Applying Health Promotion Principles And Practices Assessment
Learning objectives
1. Describe examples of the range of broad and diverse futures for health promotion.
2. Critique the role of technology in the practice of health promotion.
3. Explore globalisation and resource constraints and examine their impact on workforce development.
4. Consider the health promotion workforce and the re-emergence of health promotion and prevention in a rapidly changing world.
5. Discuss the economics of prevention.
APPLYING HEALTH PROMOTION PRINCIPLES AND PRACTICES
Te application of health promotion principles and practices is a very important part of the advancement of population health for a number of reasons. First, in addition to enabling people to live productive lives, promoting health and wellbeing helps to keep people out of the health- care system for longer.Where it is necessary to be admitted to hospital, health promotion can often also assist a return to a good quality of life after treatment. Second, while the focus of health promotion is the entire lifespan, specifcally targeting the health of young people supports the foundations of good health practices.Tird, both socially and economically, it is important to consider the social benefts of good health as well as the economic benefts to society of community wellbeing. Fourth, a focus on health and wellbeing helps to enhance mental health. Fifth, joined-up multi-level and multi-dimensional programs, from policy and legislation and whole-of-population strategies to self-help and more intensive interventional support, need to be implemented so we have the best opportunities possible to reach the entire population in diferent ways at diferent times. Finally, changing technologies and advances in access to and use of multiple technologies can be used as positive tools for the promotion of health.
Furthermore, when applied to the promotion of health, the important principles of access and equity ensure that all sectors of society can access a continuum of care within the health-care system. Aboriginal and Torres Strait Islander health and wellbeing are clearly infuenced by factors other than the individual’s ability to make changes, meaning that many factors infuence health and wellbeing beyond the provision of health care.
Recent examples of such infuences are as diverse as the Royal Commission into Institutional Responses to Child Sexual Abuse (2013), the Royal Commission into Misconduct in the Banking, Superannuation and Financial Services Industry (2017) and the Royal Commission into Aged Care Quality and Safety (2018). Some of these examples have a clear link to health care, while others may appear more distant, yet all the fndings of these Royal Commissions have an impact on health and wellbeing. Health promotion must be multisectoral because health and wellbeing are infuenced and impacted by many factors outside health, including level of education, housing, meaningful employment and access to transport.
In this textbook, we show how complex the dimensions and determinants of health can be, and how many sectors play an important role in sustaining health and wellbeing. We also explain why factors outside of health contribute substantially to ensuring and promoting ongoing health and wellbeing.
THE CHANGING CONTEXT
The promotion of health involves a range of policy and legislative approaches that work towards engaging communities and populations in the pursuit of wellbeing ( Jancey et al. 2016). These eforts need to be cognisant of generational changes in the population and must be fexible and adaptive in their application.
This fact is exemplifed by the Ninth Global Conference on Health Promotion in Shanghai (2016) and the subsequent release of the Shanghai Declaration on Promoting Health. The World Health Organization’s (WHO) 2030 Agenda for Sustainable Development (WHO 2016) provides evidence of the resilience and capacity of health promotion to be applicable in a more complex world. Further, reference to the Sustainable Development Goals clearly links to strategies that trace their heritage to the Ottawa Charter for Health Promotion (WHO 1986). Te Shanghai meeting was important because, for the frst time, there was consideration of the role and contribution of the World Health Organization to the achievement of the United Nations Sustainable Development Goals, beyond Goal 3, the health-specifc goal (Kickbusch and Nutbeam 2016).
It is also important to ensure that the discourse about health issues and the politics of health focus on the social determinants of health. While there is a clear discourse about overweight and obesity in the context of implications for the health and wellbeing of individuals and the population more generally, a discourse also exists about obesity and the politics of ‘fatness’. In this latter discourse, Monaghan, Colls and Evans (2013: 249) disagree with contemporary research and policy focusing on weight, size and fatness as a proxy for health and assumptions that diet and/or physical activity are the clear explanations for obesity. Recently, Young, Hinnant and Leshner (2016) suggested that there should be a greater focus on the social determinants of health in contemporary anti-obesity campaigns that
often over-emphasise the role of individual behaviour in obesity at the expense of other factors.
It is also worth reminding ourselves that ‘technology’ in its multiple forms has emerged as a challenging part of our future world. Younger generations are technologically savvy, use multiple types of technology—some of which are clearly disrupters of current ways of doing things—and are open to many more new and innovative technologies. Tat is why we cannot rest on past health promotion successes: each new generation will need to see the relevance of the promotion of health and wellbeing to them as we embrace new and diferent ways of using technology in the pursuit of wellbeing. We must always remember that access and equity are fundamental principles of the social determinants of health and need to be placed front and centre of all policy and practice (Marmot 2018). As Baker and colleagues (2018) suggest, better strategies for infuencing decision-makers and moving health equity as a priority in the future will require advocates to appreciate the factors that infuence government agenda-setting.
DEFINING AND DESCRIBING HEALTH PROMOTION
Te Ottawa Charter for Health Promotion (1986) emphasised healthy public policy, the social and physical aspects of the health environment, community education for health advocacy and action, and the development of personal skills as the component parts of health promotion. These components are as applicable today as they were some 30 years ago (Tilford 2016; Tilford 2017). As we traverse these issues in this book, we will consider and critique these areas of focus. Clearly it is worth considering how much the defnition of health promotion has changed or been modifed over the last 30 years (Nutbeam 2018; Smith, Crawford and Signal 2016).
This book is divided into this introductory chapter, which the overall content of the book, and three major sections:
Part 1—Promoting health;
Part 2—Health promotion in action; and
Part 3—Health promotion skills in practice. A final chapter draws together the major points made in the book and considers the evolution of health promotion eforts in the 21st century.
PART 1: PROMOTING HEALTH
Tis part introduces the evolving defnitions of health, health promotion, public health and primary health care. Chapter 2 provides abroad grounding in health promotion theory and practice, both internationally and within Australia. It includes an introduction to the future of health promotion, social and demographic infuences, defnitions of health education, health promotion and public health, and the relationship between such defnitions. It concludes by looking at the challenges health promotion will face in the future.Te economics of prevention, as discussed in Chapter 3, has become a centrally important conversation about the value or worth of health promotion practice. For decades, advocates of health promotion practice have argued that promotion of health keeps people out of hospital and healthy for longer, thus reducing the load on an already over-burdened hospital system. Others have advocated strongly for measuring the economic benefts of prevention as a strong argument for funding for health promotion practice.
Chapter 4 focuses on complexity and risk. Essentially, this chapter is concerned with epidemiology. It examines a range of health issues, discusses the impact of multiple risk factors and broadly considers health determinants and other factors impacting on health. It uses examples to articulate complex health issues—often referred to as ‘wicked problems’ because there are multiple causative factors that require complex solutions. Complexity is a central theme running through this chapter—for example, it explores how complexity infuences risk; how we handle complexity; how we intervene at a variety of levels; and why health promotion needs multiple solutions and strategic opportunities.
Chapter 5 concludes this part by addressing issues of Indigenous health and wellbeing. Issues of access and equity for Aboriginal and Torres Strait Islander Australians are considered and the chapter explores why particular health promotion programs have been successful. Te chapter includes examples of health promotion programs designed by Indigenous health workers for Indigenous people. It also examines the range of factors that enhance health and wellbeing for Indigenous people and looks at the factors that continue to impact the health of Aboriginal and Torres Strait Islander people.
PART 2: HEALTH PROMOTION IN ACTION
Settings and other approaches for health promotion are the focus of Chapter 6.We examine the frameworks that guide a settings approach and also consider how other approaches can intersect with settings to provide greater depth and complexity of health promotion activity. The chapter considers what contemporary frameworks for health promotion might look like. Does a settings approach address health issues as the best source of focus? How does a traditional approach to a setting meet the needs of, for example, a workforce that is increasingly casualised, online and/or self-employed?
Chapter 7 focuses on social and behaviour change in theory and practice in health promotion. We help develop an understanding of common behaviour change theories and look at how they can be applied to current health challenges. We describe the key constructs of at least two theories commonly used in public health interventions and identify important future considerations for health-related behaviour change.
Chapter 8 examines the role of governments, organisations and communities and considers the potential for both synergy and tension between these elements.Te role of governments at all levels in health promotion and wellbeing suggests some degree of working together, but also a fair degree of individual activity. For example, how a state health department organises its health promotion policy, strategies and programs will often difer from what occurs at a regional or council level. We ask questions about how they do and could work together, and fnd out what hinders synergy.
Chapter 9 examines the role of policy, legislation and environmental change in health promotion. We present evidence of best practice to enhance positive wellbeing rather than relying solely or predominantly on the individual to change their behaviour. The critique of this perspective is often presented as being about civil liberties. Is this a ‘nanny state’? Are we blaming the victim? We consider the middle ground, where individual responsibility combines with legislative and environmental changes to make healthy choices easier for the population. We also consider how politicians respond when they are faced with economic issues as well as examining the impact of health, social and environmental issues.
PART 3: HEALTH PROMOTION SKILLS IN PRACTICE
Using evidence to inform practice, we consider what works in the planning, managing and implementation of health promotion. Chapter 10 examines planning theories: what they are, their areas of focus and how they are used in practice. Planning is not a linear process, as evidenced by the examples presented and the considerations required when putting theory into practice.
Chapter 11 considers new ways of thinking about evaluation as a combination of both practical and theoretical approaches. Populations and sub-populations are tired of being evaluated, but how else do we know whether programs work? What evidence do we need and for whom? Do we need to examine and evaluate diferent levels of change and how is evaluation funded? Are there sufcient funds or is it not entirely about the money? Tese important questions are considered in this chapter.
Chapter 12 addresses what program sustainability means to health workers designing, developing, implementing and evaluating health promotion programs. We examine how sustainability can be measured and look at what current evidence suggests about programs that are successful in sustaining their activity after implementation.
The final chapter, Chapter 13 draws together and articulates the challenges and opportunities facing health promotion in the 21st century. It asks you to think about the global, national and local challenges facing the promotion of health, many of which are outside the health system. It challenges students and practitioners of health promotion to consider questions such as: Can we aford the continued advancement of chronic illness? Do infectious diseases pose a greater threat to human health in parts of Australia and the Asia-Pacifc region? Where should we invest precious resources and how should that resource investment be managed and implemented? What is happening with digital disruption and the enabling of technological solutions to health issues for younger members of the population? How applicable are these changes to ageing populations and do such populations continue to rely on less technologically advanced solutions?
