HEALTH PROMOTION: Models and Approaches

1 HEALTH promotion : HEALTH promotion : Models and ApproachesModels and ApproachesJOSEF TRAPANIJOSEF TRAPANIEN EN SN Conversion CourseSN Conversion CourseOctober 2007 October 2007 OctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani22 TOPTOP--DOWN VS. BOTTOMDOWN VS. BOTTOM--UPUP Priorities set by HEALTH Priorities set by HEALTH promoters who have the promoters who have the power and resources to make power and resources to make decisions and impose ideas of decisions and impose ideas of what should be donewhat should be done Priorities are set by people Priorities are set by people themselves identifying issues themselves identifying issues they perceive as relevantthey perceive as relevantOctOct--0707EN EN --SN Conversion Course SN Conversion Course J.

2 TrapaniJ. Trapani33 FIVE MAIN APPROACHESFIVE MAIN Medical or Preventive ApproachThe Medical or Preventive Behaviour Change or Lifestyles The Behaviour Change or Lifestyles Educational ApproachThe Educational Empowerment or ClientThe Empowerment or Client--Centred Centred Social Change or Radical ApproachThe Social Change or Radical ApproachTHE MEDICAL THE MEDICAL OR OR PREVENTIVE PREVENTIVE APPROACHAPPROACHOctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani55 THE MEDICAL APPROACHTHE MEDICAL APPROACH AimAim:: Reduce morbidity and premature mortalityReduce morbidity and premature mortality Target whole populations or high risk Target whole populations or high risk groupsgroups HP ActivityHP Activity: promotion of : promotion of medical intervention to medical intervention to prevent or ameliorate illprevent or ameliorate ill--healthhealthOctOct--0707EN EN --SN Conversion Course SN Conversion Course J.

3 TrapaniJ. Trapani66 MEDICAL APPROACHMEDICAL prevention of prevention of onset of disease, immunisation; onset of disease, immunisation; encouraging non smokingencouraging non preventionSecondary prevention preventing preventing progression of disease, Screeningprogression of disease, preventionTertiary prevention reducing further reducing further disability and suffering in those already disability and suffering in those already ill, Rehabilitation, patient education, ill, Rehabilitation, patient education, palliative carepalliative careOctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani77 POPULARITY OF THE MEDICAL APPROACHPOPULARITY OF THE MEDICAL APPROACH Uses Uses scientific methodsscientific methods, epidemiology, epidemiology Prevention and early Prevention and early detection of disease detection of disease is is cheapercheaperthan treatmentthan treatment TopTop--down approachdown approach, led by experts.

4 , led by experts .. reinforces authority of HEALTH professionals who reinforces authority of HEALTH professionals who are viewed as having necessary knowledge to are viewed as having necessary knowledge to achieve resultsachieve results Highly Highly successful examplessuccessful examplesin the past, in the past, eradication of smallpoxeradication of smallpoxOctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani88 DISADVANTAGESDISADVANTAGES Focuses on the absence of disease rather than Focuses on the absence of disease rather than on promoting positive healthon promoting positive HEALTH Based on a medical definition of healthBased on a medical definition of HEALTH Ignores the social and enviromental dimensions Ignores the social and enviromental dimensions of healthof HEALTH Encourages dependency on medical knowledge Encourages dependency on medical knowledge and compliance with treatmentsand compliance with treatments Removes HEALTH decisions from the people Removes HEALTH decisions from the people concerned (paternalistic approach)concerned (paternalistic approach)

5 OctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani99 REQUIREMENTS FOR REQUIREMENTS FOR MEDICAL APPROACHMEDICAL APPROACH Preventive procedures need to be based Preventive procedures need to be based on a sound rationale derived from on a sound rationale derived from epidemiological evidenceepidemiological evidence Relies on having an infrastructure capable Relies on having an infrastructure capable of delivering screening or an immunisation of delivering screening or an immunisation programme, Trained personnel, programme, Trained personnel, equipment and laboratory facilities, record equipment and laboratory facilities, record keeping facilities, effective and safe keeping facilities.

6 Effective and safe vaccinevaccineOctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani1010 EVALUATION OF MEDICAL EVALUATION OF MEDICAL APPROACHAPPROACH Short Term EffectsShort Term Effects Increase in percentage of target population Increase in percentage of target population being screened or immunisedbeing screened or immunised Long Term EffectsLong Term Effects Reduction in disease rates and associated Reduction in disease rates and associated mortalitymortalityTHE THE BEHAVIOURAL BEHAVIOURAL CHANGE CHANGE (LIFESTYLES) (LIFESTYLES) APPROACHAPPROACHOctOct--0707EN EN --SN Conversion Course SN Conversion Course J.

7 TrapaniJ. Trapani1212 AIMS AND ASSUMPTIONSAIMS AND ASSUMPTIONS Encourages individuals to adopt healthy Encourages individuals to adopt healthy behaviours which improve healthbehaviours which improve HEALTH Views HEALTH as a property of individualsViews HEALTH as a property of individuals People can make real improvements to their People can make real improvements to their HEALTH by choosing to change lifestylehealth by choosing to change lifestyle It is peopleIt is people s responsibility to take action to s responsibility to take action to look after themselveslook after themselves Involves a change in attitude Involves a change in attitude followed by a change in behaviourfollowed by a

8 Change in behaviourOctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani1313 LIMITATIONSLIMITATIONS HEALTH related decisions are very complex HEALTH related decisions are very complex Depends on personDepends on person s readiness to take s readiness to take actionaction Complex relationship between individual Complex relationship between individual behaviour and social and environmental behaviour and social and environmental factorsfactors Behaviour may be a response to a Behaviour may be a response to a personspersons living conditions which may be living conditions which may be beyond individual control ( Poverty, beyond individual control ( Poverty, unemployment)unemployment)

9 OctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani1414 METHODSMETHODS Campaigns to persuade people to persuade people Not to smokeNot to smoke To drink To drink sensiblysensibly To adopt a healthy dietTo adopt a healthy diet To undertake regular exercise, To undertake regular exercise, Targeted towards individualsTargeted towards individuals May use massMay use mass--media to reach themmedia to reach themOctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani1515 EVALUATIONEVALUATION Theoretically SimpleTheoretically Simple Ask: Ask: Has the HEALTH behaviour changed after Has the HEALTH behaviour changed after the intervention?

10 The intervention? HOWEVERHOWEVER Change may become apparent only after a Change may become apparent only after a long periodlong period Difficult to determine whether behaviour Difficult to determine whether behaviour change was due to HP interventionchange was due to HP interventionTHE THE EDUCATIONAL EDUCATIONAL APPROACHAPPROACHOctOct--0707EN EN --SN Conversion Course SN Conversion Course J. TrapaniJ. Trapani1717 AIMS AND VALUESAIMS AND VALUES To enable people to make an informed To enable people to make an informed choice about their HEALTH behaviour bychoice about their HEALTH behaviour by providing knowledge and information ANDproviding knowledge and information AND developing the necessary skills developing the necessary skills Does NOT try to persuade or motivate Does NOT try to persuade or motivate change in one directionchange in one direction OUTCOME is clientOUTCOME is client s voluntary choice s voluntary choice which may be different from the one which may be different from the one preferred by HEALTH promoterpreferred by HEALTH promoterOctOct--0707EN EN --SN Conversion Course SN