Effective health promotion or education issues - Essay Example

What is health promotion In brief, health promotion is usually either a government initiative or commercial idea to make people aware and responsiblefor their own health. This can be approached by many methods such as providing information about health risks and hazards, by getting people to participate in learning techniques or organizing individuals to act collectively in order to change their physical and social environments. These can be achieved through such methods as leaflets, posters, magazines, newspapers, the internet, keep fit and slimming classes and campaigns such as 'Cycle to work campaign' or 'Campaigns against phone masts'. Most promotion material is geared towards particular target groups such as teenagers, middle aged men, children, OAPs and pregnant women. Before the theories and definitions of health promotion can be looked at the concept of health must be understood. A concept can be defined as an idea, or mental image of reality, it is the building blocks and elements of a theory (Rodwell 1996). Definitions of health arise from many different perspectives. For some individuals the definition of health is the absence of illness or disease. This definition sends powerful signals that health is about not having a disease. This view that health is the absence of illness or disease, and that medical treatment can restore good health has been criticized because the word health is actually derived from whole, and healing giving rise to the idea that health concerns the whole person (Naidoo & Wills 1994). This definition of health is multi-dimensional, in that it is not solely concerned with physical health, but also addresses mental, social, emotional and spiritual health (Kendall & Latter 1997). This is in keeping with The World Health Organisation (WHO 1946) definition of the concept of health as "Health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity". Health is subject to wide individual, social and cultural interpretation. Individuals experience health and illness, but it is through influences such as culture, class and gender that the experiences are shaped. Images of health are also built on media messages and prevalent ideas about health rights, levels of service, access, awareness and so on. These images of health also include social expectations about what it means to be healthy in a particular society. The nature of health is that the different aspects are inter-related. Some authors, namely Aggleton & Homans (1987) and Ewles and Simnett (1992) believe that health is holistic and one must take into account the different influences and interactions of the different dimensions. The dimensions that they discuss are an inner circle of physical, mental, emotional, social, sexual and spiritual health. This is surrounded by two outer circles of the broader health dimensions, namely social and environmental factors. The social factors link to the structure of society and the link with health, for example, the infrastructure that is required. The environmental aspect takes into account the environment in which individuals live, including housing, sanitation etc. Indeed social advances in living conditions such as improved sanitation and nutrition have been responsible for most of the reduction in mortality rates in the last century ( McKeown & Lowe 1974). However, whilst mortality rates have reduced, the inequalities in health between social class has in fact risen. Naidoo and Wills (1994) argue that one reason for this is that the "distribution of health mirrors the distribution of material resources within society". Britain has inequalities in wealth and income, which are associated with inequalities in health (Townsend et al 1988). The government are aware of the continued inequalities in health and have therefore developed the "Our Healthier Nation" initiative that has the two key aims of increasing life expectancy by reducing ill health and tackling the inequalities in health (Health and Safety Executive 1998). Health is a major focus of interest and concern in society with the notion of health as "the foundation of achievement" (Seedhouse 1986). Health promotion is generally understood as the activities that intend to prevent disease, improve health and thus enhance wellbeing (Naidoo & Wills 1998). Kendall and Latters (1997) argue that health promotion should be aimed at enhancing positive health and wellbeing and not just focussing on the prevention of ill health. This is because they believe that health promotion is often perceived negatively as it advises "giving up pleasurable habits for the sake of avoiding illness in the long term" (Kendall & Latters 1997). Just as there are different concepts of what health is there are different approaches to health promotion that can be used depending on the situation. The medical approach: this approach is targeted at high risk groups with the aim to reduce morbidity and premature mortality. The overall aim is freedom from medically defined disease and disability. The medical approach promotes medical intervention to prevent or reduce ill health and requires individuals to comply with preventative medical procedures. Behavior change: this approach aims to encourage the adoption of healthy behavior that is conducive to freedom from disease. This in turn will ensure improved health through healthy lifestyles. Educational approach: this approach provides the knowledge and information so that individual's can make informed choices with regards to their health behavior. Through having information regarding the cause and effects of health, and the exploration of values and attitudes the individual will develop the skills required for healthy living Empowerment: this approach works with the individual on their own terms. By working with health issues, choices and actions with which the individual identifies enables the facilitation for the individual gain the skills to act on them. Approaches to health promotion are descriptions of what happens, the analytical means of identifying types of health promotion has been the development of health promotion models (Naidoo & Wills 1994). A model can be described as a conceptual framework. It an abstraction of reality in that it is a descriptive picture of practice which adequately represents the real thing. Models are important as they are the theories and concepts of health promotion practice. Using models encourages one to think theoretically and to prioritize. There are many health promotion models available but due to word constraints three models that are relevant to occupational health nurses will be discussed. The aim of health promotion is to focus on changing behavior towards a healthier lifestyle (Alston & Atwell 1990). The stages of change health promotion model developed by Prochaska and DiClemente (1984) has its origins in showing the process through which people travel to change addictive behavior (Kendall & Latters 1997). This model believes that individuals go through many stages in relation to undergoing change and that any changes are not an ending but one of many (Naidoo & Wills 1994). The stages of change are: Precontemplation: Individuals at this point are not thinking about making any changes in their lifestyle. They may not be aware that there is a problem and could be resistant to making changes. Contemplation: at this point the individual may be aware that there is a problem that could be improved, or the potential risks of continuing current behaviour. The individual at this stage is thinking about change in that they are weighing up the costs and benefits of change, but they are not yet ready to make the changes. Preparation: An individual becomes aware that the perceived the benefits of change outweigh the costs. The individual starts to believe that change is possible and worthwhile, they may make small behavioral changes, and make a commitment to act. Action: the individual takes action to change their behavior, At this point the individual needs a clear goal, with realistic planning, and support and rewards to ensure success. Maintenance: Once habits are broken the individual must settle into a new way of behaving. As the new habits become established the individual sustains the change in behavior and moves on to a healthier lifestyle. Prochaska et al (1992) believe that whilst few individuals go through each stage in an orderly fashion they will however, go through each stage. Thus the individuals go through a cycle of change with the end result being a healthier lifestyle. The key to this model is that the individual sees it is in their best interest to change and remains motivated to do so. The Prochaska and DiClemente model focuses on the process of change and the support that individuals might need to enable them to work through the change. However, this model is mainly descriptive and has been critisised for presenting a smooth unidirectional process of change, when change is often fluctuating and unpredictable (Heather 1991). This model only demonstrates how people change but not why they change. By contrast Downie et al (1990) looked at health promotion as three overlapping circles of activity: health education, health protection, and prevention. The three areas overlap and relate to each other in the process that is known as health promotion (Naidoo & Wills 1994). Within the intersecting circles lie seven possible dimensions of health promotion: Preventive services such as immunisations and health screening/surveillance. Preventive health education, e.g. smoking advice. Preventive health protection, e.g. reduction in workplace exposures and provision of personal protective equipment. Health education for preventive health protection e.g. training and education with regards personal protection equipment Positive health education, e.g. healthy lifestyle promotion, healthy options in canteen. Positive health protection, e.g. implementation of workplace policies such as smoking and alcohol policies Health education aimed at positive health protection, e.g. campaigning for protective legislation Finally, health promotion is an important element of the government's health agenda. On forming a new government New Labour set public health policies in line with it's health agenda. Out of this rose a new white paper Saving Lives: Our Healthier Nation, which sets ambitious targets for life expectancy to be increased, and inequalities in health to be reduced. The Labour Government plan to achieve this through it's public health policy in a "third way" (Connelly 1999). Labour's policies are aimed at strengthening communities, and encouraging individuals to seize opportunities and take responsibility for their action. References: Aggleton P, & H. Homans (1987(, Educating about AIDS, NHS Training Authority. Alston R. & C. Atwell (1990) Health promotion - the OHN's role. 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