Class 3:

Achieving
Health for All
HLST Winter 2023
Janet Kemei, BScN, MSc, PhD
 Learning objectives
The student will be able to demonstrate:
• Define health
• Describe population
• Demonstrate health population strategies
• Describe community health as an agent of population health
• Describe community health strategies
What is Health?

• “The enjoyment of the highest attainable standard of health is one of the

fundamental rights of every human being without distinction of race, religion,
political belief, economic or social condition” (WHO, 1946).
• “The ability to identify and to realize aspirations, to satisfy needs, and to
change or cope with the environment. Health is therefore a resource for
everyday life, not the objective of living. Health is a positive concept
emphasizing social and personal resources, as well as physical capacities”
(WHO, 1986)
Linking Activity
• https://youtu.be/aJbpRt4r5cE
• https://youtu.be/l2pBNoqYbjY

• . WHAT (“What are the health issues facing this population?”)

• 2. WHAT (“What are the causes or determinants of these problems?”)

• 3. HOW (“How should we take action?”).

• 4. WHO (“With whom should we act?”). Decide at what level you will target your
intervention: individual, family, community, sector–organization, or society–policy.
Population Health: Achieving Health for All
Population Health Cont..
Population health is the outcome of the health of the populations
• Entire range of individual and collective factors
• Focus is whole group or populations
• Maintain and improve health status
• Reduce inequities
Health promotion
Multifaceted exercise
• Education
• Training
• Research
• Legislation
• Policy coordination
• Community development

No one action is effective on it’s own!

 Examples of Health Promotion Programs in
Canada
• Dialogue on Drinking;
• The Breast- Feeding Program
• It's Just Your Nerves: a program on women's use of alcohol and
tranquillizers
• Time to Quit: a smoking-cessation program
• Stay Real: a drug information program
• Break Free: a recent collaborative initiative aimed at reducing
smoking among young people.
Discussion Activity
• https://youtu.be/iGCnY6gEZ8I
• What are the internal and external influences on tobacco and alcohol policies?
• Who benefits from them?
• What are the vested interest?

• Alcohol is the second leading risk factors for death, disease and disability.

• Alcohol creates a significant burden of health and social costs. For example, the estimated
total direct and indirect costs of alcohol in Canada, based on 2002 data, were $14.6 billion,
with over $7.1 billion as indirect costs due to productivity losses, $3.3 billion in direct costs
to health care, and $3.1 billion in direct costs to law enforcement. By comparison, the
estimated total costs of tobacco use in 2002 were $17 billion (Rehm et al.,2006)
 Community Health
• The ability of a community to generate and effectively use assets and
resources to support well-being and quality of life for the community as a
whole.
• Three dimensions: status (how many), structure ( who does it involve, what is
available, and where we live, work, learn and play and the conditions that
impact that), and process (what we do to support health promotion and
collaboration).
• The power of “with”.
• Community Resiliency: achieving improved health for all by responding to
adversity.
(Fournier, Karachiwalla, & Shah, 2021, p. 61)
 Prevention of Diseases and illnesses in the
Community
• Primary prevention: Refers to actions aimed at avoiding the
manifestation of a disease

• Secondary prevention: Deals with early detection when this improves

the chances for positive health outcomes

• Tertiary prevention: Attempts to reduce complications by treating and

rehabilitating individuals with disease; carried out by the health care
system
 Activity
Match the following prevention strategies to the level of prevention
• Checking a client’s BP
• Prescribing daily exercise
• Implementing recreation activities in the community
• Prescribing a cholesterol-lowering mediation following a heart attack
• Referring a client with post-COVID lung disease to improve their
exercise tolerance
Answers
 Community Health: An agent of health
promotion

• Reducing inequities
• Increasing prevention
• Enhancing people’s capacity to cope
• key role in fostering self-care
• Mutual aid and the creation of healthy environments
• Coordinating programs much more closely with those of social
services in order to maintain momentum in the health promotion
effort.
Examples of Community Development
• Asset-Based Community development
• Asset Based Community Development’s premise is that communities can
drive the development process themselves by identifying and mobilizing
existing, but often unrecognized assets
• Citizens Juries
• Involving people (citizens) in discussions about policies and other value-laden
issues (Alberson et al., 2003)
• Community Organizing
• Use problem-oriented approach to mobilize groups of people to accomplish a
particular task.
Population health Strategies
• https://youtu.be/G2quVLcJVBk
 Upstream Strategies
Health Promotion

FIG 3.5 The Ottawa Charter for Health Promotion.

From World Health Organization. [1986]. Ottawa Charter for Health Promotion. Ottawa: Canadian Public Health Association. Retrieved from
https://www.med.uottawa.ca/sim/data/Health_Promotion_e.htm#Ottawa_Charter
Upstream vs Downstream: Introduction
• Upstream interventions and strategies focus on improving fundamental social and
economic structures in order to decrease barriers and improve supports that allow
people to achieve their full health potential.
• The upstream, structural determinants such as social status, income, racism, and exclusion.
• Midstream: Seek to reduce exposure to hazards by improving material working
and living conditions, or to reduce risk by promoting healthy behaviors.
• Focusing on intermediary determinants, or material circumstances such as housing,
conditions, employment and food security
• Downstream Focus on increase of equitable access, at an individual or family level,
to health and social services.
• interventions and strategies focus on providing equitable access to care and services to
mitigate the negative impacts of disadvantage on health.
Sometimes it feels like this. There I am Strategies 
standing by the shore of a swiftly flowing river
and I hear the cry of a drowning man. So I
jump into the river, put my arms around him,
pull him to the shore and apply artificial
respiration. Just when he begins to breathe,
there is another cry for help. So I jump into
the river, reach him, pull him to shore, apply
artificial respiration, and then just as he
begins to breathe, another cry for help. So
back into the river again, reaching, pulling,
applying, breathing and another yell. Again
and again, without end, goes the sequence.
You know, I am so busy jumping in, pulling
them to shore, applying artificial respiration,
that I have no time to see who in the hell is
upstream pushing them in.
cited in McKinlay, 1979, p.9.
What does Health for all Mean?
A process where health is within the reach of everyone everywhere
● Consider the multidimensionality of health as
○ a holistic concept a personal state of wellbeing, not just the availability of health
services or absence of disease; a state of health that enables a person to lead a socially
and economically productive life
● Removing obstacles
● Demands a multisectoral approach (environmental, social, and economic
factors)
● Health and social awareness go hand in hand (community involvement)
● Canadian Context: It means ensuring that policies and practices are in place to
provide Canadians with a healthy environment at home, school, work or
wherever else they may be. It means communities and regions working
together to create environments which are conducive to health.
Working more upstream
• Challenge our assumptions about the causes of health and illness.
• Watch for and address lifestyle drift
• Find people outside your own circle and work together
• Take or offer training in skills needed for working upstream.
• Share and promote your upstream efforts and learning
References

• Abelson, J., Forest, P. G., Eyles, J., Smith, P., Martin, E., & Gauvin, F. P. (2003). Deliberations about deliberative
methods: issues in the design and evaluation of public participation processes. Social science & medicine, 57(2),
239-251.
• Fournier, B., Karachiwalla, F., & Shah, C. P. (2021). Shah’s public health and preventive
healthcare in Canada (6th ed.). Toronto, ON: Elsevier.
• Government of Canada. (2006). Achieving health for all: A framework for health promotion.
https://www.canada.ca/en/health-canada/services/health-care-system/reports-
publications/health-care-system/achieving-health-framework-health-promotion.html
• Health Canada. (2001). Population health template: key elements and actions that define a population health
approach. July 2001 draft. Health Canada.
• National Collaborating Centre for Determinants of Health (2014). Let’s talk: Moving upstream. Antigonish, NS:
National Collaborating Centre for Determinants of Health, St. Francis Xavier University
• Rehm, J., Giesbrecht, N., Patra, J. and Roerecke, M. Estimating chronic disease deaths and hospitalizations due to
alcohol use in Canada in 2002 – Implications for policy and prevention strategies. Preventing Chronic Disease
2006a; 3 (4). [online journal]