an introduction to health promotion policy, programming and approaches sue thompson lecturer in...
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An Introduction to Health Promotion Policy, Programming and
ApproachesSue Thompson
Lecturer in Adult Nursing University of Nottingham
Public Health
Health PromotionEnabling people to
increase control over their health
Health SurveillanceMonitoring people’s
health
Health ProtectionFighting epidemics, infectious diseases
Health EducationProviding informationRaising awareness
What is health promotion?
• “The process of enabling individuals and communities to increase control over the determinants of health and thereby improve their health” (WHO 1985)
Who makes policy?• Dept of Health (in England and the devolved nations)
strongly influenced by government in power – Minister for Health
• NHS bodies – regional strategic health authorities/health trusts
• Local authorities to be given power to commission public health
• Advisory bodies – eg NICE• Professional bodies – eg RCN, BMA• Single issue groups eg ASH• Independent commissions eg Health care
Commission, Acheson Enquiry
The Proposed New System of Public Health Provision in England
• New body Public Health England to get ring fenced money from Dept of Health to spend on population (country) wide interventions
• Local Authorities to commission public health services to address local needs (ring fenced)
• Disadvantaged areas to get more money (a health premium) if they prove successful, especially in reducing health inequalities
Needs• Normative. Defined by professionals• Felt. Defined by clients, what they want/say they
want• Expressed. Defined by action, a demand for and
take up of services• Comparative. Defined by equality issues, what is
provided to comparable populations• Needs may be defined already
– national epidemiological data.• Local community profiles and local agencies reports
Who’s agenda is it?
• Practitioners very often do not start with a blank sheet and often have to work on issues that have been determined nationally.
Community Problem Definition (Nutbeam 2001)
Epidemiological and
Demographic
information
Behavioural and social research on the determinants of health
Community needs and perceived priorities
Solution Generation (Nutbeam 2001)
Theory and intervention models
Evidence from past programmes
Experience from practitioners
Programme Evaluation (Nutbeam 2001)
Assess Health Promotion outcomes. Intervention impact measures eg health literacy, social action and influence, healthy public policy and organisational practice
Intermediate health outcomes. Modifiable determinants of health eg healthy lifestyles, effective health services, healthy environments
Health and social outcomes eg reduced morbidity/avoidable mortality and increased quality of life, functional independence
Health Promotion ApproachesMedical Approach
Aims to prevent ill health, to reduce morbidity and premature mortality through clinical interventions,
eg medication to control of blood pressure and cholesterol. Also surgical interventions eg Angioplasty
Behavioural Approach
• Aims to ensure that individual lifestyles are healthy and therefore risk of disease is less
• Egs weight management programmes, stop smoking clinics
Educational Approach
Aims to provide information on health issues which will increase knowledge and understanding of public health issues.
Hopes to lead to people making informed decisions and taking positive action to improve their health.
Empowerment Approach Aims to provide
support to enable people and communities to take control of their health, to set their own priorities and format their own agenda.
Working in partnership with patients to facilitate their control over their own condition, treatment, management etc.
Social Change Approach
Aims to bring about changes in physical, social and economic environment in order to make healthy choices easier.
Policy development at local and national level
Health Practitioners Role in Health Promotion
• Population wide-Lobby and advise through strategic work or through professional body
• 1-1 work with patients/relatives• Provide information • Facilitate empowerment and self efficacy• Be aware of others services for referral and
signposting• Provide on going support and practical help• Be non judgemental
References and reading
• Davies M and Macdowall W (2006) Using theory to guide changing individual behaviour in Health Promotion Theory p24-36. Maidenhead: OU Press
• Department of Health (2006) Health Profile of England. DoH Pubs
• Gross R (2001). Models and beliefs in Psychology:the science of mind and behaviour. p 162-165
• Naidoo J and Wills J. (1994)Helping People to Change in Health Promotion, Foundations for Practice p178-199. London: Bailliere Tindall
• Tones K and Green J.(2004) Education for Health-the conditions of learning in Health Promotion, Planning and Strategies p208-239.London: Sage
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