presumed risks (because it is about probabilities)* ○ Anxiety went from 2-4%, now 40% ○ We're talking about it but nothing really done ○ Statistical associations are about a set of observations or a population → For example, we might compare a group of people who have had heart attacks with a group who have not, collecting information about the characteristics of the people in each population and information about the various risks to which they have been exposed. → We may then infer that variables strongly associated with the outcome, say smoking with heart attack, are risk factors for that disease. ○ Associations, Risks are not Causes → Risks are therefore probabilities, statistical associations with a health outcome → An association or probability is NOT a cause; it's a measure of amount of risk. → Smoking is risky because more smokers than non-smokers will get lung cancer or have heart attacks. But we do not know how smoking will affect a given individual's health even though we do know that a group of smokers, as a group, will be less healthy than a group of non-smokers ○ Behaviours Portrayed as Individual Risk Factors → Lifestyle and behavioural choices are a target of interventions. → Social patterning of behaviour: The study of the social determination of health behaviour. → Modifying individual lifestyle is a daunting task. → Blaming people for illness is counterproductive and unfair if significant factors are beyond their control. This is the

Comprehensive approach of HP

- Multi-disciplinary, truly comprehensive HP incorporates elements from many fields such psychology, sociology, nursing, social work, community organizing, and planning & education

Features of HP

- Operationally, HP has a number of unique features that distinguish it from other approaches such as disease prevention 1. A holistic view of health 2. A focus on participatory approaches 3. A focus on the determinants of health 4. Building on existing strengths and assets 5. Use of multiple, complementary strategies

Ottawa Charter

- Over the past 30 years, the field of HP has developed as a way of acting on the root causes of health and wellness. - The Ottawa Charter for Health Promotion emerged in 1986 as the predominant Canadian framework - Defines Health Promotion as: ○ "The process of enabling people to increase control over, and to improve, their health" - To better understand this definition, it helps to appreciate they key values that guide how health promoters work with individuals, groups and communities to address health issues

Shifting away from sub-molecular level

- Reducing ill health to sub-molecular levels has been great for medicine, it has improved medicine's ability to intervene with heightened precision & effectiveness ◊ But gains made have been at the expense of neglecting the whole person (isolation of the disease, including: social , behavioural, and cultural influences on health) ◊ Sub-molecular level = high tech (essentially) ◊ In the medical field, incentives are stacked in favour of high tech, rather than social, cultural & behavioural aspects of care (even though simpler methods could often be as beneficial ◊ As such, HP services - because they aren't high tech - suffer in clinical settings ◊ Favoured and often equated with the high tech used for treating ill health ○ HP looks beyond treating ill health → HP focuses on the whole person in order to enhance health, rather than the sub-molecular level, which tends to be more about reacting to the occurrence of illness → And all of this happens by emphasizing the determinants of health

Measures

- Students provided their age, sex, current residence, ethnicity, relationship status, and year in school - BMI determined from self-report weight and height ○ BMI below 18.50 kg/m2 - underweight, 18.50 to 24.99 kg/m2 healthy weight, Over 25 kg/mm2 - overweight - PA (MVPA, individuals who engaged in 150 mins per week, and strength training two+ a week - classified meeting strength training guidelines - Nutrition ( 5 or more portions of fruit and vegetables per day were coded as meeting dietary guidelines) Smoking ( individuals reported never or not in the past 30 days classified as non-smokers)

HP - Mid 1970's - 2000

- The 1970s brought the next phase in the development of HP - 1974: Lalonde Report - A New Perspective on the Health of Canadians ○ Marc Lalonde (federal Minister of Health) ○ Supported the growing emphasis on reducing health risks by promoting healthy lifestyles ○ The Report resulted in the international recognition of Canada as a leader in the conceptual development of HP, thus beginning a second important phase in HP development that evolved through the latter part of the 20th century ○ Health as a product of 1. Lifestyle 2. Biology 3. Environment 4. Health care organization ○ "individual blame must be accepted by many for the deleterious effect on health of their respective lifestyles" ○ Unhealthy practices --> "self-imposed risks" - 1978: Canadian government establishes Health Promotion Directorate ○ The first bureaucratic structure devoted to HP in the world - 1979: U of T establishes the first Canadian post-secondary degree program in HP - 1979 - 1984 ○ Black Report and Alameda County study demonstrate importance of social, economic, and environmental determinants of health ○ Lalonde Report and lifestyle approach face criticism for victim blaming ○ This research caused by the narrowly focused HP "lifestyle" approach to fall into disrepute. Many HP programs were criticized for "blaming the victim" by ignoring the social and economic barriers to making healthy choices - 1986: First international conference of HP convened in Ottawa ○ Ottawa Charter for HP is developed and becomes the predominant framework for HP practice worldwide - 1986 - 1991: ○ HP expands ○ Provincial governments include HP in bureaucratic structures and funding - 1991 - 1996: ○ HP fields faces challenges ○ Emphasis on accountability and effectiveness ○ Canadian government shifts focus to population h

HP - 2000's and beyond

- The 21st century brought another wave of development ○ New technologies embraced ○ Continuing climate of fiscal restraint ○ Renewed interest in public health due to re-emergence of communicable disease threats ○ Development of professional competencies - 2003: Public Health Agency of Canada (PHAC) is created ○ Separate provincial ministries with public health/health promotion mandate are established - 2004 - 2007: ○ The Public Health Agency of Canada initiated the development of public health workforce competencies. ○ Health Promotion Ontario was funded by the Public Health Agency of Canada to develop the first Canadian set of discipline-specific competencies for health Promotion - 2005: Bangkok Charter for HP in a Globalized World ○ Through the Charter, the WHO sought pledges to address the determinants of health in a globalized world. (34) ○ Specifically, the WHO recommended that the promotion of health become: 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. ○ In 2005 the World Health Organization established the Commission on Social Determinants of Health, in order to help countries and global health partners address social factors and inequalities that affect health. ○ The three overarching recommendations of the Commission include: 1. Improve daily living conditions 2. Tackle the inequitable distribution of power, money, and resources 3. Measure and understand the problem, and assess the impact of action - 2008 : Galway Consensus Conference Statement ○ In 2008, interest in the development of health promotion practice competencies gained momentum with the release of the Galway Consensus Conference Statement on Domains of Core Competency, St

The Ottawa Charter

- The first International Conference on Health Promotion, meeting in Ottawa this 21st day of November 1986, hereby presents this CHARTER for action to achieve Health for All by the year 2000 and beyond. - A response to growing expectations for a new public health movement around the world. - Focused on the needs in industrialized countries, but considered all other regions. - Built on the progress made through the Declaration on Primary Health Care at Alma Ata, the WHO's Targets for Health for All document, and the recent debate at the World Health Assembly on intersectional action for health. - They defined HP - They determined what it means to do HP: → Build healthy public policy → Create supportive environments → Strengthen community action → Develop personal skills → Reorient health services - "This CHARTER for action was developed and adopted by an international conference, jointly organized by the World Health Organization, Health and Welfare Canada and the Canadian Public Health Association. - Two hundred and twelve participants from 38 countries met from November 17 to 21, 1986, in Ottawa, Canada to exchange experiences and share knowledge of health promotion."

The Medical Model

- The foci of health interventions are reducing host susceptibility (e.g. improving the diet of the elderly, getting them immunized for flu) and reducing risk (e. g separating potentially infectious people from vulnerable ones) - The medical model assumes the centrality of the host/agent interaction - Epidemiology - the science of explicating the causes and variations of disease incidence, is likewise based on the host/agent model

Exploring the prevalence and correlates of meeting health behaviour guidelines among university students (Scarapicchia et. al)

- Time characterized by elevated rates of health risk behaviours - unhealthy weight control, decreased PA, increased substance use - Only 22% of university students have ben show n to engage in recommended 150 mins a week od MVPA - Dietary patterns established in university are likely to be maintained in adulthood ○ Fruit and vegie consumption starts to decline at age 20, usually 2 to 5 servings, Women consume more than men - Smoking prevalence increased: ○ Highest among 25 to 34 year olds (23.88%) and among 20 to 24 year old (21.5%), higher among males then females ○ Need for university health initiatives t o target smoking cessation - Gender and weight status have strong effects on health behaviours - The purpose of the current research was threefold: 1. To examine the prevalence of university students meeting MVPA, strength training guidelines, and fruit and vegetable consumption(5> servings), and not smoking 2. To examine gender and weight status differences among students meeting these recommendations 3. To assess personal characteristics (age, ethnicity, gender, body mass index [BMI], weight perception and weight action) as correlates of meeting these guidelines

Measuring Health

- Very difficult so we define health with its opposite = ill health - Death rates - number of deaths per 100,00 residents in the population. Most reliable single indicator of health status of the population, clearly defined event - Life expectancy - the average number of years of life remaining to a person at a particular age and is based on a given set of age-specific death rates - Years of potential life lost - measure of premature mortality (subtract person's current age from expected life expectancy age .. Usually age 75 is used - Disability-adjusted life years - when an accident has occurred (such as paralysis due to a car accident or depression following a stroke), the burden of living with a disability is expressed as the number of years of healthy life lost - Process lends itself to huge assumptions (if not ill or dead, must be healthy!) - These are the measurements used within HP, but they are mot reflective of the intended outcome of HP

Expectations & Assumptions of HP Programs

- What can we expect from HP programs? - HP programs are NOT a "magic bullet" solution to the nation's health concerns. - They ARE one part of the puzzle. - 9 Assumptions of HP 1. Health status is changeable. 2. Health & disease are determined by interactions among biological, psychological, behaviour, and social factors. 3. Behaviour can change, and those changes can influence health. 4. Individual behaviour, family interactions, community & work relationships & resources, and public policy. all contribute to health and behaviour change. 5. Interventions can teach HP-ing behaviours or attenuate (reduce effect of) risky ones. 6. Determinants, nature, & motivation for behaviour must be understood for health behaviour to change. 7. Initiating & maintaining behaviour change is challenging 8. Individual responsibility does not equal victim blaming! 9. For permanent health behaviour change, a person must be motivated & ready. - Operationalizing Assumptions - Important message: - "The greatest chance for success will come to those who have the knowledge and skills to plan, implement, and evaluate appropriate programs" THUS, the focus of the course!! - Efficacious HP efforts are based on assumptions, and follow a basic generic format that includes approx. 6 "steps" (with each step including many, many more!) NOTE: Our Text includes just 5 steps.

Four modifiable risk behaviours

- lack of exercise or PA, poor nutrition, tobacco use, and excessive alcohol use, if changed all causes of mortality could be reduced by 50% (according to one study)

Tetiary prevention

- measures aimed at rehabilitation following significant disease, illness or injury - health status: disability, impairment, or dependency - activities directed at rehabilitation to return a person to maximum usefulness - e.g. diseases management programs, support groups, cardiac rehabilitation programs

Primary prevention

- measures that forestall the onset of disease, illness, or injury - health status: healthy, without signs and symptoms of disease, illness or injury - activities directed at improving well-being while preventing specific health problems - eg. legislation to mandate safe practices, expertise programs, immunizations, fluoride treatments

Secondary prevention

- measures that lead to early diagnosis and prompt treatment of a disease, illness, or injury to minimize progression of health problem - health status: presence of disease, illness or injury - activities directed at early diagnosis, referral, and prompt treatment - eg. mammograms, self-testicular exam, laboratory tests to diagnosis diabetes, hypercholsterolmia programs to prevent reinjury

Process of HP - The Generalized Model

1) Understanding the community & engaging the target population. → Empower them by involving them, kind of like a buy in 2) Needs assessment of the population (chapter 4) - involves some method that is used to get feedback from community/target population. - WHY ASK THE TARGET GROUP? ◊ Empower them by involving them, kind of like a buy in - Buy-in/Ownership is required for success. - Not including input from people in community = mild acceptance at best. - What do we want? Excitement & motivation --- makes a big difference 3) Develop suitable goals & objectives. 4) Create a setting that is appropriate to the intervention. 5) Implement the intervention. 6) EVALUATE!!!!

HP focuses on:

1. Advocacy - conditions of health favourable through advocacy for health as a resource - HP aims at making conditions as a resource (social, economic and personal development conditions) favourable through advocacy for health 2. Enabling - focuses on achieving equity in health - HP focuses on achieving equity in health, reducing differences among SES groups, facilitating equal opportunities and resources to enable all people to achieve their fullest health potential (including access to information, life skills etc.) - What potential barriers can we identify to enable everyone to have equal access? 3. Mediating - demand coordination of sectors - HP demand coordinated action by all concerned re health: governments, health & other social & economic sectors, non-gov, vol. organization, etc.

Introduction to HP in Canada

1. Health Portfolio ○ Oversight by the Minister of Health. ○ About maintaining and improving the health of Canadians. - Supported by the Health Portfolio: Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research, the Patented Medicine Prices Review Board and the Canadian Food Inspection Agency. ○ Approximately 12,000 FTE employees + annual budget of over $3.8 billion. 2. Public Health Agency of Canada ○ Empowers Canadians to improve their health. ○ In partnership with others, focuses on preventing disease and injuries, promoting good physical and mental health, and providing information to support informed decision making. ○ Values scientific excellence and provides national leadership in response to public health threats. ○ Is a federal institution that is part of the Health portfolio. 3. Centre for Health Promotion (CHP) ○ Uses a life stages approach to guide the implementation of policies and programs aimed at enhancing the conditions that enable healthy development. ○ Actions taken are based on principles of population and public health. ○ Addresses matters related to the determinants of health. ○ Facilitates successful movement through the life stages. ○ CHP "acts through programs addressing healthy child development, families, aging and lifestyles, public information and education, as well as issues related to rural health and support of the voluntary sector". ○ Components of the CHP: → Healthy Communities Division → Division of Childhood and Adolescence → Division of Aging and Seniors Health Surveillance and Epidemiology Division - Plus ....... There are lots of organizations at the provincial/territorial & municipal levels that are actively engaged in Health Promotion. - Most publicly funded, health-focused, organizations do HP.

"... better control of behavioural risk factors alone could prevent between __________ of ALL premature deaths, __________ of all acute disabilities, and __________ of chronic disabilities..."

40-70%, 1/3, 2/3

__ out of ___ deaths each year from chronic diseases; heart disease, cancer, and stroke account for _____%

7 out of 10, 50% - Chronic diseases are the most deadly, costly, and most preventable of all heath problems - Much of the death and disability is associated with chronic diseases

Healthy People : The Surgeon General's Report on Health Promotion and Disease Prevention ( USDHEW, 1979) (US)

□ Brought together much of what was known about the relationship of personal behaviour and health status □ Document presented a "personal responsibility" model, depicted how to reduce your health risks and increase chances of good health □ Document was readable format made info available to general public, made this publications so significant

Promoting Health/Preventing Disease: Objectives for the Nation (USDHHS, 1998)

□ First set of health goals and objectives, have defined health agenda and brought forth policy to uphold them

3. Harm Reduction (other approaches of HP)

○ "Any program or policy designed to reduce harm without requiring the cessation of a practice or addiction." ○ Example: needle exchange programs, condom distribution ○ Complements health promotion with empowerment and inclusion values ○ Differs in that HP is broader than high-risk behaviour

2. Participatory Approaches

○ Address health issues by doing things with people rather than doing things for them ○ HP emphasizes this ○ Enable people to take greater control over the conditions affecting their health ○ Most important feature of HP, it embodies the values introduced earlier

Health Promotion

○ Any planned combination of educational, political, environmental, regulatory or organizational mechanisms that the supports the actions and conditions of living conducive to the health of individuals, groups, and communities ○ Knowing everyone has a degree of health that will exist along a continuum ○ Promoting health has to focus on enhancing capacity for living (well) ○ HP encourages movement towards health ○ Respect and work with people with the position they're at ○ "HP takes into account that human behaviour governed by personal factors (e.g. knowledge, expectancies, competencies, and well-being), but also by structural aspects of the environment" ○ The success of HP program is usually linked to the planning of the program (" if you fail to plan, your plan will fail") ○ Increase of 31.5 years in the average life span of a person ○ Witness a disease prevention change "from focusing on reducing environmental exposures over which the individual had little control, such as providing portable water, to emphasizing behaviours such as avoiding use of tobacco, fatty foods and a sedentary lifestyle" (Breslow, 199, p. 1030) ○ US ranks 94th (out of 225 countries) in crude death, 42nd out of 224 countries in life expectancy at birth, and 1st in health care spending ○ Health behaviour - those behaviours that impact a person's health

1984 - Birth of the Healthy Cities Movement

○ Comprehensive approach to health policy at the local level - This conference led to the launch of the "Healthy Cities" project, initiated by the WHO in 1986 ○ Adopted in cities, towns, village and communities worldwide

2. Disease Prevention (other approaches of HP)

○ Concerned with the prevention of chronic diseases contributing to premature mortality ○ In his Dictionary of Public Health, John Last defines four levels of prevention. - Primordial prevention works to eliminate predisposing risk factors such as environmental controls, maternal deprivation or illiteracy. - Primary prevention includes strategies to prevent disease, such as immunization. - Secondary prevention uses screening procedures to detect and treat serious disease as soon as possible. - Tertiary prevention is aimed at stopping the progress of established disease. → For example, after a heart attack, a patient may undergo cardiac rehabilitation to prevent a relapse. ○ HP vs. Disease Prevention - Similar strategies, focus on prevention of diseases - Differences → Focus on assets and strengths → Commitment to participatory approaches → Moves beyond biological factors to focus on other causes of health and illness → Example: diabetes treatment now involves self-monitoring of blood sugars → Illustrates a participatory approach, and empowerment

HE, Disease Prevention & HP

○ Consider differences between HP & Disease Prevention(DP) ○ HP roots in HE ○ HE still is an integral part of HP ○ Are unique differences between HE and HP ○ HE = more specific to a role with a purpose within HP ○ HP = more broad and includes various factors ○ HE used to enable HP - Disease Prevention - most deaths & disabilities are directly related to chronic diseases

1. Holistic View of Health

○ Considers not just physical health, or absence of disease, but also mental and social well-being ○ WHO definition of health incorporates these concepts ○ Health - "a state of complete physical, mental and social well-being rather than a mere absence of disease or infirmity" - Health as "a resource for everyday life"

The emergence of HP to target lifestyle

○ HE historically successful in public health campaigns, e.g. immunization ○ Were concerns about HE's ability to address lifetime habits (lifestyle choices) ○ Need identified: Various sectors needed to come together to influence the health of the population ○ Ex. Public health campaigns such as immunizations, e.g. HPV in schools -- through patient education and self-care initiatives ○ Recognition: Various sectors and new sources of influence (e.g. economic & regulatory measures) would need to join together to make a stronger collective approach to HP ○ Bring multiple social forces together, making them strong enough to influence the problems, concerns, conditions of behaviour and lifestyle ○ The collective approach = recognized to be much bigger and more influential than HE on its own ○ Health educator became aware of the need for positive approaches HE → Must be voluntary, of not it will not have lasting effects ○ Positive = enhancing health and creating health potential rather than focusing on disease prevention ○ It became self-evident that HE could only develop its full potential if supported by structural measures (legal, environmental, mental, regulatory, etc.) → End goal --> Trying to get people to change their behaviour voluntarily ○ Lifestyle - are patterns of choices made from alternatives available to people according to their SES circumstances and the ease with which they are able to choose certain ones over others (at the heart of HP) → An enduring pattern of behaviour or socialization - Focus on determinants of health, rather than measuring and explaining disease at sub-molecular level

5. Multiple, Complementary Strategies

○ HP applies multiple, complementary strategies ○ Uses a comprehensive approach ○ Levels of intervention vary: - Individuals - Networks (families, social, groups/communities) - Organizations - Entire populations/society ○ Ottawa Charter action areas: 1. Build healthy public policy 2. Create supportive environments 3. Strengthen community action 4. Develop personal skills 5. Re-orient health services ○ There are a variety of HP techniques or strategies that can help address the Ottawa Charter action areas, examples include - health communication/ education, self-help/mutual aid, organizational change, community development and mobilization, advocacy, policy development, and intersectoral collaboration ○ Research indicates that health promotion programs using multiple strategies are more affective than those with a single strategy approach

4. Strengths and Assets

○ HP practice builds on practice factors promoting the health of individuals and communities ○ May include; - Community leaders, existing programs and services, strong social networks, community institutions and events that bring people together

Health Promo

○ Health Promotion (all encompassing) - "Any planned combinations of educational, political, environmental, or organizational mechanisms that support actions and conditions of living conducive to the health of individuals, groups, and communities (Joint Committee, 2012) ○ "Each person has a certain degree of health that may be expressed as a place in a spectrum (Breslow,1999) ○ HP must focus on enhancing people's capacities for living ○ "HP takes into account that human behaviour is not only governed by personal factors, but also the structure of the environment (Vogele, 2005, p.272) ○ Personal factors & social determinats of a person will follow through with the program at hand ○ Health is a positive concept ○ A resource for everyday life, rather than the objective of living ○ Its about making the healthier choice the easier choice ○ The science and art of helping people change their lifestyle to move toward a state of optimal health ○ Is not just the responsibility of the health sector, but goes health life-styles to well-being

Health Education

○ Health education is "using evidence-based practices and/or sound theories that provide the opportunity to acquire knowledge, attitudes, and skills needed to adopt and maintain healthy behaviours" (Joint Committee, 2012) ○ What groups were involved in the gathering of this evidence? ○ "any planned combination of learning experience designed to predispose, enable ,and reinforce voluntary behaviour conducive to health in individuals, groups, and communities" (Green & Kreuter, 2005, p. G-4). ○ Evidence based ---> evidence in form (realizing its not everything but were on the right track ○ What qualifies for evidence? □ Does not necessarily have to be proven ○ Health education is a planned learning experience to facilitate voluntary change in behaviour ○ HE is concerned with "health directed behaviour" for disease prevention or further disease progression ○ HE is used for solving discrete and immediate problems of importance to individuals/groups (e.g., family planning, immunization programs, screening programs)

Program Planning

○ Systematic planning is important for the following reasons (Hunnicutt, 2007a): → Planning forces planners to think through details in advance. → Planning helps to make a program transparent. → Good planning keeps the program stakeholders (any person or organization with a vested interest in a program) informed. → Planning is empowering. → Once decision makers (those who have the authority to approve a plan) give approval to the resulting comprehensive program plan, planners and facilitators are empowered to implement the program, encouraging ownership of the program. → Planning creates alignment. ○ All organization members have a better understanding of where they "fit" in the organization and the importance that the plan carries. ○ Pre-planning - allows a core group of people (or steering committee) to gather answers to key questions that are critical to the planning process, it also helps clarify and give direction to planning which helps stakeholders avoid confusion as the planning progresses ○ Planners need to have a very good understanding of "community" - "a collective body of individuals identifies by common characteristics such as geography, interests, experience, concerns or values." (ex. A cancer-survivor community, religious community, etc.) ○ Priority population - those for whom the program is intended to serve and the environment in which it exists → They need to be engaged and included in the planning process ○ When is the best time to plan such a program, what data are needed, where the planning should occur, what resistance can be expected, and generally, what will enhance the success of the project" (Minelli & Breckon, 2009, p.138)

3. Determinants of Health

○ The range of social, economic, and environmental factors that affect health status of individuals or populations ○ The Public Health Agency of Canada identifies the following; 1. Income and Social Status 2. Social Support Networks 3. Education and Literacy 4. Employment/Working Conditions 5. Social Environments 6. Physical Environments 7. Personal Health Practices and Coping Skills 8. Healthy Child Development 9. Biology and Genetic endowment 10. Health Services 11. Gender 12. Culture

Jan 1979, the Role Delineation Project began (National Task Force on the Preparation and Practice of Health Educators, 1985)

○ This project yielded a generic role for the entry-level health educator