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Session 1: Health Promotion Concepts and Principles

Learning Objectives
By the end of this session, students are expected to be able to:
 Define health promotion
 Explain the goals, objectives and scope of health promotion
 Describe the principles of health promotion
 Identify health promotion strategies
 Describe health promotion approaches

Definition of Health Promotion

 Health is a state of complete physical, mental, and social well being and not merely(nothing
more) the absence of disease and infirmity.(physical illness)

 Health promotion (HP) ; As stated in the 1986 World Heath Organization Ottawa Charter for
Health Promotion ,is defined as the process of enabling people to improve and increase
control over their health.

 According to WHO, health is the science and art of helping people change their lifestyle to
move toward a state of optimal health.
 Health promotion integrates all dimensions of health, physical, social, mental and spiritual.
 It emphasizes on collective actions through participation of people and communities in order
to improve their health.
 HP action involves helping people to develop personal skills, creating supportive
environments, strengthening communities and influencing governments to enact health
public policies.

Some examples of health promotion activities include:

o Water and sanitation activities
o Nutrition program for a community
o Infection prevention activities such immunization
o Awareness campaign on HIV testing

Goals, Objectives and Scope of Health Promotion

 Goal
o HP aims to strengthen the skills and capabilities of individuals and groups so that they can
take actions to change social, environmental, and economic conditions to improve public
and individual health.

 Main objectives of health promotion

o Prevent disease (preventive and early medical treatment) and early medical treatment,
aimed at preventing diseases before they occur and if they do occur, identifying them early
 and ensuring early treatment to prevent complications (primary and secondary
prevention).
o Prevent complications of diseases by making sure that actions are taken to prevent death
and rehabilitate the person so that they are able to do normal daily living activities (tertiary
prevention).

o Ensure that people are well-informed and able to make healthy choices.

o Help people acquire the skills and confidence to take greater control over their health
(education and empowerment) through behaviour change communication (BCC) or
information education and communication (IEC).

o Helps to promote individual’s ability to make positive decisions about health

o Social change encompasses socio-economic aspects and policies on the promotion of
health.

The Scope of Health Promotion

 The scope of health promotion is determined as much by expected health outcomes as by
methods and forms.
 From its purpose to enable people to gain greater control over the determinants of their
health, health promotion can be defined as any combination of educational and
environmental supports for actions and conditions of living conducive to health.

Health Promotion Priority Action Areas

Build healthy public policy
i. HP policies include legislation, fiscal measures, taxation and organization change.

ii. Identify obstacles to the adoption of health public policies in non-health sectors
and the development of ways to remove them.

 Create supportive environment

o The protection of the environments and the conservation of natural resources must be
addressed in any health promotion strategy.

 Strengthen community actions

o To develop systems for strengthening public participation in health matters. This requires
full and continuous access to information and learning opportunities for health.

 Develop personal skills

o Enabling people to learn and to cope with chronic illness and injuries. This has to be
facilitated in schools, home, work and community settings.

 Reorient(change focus or direction) health services

 o The role of health sector must be in a health promotion direction, beyond clinical and
curative services.
 Moving into the future

o Women and men should become equal partners in each phase of planning, implementation
and evaluation of health promotion activities.
 Work with individuals, families and communities
o It is an active process for better health, encompassing educational components, behaviour
change initiatives; and environmental and legislative interventions strategies

Principles of Health Promotion

Health promotion initiatives should be planned and implemented in accordance with the
following principles:
 Equity in health
o Means that the needs of people should guide the distribution of opportunities for well-
being
o All people have equal opportunity to develop and maintain their health through fair and
just access to health resources

 Empowerment(authority or to give power ) for health

o Health promotion initiatives ( ability of taking action and responsibility) should enable
individuals and communities to assume more power over the personal, socio-economical,
cultural, psychological or political processes through which they are able to express their
needs, present their concerns, devise strategies for involvement in decision-making, and
achieve political, social and cultural action to meet those needs.

 Participatory
o Health promotion initiatives should involve those concerned in all stages of planning,
implementation and evaluation

 Intersectoral
o Health promotion initiatives should involve the collaboration of agencies from relevant
factors

 Sustainable( able to maintain at a certain level)

o Health promotion initiatives should bring about changes that individuals and communities
can maintain once initial funding has ended.

 Multi-strategy
o Health promotion initiatives should use a variety of approaches, including policy
development, organizational change, community development, legislation,
advocacy(public support), education and communication in combination with one another.

 Holistic(whole)
 o Health promotion initiatives should foster physical, mental, social and spiritual health
Pillars of Health promotion according to (WHO)
- Good government
- Promoting Health literacy
-Building health cities and improving urban health
-Increasing social mobilization

Health Promotion Strategies and Approaches

Three Main Strategies Used In the Implementation of Health Promotion

 Enabling( gives some one means of doing things)
-This means taking action in partnership with individuals or groups to empower them,
through the mobilization of human and material resources, to promote and protect their
health.
-Health promotion includes strengthening people’s health knowledge and the skills
required to prevent ill health, enhance and protect healthy behavior.
-This is achieved through Health education, IEC, and Social mobilization interventions
among individuals and communities

 Creating environments that are supportive of health

-Health promotion facilitates mediation in society through which the different interests of
individuals and communities and different sectors, both public and private, are
reconciled(friendly relation) in ways that promote and protect health.
-This is achieved through legal, economic and environmental policies and
legislation(making laws).

 Advocacy (influencing decisions) to create the essential conditions for health

o Advocacy for health implies a combination of individual and social actions designed to
gain political commitment, policy support, social acceptance and systems support for a
particular health programme
o Advocacy may be carried out through lobbying (interest representation), social
marketing, IEC and community organizing, identify health promotion approaches and
strategies

Health Promotion Approaches

 There are various approaches to health promotion which use different means to achieve the
goals, all approaches aim to promote good health and to prevent or reduce the effects of
illness.

Preventive Approach
-This approach aims to reduce premature deaths (mortality) and avoidable diseases
(morbidity or rate of diseases). It has three levels:
i. Primary prevention
 -Prevention of disease onset, example: immunizations
ii. Secondary prevention
-Prevention of the progression of disease, example: screening and other
methods of early diagnosis and treatment
iii. Tertiary Prevention ( focuses on people who are already affected by a disease.
The goal of this is to improve quality of life , by reducing further disability or
preventing the recurrence of illness.

Behaviour Change Approach (information –giving

-This approach aims to bring about change in individual behaviour through changes in
individuals’ knowledge.

It is usually implemented through provision of information related to health risks through the
mass media, leaflets or posters.
In this approach HP is really synonymous with health education that aims to increase
individual’s knowledge about the causes of health and illness.
o An example is giving information to clients about the effects of using excess alcohol and
helping them to explore their own values and attitudes and come to a decision.

Self Empowerment Approach- Educational

-The goal of this approach is to empower individuals to make healthy choices.
-Self empowerment can be defined as the process by which groups and individuals increase
their control over their physical, social and internal environments.
-Education may lead to behaviour change and health promotion. It seeks to provide
knowledge and information, and to develop the necessary skills so that people can make
informed decisions about their behaviour.
-It is strongly linked to health education.
-In order to facilitate self-empowerment, participatory learning techniques allow people to
examine their own values and beliefs and explore the extent to which factors such as past
socialization and social location affects the choices they make.
-Examples of participatory learning include group work, counseling, training, storytelling
and educational drama.

Community Development Approach or Social Change Approach

-Poor infrastructure at rural communities, including lack of: safe water, food, education, good
shelter, and access to health services, as well as poverty, leads to poor health and can results
in premature death.
-This approach focuses on influencing health policy.
-Aims to bring about physical, social, economic, political, and environmental changes to
promote or enhance health
-Improving the socio-economic environment through policy can improve the health of the
individual and community. In this, individuals organize and act collectively in order to
change their physical and social environments.
 -There is participatory planning through community needs assessment, goal setting, resource
planning and task allocation to as many participants as possible.
-The main benefits of this approach is improved networking in a community, identification of
health needs from the user’s point of view, in particular the disadvantaged and socially
excluded groups, development of local services and structures that act as a resource and
improved self esteem and learning of new skills.
-Examples of the social change approach include national policies like those that help the
poor or provide equal access to free medication, and the ministry of health and social welfare
(MOHSW’s) goal to provide a dispensary in every village and ward.
The Ecological Approach
-Focuses on the relationship of the individual to the system in which they act , a relationship
which is seen as interdependence.

-To promote health, an ecosystem(group of organisms that live in and interact with each other
in a specific environment) must offer economic and social conditions conducive to health and
healthful lifestyles.
-These environments must also provide information and life skills that enable individuals to
engage in healthful behaviors.
-Finally, healthful options among goods and services must be available. In an ecological
context, all such elements are viewed as determinants of health. They also provide support in
helping individuals modify their behaviors and reduce their exposure to risk factors

-The Ottawa charter for Health promotion is the name of an international agreement signed at
the first international conference on Health promotion ,organized by world Health
organization and held in Ottawa, Canada in November 1986 which established the core
principles of health promotion which seek to identify and positively affect the root causes, or
determinants of health. These are social and economic factors that determine health status
such as income, education, profession, working conditions, mental status, which in turn
can affect risk factors such as smoking, alcohol consumption and poor eating habits.
-In health promotion it is essential to work with individuals, families and communities. It is
an active process for better health, encompassing educational components; behaviour change
initiatives; and environmental, organizational and legislative interventions strategies. The
process is described below:

Focus Strategies Impact Outcomes

Individuals Educational Behavioural

Motivational Adaptations Better Quality of
Groups
Organizational Health life
Population Environmental
Economic improved
Adaptations
Legislative
Technological
QUATIONS TO STUDENTS
 What is health promotion?
 Can someone please explain the goals, objectives and scope of health promotion?
 What are the principles of health promotion?
 What are the strategies for health promotion?
 What are the approaches in health promotion