Individual Behaviour and the Community Development Health Promotion Approaches - Term Paper Example

HEALTH PROMOTION APPROACHES Individual behaviour and the community development health promotion approaches: Smoking Name Course/Unit Instructor 15 October 2012 Introduction When it comes to the issue of health, World Health Organisation (WHO) does not consider an individual to be healthy when that individual indicates signs of absence of disease or infirmity, but lacks to demonstrate absolute physical, mental and social well-being. As a result, WHO ascertains that absolute health well-being is possible when these conditions are available: peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity (World Health Organisation 2012, p.1). Health promotion is facilitated through diverse individual behaviour and community development health promotion approaches. According to Ottawa Charter for Health Promotion (1986) the health promotion approaches aim to establish and develop personal skills, strengthen community actions, establish supportive environments, create health public policy, and reorient health services (World Health Organisation 2012, p.2). Through this, it becomes possible to achieve absolute health in terms of physical, mental and social wellbeing. Therefore, the paper is an assessment that aims to evaluate and critically analyse individual behaviour and community development health promotion approaches for the smoking population in society. Health promotion The widely used definition of health promotion is the one developed by World Health Organisation in a conference held in Ottawa- Canada, in 1986 (World Health Organisation 2012). Popularly known as Ottawa Charter Declaration (1986), health promotion is considered as; “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 realise aspirations, to satisfy needs, and to change or cope with the environment” (World Health Organisation 2012, p.1). The definition further calls for consideration of health as a resource utilised and enhanced for everyday life, and not just the objective to live. The essence of this is that individuals, groups, and communities have to perceive health as a positive concept that puts emphasis on social and personal resources, without forgetting the physical capacities (World Health Organisation 2012). In this way, there is need for health promotion to be regarded as a responsibility by all stakeholders and not just the health sector, and at same time go beyond the health life-styles to well-being (World Health Organisation 2012, p.1). Health promotion can be viewed to mean a process that empowers individuals and communities in all matters to do with health (Rootman, 2001). In this manner, health promotion facilitates empowerment of individuals and communities, in order for them to increase control over the diverse determinants of health, and in the process, be able to improve their whole health (Healey and Zimmerman 2009). What this statement postulate is that health promotion should involve efforts directed at evaluating and obtaining evidence on process as well as outcome on key areas of empowerment of individuals and communities, interventions, positive health outcomes, and prevention of negative outcomes (Rootman, 2001). Besides, the implication is that consideration in health promotion process has to base on using evaluation process as means to improve the capacities of individuals, groups, and communities in enhancing their control over the determinants of health. Health promotion approaches Health promotion is facilitated through use of diverse approaches that range from individual –focused approaches to community-focused approaches (World Health Organisation 2012). People create and experience health within the settings of their daily life, where they learn, work, play, and carry on with their lives. As a result, health promotion includes and encourages individuals to have responsibility and action of over their health. Apart from putting focus on individual, health promotion approaches target community, whereby, the promotion programmes are directed at individual, local communities, states or the country (World Health Organisation 2012). Ewles and Simnett (2003) ascertain that there are five approaches to health promotion that include medical approach, the behavioural-lifestyle approach, the educational approach, the client-centred approach, and the socio-environmental approach (cited in Whiting and Miller 2009). This assessment only considers the behavioural-lifestyle approaches and socio-environment approaches that are of interest to the objectives of the paper. This is not to mean other approaches indicated are not important. Behavioural-lifestyle approach puts focus on individuals or groups that demonstrate behavioural or social situations that place them at a greater risk of developing poor lifestyles (Whiting and Miller 2009). The approaches normally target individual people or smaller groups considered to be at risk within the larger population in order to develop strategies aimed at changing behaviours of these individuals and groups. The understanding is that if a small percentage of individuals or groups can be changed, then there is likelihood of having a significant higher number of people changing (Whiting and Miller 2009). Therefore, behavioural-lifestyles approaches are likely to target people who smoke, eat poor diet, misuse substance, and many more. Some of the approaches in this category include health education, social marketing, self-help and care skills training (Whiting and Miller 2009). Socio-environmental health promotion approach on the other hand targets community, where they aim to address larger social determinants of health, that may include access to food, housing, income, employment, transport and education, as well as other factors such as addiction, social isolation, and experiences in the early life (Whiting and Miller 2009). A number of health promotion approaches exist at this level that can be used to improve health. Such approaches include establishing appropriate environment that supports health, working with communities to strengthen their capacities, organisational change and planning, enforcement of laws and regulations, and advocating for proper public policy framework (Whiting and Miller 2009). Smoking United Kingdom has a long history of its people consuming tobacco that traces back in the 16th century (Cancer Research-UK 2012). Since this period, tobacco consumption has evolved to become one of the social activities many people engage in, although its health impacts are adverse and rampant. In recent decades, the rates at which people are smoking in the country continue to statistically decline, but practically, the percentage of those who smoke remain alarming in the country (Health Knowledge 2008). At the same time, national statistics shows that more males than female smoke, although changes occur among the teenagers, where more teenage females tend to smoke more than males (Health Knowledge 2008). Furthermore, studies, as well as, statistics show that the rate of smoking is high among the lower socio-economic groups than higher socio-economic groups (Health Knowledge 2008). Statistics of smoking among Muslims and Chinese in the country further show that these demographic groups have less cases of smoking, hence smoking cases are rare. But, the situation is different in other areas such as occupations where established statistics show that soldiers and manual workers have high rates of smoking (Health Knowledge 2008). Besides, studies have established strong relationship between smoking and high alcohol consumption (Health Knowledge 2008). Given this situation, health promotion has become one critical area concerned stakeholders continue to explore and utilise in order to realise meaningful change of behaviour among the affected individuals, communities, and populations. The government has become an important player in this process, where it has actively participated in establishing and implementing policy measures aimed at addressing the issue of smoking in the population (Health Knowledge 2008). Government effort at policy level is premised on the need to realise change of behaviour in individuals by developing behavioural-lifestyle approaches and realise change in socio-environmental by developing community development approaches. In this manner, there are numerous individualised approaches such as social marketing initiatives, brief educative interventions, individual behavioural counselling, group behaviour therapy, pharmacotherapy, self-help materials, and telephone counselling (Health Knowledge 2008). On the other hand, government policy has also emphasised the need to have a change of environment at community level in order to encourage positive behaviours on quitting smoking, while at same time discourage negative behaviours on smoking. The change of environment has been realised through ‘Smoke-free Legislations’ that have been adopted in the country. Some of these legislations include Smoking Kill (1998), Choosing Health: Making Healthier Choices Easier (2004) and Excellence in Tobacco Control: 10 High Impact Changes to Achieve Tobacco Control, enacted before 2008 (Health Knowledge 2008). Appropriate environment that supports health that has been created through policy framework include increasing the age of smoking for young smokers from 16 years to 18 years, media and education campaigns, reducing chances in which tobacco products can be available, limiting tobacco advertisement through legislation, and overall initiatives to regulate tobacco (Health Knowledge 2008). Incorporation of local communities in these initiatives has also been one of the ways the issue of smoking is being addressed in the country. WHO, has also played an important role in these efforts and can be evidenced in the way principles and goals of the Ottawa Charter for Health Promotion (1986) continue to influence the policy direction in the country, especially in key areas of advocacy, enabling, and mediation. Moreover, United Kingdom policy framework reflects the goals of the Charter to ensure creation of healthy public policy, establishing an environment that is supportive, strengthening community actions, developing personal skills, and reorienting health services (World Health Organisation 2012). Health promotion approaches: Beattie’s model Beattie (1991) provides a valuable analogical classification of the series of different health promotion approaches (Green and Tones 2010). Beattie’s model incorporates two essential dimensions that are mode of intervention, ranging from authoritative to negotiated, and focus on intervention, which is either focused on individual or community (Green and Tones 2010). Therefore, health promotion approaches for smoking problem can be facilitated by adopting interventions that are both negotiated and authoritative, where focus on adopted interventions target both individuals and community. The Beattie Model (1991) provides opportunity to map and evaluate diverse health promotion approaches for smoking population in the assessment. It is divided into two dimensions (top and bottom) with two boxes (paradigms) in each of the given dimensions. Furthermore, each paradigm has a description of approaches that are delivered in an authoritarian or ‘top down’ style (Cattan and Tilford 2006). Approaches in this paradigm include health persuasion and legislative action. In the bottom dimension there are two paradigms delivered in a negotiated or bottom up approaches. Some of the approaches here include personal counselling and community development (Cattan and Tilford 2006). The authoritative approaches in the case of assessment can be said to aim to provide information that concerns unhealthy nature of smoking and what change programmes at national level can or should be initiated. On the other hand, the negotiated approaches aim to provide general empowerment to individuals and communities that experience high cases of smoking in order to enable them make healthier choices (Cattan and Tilford 2006). Individual behaviour health promotion approaches According to the Beattie Model, individual behaviour health promotion approaches for smoking individuals include adopting authoritative health persuasion techniques that include advising the affected individuals on the dangers of smoking, educating the individuals on the appropriate positive behaviours they can develop, discouraging negative behaviours, undertaking strategies aimed at behavioural change of the individuals, and conducting mass media campaigns. With regard to negotiated approaches, the problem of smoking can be addressed through counselling sessions that may include opportunistic advice, educative discussions, and encouragement sessions (Denman 2002). At the same time, the counselling sessions should largely constitute individual behavioural counselling, where the smoker interacts on face to face with the counsellor. Apart from counselling, other negotiated approaches include education and group work approaches. Group behaviour therapy is important, where meetings are arranged between counsellors and people who smoke. Information is exchange in form of advice, encouragement, and appropriate behavioural interventions are adopted (Denman 2002). Furthermore, self-help material may be distributed to smoking people, as well as, conducting telephone counselling in attempt to motive the people to quit smoking. Evaluation is critical in health promotion process, where it enables identification and discovery of whether the goals of the approaches have been achieved (World Health Organisation 2001). According to Thompson (1992), there are three issues of concern in health promotion evaluation: concept and design, processes and impact (World Health Organisation 2001). At the same time, evaluation has to extend to the level of establishing the operation of the initiative, the effects, the achievement of objectives and goals, and also alternatives to the interventions (World Health Organisation 2001). Therefore, evaluation of individual behaviour health promotion approaches requires establishing the level at which the approaches are successful in achieving the goals, or not successful, when objectives are not achieved. In this case, evaluation of individual behaviour health promotion for smoking include establishing the response of individual smokers to the programmes, establishing the number of successful individuals who have quit, establishing positive behaviour change among the individual smokers, and establishing the level of turn-up in counselling groups. It has to be noted that the evaluation process incorporate both qualitative and quantitative evaluation such as measurement and verbal communication. Individual behaviour health promotion approaches exhibit advantages such as easy to undertake and implement, easy for smokers to adopt, it is also easy to measure results through evaluation, personalised attention ensures behaviour change is directed and managed properly (Davies and Macdowall 2005). Given that attention is based on individuals, it becomes possible to execute and monitor process, where little resources may be used. Nevertheless, one problem with this approach has to do with high chances of recurrence of smoking behaviours, since the general environment remain intact for promotion and facilitation of smoking behaviours (Davies and Macdowall 2005). Effective re-dress is only realised through ability to address the whole environment that motivates and facilitates smoking behaviours. Community development health promotion approaches According to the Beattie Model, community development health promotion approaches for smokers in the community include adopting authoritative, ‘top down’ approaches that include legislation, policy making and implementation, and also health surveillance (Denman 2002). The aim of legislative measures should aim to stop smoking activities, especially in the threatened population, at same time aim to prevent certain demographic groups from initiating the behaviours or becoming addicted (Denman 2002). Therefore, the role of legislative measures should be reflected in the ability to reduce the exposure, especially to passive smokers, ensure cessation of smoking, conduct massive media education campaigns, put in place initiatives to reduce availability of tobacco products, take necessary measures to limit the level of tobacco advertising, and initiating large-scale tobacco regulation measures (Health Knowledge 2008). On the other hand, negotiated approaches, ‘bottom-up’ methods, target community and the aim is to put focus in interventions initiatives that aims to empower the community in an attempt to ensure environmental factors are eliminated to address the issue of smoking. As a result, some of the approaches aimed at community empowerment include lobbying, undertaking action research, enhancing and promoting skills sharing and training, encouraging group work, and enhancing community development (Health Knowledge 2008). Moreover, the focus at this level is largely to promote resource and skills intensive, and emphasis of policy work is to address context and not the content in addressing and reducing the smoking behaviours. Therefore, partnership initiatives in the community that largely exhibit high level of inclusiveness and participation are largely deemed to be appropriate in ensuring the whole environment that promote and encourage smoking is addressed. Community development in this case is all about developing support for personal and social development, which can be achieved through providing appropriate information, education and health, and enhancing critical skills that can enable smokers to live successful lives. It is an approach that enables people to learn on a continuous basis, giving them opportunity to prepare adequately in tacking smoking behaviours. Evaluation of community development health promotion approaches in this case address the community and this has to do with undertaking change initiatives in at home, in school, work, hospital, and any other community place. As a result, evaluation process in community development health promotion reflects a participative process that involves individuals, community groups, health professions, institutions, and also government (Clark 2001). The evaluation involves collection of data on community initiatives aimed at smoking cessation, data on people who are smoking, data on each institution, agency, body, or organisation involved in community activities of reducing prevalence of smoking, and data on the overall change of behaviour and empowerment initiatives established in the community to address the smoking issue (Clark 2001). Community development approaches exhibit a number of merits. For example, community initiatives of empowerment ensure wide aspects in the environment that contribute to smoking behaviours are addressed (World Health Organisation 2012, p.2). Furthermore, community development approaches ensures macro-level success of the cessation effort given the high number of stakeholders involved in the process, this ensures contribution made by each individual is incorporated to the success of change of behaviour. Nevertheless, one problem associated with community development approaches originates from the long-term weakness associated with ‘bottom-up’ approach, which in most cases is slow and takes longer time to realise objectives and success goals (Kerr 2000). Furthermore, issues to do with community leadership, agenda setting, and mobilization, are likely to be obstacles, especially where prior effort is not made to establish genuine rapport with key stakeholders in the community. Ethical and cultural considerations remain at the heart of health promotion approaches. The health promotion process has to be based on moral principles that advocate for respect for the person, and great level of autonomy has to be observed (Minkler 2004). In this manner, addressing smoking behaviours and issues has to ensure that individuals and the larger community are able to exercise self-determination, choice, nonmaleficence, beneficence and justice (Minkler 2004). In other words, dealing with health promotion approaches for smokers should not deviate from the role to observe and facilitates relationship that is based on choice, decisions, action and moral responsibility that does not invite harm, demean, or shame to the victim. Personal reflection For sometime, I have been convinced that health promotion can succeed based on singular individual behaviour approaches. Looking at individuals such as smokers, alcoholics, and drug abusers, I have always contended that the best way to initiate genuine change of behaviour involves addressing individuals’ issues, thereby, adopting personalising health promotion approaches such as counselling, education, self-care and empowerment, and group therapies. Therefore, I can term this to have been a big subjective and less exposed position. Nevertheless, for the period I have gone through the module and the success I have achieved in accomplishing my project assessment have actually impacted me in a profound manner that has enabled me to realise change of perception and understanding. Reading the World Health Organisation materials, especially the Ottawa Charter for Health Promotion (1986), I am now convinced that effective approaches of health promotion that change rampant negative behaviours are those approaches that address the wider socio-environment in which the victims are live and interact. The emphasis on the wider socio-environment is further informed by the frameworks of community development that postulate that finding solutions to major problems of health requires establishing, enhancing, and developing the community. The development process incorporates diverse stakeholders, who contribute in their various capacities. At the same time, developing community ensures the wider environment is free from determinants of ill health and negative health behaviours. Therefore, the knowledge and experience I have gained so far enables me to look at the big picture with regard to health promotion, instead of the limited and blurred pictured I have always thought is enough in the past. Conclusion Health promotion for the last few decades has become an integral part of health process. Originating from the Ottawa Charter for Health Promotion (1986), it is postulated that achieving the primary tenets of complete or absolute well-being requires ability to empower people and communities to increase control and improve their health. This is to say, when individuals are able to achieve an absolute state of physical, mental and social well-being, then the individuals have power to identify and realise aspirations that enable them to change or cope with their environment. The assessment has successful addressed the aspects of well-being in terms of evaluating individual behaviour and community development health promotion approaches. Reference List Cancer Research-UK., 2012. Smoking Statistics. Available at: [Accessed 16 October 2012]. Cattan, M., and Tilford, S., 2006. Mental Health Promotion: A Lifespan Approach. Berkshire: McGraw-Hill International. Clark, C. C., 2001. Health Promotion in Communities: Holistic and Wellness Approaches. Springer Publishing Company. Davies, M., and Macdowall, W., 2005. Health Promotion Theory. Berkshire: McGraw-Hill International, 2005 Denman, S., 2002. The Health Promoting School: Policy, Research and Practice. London: Routledge. Green, J., and Tones, K., 2010. Health Promotion: Planning and Strategies. London: SAGE. Healey, B., and Zimmerman, S., 2009. The New World of Health Promotion: New Program Development, Implementation, and Evaluation: New Program Development, Implementation, and Evaluation. London: Jones & Bartlett Learning. Health Knowledge. 2008. Smoking: Health and Social Behaviour: The Effects on Health of Smoking and Combating the Issue. Available at: < http://www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2e-health-social-behaviour/smoking> [Accessed 16 October 2012]. Kerr, J., 2000. Community Health Promotion: Challenges for Practice. London: Elsevier Health Sciences. Minkler, M., 2004. Community Organizing and Community Building for Health. 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