2. INTRODUCTION
According to the World Health Organization :-
Health is a state of complete physical, mental
and social wellbeing and not merely absence
of disease and informed opinion and active
cooperation on the part of the public are of
the utmost importance in the improvement of
the health of the people(Basch,1990)
3. ..ct..
In order to promote health and stay healthy,
people should:-
Practice health enhancing behaviour
according to their values, attitudes, beliefs
and external social and cultural orientation.
The Concept of Health Promotion
• The World Health Organization (WHO) states
that, 'Health promotion encompasses the
principles that underlie a series of strategies
that seek to foster conditions that allow
populations to be healthy and to make healthy
choices.
4. ..ct..
• WHO (1984:3) defines health promotion as,
'the process of enabling people to increase
control over and improve their health
HEALTH PROMOTION
• Health promotion is the science and art of
helping people change their lifestyle to move
towards a state of optimal health .
5. …ct..
Optimal health
Is defined as a balance of physical, emotional,
social, spiritual and intellectual health.
Life style change can be facilitated through a
combination of efforts to enhance awareness
,change behaviour and create environments
that support good health practices.
Of the three, supportive environments will
probably have the greatest impact in
producing lasting change
6. ..ct..
Health promotion consists of the development of
lifestyle habits which healthy individuals and
communities can adopt to maintain and enhance
the state of wellbeing .
1. Health promotion addresses individual
responsibility.
2. Health promotion entails positive behaviour
changes that can promote health like:-
• Physical fitness
• Smoking control or cessation
• Physical
• Emotional
• Social
• Spiritual health
7. ..ct..
To promote health
• It is the responsibility of the individual to develop
and maintain their physical, spiritual, emotional,
social, intellectual and environmental
components of their health consistent with the
culture in which they live.
Other measures to promote health include:
1. Taking care of their nutrition either to prevent
malnutrition or to reduce weight among the
obese.
2. Stress management and work safety strategies
are also very crucial aspects of health promotion
8. Approaches to Health Promotion
The literature describes three approaches to
health promotion:-
1. The preventive
2. Empowerment
3. Radical approaches.
1.Preventive approach
Knowledge is given to the community regarding
specific health condition
In the medical model prevention of disease is
divided into three levels namely:-
i. Primary prevention
ii. Secondary prevention
iii. Tertiary prevention.
9. ..ct..
a. Primary prevention
This phase includes health promotion and
specific protection, i.e. reducing the risk of
community members contracting certain
health problems.
This covers aspects such as exercise, balanced
nutrition, proper hygiene, relaxation, shelter,
employment and immunization
10. ..ct..
b. Secondary prevention
This covers aspects such as the early
detection, diagnosis and prompt treatment
of disease (including screening programmes).
Secondary prevention aims at halting the
progression of a health problem.
c. Tertiary prevention
• Tertiary prevention includes treatment of
diseases and rehabilitation.
11. ..ct..
• This is an attempt to enable the patient to
recover to his or her full potential although it
is not always possible.
• Treatment can include medication, dietary
changes, physiotherapy and occupational
therapy.
• Tertiary prevention aims at improving the
quality of life of the individual.
12. 2. The empowerment approach
This enables the community members to make
informed decisions and become participants in
community affairs.
They feel that they have control over their health.
3. The radical approach
This is a community-based approach.
It promotes healthy public policy and inter-
sectoral collaboration as was discussed in the
Ottawa Charter.
The aim of the community-based programme is
to empower members to achieve social change
and therefore health.
13. International Perspective on Health
Promotion
The commitment by health care professionals
internationally to promoting the health of their
communities was reconfirmed twice after the
Alma Ata Conference.
A conference on Health Promotion was held in
Ottawa on 21 November 1986, which 'built on
the progress made through the Declaration on
Primary Health Care at Alma Ata'.
The Jakarta Declaration on Health Promotion was
concluded in 1997 in Jakarta 20 years after the
WHO member states committed themselves to a
'global strategy of Health for All'.
14. ..ct..
The Ottawa Charter was seen as 'a source of
guidance and inspiration for health promotion' in
the period since the Ottawa conference (WHO,
2002:1).
Ottawa Charter for Health Promotion
At the Ottawa conference on health promotion
which took place on 21 November 1986, health
promotion was defined as:-
Partially helping people to improve their own
health and helping people to have greater control
over factors which would allow them to do so.
15. ..ct..
Five principles of health promotion were spelled out at
the Ottawa conference in 1986:-
1. Health promotion involves the population as a whole
in the context of their everyday life, rather than
focusing on people at risk for specific diseases.
2. Health promotion is directed towards action on the
determinants or causes of health.
3. Health promotion combines diverse but
complementary methods or approaches.
4. Health promotion is aimed particularly at effective
and concrete public participation.
5. Health professionals, particularly in primary health
care, have an important role in nurturing and enabling
health promotion.
16. Jakarta Declaration
At the 1997 Jakarta International Conference on Health
Promotion, it was declared that:-
'Health is a basic human right and essential for social
and economic development' (WHO, 2002: 1).
Five priorities for health promotion were set at the
conference: -
1. Promoting social responsibility for health
2. Increasing investments for health development
3. Consolidating and expanding partnerships for health
4. Increasing community capacity and empowering the
individual
5. Securing an infrastructure for health promotion.
17. Mexico City Declaration
In 2000, a Health Promotion Conference was held in
Mexico City where the importance of health promotion
strategies worldwide was stressed again.
The role of health promotion in addressing health
improvement and development was the main point of
discussion.
Evaluation of health promotion programmes by means
of research also got attention.
It was suggested that health promotion requires the
skills of a multi-disciplinary team of individuals and
concerned groups with all aspects of health care such
as teachers, drama specialists, and community
organizers from many different sectors.
18. ..ct..
Health Promotion Programmes
• Several behavioral and environmental factors
may influence a person's health and health-
seeking behaviour
These factors may include the person’s:-
1. Physical, psychological and social background
2. Previous exposure to health promotion and the
extend of that exposure
3. Past experience of health, health services and
disease
4. Cultural beliefs regarding health
5. Family problems.
19. ..ct..
• Health promotion programmes attempt to reduce
these behavioral and environmental risk factors
that lead to morbidity and premature death.
• It is important that communities are empowered
through health promotion to deal with these risk
factors.
The steps of the nursing process can be followed
to design and implement health promotion
programmes:-
i. Assessment
ii. Planning
iii. Implementation
iv. Evaluation
20. ..ct..
1. Assessment
No health problem can be addressed, nor can
good health be promoted without knowing the
specific health needs of the community.
The assessment will assist in identifying the
health needs of the community.
Certain health needs of communities are
universal but other health needs may be specific
in a given community.
When assessing the needs of the community it is
crucial to know who has actually felt that there is
a need to be addressed in the community.
21. ..ct
Once you have identified the person or the
group of people of felt the needs, you should
work with them:-
i. To establish the nature of that need
ii. The basis of that need
iii. The evidence supporting the need.
NB. Screening programmes in community
clinics, schools, homes for the elderly and
occupational settings are fruitful in the
identification of health needs.
22. Planning health promotion strategies
• Community profile will provide you with first hand
knowledge about the community and can be a
valuable contribution to planning health promotion.
Community profile should address the following
questions:-
• The morbidity data, e.g. what diseases do the
community members suffer from?
• Are these diseases due to lifestyle choices?
• Are males or females, infants or children, the aged
or the poor affected by these conditions?
• What socio-economic groups are involved?
23. ..ct..
• Where do those involved live?
• Who are the role players involved in the whole
programme
• What are the environmental conditions?
• What is the risk profile of the community?
• Are risk factors hereditary, environmental or
lifestyle-related in nature?
• Does only the multi-disciplinary team need to
be involved or the multi-sectoral team as well?
• What resources do I have and what resources
will I need?
• How am I to evaluate my programme?
24. Implementation of the health promotion
strategy and programmes
• Implementation of health promotion
programmes should be done with the
involvement of the community.
• A multi-sectoral approach should be followed
and the member of the team who knows the
community better should lead the
implementation process.
25. Evaluation of health promotion
• Health promotion forms a major component
of the activities of the health services.
• You are accountable for the quality of all
health services rendered and should therefore
be involved in the ongoing evaluation process.
• Statistics can be used to show improvement.
26. ..ct..
Roles of Nurses in Health Promotion
Promoting the health of individuals and
communities often involves changes in attitudes,
behaviour and lifestyle.
This does not happen overnight in the individual
and community.
Novice community health nurse working in a
community can commence a career with great
enthusiasm but may soon be disillusioned by the
fact that people do not change in the way that
the health care professional envisaged.
Patience and more patience is the answer, as
people quite often do not change poor health
habits overnight.
27. ..ct..
Patients should not be given advice but be guided
skillfully regarding matters concerning their health.
All health care professionals must possess excellent
communication skills and thorough knowledge
regarding the methods of communication that are the
most applicable to the specific community.
Community health nurses do not only communicate
with patients but also with other members of the
multi-disciplinary and multi-sectoral team.
The communication takes place verbally and non-
verbally. This implies that the community health nurse
should also be skilful in expressing him or herself
clearly in writing.
