Foreign Literature and Journals Health Promotion dates back up to the time when religion and superstition influenced

peoples belief on health and illness. The Babylonians, the Greeks, Egyptians, Palestinians, Romans, and the Chinese have laid down the foundation of most of the health promotion practices that we enjoy today. Concepts on hygiene and sanitation were introduced to civilization by the Greeks whose belief in health and illness was mandated by their gods and goddesses; the quarantine practices that benefit people of today especially in communicable diseases can be traced back during the Palestinian times under the Mosaic Code which emphasized the importance of segregation by separating what is clean from the unclean. The public health sanitation like street cleaning, building construction, ventilation, heating, and water sanitation that we enjoy today are some of the accomplishments of the Romans and Egyptians (Murray, 2009). Even during that time, health was already considered of prime importance and its enhancement was necessary, some for the purpose of achieving balance of the mind, body and spirit and some as a form of luxury and personal indulgence. Whatever the purpose may be, these ancient practices bear the underlying fact that an individual, even in the earliest times, is always in search of activities that can prolong life and improve the quality of life (Marks, et al, 2005). As Health Promotion gains popularity, myriad of definitions rose and overlap with one another. Oftentimes, the term health promotion is used interchangeably with health education, health maintenance, and health protection. The leading organization in managing health, the World Health Organization (WHO) defined Health Promotion as the process of enabling people to increase control over, and to improve their health.(WHO, 1986). During this definitions inception, five key strategies were also identified namely Building healthy public policy, Creating physical and social environments supportive of individual change, Strengthening

community action, Developing personal skills such as increased self-efficacy, and Reorienting health services to the population and partnership with patients (Ottawa Charter, 1986). This definition coincides with the definition of Marks, et al (2005) which is any event, process, or activity that facilitates the protection or improvement of the health status of individuals, groups, communities, or populations. It targets a wider range of population as it intends to focus on the community level which includes environmental interventions such as targeting the built environment (e.g. fencing around dangerous sites) and involve legislation to safeguard the natural environment (Marks, et al, 2005). It encompasses a broader scope as it represents a comprehensive social and political process and with actions directed towards changing social, environmental, and economic conditions so as to alleviate their impact on public and individual health (Health Promotion Glossary, WHO, 1998). A more individualistic approach on Health Promotion is reflected on the definition of Pender, et al. (2006) which states that Health Promotion is the behavior motivated by the desire to increase well-being and actualize human health potential. This definition, on the other hand, includes the behavioral approach of health promotion, which focuses on secondary and primary prevention to improve health status through lifestyle and behavior changes of individuals (Leddy, 2006). These behavioral interventions are primarily concerned with the consequences of individuals actions whose focus is on the concept of empowerment (Marks, et al., 2005). The objective of this approach is to generate changes in the behavior of an individual towards health, so that independence and self-reliance can be fostered. This can be achieved by increasing the awareness and knowledge of an individual on health and ways on how to improve it through health education. Health Education is defined as any planned combination of learning experiences designed to predispose, enable, and reinforce voluntary behavior conducive

to health in individuals, groups, or communities (Green and Kreutuer, 2005). Using Traviss Illness-wellness Continuum, movement in the direction of wellness state must begin with awareness, followed by education, then growth (Kozier, 2008). Therefore, health Education capitalizes on awareness and knowledge in initiating behavioral change in an individual. This insight reflects the difference between health promotion and health education, where health education serves as a tool in implementing health promotion. To further operationalize the definition of health promotion, Breslow stated on his commentary on health promotion in JAMA, 1999 that each person has a certain degree of health that may be expressed as a place in a spectrum. From that perspective, promoting health must focus on enhancing the peoples capacities for living. That means moving them toward the health end of the spectrum, just as prevention is aimed at avoiding disease that can move people toward the opposite end of the spectrum. For this reason, Health promoting behaviors must be geared towards the High -Level Wellness of Traviss Illness-Wellness Continuum. Another definition of Health Promotion deals with the actions done to promote health. Health behavior refers to the actual actions performed by an individual to improve health. Health behavior alone is defined as any activity undertaken by an individual regardless of actual or perceived health status, for the purpose of promoting, protecting, or maintaining health, whether or not such behavior is objectively effective toward that end (WHO, 1998). This definition introduces the other two terminologies that are frequently confused with the promotion of health. There is a mention of the word protection of health, which, according to Sharma (2008), are actions leading to protection of health are those behaviors that protect a person from developing ill-health or specific disease, example of which is immunization against Tetanus. Another is the word maintenance of health where actions under health maintenance

are those that seek to maintain health avoid illness, disability, and so forth. Example would be wearing of seatbelts, eating a balanced diet, and quitting smoking (Murray, 2009). This kind of behavior is motivated by a desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness (Pender, et al., 2006, p. 7). These two terminologies bear the two significant words prevent and avoid, both conveying a negative connotation and focus on the presence of disease. Using Traviss Illness-Wellness Continuum, Health Protection and Health Maintenance behaviors do not encourage movement of an individual toward the High level of Wellness but maintain health on a status quo, preventing health from moving towards the other end of the continuum which is the Premature Death (Kozier, 2008), whereas Health promotion encourage movements to the positive side of the continuum. To clearly delineate the difference between the two, lets take the example of a man jogging around the village every morning. The man jogs everyday because he believes that this will improve his stamina and increase his energy (Health Promotion) and at the same time he is doing this to prevent burn fats and avoid cardiovascular diseases (Health Protection or Disease Prevention) (Pender, et al., 2006). These three foci of health behavior: promotion, protection, and maintenance of health can now be summed up as all actions with a potentially measurable frequency, intensity, and duration performed at the individual, interpersonal, organizational, community, or public policy level for primary, secondary, and tertiary prevention (Sharma, 2008). Health Promotion Behavior, or Health Promotion Practices are used interchangeably in this study, although the term Health-promoting behavior is now being used more often in health literature and bears a renewed interest as behavior is motivated by a desire to promote personal health and well-being (Pender, et al., 2006).

Health Promoting Practices or Behaviors of an individual differ from one person to another. Pender (2006) stated it best that each person has unique personal characteristics and experiences that affect subsequent actions. There are five levels that affect a persons behavior (Sharma, 2008). First, are the individual factors, like the attitude of a person. If a person believes that a healthy body will permit him to perform more challenging tasks, then engaging in health promotion activities would come naturally. According to Fawcett (2005), Environment, culture, family background, work ethic, educational level, social standing, and gender may contribute to the individuals perception of heath and illness. Then personal view and understanding on the concept of health and illness also falls on this level. In the earlier times, if a disease is believed to be caused by an entry of an evil spirit, holes are bored into the skull of the patient to release these spirits. In the Philippines, if illness or disability is caused by nunu sa punso or aswang, people immediately visit an arbolaryo and submit the patient to a tawas to detect the spirit believed to cause the disease. In addition to this, an individuals environment also play a crucial role in his health promotion practices as stated in an article from the Global Health Promotion (Jul, 2010) entitled How does socio economic position link to health behaviour? Sociological pathways and perspectives for health promotion by Weyers S., et al. The study showed that the characteristics of the neighborhood environment influence health behavior of its residents above and beyond their individual background. Therefore, the physical environment also determines the health promotion practices of an individual. Also included in the individual factors are the age, civil status, spiritual beliefs, occupation, and educational attainment of the individual. Second level is the Interpersonal factors where an external factor affects the behavior, example of which is a spouse requesting for a healthy breakfast. Third level refers to organizational factors which include policies that contribute to a better health like a company

that allots 1 hour of exercise for employees every morning. Fourth level is community factors, such as the physical environment an individual is surrounded with. For example, if the person needs to fetch water every day from the communal faucet that is 1 kilometer away from his house, then that activity can be considered as a vigorous form of exercise. Last is the role of public policy factors. For example, if a memorandum coming from the Mayor mandates the cleaning of suspected breeding and resting sites for Dengue mosquitoes three times a week, then that memorandum compels the residents to do such (Sharma, 2008). In this study, the factors that are taken into consideration are the 6 dimensions of healthpromoting lifestyle identified in the Health Promotion Lifestyle Profile II (Walker, et al., 1996). These are the Spiritual Growth, Interpersonal Relations, Nutrition, Physical Activity, Health Responsibility, and Stress Management. Health Promotion Lifestyle Profile II is used to measure the health promoting behavior of an individual. Lifestyle, according to Pender (2006), is defined as discretionary activities that are regular and part of ones daily pattern of living and significantly influence health status. In this study, the term lifestyle is synonymous with Health Promoting Behaviors. Spiritual growth or health is defined as the ability to develop ones inner nature to its fullest potential which includes the ability to discover and articulate ones basic purpose; to learn how to experience love, joy, peace, and fulfillment (Pender, et al., 20 06, p. 104). Spiritual health is essential in assessing the heath-promoting practices because this affects the clients interpretations of life events and health (Chuengsatiansup, 2003 as cited in Pender, et al. 2006). Numerous studies have been done supporting this significant correlation of spirituality and health experiences. One of these is a study entitled Spiritual health, clinical practice stress, depressive tendency and health promoting behaviours among nursing students by Hsiao Y. et al. (2010)

wherein Spirituality was positively associated with health-promoting behaviors. This relationship will contribute to the holistic approach in assessing the health promotion practices of an individual. Interpersonal Relations, likewise, is also vital in assessing health promotion practices as this reflects the social relationship an individual posses. According to Lucas (2005), positive social relationships stimulate the production of a health-promoting hormone and block the production of hormones usually related to stress. Positive social relationships offer a venue for verbalization of feelings of the individual which is necessary for the individual to get in touch with their feelings and emotions and enables the individual to select the most appropriate strategy in dealing with stress through feedbacks from others. This dimension is related to the third dimension of the HPLP II which is Stress Management as high levels of social support have also been linked to positive affect, and may thus protect against distress from life events associated with high stress (Lucas, et al., 2005 p. 130). Stress is defined as anything that may threaten the physical and psychological well-being of a client. Assessment of how an individual handles these stresses may serve as a better predictor of his health promoting practices. Fourth and fifth dimensions of the HPLP II are the Nutrition and Physical Activity, respectively. Nutrition involves the way an individual selects and consumes foods that are essential in promoting a health well-being. Their selection of food must be consistent with the guidelines provided by the Food guide Pyramid. Physical Activity, on the other hand, involves regular participation in light, moderate, and/or vigorous activity (Walker, et al., 1996). Assessment of physical activity is important since sedentary lifestyle, for many individuals, begin with childhood and continues until adulthood (Pender, et al., 2006, p. 102) and lack of physical exercise has been directly related with the occurrence of cardiovascular diseases.

Last, but not the least, is the dimension on Health Responsibility, which involves an active sense of accountability for one own well-being (Walker, et al., 1996). This includes paying attention to ones health through education and exercise of informed consumerism. As Pender, et al., (2006) mentioned, individuals play a significant role in the determination of their own health status because self-care represents the dominant mode of health care in our society. Like breathing, no one else can take care of ones health than the person owning that health. The desire to enhance health and well-being must come from within. Having a poor health promotion practices among public utility tricycle drivers they are at risk in developing TB. Sir Thomas Oliver (2006 ) from Ireland found that 3.06% of the TB infected patients were coach, car drivers and van men. In another study done by Rosenman and Hall (1990),they found that truck drivers have elevated risk for TB. Similarly, Gary and Trinh (2000) found in another study that 62% of taxi drivers were found to be positive for skin test for TB. Based upon these studies, public utility vehicle drivers are at risk in developing TB. (Suarez,M.,The Perception and Prevalence of Pulmonary Tuberculosis among Public Utility Jeepney Drivers on Selected Barangays in Zamboabga City) According to the latest WHO estimates (2007), currently 210 million people have COPD and 3 million people died of COPD in 2005. WHO predicts that COPD will become the third leading cause of death worldwide by 2030.Worldwide, its responsible for the deaths of over 3 million individuals each year. COPD was highest among jeepney drivers affecting 32.5%, 16.4% for bus drivers and the commuters with the lowest prevalence affecting 14.8%. According to the same study PUJ drivers are at risk of contracting Tuberculosis and that 17.5% of them were already affected the same

figure is also projected by Philippine Environment Air Quality Monitoring Team supported by the WHO which they said is relatively high. Air conditioned bus drivers are also not exempted with the negative effects of air pollution as a factor to the development of COPD as they ranked number two affecting 16.4 percent of them as stated by World Bank. One must bear in mind that human health promotion is a moral endeavor. In the individual level, health promotion provides services that will assist humans in their functioning taking into consideration their particular circumstance. Therefore, a need to include the factors that influence a persons health status like mental, physical, spiritual, and environmental factors in the assessment of an individual is a must (Edelman, et al., 2006). This will only be possible if thorough assessment will be done on the health promotion practices of the respondents. Prolonging life and improving its quality is the objective of Health Promotion (Marks, et al., 2005). In order to achieve this goals, health promotion must concentrate more on enhancing the physical, psychological, and emotional well-being of an individual instead of focusing on reducing the risk of acquiring diseases. A more positive approach to promote health is needed to stimulate in individuals the desire to enhance the quality of life.