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HEALTH PROMOTION AND PROTECTION

Community health nursing (University of Cebu)

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COMMUNITY HEALTH NURSING

LECTURE

Midterm Lesson 1: Health Promotion and

 Eventually, these Disease
health promotion activities led
to a change in public policy, which now requires
COMPARISON BETWEEN HEALTH the manufactures to add a warning label directly
PROMOTION AND HEALTH PROTECTION to the package.
 Health promotion experts hope that by educating
 Multiple public and private organizations function people about the danger of certain elective
to improve the health and wellbeing of the behaviors, they will gradually curb their behavior
general public. and make healthier choices.
 Some of these bodies function independently,
others collaboratively, but all are dedicated to HEALTH PROTECTION
building and maintaining an environment  is concerned with preventing the spread of
that supports a healthy population. communicable diseases by establishing
 These groups may be more broadly generalized minimum standards, often in the form of
into two categories that guide various regulatory regulations.
and care-oriented organizations:  Health protection is often managed by the public
 health promotion sector.
 health protection  In the United States, the responsibility of
establishing and maintaining health protection
HEALTH PROMOTION standards is entrusted to government agencies
 Health promotion addresses large scale public like the Food and Drug Administration,
health concerns, beginning with the well-being of Environmental Protection Agency, and
each individual Department of Health and Human Services.
 Health promotion activities are those which seek  Another example of the standards set for health
to modify the behavior of individuals by protection includes the standardized response
improving the choices that affect society at large. and reporting procedures, occupational safety
 The goal is to decrease the risk of illness or standards, and certain guidelines for optimizing
disease and improve overall health. worker rehabilitation following injury.
 Many of the initiatives that fall under the  The Occupational Safety and Health
umbrella of health promotion are educational in Administration regulates many of these
nature. workplace administrative duties in the U.S.
 These educational initiatives address the  As a leading provider of occupational medicine,
individual’s knowledge of specific risk topics Concentra works closely with these agencies to
such as: nutrition, physical fitness, sexual assist employer efforts to follow the proper
practices, drugs and alcohol, tobacco, mental employee health and safety regulations.
health, family planning, and multiple forms of  Concentra also partners with employers to offer
abuse. ambulatory medical care to their employees
 In the many instances within the United States, such as pre-employment testing, primary care,
health promotion initiatives can become a part of and urgent care for ill or injured workers.
a larger public policy.  A good example of health protection is the
 A popular example of successful health regular testing of soil where farmers grow
promotion is the warning label that now exists on produce or raise items for consumption.
cigarettes.  By ensuring that food supply will not be
 Historically, cigarettes were considered socially contaminated with agents of disease, the FDA is
acceptable, and commonly sold without any able to prevent people from eating tainted food
warning about the risk to the health of the user. and becoming sick.
 However, health experts noted the increased
incidence of disease and began to educate the
public on the risks of smoking and tobacco use.

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THE OTTAWA CHARTER FOR HEALTH  Prerequisites for Health

 The fundamental conditions and
resources for health are:
1. peace,
2. shelter,
3. education,
4. food,
5. income,
6. a stable eco-system,
7. sustainable resources,
8. social justice, and equity.
 Improvement in health requires a secure
foundation in these basic prerequisites.

The 3 Basic Strategies for Health Promotion

1. Advocacy for Health
 Good health is a major resource for
 The first International Conference on Health social, economic and personal
Promotion, meeting in Ottawa, Canada this 17th development and an important
to 21st day of November 1986, hereby presents dimension of quality of life.
this CHARTER for action to achieve Health for  Political, economic, social, cultural,
All by the year 2000 and beyond. environmental, behavioral and biological
 This conference was primarily a response to factors can all favor health or be harmful
growing expectations for a new public health to it.
movement around the world.  Health promotion action aims at making
 Discussions focused on the needs in these conditions favorable through
industrialized countries, but took into account advocacy for health.
similar concerns in all other regions.
 It built on the progress made through the 2. Enabling all people to attain their full health
Declaration on Primary Health Care at Alma-Ata, potential
the World Health Organization's Targets for  Health promotion focuses on achieving
Health for All document, and the recent debate equity in health.
at the World Health Assembly on intersectoral  Health promotion action aims at
action for health. reducing differences in current health
 Health promotion status and ensuring equal opportunities
 is the process of enabling people to and resources to enable all people to
increase control over, and to improve, achieve their fullest health potential.
their health.  This includes:
 To reach a state of complete physical, a) a secure foundation in a
mental and social well-being, an supportive environment,
individual or group must be able to: b) access to information, life skills
 identify and to realize aspirations and opportunities for making
 satisfy needs, and healthy choices.
 change or cope with the  People cannot achieve their fullest
environment. health potential unless they are able to
 Health is, therefore, seen as a resource for take control of those things which
everyday life, not the objective of living. determine their health.
 Health is a positive concept emphasizing social  This must apply equally to women and
and personal resources, as well as physical men.
capacities. 3. Mediate
 Therefore, health promotion is not just the  Mediating among the different sectors of
responsibility of the health sector, but goes the society in efforts to achieve health.
beyond healthy life-styles to well-being.  The prerequisites and prospects for
health cannot be ensured by the health
sector alone.

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 More importantly, health promotion

demands coordinated action by all 2. Create Supportive Environments
concerned by:  The inextricable links between people
a. governments, and their environment constitutes the
b. health and other social and basis for a socioecological approach to
economic sectors, health.
 The overall guiding principle for the
c. Non-governmental and
world, nations, regions and communities
voluntary organization,
alike, is the need to encourage
d. local authorities, reciprocal maintenance – to take care of
e. Industry and each other, our communities and our
f. the media. natural environment.
 People in all walks of life are involved as  The conservation of natural resources
individuals, families and communities. throughout the world should be
 Professional and social groups and emphasized as a global responsibility.
health personnel have a major  Changing patterns of life, work and
responsibility to mediate between leisure have a significant impact on
differing interests in society for the health.
pursuit of health.  Work and leisure should be a source of
 Health promotion strategies and health for people.
 The way society organizes work should
programmes should be adapted to the
help create a healthy society.
local needs and possibilities of individual
 Health promotion generates living and
countries and regions to take into working conditions that are safe,
account differing social, cultural and stimulating, satisfying and enjoyable.
economic systems.  Systematic assessment of the health
impact of a rapidly changing
5 PRIORITY ACTION AREAS PROVIDE environment – particularly in areas of
SUPPORT TO THESE 3 STRATEGIES technology, work, energy production and
Health Promotion Action Means: urbanization – is essential and must be
1. Build Healthy Public Policy followed by action to ensure positive
 Health promotion goes beyond health benefit to the health of the public.
care.  The protection of the natural and built
 It puts health on the agenda of policy environments and the conservation of
makers in all sectors and at all levels, natural resources must be addressed in
directing them to be aware of the health any health promotion strategy
consequences of their decisions and to
accept their responsibilities for health. 3. Strengthen Community Actions
 Health promotion policy combines  Health promotion works through
diverse but complementary approaches concrete and effective community action
including legislation, fiscal measures, in setting priorities, making decisions,
taxation and organizational change. planning strategies and implementing
 It is coordinated action that leads to them to achieve better health.
health, income and social policies that  At the heart of this process is the
foster greater equity. empowerment of communities – their
 Joint action contributes to ensuring safer ownership and control of their own
and healthier goods and services, endeavors and destinies.
healthier public services, and cleaner,  Community development draws on
more enjoyable environments. existing human and material resources
 Health promotion policy requires the in the community to enhance self-help
identification of obstacles to the and social support, and to develop
adoption of healthy public policies in flexible systems for strengthening public
non-health sectors, and ways of participation in and direction of health
removing them. matters.
 The aim must be to make the healthier  This requires full and continuous access
choice the easier choice for policy to information, learning opportunities for
makers as well. health, as well as funding support.

4. Develop Personal Skills

 Health promotion supports personal and
social development through providing

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information, education for health, and  Caring, holism and ecology are essential
enhancing life skills. issues in developing strategies for
 By so doing, it increases the options health promotion.
available to people to exercise more  Therefore, those involved should take as
control over their own health and over a guiding principle that, in each phase of
their environments, and to make choices planning, implementation and evaluation
conducive to health. of health promotion activities, women
 Enabling people to learn, throughout life, and men should become equal partners
to prepare themselves for all of its
stages and to cope with chronic illness
Theories of Health Promotion
and injuries is essential.
 This has to be facilitated in school,  Health promotion is the process of encouraging
home, work and community settings. people to make healthy choices and motivating
 Action is required through educational, them to be consistent with their intentions based
professional, commercial and voluntary on theories related to human behavior.
bodies, and within the institutions
themselves. The 5 Approaches to Health Promotion
5. Reorient Health Services 1. Health Promotion Model (HPM)
 The responsibility for health promotion in  Nola Pender
health services is shared among  based on the idea that people’s
individuals, community groups, health experiences affect their health
professionals, health service institutions outcomes.
and governments.  Health promotion models are focused on
 They must work together towards a exploring people’s attitudes about health
health care system which contributes to and individual experiences related to it.
the pursuit of health.  According to the theory, to understand
 The role of the health sector must move most of their health-related decisions,
increasingly in a health promotion one would have to look at people’s:
direction, beyond its responsibility for o Lifestyles
providing clinical and curative services. o psychological health
 Health services need to embrace an o social and cultural environment.
expanded mandate which is sensitive  For example, not eating fresh
and respects cultural needs. vegetables because one grew up not
 This mandate should support the needs consuming produce is a way of
of individuals and communities for a understanding why someone may suffer
healthier life, and open channels from a severe condition like obesity.
between the health sector and broader
social, political, economic and physical 2. Health Belief Model (HBM)
environmental components.  The Health Belief Model theory suggests
 Reorienting health services also that a person’s belief of a diagnosed
requires stronger attention to health illness combined with their view of a
research as well as changes in treatment’s effectiveness predicts their
professional education and training. likelihood of adopting a change.
 This must lead to a change of attitude  If someone suffers from an illness that is
and organization of health services hard to diagnose, they might find it
which refocuses on the total needs of harder to prioritize treatment for the
the individual as a whole person. cause.
 Based on this idea, health practitioners
Moving into the Future might take immediate action of telling
 Health is created and lived by people someone that they’re either susceptible
within the settings of their everyday life; or have a serious medical condition.
where they learn, work, play and love.  Moreover, they might expect a person to
 Health is created by caring for oneself question the medical approach if they
and others, by being able to take don’t feel the symptoms and show
decisions and have control over one’s apprehension toward medical advice.
life circumstances, and by ensuring that  What follows this initial outcome might
the society one lives in, creates be an informed recommendation of the
conditions that allow the attainment of risk factors that can worsen illness.
health by all its members.

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 In more severe cases of non- o People quit smoking because

compliance, healthcare leaders must they believe it will improve their
develop strategies based on the HBM. health.
 The belief that action will lead to
Six Health Belief Model Concepts beneficial results makes a person more
1) Perceived Susceptibility likely to take action.
 refers to a person’s belief about their  Sometimes the benefits of changing
chances of getting a certain condition. behavior are not strong enough to cause
 For a person to take action, they must a change, even when a person believes
believe they are at risk for disease, they are susceptible.
illness or negative health outcomes.  The perceived benefits may be
When people believe they are at risk for outweighed by perceived barriers.
a disease, they will be more likely to do
something to prevent it from happening. 4) Perceived Barriers
  the most significant factor in determining
 The opposite is also true: when people behavior change.
believe they are not at risk or are at low  Perceived barriers are a person’s view
risk, they tend to have behaviors that of the obstacles that stand in the way of
are less healthy. behavior change.
 Perceived susceptibility alone is often  If barriers are stronger than benefits,
not enough to cause behavior change. change will not occur
For example, older adults are among  Barriers can be:
those most at risk for food-borne illness,  Tangible barriers
often with serious ill health effects.  lack of financial
 Older adults may know they are at risk resources, lack of
for food-borne illness but may continue transportation, childcare
to use unsafe food-handling practices needs, etc.
 Intangible barriers
2) Perceived severity  psychological, like fear
 refers to a person’s belief about the of pain, embarrassment
seriousness or severity of a disease. or inconvenience.
 Severity can be based on medical 5) Cues to action
consequences, like death or disability, or  are events, people, or things that trigger
personal beliefs about how the condition people to change behavior.
or disease would affect their life.  Advice from others, the illness of a
 For example, despite public health family member or social media can
recommendations, some people do not provide cues.
get the flu vaccine. They probably know  Restaurants that provide nutrition
they can get the flu, but may believe that information on their menus offer a cue to
getting the flu will not be serious. consider calorie content in food choices.
 Perceived severity might also be  Posters in public restrooms offer hand
heightened among those self-employed washing cues. Highway signs to “buckle
because missing a week of work means up” provide cues to action.
reduced income.  Calendar reminders and mobile device
 When perceived susceptibility and alarms can also trigger action.
severity are heightened, people are  Cues can also be internal, such as chest
more likely to take action. pain, discomfort or fatigue fear of pain,
embarrassment or inconvenience.
3) Perceived benefits
 refer to a person’s opinion of the value 6) Self-efficacy
or usefulness of a new behavior in  is a person’s confidence and belief in
lowering the risk of disease. ability to take action or perform a given
 To make a change, people must believe behavior.
that the change will have a positive  People generally do not try to adopt new
result. behaviors unless they believe they can
 For example: do them.
o people with diabetes take  A person who thinks altering their
medication believing it will work behavior is worthwhile (perceived
to control blood sugar. benefit) but is unsure of their ability to
make a change is unlikely to attempt
lifestyle changes.

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 In other words, even if a person believes

adopting healthier behaviors will have 4. Theory of Reasoned Action (TRA)
significant benefits, they are unlikely to  Although it’s not a model, this theory is
change current behaviors if they doubt highly credited under the HBM and is
that the barriers to change can be considered separate.
overcome.  The theory assumes that a person will
 Self-efficacy can be increased with act a certain way on a health issue
encouragement, training and other depending on their willingness due to
support. subjective norms.
 The norms are usually the result of
3. Transtheoretical Model (TTM) social and environmental surroundings
 Sometimes when a healthcare and the person’s perceived control over
professional informs a patient about a that behavior
potential medical condition and  For example, a healthcare professional
educates them about preventive might ask a young man if his close circle
measures, the person may believe them of friends thinks he should incorporate
but avoid immediate action. exercise into their daily routine.
 This choice is based on the idea that  In a medical study done by the Iran
when someone receives information University of Medical Sciences,
about their health, they might think researchers used TRA to evaluate the
about it before acting on it. effectiveness of an educational
 Because of such behavior, the intervention dealing with breakfast
transtheoretical theory outlines six consumption amongst children and
stages that someone might go through: adolescents.
a) Pre-contemplation
 the patient does not 5. Diffusion of Innovation Theory (DOI)
intend to act yet despite  Diffusion of Innovation (DOI) is another
knowing about the theory that falls under community and
medical condition organization participation models.
b) Contemplation  The theory investigates how a new idea
 the patient is planning or health behavior is disseminated in a
to act with intention. social structure or community and
c) Preparation identifies what influences how quickly
 the patient establishes a the idea or behavior is adopted.
course of action and  The adoption of new ideas depends on
sets a timed objective. the type of innovation, communication
d) Action channels, time and social system.
 the patient takes the  According to the Health Communication
course of action Capacity Collaborative, the DOI model
e) Maintenance “highlights the uncertainties associated
 the patient focuses on with new behaviors and helps public
not relapsing and health program implementers consider
maintaining a plan ways to resolve these uncertainties.
within their daily
routines. PREVENTIVE APPROACH TO HEALTH
 For some individuals,
this may last a few Health Promotion and Levels of Prevention
months, while for  Health promotion activities enhance resources
others, it could turn into directed at improving well-being.
a permanent state.  Disease prevention activities protect people
 For example, a from disease and the effects of disease.
recovering alcoholic  Leavel & Clark (1958) identified 3 levels of
may struggle with prevention:
relapses and might stay 1. primary prevention
in the maintenance 2. secondary prevention
stage their entire life. 3. tertiary prevention
f) Termination
 the patient is actively
healthy and no longer 3 LEVELS OF PREVENTION
interested in returning to
old behaviors. PRIMARY PREVENTION

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 activities directed at preventing a problem before breastfeeding on the first 6 months of

it occurs by altering susceptibility or reducing life
exposure for susceptible individuals 2. (Secondary Prevention) Conduct
 Primary prevention consists of 2 elements: periodic “Operation Timbang”
1. general health promotion 3. (Tertiary Prevention) Provide nutrition
2. specific protection education to mothers of children with
 health promotion efforts enhance resiliency chronic and severe malnutrition
and protective factors and target essentially well
populations. The Relationship of Risk to Health and Health
examples: Promotion Activities
 promotion of good nutrition
 provision of adequate shelter  Health is directly related to: (Risk Factors)
 encouraging regular exercise  Lifestyle
 earthquake and fire drills  food that we eat
 specific protection efforts reduce or eliminate  substances we are exposed daily
risk factors (risk reduction) and include such  genetic makeup
measures as:  gender
 immunization  age
 seat belt use  environment
 water purification
2 TYPES OF RISKS
SECONDARY PREVENTION  Modifiable Risks
 refers to early detection and prompt intervention ► patient has some control
during the period of early disease pathogenesis. ► Examples:
 is implemented after a problem has begun but o smoking
before s/sx appears, and targets those o sedentary or active lifestyle
populations that have risk factors. o type & amt. of food eaten
examples: o type of activities he/she
 mammography
engages
 Bp screening
 Non-Modifiable Risks
 newborn screening
► patient has NO or Little Control
 papsmear
► examples:
 is also directed toward prompt intervention to
prevent worsening conditions of the affected o genetic makeup
populations. o gender
examples: o age
 teaching a mother how to give o environment
ORESOL to her child with diarrhea to
prevent dehydration Risk Reduction
 adm. vit. A capsule to children with  is a proactive process in which individuals
measles. participate in behaviors that enable them to react
 provision of first-aid and emergency to actual or potential threats to their health
care (Pender, 1996)

TERTIARY PREVENTION Risk Communication

 examples:  is the process through which the public receives
1. teaching how to perform insulin injections information regarding possible or actual threats
and disease management to a diabetic to health.
patient  is affected by the way individuals and
2. referral of a patient with spinal cord injury for communities perceive, process, and act on their
occupational and physical therapy understanding of risk.
3. leading a support group for cancer patients
who have undergone cancer treatment
4. palliative treatment for those with chronic
illness
 Applying “Levels of Prevention” concerning
malnutrition among young children in a
community
 a nurse might perform the following intervention:
1. (Primary Prevention) Educate pregnant
women on the benefits of exclusive

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