Health Promotion

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 Learning Objectives
By the end of the session you will be able to:
1. Discuss the conceptual framework of Health in PHC
2. Discuss the goals of health promotion
3. Discuss the Ottawa Charter of health promotion
4. Discuss the health promotion model
5. Distinguish levels of prevention
6. List the principles of health promotion
7. Discuss the dimensions of health promotion
8. Discuss the role of nurses in health promotion
9. Share the Pakistan‟s strategies for health promotion
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Conceptual Framework of Health in
PHC

• HEALTH ILLNESS DEATH

• Health promotion is the process of enabling people to

increase control over and to improve their health.

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 Goals of Health Behavior
• Health Promotion: Is a behavior directed towards
achieving a greater level of health

• Illness Prevention: Is a behavior directed towards

reducing the threat of illness and or disease

• Health Maintenance: Is directed towards keeping a

current state of health.
(Stanhope & Lancaster,
2004)
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Health Promotion

• “Health Promotion is the process of helping

people enhance their well being and maximize their
human potential. It combines education,
organizational involvement, economics, and
political influences to bring about changes in
behaviors of individuals and groups related to
improved health and well-being” (Maurer & Smith,
2005).

• Health promotion is carried out by and with people,

not on or to the people. (International Council of
Nurses, 2000). 5
Change in health
behavior depends
on!!!

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The key to health lies in
the people themselves

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Ottawa Charter – 5 strategies for Health
promotion
• The Ottawa Charter for Health Promotion was the
result of the First International Conference held in
1986 on Health Promotion and has been supported
by the World Health Organization.

• The five priority areas:

– Create supportive environment
• Ensure physical and social environment to
support peoples abilities to live
healthy life
– Strengthening community action,
• Support activities that affect their health 8
 Ottawa Charter…(Cont..)
– Develop personal skills,
• Enable people to „learn throughout life‟ and
prepare themselves for all its stages‟
– Building healthy public policy,
• Putting health on the agenda of all policy
making
– Re-orient health services.
• Community based rather than Institution
based
• Shift to health promotion rather than service
delivery
As a result, many countries adopted and integrated 9
 Principles of Health Promotion
• Involving population as a whole as distinct from people
at risk
• Action on determinants or causes of health, including a
focus on total environment
• Use of diverse but complementary approaches to health
promotion: social network, education, communication,
community development
• Promoting the health behaviour, appropriate coping
strategies, facilitating positive choices
• Increasing knowledge and disseminating
information 10
MODEL FOR HEALTH PROMOTION

Health
Education

Health Health
Protection Prevention

• Downie, Fyfe and Tannahill, 1990

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 Health Education
• Health education is mainly concerned with providing
information about health and illness with the aim of
changing individual attitudes and behaviors
• It is one of the most important component of health
promotion and involves combination of the following
– Motivation to involve health promoting behaviour
– Helping people to make decision about their health and
acquire the necessary confidence and skills to put
their decisions into practice.

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 Health Literacy
• Nutbeam (2000) defined the term health literacy as a
relatively new concept in health promotion.

• Health literacy involves combination of established

ideas concerning the relationship between education
and empowerment. From this perspective, health
education is directed towards improving health
literacy.

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 LEVELS 0F PREVENTION

http://exerciseismedicine.org.au/the-missing-prescription-exercise

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 Health Protection
• Health Protection deals with regulations and policies
such as the implementation of a workplace smoking
policy in the interests of providing clean air or the
commitment of public funds to the provision of
accessible leisure facilities in order to promote
positive health.

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MODEL FOR HEALTH PROMOTION

Health
Education

Health Measures
Health For
No Smoking
Protection Early Detection
Prevention
Policy

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An Integrative Model of Community
Health Promotion

(Stanhope & Lancaster, 2004) 18

An Integrative Model of Community
Health Promotion

Immunization Reinforcement Newborn

shots for Knowledge immunization
community referral

(Stanhope & Lancaster, 2004) 19

An Integrative Model of Community
Health Promotion

Skills Individual
Volunteers
Development who knows
Participation
Project skills

(Luffrey & Kulbok, 1999 in Stanhope & Lancaster, 2004) 20

Who is responsible for
health promotion?

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Dimensions of Health Promotion

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(Health promotion Framework,
Dimensions of Health Promotion
Poverty
Environment Low socio-
Work place economic
status
Malaria
Prevention
Mass level Females don‟t
spray go to DR as
Net he is male
provide

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(Health promotion Framework,
 Where to intervene?
INDIVIDUAL LEVEL:
Behaviour, Psychological and Physical

ORGANIZATIONAL GOVERNMENT
LEVEL: Policies, LEVEL: Policies,
Practices, Programs, Ordinances and Legislation,
Facilities and Resources Enforcement, Regulation ,
Resource Allocation
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Role Of Nurses In Health Promotion

Mitchinson (1995) mentioned that according to Florence

Nightingale (1859),

“I look forward to the day when there will be no nurses

of the sick only those of the well” (p.356).

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 Strategies Proposed by Pakistan

• “Make the paradigm shift in the policy from curative

services to preventive, promotive and primary
health care”

• Effective, efficient and responsive ---health care

system
(Health promotion Framework,
2008)

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 Strategies Proposed by Pakistan

• Raising public sector health expenditures through

a focus on prevention and control of diseases

• Focuses on disadvantaged, weaker sections of society

especially those belonging to rural areas
(Health promotion Framework, 2008)

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 Areas of Health Promotion
• Some examples!
• Health promotion topics are such diverse areas as:
– Adoption of family planning
– Blood Pressure control
– Fat reduction in diet
– Drug abuse prevention etc

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 Conclusion
“Health promotion strategies are not limited to a
specific health problem, nor to a specific set of behaviours.
WHO as a whole applies the principles of, and strategies
for, health promotion to a variety of population groups, risk
factors, diseases, and in various settings”
(WHO, 1986)

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 Summary (Cont..)
To work in a health promoting way means:

1) Focusing on health not only on illness and make

efforts to enhance well-being and not merely focus on
reduction or alleviation of illnesses.

2) Empowering clients by enabling individuals and

groups by supporting people to recognize the value
of their perspective, acquire the skills and confidence
to take greater control of their own health.

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 Summary (Cont..)
3) Recognizing that health is multi-dimensional
including; mental, social, emotional, spiritual, and
sexual needs are as important as physical one.

4) Acknowledging that health is influenced by factors

outside the individual control. Health promotion is
try to address the root causes of ill-health and not
„blaming the victim‟

(Naidoo & Wills, 1998).

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 References
Clarke, A. (1991). Nurses as role models and health educators.
Journal of Advanced Nursing, 16, 1178-1184.
Delaney, F. G. (1994). Nursing and health promotion:
Conceptual concerns. Journal of Advanced Nursing, 20,
828-835.
Lindsey, E., & Hartrick, G. (1996). Health-promoting nursing
practice: The demise of the nursing process? Journal of
Advanced Nursing, 23, 106-112.
Stanhope, M. & Lancaster, J. (2004). Community and public
health nursing. (6th ed.). New York: Mosby.
Stuifbergen, A. K., Seraphine, A., & Roberts, G. (2000). An
explanatory model of health promotion and quality of life in
chronic disabling conditions. Nursing Research, 49, 122- 129.
Tannahill, A. (1985). What is health promotion? Health
Education Journal, 44, 4.

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