Unit 1: In class Notes Flashcards
1
Q
Relationship between HE & HP
A
- Health promotion ties everything together
- Health education is at the core
- Health promotion= environmental factors
- Proper HP relies on everything (consider all the areas of influence)
2
Q
HE, DP & HP
A
- Huge diff between HP & DP
- HP roots in HE (HE still factors into HP)
- HE= more specific role with a purpose within HP
- HP= broader and includes various factors
- HE enabled HP
- E.g. diabetic child and mother need to learn how to use insulin (HE)
3
Q
Disease Prevention
A
- Most deaths and disabilities are related to chronic disease
- Teens: accidents & Suicide
- Educate people through HP campaigns (e.g. suicide prevention day)
4
Q
Most common causes of death vs actual causes of death
A
- Cause vs outcome (common causes)
- All causes of death seem to be behavioural risk factors
5
Q
Primary Prevention
A
measures that forestall the onset of a disease, illness or injury
6
Q
Health status of primary prevention
A
Healthy, without signs or symptoms of disease, illness or injury
7
Q
Example interventions of primary prevention
A
Activities to improve well-being while preventing specific health problems (e.g. legislation to mandate safe practices)
8
Q
Secondary Prevention
A
measures that lead to early diagnosis and prompt treatment of a disease, illness or injury to minimize progression of health problem
9
Q
Health status of secondary prevention
A
Presence of disease, illness or injury
10
Q
Example interventions of secondary prevention
A
Activities directed at early diagnosis, referral and prompt treatment (e.g. mammograms, self-testicular exams etc.)
11
Q
Tertiary Prevention
A
measures aimed at rehabilitation following significant disease, illness or injury
12
Q
Health status of tertiary prevention
A
Disability, impairment or dependency
13
Q
Example interventions of tertiary prevention
A
Activities directed at rehab to return to maximum use (e.g. disease management programs, support groups, cardiac rehab programs etc.)
14
Q
Disease Prevention Facts
A
- Health= absence of disease
- Medical model
- Aimed at high-risk groups in the population
- Specific pathology
- One-shot strategy
- Directive & persuasive strategies
- Directive measures enforced in target groups
- Focused on individuals & groups of subjects
- Preventative programs consider the affairs of professional groups from health disciplines
15
Q
Health Promotion Facts
A
- Health= (+) & multidimensional
- Participatory model of health
- Aimed at the population in its total environment
- Concerns network of issues
- Diverse & complimentary strategies
- Facilitating & enabling approaches
- Incentive measures offered to a population
- Program aims to change a person’s status and their environment
- non-professional organizations, civic groups, local, municipal, regional & national governments necessary for achieving the goal of HP
16
Q
Conventional Model
A
- Our culture & western medicine relies on a common model of health & disease
- The interaction of an individual’s susceptibility (resilience) and risks (protective factors)
- Susceptibility- individual characteristics (e.g. sex, age, genetics)
- Risks- ranges from pathogens to poisons to environmental conditions
17
Q
Medicine in 1916
A
- Reacting to illness (not preventing)
- Relied on medical model
- Humans= slow to use HP
- E.g. Flint Michigan water crisis
- primitive techniques
18
Q
Host & Agent Example
A
-If I am elderly, eat poorly, and have little social support, I am very susceptible to the risk posed by exposure to influenza virus
19
Q
Host susceptibility
A
- characteristics that increase/ decrease vulnerability
- e.g. the virulence of the influenza contribute to the
20
Q
Agent Potential
A
- risk to damage health
- medical vulnerability
21
Q
Medical Model
A
- Health interventions are aimed at reducing host susceptibility (e.g. improving the diet and getting them immunized for flu) and reducing risk (e.g. separating potentially infectious people from vulnerable ones)
- Assumes centrality of host/agent interaction
22
Q
Epidemiology
A
- the science of explicating the causes and variations of disease incidence, based on the host/agent model
- hot spots/ prevalence rates
23
Q
Diff between HP & HE
A
- HP- broader topic that influences individuals in various settings
- HE- smaller more specific topics
24
Q
HE Definition
A
“using evidence-base practices and/or sound theories to provide the opportunity to acquire knowledge, attitudes, and skills needed to adopt and maintain healthy behaviours” (Joint Committee, 2012)
25
Inventories...
may exclude certain cultural and gendered groups
26
"Evidence based Practice"
Personal experience or observation (qualitative/ narrative based)
27
Positivism
absolute truth in some way
28
"health directed behaviour"
for disease prevention or further disease progression
29
E.g. degenerative condition-> optimum well-being despite their condition
- Deals with people who are older or with chronic disease (not always healthy)
- Planned learning experience to facilitate voluntary change in behaviour-> used for solving discrete and immediate problems of importance to individuals and groups
- E.g. family planning, immunization & screening programs
- HE is related to specific health directed behaviour & disease prevention, rather than promoting lifestyle changes for wellness.
30
HP Definition
“any planned combination of education, political, environmental, regulatory or organizational mechanisms that support actions and conditions of living conducive to health of individuals, groups and communities."
31
HP Facts
- Considers factors of influence
- HE is hired by HP campaign to follow through
- Role is more complex as you must look at factors that intersect
- Human behaviour is not only governed by personal factors, but also the structure of the environment (SDoHs)
- Whether someone chooses and is able to take care of their health
- Health as a positive concept
* making the healthier choice the easiest choice
- Helping people change their lifestyle to move toward a state of optimal health
- *Not only the responsibility of the health sector, but beyond lifestyles and well-being
- Science= evidence, art= facilitating
- Not sole responsibility of the health sector
- Society knows what is good vs bad (audience is used to opposing forces)
32
HP focuses on...
- Advocacy: conditions of health favourable through advocacy for health as a resource
- Enabling: focuses on achieving equity in health
- Mediating: demands coordination of sectors (competing agendas-> patient care, professional, corporate & political)
33
Advocacy
- HP aims at making conditions of health as a resource (social, economic and personal development conditions) favourable through advocacy for health
- Want people to participate because they want to
- Facilitate change in others
- E.g. “The Insiders”: noticed issues with data in tobacco studies
- Companies hiding the addictive and bad effects of tobacco
- Making fully informed choices
- E.g. “Sugarcoated” & “Perdue”-> fake claims about oxy drug led them to go bankrupt
34
Enabling
- Achieving equity in health, reducing differences among SES groups, facilitating equal opportunities and resources to enable all people to achieve their fullest health potential (access to info, life skills etc.)
- Survey-> access to all the content someone needs to make changes to their health
- Barriers to info?
- Needs assessment in HP identifies this
- Equity + access= easier choice!
35
Mediating
- HP demand coordinated action by all concerned for health: gov, health & other social/ economic sectors, non-gov, vol organizations, etc.
- How to bring people on board?
- Health care is about reacting not preventing
- Doesn’t want to invest upfront for long-term gain
- Nordic countries are better
36
Need for HE
-provides concern-arousing, action-stimulating force for public involvement & social reform
-essential for democracy in decision-making & accountability
-Keeps the social change component of HP accountable
-w/out social policy supports for social change, HE is powerless to help people reach their health goals
-Accountability- reliable resource for the greater good of this group
-Tragedy leads to policy change
•E.g. How women became smokers? "Century of the Self"
-HE aims at voluntary actions people can take (individually or collectively) for their own health or common good of community
37
Without HE, HP=
manipulative social engineering enterprise (dictatorship)
38
HE within HP
- About enhancing awareness, changing behaviors & creating environments that support good health practices
- HP produces results through recruiting and targeting social and political actions and molding them into a form/forms of programs that will target specific gains.
- For example, heart disease or cancer= big social problem and political issue ($)
- HP targets these sectors (organizations) and produces programs like “walk for cancer” or “hearty healthy cookbooks”
- Big industries are often behind HP campaigns (corporate aspects of health care)
39
Why HP is broader than HE?
- HP= “the combo of educational and ecological supports of actions and conditions conducive of health.” (Green & Kreuter, 1999)
- Social, political and community
- Education= health education
- Environmental= social, political, organizational, policy, economic & regulatory circumstances bearing on health
40
To reach a state of physical, mental and social well-being you must...
-Be able to identify & realize aspirations, satisfy needs & change/cope with the environment
-HP is informed because…
Ways to help make easy choices
Voluntary aspect
Want people to feel successful
-HP= process of enabling people to increase control over and improve their health
41
Health Status in 20th Century (1900s)
- 20th Century (1900s)
- Many infectious diseases were controlled-> chronic diseases became a greater concern (penicillin and new innovations in medical care)
- Now chronic diseases have overtaken communicable diseases as #1 death cause
- Average life span increased to 29.7 years (roughly 30 years)
- US ranked 89th out in crude death rate and 50th in life expectancy
- Most developed but not everyone has access to health care
- Stats differ in Canada as we don’t need to pay for diagnostic tests
- HP era of public health began in 1974
- Canada Health Act (1950s-60s)
42
Lalonde Report
o Health information and Health promotion Act in the US
-4 modifiable health-damaging health behaviours identified:
-Tobacco use
•No clue of how bad it was
•1 in 4 doctors smoked (cool)
-Lack of physical activity
•Our generation is more fitness obsessed
-Poor eating habits
-Excess alcohol consumption
-Inspired public health campaigns
-E.g. “Chariots of fire”: movie based on people running for health
-Investments made in HP= reduction in cost of health care
-Lost working force= burden on society (#1 contributing factor was mental health)
43
Health Status in 21st Century (2000s)
-Behaviour patterns= most prominent influence over health prospects in the US (McGinnis, Williams-Russo & Knickman, 2002, p. 82)
-Need for health info to be understood by the average person
-Need for health professionals to provide the public with the info and skills necessary to make quality health decisions
•People used to listen to their doctor and not question the advice given (now we demand to control and understand our own health)
44
Historical Roots in HP
- Things we figured out
- School health- wash your hands, clean your teeth, STDs, immunizations etc.
- Disease and injury
- Occupational health- costs money if people can’t work
45
HP to target lifestyle
- HE historically successful campaigns (e.g. immunizations)
- Concerns about HE is being able to address lifetime habits (lifestyle choices)
- Other factors that affect our ability to choose health behaviours
- Need identified= various sectors needed to come together to influence the health of the population
- “together we are stronger and more effective”
46
Use of Public Health Campaigns
- Recognition: various sectors & new sources of influences (e.g. economic & regulatory measures) would need to join together to make a stronger collective approach to HP
- Need to engage stakeholders= mass buy in
- Bring multiple social forces together making them strong enough to influence problems/concerns/conditions of behaviour and lifestyle
47
The collective approach
- recognized to be much bigger and more influential than HE on it’s own
- Health educators became aware of the need for positive approaches to HE
- Positive= enhancing health and creating health potential rather than focusing on disease prevention. (stronger adherence)
- Targets lifestyles
- HE could only develop its full potential if supported by structural measures (legal, enviro, mental, regulatory etc.)
48
Heart of HP?
LIFESTYLE
- Patterns of choices made from alternatives available to people according to their SES circumstances and the ease that they are able to choose certain ones over others
- Enduring pattern of behaviour or socialization (long-lasting change, not preventing disease)
- Focus on determinants of health, rather than measuring and explaining disease at sub-molecular level
49
Sub-molecular level
- Reducing ill health to sub-molecular levels has been great for medicine
- Neglecting the whole person
- Medicine is good for expertise when looking at a specific disease (isolating the disease process and how they should be addressing it)
- Improves the ability to intervene with heightened precision & effectiveness
- Neglects social, behavioural and cultural influences on health
- Sub-molecular level= high tech
50
Sub-molecular level used in Medicine
- work of doctors in less developed countries is still good as doctors receive adequate training
- HP services suffered in clinical settings: led to biomedical model to be more popular approach to disease treatment (rather than HP or DP approaches to health & wellness)
- Advances in care, not promotion
51
Why look at SDoHs?
- Doesn’t exist in healthcare
- 360 considerations of all factors
- Power to make changes necessary
- Primary stakeholders may know more
- Beyond medical model (healthy people existed before hospitals)
- want to keep people out of systems (prevent and stabilize chronic illness)
52
Components of life
health sciences, programs, practices and policies that relate to the health of human populations.
- Relations to health of human populations happens in other sectors (schools, industry and social services)
- Happens anywhere people with challenges could be
53
Health in other sectors
- Recreation & transportation, building & waste management, taxation & regulation, commercial services & trade
- Where people receive social assistance?
54
Populations & Persons
- Reduce the incidence of lung cancer by reducing smoking prevalence in population from 50% to 25%
- Don’t know risk of cancer if someone quits smoking
* Risks, as probabilities are population attributes
- Individual vs population
55
Shift away from conventional model
*Canada= theoretical leader in reform thinking about health (publicly funded= more government responsibility)
56
4 important events that shifted us away from the conventional model
- Publication in 1974-> A New Perspective on the Health of Canadians
- 1986 report-> Achieving Health for All: A Framework for Health Promotion & Ottawa Charter: attended by 38 countries about the values of HP
- 1997-> statement by the Canadian Federal, Provincial & Territorial Advisory Committee on Population Health (large volume of people hired to file reports at this time)
57
Population Health
- Each development move thinking further from individualistic host/agent model to population health model
- Focus on interrelated conditions & factors that influence the health of populations over the life course (Public Health Agency of Canada, 2012)
- costs of employment for companies ($$$)
- HP-> gov focused on it to reduce health care costs
58
12 diff SDoHs
1. income & social status
2. Social support networks
3. Education & literacy
4. Employment & working conditions
5. Social environments
6. Physical environments
7. Personal health practices & coping skills
8. Healthy child development
9. Biology & genetic endowment
10. Health services
11. Gender
12. Culture
59
Intersectionality of SDoHs
- Looks at health as a produce of an “equation”
- Intersectionality of determinants
- Can led to (+) or (-) outcomes
- Various factors come together to determine our health
60
Illness model for infectious disease
- TB requires an agent (the microorganism mycobacterium tuberculosis) + a susceptible host (the patient who may be malnourished, or have alcoholism) + an environment (sharing an overcrowded shelter for the homeless)
- Outcome= TB
61
Quantifying health & status
-Difficulty of the task leads us to define health with its opposite: ill health
62
Death Rates
- # of deaths per 100,000 residents in the population
- Transition between wellness & ill health is often gradual and poorly defined
- Death= clearly defined event that is used to indicate the health status of a population
63
Life Expectancy
- Average # of years of life remaining to a person at a particular ae & is based on a given set of age-specific death rates
- Higher in women
- Gone up over the last 100 years
64
Years of potential life lost
- Measure of premature mortality
- Person’s current age (-) expected life expectancy age (75 years)
- Hope that people will last the full life span
65
Disability- adjusted life years
- Accident occurs (e.g. paralysis after car accident or depression following stroke), the burden of living with a disability is expressed by the # of years of healthy life lost
- Not completely accurate
- Doesn’t include those who can go into recovery
- Not fully healthy, life has been significantly changed
66
Assumptions of health
- If not ill or dead= healthy
- Social media= ill informed sources that are biased
- Measurements used in HP but are not reflective of the intended outcome of HP
- Informed process
- Enabled HE within HP
- E.g. anxiety used to be 2-4% prevalent now has jumped to 20% (factors that led to this leap?)
67
Analysis of Risks
- Medicine and epidemiology are concerned with risk analysis:
- Disease rates & prevalence
- Interaction btw: risk factors and variables affecting susceptibility (SDoH interactions)
- Probability of health outcome associated with those variables
68
Risk Factor Analysis
requires populations of people w/ & w/out a disease of interest and populations who have & have not been exposed to presumed risks (leads to fear mongering-> Opp of HP!)
69
Statistical Associations
- Set of observations of a population, not a single event or person (longitudinal studies)
- E.g. comparing a group of people who have had heart attacks to those who haven’t, collecting the info about the characteristics of people in each population and info about the various risk they’ve been exposed to
- Infer that variables are associated with outcome (e.g. smoking + heart attack)
70
Risks aren't causes
- Risks= probabilities (statistical associations)
- Not cause, measure of risk
- E.g. smoking may be risky as more smokers than non-smokers may get lung cancer or have heart attacks
- No info on the effect given an individual’s health (only have info on groups)
71
Limitations of Risk factor Analysis
- Determines associations among susceptibilities/ risks & outcomes
- Intervention allows reducing in disease incidence
- Intervention based on analysis only applies to populations with those susceptibilities and exposures to risk (not to individual members)
72
Behaviours portrayed as individual risk factors
Lifestyle and behavioural choices= target of interventions
73
Social patterning of behaviour
the study of social determination of health behaviour (choices affect the outcome)
-Modifying individual lifestyle= daunting task
74
Victim Blaming Approach
-Blaming people = counterproductive & unfair (factors may be out of their control)
75
Societal effect on behaviour
- Shaping beliefs & norms
- Enforcing patterns of social control
- Proving or denying opportunities
- Reducing or producing stress, providing or failing to provide supports to individuals and families
- Influences how we look (enables or discourages people)
76
Social Dimension
- Patterned, systemic differences in the health of different groups of people within any society
- E.g. amish people (intermarriage), indigenous communities (substance abuse) etc.
- Differences are socially determined and have little to do with health are, individual behaviours or lifestyles
- E.g. London is the HIV capital of Canada due to IV drug use
77
Common issues & behaviours
- Heart health
- Obesity-> sugar, fast food, bigger portions etc.
- Physical activity & nutrition
- Stress
- Smoking
- Mental health-> biggest economic drain worldwide
- Each one is affected by multiple factors of influence
78
Health Portfolio
- Oversight by the minister of health
- Maintaining & improving the health of Canadians
- Supported by the health portfolio-> health Canada, the public health agency of Canada, the Canadian institutes of Health Research, the patented medicine prices review board and the Canadian food inspection agency
- 12,000 FTE employees + annual budget over $3.8 billion
79
Public Health Agency of Canada
- Empowers Canadians to improve their health
- Partnerships with others
- Focuses on preventing disease and injuries
- Promoting good physical and mental health
- Providing info to support informed decision making
- Values scientific excellence and provides national leadership in response to public health threats (e.g. H1N1 & SARS)
- Federal institution that is part of the Health portfolio
80
Center for Health Promotion (CHP)
- Uses a life stages approach to guide the implementation of policies and programs aimed at enhancing the conditions that enable healthy development
- Why is there still childhood poverty in Canada?
- Actions taken are based on principles of population and public health
- Address matters related to SDoH
- Facilitates successful movement through the life stages
- Population focused
- “acts through programs addressing health child development families, aging and lifestyles, public info and education, as well as issues related to rural health and support of the voluntary sector”
81
Components of CHP
- Health community’s division
- Division of childhood & adolescence
- Division of aging & seniors
- Health surveillance & epidemiology division
- Lots of organizations at the provincial/territorial & municipal levels that are actively engaged in HP
- Most publicly funded, health-focused, organizations do HP
- E.g. YMCA, Canadian Blood Services, Heart & Stroke Foundation
82
The Ottawa Charter
- Response to growing expectations for a new public health movement around the world
- Focuses on the needs in industrialized countries but considered all regions
- Built on the progress made through the Declaration on Primary Health Care at Alma Ata, the WHO’s targets for health for all document & the recent debate at the World Health Assembly on intersectional action for health
- Determined what it means to do HP
- Build healthy public policy
- Create supportive environments
- Strengthen community action
- Develop personal skills
- Reorient health services
83
Importance of the Ottawa Charter
- Developed and adopted by an international conference, jointly organized by the WHO, Health & welfare Canada and the Canadian Public Health Association
- 212 participants from 38 countries met Nov 17-21st, 1986 in Ottawa, Canada to exchange experiences and share knowledge of health promotion
84
The Kirby Report
- Canada’s publicly funded health care system sparks discussion
- Rational debate of issues affecting the federal’s government’s role in Canada’s health care system
- Reflects political agenda
- Health care= activity done to improve or maintain the health of individuals or to prevent deterioration of health (includes HP, DP, health protection, public health and research, diagnostic services & treatment of disease
- Wide variety of health care delivery sites and health care providers
85
Importance of Chapter 5 of the Kirby Report
- provides info on the health status of Canadians and explains concepts of “health determinants” & “population health”
- Most relevant and looks beyond disease
86
9 Assumptions of HP
1. Health status is changeable
2. Health & disease determined by interactions among biological, psychological, behavioural & social factors
3. Behaviour can change-> influences health
4. Individual behaviour, family interactions, community & work relationships/resources, and public policy all contribute to health & behaviour change.
5. Interventions can teach HP-ing behaviours or reduce the effect of risky ones (e.g. Harm reduction effect-> giving people clean needles for Iv drugs
6. Determinants, nature, & motivation for behaviour must be understood for health behaviour to change.
7. Initiating & maintaining behaviour change is challenging!
Behaviour changes are complex
Positive motivation
8. Individual responsibility doesn’t = victim blaming! (people choose how to change their behaviours)
9. For permanent health behaviour change a person must be motivated & ready (pre-contemplation= not ready)
87
Operationalizing Assumptions
o Greatest chance for success will come to those with the knowledge and skills to plan, implement and evaluate appropriate programs-> EXAM
o HP efforts are based on assumptions following these 6 steps
88
The Generalized Model
1. understand & engage
2. assess needs
3. set goals & objectives
4. develop intervention
5. implement intervention
6. evaluate results
89
Understand & Engage
Understanding the community & engaging the target population
90
Needs Assessment
```
involves some method that is used to get feedback from community/target population
Why ask the target group?
-Nuances in the group
-Want them to be involved (empowered)
-Buy-in/ ownership is needed for success
-Not including input= mild acceptance
-Excitement & motivation
```
91
Set goals & objectives
Develop suitable goals & objectives
92
Develop Intervention
Create a setting that is appropriate to the intervention
93
Evaluating the Results
Program Planning 1:
-Systematic planning is important because…
-Planning forces planners to think through details in advance
-Planning helps to make a program transparent
-Good planning keeps the program stakeholders informed ($$$)
Program Planning 2:
-Planning is empowering
-Decision makers give approval to resulting comprehensive program plan, planners & facilitators are empowered to implement the program, encouraging ownership of the program
-Planning creates alignment
-All organization members have better understanding of where they “fit” in the organization and the importance that the plan carries
94
Key Questions for Pre-planning Process
- purpose of the program
- scope of the planning process
- planning process outcomes (deliverables)
- leadership & structure
- identifying and engaging partners
- identifying and securing resources
95
HE specialists in Canada
- We do have diabetes educators, MG 1st aid etc.
| - Not as defined roles as US
96
Area I of responsibility
Assess needs, resources, and capacity for health education/ promotion
97
Area II of responsibility
Plan health education/promotion
98
Area III of responsibility
Implement health education/promotion
99
Area IV of responsibility
Conduct evaluation & research related to health education/promotion
100
Area V of responsibility
Administer and manage health education/promotion
101
Area VI of responsibility
Serve as a health education/promotion resource person
102
Area VII of responsibility
Communicate, promote, and advocate for health, HE/HP & the profession
103
US centric content
- Canada takes longer
- Same patterns, values and concerns towards public health care
- Differently based on geographic areas (high population in US)
- Theoretically looking at content relevant to your population of interest
